Peds General Flashcards
Higher functioning adolescents with autism are at increased risk for: a. Significant phobias b. Panic attacks c. Substance abuse d; Obsessive Compulsive disorder
Obsessive Compulsive disorder
Treatment for AOM Antibiotic treatment after 48 - 72 hr of failure of initial antibiotic treatment and with PCN allergy
second Line treatment Amoxicillin-Clavulanate (Augmentin)—90 mg/kg/day of amoxicillin and 6.4 mg/kg of clavulanate in 2 divided doses OR Third line treatment Ceftriaxone—50 mg/kg 2 doses IM or IV/day for 3 days IF PCN ALLERGY (RASH NOT ANAPHYLAXIS) Use Ceftriaxone—50 mg/kg 2 doses IM or IV/day for 3 days OR Clindamycin (30 -40 mg/kg/d in 3 divided doses with or without a 3rd generation cephalosporin Consider tympanocentesis, referral to specialist.
The most appropriate management of a 5-year-old with a firm, nontender nodule in the mid-upper eyelid for 3 weeks would be: a. Coolcompresses b. Topical ophthalmic ointment c. Oralantibiotics d. Oralsteroids
b. Topical ophthalmic ointment
- Prematurity increases the risk of developing which one of the following? a. Nystagmus b. Astigmatism c. Myopia d. Glaucoma
c. Myopia
- A 15-month-old failed treatment with amoxicillin for an otitis media. At his 2-week recheck, his TM remained red with distorted landmarks and he persisted with nasal congestion, poor nighttime sleeping, and with a 101°F fever for the past 2 days. The next best step would be to treat with: a. A 10-day course of Augmentin b. A 3-week course of a cephalosporin c. A higher dose Amoxicillin and topical antibiotics d. Ceftriaxone and an antihistamine
a. A 10-day course of Augmentin
What is pyloric stenosis
Never use SSRI with what herb?
St. John’s Wart
Diagnosis of AOM in children
Inflammation of the middle ear with fluid in the middle ear space (suppurative otitis media); the 2013 American Academy of Pediatrics specify 3 criteria that must be present: 1. moderate or severe bulging of TM with otalgia (pain) OR new onset of otorrhea (drainage) not related to external OE with otalgia OR 2. Mild bulging of TM and recent (
- Fluorescein staining of the eye is used to detect a: a. Keratitis b. Foreignbody c. Corneal abrasion d. Hyphema
c. Corneal abrasion
- A 3-month-old has a mild asymmetrical corneal light reflex on physical exam. What is the next appropriate step? a. Observe and reevaluate at the next well check b. Refer immediately to ophthalmology c. Begin atropine drops or eye patching d. Protect eyes from sunlight
a. Observe and reevaluate at the next well check
- A 10-year-old has marked ear pain, not wanting anyone to touch his ear. The canal is edematous and exudate is present. TM is normal. How should this be managed? a. Topical fluoroquinolone b. Oral steroids and topical neomycin c. Oral amoxicillin and topical anesthetic d. Oral amoxicillin and topical steroid
a. Topical fluoroquinolone
- All but which one of the following assessments is used to determine the presence of a strabismus? a. Hirschberg test b. Cover-uncover test c. Extraocular movements d. Pupillary response
d. Pupillary response
- Conductive hearing loss can be caused by: a. Braintumor b. Ototoxic drug exposure c. Loudnoises d. Serous otitis
d. Serous otitis
b. Hearing loss Hearing loss is the most common complication of otitis media. Children who have multiple infections should have their hearing assessed. Tonsils are normally large in young children. Shotty lymph nodes are usually associ- ated with past infections and are not clinically significant.
What are the side effects of stimulants in ADHD? (mnemonic)
TASHI Tics (tourettes syndrome) Anorexia Suicide Headaches Insomnia
A conjunctivitis appearing in a 2-day-old newborn is likely due to: a. Chemical irritation from eye drops b. Group B streptococcus c. Chlamydia d. Gonorrhea
a. Chemical irritation from eye drops
- All but which one of the following patients are at an increased risk of developing otitis media? a. 2-year-old with cleft palate repair at 1 year of age b. 15-month-old with Down syndrome c. 9-month-old with lactose intolerance d. 3-year-old with IgA immune deficiency
d. 3-year-old with IgA immune deficiency
What is severe illness in AOM? choose all that apply a. mild otalgia for 48 hrs e. Fever more or equal than 39 C (102.2 F)
c. moderate to severe otalgia OR d. otalgia for > 48 hrs OR e. Fever more or equal than 39 C (102.2 F)
- Patients with otitis externa should be instructed to do which one of the following? a. Keep ear dry until symptoms improve b. Limit swimming for remainder of summer c. Wear ear plugs at all times with swimming d. Use alcohol drops before swimming each day
a. Keep ear dry until symptoms improve
What pharmacological treatments are used for ADHD
Stimulants Amphetamines: (Adderall, Vyvanse) Non-stimulants Atomoxetine (straterra) Antihypertensives: Propanalol and clonidine
What is at -risk children with OME?
Persistent effusion accompanied by language delay and or suspected or documented hearing loss.
What are the 3 main organisms for Otitis Media?
