Common Presentations

Question 1

In which populations should we take fever more seriously?

Answer 1

Immunocompromised, age <2mos, ill appearance

Question 2

Give a ddx of SBIs we need to rule out in the febrile child

Answer 2

UTI, meningitis, bacteremia, septic joints, appendicitis, pneumonia

Question 3

What are the most common bacterial organisms in kids <28 days?

Answer 3

E coli, S. pnuemo, listeria, GBS, MRSA

Question 4

Workup that should be performed in all febrile neonates < 28 days?

Answer 4

LP, blood&urine cultures, CBC, +/- CXR, stool Cx, HSV testing
Start empiric amp+gent and consider acyclovir

Question 5

What workup should be performed in a febrile 1-3mo?

Answer 5

CBC, UA, Blood&urine cultures. Look at either Rochester/Philly/PECARN guidelines and stratify the child–if not low risk get the LP

Question 6

Is hypotension a late or early finding in pediatric sepsis?

Answer 6

Late finding! Children have increased sympathetic tone and can maintain BPs despite sepsis or hypovolemia

Question 7

What life threatening diagnosis should always be considered with URI sxs?

Answer 7

Meningitis!

Question 8

What age group should never get ibuprofen?

Answer 8

Children <6mos

Question 9

What is the most common SBI in children <36mos?

Answer 9

Urinary Tract Infections

Question 10

What are risk factors for urinary tract infections?

Answer 10

Females <12mos, uncircumcised males, nonblack race, >24 hours of fever, fever >39C, no obvious infection source

Question 11

Which marker on a UA is sensitive for UTI and which marker is specific for a UTI?

Answer 11

leukocyte esterase=sensitive

nitrates=specific

Question 12

What non-infectious ddx items should be considered in the ill appearing infant <60 days old

Answer 12

congenital heart disease, metabolic disease (e.g. galactosemia), congenital adrenal hyperplasia with adrenal crisis, seizure and non-accidental trauma

Question 13

If a patient has >/= 2 of which criteria should you consider performing a strep swab

Answer 13

absence of cough, tonsillar exudate/edema, fever, anterior chain cervical adenopathy, age between 15yrs and 3mos

Question 14

What criteria indicate a patient who may benefit from tamiflu and thus warrant flu testing?

Answer 14

= 24 mos, pt with chronic conditions, patient sick enough to require admission

Question 15

What diagnoses should be considered in children who present with URI sxs?

Answer 15

influenza, OM, strep pharyngitis, sinusitis

Question 16

What criteria should alert you to consider bacterial sinusitis?

Answer 16

URI sxs not improving for >10 days, worsening sxs after initial URI sxs resolve, severe sxs (purulent nasal discharge, fever >39C) for >3 days

Question 17

What clinical criteria are used to diagnose pertussis infection?

Answer 17

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

Question 18

What lab should be obtained in all children to be hospitalized for pneumonia?

Answer 18

blood culture

Question 19

What antibiotics should be used for pneumonia?

Answer 19

<5yo=amoxicillin or ampicillin
>5yo=macrolide
If pertussis=azithromycin

Question 20

What should be assessed during an asthma exacerbation?

Answer 20

ability to speak full sentences, retractions, O2 sat, respiratory rate, auscultory findings

Question 21

What therapies should be given in a severe asthma exacerbation?

Answer 21

NS bolus, duonebs, continuous albuterol, IV magnesium, steroid.
Consider IM epi, heliox, NIPPV, and intubation

Question 22

Give a ddx for croup

Answer 22

retropharyngeal abscess, peritonsillar absces, tracheitis, foreign body, epiglottitis

Question 23

Tx for croup

Answer 23

dex, racemic epinephrine

Question 24

Which patients are most at risk for bronchiolitis complications?

Answer 24

Age<3mos, preemies, pts w/ comorbidities

Question 25

Give a ddx for abdominal pain (large list)

Answer 25

PID, HSP, UTI, acute gastroenteritis, constipation, volvulus, appendicitis, DKA, HUS, lower lobe pneumonia, testicular or ovarian torsion, intussusception, incarcerated hernia

Question 26

What are factors that increase the likelihood of a patient with abdominal pain needing surgery?

Answer 26

fever, bilious emesis, bloody diarrhea, absent bowel sounds, guarding, rigidity, rebound tenderness

Question 27

What labs should you get for a patient presenting with abdominal pain?

Answer 27

CBC, hepatic panel, UA, pregnancy test

Question 28

What are the most common causes of surgical abdomen in infants and older children?

Answer 28

infants=intussusception

older children=appendicitis

Question 29

In what patients is it possible to observe OM w/out giving antibiotics?

Answer 29

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

Question 30

Describe the antibiotic choices for treating OM

Answer 30

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)

Question 31

Life threatening ddx for N/V/D in infants

Answer 31

pyloric stenosis, intussusception, malrotation, volvulus, UTI, increased ICP

Question 32

Life threatening ddx for N/V/D in toddlers

Answer 32

intussusception, appendicitis, HUS, increased ICP, DKA, ingestion

Question 33

What are the 3 best predictors of dehydration?

Answer 33

prolonged cap refill
abnormal skin turgor
abnormal respiratory pattern

Question 34

What guidance should you give families discharged with N/V/D to avoid dehydration?

Answer 34

Return precautions-unable to tolerate PO, no UOP >12 hours

Replace episodes of vomiting or diarrhea with 10mL/kg of PO hydration