NBME Shelf Review (Part 3) – Pediatrics

Summary: <br> Febrile Seizures<br> <br> <br> <br> * Simple (All features must be present)* Age 6 months – 5 years* Febrile* Lasts less than 15 minutes* Only one seizure in 24 hour period* No focal neuro deficits on exam* Generalized seizure (must have LOC)* Treat with acetaminophen and reassurance* Complex* Does not meet ALL of the criteria for a simple febrile seizure* Consider full workup including lumbar puncture<br> <br> <br> <br> Pediatric Abdominal Pain<br> <br> <br> <br> * Intussusception* Classic history* Severe emesis* INTERMITTENT severe abdominal pain* Common causes* Meckles diverticulum* Henoch-Schonlein purpura* Diagnose with abdominal ultrasound* Look for target sign* Treat with air enema* Malrotation with Volvulus* Classic symptoms* Bilious emesis* Projectile* CONSTANT severe abdominal pain* Peritonitic abdominal exam* Common tests (if stable)* Upper GI Series* Corkscrew sign* Coffee-bean sign* Necrotizing Enterocolitis* Classic symptoms* Premature neonate* Bloody stool* X-Ray shows pneumotosis intestinalis* (Air in the bowel wall)* Hirschsprungs Disease* Delayed passage of meconium* Diagnosis* Contrast enema (not typically done in ED)* Look for distal transition point* Rectal suction biopsy (DEFINITELY not done in the ED)* Gold standard for diagnosis<br> <br> <br> <br> Bronchiolitis<br> <br> <br> <br> * Commonly caused by RSV* Initial fever and URI* Progresses to respiratory distress<br> <br> <br> <br> Croup (laryngotrachealbronchitis)<br> <br> <br> <br> * Commonly caused by parainfluenza* Initial fever and URI* Progresses to stridor* Barky cough* Neck xray will show “steeple sign” (subglottic narrowing)* Treatment* Steroids* Nebulized epinephrine<br> <br> <br> <br> Epiglottitis<br> <br> <br> <br> * Commonly caused by Haemophilus influenzae * Classic symptoms* Fever* Sore throat* Drooling* Muffled voice* Treatment* Keep the child calm* Intubation in a controlled environment* Antibiotics<br> <br> <br> <br> Additional Reading<br> <br> <br> <br> * Pediatric Abdominal Pain <a href="http://www.emclerkship.com/tummy-ache/">(EM Clerkship)</a>* Peds O – Oxygen, Airway, and Respiratory Disorders <a href="http://www.emclerkship.com/peds-o-oxygen-airway-and-respiratory-disorders/">(EM Clerkship)</a><br>