Term
| What are torus fractures? |
|
Definition
| involve "buckling" of the cortex with compression of the bone |
|
|
Term
| What is a greenstick fracture? |
|
Definition
| incomplete fractures that break one side of a bone and bend the other |
|
|
Term
| What is the weakest part of a child's skeletal system? |
|
Definition
|
|
Term
| How are epiphyseal fractures classified? why are they classified? |
|
Definition
| by the salter-harris system; classification determines prognosis |
|
|
Term
| What is another term for asthma? |
|
Definition
|
|
Term
|
Definition
| a bronchial disorder characterized by inflammation, reversible smooth muscle constriction and mucus production |
|
|
Term
| How many children are affected by asthma? |
|
Definition
|
|
Term
| Name some primary triggers of asthma? |
|
Definition
| irritants such as cigarette smoke, air pollution and ozone |
|
|
Term
| What are some allergic triggers of asthma? |
|
Definition
| pollens, dust mites, pets, and cockroaches |
|
|
Term
| What are some asthma triggers that are neither primary irritants or allergens? |
|
Definition
| exercise, cold weather, respiratory infections, drugs (aspirin, beta blockers), stress, foods, and food additives |
|
|
Term
| What disease concurrent with asthma can make the asthma worse? |
|
Definition
|
|
Term
| Salter harris classification I= |
|
Definition
|
|
Term
| What is salter harris classification II? |
|
Definition
| through the metaphysis and growth plate |
|
|
Term
| What is salter harris class III? |
|
Definition
| through growth plate and epiphysis into joint |
|
|
Term
| What is salter harris class IV? |
|
Definition
| through metaphysis growth plate, and epiphysis into joint |
|
|
Term
| What is salter harris class V? |
|
Definition
|
|
Term
| Which salter harris classification may be missed on xray? |
|
Definition
|
|
Term
| What is the allergic triad? |
|
Definition
| asthma, atopic dermatitis, and allergic rhinitis |
|
|
Term
| Chest percussion on asthmatic pts will sound... |
|
Definition
|
|
Term
| T/F Asthma can occur without overt wheezing? |
|
Definition
| true (cough variant asthma produces chronic cough) |
|
|
Term
| What are some key indicators of asthma severity? |
|
Definition
| frequent ER visits, a history of intubation, hospitalizations, steroid use |
|
|
Term
| What is status asthmaticus? |
|
Definition
| severe asthma attacks that may not be responsive to standard treatments; life threatening condition that may lead to respiratory acidosis and respiratory arrest; pts usually need to be hospitalized and mechanically ventillated |
|
|
Term
| What is changed on a pts PFTs when they have asthma? |
|
Definition
| decreased vital capacity, increased functional residual capacity, increased residual volume, decreased FEV1, decreased peak expiratory flow, and reversal of pulmonary abnomralities by inhalation of aerosolized albuterol |
|
|
Term
| What is peak flow monitoring? |
|
Definition
| measures how fast a patient can forcibly expire air after a maximal inhalation |
|
|
Term
| What is a "bad" peak flow? |
|
Definition
| reduction of 50-80% indicate mild to moderate obstruction; anything <30% indicate severe obstruction |
|
|
Term
| What do you see on CXR of asthma? |
|
Definition
| nonspecific findings but may find hyperinflation, depressed diaphragm, and atelectasis |
|
|
Term
| What do you see on CBC of an asthmatic? |
|
Definition
|
|
Term
| At what PCO2 should you be worried in an asthmatic with tachypnea? |
|
Definition
| PCO2 should be well below 40 if they are tachypnic; anything more and you need to be worried about respiratory failure |
|
|
Term
| How do you give in haled medications to children of different ages? |
|
Definition
| less than 1 need a nebulizer; from 1-4 can use a spacer with a face mask and children >4 can use a metered dose inhaler (MDI) with a spacer |
|
|
Term
| What is acute therapy for asthma? |
|
Definition
| bronchodilators (nebulized albuterol 0.15 mg/kg in 2-3 cc NS or MDI two puffs q 1-6 hr PRN); a five day pulse of PO prednisone or IV methylprednisolone (solumedrol) is highly effective but takes 4-6 hours to have an effect |
|
|
Term
