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MS3 > Peds 8 > Flashcards

Peds 8 Flashcards

1
Q

Workup of 2 day old presenting with fever

A

o Blood: CBC, CRP, blood culture
o Urine: cath UA with micro, urine culture
o CSF: cell count, glucose, protein, CSF culture, (+/- HSV PCR)

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2
Q

Management of 2 day old presenting with fever

A

o Admission for IV empiric antibiotics
♣ Ampicillin + gentamicin OR ampicillin + cefotaxime
♣ (+/- acyclovir)

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3
Q

Name the TORCHES infections

A 
o	T oxoplasmosis
o	O ther (Varicella or Parvovirus) 
o	R ubella
o	C MV
o	H SV, HIV
o	E nterovirus
o	S yphilis
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4
Q

How do you diagnose CMV

A

Urine culture/PCR

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5
Q

Describe presentation of congenital CMV

A

• Ear: most common acquired cause of deafness
• CNS: intracranial calcifications, microcephaly
• Blood: low platelets, WBC
• Liver/Spleen: hepatitis, hepatosplenomegaly
• Eye: chorioretinitis
Skin: blueberry muffin rash

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6
Q

Tx of congenital CMV

A

Ganciclovir

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7
Q

What are the 3 types of neonatal HSV

A
  • SEM: skin, eye, mucous membrane
  • Disseminated: liver failure, high mortality
  • CNS: seizures, developmental delays
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8
Q

Work-up for neonatal HSV

A

• Surface swabs (lesions, eye, throat, rectum), CSF HSV PCR, blood PCR, LFTs

• IV Acyclovir until results return
o 14 days for SEM
o 21 days for CNS/disseminated
o Follow with 6 months PO Acyclovir

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9
Q

Most common diseases caused by Group B strep

A

bacteremia, meningitis, septic arthritis, pneumonia

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10
Q

Tx of GBS

A

Ampicillin

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11
Q

Tx of Roseola

A

• No FDA treatment, just keep the patient cool and give fluids

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12
Q

Complications of untreated strep pneumo

A

♣ Hearing loss
♣ Effusions
♣ Empyema

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13
Q

Tx of Strep pneumo meningitis

A

♣ IV Ceftriaxone

♣ IV Vancomycin (stop if susceptible to PCN/Ceph)

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14
Q

What are the live attenuated vaccines you should think of

A

MMR and Varicella

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15
Q

Describe presentation of Kawasaki Disease

A 
♣	Viral-like symptoms – fever, conjunctivitis, cervical lymphadenopathy
♣	Strawberry tongue 
♣	Rash on hands and feet
♣	May develop coronary artery aneurysm:
•	Thrombosis with myocardial infarction
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16
Q

Tx of Kawasaki

A

♣ Aspirin (to prevent thrombosis of coronary arteries)

♣ IVIG

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17
Q

What should you think of with a kid with pneumonia that does not respond to Amoxicillin

A

Mycoplasma pneumonia

18
Q

Tx of mycoplasma

A

Azithromycin

19
Q

Viral Ddx of exudative pharyngitis

A

Adenovirus: pharyngoconjunctival fever

EBV/CMV: mononucleosis

HIV: acute retroviral syndrome

20
Q

Bacterial ddx of exudative pharyngitis

A
  • Group A Strep
  • Mycoplasma
  • Arcanobacterium haemolyticum
  • Gonorrhea
21
Q

What should you think if you a 16 y/o is positive to strep pharyngitis and you treat with Amoxicillin and then pt comes back with rash

A

This is EBV

Pt was just colonized with strep

22
Q

Describe toxic shock syndrome

A

Pathophysiology: focal bacterial infection produces toxin (TSS T-1) -> capillary leak -> hypotension + multiorgan failure + intense “sunburn” rash

Staph Aureus, or group A strep

23
Q

How do you diagnose Toxic shock syndrome

A

Diagnosis: clinical

- blood cx negative, site cx more helpful

24
Q

Management of Toxic shock syndrome

A
  • Fluid resuscitation
  • Antibiotics
  • — Anti-staph abx (Vanco)
  • — Clindamycin (protein synthesis inhibition to shutdown toxin production)
  • — +/- IVIG if refractory shock
  • Drain focus
  • — Pull tampon
  • — Drain abscess
25
Q

What labs are indicative of Kawasaki

A

♣ Elevated WBC (eos), CRP, ESR, LFTs (platelets late)
♣ Low Hct, albumin
♣ Sterile pyuria (WBCs but no bacteria in urine)

26
Q

Fever and non-blanchinf rash that starts as petechiae and presents to purpura

A

Meningococcemia

27
Q

Tx of meningococcemia

A

IV Ceftriaxone

28
Q

What are triggers for SJS

A
  • Mucous membrane predominant: Mycoplasma
  • Skin predominant: HSV
  • Antibiotics
29
Q

What is the most emergent part of SJS

A

o Ophthalmologic emergency

30
Q

Management of SJS

A

o Supportive care

o Watch airway, skin for superinfection

31
Q

Diagnose: morbilliform rash, cough, conjunctivitis

A

Measles

Also coryza (runny/stuffy nose) and Koplik spots (blueish spots on red background on buccal mucosa)

32
Q

Ddx for anatomical causes of constipation

A
  • Hirschsprung – not likely if they have passed meconium within 48 hours
  • Sacral plexus stuff – mass, spina bifida, tethered cords (Will not have normal anal sphincter function)
  • Imperforate anus with anorectal malformation (e.g. the anus does not have a normal opening so the rectum has to find another location to exit)
33
Q

Ddx for endocrine causes of constipation

A
  • Hypothyroidism
  • Electrolyte abnormalities (low Mg, high calcium)
  • Celiac Disease
  • Cystic Fibrosis
34
Q

Management of stool impaction

A

First undo the impaction

  • Stool softener (e.g. Polyethylene glycol or lactulose)
  • Stimulant laxative (e.g. Senna)
  • Digital swipe
  • Enema

Then put on maintenance - chronic constipation leads to colonic dilation; dilated colon does not squeeze well, so need to be treated for a long time

35
Q

How can you diagnose Hirschprung disease

A
  • Biopsy

* Manometry

36
Q

Next step in management of suspected volvulus

A

Upper GI

X-ray is good to rule out perforation, but not necessarily diagnostic

37
Q

Next step in management of suspected pyloric stenosis

A

US

38
Q

What are the 5 causes of hypoxemia

A
  1. V/Q mismatch
  2. Shunt
  3. Hypoventilation
  4. Diffusion
  5. Decreased PiO2 (eg high altitude)
39
Q

Tx of croup

A
  • Steroids

- Racemic epinephrine (causes vasoconstriction and decreases edema)

40
Q

What do you think of if kid has stridor and HIGH fevers

A
  • Epiglottitis
  • Tracheitis
  • Abscess
41
Q

Most common cause of bacterial tracheitis

A

Staph aureus

MS3 (88 decks)

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