Exam 3: Lectures 9-11 Flashcards
Otitis Externa pathogens
pseudomonas and Staph Aureus
Otitis Externa prophylaxis
Topical solutions (ETOH, boric acid, acetic acid) to restore pH & sterilize canal. Alcohol causes water to evaporate (“SWIMFREE”) is a product with alcohol drops.
What is the hallmark of otitis externa?
Pain on movement of the tragus
What is the 1st line treatment for acute bacterial sinusitis?
Amoxicillin with or without clavulanate (or wait 3 days before initiating)
Treatment of sinusitis guidelines
- Amoxicillin at a standard dose of 45 mg/kg/day in two doses is the first line treatment in communities with low incidence of nonsusceptible S. pneumoniae.
- In communities with >10% of resistant S. pneumoniae, amoxicillin should be used at 80-90 mg/kg/day.
3 top offending organisms that cause Sinusitis/URI’s
(1) Haemophilus influenzae
(2) Strep pneumoniae
(3) Moraxella catarrhalis
Which of the following drugs is appropriate in a 3 year old with sinusitis if amoxil is ineffective? - Bactrim, Cipro, Clinda, Oxacillin
Clindamycin is a very good choice (side effect pseudomembranous colitis aka C. diff)
Management of Epistaxis
- packing and topical vasoconstrictor drugs (i.e., Neosynephrine)
- Use a bedside humidifier to moisten the air in dry climates or in winter with forced air heating
- Normal saline nose sprays are also effective
- Apply topical antibiotic to the site of the septal scab for 5-7 days to keep moist, reduce itching, and assist healing
These specific symptoms point to MYCOPLASMA PNEUMONIAE as the cause of pharyngitis
- Persistent cough along with a sore throat
- Mycoplasma is generally milder in young children, and more severe in adolescents
Hallmark of Epstein Barr as infectious agent in pharyngitis
Exudate on the tonsils, soft palate petechiae, and diffuse adenopathy
Hallmark of Adenovirus as infectious agent in pharyngitis
Follicular pattern on the pharynx
Hallmark of Neisseria gonorrhoeae (GC) as infectious agent in pharyngitis
No distinctive finding on exam from other pharyngitis
Hallmark of Enterovirus (coxackie) as infectious agent in pharyngitis
Vesicles or ulcers on the tonsillar pillars and posterior fauces. Coryza, vomiting, or diarrhea may be present.
Hallmark of Herpes virus as infectious agent in pharyngitis
Ulcers anteriorly and marked adenopathy. Also gingivitis (you need to lift up the gum!)
Hallmark of GABHS as infectious agent in pharyngitis
Lack of a cough or nasal symptoms, along with an exudative, erythematous pharyngitis with a follicular pattern and typical historical
Hallmark of Parainfluenza and RSV as infectious agent in pharyngitis
Lower respiratory tract disease with their typical respiratory signs of stridor, rales, or wheezing
Hallmark of Influenza as infectious agent in pharyngitis
More systemic complaints. Flu is a sick kid, cough, high fever… if you can run around, you don’t have the flu.
Hallmark of Arcanobacterium haemolyticum (A. hemolyticum) as infectious agent in pharyngitis
Exudative pharyngitis with marked erythema and a pruritic, fine, scarlatiniform rash
Diphtheria clinical presentation
Grey pseudomembrane sitting on a child’s tonsils! Due to membranous obstruction of the upper airway, including the trachea, it can lead to extensive neck swelling with cervical lymphadenitis, causing airway obstruction. Local infection is associated with a low-grade fever, and gradual onset of symptoms over 1-2 days with a shedding for 2-6 weeks in untreated patients.
Anemia definition
HCT or Hgb >2 SD below the mean for age
- Full term newborn: HCT <39%
- 2 months (35/11.2)
- 6 months (36/12.0)
Polycythemia definition
Increased total RBC mass - venous Hct >64%
