Rotations Flashcards
Does the color of the nasal discharge predicts the presence of concurrent sinusitis?
No, it can also be purulent early in the course of URI
What do you suspect in a child with persistent fever or URI symptoms for more than 10 days?
Bacterial superinfection (Acute otitis media, sinusitis )
How do you diagnose URI
Clinically, symptoms are runny nose, low grade fever, cough, and sore throat
What is the most important step in URI management?
Adequate rehydration
Do over the counter medications like cough suppressants, mucolytics and antihistamines have an effect in the management of URI?
Minimal effectiveness and may cause side effects.
When do sphenoid sinuses develop?
3-5 years of age
When do frontal sinuses develop?
7-10 years of age
Is physical examination reliable in diagnosing uncomplicated sinusitis?
No
Management of uncomplicated sinusitis?
Empiric antibiotics (amoxicillin -clavulanate)
Most common pathogens in sinusitis
S. Pneumoniae, H. Influenzae, Moraxella catarrhalis
What is specific about EBV pharyngitis?
Enlarged posterior lymph nodes
Hepatosplenomegaly
Malaise
What is specific about coxsackievirus pharyngitis?
Painful Vesicles or ulcers on posterior pharynx and soft palate (hyperangina)
Blisters on hands and feet (hand-foot-mouth disease)
What is specific about group A beta hemolytics pharyngitis?
- lack of URI symptoms such as cough
- fever
- exudates on tonsils, peteachie on soft palate, strawberry tongue
- enlarged cervical anterior lymph nodes
- could present with scarlatiniform rash
- school aged children 5-15
Gray adherent tonsillar membrane?
Diphtheria
Gold standard for Group A beta hemolytics?
Culture (gold standard), rapid antigen test
Do you treat nonsymptomatic otitis media?
No, its self resolving. Only treat if there are symptoms.
What is Acute otitis media?
Acute infection of middle ear space
What is otitis media with effusion?
Fluid within middle ear space with no signs of infection
What cause acute otitis media?
S. Pneumonia, nontypeable H. Influenzae, m. Catarrhalis
Sometimes viral
Most reliable method for detecting fluid in middle ear space?
Otoscopy
Treatment for AOM?
Amoxicillin, if the patient already used antibiotics in the last 1-2 months, they might have penicillin resisted s. Pneumonia. So give them amoxicillin-clavulanic acid, high dose amoxicillin, cephalosporin
Is antibiotics indicated for otitis media with effusion?
No
Otitis externa etiology
P. Aeruginosa
S. Aureus
Candida albicans
Secondary to AOM with perforated membrane
Diagnosis of otitis externa?
Erythema and edema of EAC
Sometimes with white or purulent whitish material
Sometimes with tenderness in palpation of tragus
Symptoms of otitis externa?
Pain
Itching
Drainage
otitis externa management - Mild?
Acetic acid solution to restore acidic environment
otitis externa management - more severe ?
Topical antibiotics
Sometimes with topical steriods
otitis externa management - with perforated membrane
Oral and topical steroids
The most common causes of wheezing in children include?
asthma, allergies, infections, gastroesophageal reflux disease, obstructive sleep apnea
The least common causes of wheezing in children?
congenital abnormalities,
foreign body aspiration,
cystic fibrosis
Use of Bronchodilators?
A group of drugs that dilate the bronchi and bronchioles by relaxing smooth muscle. Used to decrease respiratory airway resistance and increase airflow to the lungs (e.g., to treat asthma and COPD).
Which type of beta-adrenergic stimulators may increase heart rate and the potential for cardiac arrhythmias?
Salbutamol being a beta-adrenergic stimulator may increase heart rate and the potential for cardiac arrhythmias
what can you also ask about in social history for patients suspected with asthma?
do you have pets?
does anyone smoke in the house?
What does Maternal tobacco use result in
low birth weight
is there a “safe” amount of alcohol that can be consumed during pregnancy to prevent fetal alcohol syndrome (FAS)?
no
What does Fetal alcohol syndrome cause?
facial abnormalities - microcephaly, smooth philtrum, thin upper lip
growth deficiency,
evidence of central nervous system dysfunction.
they may exhibit cognitive disability and learning problems (i.e., difficulties with memory, attention, and judgment) as well as neurobehavioral deficits such as poor motor skills and impaired hand-eye coordination.
Maternal heroin use is associated with? increased risk of fetal growth restriction, placental abruption, fetal death, preterm labor and intrauterine passage of meconium.
increased risk of|: fetal growth restriction, placental abruption, fetal death, preterm labor intrauterine passage of meconium.
All infants born to women who use opioids during pregnancy should be monitored for symptoms of _________? neonatal abstinence syndrome (i.e. uncoordinated sucking reflexes leading to poor feeding, irritability, and high-pitched cry) and treated if indicated.
neonatal abstinence syndrome (i.e. uncoordinated sucking reflexes leading to poor feeding, irritability, and high-pitched cry) and treated if indicated.
Cocaine and Other Stimulants use in pregnancy can cause
vasoconstriction leading to placental insufficiency and low birth weight, premature delivery, smaller head circumferences and shorter lengths.
may cause some aspects of cognitive performance, information processing, and attention to tasks abilities that are important for success in school
what is the percentage of infants who Without antibacterial prophylaxis will develop invasive disease (sepsis, pneumonia and meningitis) in mother colonized with GBS?
1-2%
what do you do if an infant is born ill-appearing?
full diagnostic evaluation (complete blood count [CBC], blood culture, chest x-ray and lumbar puncture) and receive IV antibiotics.
When do you give intrapartum antimicrobial prophylaxis against Group B streptococcal disease (GBS) ?
