Pediatric ID 2 Flashcards
Fever
- defined as
- 3MC cause of FUO
- Common bacterial causes of fever
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
Work up for non-toxic appearing FUO
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.
Work up on toxic appearing FUO
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
Tx non toxic FUO
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.
Tx for FUO toxic
- admit for further tx, pending culture results, administer parenteral abx
- ceftriaxone, cefotaxime, or ampicilling/sulbactam(Unasyn)
Impetigo
- MC in what climates?
- types
- pathophysiology
- dx
- tx
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.
Molluscum Contagiosum
- what is this?
- characteristics of skin lesions
- sx
- transmission
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
Molluscum Contagiosum
- dx
- tx
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.
Pediculosis
- aka
- what is this?
- types
- sx
- PE
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.
Lice Tx
- medication:
- -permethrin cream (Nix)
- -malathion
- -benzyle alcohol
- -spinosad
- -Ivermectin
Scabies
- caused by what parasite?
- pathophysiology of infection
- dx
- tx
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
Urinary Tract Infections
- MC cause
- MC in boys at what age?
- risk factors
- signs and sx
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
UTI
-dx
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
UTI:
- labs
- imaging
- tx
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.
Sepsis:
- what is SIRS?
- what is Sepsis?
- Pathogens
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
Signs and Sx of sepsis
PE findings
Dx
- 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!
Sepsis
Tx
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
Meningitis:
- cause
- sx (make sure to list the triad)
- dx
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)
Meningitis Tx
MAINTAIN ABC’s.
- IV fluids for shock or hypotension
- seizure precautions
- airway protection
- Start abx immediately after LP and blood cultures (vanco + rocephin)
Syphillis
- sx
- stages
- cause
- transmission
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
Congenital syphillis sx:
- newborn
- young infants
- children
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
Syphillis
- dx
- tx
Dx: dark field microscope*
-serologic testing (VDRL and RPR, FTA-ABS)
Tx:
-Penicillin G
Chlamydia
- sx
- labs
- tx
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.
Neisseria Gonorrhea
- sites of infection
- sx
- dx
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.
