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Pediatrics Flashcards

1
Q

At delivery, give newborns…

A
  • 1% silver nitrate or 0.5 erythromycin ophthalmic ointment

- 1mg of Vitamin K to prevent hemorrhagic disease

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2
Q

Before discharge, one should do the following:

A
  • Perform hearing tests to r/o congenital sensorineural hearing loss
  • Order neonatal screening tests
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3
Q

Neonatal screening tests

A
  • Phenylketonuria
  • Galactosemia
  • Hypothyroidism
    • best done after 48 hrs
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4
Q

APGAR Score

A
  • measure of the need and effectiveness of resuscitation
  • 1 minute score gives idea of what was going on during labor and delivery
  • 5 minute score gives an idea of response to therapy
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5
Q

Mongolian Spots

A
  • blue/gray macules on presacral back/posterior thighs
  • usually fade in first few years
  • must r/o child abuse
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6
Q

Erythema toxicum

A
  • firm, yellow white papules/pustules with erythematous base, which peak on 2nd day of life
  • usually self limited
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7
Q

Port wine stain (Nevus flamus)

A
  • permament, unilateral vascular malformation on head and neck
  • associated with Sturge Weber syndrome (AV malformation results in seizures, mental retardation and glaucoma
  • can give pulsed labor therapy
  • If Sturge Webser, evaluate for glaucoma and give anticonvulsives
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8
Q

Hemangioma

A
  • red sharply demarcated raised lesions appearing in first 2 months, rapidly expanding then involuting by 5-9 yrs
  • consider underlying organ involvement with deep hemangiomas
  • if it involves larynx, can cause obstruction
  • may cause high cardiac output when large
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9
Q

Tx of hemangioma

A
  • treat with steroids or pulsed laser therapy if large or intereferes with organ function
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10
Q

Periauricular tags/pits

A
  • associated with hearing loss
  • genitourinary abnormalities
  • further evaluate with hearing test and U/S of kidneys
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11
Q

Coloboma of the iris

A
  • defect in the iris
  • associated with CHARGE syndrome
  • make sure to screen for CHARGE syndrome
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12
Q

CHARGE syndrome

A
  • Colonoma
  • Heart defects
  • Atresia of the nasal choanae, growth
  • Retardation
  • Genitourinary abnormalities
  • Ear abnormalties
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13
Q

Aniridia

A
  • absence of the iris
  • associated with Wilms’ tumor
  • screen for Wilms’ tumor with abdominal U/S q3 months until age 8
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14
Q

Branchial cleft cyst

A
  • mass lateral to midline
  • remnnt of embryonic development associated with infxns
  • tx with surgical removal
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15
Q

Thyroglossal duct cyst

A
  • mass midline that moves with swallowing
  • associated with infections
  • may have thyroid ectopia
  • tx with surgical removal
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16
Q

Omphalocele

A
  • GI tract protrusion through umbilicus WITH sac
  • caused by failure of GI sac to retract at 10-12 weeks
  • associated with malformations and chromosomal disorders
  • screen for trisomies 13, 18, and 21
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17
Q

Gastrochisis

A
  • abdominal defect lateral to midline WITHOUT sac

- associated with intestinal atresia

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18
Q

Umbilical hernia

A
  • congenital weakness where vessels of fetal and infant umbilical cord exited through rectus abdominal muscle
  • associated with congenital hypothyroidism
  • screen with TSH
  • may close spontaneously (usually by 2)
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19
Q

Hydrocele

A
  • scrotal swelling, transillumination
  • associated with inguinal hernia
  • must differentiate from inguinal hernia
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20
Q

Undescended testes

A
  • unilateral absences in scrotal sac
  • associated with malignancy if > 1 yr of age
  • tx with surgical removal
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21
Q

Hypospadias

A
  • urethral opening on ventral surface
  • associated with other GU abnormalities (MCC is undescended testes and inguinal hernia)
  • DO NOT CIRCUMCISE
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22
Q

Epispadias

A
  • urethral opening on DORSAL side of penis
  • associated with urinary incontinence (form of urinary exstrophy)
  • tx with surgical evaluation for bladder exstrophy
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23
Q

Inguinal hernia

A
  • usually indirect
  • inguinal bulge or reducible scrotal swelling
  • tx with surgery
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24
Q

Pt is 9.5lb newborn who is jittery. Pregnancy complicated by prolonged delivery w/ shoulder dystocia. PE shows large plethoric infant who is tremulous. Pan-systolic murmur is heard. What’s most appropriate diagnostic test?

A

Blood glucose

- Child is likely infant of diabetic mother

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25
Q

Newborns of diabetic mothers

A
  • Look for macrosomia (enlarged organs)
  • Hx of birth trauma and cardiac abnormalities
  • tx with glucose and small, frequent meals
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26
Q

Lab abnormalities: infant of diabetic mother (IODM)

A
  • Hypoglycemia (after birth)
  • Hypocalcemia
  • Hypomagnesmia
  • Hyperbilirubinemia
  • Polycythemia
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27
Q

IODM associated with which cardiac and GI abnormalities?

A
  • ASD
  • VSD
  • Truncus arteriosus
  • Small left colon syndrome (abdominal distention)
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28
Q

IODM is associated with what risks for child?

A

Increased risk of developing diabetes and childhood obesity

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29
Q

Newborn is in respiratory distress. Best initial therapy?

A

Chest X-ray

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30
Q

Other diagnositic tests to consider in newborn in resp distress?

A
  • ABG
  • Blood cx (r/o sepsis)
  • Blood glucose (r/o hypoglycemia)
  • CBC (r/o anemia or polycythemia)
  • Cranial U/S (intracranial hemorrhage)
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31
Q

Best initial treatment for newborn in respiratory distress?

A
  • Oxygen: keep SpO2 > 95%
  • Give nasal CPAP if high oxygen requirements to prevent barotrauma and bronchopulmonary dysplasia
  • Consider empiric abx for suspected sepsis
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32
Q

If newborn in respiratory distress is still hypoxic with oxygen therapy, next cause?

A

Evaluate for cardiac causes

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33
Q

Clinical fx of premature neonate in respiratory distress

A
  • Tachypnea
  • Nasal grunting
  • Intercostal retraction within hours of birth
  • HYPOXEMIA
  • Eventually hypercarbia and respiratory acidosis develop
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34
Q

Best initial diagnositc test for newborns in respiratory distress?

