E3 peds ID

Question 1

Middle ear fluid is sterile; no signs of acute infection.
Antibiotics not indicated and not beneficial

A. Otitis media with effusion (OME)
B. Acute otitis media (AOM)

Answer 1

A

Question 2

Bacterial infection likely

Antibiotics indicated if symptomatic
A. Otitis media with effusion (OME)
B. Acute otitis media (AOM)

Answer 2

B

Question 3

big 3 pathogens for acute otitis media

Answer 3

• strep pneumo
• H. flu
• moraxella

Question 4

two current pneumococcal vaccines available for peds

Answer 4

• PCV15
• PCV20

Question 5

1 clinical manifestation of AOM along with some other common ones

Answer 5

• oralgia (ear pain) *
• fever
• otorrhea (ear discharge)

Question 6

3 things under tympanic membrane for diagnosis of AOM

Answer 6

• bulging
• cloudy or purulent effusion
• immobile

Question 7

diagnosis of AOM:
diagnosis requires what 3 things

Answer 7

• acute onset
• middle ear effusion
• sxs of middle ear inflammation

Question 8

2 things for non-severe AOM classification

Answer 8

• mild otalgia
  AND
• fever < 39C in past 24 hours

Question 9

2 things for severe AOM classification

Answer 9

• moderate to severe otalgia
  OR
• fever >39C

Question 10

theres a table for observation vs treatment for AOM, what are the 3 boxes that say you can observe

Answer 10

• unilateral 6 months-2 years old NON-SEVERE
• > 2 years old bilateral or unilateral NON-SEVERE

Question 11

how can you overcome strep pneumo resistance when treating AOM?

Answer 11

high dose amoxicillin*

Question 12

how do you overcome resistance of H.flu when treating AOM?

Answer 12

adding b-lactamase inhibitor **

Question 13

first line antibiotic for AOM and dose

Answer 13

amoxicillin
80-90 mg/kg/day divided by q12h x 5-10 days

Question 14

when are some times we would not use amoxicillin in AOM? (will be on exam!!)

Answer 14

• known resistance
• tx failure
• amox in last 30 days
• allergy
• concomitant conjunctivitis

Question 15

2nd line for AOM

Answer 15

augmentin (usually if failure on just amox)

Question 16

when is augmentin 1st line for AOM?

Answer 16

if amox in last 30 days OR conjunctivitis ***

Question 17

dose of augmentin for AOM

Answer 17

90 mg/kg/day amox component divided by q12h

Question 18

1 big disadvantage of augmentin in AOM and how to negate it

Answer 18

diarrhea*
dose clav at <10 mg/kg/day *

Question 19

which of these are you picking for AOM
A. 125 mg amox/31.25 mg clav/5 mL
B. 200 mg amox/28.5 mg clav/5 mL
C. 250 mg amox/62.5 mg clav/5 mL
D. 400 mg amox/57 mg clav/5 mL
E. 600 mg amox/42.9 mg clav/5 mL

Answer 19

E, the extra strength is 600

Question 20

where do cephalosporins fall for treatment of AOM? which ones do you use?

Answer 20

• 2nd line but may be 1st if needed
• cefpodoxime**, cefuroxime, cefdinir (fallen out of use)

Question 21

cross reactivity is highest between penicillins and __ gen cephs

Answer 21

1st

Question 22

what is the drug for severe cases of AOM when oral treatment is not an option?

Answer 22

ceftriaxone (parenteral only so)

Question 23

dosing of ceftriaxone for AOM

Answer 23

50/mg/kg/day
one dose initial therapy
3 doses if treatment failure

Question 24

when do you avoid using ceftriaxone in AOM?

Answer 24

if <1 month old -> can cause the carnicturus thing or whatever

Question 25

2 cautions for use of ceftriaxone in AOM

Answer 25

calcium co-admin c.diff risk

Question 26

if a pt with AOM is younger than 2 how long do you do therapy? what if they're older than 2?

Answer 26

10 days. 5-7 days if older

Question 27

2 adjunctive therapies and their doses for AOM

Answer 27

tylenol: 10-15/mg/kg/day ibuprofen: 5-10mg/kg/day q6-8h (ONLY IF OLDER THAN 6 MONTHS)

Question 28

when do you want to follow up for AOM? - infants/young children w/ hx or frequent recurrences: - children w/ only a sporadic episode: - older children

Answer 28

- within 2 weeks - 1 month after - no follow up needed

Question 29

some prevention for AOM

Answer 29

- pneumococcal/flu vacs - tubes

Question 30

when would you consider tubes for AOM? - _ or more episodes in < 6mo - _ or more episodes in <12 mo

Answer 30

3 4

Question 31

what is the most severe form of otitis media?

