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מבחן גמר בילדים > Infectious > Flashcards

Infectious Flashcards

1
Q

Scarlet fever rash:
1. when it starts
2. from where it develop- the sequela of the rash
3. other menefistations
4. pathogen

A
  1. when it starts- 24-48 hrs **
    2.     from where it develop- **Groin and axilla and spread to trunk and extremity&raquo_space; 3-4 days after the rush disaprre and the skin start to desquimation from face to bottom. , skin has Sand-like apperance
  2. other menefistations- straberry tounge, exudate, red tonsilst, red uvula, post. platal patechial
  3. pathogen- GAS
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2
Q

Which types of GAS can cause RF?

A

M types, 1,3,5,6,18,29

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3
Q

Which ages of kids are at hish risk for RF?

A

5-15 yrs

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4
Q

Jones criteria - how we diagnose acute RF?

A

2 major or 1 minor or 1major + 2 minor
in all must be evidance of recent GAS infection

Recent infection- positive throat culture or RAPD / ALSO or Anti- DNAse B / antihyloronidase

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5
Q

What are the major critera of Jones?

A

J- Joint = migratory arthritis
O = Pancarditis
N = Nodules (subcutenous, mainly on joints)
E = Erythema marginatum
S = Syndheam chorea (could also present as cry/ lugher

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6
Q

What are the minor criteria of acute RF?

A
  1. Fever
  2. Arthralgia - only of no major Joint criteria
  3. CRP / ESR
  4. prolong PR- only if no major pancarditis criteria
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7
Q

Which Ab can be tested to proove GAS infection

A

Anti-DNAse B
Anti-strptolysin O

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8
Q

In which 3 situations we can diagnose acute RF without filling criterias?

A
  1. Syndheam Chorea is the only major criteria
  2. indolent Carditis in a pt coming monthes after disease
  3. reccurent RF in High risk populations
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9
Q

Tx for Acute RF with Syndenham chorea?

A

Penecillin + phenobarbital

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10
Q

How to prevent reccurent RF?

A

PPX penecillin G IM
until age 21 or until 40 if theres a valvular damage

w/o carditis- 5y or until 21 (the longest)
with carditis w/o residual disease- 10y or until 21
wth residual disease- 10y or 40 , consider for life

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11
Q

Tx for Acute RF?

A
  1. penecillin / amoxicillin PO 10 days or IM peneciilin one time
  2. migratory polyarthritis or/with carditis- aspirin PO for several weeks
    3.** caditis, cardiomegaly, heart failure-** Steroids

macrolide if theres an allergy to penecilin (azitromycin, clncamycin, erythromycin)

severe carditis- treat like HF

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12
Q

Which vaccinces are dead ones?

חיסון מומת

A
  • Influenza IM
  • HAV
  • Polio IM
  • Rabies
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13
Q

Which immunization contain recombinant products?

A
  • HBV
  • HPV
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14
Q

Which immunizations contain toxoids?

A
  • diphteria
  • tetanus
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15
Q

What is tha major advantage of conjuctudate vaccine vs polysaccharide one

חיסון מצומד לעומת פוליסכרידי

A

מוצמד = מוריד שיעור נשאות, מייצר נוגדנים עם אבידי גבוה יותר.

pnuemoccoc, Hib , hemingoccoc

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16
Q

When we will give HPV vaccine

A

11-12 yrs
2 doses

if immunocomprimesied / > 15yrs - 3 doses

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17
Q

Palivizumab is immunization against?

and what are the indications to give

A

RSV- in the start of brionchioles season

will be given to high risk pt:
1. neonate < 29wks until 1 yr old
2. Heart or lung condtions (congenital / nuromascular)- until 1 yrs old
3. BPD - until 1-2 yrs old

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18
Q

which Abx can be use ppx for meningoccoc exposure?

and when we will give ppx

A

1.Rifampin- 2Xday for 2d
2.Ceftriazone- one dose
3.Ciprofloxacin- one dose (age > 1 month)

7 days before onset for household, pre-school exposure, close contact, flight next to in flight > 8 hrs

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19
Q

PPx for tetanus after possible exposure?