A

CXR: ground glass appearance, atelectasisa, air bronchograms

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35
Q

Most accurate test for respiratory distress :

A

Lecithin-sphingomyelin (L/S) ration on amniotic fluid prior to birth

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36
Q

Best initial treatments for newborn in respiratory distress?

A

Oxygen and nasal CPAP

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37
Q

Most effective treatment for newborn in respiratory distress?

A

Exogenous surfactant adminitstration (proven to decrease mortality)

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38
Q

Primary prevention of newborn RDS

A
  • Antenatal betamethasone: most effective if > 24 hrs before delivery and < 34 gestations
  • Avoid prematurity: give tocolytics
  • Postnatal corticosteroids do not help and are not indicated
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39
Q

Complications of newborn RDS

A
  • Retinopathy of prematurity 2/2 hypoxemia
  • Bronchopulmonary dysplasia 2/2 prolonged high-concentration oxygen
  • Intraventricular hemorrhage
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40
Q

If fetus is in danger of preterm delivery < 34 weeks, next step?

A

Give corticosteroids

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41
Q

Transient Tachypnea of the Newborn (TTN)

A
  • presents as tachypnea after a term birth of infant delivered by Cesarean section or rapid second stage of labor
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42
Q

Diagnostic test for TTN

A

Perform CXR to look for:

  • air trapping
  • fluid in fissurs
  • perihilar streaking
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43
Q

Best initial treatment for TTN

A

Oxygen (minimal requirements need) results in rapid imporovement within hours to days

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44
Q

Birth weight

A
  • normally doubles by 6 months

- triples by 1 year

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45
Q

Height percentile

A
  • at 2 years of age normally correlates with final adult height
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46
Q

Best indicator for acute malnutrition

A

Weight/height < 5th percentile

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47
Q

Best indicator for under- or overweight

A

BMI

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48
Q

Skeletal maturity

A
  • correlates with sexual maturity (less related to chronological age)
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49
Q

Most common cause of failure to thrive in all age groups

A

Psychosocial deprivation

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50
Q

Ddx: Low weight gain&raquo_space; Low length/height

A
  • Undernutririon
  • Inadequate digestion
  • Malabsorption (infxn, celiac disease, cystic fibrosis, disaccharide deficiency, protein-losing enteropathy)
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51
Q

Workup: low weight gain&raquo_space; decreased length height

A
  • Assess caloric intake
  • Perform stool studies for fat
  • Perform sweat chloride test
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52
Q

Ddx:

Normal weight Low length/height

A
  • Growth hormone or thyroid hormone deficiency
  • Excessive cortisol secretion
  • Skeletal dysplasia
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53
Q

Workup: for normal weight, low length/height

A

-Growth hormone deficiency
- IGF-1 and IGF-binding protein
Thyroid hormone
- TSH, free T4, free T3
Cushings
- 24 hr urinary cortisol or free cortisol
Bone age (X-ray of hand and wrist)
- Skeletal dysplasia: no delay in bone age and disproportionate bone length on exam

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54
Q

Meconium aspiration

A
  • severe respiratory distress and hypotexmia and TERM neonate with hypoxia or fetal distress in utero
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55
Q

Meconium aspiration: Diagnosis

A 
Chest X Ray
Look for:
- patchy infiltrates
- increased AP diameter
- flattening of diaphragm
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56
Q

Meconium aspiration: treatment

A
  • Positive pressure ventilation
  • High frequency ventilation
  • Nitric oxide therapy
  • Extracorporeal membrane oxygenation
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57
Q

Meconium aspiration: prevention

A

Endotracheal intubation and airway suction for depressed infants

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58
Q

Possible complictations of meconium aspiration

A
  • Pulmonary artery hypertension
  • Air leak (pneumothorax, pneumomediastinum)
  • Aspiration pneumonitis
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59
Q

Diaphragmatic Hernia

A

severe respiatory distress and scaphoid abdomen (distress related to pulmonary hypoplasia)

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60
Q

Diaphragmatic Hernia: Diagnostic Testing

A

Chest X-ray

- look for loops of bowel visible in the chest

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61
Q

Diagphramatic Hernia: Treatment

A

Immediate intubation (may require extramembrane corporeal oxygenation), followed by surgical correction

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62
Q

Meconium plugs

A

presents initially as intestial obstruction

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63
Q

Meconium plugs associated with the following conditions

A
  • Small left colon in IODM
  • Hirschsprung disease
  • Cystic fibrosis
  • Maternal drug abuse
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64
Q

Meconium ileus: associated w/ which conditions?

A

Cystic fibrosis

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65
Q

Best diagnotic test for meconium plug or meconium ileus

A

Abdominal X-ray

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66
Q

Meconium plug/ileus: treatment

A

Gastrografin enema

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67
Q

Newborn is born by normal vaginal delivery w/o complications. There is no RDS. Upon first feed, he is noted to have prominent drooling: he gags and develops RDS. CXR shows infiltrate on the lung. Which of the following best confirms the diagnosis?

A

Nasogastric tube placement

- Pt has tracheoesophageal fistula

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68
Q

Premature infant is born by normal vaginal delivery w/o complications. There is no RDS. Upon her first feed, she begins vomiting gastric and bilious material. CXR show “double bubble. Most likely diagnosis?

A

Duodenal atresia

  • associated w/ Downs syndrome
  • treat w/ nasogastric decompression and surgical correction
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69
Q

VACTERL abnormalities

A 
Vertebral defects 
Anal atresia
Cardiac abnormalities
Tracheoesophageal fistula
Radial and renal anomalities 
Limb Syndrome
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70
Q

Ddx: Double bouble seen on CXR

A
  • Duodenal atresia
  • Annular pancreas
  • Malrotation
  • Volvulus
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71
Q

Necrotizing Enterocolitis

A
  • premature infant with low APGAR scores, bloody stools, apnea, and lethargy when feeding is started
  • abdominal wall erythema and distention are signs of ischema
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72
Q

Best initial test for necrotizing enterocolitis?

A

Abdominal X-ray

** pneumatosis intestinalis is pathognomonic

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73
Q

Intial therapy for necrotizing enterocolitis

A
  • Stop all feeds
  • Decompress the gut
  • Begin broad spectrum abx
  • Evaluate for surgical resection
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74
Q

Best initial test if infant fails to pass meconium

A

Rectal exam

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75
Q

Newborn fails to pass meconium on own however with DRE, patient passes large volume of stool. Suspected dx?

