NBME Shelf Review (Part 3) – Pediatrics

Febrile Seizures

* 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

Pediatric Abdominal Pain

* 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

Bronchiolitis

* Commonly caused by RSV* Initial fever and URI* Progresses to respiratory distress

Croup (laryngotrachealbronchitis)

* 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

Epiglottitis

* Commonly caused by Haemophilus influenzae * Classic symptoms* Fever* Sore throat* Drooling* Muffled voice* Treatment* Keep the child calm* Intubation in a controlled environment* Antibiotics

Additional Reading

* Pediatric Abdominal Pain (EM Clerkship)* Peds O – Oxygen, Airway, and Respiratory Disorders (EM Clerkship)