A
  1. clean with soap and water
  2. vaccination (DTap, Tdap, Td) for - less then 3 doses or > 10 yrs since last shot
  3. Abs (TIG) for infected wound- with dirt, feces, soil, saliva in non-immunizations and HIV pt

TIG only given when immunization status is : uncertain or < 3 doses only in wound that is not clear and minor

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20
Q

PPx for rabies after possible exposure?

A
  1. wash with water and soap
  2. RIG (rabies Ab’s)- SC to the bite area
  3. 4 doses Rabies killed vaccine- at presentation to the ER&raquo_space; 3d&raquo_space; 7d&raquo_space; 14d
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21
Q

when to treat for rabies from a home animal bite?

A

10days quarentine of the animal&raquo_space; if the animal develops signs of rabies then start Tx.

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22
Q

What is the most commo cause of Severe bacterial infeciton in babies < 3 months?

A

UTI

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23
Q

Workout for toxic look baby (0-3 month) ?

A
  1. hospitalization
  2. empiric Tx
  3. full workout- labs, culture, urine, LP
  4. specific test (depends on presentation)- CXR, articulate puncture, stool culture
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24
Q

with fever

Empiric Abx for newborns until 2 moths of age

A

Ampicillin + Gentamycin

if sepsis or menengitis:
switch Gentamycin to Ceftriaxone (3rd generation)

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25
Q

Empiric Abx for 2-3 month of age with fever

A

Ceftriaxone

if pneumoccoc meningitis is suspect- add vanco

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26
Q

When we will empirically cover HSV?

A
  1. skin finding consist with HSV
  2. toxic baby with clinical suspect
  3. neurolohic symptoms - siezures, encephalitis, pleocytosis and mononuclears on CSF

Tx if Acyclovir IV 60mg/kg day devided to 3 doses

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27
Q

FUO definition

A

fever (38) > 8 days w/o source

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28
Q

How much time its take to drug fever to pass after medication is stopped?

A

around 72 hrs

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29
Q

which disease cause it?

how it spread?

A

Parvo B-19
slapped cheek

spread by droplet. start in face and then downwards

Fifth disease

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30
Q

which pathogen that present in adults in arthralgia and arthritis can cause in fetus Hydrops fetalis

A

Parvo-B19

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31
Q

Presentation of rubella?

A

Rash- from the face downwards (like measles but rubella disapper from head after 3 days not like measles)

Lymphadenopathy- Post. cervical, post, auricular, suboccipital

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32
Q

What is the congenital syndrome seen in rubella inf.

A
  1. deafness (sensrinural)
  2. bluberry muffin rash
  3. jaundice
  4. congenital cataract
  5. microencephaly
  6. Patent ductus arteriosus
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33
Q

What is the 6th disease?

which condition is higly a/w?

A

HHV6 (Roseola)
fever for 3-4 days&raquo_space; then the fever fade an a rash show (diffuse rash w/o the face)

higly a/w febrile seziures

infected CD4 cells.

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34
Q

What are the 4 c’s of Measles?

A

Cough
Coryza (runny nose)
Conjuctuvitis
Koplik spots- bluish spots on buccal mucosa

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35
Q

What is the most common cause of death due to measles?

חצבת

A

pnuemonia (by virus imself or secondary to bacterial inf.)

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36
Q

SSPE (Subacute sclerosing panencephalitis) is a rare complication of which infection?

when it usally occure?

A

progressive demyelinating inflammation of the brain
measles

occur around 10 yrs after the disease

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37
Q

What is the chrecteristic of Measels rash

A

Start behind ears&raquo_space; spread to face and neck&raquo_space; sperad to entire body and merge + palms and soles

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38
Q

What are the complications of measles?

A
  • Acute otitis media- most common
  • pneumonia
  • encephalitis
  • black measels- detach of skin
  • SSPE- late
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39
Q

Tx for Measels?

