Section 9 - Pediatrics

Question 1

Temperature threshold infant

Answer 1

Neonate: 100.4

Infants/children: 102.2

Question 2

Tx for 0-28 day old infants?

Answer 2

Full sepsis testing (CBC, all the cultures, UA, CXR, LP), admission, empiric abx

Question 3

Abx tx for neonate 0 to 28 days sepsis? Meningitis?

Answer 3

Sepsis: amp plus cefotaxime, meningitis: amp plus cefotaxime

Question 4

Abx tx for infants 29-90 days bacteremic? Septic? Meningitic?

Answer 4

Bacteremia: ceftriaxone, sepsis: amp plus cefotaxime or ceftriaxone plus vanc, meningitis: amp plus cefotaxime or ceftriaxone plus vanc

Question 5

Abx tx for children >90 days bacteremic? Septic? Meningitic?

Answer 5

Bacteremia: ceftriaxone, sepsis: cefotaxime or ceftriaxone plus vanc, meningitis: cefotaxime or ceftriaxone plus vanc

Question 6

Age group and sex of children with UTI?

Answer 6

Females prior to toilet training, circumcised boys younger than 6 months, uncircumcised boys under 1 year

Question 7

Tx of fever?

Answer 7

Give acetaminophen every 4-6 hours and ibuprofen in children older than 1 year every 6-8 hours

Question 8

Tx of septic shock in children?

Answer 8

20 ml/kg bolus of NS, repeat as needed until 100 ml/kg total; give abx; refractory give dopamine or norepi

Question 9

Sx of sepsis in young children? Sx of meningitis in young children?

Answer 9

Lethargy, poor feeding, irritability, or hypotonia

Question 10

Frequency of feedings for bottle fed infants? Breast fed infants?

Answer 10

Bottle fed: 6-9; breast fed: every 1-3 hours

Question 11

What are the weight changes of infants?

Answer 11

Lose 12% body weight in first 3-7 days, gain 1 oz/d afterwards

Question 12

What are the stooling habits of infants?

Answer 12

Can go 5-7 days without stooling or 6-7 stools a day and be normal

Question 13

Definition of colic?

Answer 13

Excessive crying at least 3 hours per day for at least 3 days per week over a 3 week period, should be done by 3 months

Question 14

Most common cause of bloody diarrhea in infants younger than 6 months?

Answer 14

Cow’s milk intolerance and anal fissures; NEC can present with other signs of sepsis with bloody diarrhea

Question 15

What age is developing jaundice in infants an issue?

Answer 15

Under 24 hours, after 3rd day of life

Question 16

Diff dx for jaundice after 3rd day of life?

Answer 16

Sepsis, UTI, congenital TORCH infxn, hemolytic anemia, biliary atresia, breast milk jaundice, hypothyroidism

Question 17

Workup for jaundice after 3rd day of life?

Answer 17

Look for sepsis, peripheral blood smear CBC, total and direct bili, liver function tests, retic count, coombs test

Question 18

Diaper rash that is macular, erythematous, sharply demarcated edges? Tx?

Answer 18

Contact dermatitis, air drying, diaper changes, barrier cream such as zinc oxide.

Question 19

Diaper rash that has erythematous plaques with a scalloped border and satellite lesions? Tx?

Answer 19

Candida dermatitis, frequent diaper changes and nystatin.

Question 20

Most common bacterial AOM?

Answer 20

Strep pneumo and h influ

Question 21

Complication of AOM?

Answer 21

Mastoiditis most common

Question 22

Sx of mastoiditis?

Answer 22

Fever, protrusion of auricle, tenderness over mastoid.

Question 23

Diff dx of AOM?

Answer 23

Acute onset of sx, middle ear effusion, signs and sx of middle ear inflammation.

Question 24

Tx of AOM?

Answer 24

Wait and see, amox 40-50 mg/kg/dose PO BID, augmentin, cef, azithro

Question 25

Bacterial cause of otitis externa?

Answer 25

Pseudomonas, staph epi, staph aureus

Question 26

Tx of otitis externa?

Answer 26

Cipro with hydrocortisone

Question 27

Causes of stomatitis in children?

Answer 27

Hand foot mouth and herpes simplex

Question 28

Causes of pharyngitis?

Answer 28

Viral, GABHS and gonorrhea

Question 29

Centor criteria: what is it? What is it used for?

Answer 29

Diagnose GABHS: tonsillar exudates, tender anterior cervical LAD, absence of cough, history of fever

Question 30

Cause of unilateral acute LAD?

Answer 30

Staph aureus or strep pyogenes

Question 31

Most common cause of stridor after neonatal period?

Answer 31

Viral croup

Question 32

Neck and CXR findings of croup?

Answer 32

Steeple sign

Question 33

Dx of croup?

Answer 33

Clinical: barking seal like cough or stridor

Question 34

Tx of croup?

Answer 34

Dex, racemic epi, heliox

Question 35

Sx of epiglottitis?

Answer 35

High fever, sore throat, drooling, strider, respiratory distress, tripod position

Question 36

Dx of epiglottitis?

Answer 36

Clinical diagnosis, thumb sign on CXR

Question 37

Tx of epiglottitis?

Answer 37

Racemic epi, heliox, BVM, intubation/definitive management by most experienced person, cefuroxime, cefotaxime, ceftriaxone

Question 38

Cause of bacterial tracheitis?

Answer 38

Staph aureus, strep pneumo, gram neg (H flu, Moraxella)

Question 39

Tx of bacterial tracheitis?

Answer 39

Intubate, ceftriaxone plus clinda, consider vanc

Question 40

Sx of retropharyngeal abscess? Age group?

Answer 40

Children 6 month – 4 years, toxic and present with fever, drooling, dysphagia, inspiratory stridor

Question 41

Tx of retropharyngeal abscess?

Answer 41

Airway stabilization/intubate, amp/sulbactam and/or clinda, steroids, ENT for drainage

Question 42

Sx of peritonsillar abscess?

Answer 42

Fevers, chills, dysphagia/odynophagia, trismus, drooling, muffled hot potato voice, uvula displaced away from side

Question 43

Tx of peritonsillar abscess?

Answer 43

Aspiration, abx, pain control; clinda or amp/sulbactam