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Pediatrics > Week 1 Lectures: Limp, Asthma, Abx > Flashcards

Week 1 Lectures: Limp, Asthma, Abx Flashcards

1
Q

Main toxicity/side effect of

(a) Penicillins
(b) Augmentin
(c) Vancomycin
(d) Bactrum

A

Main toxicity

(a) Penicillin- anaphylaaxis in 1/1,000
(b) Augmentin- diarrhea
(c) Vancomycin- red man’s syndrome due to histamine release => need to slow down rate of infusion
(d) Bactrum side effect = bone marrow suppression

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2
Q

What does vanco coverage?

A

Vanco covers MRSA, staph, and Strep (all gram positive cocci)

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3
Q

Describe the two types of tx for asthma

A

Rescue:

  • albuterol (short acting beta agonist)
  • oral corticosteroid

Controllers

  • inhaled corticosteroids
  • leukotriene inhibitors (Montelukast)
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4
Q

What can amox be used in combination w/ for Enterococcal infxn coverage

A

Amox + aminoglycosides (ex: gentamicin) for enterococcal coverage

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5
Q

Which of the 3rd gen cephalosporins covers pseudomonas

A

Only one: Ceftazidime

NOT Cafotaxime or Ceftriaxone

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6
Q

Pt has AKI on Vancomycin, what are they switched to next?

(a) Why is this drug second line

A

Assuming Vanco is used for coverage of MRSA (ex: MRSA cellulitis/abscess)
-side effect of Vanco = AKI => switch to Linezolid

(a) Linezolid is second line b/c it’s so expensive

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7
Q

Indications for trimethoprim/sulfa

A

Bactrim

  • outpatient MRSA coverage after transition off IV Vanco: cellulitis
  • UTI b/c covers E. Coli
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8
Q

Which abx can cause eosinophilia?

A

Macrolides: erythromycin/azithromycin

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9
Q

Indication for Daptomycin

A

VRSE = Vanco resistant staph species

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10
Q

Juvenile Idiopathic Arthritis

a) Indication of ANA (+
(b) When is RF sent?

A

JIA

(a) ANA (+) predicts higher risk for anterior uveitis
(b) Send RF in older children w/ poly-arthritis

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11
Q

Why is bactrum a great drug?

A

Bactrum = TMP + SMX (both folic acid synthesis inhibitors) is great b/c it covers for MRSA and is oral => can be given outpatient

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12
Q

Features of septic arthritis

A

Septic arthritis

  • refusal to bear weight
  • febrile
  • ill-appearing
  • worse at night
  • autonomic instability: tachy, tachypnic, resting position of the limb is w/ hip abducted
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13
Q

What to use in an acute asthma exacerbation where albuterol isn’t enough

A

Systemic (oral/IV) corticosteroids

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14
Q

Describe proposed pathophysiology of Henoch Schonlein Purpura

A

IgA vasculopathy
-IgA deposition

Supportive biopsy of affected organ (ex: skin, kidney) shows IgA deposition

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15
Q

Rash + limp + episodic severe belly pain + patches of purple raised skin over legs and but

A

HSP = Henoch Shonlein Purpura
-immunoglobulin A vasculitis (IgA deposition)

  • rash = non-thrombocytopenic (normal platelet count) purpura
  • limp b/c of arthralgia/arthritis = swollen ankle
  • episodic severe belly pain- ileoileal intussusception
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16
Q

Common side effects of albuterol in children

A

Kids get very hyper/jumpy

-anxiety, palpitations, tremor, headache

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17
Q

CC: Limp + knee pain

-worse at night, ill-appearing, febrile to 104, carried into the ER

A

Septic arthritis

  • unable to weight bear => carried in
  • knee pain due to referred hip pain
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18
Q

Define SIRS

A

Autonomic instability + elevated white count

SIRS = systemic inflammatory response syndrome

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19
Q

First line tx for mild persistent asthma

A

Mild persistent asthma tx

test answer = low dose inhaled corticosteroid

-real life: often try leukotriene inhibitor (montelukast) first b/c simple small QD chewable

+ SABA PRN (for all asthmatics)

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20
Q

First line tx for intermittent asthma

A

Intermittent asthma: tx w/ SABA (albuterol) for symptom control

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21
Q

Petechiae + Limp

A

Leukemia

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22
Q

Dangerous side effects of albuterol

A

Sudden death: 2 causes

  • cardiac: arrhythmia
  • airway plug: build up of underlying mucous/inflammation
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23
Q

Which abx do we give to GBS (+) moms who are allergic to Penicilin

A

Azithromycin (Macrolide)

-wouldn’t give Amox b/c that’s a type of Penicillin!!

