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%)
2
Q
Tx for AOM?
A
- amoxicillin first line
- alts: cephalosporins, macrolides, tx failure - augmentin, possible ceftriaxone
3
Q
If you aren’t certain that pt has AOM what should you do?
A
- pneumatic otoscopy
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
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
6
Q
What is otitis externa? Causes of otitis externa?
A
- inflammation of EAC or auricle
- causes: infectious, allergic, and dermal disease
7
Q
Major RFs for developing OE?
A
- swimming
- humid enviro
- fbs: Q tips, paperclips
- immunocompromised: worried about malignant otitis externa
8
Q
Bacterial culprits of otitis externa?
A
- staph aureus
- pseudomonas aeruginosa (swimmers ear)
- proteus
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
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
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
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
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)
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
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
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
17
Q
What virus presents with beefy red tonsils plus exudate?
A
- EBV - mono
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
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
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
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
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
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
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
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
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
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