A
  • Isoprinosine (anti-viral)- remission in 30-40%
  • Carbamazepine (early myoclonus)
  • vitamin A
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40
Q

Post exposure PPx for measles?

A

vaccine in 3 days or IVIG in 6 days

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41
Q

Hand and mouth disease?

Dx?

A

Coxsackievirus A16, Echovirus

Dx
virus culture- 50-75% sensetivity
PCR- more sensetive in less time

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42
Q

Which complication can be seen in Coxsackievirus infection??

A

Aspetic meningitis- mainly type A
Myocarditis- mainly B type
Dilatead Cardiomyopathy- mainly B type
devil’s grip (Bornholm disease)- unilateral pleuritic pain in lower chest&raquo_space;> mainly B type

type A more common to see- the type causeing hand and mouth disease

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43
Q

When we will give Acyclovir for VZV infection?

A

immunosupression + unvacinated > 1 yr only if given 24 hrs from onset of rash

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44
Q

Complications of VZV?

A
  1. secondary bacterial skin infection - 5% of kids
  2. Reye syndrome- do not use Aspirin
  3. newborns- from mother
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45
Q

how can newborn get VZV infection and what is the Tx?

A

From mother- if she was sick 5 days prior the delivery to 2 days post delivery

must treat with VZIG

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46
Q

which CN is involve in Ramsay Hunt syndrome

A

CN VII
(VZV shingles)
פאציאליס ושלפוחיות בתעלת האוזן

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47
Q

What is the Tx for VZV shingles in kids and what its main benefit

A

acyclovir
accelerate recovery and reduce risk for post herpetic neuralgia

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48
Q

which CN is involve in lesions of VZV in mouth and cornea

A

CN V

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49
Q

Tx for impetigo

A

Abx ointment- Mupirocin or fusidic acid
Abx PO (rapidly involving inf. / reccurent / facial lesions) - Ceflaxine (1st generation)

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50
Q

Tx for Cellulitis

A

Ceflaxine or cefalozine PO (1st generation)

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51
Q

Tx for S. aureus folliculitis

A

Anti-septic Soap

if cont.&raquo_space; Abx ointment

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52
Q

Which inf. a/w abcess in the follicular head 1-2 cm

A

Furuncle

S.aureus

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53
Q

Tx for furuncles?

A

Abx PO
driange- if abcess
mupiricon- if carrier in nostrils

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54
Q

What we need to check in a case of reccurent furunculosis?

A

S.aureus carrier (child or close family)

אבחון עם משטף אף

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55
Q

Which pathogen is a/w SSSS what is the Tx?

A

S. aureus&raquo_space; Epidermolytic toxins

Tx
* IV penecillin + Clindamycin
* Supportive

risk for declie and sepsis

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56
Q

what is Paronychia?

whats the pathogen and Tx?

A

זיהום של שולי הציפורן, כסיסה, הגיינה יודה , מציצתאצבע

Acute- s. aureus
Chronic- Candida

Tx:
אמבטיית חיטוי
משחה אנטיביוטית
ניקוז- במוגלה
זיהום חום- אנטיובטיקה דרך הפה

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57
Q

What is the disease in each of the photos

from left to right

A
  1. impetigo- Abx ointment or Cephazolin PO
  2. cellulitis- Cephazolin / Cheplaxine PO
  3. folliculutus- anti-septal soap&raquo_space; consider Abx ointment

S. aurues

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58
Q

Whays the main different between this two situations?

A

one is furuncle = abcess in follicule
other = Carbuncale = Abcess in few follicules and not single

S. aurues

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59
Q

What we see in each photo from left to right and clinical menefistation

A
  1. Erysipelas- superfical dermis, acute onset with fever
  2. Ecthyma- complication of impetigo by GAS, כיב עמוק מכוסה בגלד עבה
  3. Perianal dermatitis- sharp borders around anus, could cause pruritus. Daycare age
  4. Blistering Dactylitis- mainly schoolage kids.