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24
Q

Cefepime

(a) Coverage
(b) What doesn’t it cover?
(c) Main indication

A

Cefepime = 4th gen cephalosporin

(a) G(+) activity of 1st gens + G(-) activity of 2nd gens = the big guns!!!
(b) BUT no anaerobe or MRSA coverage
(c) Indication = fever in neutropenic pt

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25
Q

2 Oral abx for C. dif

A

Oral Vancomycin OR metronidazole (Flagyl)

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26
Q

Do asthma pts have to stay on controllers for their entire life?

A

Controllers are just that, just controllers (not a cure) => only work while the pt is on them

-work to prevent fibrosis/scaring

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27
Q

Indication for PenG

A

Syphilis

-b/c most strep is now resistant

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28
Q

Which abx causes Red Man Syndrome?

(a) What is Red Man Syndrome?
(b) How do we prevent this

A

Red Man Syndrome = chills, fever, phlebitis (venous inflammation), ototoxicity, nephrotoxicity
-due to Vanco b/c of the way Vanco is made that it causes histamine release throughout the body

(a) Histamine release during infusion =>
(b) Have to really spread out Vanco doses, infuse slowly to prevent Red Man Syndrome

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29
Q

Juvenile Idiopathic Arthritis

(a) gender
(b) asymmetric or symmetrical?
(c) acute or gradual onset?
(d) constitutional symptoms?

A

Juvenile Idiopathic Arthritis

(a) F > M
(b) symmetrical
(c) gradual onset- usually indolent until infection precipitates dramatic increase in symptoms
(d) Constitutional symptoms (fever etc) usually not present

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30
Q

Why don’t you want to keep asthmatics on chronic oral corticosteroids?

A

Side effects of steroids

  • weight gain (moon face)
  • immunosuppression
  • growth suppression (so super bad for kids!!)
  • aseptic necrosis of femoral head + osteonecrosis
  • suppressed HPA => knock out the adrenal gland’s response to stress
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31
Q

Define SIRS: 2 out of 4 criteria

A

SIRS = presence of 2+

-temp > 38.5 or

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32
Q

What would you add to Cefepime to cover for

(a) MRSA
(b) anerobes

A

Add to Cefepime to cover

(a) MRSA = add Vanco
(b) Anerobes- add Flagil

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33
Q

Define asthma

A

Chronic inflammatory disease of the lungs

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34
Q

Aminoglycosides
Give examples

(a) reversible toxicity
(b) irreversible toxicity

A

Aminoglycosides = Gentamycin, Tobramycin

(a) Reversible toxicity = renal
(b) Irreversible toxicity = ototoxicity

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35
Q

Abx coverage for GBS Sepsis in newborn

A

First line = Ampicillin

Second line = Cephalosporin- Cefotaxime (NOT Ceftriaxone in newborns b/c of biliary sludging)

36
Q

Why is septic arthritis a medical emergency

A

Can see permanent joint damage in just 24-48 hours

37
Q

Why albuterol shouldn’t be used as controller?

A

Tolerance- beta2 receptor downregulation
Not treating the underlying cause

  • risk of sudden death: arrhythmia, airway plug (inflammation, mucus builds up and plugs airway)
  • SE of albuterol: anxiety, palpitations, tremor, headache, very hyper kid
38
Q

Physical exam findings of septic arthritis

(a) specific physical exam maneuver

A
  • Can’t palpate b/c of intense guarding and pain
  • swollen hip

(a) painful FABER test: flexed, ab-ducted, externally rotated (frog legged position)

39
Q

Most common systemic vasculitis of childhood

(a) Second most common childhood vasculitis

A

Henoch Schonlein Purpura
-immunoglobulin A vasculitis

(a) Second most common childhood vasculitis = Kawasaki (fever syndrome)

40
Q

How is asthma severity classified?

