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Pediatrics > ID I > Flashcards

ID I Flashcards

1
Q

Peak incidence of otitis media? Major RFs? Most common bugs?

A
  • peak: 6-36 months
  • major RFs: caretaker smoking, bottle propping, and day-care attendance (breastfeeding is protective)
  • most common bugs: strep pneumo (50%), H. flu (30%), M. Cat (10-15%)
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2
Q

Tx for AOM?

A
  • amoxicillin first line

- alts: cephalosporins, macrolides, tx failure - augmentin, possible ceftriaxone

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3
Q

If you aren’t certain that pt has AOM what should you do?

A
  • pneumatic otoscopy
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4
Q

Tx kids over 2 for AOM?

A
  • educate parents with kids over age of 2 about the wait and see approach if it applies in the given circumstance
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5
Q

Complications of AOM?

A
  • mastoiditis. venous sinus thrombosis, brain abscess
  • scarring of structures of middle ear
  • research shows that tx of AOM with abx doesn’t decrease incidence of complications
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6
Q

What is otitis externa? Causes of otitis externa?

A
  • inflammation of EAC or auricle

- causes: infectious, allergic, and dermal disease

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7
Q

Major RFs for developing OE?

A
  • swimming
  • humid enviro
  • fbs: Q tips, paperclips
  • immunocompromised: worried about malignant otitis externa
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8
Q

Bacterial culprits of otitis externa?

A
  • staph aureus
  • pseudomonas aeruginosa (swimmers ear)
  • proteus
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9
Q

Signs and sxs of otitis externa?

A
  • otalgia
  • pain at tragus or when auricle is pulled
  • pruritis
  • discharge
  • hearing loss
  • auricular nodes will be swollen
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10
Q

What will we see on otoscopic exam if pt has otitis externa?

A
  • edematous and erythematous ear canal
  • yellow, brown, white or grey debris
  • should be no middle ear fluid
  • TM should be mobile (if you can see it) - if you can’t see it - don’t use steroids or aminoglycosides
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11
Q

Tx of otitis externa?

A
  • clean ear canal: irrigate with 1:1 dilution of 3% hydrogen peroxide at body temp (gently - no high pressure if you can’t see TM)
  • protect ear canal from water
  • tx of inflammation and infection ( don’t use following if you don’t have intact TM):
    cortisporin
    cipro HC
    tobradex
  • use ofloxacin if you can’t visualize intact TM
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12
Q

Etiology of a sore throat?

A
  • occurs as a result of inflammation or infection of the tonsils, uvula, soft palate, and posterior oropharynx
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13
Q

Sore throat is more common in what age groups? What accounts for majority of cases?

A
  • more common in older kids
  • uncommon in infants and kids younger than2
  • viruses account for majority of cases esp in kids 2-5
  • strep pyogenes (GABHS) is the most common bacterial cause (complications: rheumatic heart disease, PSGN)
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14
Q

How does a viral pharyngitis present?

A
  • occurs in association with other sxs of respiratory tract infection such as rhinorrhea, cough
  • pharnygitis is usually mild
  • fatigue, anorexia, and abdominal pain may be present
  • management is sx
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15
Q

How does sore throat that is caused by GABHS present?

A
  • beefy red tonsils with exudate, swollen uvula, exudate in back of throat
  • tender anterior cervical lymphadenopathay
  • fever
  • absence of URI sx
  • not uncommon to have HA and abdominal pain
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16
Q

Dx GABHS?

A
  • rapid antigen testing: not always accurate
  • throat culture is dx of choice
  • may have strawberry tongue
  • PCN is drug of choice, macrolides first alt (azithro)
  • clindamycin if not sensitive to macrolides
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17
Q

What virus presents with beefy red tonsils plus exudate?

A
  • EBV - mono
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18
Q

How will a pt with mono present?

A
  • have malaise
  • also presents with beefy red tonsils and exudate
  • usually diffuse lymphadenopathy but particularly posterior cervical
  • splenomegaly
  • often afebrile
  • if given PCN - get a rash
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19
Q

Dx mono? Management?

A
  • EBV
  • heterophile ab testing (monospot) - may be falsely negative early in course of disease
  • CBC: atypical lymphocytosis
  • EBV specific abs may be used if disease is suspected but negative monospot (can test for IgG and IgM)
  • management: education, no contact sports for 6-8 wks
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20
Q

Cause of herpangina? Presentation?

