Term
| How should you treat a fever in an infant less than 28 days old? |
|
Definition
| should be hospitalized for a full sepsis workup; treated with amp and gent or amp and cefotaxime while awaiting culture results; acyclovir if HSV is suspected |
|
|
Term
| How do you manage a fever in an infant from 28 to 90 days old without a source? |
|
Definition
| if they are toxic, they need a full workup for sepsis and started on IV abx; for nontoxic appearing low risk infants, outpt management is reasonable with either full workup and ceftriaxone 50-75 mg/kg IM and reevaluate in 24 hrs; or UA/urine culture only with no antibiotics and reeval in 24 hrs |
|
|
Term
| What are the most common organisms responsible for neonatal sepsis? |
|
Definition
| GBS, gram negative bacilli, and listeria |
|
|
Term
| What is the most common cause of bacteremia in children 3 to 36 months of age? |
|
Definition
|
|
Term
| How do you manage toxic appearing children with fever who are 3 to 36 months of age? |
|
Definition
| full sepsis workup, hospitalized, started on IV abxs empirically until cultures return negative at 48 hrs |
|
|
Term
| How should you treat children 3 to 36 months of agewith fever less than 39 C who are not toxic appearing? |
|
Definition
| give the child acetaminophen 15 mg/kg q 4 hrs and return to the office if the fever persists for more than 48 hours or if the clinical condition deteriorates |
|
|
Term
| A febrile 3-36 month old child with temp >39, should recieve antibiotics if... |
|
Definition
| absolute band count >1500, PMN >10,000, or WBC >15,000 should be given empiric ceftriaxone 50 mg/kg IM |
|
|
Term
| FOr children, when do you need a catheterized urine sample to send for culture versus just a clean catch? |
|
Definition
| if circumcised male under 6 months of age; uncircumcised less than 12; female less than 2 |
|
|
Term
| What is teh dosing of acetaminophen for discomfort associated with fever? |
|
Definition
|
|
Term
| What are common viruses that cause meningoencephalitis? |
|
Definition
| enteroviruses, mumps, measles, HSV, VZV, arboviruses, EBV, rabies, and adenovirus |
|
|
Term
|
Definition
| flesion of the hip to 90 degrees with subsequent pain on extension of the leg |
|
|
Term
| What is Brudzinski's sign? |
|
Definition
| involuntary flexion of the knewwsand hips following flexion of the neck while supine |
|
|
Term
| When should you obtain a CT before getting an LP? |
|
Definition
| if there are focal neurologic findings or papilledema |
|
|
Term
| What opening pressure on LP indicates bacterial meningitis? |
|
Definition
|
|
Term
| What are the most common bacterial pathogens in neonates with meningitis? |
|
Definition
| GBS, Ecoli, listeria, HSV |
|
|
Term
| How do you empirically treat meningitis in neonates? |
|
Definition
| ambicillin (200 mg/kg) x 14-21 days for GBS and listeria; cefotaxime (100-150 mg/kg) for > 2 weeks after CSF sterilization for gram negative organisms; add acyclovir for suspected HSV |
|
|
Term
| What are the most common pacterial pathogens for infants 1-2 months with meningitis? |
|
Definition
| S. pneumoniae, N. meningitidis, BGS |
|
|
Term
| What is the empirical treatment for meningitis in infants 1-3 months of age? |
|
Definition
| cefotaxime (200 mg/kg) or ceftriaxone (100 mg/kg) and ampicilline (200 mg/kg) x 7-10 days for uncomplicated Hib or N. meningitidis; cefotaxime (200mg/kg) and vancomycin (40-60 mg/kg) x 10-14 days for S. pneumoniae |
|
|
Term
| What are the most common bacterial pathogens in children 3 months to 18 years? |
|
Definition
| N. menigitidis, S. pneumoniae, H. influenzae |
|
|
Term
| How do you empirically treat meningitis in children 3 months to 18 years? |
|
Definition
| cefotaxime (200 mg/kg) or ceftriaxone (100 mg/kg) and ampicillin (200 mg/kg) x 7-10 days for uncomplicated Hib or N. meningitidis; cefotaxime (200 mg/kg) and vancomycin (40-60 mg/kg) x 10-14 days for S. pneumoniae |
|
|
Term
| What is paradoxical irritation? |
|
Definition
| sign of meningitis in infants 0-3 months where they are less irritable when not held |
|
|
Term
| At what age do children start to have nuchal rigidity as a sign of meningitis? kernigs and brudzinski's sign? |
|
Definition
| nuchal rigidity after 18 months; kernig's sign and brudzinski's sign after 24 months |
|
|
Term
| What does the WBC count show in meningitis? |
|
Definition
