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Peds 2 > Pediatric ID 2 > Flashcards

Pediatric ID 2 Flashcards

1
Q

Fever

  • defined as
  • 3MC cause of FUO
  • Common bacterial causes of fever
A

defined as temperature as a rectal temp that exceeds 100.4F.

3 MC causes of FUO:

  • infectious dz
  • CT dz
  • neoplasms

Bacterial:

  • S pneumo** Leading cause of bacterial URI
  • meningitidis
  • h flu type B
  • E coli
  • salmonella
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2
Q

Work up for non-toxic appearing FUO

A

CBC w/ diff

UA by bladder catherterization and urine culture on all males younger than 6 mo and all uncircumcised males younger than 12mo & females younger than 24mo

Rapid testing for viruses

Consider stool sample for WBC counts and guaiac if diarrhea is present.

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3
Q

Work up on toxic appearing FUO

A

CBC w/ diff

Blood cultures

CXR; if tachypnea, retractions, focal auscultatory findings or oxygen sat on RA less than 95%

UA by bladder catherterization/suprpubic aspiration and urine culture on all males younger than 6 mo and all uncircumcised males younger than 12mo & females younger than 24mo

CSF for studies and cultures

Stool sample for WBC & guaiac if diarrhea present

rapid testing for virus

admit pt to hospital

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4
Q

Tx non toxic FUO

A

After thorough work-up pts ages 2-36mo may not require admission; only if they look toxic, just have F/U apt 24-48hrs. Empiric abx therapy is not warranted.

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5
Q

Tx for FUO toxic

A
  • admit for further tx, pending culture results, administer parenteral abx
  • ceftriaxone, cefotaxime, or ampicilling/sulbactam(Unasyn)
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6
Q

Impetigo

  • MC in what climates?
  • types
  • pathophysiology
  • dx
  • tx
A

MC in hot humid climates

Types:

  • nonbullous: MC, staph aureus, GABHS
  • bullous impetigo: S aureus

Pathophysiology: Highly contagious!!!!
-scratching, dematophytosis(ring worm), herpes simplex, scabies, pediculosis(head lice), trauma, insect bites.

Dx:

  • based soley on Hx & clinical appearance
  • labs: gram stain and culture to identify the bacteria

Tx:

  • local wound care
  • abx therapy:
  • -Topical: Mupirocin (Bactroban)
  • -Oral: Cephalexin or Dicloxacillin (1st line), Erythro or clarithro (2nd line); sulfa, clinda, or doxy for MRSA coverage.
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7
Q

Molluscum Contagiosum

  • what is this?
  • characteristics of skin lesions
  • sx
  • transmission
A

What: benign viral infection (poxvirus)

Characteristics: single or multiple rounded dome-shaped pink waxy papules, umbilicated*

Sx: usually asymptomatic, MC on the face, trunk, and extremities in children. Groin and genitalia in adults.

Transmission:
-children sharing bath, athlettes sharing gym equipment, swimming pools, sexual activity

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8
Q

Molluscum Contagiosum

  • dx
  • tx
A

Dx:

  • clinical, if uncertain do bx
  • if adult consider STD workup

Tx:

  • benign neglect: resolve on own in few months
  • direct lesional trauma
  • antiviral therapy: cimetidine
  • Topical therapy: imiquimod, cantharidin
  • cryotherapy w/ curettage
  • Activity: avoid sports, and physical contact between infected areas, sexual abstinence.
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9
Q

Pediculosis

  • aka
  • what is this?
  • types
  • sx
  • PE
A

aka: lice
what: ectoparasites that live on the body and feed on the human blood after piercing the skin.

Types: pediculosis capitus: head lice

pediculosis corporis: body lice

Sx:
-pruritis is MC

PE:

  • observation of Eggs (nits), nymphs, mature lice
  • 2ndry infection from excoriation
  • wood lamp of area (yellow-green flourescence of lice/nits.
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10
Q

Lice Tx

A
  • medication:
  • -permethrin cream (Nix)
  • -malathion
  • -benzyle alcohol
  • -spinosad
  • -Ivermectin
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11
Q

Scabies

  • caused by what parasite?
  • pathophysiology of infection
  • dx
  • tx
A

caused by Sarcoptes scabiei

pathophys: linear burrows at the wrist, ankles, finger webs, axillary folds, genitalia, or face.

Dx:
-scrape unscratched papule and examine microscopically in immersion oil.

Tx:

  • Permethrin creme
  • Ivermectin
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12
Q

Urinary Tract Infections

  • MC cause
  • MC in boys at what age?
  • risk factors
  • signs and sx
A

MC cause e. Coli

MC in boys less than 1 YO.

Risk factors:

  • lack of circumcision
  • caucasion
  • urinary obstruction
  • VUR

Signs and Sx:

  • poor feeding
  • fever
  • failure to thrive
  • vomiting
  • abd pain
  • flank pain
  • frequency, urgency, dysuria
  • suprapubic tenderness
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13
Q

UTI

-dx

A

Dx:

  • Collect urine:
  • -Midstream clean catch: must be toilet trained
  • -Clean Voided Bag collection: noninvasive, NOT used for culture, DO NOT administer abx on basis of a UA from this method.
  • -Bladder cath
  • -Suprapubic bladder aspiration: usally reserved for male in whom cath is difficult and uncircumcised boys with tight foreskin, periurethral irritation
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14
Q

UTI:

  • labs
  • imaging
  • tx
A

Labs:

  • CBC
  • CMP
  • blood cultures
  • renal function studies
  • electrolytes

Imaging:
- not indicated unless recurrent, may get voiding cystourethrogram or renal US

Tx:

  • hospitalize if toxic/septic, urinary obstruction, infants less than 2 w/ febrile UTI, all infants younger than 1 mo with UTI even if not febrile.
  • amoxicillin and bactrim are 1st line.
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15
Q

Sepsis:

  • what is SIRS?
  • what is Sepsis?
  • Pathogens
A

SIRS: systemic inflammatory response syndrome widespread inflamm response that may/may not be associated with infection.

