Final Exam Old Material Flashcards
How is a fever defined?
T > 100.4 (38)
Define Fever without focus/fever without source
acute febrile illness of less than 1 week duration in children under 24 months of age in which fever etiology is not apparent after careful H&P
Define fever of unknown origin
Temperature greater than 38 (101) or greater on several occasions of more than 2-3 weeks duration with failure to reach a dx despite 1 week of intense investigation
How would you work up a fever in an infant aged:
29-60 days
61-90 days
90 days +
- Infants 29-60 days: if well appearing – UA, CBC
- Infants 61-90 days: UA, CBC
- Infants 90 days-24 months: UA and culture to start
What is the general approach to managing pediatric fever?
- Infants 0-4 weeks: ER referral
- ILL appearing infants 29-60 days: ER referral
- Empiric treatment is not recommended
- If immunization within past 24 hours and temp <101.5: watchful waiting
What is included in the diagnostic criteria of Kawasaki disease?
Diagnostic criteria: Fever ≥ 5 days* and ≥ four of the following five principal clinical features
- Oropharyngeal mucosal changes: strawberry tongue, oral and pharyngeal erythema
- Bilateral non-purulent bulbar conjunctivitis
- Polymorphous rash: maculopapular, erythema multiforme-like rash
- Extremity changes
- Acute: edema of hands and feet, erythema of palms and soles
- Subacute: desquamation of fingers and toes
- Cervical lymphadenopathy
Which children are at high risk for UTI?
- Females under 12 months (females 6months+ are at high risk for UTI)
- Uncircumcised males esp if fever is 102.2+ and lasts longer than 24-28 hours
Match the presentation of UTI to the age group:
- stomach discomfort, anuresis, malodor, vomiting/diarrhea, malaise, fever, diaper rash
- irritable, fever, poor feeding, pain, hypothermia, vomiting/diarrhea, cyanosis, abd distension/pain
- frequency, urgency, pain with urination, fever/chills, malaise
- Older child
- Neonate/infant
- school age/adolescents
What do you treat Pediatric UTI with?
Bactrim
Augmentin if suspicious of pyelonephritis
For what criteria would you perform a renal and bladder US?
- <2 yo w/ first UTI
- All children w/ fever and UTI or pyelonephritis
- Recurrent UTI
What is used to treat acute otitis media? When should patients start to see improvement in symptoms?
- Adults: Amoxicillin
- Peds: Amoxicillin, cephalosporin; Augmentin if amox given in the last 30 days; ceftriaxone if patient vomiting
- Should see improvement in 3 days, if don’t see improvement may try Augmentin to widen the coverage
What would be used for acute otitis media if the tympanic membrane is perforated, there is otorrhea present or patent tubes in place?
Ciprofloxacin drops
What is the “watchful waiting” criteria for acute otitis media?
- Observe, analgesics, and f/u 48-72 hrs IF
- Unilateral AOM without fever > 102.2 or severe symptoms
- 24 months, no severe symptoms
When would you start treatment right away for acute otitis media in a pediatric patient?
- < 6 months or underlying conditions
- 6 months with severe signs/sx
- 6-23 months with bilateral AOM
- Unreliable caregiver
What are the components of the CENTOR score for GAS?
- C: Absence of cough +1
- E: Exudate +1
- N: Tender anterior cervical lymphadenopathy +1
- T: Fever +1
- OR: Age modifier
- Age less than 15 +1
- Age greater than 45 -1
How would you interpret the results of the CENTOR score?
- Rapid strep if CENTOR score 2-5
- Empiric antibiotics if CENTOR score >6 (Amoxicillin)
- If rapid strep is negative, follow up with regular culture for peds - do not need to do this in adults
What are the 1st and second line meds for Group A Strep pharyngitis?
- 1st line: PCN or amoxicillin
- 2nd line: Cephalexin, clindamycin or macrolide
Head injury red flags (7)
- Decreased LOC
- Confused/restless/agitation
- Focal neuro deficits
- Amnesia
- Neck pain
- Loss of consciousness > 30 seconds
- Otorrhea/rhinorrhea
Headache red flags (7)
- Worst headache of their life
- Unexplained abnormal exam finding w/ non-acute HA pattern
- Recent change in pattern, frequency, severity
- Progressive worsening despite appropriate tx
- Onset w/ exertion, cough or sexual activity
- Onset after age 40
- Thunderclap headache
What can be used as abortive vs. preventative therapy for migraine?
