Exam 3 Flashcards
Differentiate between S&S of viral, allergic, and bacterial conjunctivitis
Viral: watery discharge, red, itchy conjunctiva, swollen eyelids, bilateral
Bacterial: Purulent discharge, always starts unilateral
Allergic: Severe itching, stringy, clear discharge, allergic shiners
Differentiate between treatment of viral, allergic, and bacterial conjunctivitis
Viral: warm or cool compresses, strict eye hygiene
Bacterial: topical antimicrobial (polytrim, cipro, tobramycin) x 5-7 days, warm compresses QID
Allergic: Prevention, saline solution, artifical tears, cool compresses, topical antihistamines (elestat), decongestants
What is the proper exam technique used to identify an eye abnormality in an infant or young child?
Red reflex (asymmetric)- dim lights, arms length from the head, inspection, fix and follow with each eye, corneal light reflex
What is strabismus? When is it concerning and need for further evaluation?
-Misalignment of eyes
-Refer if ocular misalignment is consistent after 4 months of age
What eye abnormalities are normal in the infant? What isn’t normal and would call for further evaluation?
-Poor visual acuity
-Variable alignment and exotropia which should resolve at 6 months of age
-Abnormal or asymmetric red reflex is abnormal- refer to ophthalmologist
What is an indication for prescribing antibiotics for a child with a respiratory infection?
-Only if suspecting bacterial cause (such as persisting > 10-14 days with high or worsening fever), most causes of URIs are viral
Differentiate between viral and bacterial respiratory infections
Bacterial: Symptoms will persist longer than expected 10-14 days, higher fever, fever gets worse
Viral: Self-limiting, improves in 10-14 days
Differentiate between the presentation of otitis media and otitis externa
Otitis Media: fever, pain, ear dsicharge, tugging at ear, crying, decreased appetitie, recent URI, unable to see normal landmarks on TM, hole in TM, TM red and bulging
Otitis Externa: recent hx of swimming or placing object in ear, painful to move tragus, redness around ear, decreased hearing
Differentiate between the treatment of otitis media and otitis externa
Otitis media: Abx, tylenol, amoxillin, cefdinir
-Otitis externa: supportive treatment with warm compress, NSAIDs, tylenol, possible prednisone
When is it ok to do “watchful waiting” with otitis media?
-If young child with unilateral AOM without severe symptoms (intense TM erythema, bulging TM) or fever; requires close follow up in 48-72 hours via clinic or phone call
Differentiate between viral and bacterial pharyngitis
Viral: cervical lymphadenopathy, may have fever rhinitis, cough, other systemic complaints more common than with bacterial
Bacterial: lack of cough or nasal symptoms, exudative, erythematous pharynx with a follicular pattern
When are antibiotics indicated for pharyngitis?
-If suspecting bacterial cause or if rapid-strep or throat culture is positive for GABHS (first choice is PCNs and if allergy do cephalexin/azithromycin)
How do you identify microcytic versus macrocytic anemia with CBC lab values? What is the significance of reticulocyte count?
Microcytic: Decreased MCV often with decreased MCH in iron-deficiency anemia
Macrocytic: Increased MCV
Reticulocyte count: Helps to distinguish disorders resulting from hemolysis or bleeding from inability to produce RBCs
What is a common cause of B12 deficiency?
-If diet lacks B12 (vegan or vetetarian diets) or if the gastric intrinsic factor necessary for absorption is absent
What is a common cause of sickle cell disease?
Genetics- autosomal recessive disorder that primarily affects people of African descent
What are common causes of iron-deficiency anemia?
LBW, rapid growth, blood loss, inadequate dietary intake, lead poisoning, early weaning to cow’s milk before one year, excessive intake of cow’s milk
What are the treatment options for different forms of anemia?
-Identify and treat cause: Folic acid, vitamin B12, iron supplements, referral to pediatric hematology, transfusion if needed
What is a common cause of thalassemia?
Cause is hereditary- autosomal recessive gene that causes microcytic anemia
What additional labs would you ordered if CBC results show iron deficiency anemia?