| usually increased in bacterial meningitis but is often unremarkable in aseptic meningitis |
|
|
Term
| Is an EEG useful in evaluating a patient withseizures? |
|
Definition
| changes rae usually nonspecific and are characterized by generalized slowing; focal slowing in the temporal area is characteristic of HSV infections |
|
|
Term
| A patient who feels better after the LP may have _____. |
|
Definition
|
|
Term
| What is the cell count/glucose/protein of a normal LP? |
|
Definition
| glucose 40-80; protein 20-50; WBCs 0-6; PMNs 0; RBCs 0-2 |
|
|
Term
| What is the glucose/protein/cell count of a bacterial meningitis LP? |
|
Definition
| glucose <30; protein >100; WBC > 1000; PMN >50; RBCs/uL 0-10 |
|
|
Term
| What is the glucose/protein/cell count in HSV CSF? |
|
Definition
| glucose >30; protein >75; WBC 10-1000; PMN <50; RBC 10-500 |
|
|
Term
| What is the glucose/protein and cell count in a CSF of a viral meningitis (other than HSV)? |
|
Definition
| glucose= >30; protein 50-100; WBC= 100-500; PMN <20; RBC 0-2 |
|
|
Term
| What is the glucose/protein/cell count of a TB infected CSF? |
|
Definition
| glucose 20-40; protein 100-500; WBC 10-500; PMN <20; RBCs 0-2 |
|
|
Term
| Besides abxs what other supportive care should be given to children with meningitis? |
|
Definition
| strict fluid balance in the light of the risk of SIADH; rehydrate with isotonic fluid until the patient is euvolemic, then switch to 2/3 maintenence fluid; frequent urine specific gravity measurement; daily weight and head circumference; neurologic assessment/seizure precaution; isolation may be necssary |
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|
Term
| What complication is common with Hib meningitis? |
|
Definition
|
|
Term
| When is dexamethasone indicated for treatment of meningitis? |
|
Definition
| if it is Hib meningitis you should administer dexamethasone before or at thetime of antibiotic administration |
|
|
Term
| What is the most common cause of pediatric pneumonia? |
|
Definition
| viruses such as RSV, influenza, PIV, adenovirus; S pneumo is the most common bacterial agent |
|
|
Term
| What organisms that causes pneumonia is asssociated with large pleural effusions? |
|
Definition
|
|
Term
| How can you start to differentiate viral vs. bacterial pneumonia based on symptoms? |
|
Definition
| bacterial is more likely to have a high grade fever and dyspnea |
|
|
Term
| What is the definition of pneumonia? |
|
Definition
| inflammation of lung parenchyma that may be either infectious or noninfectious |
|
|
Term
| What is different on CBC between bacterial vs viral pneumonia? |
|
Definition
| bacteria= leukocytosis with left shift; viral= normal or increased with a lymphocyte predominance |
|
|
Term
| Describe the presentation of C. trachomatis pneumonia in newborns? |
|
Definition
| afebrile; conjunctivitis and a staccato cough |
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|
Term
| An adolescent with pneumonia due to mycoplasma may present with... |
|
Definition
| prolonged cough; afebrile |
|
|
Term
| What would aspiration pneumonia lok like on CXR? |
|
Definition
| right middle or upper lobe infiltrates |
|
|
Term
| How do you work up patients you suspect of having pneumonia? |
|
Definition
| viral nasal wash or nasal swab for respiratory pathogens; CXR if ill appearing, require hospitalization or worsen on abx, |
|
|
Term
| What should you look out for on CBC of a newborn you suspect of having pneumonia? |
|
Definition
| if the white count is less than 5000, they might have sepsis |
|
|
Term
| When do you hospitalize for pneumonia? |
|
Definition
| if they are under 2 months; if they are over 2 months with respiratory distress, hypoxia, inability to take oral meds, failure to respond to abx, immunosuprpession, underlying cardiopulmonary disease, or evidence of empyema on CXR |
|
|
Term
| How long do you treat pneumonia in children that are hospitalized? |
|
Definition
| treat with IV abx until afebrile and then give oral antibiotics to complete a total of 7-10 days of treatment |
|
|
Term
| What are the most common causes of pneumonia in infants <6 weeks? |
|
Definition
| GBS, C. trachomatis, S. aureus, gram neg enterics, RSV, CMV, HSV enterovirus |
|
|
Term
| What should you use for empiric coverage of infants less than 6 weeks with pneumonia/ |
|
Definition
| amp and gent or amp and cefotaxime; add PO erythromycin for suspected C. trachomatis; add IV acyclovir for suspected HSV |
