Pediatrics

Question 1

What are the 4 criteria for Septic arthritis in children?

What are the next steps of action?

Answer 1

Kocher criteria:

1. Non-weight-bearing
2. Fever >38.5C (101.3)
3. ESR > 40 mm/hr or CRP >2mg/dL
4. Leukocytosis

Tx: Joint aspiration, Parenteral Abx

Question 2

What is the typical pathogen involved w septic arthritis

Answer 2

Age <3Mo: S. aureus, GBS, Gram - bacilli

Age >3Mo: S. aureus, GAS

Question 3

How does congenital hypothyroidism present? How is it managed?

Answer 3

Most infants initially lack clinical signs (maternal T4 crosses placenta) - display decrease physical/mental activity as maternal T4 disappears

-Immediately begin hormonal supplementation (permanent intellectual disability may happen is not immediately begun)

Question 4

What is dx:
1 month old that stops breathing and then takes lots of quick breaths. Occurs many times with in a minute then continues breathing normally.

Answer 4

Periodic breathing - secondary to recurrent central apnea due to immaturity of the nervous system.

Question 5

What is the initial therapy for ADHD in a 4 yr old child?

Answer 5

1. 3-5 yr old = Nonpharmacological intervention

2. >/= 6 - Pharmacotherapy is firstline

Question 6

What is dx:
3 day old w bilious vomiting, abd distention, passed small amount of meconium, no other stool.

Abx xray shows dilated, gas-filled loops of small bowel, absent air fluid levels, ground glass mass in right side of abdomen

Answer 6

Meconium Ileus (may be earliest manifestation of cystic fibrosis)
--ground glass mass = mixing of airbubbles and meconium

Question 7

12 month old about to receive VZV vaccine with immunosuppressed sister.

What should you do?

Answer 7

Vaccine should be administered, but child should be monitored for rash (<10%) which may be potentially contagious to immunocompromised

Question 8

What is the Tx of choice in the outpatient setting of uncomplicated community acquired pneumonia?

Answer 8

High-dose oral amoxicillin

—Atypical = azithromycin

Question 9

What are the empiric antibiotics for neonatal sepsis

1. <28 days old
2. <28 days old

Answer 9

1. Ampicillin + gentamicin or Cefotaxime
   - -E. coli or GBS
2. Ampicillin + Ceftriaxone or Cefotaxime
   - -S. pneumo, N. meningitidis

Question 10

What are the 3 most common bacterial causes of Acute Otitis Media?

Answer 10

1. S. pneumo
2. NONTYPEABLE H. flu - since vaccines, type b is less common
3. Moraxella Catarrhalis - does not cause otitis-conjunctivitis syndrome

Question 11

What is the second line management of epistaxis refractory to putting pressure on the nose?

Answer 11

topical vasocontrictor - oxymetazoline w a squirt bottle or cotton pledget
–topical vasoconstrictors should not be used >3 days in a row

Question 12

What is dx?
5 yr old with sore throat, fatigue, headache, pain with swallowing. Febrile with vesicles on posterior soft palate, no cervical lymphadenopathy

Answer 12

Herpangina - Coxsackie group A virus