Term
|
Definition
| local collection of puss that becomes painful, warm, and tender |
|
|
Term
| what are the aerobic causes of abscess (5), what is the prevelence |
|
Definition
50% aerobic
S. aureus 25%
GAS, strep, enterobacter, E. coli |
|
|
Term
| what are the anaerobic causes of abscess (2), what is the prevelence |
|
Definition
25% anaerobic
bacteroides, fusobacterium |
|
|
Term
| what is the prevelence of a mixed, aerobic and anaerobic, abscess |
|
Definition
|
|
Term
| what are the common causes of a perirectal abscess(4) and their prevelences |
|
Definition
85% anaerobes
35% S. aureus
E. coli, strep |
|
|
Term
| what are the ddx of abscess, why |
|
Definition
cellulitis: can progress to abscess
cyst: infected cyst is like an abscess |
|
|
Term
| what is lymphangitis, how can it be identified, what are the concerns |
|
Definition
streaks showing infection moving through the lymph vessels
can get into blood and cause bacteremia and systemic infection |
|
|
Term
| what is the treatment for abscesses (3) |
|
Definition
| antibiotics, incision, drainage |
|
|
Term
|
Definition
| painful, hot, swollen node |
|
|
Term
| what do you do if you suspect adenitis (4) |
|
Definition
look for source of the infection
if fluxcuant do aspiration
if purulent drain node
ultrasound may help determine |
|
|
Term
|
Definition
| abscess caused by chewing on hangnail |
|
|
Term
| what are the overall most common, cervical, axillary, inguinal, and systemic causes of adenitis |
|
Definition
overall tops: S. aureus, GAS
cervical: TB, influenza
Axillary: cat scratch, sporotrichosis
inguinal: anaerobes, enteric, plague
systemic: mono, toxoplasmosis, CMV, kawasaki, syphilis |
|
|
Term
| what are the two types of adenitis |
|
Definition
lymphadenitis
mycobacterium adenitis |
|
|
Term
| what are the 4 signs of lymphadenitis |
|
Definition
erythema
thin skin
fluctuance on palpation
central necrosis |
|
|
Term
| what are the 4 signs of mycobacterium adenitis |
|
Definition
gradual node enlargement
little warmpth and iflammation
thick, discolored, tense, adherent skin |
|
|
Term
| what is the treatment for adenitis (3) |
|
Definition
antibiotic trial
aspiration
drainage if fluctuant |
|
|
Term
| what do you do if the antibiotics for adenitis dont work |
|
Definition
| reactive adenitis would have resolved so consider persistant adenitis caused by Tb, cat scratch, mono, or malignancy |
|
|
Term
| what are the signs of bacteremia |
|
Definition
|
|
Term
| what do you do if you suspect bacteremia in a kid under 2 mo |
|
Definition
|
|
Term
| what do you do if you suspect bacteremia in a kid over 2 mo |
|
Definition
|
|
Term
| what are 5 causes of bacteremia and their prevelence |
|
Definition
S. pneumoniae (90%)
influenza (10%)
salmonella, E. coli, S. aureus |
|
|
Term
| what are the parts to a bacteremia work up (5) |
|
Definition
urinalysis
urine culture (males <6mo, females <2yo)
CXR
stool culture
blood culture with temp >39C |
|
|
Term
| what do you add to a bacteremia work up to make it a sepsis work up (3) |
|
Definition
urine culture at any age
spinal tap
CBC |
|
|
Term
| what is the qualification for a fever of unknown origin |
|
Definition
fever >100.4 at least twice a week for 3 weeks
at least one week of patient investigation without physical exam findings |
|
|
Term
| what is the initial work up for fever of unknown origiin (6) |
|
Definition
history and physical
CBC
urinalysis and culture
CXR
TB test
ANA titer (autoimmune testing, in older kids) |
|
|
Term
| what is the work up in a return vision for fever of unknown origin (10) |
|
Definition
CBC repeat
ESR
urinalysis and culture repeat
EBV screen
CXR review
blood culture
anti-streptolysin O
HIV antibody
Hep C antibody
twice daily temp recordings |
|
|
Term
