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Peds Block 2 Flashcards

1
Q

What are the three categories of fever?

A

Short duration- localized S/Sxs; dx w/ history and PE

W/out focus- often kids <3y/o; Hx or PE fail to show cause

Unknown origin- Fever >8 days w/out identifiable etiology despite PE, labs or after 1wk of hospitalization

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2
Q

Teething kids usually don’t have a fever higher than ?

What are two main causes of Fever Without Focus/Source?

A

100.4*

UTI and pneumonia

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3
Q

Serious bacterial infections in neonates/infants are usually due to ? 3 things

What is the most and second most common microbe?

A

Bacteremia UTI Meningitis

E Coli*, GBS

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4
Q

HSV induced virus is considered if PT is febrile and younger than ?

Peds who appear well but with fever are more likely to have ?

A

<28days

Virus

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5
Q

Peds under ? w/ fever need to be evaluated by the ER and NOT given ?

Tachypnea= ?
Tachycardia= ?
A

2mon, no antipyretics

> 60breaths pm
180bpm

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6
Q

How do you determine petechiae from other rashes?

All kids <1mon w/ fever w/out focus or source have what follow up step done

A

Petechiae= no blanching, more concerning

Admitted
CBC, culture, UA/culture, LP, CXR, stool WBC/culture if diarrhea is present
Post-labs: start ampicillin/gentamycin

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7
Q

Kids w/out fever but have toxic signs and are 1-36mon get

A 
Admitted
CBC, blood culture, UA/culture, LP (if 1-3mons and irritable*)
Stool WBC/culture if diarrhea
CXR if Temp >102.1 and WBC >20K
Empiric Ceftriaxone or Cefotaxime
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8
Q

What are 2 common bacterial infections in kids?

A

Acute Otitis Media- bulging, erythematous, and non-mobile TM

Strep Pharyngitis- seen late fall/winter, uncommon <3y/o
Prevent heart complications w/ PCN

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9
Q

What are the female risk factors for UTIs?

What re the risk factors for males?

A

White, <1yr, 102.2* or higher, Fever 2 days or longer

Uncircumcised, nonblack, temp 102.2 for more than 1 day

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10
Q

What are the two main types of bacteremia?

What are the more common agents?

A

Source: pneumonia, cellulitis
Occult: +culture in well appearing child

Pneumococcus
H Influenza Type B

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11
Q

Define Fever of Unknown Origin

What’s the difference between FOUO and Fever of Known source?

A

Fever >100.4 no origin +8 days

Duration

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12
Q

PT >6yo w/ fever is usually due to ? while adolescents w/ fever are more likely due to ?

Preterm infants less than <32wks have not received all maternal ?

Low birth weigh babies can summon ? type of immune reaction?

A

Respiratory/GU
TB autoimmune IBD lymphoma

IgG- cross placenta during second half of last trimester via active transport

IgM

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13
Q

Define Sepsis and Severe Sepsis

A

Systemic Inflammation Response Syndrome
Severe= end organ compromise

Temp >101.3
Tachy >2SD for age or,
Hypoxemia <70mm room air

HR >2SD for age or,
HOTN <2SD for age or,
Cap refill >3 sec

Lactic acidosis
Oliguria
AMS

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14
Q

Bacterial meningitis will present with what type of opening pressure?

What type of defect cause kids to be susceptible meningitis?

What two PT populations are more likely to get Strep Pneumo meningitis infections?

A

High

C5-8 defects w/ spleen issues

Functional asplenic- sickle cell
HIV

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15
Q

How is meningitis transmitted and what PT populations may be more susceptible?

What PT populations are more likely to get N Meningitidis infections?

What 4 serogroups are in the MCV4 vaccine?

A

Respiratory tract secretion/droplet
Native American/Eskimo

Younger than 5y/o, 15-24y/o

A C W Y X (verify)
B- has own vaccine
A: MC in Africa
B: MC in US

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16
Q

HIB infections more common during what part of life?

N Meningitidis has what 6 serogroups?

N Meningitidis mengingitis presents w/ what 2 S/Sxs?

A

70% of cases in first 5yrs of life
Peak at 6-9mon

A B C X Y W-135

Pruprua + non blanching

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17
Q

Since ABX are usually started prior to obtaining an LP, what lab results can be elevated for days later?

Traumatic LP taps are less likely to affect Gram stain, culture and glucose but can affect what two results?

A

Pleocytosis w/ neutrophils
Elevated protein
Red glucose

Leukocytes and Protein

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18
Q

What are 3 meningitis DDx?

A

Partially treated bacterial meningitis

Encephalitis- changes in mental status, greater risk for seizures, global neuro abnormalties

CNS abscess- focal neuro signs, Dx w/ CT

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19
Q

What ABX for meningitis is recommended for kids outside of neonatal period?

A

Vancomycin w/ 3rd gen Ceftriaxone
Meropenem- PCN/cephalosporin allergy
L monocytogenes suspected= ampicillin
Imm compromised/gram neg microbe- Cefepime/Meropenem

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20
Q

Three potential complications of meningitis Tx

Which microbe causes the survivors to have sequelaes of deaf, seizure, blind or learning disabilities?

A

SIADH
Hearing loss
Subdural effusion w/ S Pneumo and H Influenza

Pneumococcal infection

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21
Q

What part of a meningitis presentation indicates a poor prognosis?

Define Encephalitis and the 3 types

A 
Young
Long duration
Seizure/coma
Shock
Low/no CSF
ImmComp PT

Inflammation of brain parenchyma causing dysfunction (post infxn, chronic degeneration, viral)

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22
Q

What are the most common cause of viral meningoencephalitis?

A

Picornaviridae- neonate (functionally immcomp) and ImmComp PTs

Arbovirus: arthropod vector, most are zoonotic

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23
Q

What does HSV1 cause?

What does HSV2 cause?

A

Sporadic encephalitis
Coma/death in 70% of PTs

Neonatal encephalitis vix vertical transmission

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24
Q

What is a common Sx at presentation of acute infectious encephalitis

PTs w/ suspected acute infectious encephalitis get what serological studies?

A

Seizure

Cat scratch dz- from kitten
Lyme dz
Epstein-Barr
Arbovirus
Mycoplasma pneumo
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25
Q

What test procedures is done for HSV, enterovirus and west nile during work ups?

What is done for Tx of viral encephalitis

A

PCR

No therapy except: HSV, Variclla, Cytomegalovirus, HIV

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26
Q

What viral CNS infection can have a severe sequelae if not Dx/Tx promptly?

Rubeola= ?

A

HSV
(Done w/ Lect 1)

Measles: koplik, cough, coryza (runny nose), conjucitibits ( Fever and 3 C’s)

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27
Q

Rubella= ?

Roseola= ?

A

German measles
Milder, Blueberry muffin baby

Exanthem Subitum/6th Dz
Fever, no fever, rash
(Subitum= sudden)

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28
Q

Varicella= ?

5th Dz= ?

A

Chicken pox
Dew drops on rose petals, itchy

Erythema infectiosum

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29
Q

How long/how are infants protected from measles?

What Dz can measles cause in Leukemia/HIV PTs?

A

Protected by transplacental maternal Ab until end of first year

Giant cell pneumonia

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30
Q

What is the most common complication of measles?

What is an acute but very late onset s/e?

A

Ottitis media

CNS: encephalomyelitis
Sclerosing panencephalitis (8yrs later)
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31
Q

Humans are the only natural host for ?

How is it transmitted and how long are PTs infectious?

A

Rubella

Droplet
2 days before-7days after rash

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32
Q

Likelihood of Rubella infecting a fetus is highest at ? and lowest after ?

A

1st trimester

16wks

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33
Q

PT w/ Rubella develop a rash first where?

How does this rash spread?

