Peds ID I &II Flashcards
Why do female pediatric patients suffer from increased incidence of UTI?
- Shorter urethra
- Perineal colonization
There is a high index of suspicion for pyelonephritis if?
- High fever
- Flank tenderness
- Vomiting
- Elevated WBCs & ESR
An UTI caused by Pseudomonas aeruginosa will be {{BLANK}} negative
Nitrite
In fever of unkown origin, what are the Dx criteria?
- No explainable cause (e.g., immunodeficiency – HIV)
- Fever ≥ 100.4 ≥ 2 x week
- For at least 3 weeks
Despite 1 week of outpatient investigation
What does the initial investigation of fever of unkown origin?
- H&P
- CBC
- Urinalysis & Culture
- CXR
- Tuberculin Skin Test
- ANA titer
Look for infectious/inflammatory cause
If initial investigation of fever of unknown origin, what continued evaluation should be performed?
Outpatient
- Repeat initial exams
- Tests acute phase reactants: ESR, CRP, serum ferritin (inflammatory condition?)
- EBV serology
- Anti-streptolysin O (developing countries – Rheumatic fever)
- HIV Ab test
- Twice daily temp recordings
Look further for infectious cause
Phase 2 investigation of Fever of unknown origin includes?
- Inpatient investigation
- Lumbar puncture
- Repeat blood cultures
- Sinus XR
- Ophthalmologic exam for iridocyclitis
- LFTs
- Serologic testing for infectious cause
Look further for infectious cause
What does phase 3 investigation of fever of unknown origin include?
- Abdominal US
- Abdominal CT
- Gallium or indium scanning
- Upper GIT XR
- Bone marrow testing
- Technetium bone scanning
Look for tumors/cancers starting
Why are infants more prone to otitis media?
- Supine position for long period of time
- Weaker immune system
- horizontal eustachian tube
Common otitis media pathogens can cause {{BLANK}}, a painful condition in which relief is not felt until spontaneous rupture
Bullous myringitis
Blocks tympanic membrane
To Dx acute otitis media you should have what S/Sx?
At least a few S/Sx
* Erythematous
* opaque
* bulging tympanic membrane
* reduce light reflex
* mobility reduced
Most cases of otitis media are caused by?
Viruses (sterile AOM)
Viruses > S. pneumoniae > H. influenzae
What is the DOC for initial treatment of otitis media?
Amoxicillin
If after 48-hours the patient has suffered from increased S/Sx of otitis media, you should switch the ABx to?
Augmentin
Effusion is suspected after otitis media but you should re-check for resolution at?
6 weeks
If effusion still persists after initial treatment of otitis media you should perform a? What if abnormal?
At 9 week visit
- Audiometry
- If abnormal, tympostomy tube
If at the 12 week F/U visit of otitis media there is still effusion you should?
- Refer to ENT
- Tympostomy
- Adenoidectomy
Why is it important to treat pediatric UTI?
- Leads to pyelonephritis
- Can destroy nephrons leading to HTN
Pyelonephritis: high fever, vomiting, WBCs, ESR, flank tenderness
What is important regarding collection of a urine specimen for UTI?
- If not potty trained, clean perineum and collect via catheter
- If potty trained, clean area & collect via stream (clean catch)
How is initial treatment in UTI performed?
Regarding urine culture
- Until culture: TMP/SMX
- If pos.: can continue
- If neg.: D/C
A positive result for a clean-voided male/female regarding # of bacterial colonies in a UTI specimen is?
Over 100,000 colonies/mL in urine
For catheterized urine sample, what is a positive result for UTI?
Over 50,000
What is the most likely pathogen of pediatric UTI?
E. coli
{{BLANK}} is an important sequelae to monitor for after a child has had multiple UTIs
Vesicoureteral reflux
Reflux of bladder contents
Prophylaxis (for UTI) continues for {{BLANK}} if no surgical correction is performed on a patient with vesicoureteral reflux
10 years
versus until reflux resolution if surgical correction is performed
A patient is negative for vesicoureteral reflux but has had 3 ≥ UTIs over the past year. What prophylaxis, if any, is necessary?
Prophylaxis is needed x 6 months
{{BLANK}} is described as skin erosions with golden yellow crusting lesions with central healing in scattered discrete satellite lesions w/ auto inoculation
Impetigo
{{BLANK}} is impetigo with blisters containing turbid fluid
Bullous impetigo
An {{BLANK}} is a type of impetigo with an ulceration with thick adherent crust that can be of a dark color
Ecthyma
What can Tx for impetigo include?
- Mupirocin oint.
- Systemic Tx (if needed – per sensitivity)
- Skin decolonization via mupirocin oint. in nares
- Fomite care (clean pillows, etc.)
How can paronychia occur?
- Chewing on hangnail
- Erythema –> suppuration
Aerobes > Anaerobes = mixed
What are the most common organisms seen in abscesses?
Aerobes
* S. aureus
* GAS
Anaerobes
* Bacteroides
What are the most common organisms seen in perirectal abscesses?
- Anaerobes (85%)
- S. aureus (35%)
- E. coli (20%)
A pediatric patient displays a painful & erythematous abscess along their pelvic (inguinal) area with thinning skin overlying the lesion. There is fluctuance to palpation. What is your Dx?
- Acute suppurative lymphadentitis
- Fluctuance on palpation –> central necrosis
What is the treatment plan for adenitis?
- Trial of ABx
- I&D (if fluctuant)
- Persistance: Consider Myocbacteria, cat scratch, infectious mono, malignancy
What are the most likely organisms seen in adenitis?
- S. aureus (40-50%)
- GAS (30-40%)
A pediatric patient is brought to you as their parent is concerned over an enlarged lymph node in the cervical area. The node is tender with little to no warmth, with a thick discolored overlying skin. What is your Dx?
Mycobacterial adenitis
What are the most common organisms seen in bacteremia?
- S. pneumoniae (80-90%)
- H. influenzae (5-10%)
A patient who is less than 2 mo presents to you with bacteremia. What type of work up do you perform?
- < 2 mo: sepsis
- > 2 mo: bacteremia
