Common Illnesses

Question 1

MC cause of the common cold

Answer 1

rhinovirus

Question 2

normal progression of mucus in the common cold

Answer 2

Nasal discharge is initially clear and watery, but soon becomes thick and colored in the first few days. The color could be yellow, white, or green. The drainage remains thick for several days and again becomes watery before the cold is resolved

Question 3

MC predisposing factor for acute bacterial sinusitis

Answer 3

viral URI

Question 4

tx of acute bacterial sinusitis

Answer 4

amoxicillin +/- clavulanate

Question 5

tx for common cold

Answer 5

supportive- heated air, saline drops, menthol vaper

Question 6

primary bacteria for pharyngitis

Answer 6

Group A, Beta Hemolytic Streptococcal Infections

Question 7

clinical findings of GABHS

Answer 7

sore throat
fever
headache
nausea, vomiting, abdominal pain
Strawberry tongue, sandpaper like rash
-Absence of conjunctivitis, coryza, hoarseness, anterior stomatitis, cough, diarrhea 
Tonsillar hypertrophy
patchy, discrete exudate
Tender, enlarged anterior cervical nodes
Beefy red, swollen uvula, petechiae on the palate and excoriation of nares

Question 8

variations of GABHS

Answer 8

scarlet fever, Erysipelas, Streptococcal Perianal Infection and balanoposthitis

Question 9

best lab tests for GABHS

Answer 9

throat culture (first line) & rapid strep test

Question 10

objectives to tx GABHS

Answer 10

prevent rheumatic fever, not likely to prevent post streptococcal AGN

Question 11

major complications of GABHS

Answer 11

• retropharyngeal abscessed

- peritonsilar abscessed

Question 12

tx for retropharyngeal abscessed

Answer 12

surgical drainage

1st line = clindamycin

Question 13

tx for peritonsilar abscessed

Answer 13

1st line - PCN (clindamycin if pt is allergic)

incision and drainage

Question 14

Treatment of Steptococcal Tonsillopharyngitis

Answer 14

PCN or amoxicillin

Question 15

GABHS tx

Answer 15

• PCN (10-30% failure)

- can tx w/ augmentin if there is suspected inactivation of PCN bacteria

Question 16

acute otitis media MC pathogen

Answer 16

H. influenzae

Question 17

pathogenesis AOM

Answer 17

• Partial obstruction of Eustachian Tube leading to Eustachian Tube Dysfunction
• Exudation of fluid into middle ear
• negative middle ear pressure

Question 18

RF for AOM or OME

Answer 18

Age <2 years, much more common
If <6mos, itll happen more times within that year
First episode of AOM when younger than 6 months of age
Absence of breast feeding
Atopy
Chronic sinusitis

Question 19

AOM vs OME

Answer 19

AOM – Rapid onset of signs and symptoms of inflammation in the middle ear, bulging TM
OME – Inflammation with fluid in the middle ear without signs and symptoms of acute infection (fluid alone sometimes)

Question 20

AOM criteria

Answer 20

• Presence of middle ear effusion (MEE)
• Inflammation as indicated by a bulging TM-must be
• Otorrhea of new onset

Question 21

AOM tx

Answer 21

First-line: Amoxicillin (high dose b/c cover highly resistant strep pneumoniae) 80-90 mg/kg/day in two divided doses

Second-line: Amoxicillin-Clavulanate 90 mg/kg/day in two divided doses
If a child has AOM concurrent with conjunctivitis or
had Amoxicillin therapy in the previous 30 days
Amoxicillin-Clavulanate should be the first line agent.

Question 22

MC classic form of croup

Answer 22

Laryngotracheitis

Question 23

classic presentation of croup

Answer 23

barking cough
prodrome viral upper respiratory infection
inspiratory stridor

Question 24

Bacterial Tracheitis

Answer 24

Croup that goes away and then suddenly develops high fever* (but no drooling like epiglotitis)

Question 25

when is croup the worst

Answer 25

at night

Question 26

radiographic signs of croup

Answer 26

steeples sign | overdistension of hypopharynx on lateral view

Question 27

is croup supra/subglottis

Answer 27

subglottis

Question 28

epiglotitis is supra/subglotis

Answer 28

supraglotis

Question 29

classic presentaion of epiglotitis

Answer 29

sore throat, drooling, and dysphagia

Question 30

epiglotitis most probable pathogens

Answer 30

be S aureus or group A streptococci.