| What is chronic therapy for asthma? |
|
Definition
| avoid triggers; give inhaled corticosteroids for prevention; leukotriene receptor antagonists; cromolyn sodium and theophyline are rarely used since advent of inhaled steroids |
|
|
Term
| What are the classifications of asthma severity? |
|
Definition
| step 1= mild intermittent; step 2= mild persistent; step 3= moderate persistent; step 4= severe persistent |
|
|
Term
| What is step 1: mild intermittent asthma? |
|
Definition
| symptoms occur < 2 times per week; asymptomatic between exacerbations; night symptoms less than 2 times per month; PEF or FEV1 >80% of predicted; no daily medications needed |
|
|
Term
| What is step 2: mild persistent asthma? |
|
Definition
| symptoms occur >2 times per week but <1x a day; exacerbations may affect activity; night symptoms >2x a month; PEF or FEV1 >80% of predicted; maintenence meds= lowdose inhaled steroid |
|
|
Term
| What is step 3: moderate persistent asthma? |
|
Definition
| dialy symptoms; two or more exacerbations per week, exacerbations limit activity; night symptoms >1x per wee; PEF or FEV1 60-80% of predicted; maintenece meds= medium dose inhaled corticosteroid or low to medium dose inhaled steroid and long acting bronchodilator; if neeeded, medium to high dose inhaled steroid and long acting bronchodilator |
|
|
Term
| What is step 4 severe persistent asthma? |
|
Definition
| continual symptoms; limited physical activity; frequent exacerbations; night symptoms frequent; PEF or FEV1 <60%; maintenance meds= daily inhaled high dose corticosteroid and long acting bronchodilator and PO steroids 2mg/kg/day |
|
|
Term
| What is broncolitis? What causes it? |
|
Definition
| an acute inflammatory illness of the small airways occurring in children <3 yoa; RSV is the primary agent although PIV (esp type 3), adenovirus and influenza, and rhinovirus have also been implicated |
|
|
Term
| When is bronchiolitis season? |
|
Definition
| late fall to early spring |
|
|
Term
| What are risk factors for severe bronchiolitis? |
|
Definition
| prematurity (less than 35 weeks), lowbirth weight, age <12 weeks, chronic pulmonary disease, CHD, and immunideficiency states |
|
|
Term
| What are the signs and symptoms of bronchiolitis? |
|
Definition
| rhinorrhea, sneezing, cough, and low grade fever followed afew days later by tachypnea and wheezing; signs of respiratory distress, including nasal falaring, retractions and intermittent cyanosis may be present; apnhea may be the presenting sign |
|
|
Term
| When do you get a CXR if you suspect bronchilitis? |
|
Definition
| only for ill or hypoxic patients or those with recurrent episodes of wheezing; will demonstrate hyperinflation (flate diaphragm, increased AP diameter) |
|
|
Term
|
Definition
| by nasopharyngeal washes by DFA or culture; although commonly tested for it rarely changes management because treatment is supportive; testing can be useful for disease surveillance and grouping of RSV positive pts in hospital wards to decrease transmisison |
|
|
Term
| When do you hospitalize a pt with bronchiolitis? |
|
Definition
| with resting rate of more than 50-60 breaths/min; hypoxemia, apnea, inability to toelrate oral feeding, chronic cardiopulmonary disease or an unrealiable home environment |
|
|
Term
| T/F Breast feeding decreases an infants chance of getting bronchiolitis. |
|
Definition
|
|
Term
| A "seal-like" bark is indicative of... |
|
Definition
|
|
Term
| T/F Bronchodilators are not longer recommended for bronchiolitis. |
|
Definition
|
|
Term
| T/F inhaled steroids helps treat bronchiolitis. |
|
Definition
|
|
Term
| What inhaled medication can be used in pts with bronchiolitis or are severely affected or high risk? |
|
Definition
|
|
Term
| When do you prophylax infants against RSV? |
|
Definition
| if they are under 2 and at high risk they can be given RSV IVIG or palivizumab (the later is preferred as ti is a monoclonal antibody and not a blood product) |
|
|
Term
| What is another name for viral croup? |
|
Definition
|
|
Term
| What is laryngotracheobronchitis? |
|
Definition
| acute inflamatory disease of the larynx, trachea, and bronchioles that especially affects the subglottic space |