A

Hirschsprung

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76
Q

If newborn fails to pass meconium. How should one proceed?q

A
  1. Digital rectal exam
  2. Barium enema (look for megacolon proximal to obstruction)
  3. Rectal biopsy
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77
Q

Best confirmatory test for Hirschsprung disease

A

Rectal biopsy ( tlook for absent ganglionic cells)

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78
Q

Hirschsprung disease: treatment

A

Surgical resection

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79
Q

If newborn fails to pass meconium and DRE shows absent anal opening. What’s the treatment?

A

Imperforate anus

- surgical treatment is best treatment

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80
Q

When is hyperbilirubinemia considered pathological ?

A
  1. On the first day of life
  2. Bilirubin > 5mg/dL/day
  3. Bilirubin > 12mg/dL in term infant
  4. Direct bilirubin > 2 mg/dL at any time
  5. Hyperbilirubinemia is present after 2nd week of life
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81
Q

Hyperbilirubinemia in 3 week old infant

A
  • Total and direct bilirubin
  • Blood type of infant and mother: Look for ABO or Rh incompatibility
  • Direct Coombs’test
  • CBC, reticulocyte count, and blood smears: Assess for hemolysis
  • Urinalysis and UCx if elevated direct bilirubin: assess for sepsis
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82
Q

Most feared complication of jaundice (2/2 to elevated indirect bilirubin)

A

Kernicterus
- Indirect bilirubin can cross BBB, deposit in basal ganglia and brainstem nuclei
-

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83
Q

Kernicterus: Sx

A
  • Jaundice
  • Hypotonia
  • Seizures
  • Opisthotonos
  • Delayed motor skills
  • Choreaoathetosis
  • Sensineural hearing loss
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84
Q

Kernicterus: Treatment

A

Immediate exchange transfusion

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85
Q

If prolonged jaundice (> 2 weeks) workup w/ no elevated of indirect bilirubin, consider the following diagnoses:

A
  • UTI or other infxn
  • Bilirubin conjugation syndromes (e.g. Gilbert, Crigler-Najjar)
  • Hemolysis
  • Intrinsic red cell membrane or enzyme defects (e.g. spherocytosis, G6PD deficiency)
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86
Q

If patient has prolonged jaundiced with elevation of conjugated bilirubinemia. What’s most likely diagnosis?

A

Cholestasis

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87
Q

Best initial test for suspected cholestasis

A

Liver function tests

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88
Q

Most specific test for cholestasis

A

Ultrasound and liver biopsy

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89
Q

Hyperbilirubinemia: Treatment

A

Phototherapy: when bilirubin > 10-12 mg/dL (normally decreases by 2 mg/dL every 4-6 hrs)
Exchange transfusion in any infant with suspected bilirubin encephalopathy or failure of phototherapy to reduce total bilirubin

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90
Q

5 week old infant is brought into the clinic with irritability, weight loss of 3 lbs over the past week and “grunting. PE reveals temperature of 102.5F. There is a bulging anterior fontanel delayed capillary refill. What is the next step of management?

A

Transfer patient to ER and initiate full sepsis workup

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91
Q

Most common cause of early onset sepsis (< 24 hrs) is..

A

Pneumonia

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92
Q

Organisms seen in early onset neonatal sepsis

A

Group B Strep
E.coli
H. influenxa
Listeria monocytogenes

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93
Q

Organisms seen late onset neonatal sepsis

A

S. aureus
E. coli
Klebsiella
Pseudomonas

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94
Q

Neonatal Sepsis: Treatment

A

If no evidence of meningitis, ampicillin and aminoglycoside until 48 to 72 hr cx are negative

If meningitis is possible, ampicillin and 3rd generation cephalosporin (NOT ceftriaxone)

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95
Q

General features of TORCH infections

A
  • intrauterine growth retardation
  • hepatosplenomegaly
  • jaundice
  • mental retardation
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96
Q

Diagnostic workup of TORCH infections

A

Elevated total cord blood IgM

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97
Q

Toxoplasmosis

A

hydrocephalus with generalized intracranial calcifications and chorioretinitis

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98
Q

Toxoplasmosis: Diagnostic Workup

A

IgM against toxoplasmosis

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99
Q

Rubella

A
  • cataracts, deafness, and heart defects

- blueberry muffin spits (extramedullary hematopoeisis)

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100
Q

Rubella: Diagnostic Workup

A

Maternal rubella immune status negative or unknown – obtain IgM against rubella

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101
Q

CMV

A

microcephaly with periventricular calcifications

- petechiae with thrombocytopenia, sensorineural hearing loss

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102
Q

CMV: Diagnostic workup

A

Urine CMV Cx - if negative, excludes CMV

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103
Q

Herpes

A

First week: pneumonia/shock

Second week: skin vesicles, keratoconjunctivitis

Third to Fourth week: acute meningoencephalitis

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104
Q

Herpes: Diagnostic Workup

A

Best initial tests: Tzanck smear/ culture (doesn’t exclude disease if negative)

Most specific test: PCR

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105
Q

Syphillis

A

osteochondritis and periostitis

desquamating skin rash of palms and soles, snuffles (mucopurulent rhinitis)

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106
Q

Syphillis: Diagnostic Workup

A

Best initial test: VDRL screening

Most specific test: IgM-FTA-ABS

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107
Q

Varicella

A

Neonatal: pneumonia

Congenital: Limb hypoplasia, cutaneous scars

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108
Q

Varicella: Diagnostic workup

A

Best initial test: IgM serology

Most specific test: PCR of amniotic fluid

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109
Q

In newborn ICU, an infant is noted to be “jittery” and has repetitive sucking movements, tongue thrusting, and brief apneic spells. Blood counts and chemistries are within normal limits. What is the initial workup of this patient?

A

Ocular deviation and failure of jitteriness to subside with stimulus

This is a seizure (with subtle repetitive movements)

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110
Q

Seizure: Diagnostic Workup

A
  1. EKG
  2. CBC, electrolytes
  3. Amino assay and urine organic acids
  4. Look for infectious causes
    • TORCH infection studies
    • Blood and urine cx
    • Lumbar puncture
  5. U/S of head in preterms
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111
Q

Seizures: Treatment

A

Phenobarbital (initial drug of choice)

If seizures persist, use phenytoin

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112
Q

Neonatal Withdrawal

A

Presents with

  • hyperactivity, irritability
  • diarrhea,
  • poor feeding
  • tachypnea
  • high pitched crying
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113
Q

Withdrawal timing: heroin, amphetamine, cocaine, and alcohol

A

Presents within the first 48 hrs of life

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114
Q

Withdrawal timing: methadone

A

Presents within the first 96 hrs (up to 2 weeks). Drug associated with higher risk of seizures

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115
Q

Infants of addicted mother are at higher risk of following complications

A
  • Low birth weight
  • Intrauterine growth restriction (IUGR)
  • Congenital anomalies (alcohol, cocaine)
  • Sudden infant death syndrome (SIDS)
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116
Q

Complications of mother’s conditions

A
  • Sexually transmitted diseases
  • Toxemia
  • Breech
  • Abruption
  • Intraventricular hemorrhage (cocaine use)
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117
Q

Neonatal withdrawal: Treatment

A

Best initial treatment: opioids (esp if specific prenatal opioid use was known) and phenobarbital

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118
Q

Why do you never give naloxone to an infant born from mother with known narcotics use?