A
  • caused by enterovirus
  • high fever and small ulcers on erythematous base on tonsillar pillars, soft palate, and uvula
  • tx: acyclovir
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21
Q

Cause of Hand, foot, and mouth disease? Presentation?

A
  • coxsackie virus
  • vesicles or red papules found on tongue, oral mucosa, hands and feet
  • mild fever and malaise
  • have child stay home from daycare for 24 hrs
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22
Q

Serious infections that can present as a sore throat?

A
  • peritonsilar abscess: pt needs IV abx and surgical drainage
  • retropharyngeal abscess
  • epiglottitis: unimmunized child (HIB)
    high fever, sore throat, stridor
    drooling and respiratory distress, don’t examine pharynx in office
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23
Q

What is aphthous stomatitis (canker sore)? What will you see?

A
  • main finding is one to several small ulcers on insides of lips or elsewhere in mouth
  • last 1-2 wks
  • management: topical preparations
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24
Q

Gingivostomatitis - cause, presentation, management?

A
  • Herpes simplex
  • ulcers can develop on buccal mucosa, anterior pillars, inner lips, tongue and gingiva
  • fever
  • tender cervical lymphadenopathy
  • lasts 7-10 days
  • management: topical preps (no corticosteroids - infection to spread)
  • early in course can use acyclovir
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25
Q

Who does thrush affect? Sxs, physical exam findings? Tx?

A
  • mainly affects infants or older children in debilitated state
  • may occur in pts taking broad spectrum abx or steroids (inhaler)
  • sxs: mouth soreness, refusal of feedings
  • physical exam: white curd like plaques predominantly on buccal mucosa
  • tx: nystatin oral suspension (remove plaques prior with moistened cotton-tipped applicator or piece of gauze)
  • sterilize pacifiers
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26
Q

When is sinusitis likely? PP?

A
  • possibility when std viral URI sxs persist beyond 10-14 days
  • pp: occurs when mucociliary clearance and drainage are impaired by URI or allergic rhinitis or obstruction from some other cause
  • frontal sinusitis unusual before age 10 (not even visible with imaging until 4-9)
  • augmentin or amoxicillin first line
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27
Q

Presentation of sinusitis?

A
  • persistent URI sxs
  • worsening sxs following stability
  • pt starts to improve from URI and then becomes worse
  • facial pain
  • maxillary teeth pain
  • malodorous breath
28
Q

Etiology, PP of croup? Most common ages? Key features?

A
  • most often caused by parainfluenza virus, also RSV, influenza, adenovirus
  • infection causing inflammation of larynx, trachea, and bronchi
  • 6 months to 3 years most common age
  • key features: URI sxs with barking cough and stridor
  • fever usually absent or low grade
29
Q

How do you diff croup from epiglottitis?

A
  • lateral xray: see thumb print sign if epiglottitis, get ready to intubate
  • croup: steeple sign on x-ray
30
Q

Tx of croup?

A
  • steroids: dexamethasone 0.6 mg/kg IM one dose
  • barking cough and no stridor at rest: supportive therapy, hydration, minimal handling, mist therapy, cold air
  • stridor at rest: O2, neb racemic epi, if sxs resolve wihtin 3 hours of steroid and epi use - can be safely d/c
  • hospitalize if recurrent epi txs are reqd or if respiratory distress persists
31
Q

Epiglottitis - cause, presentation, tx?

A
  • true medical emergency
  • most commonly due to HIB
  • generally presents with sudden onset: fever, dyspagia, drooling, muffled hot potato voice, inspiratory retractions, soft stridor
  • don’t examine pt
  • get STAT soft tissue lateral portable x-ray of neck and prepare to intubate immediately
  • tx with ceftriaxone (abx of choice)
32
Q

What is mumps? How does it present? Tx?

A
  • classic childhood infections prior to vaccinations, spreads through respiratory route
  • clincial disease is rare in vaccinated kids today
  • presents in variety of ways: parotid gland swelling common, aseptic meningitis, transient pancreatitis, orchitis or oophoritis, epididymitis (worried about males being sterile, but if males develop oorchiditis doesn’t mean that they will be sterile)
  • tx: supportive
33
Q

4 keys with GABHS?

A
  • fever
  • severe sore throat
  • tender anterior cervical adenopathy
  • absence of viral URI sxs
34
Q

Primary reason why we tx strep throat?

A
  • prevent rheumatic fever (have to initiate tx by day 9)
35
Q

heterophile ab test is used for?

A
  • EBV - testing for mono (can be negative early in course of the illness)
36
Q

tx of choice for croup?