A

NIH classifies asthma severity by frequency of symptoms

Symptoms no more than 2 days/week w/ 2 or fewer nighttime awakenings/month = Intermittent asthma

Then symptoms > 2 days/week = Persistent

Mild Persistent = symptoms > 2 days/week but not daily
-nighttime awakening 1-4x/month

Moderate Persistent = symptoms daily, nighttime awakening > 1/week but not nightly

Severe Persistent = symptoms throughout the day, often every night

41
Q

Side effects of cephalosporins

A
  • diarrhea
  • C. diff risk
  • possible thrombocytopenia and neutrocytopenia b/c can affect bone marrow
42
Q

Which gen cephalosporins are great for sinus infections

A

2nd gen cephalosporins have great coverage of skin (staph) and respiratory flora (H. flu, moraxella catarrhalis, E. Coli, Klebsiella) => good for sinus infections

-also better CNS penetration than 1st gen

43
Q

2 methods by which children can use albuterol inhaler

A

Spacer: takes just one minute

Nebulizer: takes about 15 minutes

44
Q

What is chromolyn?

(a) Why is it second line in asthma tx?

A

Cromolyn = mast cell stabilizer- prevents release of inflammatory chemicals (ex: histamine) from mast cells

(a) However, second line to montelukast b/c it has to be inhaled (not oral) 3-4 x/day
- while montelukast (singulair) is a nice tasty small chewable tablet once a day)

45
Q

Which cephalosporin needs to be avoided in children under 1 moa?

A

Avoid ceftriaxone in children under 1 moa- use Cefotaxime (also a 3rd gen cephalosporin) instead

46
Q

Which abx does ortho love

A

Clindamycin (in its own class)

-b/c achieves high levels in bone

47
Q

Most common bug for osteomyelitis

A

Staphhhhhh (usually MSSA)

48
Q

Common pathway by which triggers cause asthma

A

Mast cell degranulation releasing: histamine, cytokines, leukotrienes

Release of these 3 inflammatory mediators => inflammation of lung parenchyma

49
Q

Differentiate the coverage of 3 types of penicillins

(a) Natural penicillins
(b) Aminopenicillins
(c) Nafcillin

A

3 types of penicillin

(a) Penicillin- covers strep and E. Coli
(b) Ampicillin (PO) and Amoxicillin (IV) cover

(c) Very narrow spectrum = Nafcillin and Oxacillin- resistant to penicillinase (beta-lactamase) produced by Staph aureus => can treat MSSA
- works for MSSA and Strep, NOT MRSA

50
Q

CC: limp

  • right knee warm, swollen, LROM w/ atrophy of thigh
  • ^ same for left ankle
  • no fever, play is ok, lasting months
A

Juvenile Idiopathic Arthritis (JIA)

-arthritis in 4+ joints

51
Q

Tetrad of Henoch Schonlein Purpura and the clinical manifestations they cause

A

HSP

(1) Abdominal pain- mild (N/V/D) to severe (GI hemorrhage, ileoileal intussecption)

(2) Palpable purpura w/o thrombocytopenia or coagulopathy
- purpura w/ normal platelet count

(3) Arthralgia and/or arthritis
- can present w/ limp or limb/joint pain

(4) Renal disease- IgA deposition glomerulonephritis
- can cause pedal edema

52
Q

MRSA

(a) Resistant to what
(b) Sensitive to what

A

MRSA

(a) Resistant to penicillins (and amox) and beta-lactams (including all generation cephalosporins, aztreonma, meropenem, sulbactam)
(b) Sensitive to vancomycin (inhibits cell wall synthesis) and Linezolid (inhibits protein synthesis)