A

It may precipitate sudden withdrawal, including seizures

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119
Q

Fetal defects: Anesthetics

A

Respiratory, CNS depression

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120
Q

Neonate: Barbituates

A

Respiratory, CNS depression

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121
Q

Neonate effects: Magnesium sulfate

A

Respiratory depression

122
Q

Phenobarbital neonate effect

A

Vitamin K deficiency

123
Q

Sulfonamides neonate effect

A

Displaces bilirubin from albumin

124
Q

NSAIDs neonate effect

A

Premature closure of the ductus arteriosus

125
Q

ACE inhibitors neonate effect

A

Craniofacial abnormalities

126
Q

Isotretinoin neonatal effects

A

Facial and ear anomalies

Congenital heart disease

127
Q

Phenytoin neonatal effects

A

Hypoplastic nails
Typical facies
IUGR

128
Q

Diesthylstillbestrol (DES) neonate effects

A

Vaginal adenocarcinoma (clear cell)

129
Q

Tetracycline neonate effect

A

Enamel hypoplasia

Discolored teeth

130
Q

Lithium neonate effect

A

Ebstein’s anomaly

131
Q

Warfarin neonate effect

A

Facial dysmorphism and chrondrodysplasia

132
Q

Valproate/ Carbamezepine neonate effect

A

Mental retardation

Neural tube defects

133
Q

Trisomy 21: Down syndrome

A
  • associated with advanced maternal age (> 35)
  • upward slanting palpebral fissues
  • speckling of iris (Brushfield spots)
  • inner epicanthal folds
  • small stature
  • late fontanel closure
  • mental retardation
134
Q

Trisomy 21: Down syndrome Diagnostic workup

A
  • Hearing exam
  • Echocardiogram: endocardial cushion defect > VSD > PDA, ASD; MVP
  • Gastrointestinal: TEF , duodenal atresia
  • TSH: hypothyroidism
  • With advancing age, risk of ALL and early onset Alzheimer
135
Q

Trisomy 18: Edward syndrome

A
  • low-set, malformed ears
  • microcephaly
  • micrognathia
  • clenched hand: index over 3rd, fifth over 4th
  • rocker bottom fee and hammer te
  • omphalocele
136
Q

Trisomy 18: Edward syndrome - Diagnostic workup

A
  • Echocardiogram: VSD, ASD, PDA
  • Renal U/S: polycystic kidneys, ectopic or double ureter
  • Most patients don’t survive past 1st year
137
Q

Trisomy 13 - Patau syndrome

A
  • defect of midface, eye, and forebrain development
  • holoprosencephaly
  • microcephaly
  • microphthalmia
  • cleft lip/palate
138
Q

Trisomy 13 - Patau syndrome: diagnostic workup

A
  • Echocardiogram: VSD, PDA, ASD
  • Renal U/S: polycystic kidneys
  • Single umbilical artery
139
Q

Aniridia-Wilms’ tumor association (WAGR syndrome)

A
  • Wilms’
  • Aniridia
  • GU anomalies
  • Retardation (mental)
140
Q

WAGR syndrome: diagnostic workup

A

When you see an infant with aniridia, do a complete workup of WAGR syndrome

141
Q

Klinefelter syndrome (XXY) - 1:500 males

A
  • low IQ
  • behavioral problems
  • slim with long limbs
  • gynecomastia
142
Q

Klinefelter syndrome: diagnostic workup

A
  • Testosterone levels: hypogonadism and hypogenitalism

- Replace testosterone at 11 - 12 years of age

143
Q

Turner syndrome (XO)

A
  • sporadic no association with maternal age
  • small stature female
  • gonadal dysgenesis
  • low IQ
  • congenital lympheema
  • webbed posterior neck
  • broad chest, wide spaced nipples
144
Q

Turner syndrome (XO): Diagnostic workup

A
  • Renal U/S: horseshoe kidney, double renal pelvis
  • Cardiac: bicuspid aortic valve, coarctation of aorta
  • Thyroid fxn: primary hypothyroidism
  • Can give estrogen, growth hormone, and anabolic steroid steroid replacement
145
Q

Fragile X syndrome

A
  • fragile site on long arm of X
  • molecular diagnosis: variable # of repeat CGG
  • macrocephaly in early childhood
  • large ears, large testes
  • most common cause of mental retardation in boys
146
Q

Fragile X syndrome: disease association

A

attention deficit hyperactivity syndrome

147
Q

Beckwith-Wiederman syndrome

A
  • IGF-2 disrupted at 11p11.5
  • multiorgan enlargement:
    • macrosomia, macroglossia,
    • pancreatic beta cell hyperplasia (hypoglycemia)
    • large kidneys
    • neonatal polycythemia
148
Q

Beckwith-Wiederman syndrome: disease association

A
  • Increased risk of abdominal tumors

- Obtain ultrasounds and serum AFP every 6 months through 6 years of age to look for Wilms’ tumor and hepatoblastoma

149
Q

Prader-Willi syndrome

A
  • deletion at 15q11q13 paternal chromosome responsible
  • obesity
  • mental retardation
  • binge eating
  • small genitalia
150
Q

Prader-Willi syndrome: disease association

A

decreased life expectancy related to morbid obesity

151
Q

Angelmann syndrome (happy puppet syndrome)

A
  • deletion of 15q11q13 - maternal chromosome
  • mental retardation
  • inappropriate laughter
  • absent speech or < 6 words
  • ataxia and jerky arm movements resembling puppet gait, recurrent seizures
152
Q

Angelmann syndrome: disease association

153
Q

Robin sequence (Pierre Robin)

