Common Presentations Flashcards
Fever, UTI, OM, URI, LRI, Asthma, Croup, Abdominal Pain, NVD, Head Injuries, Bronchiolitis
In which populations should we take fever more seriously?
Immunocompromised, age <2mos, ill appearance
Give a ddx of SBIs we need to rule out in the febrile child
UTI, meningitis, bacteremia, septic joints, appendicitis, pneumonia
What are the most common bacterial organisms in kids <28 days?
E coli, S. pnuemo, listeria, GBS, MRSA
Workup that should be performed in all febrile neonates < 28 days?
LP, blood&urine cultures, CBC, +/- CXR, stool Cx, HSV testing
Start empiric amp+gent and consider acyclovir
What workup should be performed in a febrile 1-3mo?
CBC, UA, Blood&urine cultures. Look at either Rochester/Philly/PECARN guidelines and stratify the child–if not low risk get the LP
Is hypotension a late or early finding in pediatric sepsis?
Late finding! Children have increased sympathetic tone and can maintain BPs despite sepsis or hypovolemia
What life threatening diagnosis should always be considered with URI sxs?
Meningitis!
What age group should never get ibuprofen?
Children <6mos
What is the most common SBI in children <36mos?
Urinary Tract Infections
What are risk factors for urinary tract infections?
Females <12mos, uncircumcised males, nonblack race, >24 hours of fever, fever >39C, no obvious infection source
Which marker on a UA is sensitive for UTI and which marker is specific for a UTI?
leukocyte esterase=sensitive
nitrates=specific
What non-infectious ddx items should be considered in the ill appearing infant <60 days old
congenital heart disease, metabolic disease (e.g. galactosemia), congenital adrenal hyperplasia with adrenal crisis, seizure and non-accidental trauma
If a patient has >/= 2 of which criteria should you consider performing a strep swab
absence of cough, tonsillar exudate/edema, fever, anterior chain cervical adenopathy, age between 15yrs and 3mos
What criteria indicate a patient who may benefit from tamiflu and thus warrant flu testing?
= 24 mos, pt with chronic conditions, patient sick enough to require admission
What diagnoses should be considered in children who present with URI sxs?
influenza, OM, strep pharyngitis, sinusitis
What criteria should alert you to consider bacterial sinusitis?
URI sxs not improving for >10 days, worsening sxs after initial URI sxs resolve, severe sxs (purulent nasal discharge, fever >39C) for >3 days
What clinical criteria are used to diagnose pertussis infection?
a cough illness >/= 2wks w/out a more likely diagnosis and atleast 1 of the following: paroxysms of coughing, inspiratory whoop, post-tussive emesis, apnea in infants <1yo
What lab should be obtained in all children to be hospitalized for pneumonia?
blood culture
What antibiotics should be used for pneumonia?
<5yo=amoxicillin or ampicillin
>5yo=macrolide
If pertussis=azithromycin
What should be assessed during an asthma exacerbation?
ability to speak full sentences, retractions, O2 sat, respiratory rate, auscultory findings
What therapies should be given in a severe asthma exacerbation?
NS bolus, duonebs, continuous albuterol, IV magnesium, steroid.
Consider IM epi, heliox, NIPPV, and intubation
Give a ddx for croup
retropharyngeal abscess, peritonsillar absces, tracheitis, foreign body, epiglottitis
Tx for croup
dex, racemic epinephrine
Which patients are most at risk for bronchiolitis complications?
Age<3mos, preemies, pts w/ comorbidities
Give a ddx for abdominal pain (large list)
PID, HSP, UTI, acute gastroenteritis, constipation, volvulus, appendicitis, DKA, HUS, lower lobe pneumonia, testicular or ovarian torsion, intussusception, incarcerated hernia
What are factors that increase the likelihood of a patient with abdominal pain needing surgery?
fever, bilious emesis, bloody diarrhea, absent bowel sounds, guarding, rigidity, rebound tenderness
What labs should you get for a patient presenting with abdominal pain?
CBC, hepatic panel, UA, pregnancy test
What are the most common causes of surgical abdomen in infants and older children?
infants=intussusception
older children=appendicitis
In what patients is it possible to observe OM w/out giving antibiotics?
Abscence of severe sxs (temp>39C, otalgia>48 hrs)
6mo-2yr: unilateral OM w/out otorrhea
>/=2yr: OM w/out otorrhea whether uni or bilateral
Describe the antibiotic choices for treating OM
Amox-if no amox w/in last 30 days and no purulent conjunctivitis
Augmentin-amox w/in 30 days, purulent conjunctivitis, or hx unresponsive OM
cefdinir vs rocephin for penicillin allergy
augmentin vs rocephin for tx failure (persistent sxs w.out improved exam after 48 hrs)
Life threatening ddx for N/V/D in infants
pyloric stenosis, intussusception, malrotation, volvulus, UTI, increased ICP
Life threatening ddx for N/V/D in toddlers
intussusception, appendicitis, HUS, increased ICP, DKA, ingestion
What are the 3 best predictors of dehydration?
prolonged cap refill
abnormal skin turgor
abnormal respiratory pattern
What guidance should you give families discharged with N/V/D to avoid dehydration?
Return precautions-unable to tolerate PO, no UOP >12 hours
Replace episodes of vomiting or diarrhea with 10mL/kg of PO hydration