Question 31

mild croup tx (stridor with excitement only or stridor at rest without signs of respiratory distress)

Answer 31

discharge home

Question 32

moderate croup tx (stridor at rest and intercostal/subcostal retractions)

Answer 32

Nebulized racemic epinephrine 0.5 ml of 2.25% (or equivalent dose of l-epinephrine preparation). –pretty good! Oral dexamethasone 0.3-0.6 mg/kg or nebulized budesonide 2-4 mg

Question 33

severe croup (severe respiratory distress, decreased air entry, altered level of consciousness)

Answer 33

Nebulized racemic epinephrine or l-epinephrine (same dose as for moderate croup but can be used more frequently according to symptoms). Oral dexamethasone 0.6 mg/kg or IM. Alternatively, trial of helium-oxygen before intubation. Prednisolone 1 mg/kg every 12 h orally or via nasogastric tube.

Question 34

bronchiolitis presentation

Answer 34

Afebrile/low grade, paraoxymal coughing, and wheezing

Question 35

chest x-ray of bronchiolitis

Answer 35

lung hyperinflation with a flattened diaphragm and bilateral atelectasis

Question 36

dx of bronchiolitis

Answer 36

clinically

Question 37

common agent causing bronchiolitis

Answer 37

RSV

Question 38

lower lobe pneumonia most probable pathogen

Answer 38

pneumococcal

Question 39

tx of bacterial pneumonia

Answer 39

IV ceftriaxone, Azithromycin (optional) and vancomycin

Question 40

pneumonia presentation

Answer 40

cough persistent day and night, tachypnea, hypoxia, poor feeding, and increased irritability, fever, crackles/wheezes on auscultation *fever, rapid shallow breathes, and cough pretty characteristic

Question 41

empiric 1st line for outpt pneumonia

Answer 41

Young Children -Amoxicillin Adolescence -Azithromycin

Question 42

empiric 1st line for inpt pneumonia

Answer 42

Young Children - Ampicillin - Cephalosporin + Azithromycin

Question 43

empiric 2nd line for outpt pneumonia

Answer 43

Macrolide or doxycycline | Fluoroquinolones (Levofloxacin or moxifloxacin)

Question 44

empiric 2nd line for inpt pneumonia

Answer 44

Vancomycin Clindamycin Linezolid

Question 45

fluids NOT recommended for acute diarrhea

Answer 45

``` Tea Juices Cola or other soft drinks Chicken broth Boiled skim milk – frequent cause of hypernatremia Sports drinks such as Gatorade Homemade solutions to which salt is added Kool-Aid and similar preparations Water alone ```

Question 46

recommended for acute diarrhea

Answer 46

pedialyte

Question 47

diet for diarrhea

Answer 47

ORS, drinks made with unsweetened yogurt (buttermilk), unsweetened orange juice, vegetable juices, mashed bananas or banana flakes, mashed potatoes, soda crackers, pretzels, beans, mashed cooked vegetables, pastas, noodles, breads, lentils, chicken meat or fish and eggs BRAT

Question 48

when do you NOT give abx for acute diarrhea (what pathogen)

Answer 48

shigatoxin producing E. coli may increase the risk of hemolytic uremic syndrome

Question 49

when do you use abx for diarrhea

Answer 49

only when it is complicated

Question 50

tx for streptococcal Tonsillopharyngitis

Answer 50

Pen V or amoxicillin

Question 51

ill appearing pt w/bacterial pneumonia

Answer 51

IV vancomycin, ceftriaxone, and azithromycin (optional)

Question 52

in children w/ a foreign body aspiration, best type of scope

Answer 52

rigid and can tx corticosteroids

Question 53

bacterial vs viral pnemonia

Answer 53

Clinical findings of high fever, rapid breathing, consolidated lobar pneumonia, and a WBC count of >13,000 generally suggest a bacterial rather than viral etiology