A
  • associated with fetal alcohol syndrome, Edwards syndrome

- mandibular hypoplasia, cleft palate

154
Q

Robin sequence: diagnostic workup

A

Monitor airway: obstruction possible over 1st 4 weeks of life

155
Q

Ddx: Decreased weight gain = decreased length/height

A

Systemic illness
- Heart failure
- Inflammation (e.g. inflammatory bowel disease)
- Renal insufficiency
- Hepatic insuficiency
Genetic short stature
Constitutional delay in growth and development

156
Q

Decreased weight gain = decreased length/height: workup

A
  • Inflammatory markers (CRP, ESR, CBC w/ diff)
  • Organ dysfunction
  • LFT, creatinine, BUN
  • electrolytes
  • Bone age
  • Genetic short stature: bone age ~ chrono age
  • Constitutional growth delay: bone age is delayed and puberty occurs later
157
Q

Breastfeeding advantages

A
  • Passive transfer of T cell immunity: decreased risk of allergies and GI and respiratory infections
  • Psycho/emotional: maternal- infant bonding
158
Q

Contraindications to breastfeeding

A
  • HIV
  • CMV
  • HSV if lesions on breast
  • Acute maternal disease if absent on infant
  • Breast cancer
  • Substance abuse
  • Drugs
159
Q

Newborn milestones

A
  • Moro, grap, rooting, tonic neck, and placing reflexes: Appear at birth and disappear at 4-6 months
  • Parachute reflex (extension of arms when fall is simulated): Present at 6-8 months and persists
160
Q

9 month milestones:

A

Has pincer grasp
Creeps and crawls
Knows own name

161
Q

12 month milestones

A

Cruises
Says one or more words
Plays ball

162
Q

15 month milestones

A

Builds 3 cube tower
Walks alone
Makes line and scribbles

163
Q

18 month milestones

A

Builds 4 cube tower
Walks down stairs
Says 10 words
Feeds self

164
Q

24 month milestones

A 
Builds 7 cube tower
Runs well
Goes up and down stairs
Jumps with 2 feet
Threads shoelaces
Handles spoon
Says 2-3 sentences
165
Q

36 month milestones

A
  • Walks downstaires alternating feet
  • Rides tricycle
  • Knows age and sex
  • Understands taking turns
166
Q

48 month milestones

A
  • Hops on one foot
  • Throws ball overhead
  • Tells stories
  • Participates in group play
167
Q

4 yr old bory has problems with bedwetting. The mother says that during the day, he has no problems but is usually wet 6 of 7 mornings. He does not report dysuria or frequency and has not increased thirst. the mother also says that he is a deep sleeper. Which of the following is the most appropriate next step in management?

A

Reassure mother bedwetting is normal

- bedwetting before age 5 (before bladder control is anticipated) is normal

168
Q

Enuresis

A
  • involuntary voiding of urine, occurring at least 2x week for at least 3 months in children > 5 years
  • daytime enuresis is more common in girls
  • nocturnal enuresis is more common in boys
169
Q

Best initial diagnostic test for enuresis

A

Urinalysis

170
Q

Enuresis: Diagnostic tests

A
  • Urinalysis
  • Signs of infection: Urine Cx
  • If recurrent UTIs: Bladder/renal U/S or voiding cystourethogram
171
Q

Best initial treatment for enuresis

A

Behavior and motivational therapy

172
Q

Enuresis: Treatment

A
  1. Behavior modification

2. If behavior mods fail, try TCAs, imipramine and desmopression (to decrease urine volume)

173
Q

Encopresis

A
  • intentional or involuntary passage of feces in inappropriate settings (e.g. clothing, onto floor) in children > 4 years
174
Q

Best initial test for encopresis

A

Abdominal X-ray

- distinguishes between retentive and nonretentive

175
Q

Distinguishes between retentive and nonretentive

A

Retentive: associated w/ constipation and overflow incontinence

Nonretentive: associated w/ abuse

176
Q

Encopresis: Treatment

A

Best initial therapies:
- Retentive encopresis: disimpaction, stool softeners, and behavior intervention

  • Nonretentive encopresis: Behavior modification alone
177
Q

Ddx: low weight gain & low length/height

A 
Systemic illness:
- Heart illness
- Inflammation (e.g. IBS or arthritis)
- Renal insufficiency
- Hepatic insufficiency
Genetic short stature 
Constitutional delay in growth and development
178
Q

Workup: low weight gain & low length/height

A 
Inflammatory markers:
- CRP, ESR, CBC with differece
Organ dysfunction
- LFT, Creatinine, BUN
- Creatinine
Bone age
- Constitutional delay of growth
- Genetic short stature
179
Q

Bone age: genetic short stature

A

Bone age is close to chrono age

Puberty occurs at normal age

180
Q

Constitutional delay of growth: bone age

A

Bone age is delayed, and puberty occurs later than most children

181
Q

Immunizations in premature infants or low birth weight

A
  • Don’t delay immunizations - immunize at chrono age

- Don’t dose adjust immunizations

182
Q

Contraindications to live vaccines

A

Immunocompromized patients

183
Q

Non-contraindications to vaccines

A
  • Rxn to previous DPT of temp < 105F, redness, soreness and swelling
  • Mild acute illness in otherwise well child
  • Fam hxof seizures or SIDS
184
Q

Is egg allergy contraindication to MMR?

185
Q

Contraindication to yellow fever vaccine

A

Egg allergy

186
Q

Influenza vaccine concerns

A
  • Egg allergy is no longer contraindication
187
Q

Influenza vaccine protocol in child > 6 months with egg allergy

A 
Give TIV (trivalent inactivated influenzae vaccine) followed by 30 minute observation period in place to recognize and treat anaphylaxis
- those with severe egg allergy should referred to allergy specialist
188
Q

Hep B vaccine: concerns

A
  • doesn’t cause demyelinating neuro disorders
189
Q

Meningococcal vaccination concerns

A
  • doesnt cause development of Guillain Barre
190
Q

Active immunizations after exposure: Measles

A

0-6 mths: immunoglobulins (Ig)
6-12 mths: Ig plus vaccine
> 12 mths: vaccine only within 72 hrs of exposure
Pregnant or immunocompromised: Ig only

191
Q

Varicella immunization after exposure:

at risk children and household contacts

A

VZIG and vaccine

192
Q

Varicella immunization after exposure: pregnant women and women who had varicella (5 days before delivery and 48 hrs after delivery)