Previous infant with invasive GBS disease
GBS bacteriuria during any trimester of the current pregnancy
Positive GBS vaginal-rectal screening culture in the 36 0/7-37 6/7th weeks of current pregnancy
Unknown GBS status at the onset of labor (culture not done, incomplete, or results unknown) and any of the following:
Delivery at < 37 weeks’ gestation
Amniotic membrane rupture ≥ 18 hours
Intrapartum temperature ≥ 38°C (100.4°F)
Intrapartum nucleic acid amplification testing (NAAT) positive for GBS
if you have an Unknown GBS status at the onset of labor (culture not done, incomplete, or results unknown) when do you give prophylaxis antibiotics
if she has any of the following: Delivery at < 37 weeks' gestation Amniotic membrane rupture ≥ 18 hours Intrapartum temperature ≥ 38°C (100.4°F) Intrapartum nucleic acid amplification testing (NAAT) positive for GBS
what is the intrapartum antimicrobial prophylaxis against Group B streptococcal disease (GBS)
Appropriate antibiotics for intrapartum antibiotic prophylaxis include penicillin, amoxicillin, and cefazolin.
In the penicillin-allergic mother, clindamycin or vancomycin may be used after determining sensitivity.
what is grunting?
Grunting is a noise that is heard on expiration when an infant in respiratory distress is working to keep his or her alveoli open to increase oxygenation and/or ventilation. This is sometimes referred to as “auto-PEEP (positive end-expiratory pressure).”
Maternal factors that decrease placental blood flow result in caloric restriction and hypoxia in the fetus, leading to _______ glycogen stores and ______ red blood cell production
decreased, increased
Smaller infants have ______ subcutaneous fat, so they may become ________
less, hypothermic
An absent red reflex (no reflection noted) may be caused by:
A cataract
An opacified cornea (such as in mucopolysaccharidosis)
Inflammation of the anterior chamber
Developmental anomalies of the eye
Retinoblastoma, a potentially lethal malignancy (careful examination of the eye of an infant with retinoblastoma often identifies a white, irregular mass within the globe).
why is Erythromycin ointment, Hepatitis B vaccine and intramuscular vitamin K are recommended for routine prophylaxis?
gonococcal eye infection, Hepatitis B, and hemorrhagic disease of the newborn, respectively.
how do antiepileptic drugs or isoniazid affect newborns?
antiepileptic drugs or isoniazid interfere with how the body uses vitamin K. so they cause Vitamin K deficient bleeding
Caesarean section at 37 weeks ____ the risk for TTN
increases
Normal stool colors for newborn
If your newborn is on breastmilk, the optimum colour is a golden yellow. If your baby is on formula, it should look brown or tan to brown in color with some green and yellow.
Abnormal stool colors for newborn
- Solid black
- Watery streaked with red
- Raspberry poop with mucus
- Chalky white
What is Glutaric aciduria type 1 (GA1) ?
Glutaric aciduria type 1 (GA1), is a rare metabolic condition with a prevalence of approximately 1 in 100,000 newborns.
It is caused by a deficiency of the enzyme glutaryl-CoA dehydrogenase (GCDH), which is involved in the breakdown of the amino acids lysine, hydroxylysine and tryptophan.
What is a symptomatic neonatal plethora?
This clinical disorder includes symptoms due both to. hypervolemia and/or hematocrit elevations caused by large transfusions of blood at birth
Manifestation of symptomatic neonatal plethora
Tachypnea, mild cyanosis, plethoric skin color, and neurological depression persisted on average for 30 h after birth.
Causes of symptomatic neonatal plethora?
caused by large placental transfusions associated with delayed clamping of the umbilical cord.
Bengin skin lesions in newborns
The main lesions described as typical of the neonatal period include:
erythema toxicum neonatorum (ETN),
transient neonatal pustular melanosis (TNPM)
benign cephalic pustulosis (BCP).
These are a benign, self-limited, asymptomatic skin diseases that occur in the first days of life.
How do you tell if it’s a diaper rash or yeast infection?
A diaper rash is normally a patchwork of inflamed and chapped skin. Signs that point to a yeast infection include: Deep red inflamed patches with bumps around the edges.
yeast diaper rash will appear in the diaper area, even in the folds of your baby’s skin
“setting sun” sign in eyes of newborn/children is associated with?
The “setting sun” sign is an ophthalmologic phenomenon where the eyes appear driven downward bilaterally. The inferior border of the pupil is often covered by the lower eyelid, creating the “sunset” appearance.
This finding is classically associated with hydrocephalus in infants and children. It signifies intracranial hypertension
Describe Cephalohematoma
Cephalohematoma is a buildup of blood (hemorrhage) underneath a newborn’s scalp. It appears soon after birth. The bulge is discrete, does not cross the suture lines of the bones on their head, and is located at the back of the head.
How many mls of blood is there per kg in newborns?
Babies born full-term have about 75 milliliters (mL) of blood per kilogram of their body weight.
omphalocele is known to have _____ associated anomalies and _____ mortality rate than gastroschisis
more, higher
omphalocele has a _____ prognosis because it is associated with a significantly increased incidence of chromosomal abnormalities (approximately 12%).
worse
Ear malformations are associated with an increased frequency of clinically significant structural ______ anomalies compared with the general population.
renal
These include specific multiple congenital anomaly syndromes, Townes-Brocks syndrome (TBS), branchio-oto-renal (BOR) syndrome, among others.
What are the cause of Innocent heart murmurs?
Innocent heart murmurs are harmless sounds made by the blood circulating normally through the heart’s chambers and valves or through blood vessels near the heart. They can be common during infancy and childhood and often disappear by adulthood. They’re sometimes known as “functional” or “physiologic” murmurs.