A

Face/neck to torso but fades

Face during progression lasting for 3 days

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34
Q

Lymphadenopathy is more prominent in Rubella PTs than other viral infections, primarily involving ? lymph nodes

What oral finding will be seen?

A

Suboccipital
Postauricular
Anterior cervical

Rose colored lesions

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35
Q

What finding can be seen in female PTs w/ rubella?

What oral finding may be seen in Rubella PTs

A

Polyarthralgia of hands

Forchheimer spots 3 days before rash

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36
Q

How is Rubella Dx?

What unique finding is seen in CRS PTs?

A

Serological IgM, usually turns + 5 days after Sxs

IgM at 3mon
Stable/rises over 7-11mon

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37
Q

Rubella infecting babies creates CRS w/ ? issues?

Why are these PTs dangerous?

A

Deaf Cataract CHDz (PDA)

Secrete virus x 12mons

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38
Q

How is Rubella Tx?

When is this vaccination c/i?

How long after receiving MMR do females need to avoid getting pregnant?

A

Supportive

ImmComp/Supressed
Pregnant
Received Immunoglobulin in past 11mon

28days

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39
Q

When can post-exposure prophylaxis be given for Rubella?

What is the most common and accompanied Sxs of mumps

A

Within 3 days

Orchitis
Fever, Parotid swelling or tenderness

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40
Q

How is Mumps spread?

How long are PTs contagious?

A

Respiratory droplet

7 days before - after parotid swelling

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41
Q

What causes 5th Dz

Because this Dz has a high affinity for progenitor cells, what PT populations are at risk?

A

Parvovirus B19

Hemolytic anemias= aplastic crisis
Fetal anemia
Hydrops fetalis

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42
Q

How is 5th Dz transferred and what season is it seen in?

Because this present with vague URI/flu like Sxs, what key finding is indicative?

A

Respiratory secretion
Blood transfusions
Spring

Slapped cheek rash w/ circumoral pallor

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43
Q

What happens in each stage of development during 5th Dz?

What areas of the body are not affected by this virus?

A

1: slapped cheek
2: erythematous truncal rash
3: central clearance leads to lacy reticulated rash leading to desquamination

Palms/soles

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44
Q

How is 5th Dz Dx?

How is it Tx?

A

IgM, PCR

Hydration, antipyretic
Transfusion if PT has aplastic crisis
IV immunoglobulins if ImmComp w/ anemia or chronic infxn

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45
Q

What PT population will not develop a rash when infected w/ 5th Dz?

What part of pregnancy is most susceptible to this infection and to whom?

What two PT populations are at highest risk for 5th’s?

A

Transient aplastic crisis PTs

2nd trimester

Pregnant
Deficient blood production d/o

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46
Q

6th Dz is AKA ?

What causes this?

A

Exanthem Subitum
Roseola

HHV 6 and 7

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47
Q

When are most cases of Roseola seen?

How does this present?

A

95% w/ HHV-6 by 2yrs, peak is 6-9mon

Fever before rash
Sudden/abrupt fever 103.5
Maculopapular rose colored rash w/ defervescence

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48
Q

What is the sequence of spreading of Roseola rash?

What is the gold standard for Dx?

A

Trunk to face to extremities

Viral culture

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49
Q

How is Roseola Tx?

What complication can occur from this dz?

A

Hydration, antipyretic
ImmComp= Ganciclovir/Foscarnet

Encephalitis
Virus associated hemophagocytosis syndrome

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50
Q

How does Varicella get transmitted and where does it reproduce?

How long are these PTs infectious?

A

Airborne
Contact w/ eye/resp tract
Nasopharynx/UR tract

Until all lesions are crusted over

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51
Q

How does Varicella rash spread?

How does this rash look and what are the stages?

A

Trunk to head, face and extremities
All lesions stages at once (all lesions in same stage= smallpox)

Non-umbilicated oval tear drop vesicles w/ erythematous base and possibly on membranes
Vesicular-pustules-scabs

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52
Q

What is the most common complication with Varicella?

What other adverse events can occur?

A

Secondary skin infections from Staph/Strep

Pneumonia
Reye syndrome- avoid ASA and salicylates

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53
Q

What happens to neonates exposed to Varicella 5 days before/2 days after delivery?

What is used for Tx?

A

Neonatal varicella, no shingles

VZIG
IV immunoglobulin

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54
Q

When do Varicella PT get an anti-viral

Mortality from varicella increases if ? 2 things are present?

A

Acy/Valacyclovir
Unvaccinated +12y/o
Chronic skin/pulmonary dz
CCS/salicylate therapy

+20y/o
ImmComp

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55
Q

When do kids get Varicella vaccine?

What type of immunity does VZIG offer when used as post-exposure prophylaxis?

A

12-15mon
4-6yrs w/ MMR

Passive- given within 96hrs of exposure

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56
Q

Define Zoster

Can mothers w/ this outbreak continue to breast feed?

A

Recurrence of latent VZV from direct contact

Yes, but must cover and prevent skin on skin/direct transmission

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57
Q

Where does Zoster outbreaks usually occur?

What is an adverse effect?

A

Thoracic/lumbar w/ unilateral lymphadenopathy

CN7 Ramsay Hunt syndrome: facial paralysis and ear canal vesicles

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58
Q

What are two predisposing signs that a PT w/ zoster outbreak will have prolonged pain?

What zoster vaccine has the CDCs recommendation as the strongest level of protection?

A

Advanced age
Severity of pain at presentation

Shingix
Zostavax

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59
Q

How/what causes hand, foot and mouth?

How do PTs present?

A

Coxsackie A16 via fecal/oral route

Sore throat
Lesions hand>feet
Anorexia
Mouth pain

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60
Q

Where do young kids present with Hand foot mouth Sxs?

How is this Tx?

A

Diapered areas

Pain control and hydration

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61
Q

What is a s/e of having hand, foot, mouth dz?

What Sx do adults develop who get hand foot mouth?

A

Desquamation of nails, hands and feet weeks later

Oral lesions

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62
Q

What causes Scarlet fever

How does this rash start and spread

A

GAS

Starts at neck, spreads to trunk/extremities that feels like sandpaper but blanches w/ pressure
Peels like sunburn after resolution

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63
Q

PT presenting with Scarlet fever rash and a Pos GAS test gets ? med

Define Herpes Gingivostomatitis

A

Amoxicillin

Herpes of gingiva and vermillion border

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64
Q

Define Herpes labialis

How does this present?

A

Cold sore/fever blister
Skin/membrane of vermillion border, most common form

Erythematous papules progressing to groups of 2-4mm and fluid filled w/ erythematous base

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65
Q

Define Viral Paronchia

How can this be acquired

A

Herpetic whitlow

Herpetic gingivostomatitis

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66
Q

Define Herpes Gladiatorum

How are they treated?

A

Unique to wrestler/rugby

PO A/V/F-fyclovir

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67
Q

What is a rare but dangerous outcome from genital herpes?

What causes pinworms?

A

Aseptic (viral) meningitis

Enterbius Vermicularis- nematode/roundworm

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68
Q

How are pinworms Tx?

What is the most effective prevention method?

A

Pyrantel pamoate (alt)
Albendazole
Mebendazole (alt)

Hand hygiene

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69
Q

What causes scabies

How does it present?

A

Mite: sarcoptes scabei

Severe/paroxysmal itching
Linear papules in axilae, umbiilicus, groin, webbed spaces w/ 1-2mm red pappules

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70
Q

What part of the body is not affected by scabies?

What is the standard Tx and what is the most effective -cide agent?

A

Face

Permethrin cream
Heat

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71
Q

What is the most common chronic relapsing skin dz in infancy/children?

What type of FamHx is this related to?