193
Q

Hepatitis B immunization after exposure

A

Ig plus vaccine: given at birth, 1 month, and 6 months

194
Q

Mumps and rubella immunization after exposure

A

No post-exposure protection available

195
Q

Hepatitis B vaccine routine w/ HBsAg negative mom

A

1st dose: birth

Total of 3 doses by 18 months

196
Q

Hepatitis B vaccine routine w/ HBsAg positive mom

A

1st dose of hepatitis B vaccine plus HBIg at 2 different sites within 12 hrs of birth. Total of 3 doses by SIX MONTHS

197
Q

DTAP vaccine routine

A

Total of 5 doses is recommeneded before school entry (last dose 4-6 years)

  • pertussis booster given at adolescence
  • Td is given at 11-12 years, then every 10 years
198
Q

HiB conjugated vaccine rotutine

A

Does not cover nontypeable Haemophilus

  • not given after age 5
  • invasive disease does not confirm immunity, patients still require vaccine if < 5
199
Q

Varicella routine

A

associated with development herpes zoster after immunization

200
Q

Meningococcal conjugate vaccine

A
  • given at age 11 - 12 or age 15
  • indicated for all college freshmen living in dorms
  • MPSV4 (menomune) indicated in children aged 2- 10
201
Q

Child Abuse: Dx Test

A 
LAB TESTS: PT, PTT, platelets, bleeding time, CBC
SKELETAL SURVEY:
- Head CT scan +/- MRI
- Ophthalmologic exam
ABDOMINAL TRAUMA:
- Urine and stool for blood
- Liver and pancreatic enzymes
- Abdominal CT Scan
AMS:
- urine toxicology screen
202
Q

Child Abuse: Treatment

A
  1. Always first address medical and/or surgical issues

2. Report issues to CPS

203
Q

Indications for hospitalization in suspected child abuse

A
  • Medical condition requires it
  • Diagnosis unclear
  • No alternative safe place

** if parents refuse, then get emergency court artery

204
Q

Croup: organismss

A

Parainfluenza 1 or 3

Influenza A or B

205
Q

Croup: classic presentation

A

Child age 3 mths to 5 yrs with URTI symptoms
Rhinorrhea, sore throat, hoarseness, BARKING COUGH
INSPIRATORY STRIDOR, tachypnea
symptoms are worse at night

206
Q

Croup: Diagnosis

A

Neck X-ray (not needed for diagnosis)

207
Q

Croup: Management

A
  1. Humidified oxygen
  2. Nebulized epinepherine and corticosteroids

** Antitussives, decongestants, sedatives or abx are NOT used to treat croup ***

208
Q

Croup: Complications

A

Spontaneous resolution in 1 week

- Always suspect diagnosis of epiglottis

209
Q

Epiglottitis: Bugs

A
  • H. influenzae type B (now less common)
  • S. pyogenes
  • S. pneumoniae
  • S. aureus
  • Mycoplasma
210
Q

Epiglottitis: Classic Presentation

A

Sudden onset, MUFFLED voice, DROOLING, dysphagia, high fever, and inspiratory stridor

** Patient prefers to sit in tripod position. Patient has toxic appearance***

211
Q

Epiglottitis: Diagnosis

A

MEDICAL EMERGENCY!! TX IMPORTANT BEFORE DX!

After stabilization:

  • Neck X-ray (thumb print sign)
  • Blood Cx
  • Nasopharyngoscopy in OR
  • Epiglottic swab cx
212
Q

Epiglottitis: Management

A
  1. Tx to hospital/OR
  2. Consult ENT and anasthesia
  3. Intubate
  4. Give ceftriaxone and steroids
  5. Give rifampin prophylaxis to household contacts if H. influenzae positive
213
Q

Epiglottitis: Complications

A

Airway obstruction and death

214
Q

Bacterial tracheitis: Bugs

215
Q

Bacterial tracheitis: Presentation

A

Brassy cough, high fever, respiratory distress, but no drooling or dysphagia

Child < 3 years after viral URTI

216
Q

Bacterial tracheitis: Diagnosis

A

Clinical plus laryngoscopy

  • CXR: subglottic narrowing plus ragged tracheal air column
  • Blood cx
  • Throat cx
217
Q

Bacterial tracheitis: Management

A

Antistaphylococcus abx

- may require intubation if severe

218
Q

Bacterial tracheitis: complicaitons

A

Airway obstruction

219
Q

Epiglottitis vs croup

A

NO BARKING COUGH with Epiglottitis

220
Q

Diphtheric croup

A
  • rare in North America
  • presents with gray-white pharyngeal membrane
  • may cover soft palate; bleeds easily!
  • Don’t forget that diphtheria is notifiable!
221
Q

Foreign body aspiration

A

look for sudden choking/coughing w/out warning

222
Q

Retropharyngeal abscess

A

patient has drooling and difficulty swallowing

223
Q

Extrinsic compression

A
  • vascular ring
  • patient has continued symptoms and does not improve w/ treatment
  • see similar symptoms with INTRALUMINAL OBSTRUCTION (masses)
224
Q

Angioedema

A
  • due to sudden allergic reaction
  • manage with steroids and epinepherine
  • if severe, intubate for airway protection
225
Q

Pertussis

A

severe cough develops after 1-2 weeks w/ characteristic whoop and spell of cough (paroxysm)
- look for child for incomplete immunization hx

226
Q

Most common site for foreign aspiration: > 1 years

227
Q

Most common site for foreign aspiration < 1 years

A

Trachea or right mainstream bronchus

228
Q

Toddler presents to ER w sudden onset respiratory distress. Mother reports child was w/o symptoms, playing with LEGOS in room w siblings. On exam, patient is drooling and in moderate respiratory distress. Decreased BS on right and intercostal retraction. Next step?