| what is the initial work up for admitted fever of unknown origin (6) |
|
Definition
LP (if antibiotics were unsuccessful or it is an infant)
blood culture repeat
sinus radiographs
opthalmic exam for iridocyclitis
liver enzyme test
multiple serologies |
|
|
Term
| what serologies might you do for an admitted fever of unknown origin patient (9) |
|
Definition
CMV
toxoplasmosis
Hep A, B, C
tulaermia
brucellisis
leptospirosis
salmonellosis |
|
|
Term
| what is the work up for a inpatient fever of unknown origin after the first work up (7) |
|
Definition
abdominal ultrasound
abdominal CT
gallium or indium scan
upper GI x-ray (older kid)
marrow test (if CBC abnormal)
techenium bone scan |
|
|
Term
| what is the most common pediatric infection |
|
Definition
|
|
Term
| why is otitis media more common in kids (4) |
|
Definition
eustachian tube is more horizontal and shorter because the cranium isnt completely developed
immune system isnt fully developed
they sick on thinks causing negative pressure
feeding supine allows entry of food near the eustachian tube |
|
|
Term
| what are the 3 layers of the TM |
|
Definition
external epithelium
middle CT layer
inner respiratory ciliated epithelium |
|
|
Term
| contents of the middle ear and the boundries |
|
Definition
ossicles
anterior: eustachian tube opening
lateral: TM
medial: connection to middle ear, nerves
posterior: opening to mastoid
superior: petrous bone
inferior: base of skull |
|
|
Term
| what are the signs of a ear infection (4) |
|
Definition
| painful, fever, minor head cold, fussy |
|
|
Term
| why is an ear infection painful |
|
Definition
| many nerve cells in the TM so when it stretches it causes lots of pain |
|
|
Term
| what are the signs in the TM of an ear infection |
|
Definition
increased vasculature in pars flaxita that leats to erythemia
opaque
rirst retraction then bulging
reduced light reflex
landmarks obscured
mobility reduced due to fluid |
|
|
Term
| bullous otitis media: aka, define, 4 sings |
|
Definition
myringitis
Ear infection due to unusual pathogen of childhood
Inflammation of epithelial layers causes excruciating pain
Bullous bleb blister like lesion obscures much of TM
Can rupture all three TM layers due to increased pressure spontaneously causing relief from pain and release of purelent goo |
|
|
Term
| two common causes of bullous otitis media |
|
Definition
|
|
Term
| most common cause of otitis media in non-immunized older kids |
|
Definition
|
|
Term
| most ocmmon cause of otitis media in immunized younger kids |
|
Definition
|
|
Term
| 5 causes of otitis media common to least |
|
Definition
strep pneumo 32%
non-pathogen (virus, allergies) 25%
influenza
moraxella, GAS |
|
|
Term
| 5 complications of otitis media |
|
Definition
fibrosis
conductive hearing loss
mastoiditis which can lead to meningitis or brain abscess |
|
|
Term
| main antibiotic used to treat otitis media |
|
Definition
amoxicillin
TMP/SMX back up |
|
|
Term
| how do you determine to give antibiotics for otitis media |
|
Definition
<6 mo give antibiotic
2mo – 2yo use judgment
2yo + wait 48 hours and give decongestant and anti-inflammatory first
If child looks sick use judgment at any age |
|
|
Term
| 7 steps of otitis media treatment |
|
Definition
1. antibiotics
2. If symptomatic 48 hours later change antibiotic
3. At 3 weeks if there is still effusion recheck in 3 weeks
4. At 6 weeks if there is still effusion change antibiotics
5. At 9 weeks if there is still effusion do tympanogram aor audiological testing. Add prednisone and give antibiotic with B-lactaminase resistance for 21 days
6. At 12 weeks if there is still effusion diagnose chronic otitis media, do tympanogram and audiological tests, refer to EENT