GAS

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60
Q

What is the Tx for the following skin infections
1. Erysipelas
2. ecthyma
3. perianal dermatitis
4. Blistering dactylitis

A
  1. **Erysipelas- **Penecillin / Cefelozin PO (if severe penecillin IV)
  2. ecthyma- ריכוך והסרה + משחה אנטיובטית, קו 2 פניצלין דרך הפה
  3. perianal dermatitis- penecillin PO
  4. Blistering dactylitis- penecillin PO + drianege
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61
Q

Abx regimen for Necrotizing fascitis

A

Clindamycin + Cefotxime or Ceftriaxone

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62
Q

Which toxin is a/w TSS?

A

TSST-1 (s. aureus)

suprantigen

mainly by MSSA

63
Q

What are the major criteria of Toxic shock syndrome

A
  1. fever > 38.3
  2. Hypotension
  3. rash- eventulay scalded
64
Q

What is needed for Dgx of TSS?

A

3 major criteria + 3 minor criteria

major- fever, hyptension, rash

minor- mucositis, GI, Liver > X2, kidney > X2, muscle, CNS, PLT < 100

65
Q

what are the 3 stages of skin in TSS

A
  1. rash
  2. healing- עור מתקלף, תוך 7-10 ימים
  3. הקרחה ואיבוד צפורנים- תוך חודשיים
66
Q

Tx for TSS

A
  1. Clindamycin + naf/ oxacillin / cefazolin
  2. in severe- IVIG / setroids
  3. if MRSA susp. - Vanco
67
Q

Which HSV is a/q genital ulcers?

A

HSV2

mor in womens

68
Q

Ulcers in 6m-5y kids in the ant. mouth with lymphadenopathy and fever

A

Primary herpatic gingivostomatitis

self limiting, Acyclovir < 72h to shorten length of disease

69
Q

What is Herpetic whitlow

A

herpes in finger of kids that sucking their fingers

Tx- PO acyclovir, reduce lengh and reccurent

70
Q

Which medicatio is C/I in Herpes in the eye?

A

Steroids- can worse the infection

71
Q

Whats the Dgx? Dentritic like lesion in eye exeminaiton?

A

Herpes in eye

יכול להגרום להצטלקות הקרנית עד לעיוורון

72
Q

Which HSV is more a/w HSV encephalitis?

A

HSV-1

73
Q

Tx for HSV enecephalitis, and what is the mortality rate w/o Tx?

A

IV acyclovir

w/o- 75% mortality

74
Q

What are petrussis stages of ilness?

A
  1. incubation - 7-10 days
  2. caterral- 1-2 wks. coryza, fever low grade
  3. proxismal- 2-4wks, whooping cough&raquo_space; vomiting
75
Q

what are the red flags in whooping cough?

A

long episode > 45 sec
cyanosis
sat% not recover
non reaction to stimuli after vomiting

76
Q

most common complication of whooping cough?

A

pneumonia- bacteria itself or pneumoccoc, strep, HIB

77
Q

Test of choice for petrussis?

A

Nasopharynx PCR

78
Q

Tx for petrussis?

A

Macrolides (azytromycin 5 dys)

79
Q

Which Abx can cause Hyperthropic Pyloric stenosis in nwb < 14 days

A

Macrolides (mainly arythromycin)

80
Q

PPx for family and close contact with petrussis?

A

5 days azytromycin for households and close contact

81
Q

Tx for gonohrrea?

A

Ceftriaxone
+
Doxy / Azytromycin- clamydia

in dissaminated disease- hospitalizaiton + ceftriaxone IM + doxy/ azytromycin

82
Q

What are the lesions seen in the 3 stages of shypilis?

A
  • stage 1- Chancre - non painfuk
  • stage 2- flu like + maculopappular rash + Condyloma lata
  • Stage 3- Gummatous lesions
83
Q

Tx after rape:

A
  1. Chepalosporin 3rd generation- genoccoc
  2. Azytromycin / doxy - Clamydia
  3. flagyl (metronidazole)- Thricomonas vaginalis and Bacterial vaginosis
  4. consider HIV PPx
84
Q

Brucelosis Triad?