A

Atopic dermatitis/eczema

Atopy (allergic rhinitis, asthma, eczema)

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72
Q

Define Atopic March

How does atopic dermatitis present?

A

Food allergy, Allergic rhinitis, Asthma

Itch that rashes/Bricks w/out mortar
Nocturnal pruritus and cutaneous reactivity= cardinal feature

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73
Q

How does atopic dermatitis present on infants?

Where does is present on older kids or chronic cases?

A

Face, scalp, extensor surface (spares the diaper)

Flexor folds, extremities

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74
Q

What finding is indicative a PT will have severe cases of eczema?

How is this condition Tx?

A

Outbreaks crossing flexor folds

Avoid triggers
Liberal bland emollients
Topical anti-inflammatory (Cornerstone= CCS)
Warm baths w/ rapid lotion
 Baths w/ 1/4 cup of bleach
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75
Q

When are Topical Calcineurin Inhibitors used for Atopic Dermatitis

When are these sought out instead of earlier treatments?

A

Immune modulators for +2y/o
Pimecrolimus- mild/mod
Tacrolimus- mod/sev

Parent w/ steroid phobia
Face/neck dermatitis

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76
Q

What meds can be used as adjuncts for Tx of Atopic Dermatits?

A

1st Gen sedating anti-histamine (diphenhydramine, hydroxyzine) for sleep and reduced pruritus

Systemic CCS- failed topical, anticipate rebound flare ups when d/c

Derm referral: severe cases of UV therapy or Systemic Cyclosporine

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77
Q

Where does Secondary Impetigo come from?

How is it Tx?

A

Atopic dermatitis- Staph A or GAS

Topical localized- Mupirocin
Widespread- PO 1st Gen cephalosporin (cephalexin)

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78
Q

Define Eczema Herpeticum

How do these PTs present?

A

Eczema/HSV overlapping dz
(Kapsois Varecelliform)

Punched out/crusted over appearance

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79
Q

What is the only two reasons to prevent infant from trying peanuts at home?

What are the two sub-types of contact dermatitis and how are each Tx?

A

Egg allergy
Severe eczema

Irritant: remove agent (dirty diaper), Tx w/ CCS

Allergic:

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80
Q

How does Diaper Dermatitis w/ Candida present?

How is this Tx?

A

Secondary process causing
beefy red/pink skin w/ numerous pustules and satellite papules

Fist: Ointment/paste barrier w/ petroleum or zinc oxide
Hydrocotisone (short term)
Disposable diapers
Anti fungals: Nystatin, Clotrimazole

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81
Q

Dry skin dermatitis is AKA ?

How is it Tx?

A

Lip licker dermatitis
Erythematous/fissured in area of exposure

Stop offending action
Moisturizer cream
Steroids/topical ABX if refractory

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82
Q

Define Juvenile plantar dermatosis

How is it Tx?

A

Pre-puberty child w/ hyperhidrosis wearing occlusive foot wear

Emolient after removing socks/swimming
Severe: med/high topical steroids

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83
Q

Define Allergic Contact Dermatitis

How do they present

A

Cell mediated immune reaction, Type 4 or delayed/ type

Pink w/ sharp margins in weird patterns that have clear vesicles/bullae in middle

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84
Q

What are the DDx of allergic contact dermatitis?

What type of plants can cause allergic contact dermatitis?

A

HSV Dermatophytoses Impetigo Cellulitis

Rhus (poison ivy/oak)

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85
Q

What causes Seborrheic Dermatitis

How does it present

A

Malassezia yeast

ASx PT w/ circumscribed w/ well defined borders of scales/hyperkeratosis on face, neck, diaper, ubilicus

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86
Q

Seborrheic in infants usually presents as ?

How do adolescents present?

A

Craddle Cap

Hair loss, blepharitis, brown scaly areas w/ yellow crust

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87
Q

What is the difference between Seborrheic dermatits and Acute Dermatitis

How is infantile seborrheic cases Tx?

A

Seborrheic doesn’t self resolve, chronic relapses

Emolients/oil
Persistent: low CCS and topical anti-fungal
Ketonconazole shampoos

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88
Q

What is the first line Tx for seborrheic dermatitis in kids/adolescents?

Define Pityriasis Rosea

A

1st: Antifungal shampoo,
Topical CCS- Fluocinolone
2nd: topical calcineurin inhibs/keratolytic (urea)
Once resolved, 1/wk antifungal shampoo wash

Winter occurrence in adolescents as Herald Patch (on trunk/prox thigh), evolves into Christmas tree pattern parallel to skin tension lines

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89
Q

How is Pityriasis Rosea Tx

Define Psoriasis

A

Menthol/Camphor lotion
PO anti-histamine
Phototherapy

Papulosquamous rash, w/ plaque being most common
Sharp demarcation, irregular borders that turn “mica” like if UnTx

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90
Q

Where does psoriasis present

Define Auspitz sign

A

Scalp knees elbow Umbilicus
Ear canal
Kids- face, nail plate

Pinpoint bleeding w/ scale removal

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91
Q

Define Guttate Psoriasis

What usually precedes this presentation?

A

Mostly in kids
Eruption of oval/round papules on trunk, face, proximal limbs

Wks after strep infection

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92
Q

What is the foundation of Psoriasis Tx?

What can be used ad adjuncts?

A

Topical CCS

Vit D analogs
Salicyclic acid

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93
Q

What secondary therapy may help adolescents w/ Psoriasis?

What is used if extensive skin involvement is present?

A

Phototherapy

Immunosuppressives- Methotrexate, Cyclosporine, TNF antagonists

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94
Q

Define Erythema Multiforme

Who/when does this primarily affect?

A

First of several hypersensitivity syndromes
Target lesion: Red, white, purple ring w/ plaque/bullae on hands, feet, elbow, knee

Males in second decade

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95
Q

What are two predisposing factors that can cause Erythema Multiofrme

This often is the first of what following two issues?

A

HSV infection
Mycoplasma pneumoniae

Steven Johnson
Toxic epidermal necrolysis

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96
Q

Steven Johnson/Toxic epidermal necrolysis are most commonly caused by

How is it Dx

A

Drugs- NSAIDs ABX sulfonamide anticonvulsant
Infection- mycoplasma pneumo

Nikolsky sign- rub skin and sloughing occurs

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97
Q

How does early cases of Steven Johnson/Toxic Epidermal present

How is it Tx?

A

Swollen lips
Bilateral conjunctiva erosion
Genital mucus erosion

Stop agent
Support- feeding, fluid/E+
Burn unit
Ophthalmology

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98
Q

What is the most common skin d/o in adolescents

What are the 3 parts of this

A

Acne vulgaris

Hyperkeratosis
Inc sebum
Propionbacterium increase

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99
Q

What are the two types of acne?

A

Non-inflammatory comedomes:
Open/blackhead- open to air, superficial
Closed/whitehead- closed to air, deeper

Inflammatory comedomes:
P. acnes colonization that ruptures, appearing as papules, pustules, cysts

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100
Q

What is the mildest form of acne?

What area is most commonly involved in men/

A

Adolescent comedomes in central face

Trunk

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101
Q

What are the stages of acne?

A

1: comedomal, minimal papules and occurs w/ puberty or 1wk prior to menses
2: papules on face only
3: pustules w/ scarring and possible cysts
4: nodulocystic acne, scarring and cysts

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102
Q

What topical agent is 1st line therapy for acne Tx?

What drugs does this line of therapy encompass?

A

Comedolytic agent: Retinoid x 6-8wks, will worsen before it gets better
Dec keratin/sebum/inflammatory
MOST effective monotherapy

Tretinoin
Adapalene
Tazarotene
Salicylic acid
Azelaic acid
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103
Q

What are the major s/e of using retinoids for acne?

When are PO ABX treatments used for acne?