Ferritin, total iron-binding capacity (TIBC)
Treatment for iron-deficiency anemia
Iron (ferrous sulfate) supplements and iron-rich foods: beans, red meat, green leafy vegetables
How long do capillary hemangiomas take to resolve?
-At about 1 year of age, the hemangioma slowly starts to shrink and fade in color; often many completely go away by 10 years of age
Using the step-wise asthma treatment approach: when would you want to escalate or deescalate treatment?
Escalate: If benefit or improvement of symptoms is not observed within 4-6 weeks and patient’s medication technique and adherence are satisfactory
De-escalate: gradually if asthma is well-controlled for 3 months
How long should you continue treatment at each step for step-wise asthma treatment plan?
-When a child is well-controlled for 3 months, the provider can gradually step-down the treatment regiment (ICS can be decreased 25-50% every 3 months to the lowest dose possible)
What age group is bronchiolitis typically found in?
Infacy- 2 years with common causative agent RSV
Describe S&S of bronchiolitis
-URI symptoms for 3-7 days
-Gradual respiratory distress
-Bronchial spasms
-Increased RR
-Crackles/wheezing
What is the difference between croup & bronchiolitis?
Croup: Acute onset at night with harsh, barking cough and inspiratory stridor with swelling/erythema of lateral walls of the trachea
Bronchiolitis: URI symptoms for 3-7 days with gradual respiratory distress, bronchial spasms, crackles, and wheezing
S&S/Dx for pneumonia in children
S&S: Abrupt high fever if bacterial, restlessness, chills, SOB, chest pain, cough
DX: CXR shows consolidation of alveolar space
What age of child should you send to the ED when you expect a diagnosis of pneumonia?
-If less than 4 months old should immediately be hospitalized
What are the criteria for hospital admission for a child diagnosed with pneumonia?
-Comorbidities, family can’t monitor closely, increased respiratory rate (> 50 BPM if older child or > 70 if infant), Ox < 92%, grunting, retractions, poor feeding
How do you identify innocent versus pathologic murmurs?
-Pathologic: radiation, diastolic, grade >IV, interferes with S1 and S2, increases with sitting/standing, unequal femoral & radial pulses
-Innocent: Midsystolic, no radiation, does not interfere with S1, S2, decreases with sitting/standing, equal pulses, normal H&P
Describe the common types of cardiac murmurs in children
Innocent:
-Stills: Midsystolic, louder when supine or with inspiration
-Pulmonary flow: Short, early systolic to midsystolic, decreases when standing
-Venuous hum: Constant swishing sound
How would you identify pediatric hypertension?
-Elevated BP on at least 3 separate occasions
What are the risk factors for pediatric hypertension?
-Family Hx
-Obesity
-Sodium intake
-Hx of kidney disease
-Murmur, cardiac history
-Meds: amphetamines, steroids
What is the treatment for pediatric hypertension?
-Tx underlying cause
-Lifestyle modifications- exercise, decreased sodium
-Referral to cardiology/nephrology
-Medications (hydralazine)
A child presents to the clinic with hypertension, and 3+ protein on UA. What labs/diagnostic tests should you order? What referrals should be immediately made (2)?
-CBC, ESR, CRP, UA, CMP, ECHO, referral to a nephrologist and/or cardiologist
Diagnosis of pertussis
-Prolonged cough with characteristic whooping sound on inspiration
What is the treatment for pertusiss?
Macrolides: erythromycin, azithromycin, clarithromycin
Isolation instructions for a child diagnosed with chickenpox
Stay away from pregnant women, immunocompromised, and unvaccinated neonates; keep out of daycares/schools until all lesions are crusted over
What is a potential complication of untreated scarlet fever?
Rheumatic fever/ heart valve disease
What are the most common symptoms associated with Tetralogy of Fallot diagnosis?
Cyanosis, hypoxia, delayed growth, metabolic acidosis, exercise intolerance, finger clubbing, systolic murmur at L intercostal spaces and holosystolic murmur at left sternal border
