Peds ID

Question 1

Treatment of Otitis Media

Answer 1

Amoxicillin for 7-10 days
• If they have received antibiotics in the past 30 days, treat with Augmentin (Amoxicillin-Clavulanate)

o <2 years old = treat with antibiotics
o >2 years old = observation, or antibiotics

Question 2

Treatment of Otitis Externa

Answer 2

Ofloxacin drops

Question 3

3 most common causes of bacterial meningitis in neonates:

Answer 3

GBS, E coli, listeria

Treat with Ampicillin and cephalosporin

Question 4

Scarlet Fever

Answer 4

Caused by strep pyogenes

strawberry tongue, pharyngitis, sandpaper rash with circumoral pallor

Question 5

JONES criteria of rheumatic fever

Answer 5

a sequela of strep pharyngitis (NOT OF IMPETIGO) that is due to cross-reactivity of antibodies against bacterial and host antigens
Major criteria
• J- migratory polyarthritis
• O- carditis **primary cause of morbidity
• N-subcutaneous nodules
• E- erythema marginatum
• S- Sydenham chorea (non rhythmic movements of the hands, feet, and face – due to antistreptococcal antibodies that cross react with basal ganglia).

Minor criteria
•	Arthralgias
•	Fever
•	Elevated ESR/CRP
•	PR prolongation

Question 6

What causes epiglottitis?

Answer 6

H influenza

Question 7

Tx H pylori infections

Answer 7

triple therapy –Amoxicillin (use Metronidazole if allergic to penicillin), Clarithromycin and proton pump inhibitor (Omeprazole)

Question 8

Conjunctivitis in newborns:

Answer 8

After delivery, babies receive erythromycin drops for prevention

Early onset = gonorrhea (2-4 days)
• Treat with one dose of ceftriaxone, IM or IV
After several days = chlamydia (5-12 days)
• Treat with oral erythromycin

Question 9

Risk of using macrolides (erythromycin, azithromycin) in neonates

Answer 9

Pyloric stenosis

Question 10

Atypical pneumonia

Answer 10

mycoplasma pneumoniae, legionella, chlamydia

Question 11

When to start Flu vaccine

Answer 11

6 months and older

Question 12

What happens if you give an EBV patient amoxicillin or ampicillin (mistakenly thinking they have strep pharyngitis)?

Answer 12

They will develop a diffuse maculopapular rash

Question 13

Causes of stridor

Answer 13

o	Croup
o	Epiglottitis
o	Retropharyngeal abscess
o	Foreign body
o	Laryngeal papilloma

Question 14

Treatment of bronchiolitis

Answer 14

o Treatment = supportive care, no nebs or steroids
• Nasal suctioning, hydration, pulse ox

Initial presentation: fever, cough, rhinorrhea followed by progressive respiratory distress
• Neonates can develop life threatening apnea
• Peak symptomology at day 3-4 of illness

Question 15

Treatment of croup

Answer 15

In the ED, receive nebulized racemic epinephrine (vasoconstrictor, to decrease swelling) and steroids (dexamethasone)
• With epi alone, they can have rebound swelling after several hours – need to observe for at least 4 hours

Question 16

Causes of Otitis Media

Answer 16

strep pneumo, H influenza (non typeable), Moraxella catarrhalis

• “My Hearing Sucks”

Question 17

Otitis Media and Conjunctivitis

Answer 17

If patient has AOM with concurrent conjunctivitis = this is likely caused by H influenza, which is a B lactamase producer and needs to be treated with Augmentin

Question 18

Kawasaki disease: presentation and treatment

Answer 18

CRASH and burn
•	Conjunctivitis
•	Rash: polymorphous, including palms and soles → can progress to desquamation
•	Adenopathy: cervical lymph nodes
•	Strawberry tongue
•	Hands and feet swelling
•	Burn: fever

Tx with ASA and IVIG

Question 19

Lyme disease treatment

Answer 19

• Kids under 8: oral amoxicillin
• Kids 8+ yo: Doxycycline
• Those with evidence of cardiac or neurological disease should get high dose penicillin G or ceftriaxone

Question 20

Mechanism of action of all pencillin antibiotics

Answer 20

Halts peptidoglycan synthesis in the bacterial cell wall by binding PBPs –> bacteriocidal

Question 21

What type of bacteria are you more susceptible to with splenic dysfunction

Answer 21

Encapsulated organisms

Strep pneumo, H. influenza, N meningitides, E coli, Salmonella, Klebsiella, Group B Strep