A

Irritation
Adapalene- minimal
Tretinoin- red and scaling
Taza- only irritation

Mod/Sev/Inflammatory resistant to topicals
Doxy, Mino>tetracycline

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104
Q

What is the s/e of taking PO ABX for acne?

What med is used w/ systemic ABX and for maintenance after completing AB regime?

A

Pill esophagitis due to routine lasting for 3mon

Benzoyl peroxide or retinoid

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105
Q

What education piece has to be done when prescribing Isotretinoin for acne?

What OCPs can be used for acne?

A

Tetratogenic agent

Triphasics- Orthotricyclen has FDA approval for acne

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106
Q

When using OCPs for acne, what do they have to be low in?

What would be the benefit of prescribing Yasmin/Yaz?

A

Progestin
(Norgestimate, Desogestrel, Levonorgestrel)

Progestins that are spironoloactone analogs w/ antiandrogenic effects

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107
Q

Where are giant congenital pigmented nevi usually seen?

What are two outcomes that need to be monitored for?

A

Posterior trunk
Head/extremeties

Neuromelanosis- melanocytes in CNS
Malignant melanoma- cutaneous or neural

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108
Q

What is the most common type of cancer is kids?

When are nodal metastases seen and what does that indicate?

A

Melanomas- white females 15-19y/o on extremities/heads of males

More likely to occur in younger kids, not associated w/ decreased survival
Adolescent w/ nodal dz- significant negative prognosis

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109
Q

What are the ABCDEs of pediatric derm?

How do peds melanomas usually present?

A 
Asymmetry
Boders
Color
Diameter >6mm
Evolving

Amelanotic
More likely- regular borders and less than 6mm in diameter
Papules/papulonodules

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110
Q

Define Pyogenic Granuloma

Where are they most commonly seen?

What is the definitive Tx?

A

Pink/red popular lesion after trauma, grow rapidly in weeks
Bleed a lot if damaged

Head, neck, UE

Surgery

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111
Q

How is Molluscum Contagiosum transmitted

What type of microbe causes it?

Where does it most commonly occur?

A

Direct contact vi autoinoculation

Poxvirus- replicates in epithelial cells

Neck, arm pit, thigh
Rare- face

112
Q

How are extensive cases of Molluscum Contagiosum Tx?

What microbe causes the majority of cervical cancer?

A

Cryotherapy
Topical Cantharidin but not on face

HPV 16 and 18

113
Q

What is the most common type of wart seen in kids?

Define Verruca Plana and where they are seen?

A

Verruca Vulgaris from HPV 1 and 2 from direct contact/fomites

HPV 3 and 10
<3mm on dorsal hand, knee, arm and face
Painful when on soles of feet

114
Q

Define Condylomata Acuminata

What type of wart Tx has topical Tx recommendation?

A

Genital warts- HPV 6 and 11
Most common STI

Flat and Common
Salicylic acid, Liquid N, Laser

115
Q

How are anogenital warts Tx?

HPV vaccine covers ? strands?

A

Topical Podophyllotoxin or Imiquimod
Laser ablation/ImmTherapy w/ intralesion interferon

6 11 16
18 31 33
45 52 58

116
Q

When are HPV vaccines given?

What causes Impetigo and how does it present?

What is a post-infection risk of Step Impetigo and what is NOT a post-infection risk?

A

2 doses 9-14y/o
3 doses if +15y/o

Staph A/GAS
Honey crusted lesion

+ Glomerulonephritis
- ARF

117
Q

How is Impetigo Tx

Define Erysipelas

A

Topical 2% Mupirocin

Superficial form of cellulitis from GAS
Tx w/ 1st Gen Cephalosporin
High MRSA= Clindamycin or Trimethoprim-sulfamethoxazole

118
Q

What causes folliculits

A

Staph A causing dome shaped/erythematous papules

Chlorhexadine wash
Clindamycin wash
Unresolved= PO ABX

119
Q

What microbe causes hot tub folliculitis

How is it Tx?

A

P aeruginosa

Pruritic deep purple pustules on areas covered by swimsuit

Self resolving in 1-2wks

120
Q

Define Furuncles

Where do they usually occur

How are they treated

A

AKA Bolis
Deep hair follicle infection causing nodule w/ inflammaotry reaction

Neck Trunk Arm pits Butt

I and D, PO ABX

121
Q

Define Carbuncle

How are they Tx?

A

Deepest hair follicle infection causing abscesses

I and D, PO ABX

122
Q

What causes Perianal dermatitis

How does it present

How is it Tx?

A

GAS

Well demarcated, tender erythema 2cm around anus

PO PCN or Amoxicillin

123
Q

PTs w/ superficial fungal infections have a lifetime risk of developing ?

How are these superficial infections Dx?

A

Dermatophytosis

KOH exam and fungal culture

124
Q

How are superficial fungal infections Tx?

How is Onychomycosis Tx

A

Creams: Mico/Clot/Keton-azoles for body, foot, jock
PO antifungal for Capitis (Grise, Terbin, Itracon)

Tinea Unguium
Confirm w/ KOH
Tx: PO Terbinafine or Itraconazole x 12wks and monitor LFTs

125
Q

What can cause neontral Kusmaul breaths?

What can cause Cheyne-Stokes?

What is and the causes of Biot respirations?

A

DKA, Metabolic acidosis

CNS injury
Depressants
HF
Uremia

Breathing followed by apnea
Brain stem injury
Posterior Fossa mass

126
Q

Define Stridor

Define Wheeze

A

Harsh sound from obstructed airway during inspriation

Obstruction of lower airway during expiration
Low- large/central airway
High- small, peripheral

127
Q

Define Rhonchi

Define Rales

A

Irregular rattling from secretion in intrathoracic airway

Fluid secretions in small airways causing cellophane crumpling sound

128
Q

What are four causes of decreased breath sounds?

What is the narrowest part of children’s and older/adult airway

A

Atelectasis
Lobar consolidation
Thoracic mass
Pleural effusion

Children: Cricoid ring
Older/Adult: Glottis

129
Q

Define stridor and the cause

Croup is AKA ?

A 
Upper airway obstruction
Infants laryngomalacia (floppy larynx)

Laryngotrachobronchitis

130
Q

Croup is most commonly caused by ?

What age does it effect?

A

Parainfluenza 1-4
Adenovirus
Influenza
RSV

6mon-3yrs, peak 2-3y/o

131
Q

What x-ray sign is significant for croup?

How is it Tx?

A

Steeple sign- subglottic narrowing

Humidified air
CCS- Dexamethasone
Prednisolone
Reacemic epinephrine- constrictor, reduces epiglottitis

132
Q

When are Croup PTs admitted?

What can be done at home to assist w/ Sxs?

A

<6mon
Multiple ED visits in 24hrs
Suspected bacteria infxn
Stridor at rest

Cool mist

133
Q

If PT has croup, starts to get better but then gets sick again, what could it be?

What microbes can cause epiglottitis?

A

Laryngomalacia

GAS
Staph A
HIB/Diphtheria- if un-vaccinated

134
Q

What is seen on PE for epiglottitis?

How are they Tx?

A

Cherry red/swollen epiglottis

ABX and intubation

135
Q

What is seen on x-ray for Epiglottitis?

What is the most common cause of infant airway obstruction?

A

Thumb sign

Liquid

136
Q

What are the most common foreign bodies seen in airways of toddlers/older kids?

When so suspected airway obstruction PTs get an x-ray?

A

Grapes, Nuts, Hot dog, Candy

First time unilateral wheezer

137
Q

What is the most common chronic Dz in childhood in industrialized countries?

What gender does it occur in more during childhood/adults?

A

Asthma

Kids: B>G
Adults: W>M

138
Q

What are the 2 phases of asthma?

How is asthma Dx?