A
  • steroids
37
Q

What is kawasaki disease? Occurs in which pop? Labs?

A
  • vasculitis of unknown etiology affecting medium sized arteries
  • occurs almost exclusively in ped pop
  • labs: hypoalbuminemia, thrombocytosis, and elevated ESR
38
Q

Dx kawasaki disease?

A 
- dx made clinically and includes:
fever for 5 days+ 4 of 5 additional criteria:
- rash
- mucous membrane involvement
- unilateral cervical adenopathy
- nonpurulent conjunctivitis
- swollen hands and feet
- other findings: fever, strawberry tongue, vascular aneurysms, abdominal pain, swollen, reddened jts
39
Q

Complications of kawasaki disease? Tx?

A
  • cardiac: coronary vasculitis, aneurysm formation leading to arrhythmias, infarction, CHF, and even death
  • leading casue of acquired heart disease in kids in US and Japan
  • Tx: high dose aspirin and 2 days of IV immunoglobulin
40
Q

What is rubeola (measles)? Presentation of it?

A
  • caused by direct viral infection of the epidermis (highly contagious)
  • incidence has dropped dramatically since widespread vaccination
  • hx should focus on immunization status, travel, contact with infected persons?
  • presentation: high fever, dry cough, rhinitis, conjunctivitis with clear discharge, distinctive rash
  • KOPLIK spots are pathognomonic (occur 1-2 days prior to onset of rash)
  • rash is dark red raised (morbilliform) and begins at hairline and spreads to trunk, arms, legs, and eventually hands and feet
41
Q

Rubella (german measles)?
Why do we vaccinate?
Sxs?
Dx?

A
  • uncommon is US, most impt reason we vaccinate is to prevent spread to pregnant women to avoid congenital rubella syndrome
  • result from direct infection of dermis
  • most common complications: arthralgia and arthritis
  • rash is fainter than measles, begins on face and progresses caudally, doesn’t coalesce
  • rash may be preceded by low grade fever, malaise, URI sxs, may have lymphadenopathy involvling posterior auricular, suboccipital and posterior cervical nodes
  • dx difficult as this appear as nonspecific viral illness (ask about immunization hx)
  • serum IgM reliable way to confirm dx
42
Q

Cause and spread of Roseola? Sxs?

A
  • results from HHV-6, very common infection
  • seroprevalance in most countries is 100% in kids over 2
  • complications are uncommon (seizures - during febrile period)
  • virus is acquired from close contact with saliva from parents or siblings
  • abrupt onset of high fever lasts 3-7 days (occasionally respiratory or GI sxs)
  • resolution of fever is followed by ERYTHEMATOUS MACULOPAPULAR RASH that spontaneously resolves (may not appear for 1-2 days after fever breaks)
  • mimics meningitis
43
Q

What is fifth disease?

A
  • mult synonymous terms including erythema infectiosum and slapped cheek disease
  • caused by parvovirus B19
  • illness usually mild and may include low-grade fever, URI sxs, and mild malaise
  • rash is flat, lacy, reticular, often pruritic, located on cheeks, trunk and extremities
  • children not contagious once rash appears
44
Q

Chickenpox presentation?

A
  • varicella
  • generalized pruritic vesicular rash beginning on face, neck, or upper trunk and spreads outward (mucous membranes may be involved)
  • lesions are in diff stages
  • other sxs: malaise, fever
  • hx of contact with another infected (either varicella or herpes zoster) within past 10-21 days
  • lesions - dew drop on a rose petal
45
Q

How long is chickenpox contagious for? Tx?

A
  • contagious from 1-2 days prior to onset until lesions have crusted
  • management: supportive, acyclovir in immunocompromised
  • immune globulin may be given to pts exposed to varicella who are at risk for severe disease
  • once you have had disease - lifelong immunity
46
Q

What is pityriasis rosea? Signs?

A
  • etiology unclear, harmless
  • 1st sign: herald patch - resembles psoriasis or tinea corporis
  • following herald patch multiple new lesions that are smaller appear, usually on central trunk
  • lesions are often oval with long axis paralleling the lines of skin stress (inverted christmas tree)
  • lesions resolve in 6-10 wks and may be pruritic (complaint: “I have this rash that won’t go away”)
47
Q

What is bronchiolitis? Who are at a greater risk?