A

Fever + Hepatosplenomagalia + arthritis (sacroiilitis)

2-4 wks after infection

85
Q

Which zoonotic disease menifest in sacroiliitis + Thrombocytopenia and eleveted liver enzymes?

A

Brucellosis

86
Q

Dgx of brucellosis?

A

Blood culture- takes time (4 wks)
Rose bengel - agglutinaiton test

87
Q

Tx for brucellosis?

A

below 8 yrs
Resprim (SMX-TMP) 4-8 wks + Rifampin 6 wks

above 8 yrs
Doxycycline 6 wks + Rifampin 6 wks / Sterptomycin / gentamycin 2 wks

88
Q

What consider to be a complicated Brucellosis and what will be the Tx?

A

Meningitis, Endocarditis, Osteomylitis

Tx:
Doxycyclin + Rifampin + gentamycin

89
Q

Mediteranean spotted fever

pathogen
Dgx
Tx

A

R. conorii
3-5 days after fever- maculopappular rash of involve hand and feets (like measles)

Dgx- Serology IgM eleveted
Tx- Doxy X2 for 7 days. if pregnant- Chlorompenicole

Tx same like murine thypus

90
Q

Q-fever
patoghen
Triad + high clue sings in childrens
Dgx
Tx

A

patoghen- Coxiella brunetti (lice from cattle)
Triad + high clue sings in childrens- Triad- high fever, atypical pneumonia, hepatitis
in kids- osteomylitis which not repsnd to empiric tx
Dgx- IgM positive for phase 2 (in chronic- IgG positive for phase 1)
Tx- doxycycline

91
Q

Most common pathogens for lymphadenitis?

painful + swollen LN

A

GAS
CMV
EBV
Satph

92
Q

What are the indication for biopsy of lymphadenitis?

A

progressive growth within 2 weeks / no reduce in size in 4-6 weeks
Red flags- FUO, B symptoms, Supraclavicular LN, mediastinal mass

93
Q

After how many days of no Tx response we will imaged a suspected LN?

A

after 1-2 days:
neck MRI/ US/ CT

94
Q

What is the most common cause of regional chronic Lymphadenopathy

A

Cat scartch

95
Q

What is the mosy common a-typical presentation in Cat scratch disease?

A

Parinaud oculoglandular syndrome
unilateral conjuctivitis + peri-ocular lymphadenopathy

96
Q

Dgx and Tx for cat scratch

A

Dgx- clinical. can use serological / PCR testing as well
Tx- self limiting. Azytromycin after 30d to accelerate recovery

97
Q

Which infection cause a unilateral non painful non motile LN&raquo_space; becoming blue&raquo_space; rupture and seen more in toddlers

A

Non TB mycobacterium
mainly MAC

Dgx- mentuo / IGRA
Tx- driange (Abx only if TB)

98
Q

Which pathogen is a/w Ampiciliin rash?

A

EBV

99
Q

A pt present with fever, exudative pharyngitis and lymphadenopathy

after administred ampicillin and rash is formed (shown in the picture)

what is most likley the pathogen

A

EBC

80%- ampicillin rash
50%- splenomegalia
10-20%- hepatomegalia

100
Q

Which disease can be fatal to boys with Duncan disease

A

EBV

101
Q

How to different primary inf. vs latent inf. in EBV

A

**primary- **EBV Early antigen positive,VCA-IgM positive,EBNA negetive

**latent- **EBNA + VCA-IgG

102
Q

Retroparyngeal abcess:
Age
etiologies
Dgx
pathogens

A

age < 5 yrs
Etiologis- after URI or trauma
Pathogens- MRSA, MSSA, PAS, anerobes
Dgx- CT. culture from abcess- definite

103
Q

Peri-tonsillar abcess:
Age
etiologies
Dgx
pathogens

A

age < adulcensts
Etiologis- after pharyngitis / tonsillitis
Pathogens- GAS and anerobes
Dgx- Clinical presenation + US

104
Q

Tx for Peri-tonsillar abcess and Retropharyngeal abcess?