A

Early: bronchospasm
Late: inflammation

Pulm function test
<5y/o- trial of meds
CXR

139
Q

Asthma is a ? issue

A

Expiration

140
Q

How is asthma classified?

A

Intermittent:
2 or less day time Sxs
Inhaler use 2 or less/wk

Persisitent:
Mild- 2 or more days/ wk using inhaler +2 days/ wk and not more than 1/day; minor limitations on life

Mod: daily Sxs and inhaler use; some limitations on life

Sev: multiple Sxs during day and inhaler use; extreme limitation on life

141
Q

How do you classify asthma control?

A

Well: <2 days wk, not more than 1 daily Sxs

Not well: >2 days/wk or multiple times per day

Poor: Sxs every day

142
Q

What is the rules of 2 for Dx/Tx of asthma

What is a known/identifiable cause of recurrent asthma and who is most susceptible?

A

Need for daily anti-inflammatory meds:
2 or more day Sxs or,
2 or more awakenings/mon

Bronchopulmonary aspergillosis from A. Funigatus
Steroid dependent asthma or CF

143
Q

PT w/ uncontrolled asthma and GI Sxs needs to have ? test?

What is the goal for Tx for asthma for inhaler use?

A

Cystic Fibrosis

SABA albuterol 2 or less days/wk

144
Q

What meds are used for acute asthma management?

What is the benefit of using CCS and which ones are used?

A

Albuterol
Ipatropium

Burst therapy to shorten exacerbation
Prednisone/solone

145
Q

Why do we not leave asthma PTs on CCS therapy for long periods of time?

After Dx asthma, what is the first line medication given and what are two common s/e?

A

HPA suppression= weight gain, suppressed growth, Cushings

Inhaled CCS
Thrush, dysphonia

146
Q

What second class of medication can be added to asthma PTs w/ inhaled CCS?

This is also especially effective for ?

A

Leukotriene antagonist- Montelukast

Exercise induced asthma

147
Q

What is the long acting B-agonist used for asthma?

What is the risk of this med?

A

Salmeterol

Black box- not for monotherapy, only in combo use w/ inhaled steroids

148
Q

What medication can be used in PTs +12y/o w/ mod/sev asthma that can dec allergic exacerbation?

What med is given for anaphylaxis or asthma unresponsive to short acting meds?

A

Omalizumab- aspergillosis PTs

Epinephrine for PTs that present as “Status asthmaticus” (CO2 retention >40mmHg, tachy and normal pCO2)= impending respiratory arrest

149
Q

MDIs w/ spacers are as effective for asthma as ?

Why is pertussis so deadly in kids?

A

Nebeulizers

Can’t get DTAP until 2mon

150
Q

What are the 3 stages of pertussis?

A

Catarrhal stage- low fever, rhinorrhea

Paroxysmal- distinctive, violent coughing fits and post-tussive emesis

Convalescent- dec Sxs, cough and whoop

151
Q

Pertussis is AKA ?

How do infants <3mon present with this Dz?

A

100 day cough

Apnea/cyanosis after coughing
Apnea alone- CNS damage

152
Q

What do older PTs complain of who have pertussis?

What is the gold standard lab test to Dx pertussis?

A

Strangulation feeling followed by coughing and emesis

PCR of nasopharyngeal wash for early phase
Serology for convalescent phase confirmation

153
Q

How does pertussis change blood and visible on labs?

What would be seen on CXR?

A

Lymphocyte dominant leukocytosis, not for Dx

Atelectasis
Peripheral infiltrates

154
Q

How is pertussis Tx?

When is the vaccine given?

A

<6mon, admit
Azithromycin including for prophylaxis
<1mon= Erythromycin, don’t use Clarithromycin

2 4 6 15-18mon
4-6yrs
Booster: 11-12yrs
Pregnant w/ each pregnancy

155
Q

What is the number once complication of pertussis?

What is the number one cause of bronchiolitis?

A

Pneumonia

RSV during 2-6mon

156
Q

What are the risk factors for bronchiolitis

What does this sound like on exam?

A

Male
2nd smoke exposure
Not breast fed
Smoked during pregnancy

Mice squeaking on lungs
Wheeze/crackles

157
Q

How is bronchilitis Dx?

What would be seen on CXR?

A

ELISA, PCR

Hyperinflated lucency
Flat diaphragm
Atelectasis

158
Q

When do Peds need additional oxygen w/ bronchiolitis?

What method is used?

What monitoring/Tx step needs to be followed?

A

90%

Nasal cannula

Dehydration monitoring

159
Q

What vaccine is given to prevent RSV?

What are the indicators to give the vaccine?

A

Palivizumab

<29wks gestation
Chronic lung dz of premature, <32wks at birth
CHDz in 1st year of life

160
Q

When is the influenza vaccine given?

What happens during pneumonia that makes it problematic?

A

> 6mons

Airway and parachyma with consolidation of aveolar space

161
Q

Define Pneumonitis

Define Atypical pneumonia

A

Lung inflammation +/- consolidation

More diffuse than lobar pneumonia

162
Q

Define Bronchopneumonia

Define interstitial pneumonia

A

Lung inflammation centered to bronchioles

Inflammation of walls of aveoli

163
Q

What type of pneumonia is most common in kids?

What are the most common etiologies of pneumonia?

A

Lobar

Neonates: GBS, Ecoli, Strep pneumo

Infant 1mon-5yrs: RSV, parainfluenza, influenza, Strep pneumo, HIB

> 5yrs: Mycoplasma, Strep pneumo, Chlamydia pneumo

164
Q

How do neonates present w/ pneumonia?

What are infants first presenting sign?

What part of the VS will help with these Dx?

A

Fever, Hypoxia

Apnea

Pulse Ox

165
Q

What will be seen on labs for kids w/ pneumonia?

How will this appear on CXR?

A 
Viral= lymphocyte dominance
Bacteria= leukocytosis, neutrophil predominance

Bacteria: lobar location
Viral: diffuse

166
Q

What are normal respiration rates for infants/toddlers?

A

0-2mon: >60
2-12mon: >50
1-5yr: >40
>5yr: >20

167
Q

How are kids w/ pneumonia who have had vaccines Tx?

A

Amoxicillin
Alt: Cefuroxime and Amox/Clavu

3rd Gen Cephalosporin or Amox/Clavu
Alt: Clindamycin

Allergy to alternate: Levofloxacin

168
Q

How are kids >7y/o w/ pneumonia who have been vaccines Tx?

A

Azithromyin, Clarithromycin, Doxy

Macrolide allergy= Levofloxacin
Alt: 3rd Gen Ceph or Clindamycin

169
Q

How is CAP in neonates Tx while inpatient?

A

Ampicillin/Gentamycin
Or PCN G

If Staph A concern- use Vancomycin
HSV- use acyclovir

170
Q

What is the most common life-limiting genetic Dz in Caucasians?

What is the etiology of this?

A

CF

Chrom7 mutation- cystic fibrosis transmembrane regulator gene, D-508

171
Q

What organs are most likely affected by CF?

PTs w/ CF and sinusitis will commonly grow ?

What Sx is seen on their hands?

A

Lung Pancreas GI Testes

Nasal polyposis

Clubbing

172
Q

Infants w/ CF can present w/ ? GI issue?

What happens in CF PTs due to pancreas involvement?

A

Meconium ileus

Steatorrhea and failure to thrive

173
Q

Infants need to be screened for CF if they present w/ ? 4 issues

When do kids need to get screened?

A

FTT
Cholestatic jaundice
Chronic respiratory Sxs
E+ abnormalities

Resp/GI/clubbing Sxs
Nasal polyps <12yrs/old
All siblings of CF PTs

174
Q

What criteria are needed for Dx CF

A

Clinical features or,
Sibling w/ CF or,
+ newborn screening

Plus

Evidence of CFTR dysfunction (2 sweat Cl tests) or,
Two CF mutations

175
Q

What is the TOC for Dx CF?