7. Tympanoscopy tubes: vent middle ear, improve hearing, reduce infection for patients with chronic otitis media |
|
|
Term
| what is the most comon cause of abscess |
|
Definition
| aerobic causes especially S. aureus |
|
|
Term
| what is the most common cause of lymphadenitis in axillary region |
|
Definition
|
|
Term
| what is the most common cause of general lymphadenitis |
|
Definition
|
|
Term
| what are the two most common causes of bacteremia |
|
Definition
S. pneumonia 90%
influenza 10% |
|
|
Term
| what is the most common cause of ear infection |
|
Definition
|
|
Term
|
Definition
|
|
Term
| 5 signs of acute sinusitis |
|
Definition
cough
nasal discharge
fever
facial pain
prolonged URI |
|
|
Term
|
Definition
strep pneumo
influenza
moraxella |
|
|
Term
| 5 complications of sinusitis |
|
Definition
cavernous sinus thrombosis
periorbital cellulitis
meningitis
maxillary osteomyelitis
brain abscess |
|
|
Term
| main cause of croup, 4 others |
|
Definition
parainfluenza
influenza, RSV, adenovirus, pertussis |
|
|
Term
|
Definition
|
|
Term
| what is the most common cause of upper airway obstruction in kids |
|
Definition
|
|
Term
|
Definition
|
|
Term
| what are 2 signs of croup |
|
Definition
strier at rest
critical airway obstruction possible - epiglottis stenosis |
|
|
Term
| what is the at home tx for croup (3) |
|
Definition
humidity
anti-pyretics
observation |
|
|
Term
| what is the hospital tx for croup (4) |
|
Definition
humidity
recemic epinepherine
O2
deaxmethazone via intubation |
|
|
Term
|
Definition
|
|
Term
|
Definition
|
|
Term
| main cause of broncholitis, 2 more |
|
Definition
main is RSV
adenovirus, parainfluenza |
|
|
Term
|
Definition
high TT
subcostal movement
wheeze |
|
|
Term
| 1 complication of broncholitis |
|
Definition
|
|
Term
|
Definition
bronchodilator B2 agonist (albuterol)
oxygen as needed |
|
|
Term
| 11 reasons to use ribivirin for RSV |
|
Definition
complicated congenital heart disease
congenital abnormalities
premature baby
under 6wks
bronchopulmonary displasia
cystic fibrosis
on ventilator
immune deficient
transplant patient
cancer patient
severly ill patient |
|
|
Term
|
Definition
2% of infants <1yo
4% of children 1-5yo |
|
|
Term
|
Definition
| inflammation and infection of alveola and pleura |
|
|
Term
|
Definition
chest pain on cough
wet cough
crackles |
|
|
Term
| when do you admit pneumonia patient (8) |
|
Definition
hypoxia, accessory muscle use, effusion
<3mo, <3yo with lobar, <5yo with multiple lobar
chronic diseasse
progression during treatment |
|
|
Term
| what are chronic diseases that you should admit the patient if you suspect pneumonia (8) |
|
Definition
CF
malignancy
anemia
diabetes
cardiac
pulmonary
renal
immune disorder |
|
|
Term
| what is the diagnostic test for pneumonia |
|
Definition
CXR confirms
can be treated off of clinical signs too (crackles) |
|
|
Term
| how is pneumonia treated in a pt <3mo, <20 wk, >5yo, 10-20yo |
|
Definition
<3mo: IV ampicillin, cephtriaxone
<20wks: add erythromycin (to cover chalmydia)
>5yo: amoxicillin, IV amoxicillin and cephtriaxone if serious
10-20: add macrolide (erythromycin) to cover mycoplasm walking pneumonia |
|
|
Term
|
Definition
girls are at higher risk
uncurcumsized boys
kids are at greater risk |
|
|
Term
| what is the general concept of the cause of UTI |
|
Definition
| inadequate wash oout and increased adherence of bacteria |
|
|
Term
| what are 9 risk factors for uti |
|
Definition
urothelial deficiency
hydronephrosis
obstruction
nephrolithiasis
vesicoureteral reflux
catheter or foreign body
non-retractable foreskin
fecal incontinence
poor hygiene |
|
|
Term
| what is the number one and 2 cause of uti |
|
Definition
|
|
Term
| what is the number 1 cause of uti in boys, why |
|
Definition
| poteus seen in 30% of boys under foreskin |
