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Pediatrics > COMSEP Cases > Flashcards

COMSEP Cases Flashcards

1
Q

Treatment for afebrile pneumonia

A

Afebrile pneumonia most commonly chlamydia trachomatis

Tx = azithromycin (bubble gum flavored, taken QD)

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2
Q

16 yo w/ nasal discharge, 103 F
-swollen red eye w/ not intact EOM

(a) Tx

A

Orbital cellulitis

(a) Tx = immediate surgical drainage then abx

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3
Q

12 yo w/ cough, CP, 101 F x 3 days

-CXR: diffuse interstitial markings

A

Community acquired pneumonia

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4
Q

Tx for allergic rhinitis

(a) 1st line
(b) 2nd line

A

Allergic rhinitis tx

(a) 1st line: 2nd generation anti-histamine (Claritin, Zyrtec, Allerga) that are not sedating
(b) 2nd line: Nasal Steroids (Flonase)

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5
Q

HUS triad

A

Hemolytic uremic syndrome:

  • microangiopathic hemolytic anemia
  • thrombocytopenia
  • acute kidney injury
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6
Q

Which would you be more likely to overtreat

(a) Hand vs. leg bite
(b) Cat vs. dog bite

A

More likely to overtreat

(a) Hand bite
(b) Cat bite: pasturella infxn

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7
Q

Etiology of orbital cellulitis

(a) Direct
(b) Indirect

A

Orbital cellulitis

(a) Direct inoculation from trauma or surgery, hematogenous spread from bacteremia
(b) Indirect as an extension of infection in periorbital structures (aka from ethmoid sinus)

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8
Q

Treatment for atypical pnuemonia in children > 5 yoa

A

Macrolides: azithromycin (tastes like bubble gum, taken QD)

-or cephalosporins (ex: Ceftriaxone or cefurozime)

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9
Q

Etiology of HUS

A

Primary and secondary causes

primary = d/o resulting in complement dysregulation

secondary = infectious causes: shiga toxin, pneumococcus, EHEC, 90% cases by STEC = Shiga toxin-producing Escherichia coli

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10
Q

Why is an albumin test done on a pneumonia pt

A

Hypoalbuminemia if pleural effusion

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11
Q

What to look for in a kid w/ allergic rhinitis

A

Triad: allergic rhinitis, eczema, asthma- in pt or family

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12
Q

Barky cough

A

Buzzword for croup = acute laryngotracheobronchitis

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13
Q

Most common causes of otitis externa

A

Pseudomonas aeruginosa and staph aureus

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14
Q

Common presentation of PID

A

Pelvic Inflammatory Disease- fever and lower abdominal pain w/o URI symptoms (no urinary urgency or frequency)

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15
Q

Erythema Multiform

(a) Etiology
(b) Tx

A

Immune mediated d/o, somewhat of a spectrum
-step above uticaria, step below Steven Johnsons

Etiology: HSV
-10% are allergic rxns to drugs: NSAIDs, sulfa drugs

Treat w/ steroids

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16
Q

Tx for HUS

A

Hemolytic uremic syndrome- supportive tx

  • peritoneal dialysis if needed
  • platelet/RBC transfusion if needed
  • fluid and electrolytes to maintain intravascular volume
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17
Q

Otoscopic findings of acute otitis media

A

TM appears bulging and erythematous (redness and bulging)

  • aberrant light reflex
  • pus line
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18
Q

Tx for pertussis

A

Tx for pertussis = Azithromycin

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19
Q

12 yo boy w/ pain below right knee when running and playing soccer

A

Osgood-Schlatter = benign inflammation of the tibial tubercle that occurs before the completion of the growth plates by 15-17 yoa

  • knee pain increases w/ activity
  • common after growth spurt, usually in athletic kids
  • no constitutional symptoms of history of trauma
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20
Q

Most frequent complication of bacterial pneumonia

(a) Rare but serious complication

A

Bacterial pneumonia
Most frequent complication = pleural effusion (tx: pleurocentesis)

(a) Rare but serious complication = empyema = pus collection in pleural cavity

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21
Q

11 yo w/ ear pain and drainage from canal

(a) If in July
(b) If in December

A

11 yo w/ ear pain and drainage from canal

(a) July- swimmer’s ear = otitis externa
(b) December- perforated TM
- acute ear pain that resolves when TM perforates

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22
Q

2 key clinical features of HUS

A

Hemolytic uremic syndrome: 1-2 week prodrome of blood tinged diarrhea => acute onset of pallor, lethargy/irritability, decrease/absent urine output