A

Bronchoscopy
- to visualize suspected foreign body and foreign body retrieval

** If significant respiratory distress, then emergency cricothyroidotomy**

229
Q

Bronchiolitis

A
  • RSV (50% of cases)
  • Parainfluenza
  • Adenovirus
  • Other viruses

** results in inflamation, which results ball-valve obstruction results in air trapping and overinflation

230
Q

Bronchiolitis: presentation

A

child < 2 years of age (most severe in children 1-2 months old)

  • mild URI
  • fever
  • paroxysmal wheezing cough
  • wheezing and prolonged expiration
  • dyspnea
  • tachypnea
  • apnea (in young infants)
231
Q

Bronchiolitis: Diagnosis

A

Most clinical

  • CXR
  • Viral antigen testing (IFA or ELISA)
232
Q

Best initial test for bronchiolitis

A

CXR: shows hyperinflation w patchy atelectasis (looks like early pneumonia)

233
Q

Most specific test for bronchiolitis

A

Viral antigen testing (IFA or ELISA) of nasopharyngeal secretions

234
Q

Bronchiolitis: Treatment

A

Supportive only:
- hospitalize if severe tachypnea (> 60/min), pyrexia, and intercostal retractions are present. Give trial of B-agonists

** Steroids are NOT indicated **

235
Q

Bronchiolitis: Prevention

A

In high risk patients, give hyperimmune RSV IVIG or monoclonal Ab to RSV F protein (palivizumab)

** High risk pts: bronchiopulmonary dysplasia and preterm**

236
Q

Best prevention against bronchiolitis:

A

Breastfeeding

- colostrum is particularly rich in IgA and protects against bronchiolitis

237
Q

Viral pneumonia

A

Most common cause in < 5 years. Most commonly RSV

  • URI symptoms
  • Low grade fever
  • Tachypnea (most consistent finding)
238
Q

Bacterial pneumonia

A 
Most common cause in > 5 years. 
common bugs: S. pneumoniae, M. pneumoniae, C. pneumoniae
- Acute onset, sudden, shaking chills
- High fever
- Prominent cough
- Pleuritic chest pain
- Markedly inflated diminished breath sounfs
- Dullness to percussion
239
Q

Chlamydia trachomatis

A
  • infants 1-3 months of age w/ insidious onset (usually > 3 weeks)
  • no fever or wheezing (distinguishes from RSV +/- conjunctivitis at birth
  • Classic findings: STACCATO COUGH and PERIPHERAL EOSINOPHILS
240
Q

Pneumonia: Diagnostic Tests

A
  • CXR
  • CBC with differential
  • Viral antigens: IgM titers for mycoplasma
  • Blood cx
241
Q

Viral pneumonia: diagnosis

A
  • CXR: hyperinflation w/ b/l interstitial infiltrates and peribronchial cuffinnd
  • CBC w/ differential has WBC < 20,000
  • viral antigens: IgM titers for mycoplasma
  • Blood cx
242
Q

Bacterial pneumonia: diagnosis

A

CXR: confluent lobar consolidation
CBC has WBC 15,000 - 40,000
Blood cx

243
Q

Mycoplasma/Chlamydia pneumonia findings on CXR

A

Unilateral lower-lobe interstitial pneumonia; looks worse than presentation

244
Q

Mild pneumonia (outpatient): treatment

A

Amoxicillin

- alternatives: cefuroxime and amoxicillin/clavulanic acid

245
Q

Pneumonia (hospitalized): treatment

A

IV cefuroxime

- If S. aureus, add vancomycin

246
Q

Viral pneumonia:

A

Withhold antibotics unless child deteriorates (as may have co-existing bacterial infection)

247
Q

Chlamydia/mycoplasma: treatment

A

Erythromycin or other macrolide

248
Q

3 y.o white female presents with rectal prolapse. Noted to be

A

Sweat chloride test

- best initial test for cystic fibrosis

249
Q

Most common initial presentation for cystic fibrosis

A

Meconium ileus

- look for abdominal distention at birth, failure to pass meconium, and bilious vomiting

250
Q

Cystic fibrosis: presentation

A
  • Meconium ileus
  • Failure to thrive (from malabsorption, steatorrhea)
  • Rectal prolapse
  • Persistent cough in 1st year of lige
251
Q

Conditions associated with cystic fibrosis

A
  • Infertility (absent vas deferens)

- Allergic bronchopulmonary aspergillosis

252
Q

Conditions associated with cystic fibrosis

A
  • Infertility (absent vas deferens)

- Allergic bronchopulmonary aspergillosis

253
Q

Cystic fibrosis: diagnostic testing

A
  • 2 elevated sweat chloride concentrations (> 60 mEq/L) obtained on separate days
  • Genetic testing
  • Newborn screening (immunoreactive trypsinogen in blood spots and then confirm w/ DNA or sweat testing)
  • CXR shows course and exacerbation
  • PFTs (done > 5 yrs to eval disease progression)
254
Q

Cystic fibrosis

A

Supportive treatment includes:

  • aerosol treatment
  • albuterol/saline
  • chest physical therapy w/ postural drainage
  • pancrelipase (aids digestion in patients w/ pancreatic dyfynction)
255
Q

Ivacaftor (VX-770)

A
  • restores function of mutant CF protein
  • recommended for patients > 6 years who have at least one copy of the G551D mutation
  • decreases sweat chloride levels, improve FEV1, pulmonary symotoms and exacerbation and improve weight gain
256
Q

Cystic fibrosis treatments: shown to improve survival

A
  • Ibuprofen: reduces inflammatory lung response
  • Azithromycin: slow rate of decline in FEV1 in pts < 13 yrs
  • Antibiotics: during exacerbations delay progression of lung fisease
257
Q

Cystic fibrosis management considerations

A
  • Give routine vaccine PLUS pneumococcal and yearly flu vaccine
  • Never delay abx
  • Steroids improve PFTs in short term, but no persistent benefit when steroids are stopped
  • Expectorants (guaifenesin or iodides) are not effective in removal of respiratory secretions
258
Q

Abx to treat mild CF

A

Give macrolide, trimethoprim-sulfamethoxaxole (TMP-SMX) or ciprofloxacin

259
Q

Abx to treat CF with documented infection w/ Pseudomonas or S. aureus

A

Treat aggressively w/

piperacillin plus tobramycin or ceftazidime

260
Q

Abx to treat CF with resistant pathogen:

A

Use inhaled tobramycin

261
Q

Most common symptom of acyanotic defect

A

Congestive heart failure

262
Q

Most common acyanotic lesions are these:

A
  • VSD, ASD
  • AV canal
  • Pulmonary stenosis
  • PDA
  • Aortic stenosis
  • Coarctation of aorta
263
Q

Primary concern for infants w/ cyanotic defects

264
Q

Common defects associated cyanosis in infants

A

Tetralogy of Fallot

Transposition of great arteries

265
Q

Congenital heart disease: common presentation

A

Shock, tachypnea, and cyanosis (esp if fever is absent)

- do not respond to oxygen

266
Q

Congenital heart disease: infants

A
  • Feeding difficulty
  • Sweating while feeding
  • Rapid respiration
  • Easy fatigue
267
Q

Congenital heart disease presentation in older children

A

Dyspnea on exertion
Shortness of breath
Failure to thrive

268
Q

Congenital heart disease: abnormalities on exam

A
  • Upper exam HTN or decreased lower extremity blood pressures
  • Decreased femoral pulses ( obstructive lesions on left heart)
  • Facial edema, hepatomegaly
  • Heart sounds: Pansystolic murmur, grade 3/6 murmur, PMI at upper left sternal border, harsh murmur, early midsystolic click, abnormal S2
269
Q

When is murmur innocent?

