ID Flashcards
4 main bugs
- bact
- virus
- fungi
- parasites
3 main fungi
- yeast
- dimorphic
- molds
2 main parasites
- protozoa
2. helminths
4 main bact
- Gram +
- gram -
- mycoplasma
- mycobacteria
3 main types of Gr + and their types
- rods
- bacillus
- clostridium
- cornybac - branching
- cocci
- staph
- strep
4 main gr -
- cocci
- neiseeria
- moraxella - pleomorphic
- chlam
- ricketsia - spirochetes
- treponema
- berrelia - bacilli
- enterics - e coli, shigella etc.
- other - H flu
ABx therapy in children
see table in 153
def. fever without a source
acute febrile illness with no obv. cause after looking well
def. fever of unknown origin
- daily
- 2 weeks
- no source
4 DDx for fever
- infection
- inflammatory
- malignancy
- misc
def. low risk based on rochester crit
- 1-3 month of age
- good past health
- >37wks
- home with mom
- no issues - Phx
- rectal
when to do a workup for sepsis
sock, toxic looking child with no obv. cause, irritable, LOC
6 parts of sepsis WO
- CBC and diff
- blood Cx
- urineanal and Cx
- LP
- CXR if resp Sx
- stool if diarrhea
algorithm for non-toxic child
p 157
- if under 1mo - full workup
- if over 1 - rochester
typical bugs for AOM
- S. pneumo
- M cata
- H flu
- viral
risks for AOM
- young
- premature
- DS
- not breastfed
- daycare
- crowding
- smoke
- Hx
- immunodef.
Hx of AOM
- ear tug
- N/V
- irritabel , fever
Phx for AOM
- vitals
- HandN exam
***3 requirements for AOM Dx
- rapid onset of ear pain
- signs of middle ear effusion
- immobile TM
- opacification
- air fluid levels - signs of middle ear inflammation
- bulging TM
2 mgmts for AOM
- watchful waiting
- 48-72hrs
- if older than 6mos
- previously well
- not severe - ABx
- amox
- if fails clav
complications of AOM
- perf and drainage
- earing loss
- mastoiditis
def. sinusitis
inflammation of mucosal lining of sinuses
- 5-13% of URTIs
50% resolve spontaneously
most common sinuses
- maxillary and ethmoid
times of various types of sinusitis
acute - 10-30d
subacute - 30-90d
recurrent acute - 3x in 6 mos
chronic - >90d
work-up for sinusitis
NONE
- xray would show opacification, air fluid levels
mgmt of sinusitis
amox - 75-80/kg/d x 10-14
complications of sinusitis
- periorbital/orbital
- cellulitis
- abscess
- osteomyelitis - intracranial
- meningitis
- brain abscess
- empyema - pott’s puffy tumor
- osteomyeltis and abscess of frontal bone
- Abx and ENT
diff between periorbital and orbital cellulitis
peri
- anterior to septum
- eyelid and periorbital structures
orbital
- spread deep to septum
- may involve optic nerve and muscles
common bugs in orbital
- staph
- strep
- H flu
sx that suggest orbital
- pain on eye movement
- diplopia
- visual loss
- proptosis
Phx signs that suggest orbital
- decreased EOM
- proptosis or displacement
- visual acuity
- disc swelling
invest. if suspect orbital
- CBC
2. emergency CT
mgmt of orbital
- EMERG
- admit and ENT
- IV clox + IV ceftriaxone + IV clinda
- surgical mgmt
mgmt of periorbital
usually outpatient if traumatic - IV cefazolin/clox non-traumatic - IV ceftriaxone/cefotaxime - mild can be PO admit for -
def pharygitis
inflamm of the pharynx - esp tonsils
common etiology of phar
- viral most common
2. group A strep
feat of bact phary
- late winter
- 5-11yo
- sudden onset
- exudates
- tender and enlarged
feat. of viral phay
- all seasons
- all ages
- mild sore throat
- non-tender, no exudates
common viruses for pharyng
- URT - rhino, flu, corona
- adeno - with conjunctivitis
- coxsackie - hand foot mouth
- EBV - sig. exudates, HSM
fever associated with strep pharyng
- scarlet fever
- sandpaper rash
- begins on face and moves to flexural lines
2 tests for pharyng
- rapid
- if neg. still need a culture - culture
mgmt of GAS phayrgitis
- 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
complications of pharyngitis
- suppurative - abscess or celluitis, otitits media
non-supputaive - ARF
- AGN
most common cause of CAP
viruses
- most can be treated outpatient
risk factors for CAP
- premature
- malnutrition
- SES
- smoke
- daycare
- crowding
- previous PNA
Phx findings for CAP
- fever
- cough
- tachypnea
- resp distress
- dulness on percussion
- tactile fremitus
- ## decreased breath sounds
invest. for CAP
- pulse ox
- CBC
- blood Cx
- CXR - 2 views - good to confirm
- chest US
- thoracentesis - for effusions
guidelines to Tx kids 3mos to 17 years with CAP
- non severe - amox PO or ampicillin IV
- if atypical - clarythro
- if severe - ceftriaxone + axitho or clarythro - assess if has influenza
- if yes, give anti-viral and amox. clav - if has pleaural effusion
- consider tap
- use ceftriaxone and clinda - if seems like might have MRSA
- add vanco or linezolid
CAP needs hospital if:
- toxic
- age 70
- resp distress
- vomiting, decreased oral intake
- failed oral therapy
- large pleural eff
- psychosocial
ICU for CAP if:
> 60% O2 needed
shock
increase RR and distress with signs of exhaustion
recurrent apnea or irreg. breathing
UTI prev. in kids with fever
5%
- more likely for males 4-6weeks
- more liekly females over 12
risk factors for UTI
- female
- toilet training
- dysfunct. voiding
- constipation
- tract abnormality
- labial adhesions
- intrumentation
- uncirc
presentation
- younger are very non-specific, fever and upset
- older the usual
2 Phx finding of UTI
- fever
- suprapubic tender
invest for UTI
- clean catch, cath, or suprapubic
- never use steile bag as culture
- unrinalysis - leuks, nitrites,
mgmt of UTI
ABx
- neonates- ampa + genta
- older - amox clav, cephalexin
- acute for 7 days
- pyelo for 10-14 days
imaging for UTI
should get and US of kidney and bladder to look for anatomic abnormalities
- VCUG if if US finds abnormalities
infant signs of meningitis
- fever
- poor feeding
- lethary
- crying a lot
- bulging fintanelle
- apnea
- ## petechaie
older child signs of meningitis
- fever
- HA
- vomiting
- neck pain/stiff
- photophobia
- kernig and bruds
- focal neuro
invest for meningitis
- LP definite
- gramstain, culture, cell count, viruses, glucose and protein
bugs and Abx by age
0-28 - GBS, ecoli, listeria - amp and cefotaxime 28-90 - overlap - cefotaxime + vanco 90+ - strep pneumo, n meningitis, h flu - ceftriaxone, + vanco
other care for meningitis
- suportive - CP and manage ICP
- dexmethasone - if older than 6 weeks
- must be given prior to Abx