-wouldn’t expected pallor (indicating anemia) from just tinged stool => hint that pt is hemolyzing

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23
Q

How to clinically distinguish transient synovitis and LCP

A

Transient synovitis (benign inflammatory joint) vs. Legg-Calve-Perthes (avascular necrosis of the hip) is time

  • transient synovitis will typically self-resolve w/in 7-10 days
  • if persistent from weeks to months = LCP
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24
Q

3 most common bacteria that cause otitis media

A

40% of otitis media are bacterial

Strep pneumo, nontypable H. flu, Moraxella

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25
Q

Most common bug to cause

(a) Bronchiolitis
(b) Croup

A

Most common cause of

(a) Bronchiolitis = RSV
(b) Croup = parainfluenza virus

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26
Q

Cough that wakes pt up at night

(a) 7 yr old
(b) 5 yr old

A

Cough that wakes up the pt at night

(a) 7 yo- sinusitis = mucous membrane inflammation of sinus cavity
(b) 5 yo- sleep apnea b/c tonsil size peak at 6
- sinuses not cavitated until 6

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27
Q

Differentiate when Prevnar 13 and pneumovac are given

A

Pneumococcal vaccines:

  • Prevnar 13 given starting around 2 mo
  • Pneumovax (23 serotypes) can be given after 2 yoa
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28
Q

Why should you not give Claritin D in kids w/ asthma

A

The “D” is for pseudophedrin which + albuterol = super hyperactive kid and increased cardiac risk (too high increase in BP or HR)

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29
Q

15 yo overweight M w/ hip pain

-no trauma or fever

A

SCFE = slipped capital femoral epiphysis

-femoral epiphysis slips posteriorly => limp and impaired internal rotation

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30
Q

Otitis media tx

(a) 1st line
(b) 2nd line

A

Treating otitis media

(a) 1st line = high dose amoxicillin -good gram (+) coverage
(b) If no improvement w/in 28 hrs: start Augmentin- adds E. coli and anaerobe coverage

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31
Q

3 week old male who squirms and grunts while having a BM

  • soft stools
  • child growing and thriving
A

Reassurance to parents, colic

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32
Q

6 week old afebrile infant

  • hx of conjunctivitis
  • px w/ staccato cough and tachypnea
  • bilateral crackles, bilateral retractions
  • CXR: patchy densities and hyperinflation
A

Afebrile pneumonia in infant = chlamydia trachomatis

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33
Q

Frequent finding in atypical or viral pneumonia

A

Wheezing

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34
Q

Causes of neonatal conjunctivitis

(a) w/in 6-12 hrs of birth
(b) 2-5 days
(c) 5-14 days

A

Neonatal conjunctivitis

(a) 6-12 hrs: chemical irritation from ocular silver nitrate
(b) 2-5 days: most serious- gonococcal conjunctivitis
(c) 5-14 days: chlamydial conjunctivitis

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35
Q

6 yo w/ pallor and irritability after week of abdominal pain and blood tinged diarrheal stools

A

HUS = Hemolytic Uremic Syndrome

36
Q

Tx for imeptigo

A

Mupirocin = topical abx

37
Q

What bugs are we worried about when ruling out sepsis in a 1 mo old?

A

GBS and E. Coli => use 3rd gen cephalosporins

Also Listeria

38
Q

Spinal tap findings indicative of herpes simplex meningitis

A

Elevated white count w/ lymphocytic elevation + red cells

39
Q

Tradeoff to not giving abx for an acute otitis media

A

60% of otits media cases are viral => some ppl watch and wait

Risk of not treating = rare but serious complication of mastoiditis

40
Q

Differentiate the spinal tap findings in bacterial vs. viral meningitis

A

Spinal tap findings in

Bacterial meningitis:

  • high white count, high polys
  • high protein and low glucose

Viral meningitis:

  • high white count, high lymphocytes
  • glucose normal and protein slightly elevated
41
Q

3 physical exam signs of meningitis

A

Physical exam findings of meningitis

  1. Nucchal rigidity- can’t bend head forward
  2. Kernig sign- pain/resistance upon extending knee
  3. Brudzinski’s sign- involuntary lifting of the legs when the head is lifted while pt in supine position
42
Q

Prophylaxis for swimmer’s ear

A

Alcohol in the ear- drys out the ear

-pseudomonas can’t grow w/o water

43
Q

Tx for 4 yo w/ sinus infection

A

Um impossible…can’t be a sinus infection under 6-7 yoa b/c that is when the sinuses open => probably URI