S. pneumonia (Treatment target in AOM) gram + H. Influenza (gram -ve) M. Catarrhalis (gram -ve)
- A 2-year-old male with a history of chronic serous otitis media is noted to have a pearly white opacity in the upper outer quadrant of his TM. He currently has no symptoms and appears to hear “okay.” The most likely diagnosis and appropriate management would be: a. Tympanosclerosis; no treatment is necessary b. Persistent perforation; prescribe topical antibiotic drops c. Foreign body; perform an ear wash for removal d. Cholesteatoma; refer to otolaryngology
d. Cholesteatoma; refer to otolaryngology
What intervention with the at-risk children for OME?
Tympanostomy or adenoidectomy surgical intervention should be considered.
What is prevention of otitis externa (swimmers ear)?
Prevention—instillation of white vinegar and rubbing alcohol (50/50) in both ear canals after swimming; avoid water in canals, vigorous cleaning, scratching, or prolonged use of cerumenolytic agents
What age is watchful waiting appropriate in AOM? When do you give antibiotics and follow up?
This is in the otherwise well child: 6 months and older with non-severe illness based on joint decision making with parents/caregivers for UNILATERAL AOM. Follow up must be ensured with ability to start Antibiotic therapy within 48 - 72 hrs if child fails to improve or worsen.
Daily eyelid cleansing with diluted baby shampoo and a cotton-tipped applicator would be appropriate in the treatment of which one of the following conditions? a. Dacryostenosis b. Chalzion c. Hordeolum d. Blepharitis
d. Blepharitis
Conjunctivitis-otitis syndrome occurs in about 25% of young children ( 3 years) and most often associated with a. Streptococcus pneumoniae b. Haemophilus influenza c. Moraxella catarrhalis d. Staphylo coccusaureus typically in ______eye/ear ipsilateral or contalateral
Haemophilus influenza ipsilateral (same side ear/eye)
The most common cause of autism is: Fragile X syndrome Klinefelter syndrome (XXY)
Fragile X syndrome
What is first line intervention for OME
Watchful waiting in the majority. 75% - 90% resolve within 3 months without specific treatment.
Treatment for AOM 1st line treatment and with PCN allergy
First line therapy - Amoxicillin—80–90 mg/kg/day (maximum 4 g/day) for 10 days in 2 divided doses. (shorter courses possibly with older children with milder cases) High dose OR Amoxicillin-Clavulanate (Augmentin)—90 mg/kg/day of amoxicillin and 6.4 mg/kg of clavulanate in 2 divided doses IF PCN ALLERGY (RASH NOT ANAPHYLAXIS) Use cefdinir (14 mg/kg/d in 1 or 2 divided dosess) OR cefuroxime (30 mg/kg/d in 2 divided doses) OR cefpodoxime (10mg/kg/d in 2 divided doses), OR Ceftriaxone—50 mg/kg 2 doses IM or IV/day for 1 or 3 day (Use this only if pt cannot be given any of the PO above first)
AAP recommends screening of Autism at which of the following times in early childhood? a. 6 and 18 months b. 12 and 24 months c. 18 and 24 months d. 24- 36 months
c. 18 and 24 months
- Concurrent otitis media and conjunctivitis is likely due to which organism? a. Streptococcus pneumoniae b. Haemophilus influenza c. Moraxella catarrhalis d. Staphylo coccusaureus
b. Haemophilus influenza
What is the most common cause of TEMPORARY speech delay in early childhood?
Persistent OME
Pain and fever control for AOM How long does it take before the fever is resolved when prescribed Antibiotics
a. Analgesics—acetaminophen, ibuprofen b. Local anesthetic otic drops can provide short term pain relief (20 -30 minutes) (contraindicated in acute/chronic perforations and ventilation tubes) It takes 2- 3 days.
Pneumatic otoscopy used for
—visualize degree of Tympanic mobility impairment in AOM
Autism Spectrum Disorder includes:
Autistic disorder, childhood disintegrative disorder, Rett’s disorder (Female) and pervasive developmental disorder
What is nonsevere illness in AOM? Choose all that apply a. mild otalgia for 48 hrs e. Fever more or equal than 39 C (102.2 F)
a. mild otalgia for
A 3-year-old has an edematous, mildly erythematous right upper eyelid for one day with a fever of 103°F. An important eye assessment would be: a. Ocular mobility b. Conjunctival inflammation c. Pupillary reaction d. Optic disc papilledema
a. Ocular mobility
what is the first line treatment for ADHD
Stimulants: Methylphenidate (Ritalin, Concerta)
What is Otitis media with effusion (OME)
Definition: Inflammation/fluid accumulation in middle ear (serous, not purulent fluid) with decreased TM mobility on pneumatic otoscopy but without signs and symptoms of ear infection; formerly known as serous otitis “glue ear”.
- All but which one of the following is consistent with glaucoma? a. Photophobia b. Epiphora (increase tears) c. Blepharospasm d. Leukocoria (white red reflex)
d. Leukocoria (white red reflex)
When is antibiotic therapy given for AOM?
- Non-severe or severe illness whether unilateral or bilateral AOM in children younger than 6 months. 2. Non severe illness with bilateral AOM in younger children (6-23 months) 3. Severe illness with unilateral or bilateral AOM in children older than 6 months.
