Infectious Disease

Question 1

neonatal fever: parent says pt felt ‘hot’ but no documentated fever

-how to manage

Answer 1

observe child several hours, document couple of core temps

Question 2

neonatal fever

what tx?

Answer 2

ampicillin (listeria) and cefotaxime

Can add:

acyclovir (disseminated herpes)–maternal herpes, sz, high lfts, high platelets, abn CSF

vanc (resistant strep pneumo)–abn CSF, hx of NICU, high fever

Question 3

UTI risk factors in 2-24 mo

Answer 3

Look at chart to decide:

prior UTI, >39C, fever no source, fever >24h, nonblack, ill appearance, suprapubic ttp

If girl and 1 risk factor, check urine

if uncirc boy <1y and 2 risk factors, check urine

if circ boy under 6 mo check urine

if circ boy >1y with 3 risk factors check urine

Question 4

how is peds sepsis different from adult?

Answer 4

hypotension occurs late, lactate not reliable.

Consider shock if 2+ signs of organ hypoperfusion: eg elevated Cr, INR, delayed cap refill, etc

Kids have good SVR but not cardiac function. So get cold shock. Whereas adults get warm shock because good cardiac response but poor SVR. Peds sepsis goal: increase cardiac output

Question 5

Peds sepsis

management

Answer 5

20ml/kg boluses

60ml/kg NS over first 15min, can go up to 200ml/kg in first hr if have not achieved shock reversal. Keep giving fluids!!

Pressors at 40-60 ml/kg mark. peripheral IV up to 4h. Think epi or dopamine for cardiac function in cold shock. Can use norepi in adolescent in warm shock like adult, but NOT in cold shock

Question 6

influenza

• what age vaccine
• what sxs more common in peds

Answer 6

6 mo

kids have more GI sxs of vomiting/diarrhea

Question 7

URI

• home remedy
• return precautions?

Answer 7

• children >2: spoonfull dark honey for cough
• teach parents about retractions and tachypnea

Question 8

meningococcemia

-what on gram stain

Answer 8

-paired gram neg diplococci

Question 9

otitis media

tx strategy

when augmentin

Answer 9

1. <6mo: give abx
2. 6mo-2y: abx unless well appearing with unilateral AOM
3. >2y, no perf: watch and wait: 48h, fill rx if still fever/pain
   augmentin: if also conjuncitivits (think hemophilus)

Question 10

otitis media:

1. what topical drops for pain?
2. what if TM perf, how to tx

Answer 10

1. topical benzocaine/antipyrine (auralgan)
2. otic abx gtt for TM perf with otorrhea: ofloxacin

Question 11

pertussis

-phases, how long

Answer 11

1. catarrhal: 1-2 weeks, URI sxs
2. paroxysmal: 1-2 weeks, whoops, or posttusive emesis
3. convalescent: 100 days, gradual recovery

Question 12

Peds PNA tx

Answer 12

1. outpt: amox >3mo

add azithro if >5y for atypicals

2. inpt: ampicillin, consider cephalosporins/vanc

Question 13

roseola

when does rash appear

Answer 13

high fevers 3-4 days

then rash appears AFTER fever resolves

diffuse maculopapular rash beginning on trunk then to extremities

no tx necessary

Question 14

scarlet fever

• signs
• tx, what to warn parents

Answer 14

• strawberry tongue, sandpaper rash, pastia lines (red lines in skin creases)
• PCN
• skin will peel after tx, tell parents

Question 15

Red butt:

dx approach

Answer 15

think mountains and valleys:

mountains: contact dermatitis. put barrier cream (eg Desitin or A+D ointment, all OTC), change diaper more often, wash butt
valleys: think candida. use antifungal topical with each diaper change. no steroid topical!

Question 16

conjunctivitis tx

bacterial, hsv, allergic

Answer 16

1. polytrim, erythromycin, or ocuflox
2. acyclovir, steroids topical (this ophtho to start)
3. antihistamine gtt (eg naphcon or patanol)