A

PTA- Amoxicillin- calvenulate / clyndamycin for 14 days
RPA- Ampicillin sulbactan, clindamycin, vanco-if MRSa susp.

105
Q

Complications for Rtero-PA and Peri-tonsillar abcess?

A
  1. Airway obstruction
  2. Mediastinitis
  3. Aspiration pneumonia
  4. Lamierre synd- Jugular throboplhbitis
106
Q

Which pathogen is mostly a/w Lemierre syndrome?

A

Fusobacterium

sending septic embolis to lungs from jugular thrombophlbitis

Ceftriaxone IV + I/D if abcess as necessary

107
Q

Whats the Dgx?

A

Retropharyngeal abcess

108
Q

What is the gold standart for GAS pharyngitis infection

A

Culture from לוע
90-95% sensetivity

109
Q

Tx for GAS pharyngitis

A
  • first line- penecillin / amoxicillin-calvinulate for 10 days *or penecillin G IM one time *
  • mild sensetivity to penecillin- cehalaxine
  • anapylaxis with penecillin- azytromycin or clindamycin
110
Q

Clinical presenation of P-FAPA?

age of presentation, times of episodes

A
  • Periodic Fever
  • Aphtous somatitis
  • Pharyngitis
  • Adenitis

sporadic syndrome age 2-5y, every 8-12 times per year for 4-6 days

111
Q

Tx for PFAPA?

A

Signle dose of presnisone / bethenazole

in severe cases- tonsillectomy

**disease itself is self limited withing 4-8yrs w/o any bad prognosis **

112
Q

Which types of worms cause the night echiness?
and what is the Tx?

A

Anterobius vernmicularis (Pinworm- interstitial nematode)
Tx-Albendazole

113
Q

Tx for peri-natal infection of HBV

A

HBIg + HBV vaccine
until 12 hrs from delivery
95% succsess.

no C/I for breastfeeding

114
Q

What are the stages of chronic infection in HBV

A
  1. immune tolerant- no Tx. most kids
  2. immune active- most Tx in here, high ALT and liver fibrosis
  3. inactive phase- seroconversion- anti-HBe
  4. re-activation- in immunosuppresion pt
115
Q

Which blood measurement is a good marker in HBV for the sevirty of demage and acute liver failure?

A

PT

116
Q

Which HBV Ab is indication for seroconversion and recovery with low risk for infection others?

A

Anti-HBe

117
Q

Pathogens of meningtitis in the following ages:
1. < 1 month
2. 1-3 month
3. > 3 month

and viruses

A
  1. < 1 month - GBS, E-coli, Lysteria
  2. 1-3 month- GBS. Pneumoccoc, Listeria
  3. > 3 months- pneumoccoc, meningoccoc

Viruses- Enteroviruses
paraechovirus

118
Q

most a/pathogen of death from meningitis?

A

pnuemoccoc

119
Q

Ampiric Tx for meningeitis in the following ages:
1. < 1month
2. > 1 month

A
  1. < 1 month - Cefotaxime + Ampi + gentamycin
    2.** > 1 month-** Cefotaxime / Ceftriaxome + Vancomycin + Steroids
120
Q

most common cause of SBI (sys. bcterial inf.) in baby < 3 months

A

UTI

121
Q

Indication for hospitalization in kids with UTI

A
  1. age < 2 month
  2. severe disease
  3. dehydration/ vomiting - things that challenge PO Tx
122
Q

Tx for cystitis and Pyelonephritis

A

Cystitis- Cehalxine (cephoral) / Augmentin
Pyelonephritis- Cehalxine (cephoral) / Augmentin / Cefuroxime

123
Q

main distinguish of pyelonephritis from cystitis?