|
|
Term
| What organisms should you suspect in infants 6 weeks to 6 months? |
|
Definition
| RSV, S. pneumoniae, Hib, GAS, C trachomatis, S. aureus |
|
|
Term
| C. trachomatis can cause pneumonia in children of what age typically? |
|
Definition
| less than 3 months of age |
|
|
Term
| What is empiric treatment for pneumonia in children 6 wks to 6 months? |
|
Definition
| supportive care for suspected viral pneumonia; mild to moderate illness PO amoxicillin or cefuroxime; severe illness= IV cefuroxime or ceftriaxone |
|
|
Term
| What is the likely organism for children 6 months of age to school age with pneumonia? |
|
Definition
| RSV, PIV, influenza, adenovirus, S. pnumoniae |
|
|
Term
| At what age are children susceptible to RSV? |
|
Definition
|
|
Term
| What are the most likely organisms to cause pneumonia in school age children? |
|
Definition
| M. pneumoniae, S. pneumoniae and adenovirus |
|
|
Term
| How do you empirically treat pneumonia in school age children? |
|
Definition
| mild to moderate= PO azithromycin if mycoplasma is suspected; severe ilness= IV cefuroxime or ceftriaxone with PO azithromycin; vancomycin may be added after 24-48 hours if the child has not improved and there is suspicion of drug-resistant S. pneumoniae |
|
|
Term
| What are the three most common bacterial pathogens that cause acute otitis media? |
|
Definition
| S. pneumo, nontypeable H flu, and m. catarrhalis |
|
|
Term
| Why are children at greater risk of otitis media? |
|
Definition
| angle of entry, short length and decreased tone of eustachian tube |
|
|
Term
| How common is acute otitis media? |
|
Definition
| 75% of children will have at least 3 episodes by age 2 |
|
|
Term
| What conditions predispose children to acute otitis media? |
|
Definition
| viral URIs, bottle feeding, pacifier use, passive exposure to tobacco smoke, day care, immunodeficiency, trisomy 21, hypothyroidism, and cleft palate |
|
|
Term
| T/F Breast feeding decreases the risk of AOM> |
|
Definition
|
|
Term
| T/F An erythematous tympanic membrane suggests AOM. |
|
Definition
| false; could be due to crying |
|
|
Term
| What is the term for inflammation of the ear drum with normal tympanic membrane mobility? |
|
Definition
|
|
Term
| A diagnosis of acute otitis media requires... |
|
Definition
| a history of acute onset of signs and symptoms; the presence of middle ear effusions; signs and symptoms of middle ear inflammation |
|
|
Term
| T/F You should always treat AOM with antibiotics. |
|
Definition
| false; you can observe/give symptomatic tx for 48-72 hrs for children >2 yoa with nonsevere illness as wellas for those 6 months to two years of age with an uncertain diagnosis (missing at least one of three requirements above) and mild symptoms |
|
|
Term
|
Definition
| amoxicillin 80-90 mg/kg/day X 7-10 days; ghigh dose amoxicillin/clavulanate (augmentin) for pts whofail to improve on amoxicillin alone in 2-3 days or those with severe illness; IM ceftriaxone if they fail to respond to augmentin |
|
|
Term
| WHen should tympanostomy tube be placed in children with AOM? |
|
Definition
| if they have > 3 infections in 6 months or 4 infections in a year; can get tympanostomy tubes or a myringotomy |
|
|
Term
| What are the complications associated with AOM? |
|
Definition
| hearing loss with risk of language delay, tympanic membrane perforation, tympanosclerosis, cholesteatoma, chronic otitis media, mastoiditis |
|
|
Term
|
Definition
| growth of desquamated stratified squamous epithelium in the inner ear |
|
|
Term
| At what age is strep pharyngitis very rare in kids? |
|
Definition
|
|
Term
| What are the two categories of complications of streptococcal pharyngitis? |
|
Definition
| suppurative vs nonsuppurative |
|
|
Term
| What are suppurative complications of strep pharyngitis? |
|
Definition
| peritonsillar and retropharyngeal abscesses |
|
|
Term
| What are the nonsuppurative complications of strep pharyngitis? |
|
Definition
| acute rheumatic fever, postinfectious glomerulonephritis |
|
|
Term
| Treatment for strep pharyngitis can prevent all complications except for... |
|
Definition
| postinfectious glomerulonephritis |
|
|
Term
|
Definition
| strep pharyngitis with fever and a characteristic erythematous sandpaper-like rash on the neck or trunk that later spreads to theextremities |
|
|
Term
| What are the symptoms of strep pharyngitis? |