- Abortive
- NSAIDS
- triptans
- Preventative
- Anticonvulsants
- Beta-blockers, CCBs
- TCAs, SSRIs
Name the condition:
- Visual disturbances, weakness of the limbs
- Facial paralysis, vertigo (brain stem); coordination, tremors (cerebellum)
- Impaired vision, pain w/ movement (optic nerve)
- Diplopia, bowel & bladder dysfunction
Multiple sclerosis
Name the components of the Ottowa knee rule
- Age ≥55
- Isolated tenderness of the patella (no other bony tenderness)
- Tenderness at the fibular head
- Unable to flex knee to 90°
- Unable to bear weight both immediately and in ED (4 steps, limping is okay)
Match the part of the knee to the presentation and provocative test:
- medial knee pain, swelling and instability not common
- Test: Valgus stress test
MCL
Match the part of the knee to the presentation and provocative test:
- acute lateral knee pain, instability leading to the knee giving way
- Test: Varus Stress Test
LCL
Match the part of the knee to the presentation and provocative test:
- Pop or dizziness, sweating or fainting
- Swelling and pain
- Test: Lachman test, anterior drawer test
ACL
Match the part of the knee to the presentation and provocative test:
- Pop or dizziness, sweating or fainting
- Swelling and pain
- Test: posterior drawer test
PCL
Match the part of the knee to the presentation and provocative test:
- May have feeling of locking or giving way, esp while descending stairs or walking on uneven surfaces
- Tests: Thessaly, McMurray, Apley compression
Meniscus
What are the imaging guidelines for back pain?
- Imaging (x-ray or MRI w/ gado) if red flags present or no improvement w/in 4-6 weeks
- Age > 50
- Recent unexplained wt loss
- Failure to improve after 1 mo of conservative tx
- Fever
- New lower extremity weakness
- Bowel/bladder dysfunction
What can be used to treat impetigo?
- Mupirocin topical
- Oral Dicloxacillin, cephalexin, azithromycin, Augmentin
What can be used to treat erysipelas?
- Oral PCN V or cephalosporin or macrolide if PCN allx
- If MRSA concern: clindamycin, doxycycline, Bactrim
What can be used to treat erythasma
- Benzoyl peroxide wash
- Clindamycin or azole creams
What can be used to treat intertrigo?
- Drying agents: zinc, aluminum, calcium
- fungal infection: clotrimazole, ketoconazole, oxiconazole, econazole; nystatin
- Oral: culture and determine abx
What can be used to treat paronychial infection?
- Topical abx, antifungals, steroids
- Oral abx for substantial infection
What can be used to treat rosacea?
- Papules and pustules: topical or oral abx:
- Metronidazole, azelaic acid, sulfacetamide/sulfur, brimonidine
- Doxycycline, tetracycline
- Phymatous or severe cases: refer to derm
What does ABCDE stand for in regards to malignant melanoma?
- Asymmetric w/ nonmatching sides
- Border is irregular
- Color not uniform; brown, black, red, white, blue
- Diameter usually >6mm
- Evolving lesions - new or changing
What does PUT ON stand for (BCC)?
- Pearly papule
- Ulcerating
- Telangiectasia
- On the face, scalp or pinnae
- Nodules
What does NO SUN (SCC) stand for?
- Nodular
- Opaque
- Sun-exposed areas
- Ulcerating
- Non-distinct borders
What considerations does an HIV positive pregnant mom need?
- Mom should be treated during pregnancy
- Baby on antiretroviral therapy for 4-6 weeks after birth
- Newborns should have RNA or DNA checked at 2 weeks of age and 1-2 months and 4-6 months and 12-18 months
- A negative antibody confirms that the baby is not infected
- No breastfeeding
When is a TST considered positive?
- > 5mm
- > 10mm
- > 15mm
- >5 is considered positive in
- Recent contact of a person w/ TB
- Immunosuppressed patients
- >10mm considered positive in
- High-risk population
- Children < 4 years
- >15mm considered positive in general population
Hep A lab results interpretation
What does a positive result of the following indicate?: IgM, IgG, Total Hep A antibody test
- IgM indicates current or recent infection: detectable 2 weeks after sx begin until 6 months post recovery
- IgG detectable for life, used to detect past infection or immunity by vaccination
- Total hepatitis A antibody test: detects both IgM and IgG antibodies, identifies current and past infections
Hep B lab results interpretation
What does a positive result of the following indicate?: HBsAg, anti-HBs, anti-HBc, IgM
- HBsAg: present in acute or chronic infection
- Anti-HBs: produced within a few weeks to months after exposure or vaccination
- Anti-HBc: detectable for life; appears as patient develops symptoms
- IgM: current or recent infection within the last 6 months
Hep C lab results interpretation
What does a positive result of the following indicate?: anti-HCV, C RNA test, genotype test
- Anti-HCV: produced in response to infection, will be positive for life
- C RNA test: measure the amount of HCV in the body if anti-HCV is positive
- Genotype test: genotype the strain for treatment