What can be given to CF Pts to reduce mucus viscosity?

A

Cl Sweat test: + >60mEq
72hr fecal fat

Aerolized DNAse and 7% NS via nebulizer

176
Q

Kids are not expected to reach normal vision of 20/20 until what age?

What is legally blind

What is the most common cause of vision impairment in kids?

A

6yrs old

20/200 or worse

Retinopathy of prematurity

177
Q

Define the Rule of 8

A

Determines need to refer childhood vision screening

Age + vision distance w/ tens digit dropped= ?

Equal 8, vision is great
9 or more, vision is poor

178
Q

What is a baby’s vision at birth?

When do tears when crying develop?

When are eye exams began and how often after?

A

20/400

1-3mon

6mon
Annually

179
Q

Baby’s eyes can move abnormally/independent and be called normal until they’re ? old

Fixation/tracking should occur by ? age

180
Q

What are the 4 ways to test distance visual acuity?

Define Hyperopia
Define Myopia

A

Snellen letter/number
Tumbling E
HOTV

Far sighted- most kids at birth
Squints, rubs eyes, lack of interest in reading

Near sighted- squints due to pin hole effect improving vision, rare except in prematures (ROP)

181
Q

Define Strabisumus

Define tropia and phoria

Define Amblyopia

A

Eye misalignment, to squint or look obliquely
Phoria + tropia

Tropia: Constant strabismus
Phoria: fixation of affected eye is interupted “letent strabismus”

Central vision loss due to lack of development

182
Q

What are the 3 types of amblyopias

What eye issue causes a misalignment of the visual axis

A

Strabismic- misalignment; brain ignores input from an eye, misalignment

Refractive- blurry; my/hyperopic

Deprivation- obstructed; retinopathy of prematurity, congenital cataract/glaucoma, retinoblastoma (usually w/ leukemia)

183
Q

Define Hirshberg test

What is normal or what would be seen in a pseudostrabismus

A

Conrenal light test to assess alignment

Norm- light reflex slightly nasal to center of pupil
Pseudo: eye look misaligned, normal corneal light reflex

184
Q

How is esotropias Tx?

How are exotropias Tx?

A

Congenital= surgery
2-5y/o= patch/glasses
After 5yrs= CNS dz

Patch for persistent
Surgery for extreme
Under 3yrs- refer to ophthmologist

185
Q

What is the cover test done to reveal?

Lack of a red reflex can be indicative of ?

A

Reveals muscle imbalances
Cover normal eye= affected eye moves in opposite direction of deviation

Leukocoria
Cataract
Tumor- retinoblastoma
Chorioretinitis
Retinopathy of prematurity
186
Q

When are complete ophthalmologic exams warranted?

A

Premature birth
Cerebral palsy/Downs
Poor school performance

Nystagmus
Strabismus
Worse than 20/40 after 3yrs or 2 line difference
Torticolis
Abnormal red reflex
187
Q

If PT has unilateral conjunctivitis, this rules out ? Dx

What would be the difference in presentation of bacterial/viral conjunctivitis?

A

Allergies

B: gunk, crusty from medial part throughout day
V: watery

188
Q

Conjunctivits does not touch what anatomical structure of the eye?

What are the 3 most common causes of ophthalmia neonatorium?

A

Limbus

Chlamydia
E Coli
Gonorrhea

189
Q

What are the top 3 causes of viral conjunctivitis

What is the etiology of the conjunctivitis if it is 1-3 days, 2-7, 3-21, or 4-19 days old

A

Adenovirus
Coxsacie
Enterovirus

1-3: chemical
2-7: Gonorrhea, Staph, Strep, Pseudomonas, E Coli
3-21: HSV
4-19: Trachomatis

190
Q

How is neonatal conjunctivitis Dx

What is used to prevent gonorrhea conjunctivitis during birth?

A

Gram stain, Culture
HSV leaves dendritic lesion on cornea

Erythromycin
Tetracycline after birth

191
Q

What is used for Tx of neontal chlamydia conjunctivits?

What is used for gonrorrhea

What is used for pseudomonas conjunctivitis

A

Erythromycin

Ceftriaxone

Gentamycin w/ systemic ABX

192
Q

What is used for neonatal HSV conjunctivitis

What is used for Staph A conjunctivitis

A

Acyclovir

Erythromycin or polysporin

193
Q

What microbe is responsible for “pink eye”?

What are the 3 microbes causing post-neonatal conjunctivits and how are they Tx?

A

Viral pink eye
Adenovirus- use COLD compress

H influenza
Strep pneumo
M catarrhallis
Tx w/ Erythromycin* or Polymyxin B- trimethoprim

194
Q

What are the 4 ABX she wants us to know for conjunctivitis?

What is the hallmark Sx of allergic conjunctiviits and how is it Tx

A

Polymyxin B and Trimethoprim
Erythromycin- best for <1y/o
Ciprofloxacin
Moxifloxacin

Pruritus, cobble stoning and bilateral onset
Tx: vasoconstrictor antihistamin NSAID Cromolyn

195
Q

Define Bleb

What is an important DDx for this?

A

Temporary blister associated w/ contact to allergen

Ciliary flush- injection around limbus, same day refer asap
Uveitis, Iritis, Iridocyclitis

196
Q

Define Bepharitis

How do they present

A

Eyelid inflammation from Staph, Seborrhea and meibomian gland issue

Photophobia, Burning, Irritation, foreign body sensation

197
Q

How are blepharitis’ Tx?

Define dacryostenosis

A

Eyelid scrub, warm compress, topical ABX

Lacrimal duct obstruction

198
Q

Define Dacryocystitis

How are they Tx?

A

Bacterial infection of Staph A or Staph in lacrimal sac causing swelling and pain

Massage, topical ABX,

199
Q

Define Hordeolum

How are they Tx

A

Stye on external eye from infected gland of Zeis
Internal= infected meibomian gland from Staph A causing pain and redness

Warm compress
NSAIDs

200
Q

Define Chalazion

How are these Tx

A

Obstructed Meibomian gland causing nontender/non-erythematous swelling

Steroid injection or Surgical removal

201
Q

Periorbital cellulitis is AKA ?

These PTs won’t have ?

A

Preseptal cellulitis

Proptosis
Ophthalmoplegia

202
Q

What microbe causes periorbital cellulitis?

What meds are used for Tx on outpaitent basis?

A

Staph A/GAS

Cephalexin, Clindamycin, Amox/Clavu
MRSA: Trimeth/Clindamycin

203
Q

What is a serious complication that can occur from sinusitis?

What microbes can cause this

A

Orbital cellulitis

Staph A
Strep pneumo
H influenza

204
Q

How is orbital cellulitis Tx?

What is a CN deficiency that can develop from this condition?

A

Admit w/ culture
Cefazolin/clindamycin
Cefuroxamine + metron
MRSA= Vanc + Cefotax + Clinda

Cavernous sinus thrombosis- CN 3, 4 V1, V2, 6 palsy from subperiosteal abscess

205
Q

Acute ottitis media indicates ? microbe etiology

What two ear issues can present w/ fluid in the middle ear and these present w/ ? PE finding

A

Viral

Acute OM
OM w/ effusion
Conductive hearing loss

206
Q

When are AOMs common and why?

What is the most common operation performed in infants/young kids?

A

First 2yrs
Ear canals are still flat, angle down w/ age

Myringotomy

207
Q

What is the most common cause of acquired hearing loss in kids?

What bacteria cause this most commonly?

What viruses cause this most commonly?