|
|
Term
| what is a common cause of uti in aldolecence |
|
Definition
|
|
Term
| what are 3 uncommon causes of uti |
|
Definition
pseudomonas
enterococcus
staph aureus |
|
|
Term
|
Definition
cystitis
foul smelling urine
fever
chills
accidents after potty training |
|
|
Term
|
Definition
| dysuria (pain), frequency, enuresis |
|
|
Term
| what is a complication of uti |
|
Definition
| develop renal scaring if they get more than 1 uti |
|
|
Term
| how is urine collected for a uti sample |
|
Definition
| pee in cup unless 2mo - 2yo then use suprapubic collection |
|
|
Term
| what do you need to remember when culturing for UTI |
|
Definition
| get repeat sample so asymptomati bacteriria can be detected |
|
|
Term
| what is tested for from a urine sample (7) |
|
Definition
WBC
leukocyte esterase
nitrite
bacteria
WBC casts
serum CRP |
|
|
Term
| how many WBC is too much in urine |
|
Definition
|
|
Term
| why might someone have a uti and not have nitrite |
|
Definition
| urine isnt concentrated enough, bacteria isnt the kind that makes it (like pseudomonas) |
|
|
Term
| how much bacteria is diagnostic for uti |
|
Definition
>50,000 CFU/mL to confirm
any bacteria in a urine aspiration |
|
|
Term
| what do casts in urine indicate |
|
Definition
if WBC: uti or pyelonephritis
PMN or tamm horsfall are ok becase they prevent bacterial adherence |
|
|
Term
| why do we check serum CRP in uti check |
|
Definition
| it can be increased in pyelonephritis |
|
|
Term
| first antibiotic for uti, 3 runner ups, how long is the perscription |
|
Definition
tmp/smx
amoxicillin, sulfisoxazole, cephalosporins
7-12d |
|
|
Term
| what group needs a different antibiotic redigmen for uti, why |
|
Definition
infants <60 days old
need to cover enterococci and liseria |
|
|
Term
| what is the concern with uti antibiotic tx |
|
Definition
| elimination of bacteria with low virulence can cause overgrowth and more agressive strains |
|
|
Term
| how do you treat someone long term uti with vesicureteral reflux |
|
Definition
if they do surgery do prophylaxis until resolution of the problem
if they dont do prophylaxis until 10 yo or until resolution |
|
|
Term
| how do you treat chronic uti in someone without vesicureteral reflux |
|
Definition
look into other GI problems
if you find something continue prophylaxis for 1year
if you dont continue for 6mo |
|
|
Term
| what GI problems can cause chronic uti without vesicureteral reflux (4) |
|
Definition
obstructive uropathy
neurigenic bladder
ureter duplication
calculi |
|
|
Term
| 5 signs of pyelonephritis |
|
Definition
high fever
flank pain
vomiting
elevated WBC and ESR |
|
|
Term
|
Definition
| cephalosporins (cephtriazone) |
|
|
Term
| what can cause uti symptoms without bacteria (11) |
|
Definition
Urethritis, vulvovaginitis, balanitis, pinworm
Metal irritation, topical irritants (soap, loation), vaginal foreign body
medication, emotional stress, trauma (sexual), daytime frequency syndrome |
|
|
Term
|
Definition
|
|
Term
| what can cause pyuria without bacteria |
|
Definition
• Urine with puss
• Febrile systemic illness
• Concentrated urine
• Catheter or instrument irritation
• Inflammation
• Calculi
• Glomerulonephritis
• Interstitial nephritis
• Nonbacterial infection: candidia, Mycobacterium TB, ureaplasma |
|
|
Term
| describe the 5 grades of vesicuoreteral reflux |
|
Definition
• Grade 1: cystourethrogram shows reflux only into ureter
• Grade 2: complete reflux into ureter, pelvis and calyces
• Grade 3: complete reflux and mild dilation of ureter and renal pelvis, only slight calyces
• Grade 4: reflux with moderate dilation of all parts, oblideration of sharp angle fornices
• Grade 5: dilation of all parts and oblideration of papillary impressions of calyces |
|
|