A

pyelo- Fever
cystitis- צריבה דחיפות ותכיפות במתן שתן

124
Q

most leading death infection in kidas < 5 yrs

A

pnuemonia

125
Q

Tx for pneumonia in the following age groups:
1. age < 1 month
2. 1month - 5 yrs
3. age > 5 yrs

A
  1. < 1 month = hospitalizaiton + Ampicilin + gentamycin
  2. 1 month-5 yrs - Amoxiciliin (5-10 days) 2nd line- augmentin, cheplaosporin zinath or ceftriaxone IM
  3. age > 5 yrs- Azytromycin 3-5 days (macrolides) for atypical

לזכור טיפול בקהילה ב-2 המצבים הבאים:
1. מתחת לגיל 5- ניתן מוקסיפן ל-5-10 ימים
2. מעל גיל 5- ניתן אזניל (אזיתרומיצין) ל-3-5 מים

Fleuroquinolones are C/I in kids < 18

126
Q

What is the definiton of reccurent pneumonia?

A

2 or more episodes in year or 3 or more episodes in life with normal imgaing btwn episodes

127
Q

Otitis externa pathogens + Tx?

A

psuedomoans + S.arueus

Tx- Abx ointment (quinolones or polymyxin + steroids

רגישות במגע באפרכסת, כאב בלעיסה, הפרשה מהאוזן. ללא חום ללא פגיעה בשמיעה

swimmers ears

128
Q

3 most common pathogens of acute otitis media

A
  1. Hib non typeable
  2. Pneumoccoc
  3. morexella catteralis

mainly co-infection with viruses (URTI)

129
Q

mainly age group peak of Acute otitis media (AOM)

A

6-15 months

130
Q

How to Dgx Otitis media?

A
  • Autoscope- bulgeing and purelant effusion
  • Tympanometry- acustic mesuremnt
  • Acustic reflectometry- screeinig for AOM&raquo_space; if pathologic &raquo_space; Pneumatic otoscopy
  • pneumatic otoscopy- evaluation of ear ventilation- very relable
131
Q

What consider to be Reccurent AOM (acute otitis media)

A

> 3 episodes in 6 months or > 4 in 1 year.

considert Tympanostemy tube replacment

132
Q

What are the complications of Otitis media?

A
  • Chronic supportive Otitis media with > 6 wks of drainage Tympanic membrane perforated
  • Mastoiditis
  • Meningitis
  • Cholesteatoma
  • conductive hearing loss
  • TM perforation
133
Q

Tx for Otitis media

A

1st line- amoxicillin PO for 7 days
2nd line- augmentin (when resistant, 3 daysw/o improvment)
3rd ine- Cegtriaxone IM
drainage- severe or unresposive cases

134
Q

in acute otiris media when Abx is not initially started

A
  1. 6-23 month baby with unilateral AOM w/o severe symptoms
  2. > 24 month old with unilateral or bi-lateral AOM w/o severe symptoms

watchful waiting for 48-72 hrs

Severe symptoms - fever > 39 or Otalgia (ear pain)

135
Q

Tx forDgx of mastoiditis and Tx

A

Dgx- clinical presenation- OM signs + אפרכסת זקורה + CT to asses involvment of mastoid
Tx- Ceftriazome IV + surgical driange if abcess present

136
Q

Coomon pathogens in bacterial sinusitis?

A

like Otitis media
Hib non-typable
morexella
pneumoccoc

137
Q

What is the definition of acute, subacute and chronic sinusitis

A

acute < 30 d
sub-acute 31-90d
Chronic > 90d

138
Q

when the following sinuses are openied
* Ethmoidal
* maxillary
* spenoidal
* frontal

A
  • Ethmoidal- from birth
  • maxillary- 4 y
  • spenoidal- 5y
  • frontal- 7-8y
139
Q

