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Peds clerkship > ID > Flashcards

ID Flashcards

1
Q

4 main bugs

A
  1. bact
  2. virus
  3. fungi
  4. parasites
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2
Q

3 main fungi

A
  1. yeast
  2. dimorphic
  3. molds
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3
Q

2 main parasites

A
  1. protozoa

2. helminths

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4
Q

4 main bact

A
  1. Gram +
  2. gram -
  3. mycoplasma
  4. mycobacteria
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5
Q

3 main types of Gr + and their types

A
  1. rods
    - bacillus
    - clostridium
    - cornybac
  2. branching
  3. cocci
    - staph
    - strep
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6
Q

4 main gr -

A
  1. cocci
    - neiseeria
    - moraxella
  2. pleomorphic
    - chlam
    - ricketsia
  3. spirochetes
    - treponema
    - berrelia
  4. bacilli
    - enterics - e coli, shigella etc.
    - other - H flu
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7
Q

ABx therapy in children

A

see table in 153

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8
Q

def. fever without a source

A

acute febrile illness with no obv. cause after looking well

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9
Q

def. fever of unknown origin

A
  • daily
  • 2 weeks
  • no source
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10
Q

4 DDx for fever

A
  1. infection
  2. inflammatory
  3. malignancy
  4. misc
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11
Q

def. low risk based on rochester crit

A
  1. 1-3 month of age
  2. good past health
    - >37wks
    - home with mom
    - no issues
  3. Phx
    - rectal
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12
Q

when to do a workup for sepsis

A

sock, toxic looking child with no obv. cause, irritable, LOC

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13
Q

6 parts of sepsis WO

A
  1. CBC and diff
  2. blood Cx
  3. urineanal and Cx
  4. LP
  5. CXR if resp Sx
  6. stool if diarrhea
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14
Q

algorithm for non-toxic child

A

p 157

  • if under 1mo - full workup
  • if over 1 - rochester
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15
Q

typical bugs for AOM

A
  • S. pneumo
  • M cata
  • H flu
  • viral
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16
Q

risks for AOM

A
  • young
  • premature
  • DS
  • not breastfed
  • daycare
  • crowding
  • smoke
  • Hx
  • immunodef.
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17
Q

Hx of AOM

A
  • ear tug
  • N/V
  • irritabel , fever
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18
Q

Phx for AOM

A
  • vitals

- HandN exam

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19
Q

***3 requirements for AOM Dx

A
  1. rapid onset of ear pain
  2. signs of middle ear effusion
    - immobile TM
    - opacification
    - air fluid levels
  3. signs of middle ear inflammation
    - bulging TM
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20
Q

2 mgmts for AOM

A
  1. watchful waiting
    - 48-72hrs
    - if older than 6mos
    - previously well
    - not severe
  2. ABx
    - amox
    - if fails clav
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21
Q

complications of AOM

A
  • perf and drainage
  • earing loss
  • mastoiditis
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22
Q

def. sinusitis

A

inflammation of mucosal lining of sinuses
- 5-13% of URTIs
50% resolve spontaneously

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23
Q

most common sinuses

A
  • maxillary and ethmoid
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24
Q

times of various types of sinusitis

A

acute - 10-30d
subacute - 30-90d
recurrent acute - 3x in 6 mos
chronic - >90d

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25
Q

work-up for sinusitis

A

NONE

- xray would show opacification, air fluid levels

26
Q

mgmt of sinusitis

A

amox - 75-80/kg/d x 10-14

27
Q

complications of sinusitis

A
  1. periorbital/orbital
    - cellulitis
    - abscess
    - osteomyelitis
  2. intracranial
    - meningitis
    - brain abscess
    - empyema
  3. pott’s puffy tumor
    - osteomyeltis and abscess of frontal bone
    - Abx and ENT
28
Q

diff between periorbital and orbital cellulitis

A

peri

  • anterior to septum
  • eyelid and periorbital structures

orbital

  • spread deep to septum
  • may involve optic nerve and muscles
29
Q

common bugs in orbital

A
  • staph
  • strep
  • H flu
30
Q

sx that suggest orbital

A
  • pain on eye movement
  • diplopia
  • visual loss
  • proptosis
31
Q

Phx signs that suggest orbital

A
  • decreased EOM
  • proptosis or displacement
  • visual acuity
  • disc swelling
32
Q

invest. if suspect orbital

A
  1. CBC

2. emergency CT

33
Q

mgmt of orbital

A
  • EMERG
  • admit and ENT
  • IV clox + IV ceftriaxone + IV clinda
  • surgical mgmt
34
Q