53
Q

Empiric abx coverage for bacterial meningitis in neonate

A

Ampicillin + Cefotaxime

Ampicillin: covers GBS and LIsteria
Cefotaxime covers E. Coli

54
Q

Fever + vomiting in a baby

A

Think UTI

55
Q

What are 5 common asthma triggers

A
  1. allergens- dust, pets, mold, rodents
  2. environmental irritants- cigarette smoke, pollution, any noxious smell
  3. exercise
  4. weather- change in temperature/pressure
  5. URI (most common!)
56
Q

1st line outpt treat for pneumonia in 5-15 yo pt

A

Most likely mycoplasma: first line Azithromycin (macrolide)

57
Q

When untreated, distinguish how often each of the 4 severity classifications of asthmatics use their rescue inhaler

A

Frequency of SABA use

-2 or less days/week = intermittent

  • > 2 days/week but not daily = mild persistent
  • daily = moderate persistent
  • several times per day = severe persistent
58
Q

First line tx for severe persistent asthma

A

Severe persistent asthma tx = high dose inhaled corticosteroids

Any adjunct:

  • Montelukast
  • LABA
  • SABA for PRN
59
Q

Which beta lactamase inhibitor combinations are

(a) PO
(b) IV

A

Beta lactamase inhibitor combinations

(a) Only Augmentin (Amox + Clavulanate) is PO
(b) Unasyn, Timentin, and Zosyn are all IV

60
Q

But aren’t inhaled corticosteroids still just steroids…?

3 ways by which inhaled corticosteroids could get into the bloodstream

A

B/c inhaled are targeted (and not just systemic and hoping for some to get to the lungs) those dose is MUCH lower

  • to avoid absorption directly into buccal mucosa pts are told to rinse out mouth/drink water after taking it
  • to avoid a little bit from getting digested if swallowed, all are 99% biodegradable so the bit that gets to the stomach gets degraded before absorbed into circulation thru liver
  • lung tissue: can’t avoid getting washed away into pulm circulation but dose is so low => no bone defects
61
Q

Lab findings of septic arthritis

A
  • Leukocytosis (elevated whites) w/ left shift

- elevated CRP (associated w/ inflammation)

62
Q

Common side effects of penicillins

A

Hives (hypersensitivity rxn), diarrhea (especially amp/amox), neutropenia (in PenG and Nafcillin)

63
Q

First line tx for moderate persistent asthma

A

Moderate persistent asthma tx = moderate dose inhaled corticosteroid

Adjuncts:

  • Montelukast
  • long acting beta-agonist
  • SABA for PRN (all asthmatics)
64
Q

Indications for beta lactamase inhibitor combination

A
  • MSSA
  • Strep
  • E. coli
  • GNR
  • Psuedomonas (for Timentin and Zosyn, NOT Augmentin and Unasyn)
  • Anaerobes
65
Q

What measurement can be used to chart/track an asthmatics lung fxn?

A

FEV1 = forced expiratory volume in one second

66
Q

How may 2 significant asthmatic episodes w/in 6 months affect one’s treatment?

A

2 significant episodes (ex: need prednisone course in hospital) in 6 mo bumps up the classification of severity above daily symptoms

67
Q

First line tx for osteomyelitis

A

Osteomyelitis

First line = Nafcillin- great staph coverage (MSSA)

68
Q

What is theophylline?

(a) Why is it second line in asthma tx?

A

Theophylline = phosphodiesterase inhibitor => raises intracellular cAMP to inhibit TNF-alpha and inhibit leukotriene synthesis

=> good anti-inflammatory

(a) Second line b/c very narrow therapeutic index
- used in adults w/ COPD

69
Q

Workup (after abx coverage) for UTI in pt under 2 yoa

A

Check for anatomic anomaly that may have led to UTI => get renal ultrasound

  • hydronephrosis
  • abscess
  • VUR = vesico-urethral reflex
70
Q

Which abx are the

(a) big guns
(b) super huge big guns

A

Abx

(a) Big guns = Cefepime = 4th gen cephalosporin
- covers G(+) but MRSA, covers G(-), doesn’t cover anaerobes

(b) Super huge big guns = Imipenem and Meropenem: only given inpatient: broad spectrum against GNR, GPC (gram positive cocci) AND anaerobes

71
Q

How are LABAs given to children?