A
  • If question includes: fever, infection, or anxiety
  • When it is only systolic (never diastolic)
  • When it is < grade 2/6
270
Q

Best initial test for congenital heart disease

A

CxR and EKG

  • increased pulmonary vascular markings suggest:
    • Transposition of the great arteries
    • Hypoplastic left heart syndrome
  • Truncus ateriosus
271
Q

Most specific test for congenital heart disease

A

Echocardiography

272
Q

Ventricular septal defect

A
  • harsh holosystolic murmur over LLSB +/- throll
  • Loud pulmonic S2
  • almost half of cases have spontaneous closure w/in the 6 months
  • surgical repair if FTT, pulmonary HTN or right to left shunt > 2:1
273
Q

Atrial septal defect

A

Loud S1, wide fixed splitting of S2, systolic ejection murmur along LUSB

  • majority are asymptomatic, secundum types, and close by age 4
  • primary and sinus types require surgery
  • PFO needs to be closed if clot goes through it
274
Q

Late complications of ASD

A
  • Mitral valve prolapse
  • Dysrhythmias
  • Pulmonary hypertension
275
Q

Atrioventricular canal

A
  • combination of primum type of atrial septal defect, ventricular septal defect, and common atrioventricular valve
  • presentation similar to VSD
  • perform surgery in infancy BEFORE pulmonary hypertension develops
276
Q

Pulmonary stenosis

A
  • may be asymptomatic or may result in severe congestive heart failure
  • give prostaglandin E1 influsion at birth
  • attempt balloon valvuloplasty
277
Q

Patent ductus arteriosus

A
  • more common in girls (2:1), babies where maternal rubella infection was present and premature infants
  • WIDE PULSE PRESSURE, bounding arterial pulses, and machinery sounds
  • indomethacin-induced closure helpful in premies
  • term infants require surgical closure
278
Q

Aortic stenosis

A

early systolic ejection click at apex of LSB

valve replacement and anticoagulation may be required

279
Q

Coarctation of the aorta

A
  • 98% occur at origin of left subclavian artery
  • blood pressure higher in arms than legs, bounding pulses in arms and decreased pulses in legs
  • Ductus dependent: give PGE1 infusion to maintain patent ductus
    Surgery repair after stabilization
280
Q

Tetralogy of Fallot

A
  • most common CHD beyond infancy
  • defects include pulmonary stenosis, RV hypertrophy, overiding aorta, VSD
  • substernal RV impulse and systolic thriil along LSB
  • intermittent hypernea, irritability, cyanosis w/ decreased intensity of murmur
281
Q

Tetralogy of Fallot: Treatment

A

Give oxygen, B-blocker, PGE1 infusion for cyanosis present at birth
- Surgical repair at 4 - 12 months

282
Q

Transposition of the great arteries

A

Most common cyanotic lesion presenting in immediate newborn

  • more common in diabetic moms
  • S2 usually single and loud, murmurs usually absent
  • Ductus dependent: Give PGE1 to keep ductus open
  • Definitive surgical switch of aorta and pulmonary artery ASAP
283
Q

Abx prophylaxis and prevention of endocarditis

A

Abx is required prior to dental procedures if:

  • prosthetic valves
  • previous endocarditis
  • congenital heart disease (unrepaired or repaired w/ persistent defect)
  • cardiac transplantation pts w/ cardiac valve abnormalities
284
Q

When to begin HTN checking in children

A

Start at age 3 (check all extremities)

285
Q

Always workup for secondary HTN if newborn

A
  • has umbilical artery catheters leads to renal artery/vein thrombosis
286
Q

Always workup for secondary HTN in early childhood if

A

Renal parenchymal disease
Coarctation
Endocrine
Medications

287
Q

Workup secondary HTN for adolescents if

A

Essential hypertension is associated w. obsesity

  • evaluate for renal and renovascular hypertension
  • majority of causes due to UTI (2/2 obstruction), acute glomerulonephritis, HSN, HUS, ATN, renal trauma
288
Q

Hypertension: Diagnostic Testing

A
  • CBC, UA, UCx, BMP
  • Lipid panel w/ essential hypertension and positive family hx
  • Echocardiogram
289
Q

Kidney evaluation for hypertension

A
  • Renal ultrasound
  • Voiding cystourethrogram (if there is a hx of repeated UTIs esp < 5 years
  • 24 hr urine colleciton for protein excretion and creatinine clearance
  • Plasma renin activity (PRA) for renovascular and renal disordes
290
Q

Endocrine causes of hypertension

A
  • Urine and serum catecholamines (if pheochromocytoma suspected)
  • Thyroid and adrenal hormone levels
  • Drug screening (in adolescents), if drug abuse is suspected
291
Q

Treatment: peds pt with HTN and is obese

A

Lifestyle modifications (e.g. weight control, aerobic exercise, no salt diet, monitoring BP)

** If no response to life mods, give anti-BP meds

292
Q

Best initial HTN medications:

A

Diuretic or B-blocker

- add calcium channel blocke and ACE inhibitor

293
Q

Most common cause of acute diarrhea in peds patietns

294
Q

Most common causes of bloody diarrhea in peds patients

A
  • Campylobacter
  • Amoeba (E. histolytica)
  • E. coli
  • Salmonella
295
Q

Best initial test for acute diarrhea

A
  • Stool cultures: ( look for blood, leukocytes, HUS)
  • C. diff toxin if recent hx of abx
  • Ovum and parasites
296
Q

Best initial therapy for acute diarrhea

A
  • Hydration and fluid and electrolyte replacement

* don’t use antidiarrheals in children

297
Q

Shigella: tx

298
Q

Campylobacter: tx

A

Self limiting

  • erythromycin speeds recovery and reduces carriet sates
  • recommended for patietns w/ severe disease or dysentery
299
Q

Salmonella: tx

A

Indicated only for patients < 3 months old, who are toxic, who have disseminated disease, or who have S. typhi

300
Q

C. difficile: tx

A

Metronidazole (Flagyl) or PO vancomycin and discontinuation of other antibiotics

301
Q

E. histolytica or Giardia: tx

A

Metronidazole

First AId 2CK (22 decks)

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