EXAM 3 PEDS Flashcards

1
Q

acute otitis media

A

ear infection

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2
Q

acute otitis media modifiable risk factor

A

Immunization status

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3
Q

acute otitis media organisms

A

Strep pneumo
H. flu
Moraxella catarrhalis

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4
Q

Diagnosis AOM

A

Visualize tympanic membrane
Normal TM: translucent, slightly concave, grey, and moves with pressure
AOM TM: bulging, cloudy fluid, immobile

Requires:
Acute onset
Middle ear effusion
Symptoms of middle ear inflammation

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5
Q

AOM severity

A

Non-severe:
Mild otalgia and Fever <39 C in 24hours

Severe
Moderate to severe otalgia
Or Fever >39 C

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6
Q

AOM treatment criteria

A

Always treat otorrhea and severe AOM

bi/unilateral: Non-severe AOM
Treat < 6months

Bilateral: Treat 6 months - 2 year

Bi/unilateral: Observe option > 2 years

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7
Q

AOM management

A

Observation: deferment ABX for 48-72 hrs
Watch for resolution of symptom
Symptomatic relief
Decision to observe based on: child’s age, diagnostic, severity

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8
Q

AOM organism resistance

A

Strep pneumonia:
Overcome by high dose amoxicillin

H. flu & Moraxella catarrhalis:
Overcome w/ b-lactamase inhibitor –> Augmentin

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9
Q

amoxicillin use AOM

A

first-line antibiotic
80-90 mg/kg/day divided Q12H for 5-10 days

half-life in ear is 4-6 hours vs 1 hr in serum

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10
Q

when do we not use amoxicillin?

A

Known resistance
treatment failure
amoxicillin in last 30 days
allergy
concurrent conjunctivitis

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11
Q

amoxicillin/clavulanate use AOM

A

2nd line after amoxicillin

1st line if amoxicillin in 30 days or conjunctivitis

90mg/kg/day amox component q12h

Diarrhea associated w/ clavulanate –> dose it <10mg/kg/day

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12
Q

oral cephalosporin use AOM

A

2nd line unless allergy

cefpodoxime

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13
Q

Ceftriaxone use AOM

A

For severe cases if PO is not an option

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14
Q

AOM adjunctive therapy

A

Analgesia: APAP PO, Ibuprofen PO

Lidocaine otic drops

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15
Q

AOM treatment duration

A

Duration:
10 day therapy for: severe/recurrent AOM, TM preformation, <2 y.o.

2-5 day therapy: children >2 years of age

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16
Q

Tympanostomy tubes

A

Treatment of uncomplicated ortorrhea

Give topical quinolone drops

17
Q

Chronic suppurative otitis media

A

CSOM = most severe form
TM w/ persistent drainage >6 weeks
MRSA is most common organism

Treatment: cipro or ofloxacin x 2 weeks

18
Q

Acute otitis Externa (swimmer’s ear)

A

Limited to external ear canal (outside TM)
Organism: pseudomonas, s. aureus

Treatment w/ ear drops first:
Polymyxin b, neomycin
Ofloxacin, cipro w/ hydrocortisone

19
Q

PEDS UTI common pathogen

20
Q

PEDS UTI methods of urine collection

A

clean catch: older patients

CATHERTERIZATION: preffered for <25 months age group

supra-pubic aspiration (SPA): gold standard, but invasive for pts who fail catheter

bag specimen not recommended: high false positive

21
Q

Urine culture

A

Clean Catch > 100,000 CFU/mL
Catheter specimen > 10,000 CFU/mL
SPA > 10,000 CF/mL

22
Q

PEDS UTI treatment considerations

A

Oral and IV equally efficacious

Most patients can have oral

IV for: hemodynamically unstable or NPO
Can change to oral when patient has clinical improvement

23
Q

PEDS UTI treatment duration

A

7-14 days for 2-24 months

10-14 days for pyelonephritis

3-7 days for cystitis in older F patients

24
Q

PEDS UTI treatment agents

A

First line: cephalexin

Alternative agents:
Amoxicillin
Amoxicillin/clavulanate
TMP/SMX

Not really used:
Nitrofurantoin only used in cystitis, so not really used
FQs not really used bc of resistance

25
PEDS UTI prevention
Prophylaxis is questionable
26
what is bronchiolitis?
Viral LRTI in infants and young children Acute inflammation, edema, and increased mucus Presentation: fever, rhinorrhea, cough, sneezing Increased work of breathing: Nasal flaring, and can lead to respiratory failure
27
What causes bronchiolitis?
Many different viruses Most common: respiratory syncytial virus (RSV) Rhinovirus (2nd most common)
28
bronchiolitis treatment
Mainstay of treatment: supportive therapy O2, hydration, mechanical ventilation, ECMO
29
bronchiolitis prevention non-pharm
Hand washing, isolation, sick pods
30
bronchiolitis prevention pharm
Pharmacologic: Influenza vaccine Everyone 6months + Children 6 months to 8 years who have not gotten 2 doses --> separate dose by 4 weeks
31
RSV protection
1. Vaccination of pregnant 2. Monoclonal antibody for infants
32
Vaccination of pregnant people
Bivalent RSVpreF vaccine (Abrysvo – Pfizer) Who qualifies: Administered before and during start of RSV season (sept- jan) People who are 32-36 weeks pregnant Some increased risk of preterm birth in trials Provides protection if given atleast 14 days before delivery and most cases replaces RSV infant immunization
33
Monoclonal antibody for infants
Nirsevimab: birth parent did not get RSV 14 days before delivery Typically infants <8 months of age Only indicated for prevention RSV Must be given before/during RSV season