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Family Medicine Boards 2020 > Fever and infectious diseases in children > Flashcards

Fever and infectious diseases in children Flashcards

1
Q

How do you work up fever in an infant < 21 days old?

A
  • admit for fever
  • CBC with diff
  • blood cultures
  • UA and Urine culture
  • LP for CSF studies and culture
  • CXR if resp sxs
  • Stool studies if diarrhea present
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2
Q

What are the IV antibiotic regimens you could use in infant < 21 days with fever?
Which IV Abx should you avoid?

A
  • Amp + gent
  • Amp + cefotaxime
    +/- acyclovir

AVOID rocephin if < 1 mo –> kernicterus risk

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3
Q

How do you work up infant 21-90 days old who have fever and are ill appearing?

A
  • treat them the same as a < 21 day old if poor appearance, breathing, or circulation
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4
Q

What is the step by step approach for working up a 21-90 day old who has fever but appears up

A

UA for leukocytes
If negative get procalcitonin
if negative et CRP and CBC –> if CRP < 20 or ANC < 10K then there is low risk for invasive bacterial infection

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5
Q

What workup do you do for first simple febrile seizure in kids?

A

No workup

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6
Q

What is the most common serious bacterial infection in children?

A

UTI –> look for it when no other obvious sources

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7
Q

Antibiotic regimen to treat UTI in kids

A

Treat when > 50K CFU

- Abx: Cephalosporin or bactrim for 7-14 days

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8
Q

When a child has a UTI, when is imaging warranted and which study should you get?

A 
Renal US 
- if first febrile UTI < 2 yo OR
- recurrent UTIs (more than 1)
Follow with voiding cystourethrogram (VCUG) if...
- US reveals hydronephrosis/scarring OR
- recurrent febrile UTIs (more than 1)
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9
Q

What do you do for the following scores on the Centor criteria for group A strep pharyngitis?
0-1
2-3
4-5

A

0-1 –> no testing or treatment
2-3 –> test with rapid antigen detection. Culture if negative in kids. Treat if positive
4-5 –> no testing, just treat

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10
Q

Treatment for strep pharyngitis

A

PCN/amoxicillin for 10 days
macrolide or clinda if PCN allergic

Prevents rheumatic fever but not glomerular nephritis

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11
Q

Should I test kids of all ages for Group A beta hemolytic strep?

A

No

IDSA 2012 guidelines indicate that GABHS infection is uncommon in children < 3 yo and recommend AGAINST testing them

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12
Q

Treatment for Epiglottitis

A
  • Airway management
  • Abx: Cephalosporin +/- clinda
  • steroids and recemic epi are NOT used
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13
Q

Treatment of viral URIs

A
  • Buckwheat honey ***
  • Umcka coldcare
  • Nasal saline irrigation
  • zinc
  • Vaporub –> don’t use < 2 yo –> airway inflammation

OTC cough/cold meds NOT recommended, particularly under age of 4

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14
Q

Management of lymphadenopathy in children

A
  • watchful waiting up to 4 weeks (in absence of red flags)
  • oral Abx can be considered if infalmmation evident
  • If persistent or red flag sxs –> CBC/smear, ESR, CXR
  • imaging: US if < 24 mo, CT if > 14 yo
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15
Q

Treatment of herpetic gingivostomatitis

A

oral acyclovir

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16
Q

Treatment of herpes labialis

A

oral/topical acyclovir

17
Q

What causes herpangina and how do you treat it?

A

Ulcers in the back of the mouth caused by coxsackie virus

Treatment is symptomatic

18
Q

Treatment of apthous ulcers (canker sores)

A

Symptomatic/topical steroids

19
Q

How will croup be described on boards and how do you treat it?

A
  • URI sx, “barky cough”, worse at night
  • Dexamethasone IM or oral single dose for croup of ALL severity
  • Nebulized racemic epi for mod to severe croup (stridors and retractions) –> then at least 4 hours observation
20
Q

How will boards describe bronchiolitis and how do you treat it?

A
  • URI, cough, wheezing, CXR normal. Fever and WBC inconsistent
  • Supportive treatment –> O2, fluid, nep saline
  • NO evidence for bronchodilators, steroids, abx
21
Q

Treatment of pertussis in children

  • inpt vs outpt?
  • meds
  • contacts?
A
  • admission for most children < 6 months
  • antibiotics decrease spread but don’t hasten recovery
  • -> macrolides, bactrim
  • close contacts should be given azithromycin
  • Adults should get Tdap as single booster dose
22
Q

How do you treat bacterial pneumonia in preschool age children up to 5 years

A

most common cause is strep pneumoniae and H flu

  • Amoxicillin
  • second choice is azithromycin or clarithromycin
23
Q

How do you treat bacterial pneumonia in school age children (5-18 yo)

A

most common cause is mycoplasma pneumoniae and chlamydia pneumoniae
- treat with azithromycin

24
Q

When should you obtain stool studies in children?

A

when symptoms last > 14 days or stools are bloody

25
Q

A child presents with rash on cheeks that appeared after he had a fever. he no longer appears ill.
- what does he have and when can he return to school?

A 
Fifth disease (erythema infectiosum) - parvovirus B19
The rash is immune-mediated and occurs after acute infection
Children may return to school or day care with this rash
26
Q

What will measles look like?

A

Conjunctivitis, cough, coryza, Koplik spots

rash that starts on face and spreads down

27
Q

What will mumps look like

A

prodrome of malaise, myalgia, anorexia, fever, HA
Parotitis is most common manifestation
may cause orchitis

28
Q

What will roseola infantum look like?

A

Caused by HHV-6 and HHV-7
usually age 6 mo to 4 years
- Day 1-4: abrupt onset of high fever, otherwise mild sxs
- day 4: rash begins as fever abates
- rash: pink almond shape blanchable macules begining on trunk and spreading peripherally
- fades in hours to days

29
Q

What will Henoch Schonlein Purpura look like?

  • do you need any labs?
  • how do you treat?
A
  • URI followed by triad of purpura, abdominal pain, and arthritis
  • palpable purpura on buttocks and legs
  • renal disease most serious complication (40-50% of pts) –> get UA
  • treat with oral prednisone for 2 weeks
30
Q

What will hand, foot, mouth disease look like?

A

prodrome of fever, sore throat, anorexia followed by rash

  • small vesicles with erythematous base
  • hands (nail borders), feet (heel margins), buttocks
31
Q

Diagnostic criteria of kawaski disease

A

Fever > 5 days and 4/5 of the following

  • bilateral conjunctival injection
  • oropharyngeal erythema, strawberry tongue, fissuring and crusting of lips
  • induration of hands and feet, erythema of palms and soles +/- desquamation at fingertips and toes
  • erythematous rash
  • enlarged lymph nodes
32
Q

How do you treat kawasaki disease?

A
  • IVIG
  • high dose aspirin
  • echo at onset and at 6-8 weeks
  • if aneurysm then aspirin + warfarin
33
Q

What is the compression to breath ratio in neonatal resuscitation?

A

3:1

Family Medicine Boards 2020 (46 decks)

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