44
Q

Most common cause of atypical/walking pneumonia

A

Mycoplasma pneumonia

  • chlamydophila
  • viral
45
Q

Most common cause of pneumonia

(a) overall in peds
(b) Newborn period
(c) First few months
(d) 1 mo- 5 yr
(e) after 5 yrs
(f) pts w/ central lines
(g) CF/chronic lung disease pts

A

Etiology of pneumonia

(a) Overall peds = Pneumococcus
(b) Newborn: GBS, Enterobacteriaceae, HSV
(c) First few mo: Chlamydia trachomatis, viral
(d) 1 mo- 5 yr: viral, pneumococcus
(e) Over 5 yoa: mycoplasma
(f) Central line (ex: ICU)- psueodomonas, candida
(g) CF/chronic lung disease- pseudomonas, aspergillus

46
Q

4 yo w/ cough and 104 F following URI prodrome

-r. sided crackles

A

Bacterial pneumonia: most likely pneumococcus (strep pneumo)

47
Q

16 mo old w/ nasal discharge and foul smell for 3 days

A

Organic foreign object

48
Q

Diagnostic test for testicular torsion

A

Doppler ultrasound

-shows velocity of blood flow

49
Q

Pertussis

(a) clinical features
(b) febrile?
(c) CXR findings

A

Pertussis

(a) Paroxysmal cough, blue spells
(b) afebrile
(c) normal CXR

50
Q

Name some risk factors for recurrent otitis media

A
  • immunodeficiency
  • Under 6 yoa (eustachian tubes get longer and angle down after 6 yoa)
  • craniofacial abnormalities
51
Q

Uticaria-like rash that is a bit more intense + mouth lesions

(a) Tx

A

Stevens Johnsons syndrome
-all mucous membranes affected: vaginal, eyes, mouth etc

Tx w/ IVIG

52
Q

Tx of Kawasaki’s

A

Anti-inflammatory tx: IVIG + aspirin

Peds cardiology consult + echo as f/u to monitor for coronary aneurysm

53
Q

Darth Vader breathing

A

= stridor

54
Q

11 yo w/ springtime nasal congestion and itchy eyes

A

Allergic rhinitis

55
Q

Treatment for chronic ear infections

A
  • prophylactic abx
  • singular
  • tubes if kid is language delayed
56
Q

9 mo old w/ 2 days of vom and diarrhea. HR 210

A

Gastroenteritis

-give fluids: compensatory HR will decrease

57
Q

Easy way to diagnose/differentiate palpable abdominal mass

A

Easy differentiation of neuroblastoma and Wilm’s (w/o imaging)- urine test
-see increased catecholamine metabolites in urine = neuroblastoma

58
Q

Differential for hip pain in children

(a) infectious
(b) inflammatory
(c) orthopedic

A

Infectious: septic arthritis, osteomyelitis

Inflammatory: transient synovitis, juvenile idiopathic arthritis

Orthopedic/mechanical: Legg-Calve-Perthes, stress fracture, SCFE (slipped capital femoral epiphysis)

59
Q

Paroxysmal cough

A

Paroxysmal cough = intermittent, aggressive attacks

-buzzword for pertussis/whooping cough

60
Q

6 yr old w/ abdominal pain for 6 weeks + episodic fecal soiling of underwear
-gaining and growing well

A

Encopresis = involuntary defecation
-see no anal tone on rectal exam, do anal wink test (stroke the anus to cause contraction) to r/o neurological cause for anal hypotonia

61
Q

Most common site of osteomyelitis in children

A

Proximal femur

62
Q

Why is a fever > 100.4 in 1 mo old concerning

A

1 mo old w/ fever over 38 C has an 8-10% chance of having a life-threatening infxn-

this is why we admit these and do sepsis workup
-blood culture, LP, UA

63
Q

How to treat pneumococcal pneumonia

A

High-dose Amoxicillin + Clavulanic acid (Augmentin)

64
Q

Ddx for young children turning blue

A

Cyanosis in young children:

  • whooping cough (pertussis)
  • breath holding spells
  • reflux
  • seizure
65
Q

Etiologies of otitis media

(a) Breakdown of percent viral vs. bacterial
(b) 3 most common bacterial causes

A

60% viral
40% bacterial

40% bacterial:

  • strep pneumo
  • moraxella
  • non-typable H. flu

(same bugs for ear and sinus infections)

