Case Files Flashcards
In the first few days of life, bacteria that usually cause pneumonia
Tx?
Enterobacteriaceae and group B Streptococcus (GBS) are the primary bacterial etiologies; other possibilities include Staphylococcus aureus, Streptococcus pneumoniae (pneumococcus), and Listeria monocytogenes.
broad-spectrum antimicrobials (ampicillin with either gentamicin or cefotaxime) are customarily prescribed.
Treatment of cerebral edema consists of ___ (3)
reduction in IV fluid, administration of IV mannitol, and hyperventilation.
During the first few months of life, Chlamydia trachomatis is a possibility (for pneumonia), particularly in the infant with staccato cough and tachypnea, with or without conjunctivitis or known maternal chlamydia history. These infants also have eosinophilia, and bilateral infiltrates with hyperinflation on chest radiograph.
Tx?
treatment is erythromycin
Most common viral etiology of newborn pneumonia & Tx
Viral etiologies include herpes simplex virus (HSV), enterovirus, influenza, and RSV; of these, HSV is the most concerning and prevalent viral pneumonia in the first few days of life. Acyclovir is an important consideration if HSV is suspected.
Beyond the newborn period and through approximately 5 years of age, viral pneumonia is common; which viruses? How to Dx?
Which bacteria cause pneumonia at this age?
CXR findings with viral pneumonia?
adenovirus, rhinovirus, RSV, influenza, and parainfluenza.
Bacterial etiologies include pneumococcus and nontypeable Haemophilus influenzae.
Tx: admit, observation, oxygen, and bronchodilator therapies. The diagnosis of a viral process may be made clinically or with CXR findings (perihilar interstitial infiltrates). Nucleic acid (PCR) amplification of secretions from a nasal swab or wash often is performed to confirm a viral etiology. A mixed viral and bacterial pneumonia can be present in approximately 20% of patients.
LRTI in kid over 5 yrs - most common etiology? Tx?
The pediatric patient older than approximately 5 years of age with LRTI typically has mycoplasma. However, most of the viral and bacterial etiologies previously listed are possible, except GBS and Listeria. Antibiotics in this age group are directed toward mycoplasma and typical bacteria (pneumo- coccus). Treatment options include macrolides (azithromycin) or cephalosporins (ceftriaxone or cefuroxime).
Pneumonia in the intubated intensive care patient with central lines may be related to ___ (2).
___ (2) are possibilities in the patient with chronic lung disease (cystic fibrosis).
___ should be considered in the patient with typical skin findings and pneumonia;
___ if concomitant retinitis is present;
___ if the patient has been exposed to stagnant water; and
___ if a patient has refractory asthma or a classic “fungal ball” on chest radiograph.
Travel to the southwestern United States exposes patients to ___,
infected sheep or cattle expose patients to ___, and
spelunking or working on a farm east of the Rocky Mountains exposes patients to ___.
Pneumonia in the intubated intensive care patient with central lines may be related to Pseudomonas aeruginosa or fungal species (Candida).
Pseudomonas and Aspergillus are possibilities in the patient with chronic lung disease (cystic fibrosis).
Varicella-zoster virus should be considered in the patient with typical skin findings and pneumonia;
cytomegalovirus (CMV) if concomitant retinitis is present;
Legionella pneumophila if the patient has been exposed to stagnant water; and
Aspergillus if a patient has refractory asthma or a classic “fungal ball” on chest radiograph.
Travel to the southwestern United States exposes patients to Coccidioides immitis,
infected sheep or cattle expose patients to Coxiella brunetti, and
spelunking or working on a farm east of the Rocky Mountains exposes patients to Histoplasma capsulatum.
Radiographic findings in LRTI may be limited, nonexistent, or lag the clinical symptoms, especially in the ___ patient.
Findings may include single or multilobar consolidation (___) (2 etiologies),
air trapping with flattened diaphragm (___),
perihilar lymphadenopathy (___), or
an interstitial pattern may predominate (___).
Finally, pleural effusion and abscess formation are more consistent with ___ infection.
Radiographic findings in LRTI may be limited, nonexistent, or lag the clinical symptoms, especially in the dehydrated patient.
Findings may include single or multilobar consolidation (pneumococcal or staphylococcal pneumonia),
air trapping with flattened diaphragm (viral pneumonia with bronchospasm),
perihilar lymphadenopathy (mycobacterial pneumonia), or
an interstitial pattern may predominate (mycoplasmal pneumonia).
Finally, pleural effusion and abscess formation are more consistent with bacterial infection.
Signs and symptoms of cholinergic excess (eg organophosphate poisoning) are often remembered with the mnemonic ___.
DUMBBELS
D diarrhea/defecation
U urination
M miosis
B brachycardia
B bronchorrhea
E emesis/excitation of muscles
L lacrimation
S salivation
Atropine works by ___
antagonizing the muscarinic ACh receptor (useful in organophosphate poisoning)
Tx after positive gonorrhea result
The gravity of these diagnoses in children dictates confirmation of a positive test with either a true culture or a second NAAT that targets a different portion of the organism’s genome.
Tx if confirmed: single dose of ceftriaxone 125 mg intramuscularly.
Pediatric sexual assault victims are tested for sexually transmissible diseases (chlamydia, gonorrhea, trichomonas, HIV, and syphilis) whenever anal-genital, genital-genital, or oral-genital contact has occurred.
Serologies for human immunodeficiency virus and syphilis should be periodically checked until at least 6 months have
elapsed following the assault.
Organisms in acute otitis media
Common bacterial pathogens include Streptococcus pneumoniae, nontypeable Haemophilus influenzae, and Moraxella catarrhalis.
Other organisms, Staphylococcus aureus, Escherichia coli, Klebsiella pneumoniae, and Pseudomonas aeruginosa, are seen in neonates and patients with immune deficiencies.
Viruses can cause AOM, and in many cases the etiology is unknown.
Tx of acute otitis media
Depending on a community’s bacterial resistance patterns, amoxicillin at doses up to 80 to 90 mg/kg/d for 7 to 10 days is often the initial treatment.
If clinical failure is noted after 3 treatment days, a change to amoxicillin-clavulanate, cefuroxime axetil, azithromycin, cefixime, ceftriaxone, or tympanocentesis is considered.
Adjuvant therapies (analgesics or antipyretics) are often indicated, but other measures (antihistamines, decongestants, and corticosteroids) are ineffective.
What is serous otitis media
OTITIS MEDIA WITH EFFUSION: A condition in which fluid collects behind the TM but without signs and symptoms of AOM. Sometimes called serous OM.
Complications of AOM
When the fluid does not resolve or recurrent episodes of suppurative OM occur, especially if hear- ing loss is noted, myringotomy with PE tubes is often used.
Rare but serious OM complications include mastoiditis, temporal bone osteomyelitis, facial nerve paralysis, epidural and subdural abscess formation, meningitis, lateral sinus thrombosis, and otitic hydrocephalus (evidence of increased intracranial pressure with OM). An AOM patient whose clinical course is unusual or prolonged is evaluated for one of these conditions.
