Common Infections in Children Flashcards
Which of the following is not part of the required criteria to make a diagnosis of Acute Otitis Media (AOM). A. Signs of middle ear effusion B. Signs of middle ear inflammation C. Middle ear perforation D. Acute onset of symptoms
C. Middle ear perforation
The diagnostic criteria includes: signs of middle ear effusion (decreased mobility of TM), signs of middle ear inflammation (bulging TM, discolouration of TM), and acute onset of symptoms.
Which of the following is not a RF for AOM? A. Tympanostomy tubes B. Craniofacial abnormalities C. Preceding viral URTI D. Atopy
A. Tympanostomy tubes
Risk factors for AOM include: parental smoking, pacifier use, bottle feeding, no immunizations, day care, SES, siblings, prematurity, craniofacial abnormalities, atopy, males, First Nations, Inuit ethnicity.
What is standard dose Amoxicillin vs. high dose Amoxicillin?
Standard dose = 45-60mg/kg/day divided TID
High dose = 75-90mg/kg/day divided BID
An 8 month old boy presents with a 2 day history of runny nose and occasional cough. He has had one day of fever, crying and restless sleep. He has been diagnosed with ear infections twice before, most recently two months ago when he was treated with penicillin. Otherwise, he is generally healthy and has been fully immunized. He attends daycare four days/week. PE reveals T39.5, slightly enlarged cervical lymph nodes and coryza. Both tympanic membranes are red, opaque and bulging. What is your management plan?
AOM is treated with high dose Amoxicillin (75-90 mg/kg/day). Treatment is indicated if the child is less than 6 month, severely ill, immunocompromised, chronic cardiopulmonary disease, anatomical abnormality of head/neck, history of complicated otitis media, trisomy 21 or limited access to health care. This child child should be treated due to his high fever, indicating severity.
If a child with AOM fails first line treatment what is the antibiotic of choice?
Amoxicillin-Clavulanate
A previously health 7 year old boy presents with a sore throat. His parents state that he has also had rhinorrhea, hoarseness, cough and conjunctivitis. Does this child require further investigation regarding this current illness?
No - If rhinorrhea, hoarseness, cough and conjunctivitis are present as the predominate symptoms no test or antibiotics are required as it is likely a viral illness.
What criteria is required to determine the need for a throat swab? (McIsaac Score)
McIsaac Score = exudate (pharyngeal or tonsillar), lymphadenopathy (anterior cervical chain), fever >38C, no cough, <15 years old. If the score is greater than or equal 2 throat swab cultures should be done.
What is the treatment of GAS tonsillopharyngitis?
General management includes fluids, analgesics/antipyretics, warm salt water gargles, throat lozenges. The treatment of confirmed GAS is Penicillin V (40 mg/kg/day div. BID x 10 days). This reduces the severity and duration of symptoms (1d), reduces risk of transmission after 24h, but DOES NOT reduce the risk of PSGN or GAS assoc. movement disorders.
What are the non-suppurative and suppurative complications of GAS tonsillopharyngitis?
Non-suppurative complications: acute rheumatic fever, GAS movement disorders (Sydenham’s chorea), pediatric autoimmune neuropsychiatric disorders associated with Strep. (PANDAs), PSGN, post-strep arthritis.
Suppurative complications: peritonsilar abscesses, endocarditis, cervical adenitis.
Toxic mediated includes scarlet fever and toxic shock syndrome.
A 3 year old presents with a fever and drooling. Mom says that she is refusing food and says her neck hurts. She will not look up. What is the likely diagnosis and required investigation?
This is likely a retropharyngeal abscess. The investigation required is a lateral neck X-ray. If the X-ray is positive a CT can be ordered.
A 12-year-old girl presents with a four-day history of episodic fever and cough. She has had a mildly runny nose. She does not feel well and it hurts to take a deep breath in. She is otherwise healthy. There are no known infectious contacts. Physical examination reveals a temperature of 38C, RR of 20, HR of 110, and normal BP. The oxygen saturation is 95%. She does not appear unwell but she is coughing at times. The head and neck exam is normal. The respiratory exam reveals no distress. Diffuse crepitations are heard on auscultation. What is your management plan?
This is a non-severe pneumonia likely caused by atypical bugs (mycoplasma, chlamydophilia). The antibiotic of choice is clarithromycin or azithromycin. Features of an atypical pneumonia include subacute onset, prominent cough, typically in a school aged child. The CXR will have a reticular pattern, with diffuse opacities to the bases.
What is the treatment for a non-severe, classic CXR pneumonia?
Amoxicillin!
previously well, 18-month old boy presents with a one-week history of illness that started with a runny nose, fever and cough. The fever initially resolved after two days, but in the last 24 hours he has again had a high fever with chills and increased cough. He is lethargic and not drinking well. He is completely immunized. Physical examination reveals an unwell looking child with a temperature of 39.4C, RR of 48, HR of 132, and BP 90/60. The oxygen saturation in room air is 91%. He is not dehydrated. The head and neck exam is normal except for coryza. The respiratory exam reveals some nasal flaring and intercostal indrawing. On auscultation, there are crepitations heard in the base of both lung fields. Is this child tachypneic? What is the most likely diagnosis? Do you admit this child?
Yes, this child is tachypneic (RR for 1-5 years has an upper limit of 40). This child likely has pneumonia. The child sounds SICK and requires admission.