A

AOM

H influenza
Catarrhalis
GAS
Strep pneumo

Rhino, influenza, RSV

208
Q

AOM Dx requires ? 3 things

What are the S/Sxs of two of these criteria

A

Acute onset of S/Sxs
Middle ear effusion and inflammation

Effusion S/Sxs:
Bulging
Dec/no movement
Air-fluid level
Otorrhea- spontaneous after TM ruptures

Middle ear inflammation:
TM erythema
Otalgia

209
Q

What is the most common sequela of AOM?

How is AOM Tx?

A

OM w/ effusion or chronic OM

Acetaminophen/Ibuprofen
ABX- all PTs 2yrs and under
Over 2yrs- ABX, consider 24hr observation 
Amoxicillin
Amox/Clavu
Cefdinir/Ceftriaxone
210
Q

When does a kid meet criteria for pressure equalization tube procedure?

What AOM adverse development can be seen on PE?

A

Developmental risks
Recurrent AOM +3mon effusion and bilateral hearing loss

Mastoiditis
Cholesteatoma
Petrositis
Intracranial extensions

211
Q

How are recurrent cases of OM Tx?

What vaccines can these PTs get?

A

<1mon since Tx: new ABX
>1mon: same ABX
>3 episodes in 6mon OR >4 episodes in 12mon, OR IM Ceftriaxone requirement= refer, atopic ABX

Vaccinate- Strep Pneumo and annual influenza

212
Q

Define Ottitis Externa

What causes it

How do PTs present

A

Swimmers ear

Pseudomonas or Staph A

Pain, discharge, pinna tender to manipulation
Tragus tenderness w/ chewing

213
Q

What is the microbe if a kid presents w/ swimmer’s ear but has tube?

How is swimmers ear Tx?

A

Staph A
Strep pneumo
Catarrhalis
Klebsiella

Ofloxacin or Cipro w/ hydrocortisone or Dexameth
Polymyxin B
Fluoroquinolones safe for tympanostomy tubes

214
Q

90% of epistaxis arise from what circulatory structure?

What is the number one cause for this to bleed?

A

Kiesselbach’s plexus

Trauma/picking

215
Q

What 2 meds can be used to help stop an epistaxis if not self resolving?

What meds are not used for PTs w/ common colds?

A

Afrin
Pheynlephrine

Antihistamines if <6yrs
No ABX
No cough suppressants
No expectorant

216
Q

Babies are born with ? 2 sinuses?

What age do others sinuses develop?

A

Maxiallary and Ethmoid

Sphenoid- 5yrs
Frontal- 7yrs

217
Q

What is the hallmark finding of sinusitis?

What meds are used to Tx?

A

Mucopurulent rhinorrhea 10-14 days after cold/URI

First line: Amox/Clavu
PCN Allergy- Levo, Clinda + 3rd Gen

218
Q

What are the 2 phases of allergic rhinitis

What are the 3 types of allergic rhinitis and what triggers them

A

Early: mast cell degranulation

Late: eosinophl, basophil, CD4, monotcytes causing inflammation

Seasonal- pollen
Perennial- mites, dander, mold
Episodic- pets

219
Q

3 most common causes of meningitis?

Parent education for controling peds eczema

A

Strep pneumo
N Meningitidis
H influenza

Cool temp
Emolients
Avoid herpes sores
Avoid irritating clothes
Avoid tobacco
No limitation on vaccine, sun or sports
Breast feed x4-6mon
220
Q

Difference in DNA between Parvovirus B19 and HHV 6 or 7

Reactivation of HHV-6 after a bone marrow transport can lead to ?

A

B19: single stranded DNA
6/7: enveloped double strand DNA

Rash
Encephalitis
Hepatitis
Marrow suppression

221
Q

Allergic rhinitis presents w/ ? atopic triad?

What is the most potent pharmacological therapy for Tx of allergic/nonallergic rhinitis?

A

Eczema, asthma, allergic rhinitis

Intranasal CCS- reduces inflammation, edema and mucus w/ no systemic effect
MFT- one
Budesonide

222
Q

What class of meds are preferred for allergic rhinitis?

What meds could be used if kid doesn’t like spraying things up their nose?

A

2nd Gen anti-histamines- Cetir/Lorata/Fexofen/Deslo-dine

Topical antihistamine:
Azelastine
Olopatadine

223
Q

What drug can be used as second/third line therapy for allergic rhinitis

This addition is best in ?

A

Montelukast

Pre-existing asthma

224
Q

What meds can be used for allergic rhinitis decongestants?

What can be used for non-allergic rhinitis and rhinitis associated w/ viral URIs?

A

Pseduophedrine
Phenylephrine

Ipratropium

225
Q

What are the two most common causes of pharngitis mono?

What is the most common viral cause of pharyngitis/tonsilitis?

A

EBV, CMV

Adenovirus

226
Q

What is the most important Sx/lack of Sx when Dx pharyngitis/tonsillitis?

What are the tonsil grading methods?

A

+ Fever
- cough

0-4
4= kissing
3= 50-75
2=25-50
1= <25%
0= not visible
227
Q

What is the Centar criteria

A 
No cough
Anterior adenopathy
Fever >100.4
Tonsil swelling/exudate
3-14y/o
45+= subtract 1 pt

1-3: culture/rapid strep
4-5: probable, culture and ABX

228
Q

What is the gold standard TOC for pharyngitis/tonsilitis?

How is mono tested for is suspected?

A

Strep swab

Monospot blood test

229
Q

What meds are used for Strep throat?

Why do we Tx this?

A

Amoxicillin
PCN
Allergy= Cephalexin, Cefadroxil, Clindamycin
B-lactam allergy: Erythromycin

Shortens Dz
Prevent ENT issue
Prevents acute TF
Prevents spread
NO prevention of kidney issue
230
Q

What does the PANDAS infection present w/

How is thrush Tx?

A

OCD, tics
Ped autoimmune neuropsych w/ strep

Nystatin
Azole if fist line fails

231
Q

When does GER peak and resolve?

What are the 3 major concerns if a baby has GERD?

A

Peak @ 4mon
Resolve by 2yrs

Weight loss/FTT
Esophagitis
Pulmonitis

232
Q

What are the risk outcomes of GERD?

What is the best imaging study to assess for this?

A

Esophageal stricture
Asthma
Barrett’s esophagus

Upper endoscopy

233
Q

What is the first line therapy for GERD?

What is the TOC if Sxs are severe or aspiration?

A

PPIs

Fundoplication- Nissen operation, prevents them from being able to throw up

234
Q

How is esophagitis Dx

How is it best Tx

A

Endoscopy

NPO
Viscous lidocaine, PPI, Metoclopramide, Sucralfate

235
Q

How is eosinophilic esophagitis Dx

How is it Tx

A

Endoscopy w/ biopsy
EoE RAST panel

Swallowed CCS

236
Q

Define Visceral pain

Define somatic pain

A

Autonomic nerves sending sensation via nonmyelinated fibers of dull, slow onset/poorly localized pain
(functional abdominal pain, IBS)

Myelinated somatic fivers sending signals of well localized pain

237
Q

What are the 4 types of IBS

What criteria is needed for Dx

A

IBS-C
IBS-D
IBS D and C
Unspecified IBS

Pain 4 or more days/wk
Pain doesn’t stop after BM
Sxs not better explained

238
Q

What is the one time essential oils are used?

How are the different stages of IBS Tx?

A

IBS- peppermint oil

Mild: diet, antidepressants
C: fiber, glycol
D: loperamide

239
Q

What PT population tends to have cyclic vomiting syndrome?

What issue do they tend to develop later in life?

A

Caucasian female

Migraine

240
Q

What meds can be used to help w/ Cyclic Vomitting syndrome?

What meds can be used for abdominal migraines?

