Exam 5: Pediatrics

Question 1

aom incidence

Answer 1

incidence highest <2 years old –> tapers gradually with age

Question 2

aom first episode difference

Answer 2

earlier the age = increased recurrence

Question 3

preventable aom risk factors

Answer 3

1. daycare attendance
2. smoke exposure
3. pacifier use
4. bottle feeding
5. immunization status

Question 4

non-preventable aom risk factors

Answer 4

1. male
2. older siblings
3. family history
4. congenital anomalies
5. immune deficiency
6. onset < 6 months old
7. lower socioeconomic status
8. season

Question 5

ome characteristics

Answer 5

middle ear is sterile, no signs of acute infection

Question 6

ome treatment

Answer 6

antibiotics not indicated and not beneficial

Question 7

aom characteristics

Answer 7

bacterial infection likely

Question 8

aom treatment

Answer 8

antibiotics indicated if symptomatic

Question 9

eustachian tube purpose

Answer 9

drain non-sterile fluid

Question 10

anatomical differences in eustachian tube purpose

Answer 10

infant eustachian tube is shorter, more flexible and more horizontal vs adult

Question 11

aom pathogenesis

Answer 11

1. ineffective aeration of middle ear space –> eustachian tube dysfunction
2. inflammation and edema of mucosal linings and narrowing of eustachian tube lumen
3. trapped air creates vacuum reversing flow of secretions, drawing fluid into middle ear
4. Bacteria multiply in fluid and stimulate inflammation

Question 12

most common aom bacterial species

Answer 12

strep pneumoniae

h. influenzae

Question 13

TM in otitis media

Answer 13

bulging
immobile
erythematous

Question 14

diagnostic requirements of AOM

Answer 14

1. acute onset
2. middle ear effusion
3. symptoms of middle ear inflammation

Question 15

non-severe AOM

Answer 15

mild otalgia
AND
fever < 39 C

Question 16

severe AOM

Answer 16

moderate/severe otalgia
OR
fever >39C

Question 17

Observe treatment in AOM when…

Answer 17

unilateral non-sev 6mo-2yr

nonsevere >2 yr

Question 18

aom first line

Answer 18

amoxicillin 80-90 mg/kg/day divided q12h x10

Question 19

when to not use amoxicillin

Answer 19

1. known resistance
2. treatment failure
3. amox in last 30 days
4. allergy
5. concurrent conjunctivitis

Question 20

AOM amox altenative

Answer 20

Augment 600/42.9 /5ml
90mg/kg/day amox divided q 12
goal 10mg/kg/day

Question 21

what to use in AOM if all amoxicillins are a no go

Answer 21

1. cefdinir
2. cefuroxime
3. cefpodoxime

Question 22

what to use for severe cases of aom

Answer 22

ceftriaxone

Question 23

ceftriaxone dosing

Answer 23

50mg/kg IM
one dose as initial therapy
three doses if treatment failure

Question 24

aom adjunctive therapy

Answer 24

APAP: 10-15 mg/kg/dose q 4-6h (max 75)
Ibuprofen: 5-10 mg/kg/dose q6-8h

Question 25

female risk factors for UTI

Answer 25

1. white race 2. age <12 months 3. temp >39C 4. Fever >2 days

Question 26

male risk factors for UTI

Answer 26

1. nonblack race 2. temp >39C 3. Fever >24 hrs

Question 27

common pathogen for UTI

Answer 27

e. coli

Question 28

preferred method of urine collection when <24 months old

Answer 28

catheterization

Question 29

first line treatment for uti and duration

Answer 29

amoxicillin 7-10 days: 2-24 months 10-14 days: pyelonephritis 3-7 days: cystitis

Question 30

approved medication for complicated e. coli UTIs and pyelonephritis in pts 1-17 yrs

Answer 30

cipro IV: 18-30 mg/kg/day q 8 (1200) PO: 20-40 mg/kg/day q 12 (1500)

Question 31

what is bronchiolitis

Answer 31

viral lower RTI in infants and younger children acute inflammation, edema, increased mucus

Question 32

RSV symptoms

Answer 32

cold-like symptoms with low-grade fever

Question 33

RSV treatment

Answer 33

supportive therapy * oxygen * hydration * mechanical ventilation * ECMO

Question 34

what is palivizumab

Answer 34

humanized murine monoclonal antibody used to prevent RSV

Question 35

can you use palivizumab to treat RSV

Answer 35

NO

Question 36

palivizumab dosing

Answer 36

15mg/kg IM every month for up to 5 doses/season

Question 37

palivizumab criteria

Answer 37

1. GA <29 weeks 2. GA <32 weeks with CLD 3. Hemodynamically significant CHD 4. Profound immunocompromised