(a) Efficacy of this method

A

LABAs given in combo w/ inhaled corticosteroids

ex: Symbicort and Advair
(a) LABAs act slowly => nice 12 hour curve of bronchodilation, but also have a synergistic effect when used as adjunct to inhaled corticosteroid

72
Q

Why get abdominal ultrasound on kid w/ presenting w/ purpura + joint swelling + limp

A

Purpura, joint swelling, limp- think HSP (Henoch Schonlein Purpura)

-get abdominal US for possible ileal-ileal intussusception

73
Q

Pallor + weight loss + limp + cervical lymphadenopathy

A

Acute lymphocytic leukemia

  • MSK presentation is common
  • pallor due to anemia
  • also see petechiae b/c of thrombocytopenia
74
Q

Meningitis buzzword

A

Lethargy

75
Q

Z-pack

(a) Coverage

A

= Azithromycin (macrolide)

(a) Coverage
- atypical pneumonia: Chlamydia, Mycoplasma, Legionella
- pertussis
- GAS in penicillin allergic pts

76
Q

Kid wakes up at night w/ MSK pain, alleviated w/ massage and is normal the next day on the playground
-normal physical exam

A

Benign growing pains

  • nighttime wakening but no symptoms during the day
  • normal physical exam
77
Q

JIA

(a) one aggravating factor
(b) one alleviating factor

A

JIA

(a) Worse in the morning
(b) Better w/ NSAIDs

78
Q

Describe the use of the following in pediatric asthmatics

(a) anti-histamines
(b) anti-cytokines

A

Pediatric asthma: targeting the 3 inflammatory factors released by degranulatied mast cells

(a) anti-histamines: not helpful
(b) anti-cytokines: helpful, in clinical trials

go to = anti-leukotriene

79
Q

Main side effect of imipenem and meropenem

A

Renal failure- almost all pts who take imipenem and meropenem will go into AKI

80
Q

Beta lactamase inhibitor combination

(a) Augmentin
(b) Unasyn
(c) Timentin
(d) Zosyn

A

Beta lactamase inhibitor combinations

(a) Augmentin (PO) = amoxicillin/calvulanate (PO
- amox = broad spectrum penicillin
- calvulanate = beta-lactamase inhibitor

(b) Unasyn (IV) = Ampicillin/sulbactam

(c) Timentin (IV) = ticarcillin/clavulanate
(d) Zosyn (IV) = Piperacillin/ tazobactam

81
Q

What is Cephalexin (Keflex)?

(a) Indications

A

Cephalexin = first gen cephalosporin => good G(+) w/ poor G(-) coverage

(a) UTI (E. coli coverage) and soft tissue infxn (big indication = cellulitis)

82
Q

Features of growing pain

(a) Physical exam findings
(b) Limp
(c) Day vs. night

A

Growing pains

Features present:

  • nocturnal wakening
  • lasts months

(a) Always normal physical exam w/ normal labs and imaging
(b) No limp
(c) Never have daytime symptoms, but have nocturnal wakening
- no joint welling

83
Q

Differentiate ampicillin and amoxicillin

A

Same thing- both broad spectrum penicillins
-cover strep, E. coli, and GNR (salmonella, shigella, enterobacter = proteus)

But: ampicillin is PO and amoxicillin is IV

84
Q

Beta lactam coverage of

(a) Strep
(b) E. coli
(c) Pseudomonas
(d) MRSA

A

Beta lactam coverage of

(a) Strep = penicillin
(b) E. coli = amoxicillin
(c) Pseudomonas = Zosyn- combination of Piperacillin (antipseudomonal penicillin) + Tazobactam (beta-lactamase inhibitor)
(d) MRSA- none! can’t use beta lactams against MRSA

85
Q

Indications for Linezolid

A

Multi-drug resistant bacteria: VRE, MRSA

  • PO and IV
  • CRAZY EXPENSIVE $$$
86
Q

Side effects of aminoglycosides

A

Gentamycin = aminoglycoside

  • irreversible ototoxicity
  • very narrow therapeutic index => need to measure peaks and troughs

Pediatrics (10 decks)

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