A

Triptans
Zofran

Prophylaxis: Cyproheptadine, Propanolol, Amitriptyline
Antimigraine for aborting episodes

241
Q

What causes Functional Diarrhea

What is a key component of making this Dx

A

Toddler Diarrhea
Watery stool from excessive sweet liquids and low fat diets

Painless
No FTT

242
Q

When is constipation dx?

What life milestones can cause this?

A

2 or less stools/wk
Hard pellets for 2wks

Intro to solid foods
Toilet training- functional constipation
Start of school- social stress

243
Q

What are four tests are ordered for constipation and what suspicions are they ordered for

What 3 meds can be used?

A

Biospy- hirshprungs
Barium enema- malformation
X-ray: spina bifida
Blood work: DM, thyroid, celiac

Glycol
Mg milk
Mineral oil

244
Q

Define Encopresis

What order is super helpful w/ this Dx

A

In/Voluntary passage of feces in inappropriate places 1/mon x 3mon

Abdominal x-ray

245
Q

Celiac dz is associated w/ ?

What are some extraintestinal manifestations that can be seen?

A

DMT1, Thyroiditis, Turners, Trisomy 21

Osteopenia
Arthritis
Ataxia
Elevated liver enzymes

246
Q

How is Celiac Dz Dx?

How is the Dx confirmed

A

IgA Antiendomysial Ab and
IgA tissue transglutaminase Ab AND
Total serum IgA

Endoscopic small intestine biopsy

247
Q

What can Celiac Pts eat?

How does Allergic Collitis present

A

Rice Tapioca Corn Buckwheat

Milk/Soy intolerant w/ blood streaked stool but no N/V/pain

248
Q

What type of formulas do Allergic Collitis babies need to have?

Define Acute Gastroenteritis

A

Hydrolyzed protein formula (casein hydrolysate)

Sudden diarrhea illness

249
Q

What is the leading cause of morbidity and common in US babies?

How is this seen as a world-wide issue

A

AGE

Childhood fatality in developing world

250
Q

What microbe is the leading cause of AGE outbreaks in day cares?

A

Shigella, Cryptosporidium

Blood= bacteria, intussusception

ABX= C Diff

251
Q

What is the only AGE microbe that causes microvilli damage

What are the other 3 common microbes in this etiology

A

Rotavirus

Astrovirus
Calicivirus
Enteric adenovirus: 40, 41

252
Q

What microbe can cause AGE that is found in pre-heated food?

What is the difference between secretory and mucosal invasion diarrhea

A

Campylobacter

Secretory: watery, normal osmolality (cholera, EPEC, ETEC, C Diff
Invasion: blood, WBCs in stool (bacteria etiology)

253
Q

What medication can help reduce vomiting in AGE PTs in attempt to avoid IV fluid resuscitation?

How is mild/mod dehydration Tx?

A

Ondansetron

Mild: 50ml/kg over 4hrs
Mod: 100mL/kg over 4hrs
Ongoing: 10mL per stool
Maintenance: 100mL over 24hrs until diarrhea stops

254
Q

Define Bezoar

When does this presentation peak?

A

Accumulation of exogenous matter in GI, mostly food or fiber

2nd decade of life

255
Q

What is the most common chest wall deformity in kids

Infants w/ CHD often have no ? and instead present w/ ?

A

Pectus excavatum

Murmur
Baby exercise- sweat
FTT

256
Q

What heart sound is a normal variant in Peds?

What type of S2 is normal and what type is indicative of a defect

A

S3
However, loud= dilated ventricle

Physiological split- N
Fixed split- ASD

257
Q

What do cardiac clicks mean?

What type of EKG finding is common

A

Abnormal valve
Dilated great vessel

Sinus arrhythmia- from immature cholinergic input

258
Q

What is the most common Sx arrhythmia in Peds

Functional murmurs are AKA

A

SVT- vagal and adenosine

Benign, Innocent

259
Q

Functional murmur includes what 4 and their location

A

Still’s murmur: 3-6yrs, systolic, LLSB or apex, vibratory/muscial, dec w/ upright

Hum: 3-6yrs; continuous, louder w/ upright, changes w/ jugular compression or head turns

Carotid bruit: systolic, over carotid and at any age

Ejection: 8-14yrs; systolic, LUSB, softer when upright and no radiation to back

Peripheral PS: newborn-6mon; systolic, axilla and back, harsh and short

260
Q

What part of a sickness process accentuates murmurs?

How are murmurs graded?

A

Fevers- inc blood flow

1: very soft
2: easily heard
3: loud, no thrill
4: loud w/ thrill
5: loud, thrill, audible @ 45*
6: heard w/ no stethoscope

261
Q

What atrial dysrhythmia is uncommon in Peds population

A

A-Fib/Flutter

Usually presents after surgical repair of CHDz or mycocarditis, drug toxicity

262
Q

How does SVT present in Peds?

How can it be managed?

A

220 or higher w/ sensation of pounding heart

Vagal, ice bag to face (dive reflex), blow through straw
IV adenosine
only do vagal/dive reflex in stable PTs

263
Q

What Tx is done for V-Tach in peds?

If mother has Lupus or Sjorden’s, what heart abnormalities can be seen?

A

Conversion if Sx/unstable
Lidocaine/amiodarone if conscious/ASx

Congenital 3* block

264
Q

Acyanotic lesion implies ?

What is the first and second most common congenital heart defect of kids?

A

No shunt or L to R shunt

VSD
PDA

265
Q

How do PTs w/ VSDs not responding to Tx present?

How do VSD and ASD look on EKG?

A

FTT, PHTN

VSD: LVH
ASD: RAD, RVH

266
Q

How do PDAs present on exam?

What med is used to keep a PDA open?

A

Bounding wide PP
Continuous machine murmur

Prostaglandin E- used for cyanotic lesions

267
Q

Tx of choice for coarctation?

What is the first and second most common cyanotic heart defect?

A

Surgery

Tetrology
Transposition

268
Q

What is the most common cause of cardiac defect deaths in the first month of life?

Lesions that produce CHF or PHTN require ? stabilization meds?

A

Hypoplastic left heart syndrome

Lasix +/- Digoxin

269
Q

Acyanotic lesions are usually corrected before ? age

If untreated, most lesions will result in what 3 issues?

A

2yrs

PHTN
CHF
Subacute bacterial endocarditis

270
Q

What causes RF

What age does this present in

A

Group A B-hemolytic strep pharyngitis causing anti-strep Abs to cross react w/ cardiac Ags

6-15y/o

271
Q

What lab work is done for RF and how is it Dx

What are the minor criteria for Jones?

A

Anti-strep O titer
2 major or,
1 major, 2 minor

CAFE PAL
CRP inc
Arthralgia
Fever 101-102
ESR inc
Prolonged PR intercal
Anamnesis of rheumatism
Leukocytosis
272
Q

What ABX are used for acute RF

What age do annual BP checks begin?

A

Benzathine PCN
Allergic- erythromycin
ASA- for anti-inflammatory

+3yrs

273
Q

How long do kids need to be still prior to taking BP?

What if the BP cuff is too narrow?

A

5min

Artificially high

274
Q

Criteria for White Coat Syndrome

What is the most common cause of HTN in adolescent

A

95th or higher percentile but normal out of office

Primary essential

275
Q

What is the most common cause of secondary HTN in kids?

How are kids placed into HTN categories?

A

Renal dz

Normal: <90th percentile
Pre: 90-95th; repeat in 6mon
1: 95th-99th + 5mmHg; repeat 1-2wks
2: >99th + 5mmHg; evaluate and refer

276
Q

What BP is always abnormal in peds?

Peds w/ HTN need to be evaluated for secondary cause if what 2 things exist?

A

+120/80

BMI +85th percentile
+140/100

IPAP (212 decks)

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