Case 21 - 12 year old female with fever Flashcards

1
Q

Influenza epidemiology

A

15-42% of preschool and school-age children are affected per year, usually self limiting and patients improve in 2-5 days

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

Risk factors for complications with flu

A

children <5 years, chronic pulmonary disease, congenital heart disease, immunosuppression

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

Complications of flu

A
  • otitis media
  • streptococcal pneumonia
  • lower resp tract infections
  • neurologic (aseptic meningitis, GBS)
  • myositis and myocarditis
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

Obesity epidemiology in children

A
  • 15% of kids 6-19 are overweight
  • affects hispanic and african american kids more
  • rates are increasing
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

Complications of obesity in children

A
  • T2DM
  • high cholesterol - 10% kids 2-19
  • hypertension
  • metabolic syndrome
  • musculoskeletal - blount’s disease, SCFE
  • GI disorders - steatosis, gallbladder dz
  • GYN - PCOS, early menarche
  • psychosocial - depression, bullying, low self-esteem
  • OSA, asthma
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

Lung sounds indicating consolidation

A

egophany, tactile fremitus, dullness to percussion, crackles, whispered pectroliloquy

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

Lung sounds that do not indicate consolidation

A

wheezes ( assoc with spasms) , ronchi ( assoc with secretions)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

Differential diagnosis for fever, cough, myalgias in 12 year old

A
  1. influenza - characterized by upper and lower resp tract sx accompanied by systemic sx, high fever, abrupt onset
  2. Pneumonia - crackles, tachypnea, consolidation, decreased breath sounds in one field
    - typical pneumonia - streptococcal, atypical (mycoplasma or chlamydia), viral (flu, RSV, adeno)
  3. Bronchitis - self limited inflammation of large airways of lung, often production of purulent sputum, usually viral, lung exam can include ronchi and wheezes
    Less likely: URI, asthma exacerbation, Group A strep pharyngitis, bronchiolitis (infants)
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

McIsaac Score

A

Indicates whether to test for strep throat

  • one point for fever >38, cough absent, tonsillar exudate, tender anterior cervical lymphadenopathy
  • plus one point for under 15, less one point for greater than 45
  • test for 2-3 points, empirically treat for 4 points or higher
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

Chest x-ray

A
  • in community, only if patient is not responding to treatment
  • all children with pneumonia should have x-ray if admitted to hospital
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

Management of influenza

A
  • antivirals decrease duration if given within first 48 hours,
  • supportive treatment - ibuprofen, fluids, cough syrup
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

Management of bronchitis

A
  • albuterol for those who are wheezing

- mostly not antibiotics because mostly viral

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

Management of pneumonia

A
  • children three months to adolescence - amoxicillin to treat streptocccal
  • school aged children with sx of atypical pneumonia - rx with azithromycin
  • admit all infants, and older chlidren if hypoxemic, grunting or having trouble feeding
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

Obesity management

A
  • use motivating terminology
  • advise whole family to change eating habits (5-2-1-0) - 5 fruits and veggies per day, 2 hours or less TV, 1 hours of physical activity per day, 0 surgary drinks
  • set reasonable weight loss goals, reduce energy-dense foods, structured meals, diet and activity monitoring
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

Screening for obesity complications

A
  • check A1c and fasting glucose in all kids >95%ile and kids >85%ile at high risk
  • check fasting lipids on every child >85%ile
  • treat kids with LDL >190 or >160 with risk factors
  • steatosis - AST/ALT for all kids >95%ile and kids >85%ile at high risk, refer to GI for 2XULN
How well did you know this?
1
Not at all
2
3
4
5
Perfectly