A
  • inflammatory process of smaller lower airways, usually caused by RSV
  • can progress to respiratory failure and potentially is fatal
  • infants with congenital heart disease, chronic lung disease (premature babies), or immunodeficiencies are at risk for severe disease and poorer outcomes
  • presentation: fever, URI sxs, and accompanied by tachypnea and wheezing
  • ## management: supportive care - O2
48
Q

Other causes of bronchiolitis?

A
  • adenovirus, parainfluenza virus
49
Q

What can be used as prophylaxis against RSV?

A
  • palivizumab (synagis) an IM monoclonal Ab that provides passive prophylaxis against RSV (given to babies at greater risk especially in winter months)
  • ribavirin: synthetic nucleoside analog with activity against RSV usually reserved for severly ill or immunocompromised
50
Q

Presentation of bronchitis? Labs?

A
  • URI sxs with cough and malaise
  • coarse bronchial sounds
  • WBC normal, CXR clear
  • most time it is viral
  • abx usually not helpful
51
Q

Pneumonia? usually viral or bacterial? Difference in presentation? labs?

A
  • most cases in kids are viral
  • but unable to predict which cases are viral so we tx with abx
  • causes of bacterial pneumonia vary with age
  • viral pneumonia often with prodrome of rhinorrhea, cough, low grade fever, pharyngitis
  • bacterial pneumonia: more abrupt, high fever, cough, chest pain and shaking chills
  • tachypnea may be only sign of underlying pneumonia
  • Elevated WBC, CXR: much more variable than with adults, don’t often see a classic lobar consolidation
52
Q

Tx of pneumonia?

A
  • abxs
  • maybe bronchodilators if trouble with airway, steroids if asthma
  • fluids, O2
  • prognosis in immunocompetent is excellent
  • hospitalize if severe
53
Q

Cause of Pertussis? Why is it dangerous? Duration?

A
  • Bordetella Pertussis
  • highly communicable
  • not all individuals will seroconvert with vaccination, many lose immunity over time
  • danger: small infant - cough so hard that they go into respiratory distress
  • duration: 4-12 wks
54
Q

Onset of pertussis (whooping cough)?

A
  • insidious: starts as URI sxs and slight fever may be present, cough is initially irritating by not paroxysmal
  • after about 2 weeks, cough becomes paroxysmal with classic whoop (lasts 2-4 weeks)
  • cough so hard that it leads to vomiting
55
Q

Guidelines for pertussis dx?

A
  • ask about IMMUNIZATION status!!!
  • classic presentation suspect pertussis
  • cough for more than 2 weeks suspect pertussis
  • nasal swab for culture (Bordet-Gengou culture medium)
  • nasal swab for PCR more sensitive: state lab, results in 3-7 days
56
Q

Tx for pertussis?

A
  • erythro for 14 days
  • azithro for 5-7
  • tx awaiting lab results if hx of known exposure
  • won’t shorten course of cough unless given in early phase but it will prevent transmission (educate pt that cough may last a couple months)
57
Q

What is bronchiectasis? Who does it occur in?

A
  • characterized by abnormal dilation and distortion of bronchial tree, resulting in chronic obstructive lung disease
  • condition is the end result of a variety of pp processes, usually including some combo of infection and impaired airway drainage or obstruction
  • CF is most common cause of bronchiectasis in kids
58
Q

PP of bronchiectasis?

A
  • induction of bronchiectasis reqrs 2 factors:
    infectious insult, and impaired mucus clearance, airway obstruction or defect in host defense
  • only common in CF pts
59
Q

When should you consider a malignancy or rheumatologic/autoimmune diseaes in pts?

A
  • with a persisten fever and when mult organ systems are involved (less likely that it is an infection)
60
Q

When should you consider kawasaki disease?

A
  • kid with persistent fever that doesn’t go away after 5 dayas and has palmar rashes
61
Q

Koplik spots are pathognomic for?

A
  • measles (rubeola)

- precedes morbilliform rash

62
Q

Why do we vaccinate for rubella?

A
  • congenital rubella syndrome
63
Q

key to roseola dx?

A
  • fever for a couple of days, breaks and then you have a rash
64
Q

How does varicella rash appear?

A
  • starts centrally and on neck, and potentially face, spreads outward, occur in crops and are unilocular
65
Q

When does bronchiolitis peak? Presentation?

A
  • 6 mo
  • generally fever with marked tachypnea and wheezing
  • highly contagious, and seasonal
66
Q

Presentation of bacterial pneumonia?

A
  • acute onset of fever
  • productive cough
  • SOB w/o URI sxs
  • fine crackles, no coarse breath sounds

Pediatrics (20 decks)

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