|
Definition
| sore throat, high fever, headache, malaise, occasional abdominal pain, absence of URI symptoms, |
|
|
Term
| What are the findings on physical exam of strep pharyngitis? |
|
Definition
| tender cervical LAD, enlarged hyperemic tonsils with exudates, erythematous pharynx, palatalpetechiae maybe present |
|
|
Term
| How do you determine if a pt has strep throat? |
|
Definition
| positive throat culture or antigen detection test (rapid strep test) |
|
|
Term
| How do you treat strep throat? |
|
Definition
| penicillin VK PO X 10 days or azithromycin (for penicillin allergic patients) x 5 days to prevent rheumatic fever |
|
|
Term
| How accurate is the rapid strep test? |
|
Definition
| the sensitivity ranges from 80-90% but specificity is >95% |
|
|
Term
| What is the major criteria for acute rheumatic fever? |
|
Definition
| jones critera= migratory polyarthritis of > 2 joints; new murmur (mitral or aortic insufficiency or Carey Coombs murmur) or symptoms of CHF, nodules over the scalp, joints or spine; erythema marginatum; sydenham's chorea |
|
|
Term
| What is erythema marginatum? |
|
Definition
| a circinate, erythematous maculopapular rash on the trunk and extremities indicative of rheumatic fever |
|
|
Term
| What is Syndenham's chorea? |
|
Definition
| emotional instability and involuntary movement; one of the major criteria of acute rheumatic fever |
|
|
Term
| How long after strep infection does post infectious glomerulonephritis show up? |
|
Definition
|
|
Term
| What are the signs of post infectious glomerulonephritis? |
|
Definition
| hematuria, proteinuria, decreased urination, hypertension, pulmonary edema and peripheral edema; C3 levels maybe low |
|
|
Term
| What is the prognosis of post infectious glomerulonephritis? |
|
Definition
| typically self limited and does not recur |
|
|
Term
| How longafter strep throat infection before you get acute rheumatic fever? |
|
Definition
|
|
Term
| How do you treat postinfectious glomerulonephritis? |
|
Definition
| penicillin, antiinflammatory medications and supportive therapy; given the high rate of recurrence, indefinate daily prophylactic penicillin should be started |
|
|
Term
| What tests should be ordered for a child with flank pain and a fever? |
|
Definition
| CXR, UA, and urine culture; because flank pain can be due to pylo or lower lobe pneumonia |
|
|
Term
| Name some common UTI pathogens. |
|
Definition
| S. saprophyticus, e coli, enterobacter, klebsiella, serratia, proteas, pseudomonas |
|
|
Term
| Where do the bacteria come from in UTIs of infants? |
|
Definition
| hematogenous seeding of the kidneys |
|
|
Term
| What are the symptoms of cystitis? |
|
Definition
| increased frequency and urgency, dysuria, incontinence, and suprapubic tenderness, hematuria, and a low grade fever |
|
|
Term
| What are the symptoms of pyelonephritis? |
|
Definition
| high fevers, chills, flank pain, nausea, vomiting, CVA tenderness (related to flank pain), and dehydration |
|
|
Term
| What is considered a positive urine culture? |
|
Definition
| more than 10^5 colonies/mL are obtained from a midstream clean catch; more than 10^4 from an "in and out" cath; any from a suprapubic tap |
|
|
Term
| When should you suspect a positive urine culture is due to contamination? |
|
Definition
| if the culture contains diphtheroid bacilli, Staph or multiple organisms |
|
|
Term
| What are teh symptoms of newborns with UTI? |
|
Definition
| fever, hypothermia, poor feeding, vomiting, jaundice, TFF, sepsis, apnea, diarrhea |
|
|
Term
| What is the treatment for uncomplicated cystitis? |
|
Definition
| five to ten days of TMP-SMX or cephalexin |
|
|
Term
| What is thetreatment for pyelonephritis or neonates with cystitis? |
|
Definition
| amp and gent or cefuroxime |
|
|
Term
| When do you give prophylactic antibiotic therapy for cystitis and what do you give? |
|
Definition
| give TMP-SMX or nitrofurantoin; if prior or undergoing a VCUG, reflux of any grade in infancy and earlychildhood, reflux of grades III-V in children over 5 yoa; pts with more than 3 UTIs per year |
|
|
Term
| When is the apgar score taken? |
|
Definition
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Term
|
Definition
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Term
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Definition
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