6 Infectious

Question 1

neonate is reported to ‘feel hot’ at home, but no fever measured at triage

do what

Answer 1

observe child for several hours, get serial core temps

Question 2

abx for neonatal fever

<4 weeks

>4 weeks

Answer 2

amp, cefotax

+/- acyclovir, vanc

amp, ceftriaxone

+/- acyclovir, vanc

Question 3

Infant with fever:

when to check UA? what are the risk factor criteria (6), ages?

-how many criteria need to fill?

Answer 3

prior UTI

>39

Fever> 24h

unknown source

nonblack race

exam findings–suprapubic ttp

female <24mo, 1 criteria: check UA

male uncircumcised <12mo, 2 criteria: check UA

male circumcised <6 mo: check UA

circumcised >12 mo, check if >3 risk factors.

confusing.

Question 4

Peds UTI

what to know about the UA different from adults

Answer 4

children urinate frequently, so urine does not have time to develop nitrites and LE

both Nitrites and LE are less sensitive

always send a cx

low threshold to treat

Question 5

Peds sepsis;

what is this warm and cold shock

why it matters

Answer 5

adult sepsis is typically warm shock: low SVR and high cardiac output

however kids often have opposite: high SVR, and cardiac output cannot mount against SVR. So pt is cold, looks like a cardiogenic shock. Kids cold and shocky, still think sepsis!

in adults, you give NE to increase SVR

however in kids with cold shock, you give DA or Epi to increase cardiac output. infact NE can make things worse

Question 6

Peds sepsis

• how much fluids to give?
• when to start pressors?
• what lines can pressor go in, and how long?
• what fluids for maintenance?
• what other med to give that typical don’t start in adults

Answer 6

20 cc/kg boluses

can easily go 60 cc/kg over 15min

Start pressors if no sxs improvement after 40-60cc/kg fluids (remember use DA or epi in cold shock!)

go still add fluids to 200ml/kg in hour 1 if no shock reversal

Pressor can go in PIV for 4h

maintenance: D10NS

Give all kids stress dose steroids. (25% will be adrenal insufficient)

give 25-50mg hydrocort

Question 7

Flu vaccine

-what age gets it

Answer 7

>6 months

Question 8

Measles

–when is it contagious

• what kind of isolation
• what is post exposure ppx for people NOT immunized? immunocompetent vs immunocompromised

Answer 8

4 days before and after onset of rash

Airborne isolation

immunocompetent: give MMR within 72h

immunocompromised, infants; IM immunoglobulin, talk to ID and health authorities

Question 9

meningitis:
what to look for on gram stain for meningococcemia

Answer 9

paired gram neg diplococci

Question 10

acute otitis media

• what are the different tx options?
• what if TM perf?
• pcn allergy?

Answer 10

wait and see 48h, with high dose amox: >2, unilateral, no perf.

high dose amox: <2 and everyone else

augmentin: conjuncitivitis
- perf, give flouroquinolone gtt
- allergy, can give Cefdinir, or clinda

Question 11

peds PNA: what outpt abx choice?

Answer 11

atypicals not present until age 5

so, give amox 90mg/kg

At age 5 add azithro

Question 12

peds Strep throat
-what if PCN allergy?

Answer 12

give PCN

if allergy, azithro

Question 13

Scarlet fever

• tx?
• what to tell parents

Answer 13

Give same tx as strep throat: PCN, or azithro

tell parents that skin will slough off/peel

Question 14

infant red butt: how to think?

Answer 14

mountains and valleys

mountains: contact diaper dermatitis. give barrier cream eg desitin
valleys: consider candida. give topical antifungals with every diaper change until rash resolves. NO steroid cream