Final - Peds ID Flashcards
Preventable risk factors AOM (acute otitis media): \_\_\_\_\_\_\_ attendance** \_\_\_\_\_\_ exposure \_\_\_\_\_\_ use \_\_\_\_\_\_ feeding \_\_\_\_\_\_\_\_ status
child care attendance**(semi-preventable, ya know) smoke exposure pacifier use bottle feeding immunization status
Non-Preventable risk factors AOM (acute otitis media): \_\_\_\_\_ gender older \_\_\_\_\_\_ \_\_\_\_\_\_ history \_\_\_\_\_\_\_\_ abnormalities \_\_\_\_\_\_\_ deficiency onset of 1st episodes before \_\_\_\_\_\_\_\_ of age lower \_\_\_\_\_\_\_\_\_ \_\_\_\_\_\_\_ of the year
male gender older siblings family hx congenital abnormalities immune deficiency onset of 1st episodes before 6 months of age lower economic status season of the year
OME or AOM:
middle ear fluid is STERILE
OME
OME or AOM:
abx not indicated/not beneficial
OME
OME or AOM:
abx indicated if symptomatic
AOM
what does OME stand for
otitis media with effusion
Ear Anatomy:
what part is the “barrier to the external ear”
tympanic membrane/ear drum
Ear Anatomy:
what tube goes towards the external nose from the ear
eustachian tube
Ear Anatomy:
what anatomical difference makes infants/kids more likely to have ear infections
their eustachian tube is shorter/more flexible/more horizontal = easier to get infections via eustachian tube
two most common bacteria to cause an ear infection
streptococcus pneumoniae
haemophilus influenzae
Clinical Signs/Symptoms of an Ear Infection?
Otalgia (ear pain)
Fever
irritability/poor feeding/disrupted sleep/malaise
otorrhea (ear discharge)
The tympanic membrane in an ear infection will look like what?
bulging
red/erythematous
immobile = won’t move to pressure because fluid is filling it with fluid
AOM:
acute or prolonged onset?
acute
Severe AOM when?
when 1 of the 2 factors are present:
- moderate to severe otalgia
- or a fever >/= 39 C
2 general options for AOM
observe or treat with abx…
Management of AOM:
- When observation: defer abx for ______
- watch for resolution of symptoms
- provide __________
- 48-72 hours
- symptomatic relief (gimme dat APAP or ibuprofen)
decide to observe or treat based on what 4 things?
childs age
diagnostic certainty
illness severity
assurance of follow-up
Observe or Treat AOM chart:
Always treat when what symptoms?
otorrhea or severe AOM!!!
Observe or Treat AOM chart:
always treat what age?
< 6 months
Observe or Treat AOM chart:
when is the “observe option” appropriate?
if 6 - 2 yrs and UNILATERAL and non-severe
or
if >/= 2 years old and non-severe
Resistance to strep pneumoniae is due to what mechanism?
alterations in PBPs (penicillin binding proteins)
Resistance to Haemophilus influenzae is due to what mechanism?
beta lactamase production
1st line abx choice for AOM?
Amoxicillin
dose to do for Amoxicillin in AOM?
80 - 90 mg/kg/DAY — divide it to Q12H for 10 days
when would you NOT use amoxicillin in AOM?
known resistance treatment failure Amoxicillin in the past 30 DAYS allergy (SHOCKING) concurrent conjuctivitis
AOM treatment:
what abx do you use as 2nd line
AMOX/CLAV
90 mg/kg/day of Amoxicillin divided Q12
(same if conjunctivitis or amox in past 30 days)
AOM treatment:
what abx do you use if conjunctivitis
AMOX/CLAV
90 mg/kg/day of Amoxicillin divided Q12
(same as if amox in past 30 days or treatment failure)
AOM treatment:
what abx do you use if amoxicillin in last 30 days
AMOX/CLAV
90 mg/kg/day of Amoxicillin divided Q12
(same as if contaminant conjunctivitis or treatment failure)
Dose clavulanate at = to ________/day or pt will have wild diarrhea
< 10 mg/kg/DAY
what Amox/Clav concen is best at preventing diarrhea side effect?
600 mg/42.9 mg clav/ 5 mL
if allergy to amoxicillin 2nd option for AOM?
cephalosporins
Cefdinir, Cefuroxime, Cefpodoxime — aka the 2nd/3rd gens have much lower cross reaction
Ceftriaxone used in AOM when?
when oral treatment is not an option
initial oral treatment fails
highly resistant s.pneumoniae
Dosing of Ceftriaxone for AOM?
50 mg/kg IM
- if initial treatment: just ONE dose
- if treatment failure: 3 doses
Avoid Ceftriaxone in what age and why?
avoid in < 1 month of age
because gets to brain and cant get out of BBB = kernicterus aka neurological damage
Cautions of ceftriaxone?
avoid co-admin with Ca2+ in the line
and C.Diff risk (?)
AOM Follow UP:
when to check in for young infants with severe episode or kids of any age with continuing age
within DAYS
AOM Follow UP:
when to check in for infants/kinds with hx of frequent recurrences
within 2 weeks
AOM Follow UP:
when to check in for kids with only a sporadic episode of AOM
1 month after initial exam
UTIs in Peds:
most common pathogen
E.Coli :0
Signs/Sxs of UTI in newborns?
Jaundice Sepsis failure to thrive vomiting fever
Signs/Sxs of UTI in Infants/young kids?
fever strong smelling urine hematuria abdominal/flank pain new onset urinary incontinence
Signs/Sxs of UTI in school-aged children?
Dysuria
Frequency
urgency
(similar to adults!)
Urinalysis:
when leukocyte esterase is present —- it suggests ________ and presence of _____
inflammation; WBCs
To have nitrite:
process takes 4Hours – why is this helpful to know when looking at urinalysis
aka so hard to see nitrite levels in babies because they empty their bladders so often
Nitrire is made from dietary nitrates in the presence of most _______ bacteria in urine
gram negative
how long to treat kids with UTIs when age 2 - 24 months?
7 - 14 days
Treatment options for UTIs:
what is 1st line
amoxicillin
Treatment options for UTIs:
what are other options than amoxicillin
cephalexin
SMX-TMP
most common cause of bronchiolitis?
RSV (respiratory syncytial virus)
risk factors for bronchiolitis?
Age < 6 mos pre-term birth cyanotic/complicated CHD Chronic lung disease weakened immune system
treatment of bronchiolitis?
its just viral…so NO ABX!!!
do supportive care (Oxygen, hydration, mechanical ventilation, ECMO)
Yay or Nay:
Use of beta adrenergic agonist in bronchioliotis?
Nay (no data)
Yay or Nay:
Use of corticosteroids in bronchioliotis?
Nay (no data)
Non-Pharm Prevention options for Bronchioliotis?
hand washing
isolation
“sick pods”?
Pharmacologic Prevention strategies of bronchioliotis?
flu vaccine
Palivizumab (Synagis)
Palivizimuab:
what is it?
NOT A VACCINE!
it is a humanized murine monoclonal antibody
Palivizimuab:
decreases rate of _________
RSV-associated hospitalization
Palivizimuab:
stop it when?
stop prophylaxis if RSV hospitalized
Palivizimuab:
not indicated for _______
RSV treatment
Dosing of Palivizimuab:
dosed how often?
once a month
Dosing of Palivizimuab:
does how many times
max of 5 doses!!!