|
|
Term
| What are the most common causes of croup |
|
Definition
| parainfluenza types 1 and 3 are the most common; other organisms include RSV, influenza virus, rubeola virus , adenovirus, and M. pneumoniae |
|
|
Term
| What are the signs and symptoms of croup? |
|
Definition
| inspiratory stridor that worsens with agitation; also characterized by a hoarse voice and a seal-like barking cough; maybe preceded by a prodrome of mild fever and coryza; diminished breath sounds, restlessness, altered mental status or cyanosis may be seen if the child becomes hypoxic |
|
|
Term
| If a pt has epiglottitis what is the treatment? |
|
Definition
|
|
Term
| How do you work up croup? |
|
Definition
| CXR and neck xray if the diagnosis is in doubt (steeple sign= subglottic narrowing) |
|
|
Term
| What is the typical age group affected by croup? |
|
Definition
| three months to five years |
|
|
Term
| How fast does croup vs. epiglotitis vs. tracheitis develop? |
|
Definition
| Whatcroup develops over 2-3 days; epiglotitis has a rapid onset over several hours; tracheitis causes acute decompensation after two to three day gradual onset |
|
|
Term
| Do disease like croup, epiglotitis and tracheitis cause fever? |
|
Definition
| croup has low grade; epiglotitis and tracheitis have high grade |
|
|
Term
| What age range is affected by epiglotitis? |
|
Definition
|
|
Term
| What age range is affected by tracheitis? |
|
Definition
|
|
Term
| What organism most commonly causes tracheitis? |
|
Definition
|
|
Term
| What is the position preference associated with croup? |
|
Definition
| prefers sitting up, leaning against the parents chest |
|
|
Term
| What is the preference position associated with epiglotitis? |
|
Definition
| tripod position with neck extended |
|
|
Term
| Does croup respond to aerosolized racemic epinephrine? |
|
Definition
| yes; the stridor improves |
|
|
Term
| Does epiglotitis respond to aerosolized racemic epinephrine? |
|
Definition
|
|
Term
| Does tracheitis respond to aerosolized racemic epinephrine? |
|
Definition
|
|
Term
| Whatsign on x ray indicates epiglotitis? |
|
Definition
| thumb sign on lateral neck film |
|
|
Term
| What is shown on imaging for tracheitis? |
|
Definition
|
|
Term
| How do you treat mild cases of croup? |
|
Definition
| mild meaning no stridor at rest; supportive measures like oral fluids, cool-mist therapy, humidity |
|
|
Term
| how do you treat moderate cases of croup? |
|
Definition
| moderate= stridor at rest; treat with corticosteroids |
|
|
Term
| How do you treat severe cases of croup? |
|
Definition
| severe= respiratory distress and hypoxemia; treat with IVhydration, systemic steroids, nebulized racemic epi, supplemental O2, and intubation if necessary (rare; only for <1% of hospitalized pts) |
|
|
Term
| Nasal polypsin any pediatric pt should prompt further evaluation for... |
|
Definition
|
|
Term
|
Definition
| dysfunctional exocrine glands due to a mutation in the CFTR gene which is located on chromosome 7 and is involved in chloride conductance |
|
|
Term
| What is teh most common lethal genetic disease affecting caucasians? |
|
Definition
|
|
Term
| What is the incidence of CF? |
|
Definition
|
|
Term
| What percent of patients with CF are diagnosed in childhood? |
|
Definition
|
|
Term
| What are the most common ways for CF to present? |
|
Definition
| meconium ileus at birth, recurrent respiratory infections, FTT, or positive newborn screen |
|
|
Term
| What percent of CF patients hav a negative sweat chloride test? |
|
Definition
|
|
Term
| What is a positive sweat chloride test? |
|
Definition
|
|
Term
| How do you work up suspected CF? |
|
Definition
| sweat test, PFT, sputum/throat culture; CXR, newborn screening programs, genetic testing |
|
|
Term
| What do PFTs show for CF pts? |
|
Definition
| both restrictive and obstructive disease |
|
|
Term
| What percent of cases of CF are picked up by newborn screen? |
|
Definition
|
|
Term
| How does the newborn screen test for CF? |
|
Definition
|
|
Term
| What is the most common genetic mutation that causes CF? |
|
Definition
| >70% are caused by deltaF508 |
|
|
Term
