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Pediatrics > Intro > Flashcards

Intro Flashcards

1
Q

Sally needs Augmentin. She is 7 years old and weighs 66 lbs. The Augmentin dose is 80mg/kg/day. It should be given Q12 hours. It comes in a 250mg/5mL suspension. How many mL’s will you tell Mom to give per dose?

A

24mL Q12H

(66lbs/2.2 = 30kg.  
30kg x 80mg = 2400mg per day.  
Divide by 2 to get 1200mg per dose.  
1200mg x 5mL = \_\_\_mL x 250mg
x = 24mL)
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2
Q

What should you always remember about pediatric dosing?

A

Obesity is on the rise, look out for MAX dose! Large kids might weight over 40kg, which puts them into adult dosing category. If you were to calculate by weight, then you’d overdose them.

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3
Q

Rule of thumb: 5mL = ____

A

1 tsp

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4
Q

Rule of thumb: 15mL = _____

A

1 Tbsp

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5
Q

Rule of thumb: 30mL = _____

A

1 oz

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6
Q

Most common infection for which abx are prescribed for children?

A

Otitis media

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7
Q

Highest risk for otitis media occurs between what ages?

A

6-24 months

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8
Q

What is the pathophysiology for OM?

A

Starts with rhinitis which causes swelling in nose/sinus. Swelling blocks horizontal Eustachian tube causing fluid to accumulate in the middle ear.

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9
Q

Lots of viruses, (such as RSV, Rhinovirus, Coronavirus, Influenza, Parainfluenza, Adenovirus, and Enterovirus) cause the majority of OM….our objectives just want us to know the 3 major bacterial causes:

A

1) strep pneumonia (most common)
2) H.flu (2nd most common)
3) Moraxella catarrhalis (3rd most common)

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10
Q

Strep pna is gram __________, H.flu is gram ________. Moraxella is gram _________.

A

positive, negative, negative

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11
Q

What are the 3 components required to make an OM dx?

A

1) acute onset of s/s
2) evidence of middle ear effusion
3) evidence of middle ear inflammation

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12
Q

erythema of TM, or generalized otalgia constitute evidence for what?

A

middle ear inflammation

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13
Q

an air-fluid level behind the TM or otorrhea are signs of what?

A

middle ear effusion

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14
Q

What is the first line tx of OM, assuming no allergies?

A

Amoxicillin

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15
Q

If Amoxicillin is not working after 2 days, what is the 2nd line tx of OM? (no allergies)

A

Augmentin

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16
Q

3rd line tx of OM? (no allergies)

A

3rd gen cephalosporin

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17
Q

What is your final resort in treating OM? (no allergies)

A

3rd gen cephalosporin via IM or IV

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18
Q

Amoxicillin specifically targets which pathogen?

A

strep pna

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19
Q

Augmentin is used when suspicion is high for which pathogens?

A

H.flu, M.Catarrhalis which produce beta lactamase

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20
Q

If the child gets a rash with PCN, what is the first line tx for OM?

A

3rd gen cephalosporin

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21
Q

If the child has an anaphylactic reaction to PCN, what is the first line tx of OM?

A

Clinda, Azithro, Bactrim (no effect on H.flu)

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22
Q

How long would you recommend these meds be given? (very general based on severity of illness)

A

Typical illness–5-7 days
Severe illness–10 days
IM meds–3 days

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23
Q

This complication of OM is characterized by scarring of the TM by hyalinization and granulation tissue deposition usually secondary to inflammation or trauma.

A

tympanosclerosis

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24
Q

This complication of OM is characterized by stratified epithelium that collects in a retracted TM (with possible eventual perforation) that can erode into the middle ear/ossicles and cause conductive hearing loss. They can even erode through the temporal bone and mastoid causing further damage and bone loss.

A

cholesteatoma

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25
Q

This complication of OM is characterized by persistent otorrhea occurs in a child with tympanostomy tubes or TM perforations

A

chronic suppurative OM

26
Q

Occasionally the TM will spontaneously ________ as a result of OM. Typically this is not worrisome, as it usually heals on its own after about 2 weeks

A

perforate

27
Q

Suppurative infection which may result in the destruction of the thin bony septae between air cells, followed by the formation of abscess cavities and the dissection of pus into adjacent areas.

A

Mastoiditis

28
Q

What is the MAJOR clinical feature of mastoiditis?

A

post-auricular fluctuance or mass that displaces the auricle –> CAR DOOR SIGN

29
Q

What is the first line tx for mastoiditis?