Answer 31

chronic suppurative otitis media (CSOM)

Question 32

most common isolate for CSOM

Answer 32

MRSA

Question 33

initial treatment for CSOM

Answer 33

ofloxacin or cipro ear drops x 2 weeks

Question 34

2 organisms for acute otitis externa (AOE)

Answer 34

pseudomonas (water bug) S. aureus

Question 35

what should you treat swimmers ear with first?

Answer 35

ear drops (polymyxin B, neomycin, ofloxacin, cipro w/ hydrocortisone)

Question 36

4 things listed under pathogenesis for peds UTI

Answer 36

- retrograde ascent - nosocomial infection - hematogenous spread - fistula formation

Question 37

MOST common pathogen for ped UTIs

Answer 37

E. Coli !!!!! (can also be Kleb, proteus, enterobacter, citrobacter, staph something, enterococcus)

Question 38

3 methods of urine collection for ped UTIs

Answer 38

- clean catch -> pref in older age groups - catheterization -> pref for <24 months - supra-pubic aspiration (SPA) -> gold standard but we dont do it as much

Question 39

urinalysis for ped UTI: test urinalysis on any "fresh" urine specimen - <_ hour(s) after voiding if room temp - <_ hour(s) after voiding if refrigerated

Answer 39

1 4

Question 40

what is something you look out for if you're using a urine dipstick for ped UTI

Answer 40

leukocyte esterase

Question 41

leukocyte esterase suggests ______ and presence of _____

Answer 41

inflammation, WBCs

Question 42

t or f: absence of leukocyte esterase in asymptomatic bacteriuria is a disadvantage

Answer 42

false, is an advantage

Question 43

leukocyte esterase separates ___________ bacteriuria from true _____

Answer 43

asymptomatic UTI

Question 44

More sensitive, less specific a. leukocyte esterase b. nitrite

Answer 44

A

Question 45

less sensitive, more specific a. leukocyte esterase b. nitrite

Answer 45

b

Question 46

false positive common a. leukocyte esterase b. nitrite

Answer 46

a

Question 47

false positive uncommon a. leukocyte esterase b. nitrite

Answer 47

b

Question 48

when nitrite and leukocyte esterase are both negative -> ____% predicitive

Answer 48

100

Question 49

what evaluates WBCs, RBCs, and bacteria in a sample?

Answer 49

urine microscopy

Question 50

T or F: IV and oral tx for ped UTI is equally efficacious

Answer 50

true

Question 51

when do you want to choose IV treatment in ped UTI

Answer 51

- toxic (do they look septic?) - unable to retain oral intake

Question 52

ped UTI duration of therapy for 2-24 months

Answer 52

7-14 days

Question 53

ped UTI duration of therapy for pyelonephritis

Answer 53

10-14 days

Question 54

ped UTI duration of therapy for cystitis in older female patients

Answer 54

3-7 days

Question 55

traditional 1st line for ped UTIs

Answer 55

amoxicillin, but e.coli resistance is on the come up so she said to pick cephalexin instead*

Question 56

FQs arent usually used in kids but what 3 times can we consider them for ped UTI?

Answer 56

- multidrug-resistant pathogens with no safe alts - IV therapy is not feasible - no other effective oral agent

Question 57

2 weird pearls for FQs in ped UTI

Answer 57

- dont give cipro suspension through a feeding tube - quinolone liquids usually require PAs

Question 58

3 things for considerations for renal/bladder ultrasound and voiding cystography in ped UTI

Answer 58

- All boys - All girls < 3 years of age - Girls 3-7 years with fever > 38.5 degC

Question 59

what is bronchiolitis caused by (not pathogen yet)

Answer 59

lower respiratory tract infection

Question 60

3 signs/sxs for bronchiolitis

Answer 60

acute inflammation, edema, increased mucus

Question 61

4 clinical presentation things for bronchiolitis

Answer 61

- fever - rhinorrhea - cough - sneezing

Question 62

most common cause of bronchiolitis

Answer 62

RSV**

Question 63

mainstay treatment of bronchiolitis/RSV (4) (IS AN EXAM QUESTION)

Answer 63

SUPPORTIVE THERAPY: - oxygen - hydration - mech vent - ECMO -> life support basically

Question 64

main prevention for bronchiolitis/RSV

Answer 64

hand washing, flu shot, RSV shot

Question 65

2 ways to protect babies from severe RSV: *********

Answer 65

1. vaccination of pregnant people 32-36 weeks of gestation*** 2. monoclonal antibody for infants -> Palivizumab, Nirsevimab

Question 66

what is a clinical pearl for pregnant people getting vaccinated for RSV that WILL be on the exam?

Answer 66

IF SHOT IS GIVEN AT LEAST 14 DAYS BEFORE DELIVERY IT IS PROTECTIVE

Question 67

when do you consider Nirsevimab for infants?

Answer 67

if mom did not get RSV shot at least 14 days before delivery *

Question 68

dosing for Nirsevimab: <5kg 5kg or more

Answer 68

50 100