66
Q

7 yo w/ hip pain + limp

-no trauma, fever, PMH

A

Transient synovitis = dx of exclusion (r/o septic arthritis)
-afebrile

67
Q

6 yo w/ fever, HA, sore throat

  • raised rough red rash on trunk and abdomen
  • no URI symptoms
A

Scarlet fever

-sandpaper rash

68
Q

2 yo w/ abrupt onset cough, wheeze, tachypnea

  • afebrile
  • wheezing on right
A

Foreign body aspiration

  • sudden onset
  • unilateral
69
Q

Lab tests to diagnose HUS

A

CBC: Hgb/Hct (low), platelet count (low)

  • peripheral blood smear: schistoytes
  • renal fxn studies: elevated BUN and creatinine
  • urinalysis: proteinuria
70
Q

Tx of intussusception

A

Air enema

71
Q

Concerning complication of Kawasaki’s

A

Coronary artery disease

-develops in 5% even w/ tx (possibly higher w/o tx)

72
Q

SCFE

(a) typical pt
(b) Xray finding

A

SCFE = slipped capital femoral epiphysis

(a) obese adolescent
(b) posterior displacement of femoral epiphysis- looks like ice cream slipping off a cone

73
Q

Describe the atopy triad

A

Either pt or family hx findings that commonly come together:

  • eczema
  • allergic rhinitis
  • allergic asthma
74
Q

Ddx for wheezing

(a) under 2 yoa
(b) > 1 yoa
(c) Any age

A

Wheezing

a) Under 2 yoa: bronchiolitis (RSV
(b) Over 1 yoa: asthma
(c) Any age- foreign aspirate

75
Q

15 yo F twists her ankle while playing basketball

Name 2 indications for X-ray

A

Indications for Xray

  • inability to bear white
  • ability to localize tenderness: open hand vs. finger localization
76
Q

First line tx for peritonsillar abscess

A

Need to cover staph/strep + anaerobes =>

Augmentin (Amox-Clavulanate) covers MSSA, strep, E. coli and anaerobes

Could also use clindamycin: broad gram (+) + anaerobe coverage
(doesn’t cover E. coli but covers MRSA)

77
Q

15 mo old treated for acute otitis media 3 weeks ago

-TM look dull, gray, and have poor mobility

A

Otitis media w/ effusion- common complication of acute otitis media

  • no fever or air pain
  • usually takes a few more weeks to resolve (self-resolve)

If worried about hearing loss- can do tympanostomy drain

78
Q

6 mo old former 28 weeker presenting w/ URI symptoms

  • tachypnic w/ retractions, crackles, and wheezes
  • CXR: bilateral perihilar streakiness and hyperinflation
A

6 mo old premie w/ URI symptoms

Perihilar streakiness + hyperinflation = bronchiolitis

79
Q

Tx for otitis externa

A

Ofloxacin or Ciprofloxacin- both fluoroquinolones w/ good gram (+) and (-) coverage
-cover for pseudomonas

80
Q

Tx of croup

A

Cool air or humidity for cough and stridor

-corticosteroids

81
Q

4 yo w/ diffuse pruritic rash

-raised erythematous lesions w/ serpiginous borders and blanched center

A

Snake-like borders w/ blanched center (central pallor) = uticaria (hives)

82
Q

Cushing’s triad

A

Cushing’s triad/reflex = response to increased ICP

hypertension, tachypnea, bradycardia

83
Q

8 yo F w/ abdominal pain, purpuritic lesions on buttocks and legs, knee and ankle pain
-darker urine

A

HSP

  • abdominal pain: common ileo-ileal intussuception
  • hematuria b/c of kidney involvement
84
Q

Osgood-Schlatter

(a) Physical exam findings
(b) Tx

A

Osgood-Schlatter

(a) Pain reproducible by putting resistance on the patellar tendon: extending knee against resistance, squatting w/ knee flexed
(b) Tx: rest, ice after activity, NSAIDs, knee immobilization if severe

85
Q

Differentiate abx choice for sepsis in 1 mo old vs. 2 mo old

A

Covering GBS and E. Coli => use 3rd gen cephalosporin in both, but a dif 3rd gen

Ceftriaxone = go-to 3rd gen, but can’t use in under 1 mo b/c of biliary sludging

For under 1 mo use Cefotaxime

To cover for Listeria add Ampicillin

86
Q

Empiric treatment for meningitis in an 8 year old

A

Ceftriaxone (3rd gen cephalo) + acyclovir (covers HSV) + vanco (covers resistant pneumococcal disease aka MRSA)

Pediatrics (10 decks)

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