A

Admit!! IV abx. (Then consider sx options, PRN)

30
Q

What imaging would you use to dx mastoiditis?

A

This is a clinical dx, however, CT used to estimate severity

31
Q

What pathogens most commonly cause otitis externa?

A

1) s. aureus

2) pseudomonas

32
Q

What physical exams findings are common with OE?

A

white debris in ear canal, pain with movement of auricle, discharge

33
Q

How do you treat OE that has no systemic symptoms?

A

Topical FQ’s x 10 days

34
Q

Dad brings 2 year old girl into office c/o sinus infection. He tells you that daughter has had purulent discharge from nose. He says that it smells terrible, and she seems to be in some pain. What should you consider besides a simple sinus infection?

A

foreign body!

35
Q

What FB needs to be removed emergently?

A

batteries

36
Q

What are the 3 methods of removing a FB?

A

1) gator clip
2) dermabond
3) suction

(PS. every time I’ve seen a FB removed from the nose, the doctor just tells Mom to blow into kids mouth, and the FB just pops out kid’s nose….usually onto her face)

37
Q

Child’s symptoms include nasal itching, clear nasal discharge, sneezing, postnasal drainage, and congestion. These are most consistent with what dx?

A

allergic rhinitis

38
Q

What physical findings do you expect with allergic rhinitis?

A

1) salute
2) shiners
3) cobblestoning
4) dennie-morgan lines
5) nasal crease
6) boggy mucosa

39
Q

What is the most effective tx of mild-moderate allergic rhinitis?

A

Continuous use of nasal steroids (better than PRN)

**No systemic side effects

40
Q

“the itch that rashes”

A

atopic dermatitis

41
Q

What is the primary treatment goal in kids with atopic dermatitis?

A

Reduce irritation and moisturize!

42
Q

Mom tells you she’s using her body lotion on Johnny after his baths, but its not helping his atopic dermatitis. What should you recommend?

A

Occlusive emollients (Vaseline/Crisco) after bath and intermittently through day

43
Q

If switching atopic dermatitis kid to mild soaps and frequent use of emollients is not enough, what then?

A

topical steroids, oral antihistamines

44
Q

what is the atopic triad?

A

allergic rhinitis, atopic dermatitis, asthma

45
Q

what is the most common complication for atopic dermatitis? What pathogen causes it?

A

Impetigo, staph and strep

46
Q

Dermatitis found in diaper region, axillae, and neck folds is often caused by what pathogen?

A

candida albicans

47
Q

How would you treat these fungal dermatitis infections?

A

topical antifungals like imidazole (Nystatin). If severe and unresponsive, use po fluconazole

48
Q

What is the name for a candida infection in the neck fold?

A

candidal intertrigo

49
Q

Ringworm = tinea. What’s it called on the head?

A

capitis

50
Q

Ringworm = tinea. What’s it called on the trunk/extremities?

A

corporus

51
Q

Ringworm = tinea. What’s it called on the groin?

A

cruris

52
Q

Ringworm = tinea. What’s it called on the feet?

A

pedis

53
Q

What is the tx for a tinea infection that does not involve the hair?

A

topical imidazole (Nystatin) x 2 weeks

54
Q

what is the tx for a tinea infection in the hair?

A

Griseofulvan x 4 weeks

55
Q

Child has cold symptoms x 14 days w/out improvement which include nasal congestion, facial pain, HA, fever. What is your dx?

A

sinusitis

56
Q

how do you tx sinusitis?

A

Amoxicillin, cephalosporins

57
Q

How do you treat orbital cellulitis?

A

CT to establish extent of infection:

1) oral abx
2) I&D, PRN

58
Q

If child has sore throat accompanied by conjunctivitis, cough, URI symptoms, ulcerative lesions, rash, or diarrhea…what is the most likely cause? How will you treat?

A

Viral, supportive

59
Q

Sudden onset of sore throat with painful swallowing, LAN, petechiae, tonsillar exudate, and a “beefy” uvula is likely caused by what? How will you treat?

A

strep, PCN or cephalosporin

60
Q

Child presents with clear nasal d/c, sore throat, fever x 4 days. What is the most likely dx? how will you tx?

A

viral rhinitis, tx symptoms w/ Tylenol/ibuprofen. Edu parents this will last about 7 days. (>10 days = sinusitis)

61
Q

Infants can have subluxation of nasal septal cartilage during birth. Why must you identify this?

A

Causes hematoma that leads to septal necrosis. (RFL to ENT)

Pediatrics (9 decks)

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