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
Who does thrush affect? Sxs, physical exam findings? Tx?
- 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
When is sinusitis likely? PP?
- 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
Presentation of sinusitis?
- 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
Etiology, PP of croup? Most common ages? Key features?
- 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
How do you diff croup from epiglottitis?
- lateral xray: see thumb print sign if epiglottitis, get ready to intubate
- croup: steeple sign on x-ray
30
Tx of croup?
- 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
Epiglottitis - cause, presentation, tx?
- 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
What is mumps? How does it present? Tx?
- 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
4 keys with GABHS?
- fever
- severe sore throat
- tender anterior cervical adenopathy
- absence of viral URI sxs
34
Primary reason why we tx strep throat?
- prevent rheumatic fever (have to initiate tx by day 9)
35
heterophile ab test is used for?
- EBV - testing for mono (can be negative early in course of the illness)
36
tx of choice for croup?
- steroids
37
What is kawasaki disease? Occurs in which pop? Labs?
- vasculitis of unknown etiology affecting medium sized arteries
- occurs almost exclusively in ped pop
- labs: hypoalbuminemia, thrombocytosis, and elevated ESR
38
Dx kawasaki disease?
```
- 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
Complications of kawasaki disease? Tx?
- 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
What is rubeola (measles)? Presentation of it?
- 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
Rubella (german measles)?
Why do we vaccinate?
Sxs?
Dx?
- 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
Cause and spread of Roseola? Sxs?
- 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
What is fifth disease?
- 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
Chickenpox presentation?
- 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
How long is chickenpox contagious for? Tx?
- 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
What is pityriasis rosea? Signs?
- 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
What is bronchiolitis? Who are at a greater risk?
- 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
Other causes of bronchiolitis?
- adenovirus, parainfluenza virus
49
What can be used as prophylaxis against RSV?
- 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
Presentation of bronchitis? Labs?
- URI sxs with cough and malaise
- coarse bronchial sounds
- WBC normal, CXR clear
- most time it is viral
- abx usually not helpful
51
Pneumonia? usually viral or bacterial? Difference in presentation? labs?
- 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
Tx of pneumonia?
- abxs
- maybe bronchodilators if trouble with airway, steroids if asthma
- fluids, O2
- prognosis in immunocompetent is excellent
- hospitalize if severe
53
Cause of Pertussis? Why is it dangerous? Duration?
- 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
Onset of pertussis (whooping cough)?
- 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
Guidelines for pertussis dx?
- 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
Tx for pertussis?
- 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
What is bronchiectasis? Who does it occur in?
- 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
PP of bronchiectasis?
- 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
When should you consider a malignancy or rheumatologic/autoimmune diseaes in pts?
- with a persisten fever and when mult organ systems are involved (less likely that it is an infection)
60
When should you consider kawasaki disease?
- kid with persistent fever that doesn't go away after 5 dayas and has palmar rashes
61
Koplik spots are pathognomic for?
- measles (rubeola)
| - precedes morbilliform rash
62
Why do we vaccinate for rubella?
- congenital rubella syndrome
63
key to roseola dx?
- fever for a couple of days, breaks and then you have a rash
64
How does varicella rash appear?
- starts centrally and on neck, and potentially face, spreads outward, occur in crops and are unilocular
65
When does bronchiolitis peak? Presentation?
- 6 mo
- generally fever with marked tachypnea and wheezing
- highly contagious, and seasonal
66
Presentation of bacterial pneumonia?
- acute onset of fever
- productive cough
- SOB w/o URI sxs
- fine crackles, no coarse breath sounds
