Pediatrics Flash Cards - Case 23 - 15yo lethargy & F

Question 1

Hallmark s/sx of meningitis?

Answer 1

fever, headache, stiff neck, altered mental status, and photophobia

Question 2

Encephalitis in pediatrics is often due to what class of organisms?

Answer 2

Viruses

Question 3

What is the first and most subtle sign of possible inadequate perfusion?

Answer 3

tachycardia

Question 4

Emergency assessment mnemonic?

Answer 4

CABD(D)E: circulation -> airway -> breathing -> disability/dextrose (neuro ∆s/ICP s/sx) -> environment/exposure (expose everything, make sure pt is warm)

Question 5

Brief definition of “shock”?

Answer 5

inadequate delivery of substrates and oxygen to meet the metabolic needs of tissues

Question 6

Early signs of shock in peds?

Answer 6

incr HR & RR, periph BV constriction (-> cool, clammy extremities and delayed cap refill), and decr pulses (d/t vasoconstriction and decr stroke volume). The vasoconstriction can lead to difficulty w/ pulse ox reading.

Question 7

Four categories of shock? Which are most common in kiddos?

Answer 7

distributive (neurogenic & anaphylactic), **septic, hypovolemic, cardiogenic [ = most common in kiddos]

Question 8

Consider starting an IO line in a shocky patient after how many failed peripheral IV attempts?

Answer 8

after 3 failed in 90 secs

Question 9

When you see fever and petechial rash think …?

Answer 9

meningococcal sepsis; also could be: RMSF, TSS, Kawasaki’s disease, scarlet fever

Question 10

Rash and fever seen in RMSF?

Answer 10

classically: rash on palms and soles; maculopapular to petechial; usu starts on wrists/ankles and moves centraly; palms and soles may be late finding

Question 11

Rash and fever seen in TSS?

Answer 11

rash is sandpaper-y and sunburn-looking

Question 12

Rash and fever seen in Kawasaki’s dz?

Answer 12

polymorphic truncal rash -> later periungal peeling of hands and feet; mucocutaneous changes (“strawberry” tongue, red-cracked lips, oral erythema); conjunctivitis; swollen feet/hands; unilateral cerv lymph > 1.5cm

Question 13

Rash and fever seen in scarlet fever?

Answer 13

Rash appears on upper trunk 12-48 hrs after fever onset; becomes confluent/sandpaper-y as it spreads to extremities; fades 4-5 days -> desquamation; Linear petechiae in body folds (Pastia’s sign); pharynx is beefy red and tongue is initially white and rough (strawberry tongue); w/in 4-5 days white coating sloughs off and tongue becomes bright red.

Question 14

Tx w/ pediatric dosing for meningococcemia/ meningococcal meningitis?

Answer 14

Penicilin G: 250,000-300,000 units/kg/day divided every 4-6 hours

Question 15

Adult PenG dosing for meningococcal meningitis?

Answer 15

Penicilin G: 12-24 million units daily divided every 4-6 hours

Question 16

Empiric tx for “sick” patient w/ fever and a rash? What is each antibiotic covering?

Answer 16

Vanco (MRSA) AND Ceftriaxone (Gm-neg and Gm-pos bugs, e.g. Staph and Strep) ADD doxy in RMSF endemic areas

Question 17

Eliminating carrier state of menigococcus?

Answer 17

at end of PenG, pt needs either rifampin (children/young adults) or cipro (adults). Alternatively, a pt can be treated 5 to 7 days w/ ceftriaxone, which also eliminates the carrier state.

Question 18

Prophylaxis choices for close contacts of a pt w/ meningococcal disease? Ped option? Adult?

Answer 18

< 18 y/o: PO rifampin or IM ceftriaxone; > 18 y/o: cipro is drug of choice. Rifampin, ceftriaxone, and azithromycin are alternatives. (No rifampin or cipro for preg women.)

Question 19

In the general population, at what age do we recommend MCV4 vaccination?

Answer 19

Children ages 11-18 (usually one at 11/12 and booster at 16); if they get it at 13-15, boost at 18; if they get it at 16+, no need to boost

Question 20

Fatality rate from meningococcal disease overall? In adolscents?

Answer 20

All ages: 10-15%; Adolscents: 20%

Question 21

Bad outcomes, besides death, from pts w/ meningococcal meningitis?

Answer 21

Hearing loss, Neuro disability, Digit or limb amputations, Skin scarring

Question 22

Classic clinical presentation of RMSF?

Answer 22

abdominal pain, headaches, myalgias, fever, and nausea, followed by blanching erythematous macules, which may be transitioning to petechiae and purpura

Question 23

Initial w/u and mgmt of suspected RMSF?

Answer 23

Admit, CBC, blood and CSF cultures, then give loading doses of doxycycline 2.2 mg/kg and ceftriaxone 100 mg/kg/day (the latter for N. meningitides coverage d/t rash also c/w meningococcal disease)