mgmt of periorbital

A 
usually outpatient
if traumatic
- IV cefazolin/clox
non-traumatic
- IV ceftriaxone/cefotaxime
- mild can be PO
admit for
-
35
Q

def pharygitis

A

inflamm of the pharynx - esp tonsils

36
Q

common etiology of phar

A
  1. viral most common

2. group A strep

37
Q

feat of bact phary

A
  • late winter
  • 5-11yo
  • sudden onset
  • exudates
  • tender and enlarged
38
Q

feat. of viral phay

A
  • all seasons
  • all ages
  • mild sore throat
  • non-tender, no exudates
39
Q

common viruses for pharyng

A
  1. URT - rhino, flu, corona
  2. adeno - with conjunctivitis
  3. coxsackie - hand foot mouth
  4. EBV - sig. exudates, HSM
40
Q

fever associated with strep pharyng

A
  • scarlet fever
  • sandpaper rash
  • begins on face and moves to flexural lines
41
Q

2 tests for pharyng

A
  1. rapid
    - if neg. still need a culture
  2. culture
42
Q

mgmt of GAS phayrgitis

A
  • need ABx, but hold until culture confirms, unless high index of suspicion and exposure
  • need to prevent rheumatic fever
  • does not prevent acute glomerulonephritis
  • amox of pen V for 10 days
43
Q

complications of pharyngitis

A
  • suppurative - abscess or celluitis, otitits media
    non-supputaive
  • ARF
  • AGN
44
Q

most common cause of CAP

A

viruses

- most can be treated outpatient

45
Q

risk factors for CAP

A
  • premature
  • malnutrition
  • SES
  • smoke
  • daycare
  • crowding
  • previous PNA
46
Q

Phx findings for CAP

A
  • fever
  • cough
  • tachypnea
  • resp distress
  • dulness on percussion
  • tactile fremitus
  • ## decreased breath sounds
47
Q

invest. for CAP

A
  • pulse ox
  • CBC
  • blood Cx
  • CXR - 2 views - good to confirm
  • chest US
  • thoracentesis - for effusions
48
Q

guidelines to Tx kids 3mos to 17 years with CAP

A
  1. non severe - amox PO or ampicillin IV
    - if atypical - clarythro
    - if severe - ceftriaxone + axitho or clarythro
  2. assess if has influenza
    - if yes, give anti-viral and amox. clav
  3. if has pleaural effusion
    - consider tap
    - use ceftriaxone and clinda
  4. if seems like might have MRSA
    - add vanco or linezolid
49
Q

CAP needs hospital if:

A
  1. toxic
  2. age 70
  3. resp distress
  4. vomiting, decreased oral intake
  5. failed oral therapy
  6. large pleural eff
  7. psychosocial
50
Q

ICU for CAP if:

A

> 60% O2 needed
shock
increase RR and distress with signs of exhaustion
recurrent apnea or irreg. breathing

51
Q

UTI prev. in kids with fever

A

5%

  • more likely for males 4-6weeks
  • more liekly females over 12
52
Q

risk factors for UTI

A
  • female
  • toilet training
  • dysfunct. voiding
  • constipation
  • tract abnormality
  • labial adhesions
  • intrumentation
  • uncirc
53
Q

presentation

A
  • younger are very non-specific, fever and upset

- older the usual

54
Q

2 Phx finding of UTI

A
  • fever

- suprapubic tender

55
Q

invest for UTI

A
  • clean catch, cath, or suprapubic
  • never use steile bag as culture
  • unrinalysis - leuks, nitrites,
56
Q

mgmt of UTI

A

ABx

  • neonates- ampa + genta
  • older - amox clav, cephalexin
  • acute for 7 days
  • pyelo for 10-14 days
57
Q

imaging for UTI

A

should get and US of kidney and bladder to look for anatomic abnormalities
- VCUG if if US finds abnormalities

58
Q

infant signs of meningitis

A
  • fever
  • poor feeding
  • lethary
  • crying a lot
  • bulging fintanelle
  • apnea
  • ## petechaie
59
Q

older child signs of meningitis

A
  • fever
  • HA
  • vomiting
  • neck pain/stiff
  • photophobia
  • kernig and bruds
  • focal neuro
60
Q

invest for meningitis

A
  • LP definite

- gramstain, culture, cell count, viruses, glucose and protein

61
Q

bugs and Abx by age

A 
0-28
- GBS, ecoli, listeria
- amp and cefotaxime
28-90
- overlap
- cefotaxime + vanco
90+
- strep pneumo, n meningitis, h flu
- ceftriaxone, + vanco
62
Q

other care for meningitis

A
  • suportive - CP and manage ICP
  • dexmethasone - if older than 6 weeks
    • must be given prior to Abx

Peds clerkship (22 decks)

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