Exam 3: Lectures 9-11

Question 1

Otitis Externa pathogens

Answer 1

pseudomonas and Staph Aureus

Question 2

Otitis Externa prophylaxis

Answer 2

Topical solutions (ETOH, boric acid, acetic acid) to restore pH & sterilize canal. Alcohol causes water to evaporate (“SWIMFREE”) is a product with alcohol drops.

Question 3

What is the hallmark of otitis externa?

Answer 3

Pain on movement of the tragus

Question 4

What is the 1st line treatment for acute bacterial sinusitis?

Answer 4

Amoxicillin with or without clavulanate (or wait 3 days before initiating)

Question 5

Treatment of sinusitis guidelines

Answer 5

• 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.

Question 6

3 top offending organisms that cause Sinusitis/URI’s

Answer 6

(1) Haemophilus influenzae
(2) Strep pneumoniae
(3) Moraxella catarrhalis

Question 7

Which of the following drugs is appropriate in a 3 year old with sinusitis if amoxil is ineffective? - Bactrim, Cipro, Clinda, Oxacillin

Answer 7

Clindamycin is a very good choice (side effect pseudomembranous colitis aka C. diff)

Question 8

Management of Epistaxis

Answer 8

• 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

Question 9

These specific symptoms point to MYCOPLASMA PNEUMONIAE as the cause of pharyngitis

Answer 9

• Persistent cough along with a sore throat

- Mycoplasma is generally milder in young children, and more severe in adolescents

Question 10

Hallmark of Epstein Barr as infectious agent in pharyngitis

Answer 10

Exudate on the tonsils, soft palate petechiae, and diffuse adenopathy

Question 11

Hallmark of Adenovirus as infectious agent in pharyngitis

Answer 11

Follicular pattern on the pharynx

Question 12

Hallmark of Neisseria gonorrhoeae (GC) as infectious agent in pharyngitis

Answer 12

No distinctive finding on exam from other pharyngitis

Question 13

Hallmark of Enterovirus (coxackie) as infectious agent in pharyngitis

Answer 13

Vesicles or ulcers on the tonsillar pillars and posterior fauces. Coryza, vomiting, or diarrhea may be present.

Question 14

Hallmark of Herpes virus as infectious agent in pharyngitis

Answer 14

Ulcers anteriorly and marked adenopathy. Also gingivitis (you need to lift up the gum!)

Question 15

Hallmark of GABHS as infectious agent in pharyngitis

Answer 15

Lack of a cough or nasal symptoms, along with an exudative, erythematous pharyngitis with a follicular pattern and typical historical

Question 16

Hallmark of Parainfluenza and RSV as infectious agent in pharyngitis

Answer 16

Lower respiratory tract disease with their typical respiratory signs of stridor, rales, or wheezing

Question 17

Hallmark of Influenza as infectious agent in pharyngitis

Answer 17

More systemic complaints. Flu is a sick kid, cough, high fever… if you can run around, you don’t have the flu.

Question 18

Hallmark of Arcanobacterium haemolyticum (A. hemolyticum) as infectious agent in pharyngitis

Answer 18

Exudative pharyngitis with marked erythema and a pruritic, fine, scarlatiniform rash

Question 19

Diphtheria clinical presentation

Answer 19

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.

Question 20

Anemia definition

Answer 20

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)

Question 21

Polycythemia definition

Answer 21

Increased total RBC mass - venous Hct >64%