Community Pediatrics

Question 1

Prophylactic Antibiotics in UTI

Answer 1

This is no longer recommended.
The only time you would is there is reflux Grade IV or V.
If so you can use septra or macrobid.
Treatment for 3-6 months.

Question 2

UTI Diagnosis and Mangement

Answer 2

Leuk Esterase: Sensitive
Nitrites: Specific
LE/N/WBC = very high specificity and sensitivity

Minimum Colony Counts:
Suprapubic aspiration: any amount
Catheter: >5 x 10^7
Clean catch: >10^8

Question 3

When do you think of a UTI in infant?

Answer 3

Infants 2-36 months with high fever (>39) and no other reason may have fever.

Question 4

U/S?

Answer 4

Ultrasound all children <2 years of age with their first febrile UTI. Do not all need VCUG, only if abnormal

Question 5

When can you start using a cup in an infant?

Answer 5

6 months

Question 6

When should you start introducing Iron?

Answer 6

6 months

Question 7

When should you screen children for hearing abnormalities and with what?
Risk factors for hearing loss (5)

Answer 7

1 month of age with otoacoustic emission.
If they fail you follow up by 3 months with brainstem evoked potentials.
Repeat at 6 months and treat then if required.

Risk factors: Hyper billi; , NICU, Torch, craniofacial abnormalities, meningitis

Question 8

What deficiencies are children at risk for with vegetarian diets?

Answer 8

Iron (biggest)
Vitamin B 12 (if mom is vegan and breastfeeding)
Calcium and Vitamin D
Zinc

Question 9

Day Care Exclusion Criteria:

Diarrhea, Conjunctivitis, Scabies, Impetigo, Varicella, pertussis, measles, rubella and Hep A

Answer 9

Diarrhea: if culture + then 2 negative cultures (salmonella is 3 cultures)
Conjunctivitis: Treatment initiation
Scabies: Treatment 5% permetherin
Impetigo and GAS: 24 hours of treatment 
Varicella: crusted lesions
pertussis: 5 days of treatment 
Measles: 3 days from rash, Mumps: 9 days from welling Rubella 6 days from rash 
Hep A: 7 days from jaundice

Question 10

What are the contraindications to flying?

Answer 10

Eisenmeingers, uncontrolled SVT, uncontrolled htn

Should provide O2 for sickle cell and cardiopulmonary disease.

Question 11

Toilet training: when will kids have daytime continence?

Answer 11

98% of children will have daytime continence by the age of 3 years.

Question 12

What signs to children need for toilet readieness

Answer 12

Neurologically ready - sphincter control 18 months
Developmentally ready:
Will please family
Can follow a 2 step command
Asking too or showing readiness

Question 13

Head Lice

Answer 13

Pediculus humarus capitus. the actual diagnosis requires the presence of a live louse.
They can live away from the scalp for about 2 days.
Treatment: Permetherin
Ivermectin can not be used in children <15 kg.

Question 14

Early Onset Sepsis Guidelines - Risk factors

Answer 14

Prolonged rupture of membranes >18 hours
Previous diagnosis of GBS
GBS Uria
GBS + 
Maternal Fever 
Chorio

Question 15

Early onset sepsis - evaluation

Answer 15

1. If baby is unwell - full work up and initiate antibiotics
2. Multiple risk factors - CBC in 4 hours; monitor every 4 hours; keep in hospital 48 hours
3. GBS Status:
   +/- Adequate antibiotics: Monitor for 24 hours then d/c.
   +/- Inadequate: Birth until 4 hours close monitoring; may d/c at 24 hours.

ONLY WBC and Neut can predict infection as compared to CRP.

Question 16

Transfusion Requirements

Answer 16

Note: EPO is not recommended due to the increased risk of ROP; unclear if transfusion increases risk for NEC.
Infants on support: 115, 100, 85
Infants not on support: 100, 85, 75

Question 17

Risks associated with Transfusions

Answer 17

1. Anaphylaxis - ABO Incompatibility
2. Graft Vs. Host
3. Infection - CMV is the most common
4. Fluid Overload
5. Electrolyte abnormalities