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Peds > Peds ID I &II > Flashcards

Peds ID I &II Flashcards

1
Q

Why do female pediatric patients suffer from increased incidence of UTI?

A
  • Shorter urethra
  • Perineal colonization
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2
Q

There is a high index of suspicion for pyelonephritis if?

A
  • High fever
  • Flank tenderness
  • Vomiting
  • Elevated WBCs & ESR
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3
Q

An UTI caused by Pseudomonas aeruginosa will be {{BLANK}} negative

A

Nitrite

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4
Q

In fever of unkown origin, what are the Dx criteria?

A
  • No explainable cause (e.g., immunodeficiency – HIV)
  • Fever ≥ 100.4 ≥ 2 x week
  • For at least 3 weeks

Despite 1 week of outpatient investigation

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5
Q

What does the initial investigation of fever of unkown origin?

A
  • H&P
  • CBC
  • Urinalysis & Culture
  • CXR
  • Tuberculin Skin Test
  • ANA titer

Look for infectious/inflammatory cause

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6
Q

If initial investigation of fever of unknown origin, what continued evaluation should be performed?

Outpatient

A
  • 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

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7
Q

Phase 2 investigation of Fever of unknown origin includes?

A
  • Inpatient investigation
  • Lumbar puncture
  • Repeat blood cultures
  • Sinus XR
  • Ophthalmologic exam for iridocyclitis
  • LFTs
  • Serologic testing for infectious cause

Look further for infectious cause

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8
Q

What does phase 3 investigation of fever of unknown origin include?

A
  • Abdominal US
  • Abdominal CT
  • Gallium or indium scanning
  • Upper GIT XR
  • Bone marrow testing
  • Technetium bone scanning

Look for tumors/cancers starting

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9
Q

Why are infants more prone to otitis media?

A
  • Supine position for long period of time
  • Weaker immune system
  • horizontal eustachian tube
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10
Q

Common otitis media pathogens can cause {{BLANK}}, a painful condition in which relief is not felt until spontaneous rupture

A

Bullous myringitis

Blocks tympanic membrane

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11
Q

To Dx acute otitis media you should have what S/Sx?

A

At least a few S/Sx
* Erythematous
* opaque
* bulging tympanic membrane
* reduce light reflex
* mobility reduced

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11
Q

Most cases of otitis media are caused by?

A

Viruses (sterile AOM)

Viruses > S. pneumoniae > H. influenzae

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11
Q

What is the DOC for initial treatment of otitis media?

A

Amoxicillin

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12
Q

If after 48-hours the patient has suffered from increased S/Sx of otitis media, you should switch the ABx to?

A

Augmentin

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13
Q

Effusion is suspected after otitis media but you should re-check for resolution at?

A

6 weeks

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14
Q

If effusion still persists after initial treatment of otitis media you should perform a? What if abnormal?

At 9 week visit

A
  • Audiometry
  • If abnormal, tympostomy tube
15
Q

If at the 12 week F/U visit of otitis media there is still effusion you should?

A
  • Refer to ENT
  • Tympostomy
  • Adenoidectomy
16
Q

Why is it important to treat pediatric UTI?

A
  • Leads to pyelonephritis
  • Can destroy nephrons leading to HTN

Pyelonephritis: high fever, vomiting, WBCs, ESR, flank tenderness

17
Q

What is important regarding collection of a urine specimen for UTI?

A
  • If not potty trained, clean perineum and collect via catheter
  • If potty trained, clean area & collect via stream (clean catch)
18
Q

How is initial treatment in UTI performed?

Regarding urine culture

A
  • Until culture: TMP/SMX
  • If pos.: can continue
  • If neg.: D/C
19
Q

A positive result for a clean-voided male/female regarding # of bacterial colonies in a UTI specimen is?

A

Over 100,000 colonies/mL in urine

20
Q

For catheterized urine sample, what is a positive result for UTI?

A

Over 50,000

21
Q

What is the most likely pathogen of pediatric UTI?

A

E. coli

22
Q

{{BLANK}} is an important sequelae to monitor for after a child has had multiple UTIs

A

Vesicoureteral reflux

Reflux of bladder contents

23
Q

Prophylaxis (for UTI) continues for {{BLANK}} if no surgical correction is performed on a patient with vesicoureteral reflux

A

10 years

versus until reflux resolution if surgical correction is performed

24
Q

A patient is negative for vesicoureteral reflux but has had 3 ≥ UTIs over the past year. What prophylaxis, if any, is necessary?

A

Prophylaxis is needed x 6 months

25
Q

{{BLANK}} is described as skin erosions with golden yellow crusting lesions with central healing in scattered discrete satellite lesions w/ auto inoculation

A

Impetigo

26
Q

{{BLANK}} is impetigo with blisters containing turbid fluid

A

Bullous impetigo

27
Q

An {{BLANK}} is a type of impetigo with an ulceration with thick adherent crust that can be of a dark color

A

Ecthyma

28
Q

What can Tx for impetigo include?

A
  • Mupirocin oint.
  • Systemic Tx (if needed – per sensitivity)
  • Skin decolonization via mupirocin oint. in nares
  • Fomite care (clean pillows, etc.)
29
Q

How can paronychia occur?

A
  • Chewing on hangnail
  • Erythema –> suppuration

Aerobes > Anaerobes = mixed

30
Q

What are the most common organisms seen in abscesses?

A

Aerobes
* S. aureus
* GAS

Anaerobes
* Bacteroides

31
Q

What are the most common organisms seen in perirectal abscesses?

A
  • Anaerobes (85%)
  • S. aureus (35%)
  • E. coli (20%)
32
Q

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?

A
  • Acute suppurative lymphadentitis
  • Fluctuance on palpation –> central necrosis
33
Q

What is the treatment plan for adenitis?

A
  • Trial of ABx
  • I&D (if fluctuant)
  • Persistance: Consider Myocbacteria, cat scratch, infectious mono, malignancy
34
Q

What are the most likely organisms seen in adenitis?

A
  • S. aureus (40-50%)
  • GAS (30-40%)
35
Q

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?

A

Mycobacterial adenitis

36
Q

What are the most common organisms seen in bacteremia?

A
  • S. pneumoniae (80-90%)
  • H. influenzae (5-10%)
37
Q

A patient who is less than 2 mo presents to you with bacteremia. What type of work up do you perform?

A
  • < 2 mo: sepsis
  • > 2 mo: bacteremia

Peds (9 decks)

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