| What is the treatment for CF? |
|
Definition
| aerosolized deoxyribonuclease to increase mucus clearance; chest physiotherapy with postural drainage; bronchodilators and abx if acute declines in lung function or pneumonia is suspected; intermittent aerosolized tobramycin for pseudomonas (BID x 4 weeks); H2 blockers, antacids; pancreatic enzyme supplements, vitamins ADEK supplements, high calorie, high protein diet |
|
|
Term
| What is the average life expectancy of CF pats? |
|
Definition
|
|
Term
| Most pts with CF eventually require... |
|
Definition
| double lung transplantation between 2nd and 3rd decades of life |
|
|
Term
| What are the respiratory symptoms of CF? |
|
Definition
| asthma with clubbing of the digits, nasal polyps, chronic pansinusitis, recurrent pneumonaie (esp staphylococcal), chronic atelectasis, chronic pulmonary disease, pneumothorax, bronchiectasis, hemoptysis or chronic cough, colonization with mucoid psuedomonas aeruginosa, xrays showing persistent hyperaeration or atelectasis |
|
|
Term
| What are the GI symptoms of CF? |
|
Definition
| meconium ileus, intestinal obstruction (meconium plug or recurrent intussusception), FTT, steatorrhea or chronic diarrhea, rectal prolapse, prolonged jaundice, hepatic cirrhosis and portal hypertension, recurrent pancreatitis |
|
|
Term
| What are musculoskeletal symptoms of CF? |
|
Definition
| bone pain and joint effusion due to hypertrophic osteoarthropathy |
|
|
Term
| What are reproductive signs/symptoms of CF? |
|
Definition
| infertility in men due to oblieration of vas deferens; infertility in women due to thick spermicidal cervical mucus |
|
|
Term
| What are some miscellaneous signs/symptoms of CF? |
|
Definition
| hypoproteinemia and edema, fat soluble vitamin deficiency, hypoprothombinemia, salty taste or salt crystals on skin, unexplained hyponatremic hypochloremic metabolic alkalosis; impaired glucose tolerance or type 1 DM |
|
|
Term
| How are children exposed to lead? |
|
Definition
| lead containing paint remaining in buildings constructed before the 70s; also, industrial plants, lead solder in pipes, lead containing pottery, toy paint, household items, some traditional herbal remedies |
|
|
Term
| What level of lead is toxic? |
|
Definition
| 10-19 ug/dL can be toxic (<10 can have neurocognitive effects) but lead poisoning requiring medical evaluation refers to levels >20 ug/dL; severe lead levels is >70ug/dL |
|
|
Term
| What are symptoms of leadpoisoning? |
|
Definition
| behavoral problems, developmental delay, anorexia, abdominal pain, vomiting, constipation, lead encephalopathy, peripheral neuropathy, burton's lines, red brown discoloration of the urine, proximal tubule dysfunction, pica |
|
|
Term
| What is lead encephalopathy? |
|
Definition
| increased ICP, headache, vomiting, ataxia, seizures, coma, or even death in severe cases |
|
|
Term
| What are the blue lines on gums of children with lead poisoning called? |
|
Definition
|
|
Term
| Are lead levels checked in all children? |
|
Definition
|
|
Term
| Peripheral blood smear of pts with lead poisoning will show... |
|
Definition
| basophilic stippling, hypochromic microcytic anemia (often with concomitant iron deficiency) |
|
|
Term
| What percent of child abuse occurs before 1 yoa? |
|
Definition
|
|
Term
| T/F THe presence of spousal abuse increases the risk of child abuse. |
|
Definition
|
|
Term
| What is the mortality rate of abused children? |
|
Definition
|
|
Term
| What kinds of fractures are suspicious for child abuse? |
|
Definition
| mandibular fractures, rib fractures (multiple and posterior), scapular fractures, long bone spiral fractures |
|
|
Term
|
Definition
| inability to have control over bowel movements |
|
|
Term
| What is the medical term for bedwettin? |
|
Definition
|
|
Term
| How do you work up a pt for abuse? |
|
Definition
| skeletal survey, bone scan, ophthalmologic exam, UA, urine culture and stool culture is sexual abuse is suspected |
|
|
Term
| What must be ruled out if you suspect hcild abuse? |
|
Definition
| osteogenesis imperfecta, bleeding disorders, and bullous skin disorders |
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|
