Peds 8 Flashcards
Workup of 2 day old presenting with fever
o Blood: CBC, CRP, blood culture
o Urine: cath UA with micro, urine culture
o CSF: cell count, glucose, protein, CSF culture, (+/- HSV PCR)
Management of 2 day old presenting with fever
o Admission for IV empiric antibiotics
♣ Ampicillin + gentamicin OR ampicillin + cefotaxime
♣ (+/- acyclovir)
Name the TORCHES infections
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
How do you diagnose CMV
Urine culture/PCR
Describe presentation of congenital CMV
• 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
Tx of congenital CMV
Ganciclovir
What are the 3 types of neonatal HSV
- SEM: skin, eye, mucous membrane
- Disseminated: liver failure, high mortality
- CNS: seizures, developmental delays
Work-up for neonatal HSV
• 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
Most common diseases caused by Group B strep
bacteremia, meningitis, septic arthritis, pneumonia
Tx of GBS
Ampicillin
Tx of Roseola
• No FDA treatment, just keep the patient cool and give fluids
Complications of untreated strep pneumo
♣ Hearing loss
♣ Effusions
♣ Empyema
Tx of Strep pneumo meningitis
♣ IV Ceftriaxone
♣ IV Vancomycin (stop if susceptible to PCN/Ceph)
What are the live attenuated vaccines you should think of
MMR and Varicella
Describe presentation of Kawasaki Disease
♣ Viral-like symptoms – fever, conjunctivitis, cervical lymphadenopathy ♣ Strawberry tongue ♣ Rash on hands and feet ♣ May develop coronary artery aneurysm: • Thrombosis with myocardial infarction
Tx of Kawasaki
♣ Aspirin (to prevent thrombosis of coronary arteries)
♣ IVIG
What should you think of with a kid with pneumonia that does not respond to Amoxicillin
Mycoplasma pneumonia
Tx of mycoplasma
Azithromycin
Viral Ddx of exudative pharyngitis
Adenovirus: pharyngoconjunctival fever
EBV/CMV: mononucleosis
HIV: acute retroviral syndrome
Bacterial ddx of exudative pharyngitis
- Group A Strep
- Mycoplasma
- Arcanobacterium haemolyticum
- Gonorrhea
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
This is EBV
Pt was just colonized with strep
Describe toxic shock syndrome
Pathophysiology: focal bacterial infection produces toxin (TSS T-1) -> capillary leak -> hypotension + multiorgan failure + intense “sunburn” rash
Staph Aureus, or group A strep
How do you diagnose Toxic shock syndrome
Diagnosis: clinical
- blood cx negative, site cx more helpful
Management of Toxic shock syndrome
- 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
What labs are indicative of Kawasaki
♣ Elevated WBC (eos), CRP, ESR, LFTs (platelets late)
♣ Low Hct, albumin
♣ Sterile pyuria (WBCs but no bacteria in urine)
Fever and non-blanchinf rash that starts as petechiae and presents to purpura
Meningococcemia
Tx of meningococcemia
IV Ceftriaxone
What are triggers for SJS
- Mucous membrane predominant: Mycoplasma
- Skin predominant: HSV
- Antibiotics
What is the most emergent part of SJS
o Ophthalmologic emergency
Management of SJS
o Supportive care
o Watch airway, skin for superinfection
Diagnose: morbilliform rash, cough, conjunctivitis
Measles
Also coryza (runny/stuffy nose) and Koplik spots (blueish spots on red background on buccal mucosa)
Ddx for anatomical causes of constipation
- 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)
Ddx for endocrine causes of constipation
- Hypothyroidism
- Electrolyte abnormalities (low Mg, high calcium)
- Celiac Disease
- Cystic Fibrosis
Management of stool impaction
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
How can you diagnose Hirschprung disease
- Biopsy
* Manometry
Next step in management of suspected volvulus
Upper GI
X-ray is good to rule out perforation, but not necessarily diagnostic
Next step in management of suspected pyloric stenosis
US
What are the 5 causes of hypoxemia
- V/Q mismatch
- Shunt
- Hypoventilation
- Diffusion
- Decreased PiO2 (eg high altitude)
Tx of croup
- Steroids
- Racemic epinephrine (causes vasoconstriction and decreases edema)
What do you think of if kid has stridor and HIGH fevers
- Epiglottitis
- Tracheitis
- Abscess
Most common cause of bacterial tracheitis
Staph aureus
