Peds 6 Flashcards
Treating group A strep early will prevent X but not X
(rheumatic fever vs. PSGN)
Treating early will treat RF but not PSGN
Recall that PSGN is a Type III hypersensitivity (antigen-antibody complexes will form even if treated early)
Causes of proteinuria that do not include renal disease
- Benign orthostatic proteinuria = just standing; gravity
- Fever
Describe diff in edema in nephritic vs. nephrotic syndrome
- In nephritic, there is increase in actual volume (too much volume everywhere - increase in both intravascular and extravascular) due to damaged kidneys not allowing urine output
- In nephrotic, there is decreased oncotic pressure, so volume leaves from intravascular space into extravascular space (so fluid is in wrong place, but there is no increase in total volume)
How do you treat edema is nephritic vs. nephrotic syndrome
- Nephritic = treat with diuretics (need to reduce total volume)
- Nephrotic = treat with albumin (need to increase oncotic pressure)
Where is erythropoeitin made and what does it do
Made in the kidney
Stimulates bone marrow to make more RBCs
Describe antalgic limp
Spending less time on painful side
Foot drop is caused by what
Damage to common peroneal nerve or other neuro disorder
Where is Toddler’s fx
spiral fx of distal tibia
What is Legg-Calve-Perthes disease
Ischemic necrosis, collapse, and subsequent repair of the femoral head
What part is affected in Osgood Schlatter
Reaction of patellar tendon insertion into distal tibia
Tx of developmental dysplasia of hip in different aged infants
< 6 months = harness
6-18 mo = closed reduction
> 18 mo = open reduction
How can septic arthritis lead to avascular necrosis
increased intracapsular pressure causes tamponade that can interfere with venous return from the femoral head, resulting in AVN
MOA of Chloramphenicol
Inhibition of 50S ribosome subunit – bacteriostatic
Uses of Chloramphenicol
- Meningitis (Strep Pneumo, H. Flu, Neisseria Menigitidis)
• Used as empiric treatment for meningitis in developing countries - Rocky Mountain Spotted fever
• Especially important in pregnancy when Doxycycline is contraindicated
Adverse effects of Chloamphenicol
♣ Anemia – Causes dose-related reversible suppression of RBC production
♣ Aplastic anemia – due to irreversible bone marrow suppresion
♣ Grey Baby Syndrome
MOA of Linezolid
♣ Inhibits 50S ribosome subunit – bacteriostatic
Uses of Linezolid
♣ Gram positive organisms such as Staph, Step, and Enterococcus
♣ MRSA (Treat with Vancomycin, Daptomycin, and Linezolid)
• Useful for nosocomial MRSA infections (e.g. hospital acquired pneumonia)
♣ Vancomycin resistant Enterococcus, VRE (nosocomial UTI and endocarditis)
Adverse effects of Linezolid
♣ Thrombocytopenia (decreased platelets)
♣ Optic neuropathy with prolonged treatment
♣ Peripheral neuropathy (glove and stocking sensory impairment)
♣ Serotonin Syndrome
• Linezolid is an inhibitor of monoamine oxidase
MOA of Aminoglycosides
♣ Acts on the bacterial ribosome, halting translation
♣ Bind IRREVERSIBLY to the 30S subunit – BACTERICIDAL
Example of Aminoglycoside drug names
Neomycin, Gentamicin, Streptomycin, Tobramycin, Amikacin, Paramycin
Uses of Aminoglycosides
♣ Aerobic, gram-negative bacilli
• In order to get past the cell wall they are coupled with cell wall active drugs (e.g. beta-lactams or vancomycin)
• Are transported into bacteria via an oxygen dependent process (hence the activity against aerobic bacteria)
♣ Enterococcus (UTI and endocarditis)
Use of Neomycin
• When taken orally, remains active in GI tract until excreted in feces– useful in bowel prep before colorectal surgery
use of Paramycin
• Luminal agent against intestinal parasites such as Entomoeba histolytica
Use of Streptomycin
- Treat Tularemia caused by Francisella
* Treats plague caused by Yersinia pestis
Use of Gentamicin
- Treats resistant gram negative infections (e.g. Enterobacter, Serratia, Klebsiella)
- Pseudomonas
Use of Tobramycin
• Similar spectrum to Gentamicin
o Both treat pseudomonas
Use of Amikacin
- Resistant to many of the enzymes that inactivate other aminoglycosides in resistant bacteria
- Treatment against pseudomonas
Describe resistance to Aminoglycosides
♣ Enterococcus create resistance by inactivating Aminoglycoside via acetylation enzyme
Adverse effects of Aminoglycosides
- Ototoxicity
- Nephrotoxicity (due to acute tubular necrosis)
- Neuromuscular blockade (contraindicated in MG)
- Teratogenic (deafness onn the newborn)
Treatment of acute chest syndrome
Supplemental O2 and antibiotics
What monitoring should be performed in kids with sickle cell in order to prevent stroke
Transcranial ultrasound
Should be initially performed at 2 year, and if normal then be repeated annually until 16 y/o
Next step in management of sickle cell kid with abnormal transcranial US
Transfusion therapy to reduce percentage of sickled cells
What is empyema
Purulent infection in the pleural space; usually seen with bacterial pneumonia or pulmonary abscess
Bacterial causes of pneumonia to consider in a neonate
Enterobacteriaceae, Group B strep, Staph aureus, Strep pneumo, Listeria, Chlamydia
Viral causes of pneumonia to consider in a neonate
HSV, RSV, enterovirus, influenza
Common viral causes of pneumonia in infants
RSV, adenovirus, rhinovirus, influenza, parainfluenza
Most common bacterial cause of pneumonia in pediatric patient > 5 years
Mycoplasma
Tx of Mycoplasma pneumonia
Macrolides (e.g. Azithromycin)
3 most common bacterial causes of acute otitis media
Strep pneumo, H. flu, Moraxella
What is the usual antibiotic used to treat AOM
Amoxicillin
What do you use to treat if Amoxicillin is not working on AOM
Amoxicillin-Clavulanate or Cephalosporin
Tympanocentesis and culture of middle ear fluid if several abx regimen are failed
Management of suspected mastoiditis as a result of AOM
Myringotomy (TM incision), fluid culture, and parenteral abx
Name 3 things that reduce risk of acute otitis media
♣ Administration of Pneumococcal and Influenza vaccines
♣ Tobacco smoke avoidance
♣ Increase breast-feeding
What is cerebral palsy
o Disorder of nonprogressive motor dysfunction that results from an insult to or anomaly of the developing CNS
In terms of cerebral palsy, differentiate between:
- Hemiplegia
- Diplegia
- Quadriplegia
Hemiplegia = involvement of a single lateral side of the body, with greater impairment of the upper extremities
Diplegia = 4 limb involvement with greater impairment of lower extremities
Quadriplegia = 4 limb involvement with significant impairment of all 4 extremities
