Pediatrics 2

Question 1

Pt age ≤ 28 days and with sepsis (E.coli, GBS)

Answer 1

Ampicillin + gentimicin
OR
cefotaxime

Question 2

Pt age > 28 days and with sepsis (S. pneumo, N. meningitidis)

Answer 2

Ceftriaxone
OR
cefotaxime
+/- vancomycin (when meningeal involvement suspected)

Question 3

Meningitis Empiric Tx

Answer 3

Vancomycin + either cetotaxime or ceftriaxone

Question 4

Viral Causes of Meningitis in Kids

Answer 4

Mumps/Measles
HSV -2 and HSV -1
Enteroviruses (Coxsackie and Echo virus) and Arbovirus

Question 5

Chemo PPX for N. meningitis and HiB

Answer 5

Rifampin

No PPX for S. pneumo

Question 6

Vesicles and ulcers in anterior oral mucosa

Answer 6

Aphthous Stomatitis (canker sores) --> no fever 
Herpes Gingivostomatitis (from HSV -1) --> has fever

Question 7

Vesicles and ulcers in posterior oral mucosa

Answer 7

Herpangina (Coxsackie Grp A virus) –> has fever, sore throat, drooling, no LNs
Part of Hand-Foot-Mouth Disease
Tx: spontaneous resolution; prevent with hand washing

Question 8

Children w/ FHx of High Cholesterol or CAD

Answer 8

Family member with premature CAD = fasting lipid profile directly

Family member has total cholesterol >240 –> child gets random cholesterol (start at age 2; never before)

• random cholesterol < 170 = repeat in 5 yrs
• random cholesterol > 200= do fasting lipid profile

Question 9

Toxoplasmosis Features (3)

Answer 9

hydrocephalus
chorioretinitis
intracranial calcifications (ring-enhancing)

Question 10

Toxoplasmosis Tx

Answer 10

pyrimethamine + sulfadiazine + folate

Question 11

Rubella Congenital Features (3)

Answer 11

PDA
sensorineural hearing loss
cataracts
blueberry muffin spots (starts on face; no palms/soles)

AVOID GETTING PREGNANT FOR 4 WKS AFTER RUBELLA VACCINE

Question 12

Rubella Child Features (6)

Answer 12

3 C’s:

• conjunctivitis
• coryza
• cervical LN

Fever, rash (starts on face), Forscheimer spots (on soft palate)

Question 13

Rubella Adults Features

Answer 13

Same SXs as child + arthralgias/arthritis

Question 14

CMV Features (5)

Answer 14

Microcephaly 
Chorioretinitis
Periventricular calcifications 
Petechiae from low PLTs 
Sensorineural hearing loss

TX: ganciclovir

Question 15

Syphilis Features (8)

Answer 15

Osteochondritis and periostitis 
Rash on palms/soles 
Snuffles (bld tinged nasal secretions)
Hutchinson teeth
8th N plasy 
saddle node
saber shins 

TX: IV PCN

Question 16

Varicella Congenital Features (4)

Answer 16

Limb hypoplasia
Cutaneous scars (skin scarring)
seizures
mental retardation

Question 17

Varicella Neonate Feature (1)

Answer 17

PNA

Question 18

Varicella Adult Feature (1)

Answer 18

PNA

Question 19

Varicella Child Features

Answer 19

Highly itchy lesions (begins on face) –> tear drop vesicles
Fever, malaise

Question 20

Rubeola/Measles Child Features (Paramoxyvirus)

Answer 20

3 C’s:

• cough
• conjunctivitis
• coryza

Koplik spots (gray macules on buccal mucosa) 
Rash (spares palms/soles) --> DARKER THAN RUBELLA 

TX: Vitamin A; prevent w/ vaccination

Question 21

Fifth Disease/Erythema Infectiosum (Parvovirus B19) Child Features

Answer 21

Fever and URI –> then Rash (slapped cheek appearance)

Question 22

Fifth Disease/Erythema Infectiosum (Parvovirus B19) Congenital Features (2)

Answer 22

Severe anemia

Hydrops fetalis

Question 23

Roseola (Herpes virus 6 and 7) Features

Answer 23

Fever and URI –> diffuse Rash (rash only comes when fever decreases)

Question 24

Mumps (Paramyxovirus –> same virus as Measles) Features

Answer 24

Fever –> then parotid swelling w/ orchitis