Sepsis:
-SIRS in the presence of suspected or proven infection.

Pathogens:

  • bacteria: Staph, strep, klebsiella, e. coli
  • viruss: RSV and influenza
  • Fungi
  • parasites
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16
Q

Signs and Sx of sepsis

PE findings

Dx

A
  • fever
  • increased HR/tachycardia
  • tachypnea, labored breathing
  • cool extremities
  • color changes

PE findings;

  • hypotension
  • mental status changes
  • anuria
  • hypothermia

Dx:

  • CBC
  • PT,PTT/INR
  • electorlytes
  • renal/liver function tests
  • UA
  • inflamm markers
  • culture blood, urine, CSF
  • serology for viral
  • CXR, US, CT, Echo
  • do US 1st!
17
Q

Sepsis

Tx

A

Tx:

  • fluid resuscitation and support of CO
  • ventilatory support w/ supplemental O2
  • maintenance of Hgb
  • correction of physiologic and metabolic derangements
  • monitor Urine Output
  • Meds:
  • -Newborns/infants
  • –ampicillin and gentamicin/ceftriaxone
  • -Older infants and children:
  • –Ceftriaxone + vancomycin …add clinda if S aureus or GABHS
18
Q

Meningitis:

  • cause
  • sx (make sure to list the triad)
  • dx
A

Cause:

  • bacterial
  • viral
  • fungal
  • parasitic
  • non infectious: cancers, SLE, head injury
Sx: 
Triad of bacterial: fever, HA, neck stiffness
-n/v
-sleepiness 
-irritability 
-delirium

dx:
- CBC w/ diff*
- serum electrolytes
- serum glucose
- BUN or creatinine and liver profile*
- PT/INR, PTT

Blood cultures*, nasopharynx, resp secretion, urine or skin lesion cultures

syphilis testing

LP and CSF analysis

Neuroimaging (CT of head and MRI of brain)

19
Q

Meningitis Tx

A

MAINTAIN ABC’s.

  • IV fluids for shock or hypotension
  • seizure precautions
  • airway protection
  • Start abx immediately after LP and blood cultures (vanco + rocephin)
20
Q

Syphillis

  • sx
  • stages
  • cause
  • transmission
A

Sx:

  • 1st sx is sore on genitals or mouth
  • fever, sore throat, HA, joint pain

Stages:

  • primary: one or more painless sores on
  • 2ndry: copper penny rash on palms and soles.
  • latent: inactive and lies dormant
  • tertiary: severe problems with heart, brain, nerves if not treated.

Cause:
-treponema pallidum

Transmission:

  • sexual contact
  • congenital
21
Q

Congenital syphillis sx:

  • newborn
  • young infants
  • children
A

Newborn:

  • jaundice
  • hepatosplenomegaly
  • edema
  • bulging fontonelle

Young infants:

  • mucocutaneous lesions
  • pseudoparalysis of arms/legs
  • hepatomegaly
  • rash on palms and soles

Children:

  • bilateral interstital keratitis (opacification of cornea)
  • periosteum thickening of tibias
22
Q

Syphillis

  • dx
  • tx
A

Dx: dark field microscope*
-serologic testing (VDRL and RPR, FTA-ABS)

Tx:
-Penicillin G

23
Q

Chlamydia

  • sx
  • labs
  • tx
A

Sx: asymptomatic 75%, may have:

  • dysuria
  • vaginal discharge
  • cervicitis
  • PID
  • epididymitis

Labs:

  • urine specimen
  • culture

Tx:

  • treat pt and partner
  • Doxycyline x 7d OR azithromycin PO once.
24
Q

Neisseria Gonorrhea

  • sites of infection
  • sx
  • dx
A

sites:
- cervix
- urethra
- rectum
- pharynx

Sx:

  • dysuria
  • white/yellow/green discharge
  • painful or swollen testicles

Dx:

  • first catch urine for NAAT
  • Culture (Thayer-Martin Agar)
  • Gram stain

Tx:
-Ceftriaxone IM PLUS Azithro I gram single dose.

25
Q

What is the MC STI?

A

chlamydia

26
Q

Chancroid :

  • cause?
  • sx
  • dx
  • tx
A

Cause:
-haemophilus ducreyi

Sx:

  • 1d -2wks develop small papule in genitals that becomes ulcer.
  • PAINFUL ulcer
  • sharp borders
  • easily bleeds

Dx:
-gram stain

Tx:
-azithromycin 1g single dose OR Ceftriaxone single dose.

27
Q

HPV

  • what types cause genital warts?
  • what type cause cervical cancer?
  • sx
  • dx
  • tx
  • vaccines
A

Genital warts: Types 6 & 11

Cervical dysplasia: 16 & 18

Sx:

  • asymptomatic
  • develop lesion on genitals

Dx:

  • biopsy
  • pap smear

Tx:

  • podofilox
  • trichloroacetic acid
  • cryotherapy
  • laser therapy

Vaccine:

  • Gardasil
  • Gardasil 9
  • Cervarix
28
Q

Herpes:

  • types 1 & 2 lesions located where?
  • signs and sx
  • dx
  • tx
A

Type 1: oral herpes
Type 2 genital herpes

Signs and sx:

  • group vesices on erythematous base*
  • fever and malaise
  • tender regional adenopathy

Dx:

  • cultured vesicles from epithelial sites
  • immunoflourescent stains
  • ELISA

Tx:

  • acyclovir
  • famciclovir
  • valacyclovir

Peds 2 (8 decks)

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