Which 2 clinical presentation in adults with sinusitis are rare in childrens

A

כאבי ראש ורגישות בניקוש על פני הסינוסים

140
Q

how to Dgx sinusitis and what is the defenite dgx way

A

Dgx by following criteria
1. גודש נזלת ושיעול > 10 ימים ללא שיפור
2. חום > 39 מעלות
3. נזלת מוגלתית מעל 3 ימים
4. סימנים מחמירים / נשנים לאחר שהיה כבר שיפור

Defintie Dgx- Sinus aspirate culture לא פרקטית ולא נעשית בשגרה

אבחנה קלינית

141
Q

Tx for sinusitis

And what is the risk factors for resistance

first line and secondline and Tx for frontal sinusitis

A

50-60% self limiting
thus only Abx in severe cases
1. Amoxicillin 5-7d
2. augmentin (if risk factors for resistent to amoxiciliin) 7-10d
3. Frontal sinusitis- Ceftriaxone IV until improvment &raquo_space; PO

risk factors for resistant-
* Abx in last 3 months
* daycare
* age < 2y
* no reposne after 72hrs
* co-morbidity
* immunodepression

142
Q

What is Ondansetron?

when we will give and when its C/I and why

A

Anti-emesis medication for kids who vomiting
C/I- severe hydration&raquo_space; can worsen diarrhea and prolong QT

143
Q

what areth the indication of Abx in Gastroenteritis?

think about background but mainly pathogens

A
  • age < 3 month
  • co-morbidity
  • dysenthera- fever, blood and WBC in stool
  • Shigella- Azytromycin / Ceftriaxone PO
  • ETEC/ EPEC- Azytromycin (azenyl)
  • Vibrio colerae- Azytromycin
  • C.difficile- in severe cases Metronidazole IV /PO + vancomycin PO / stool transplant

  • Compylobacter- only if dysentria - Azytromycin
  • Non-thypi salmonella- only in specific pt (immunocompremise)&raquo_space; Ceftriaxone
  • EHEC O157:H7 - Tx with Abx can cause HUS
144
Q

Osteomylitis
age
bones

A

age < 5 yrs, more in boys
bones- lower leg&raquo_space; Femur > tibia > humerus > fibula

145
Q

Osteomylitis pathogens in newborns < 3 months

A
  • S.aureus
  • GBS
  • E.coli
  • Gram negetive
146
Q

Osteomylitis in childrens > 3 months

A
  • S.aureus
  • pneumoccoc
  • Kingella kingi
  • GAS (can present with VZV)
  • Salmonella - sickle cell
  • coagulase negetive staph - cath. associated

Sexually active- think about Genoccocus

othes zoonotic- Brucella, Q-fever

147
Q

Tx for osteomylitis
under age 3 month and above

A

under 3 month- Cefazolin + Gentamycin
above 3 month- Cefuroxime / Naficillin / Cefazolin

naf or oxacillin

148
Q

Tx of brucelosis < 8 and > 8 yrs

A

age < 8 - resperim + Rifampin
age > 8 - doxy + Gentamycin / Rifampin

for Q fever- Rifampin/ Resperim/ Tetracyclins

149
Q

Length of treatment in osteomylitis

A

3-4 weeks but can be up to 6 weeks

150
Q

Septic arthritis,
most comoon joints + age

A

age < 3 , mainly boys
Most common joints- knee > hip > uncle

151
Q

Dgx of septic arthritis

A

US- most sensetive
X-ray- follow bone healing
Articulocentesis- if suspect to be infected and accsable.

152
Q

Empiric tx for septic arthritis.

which pathogens we want to cover
when we will need surgical drainage?

A
  1. S. aureus
  2. in little ones kingella 6-36 months

for both we can cover with cephazolin or vanco (if MRSA suspceted)

  1. Septic hip- emergency and need surgical drainage
153
Q

in Septic Arthritis when we can cosider to change IV to PO therapy?

A

clinical improvment - no fever > 48 hrs, CRP decreasein 30-50%, negetive blood cultures

154
Q

Rash + migratory arthritis

A

Acute RF

מבחן גמר בילדים (23 decks)

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