Final - Peds ID Flashcards Preview

Therapeutics V Spring 2019 (P3 Spring) > Final - Peds ID > Flashcards

Flashcards in Final - Peds ID Deck (61):
1

Preventable risk factors AOM (acute otitis media): _______ attendance**
______ exposure
______ use
______ feeding
________ status

child care attendance**(semi-preventable, ya know)
smoke exposure
pacifier use
bottle feeding
immunization status

2

Non-Preventable risk factors AOM (acute otitis media):
_____ gender
older ______
______ history
________ abnormalities
_______ deficiency
onset of 1st episodes before ________ of age
lower _________
_______ of the year

male gender
older siblings
family hx
congenital abnormalities
immune deficiency
onset of 1st episodes before 6 months of age
lower economic status
season of the year

3

OME or AOM:
middle ear fluid is STERILE

OME

4

OME or AOM:
abx not indicated/not beneficial

OME

5

OME or AOM:
abx indicated if symptomatic

AOM

6

what does OME stand for

otitis media with effusion

7

Ear Anatomy:
what part is the "barrier to the external ear"

tympanic membrane/ear drum

8

Ear Anatomy:
what tube goes towards the external nose from the ear

eustachian tube

9

Ear Anatomy:
what anatomical difference makes infants/kids more likely to have ear infections

their eustachian tube is shorter/more flexible/more horizontal = easier to get infections via eustachian tube

10

two most common bacteria to cause an ear infection

streptococcus pneumoniae
haemophilus influenzae

11

Clinical Signs/Symptoms of an Ear Infection?

Otalgia (ear pain)
Fever
irritability/poor feeding/disrupted sleep/malaise
otorrhea (ear discharge)

12

The tympanic membrane in an ear infection will look like what?

bulging
red/erythematous
immobile = won't move to pressure because fluid is filling it with fluid

13

AOM:
acute or prolonged onset?

acute

14

Severe AOM when?

when 1 of the 2 factors are present:
-moderate to severe otalgia
- or a fever >/= 39 C

15

2 general options for AOM

observe or treat with abx...

16

Management of AOM:
-When observation: defer abx for ______
-watch for resolution of symptoms
-provide __________

-48-72 hours
-symptomatic relief (gimme dat APAP or ibuprofen)

17

decide to observe or treat based on what 4 things?

childs age
diagnostic certainty
illness severity
assurance of follow-up

18

Observe or Treat AOM chart:
Always treat when what symptoms?

otorrhea or severe AOM!!!

19

Observe or Treat AOM chart:
always treat what age?

< 6 months

20

Observe or Treat AOM chart:
when is the "observe option" appropriate?

if 6 - 2 yrs and UNILATERAL and non-severe
or
if >/= 2 years old and non-severe

21

Resistance to strep pneumoniae is due to what mechanism?

alterations in PBPs (penicillin binding proteins)

22

Resistance to Haemophilus influenzae is due to what mechanism?

beta lactamase production

23

1st line abx choice for AOM?

Amoxicillin

24

dose to do for Amoxicillin in AOM?

80 - 90 mg/kg/DAY --- divide it to Q12H for 10 days

25

when would you NOT use amoxicillin in AOM?

known resistance
treatment failure
Amoxicillin in the past 30 DAYS
allergy (SHOCKING)
concurrent conjuctivitis

26

AOM treatment:
what abx do you use as 2nd line

AMOX/CLAV
90 mg/kg/day of Amoxicillin divided Q12

(same if conjunctivitis or amox in past 30 days)

27

AOM treatment:
what abx do you use if conjunctivitis

AMOX/CLAV
90 mg/kg/day of Amoxicillin divided Q12

(same as if amox in past 30 days or treatment failure)

28

AOM treatment:
what abx do you use if amoxicillin in last 30 days

AMOX/CLAV
90 mg/kg/day of Amoxicillin divided Q12

(same as if contaminant conjunctivitis or treatment failure)

29

Dose clavulanate at = to ________/day or pt will have wild diarrhea

< 10 mg/kg/DAY

30

what Amox/Clav concen is best at preventing diarrhea side effect?

600 mg/42.9 mg clav/ 5 mL

31

if allergy to amoxicillin 2nd option for AOM?

cephalosporins
(Cefdinir, Cefuroxime, Cefpodoxime --- aka the 2nd/3rd gens have much lower cross reaction)

32

Ceftriaxone used in AOM when?

when oral treatment is not an option
initial oral treatment fails
highly resistant s.pneumoniae

33

Dosing of Ceftriaxone for AOM?

50 mg/kg IM
-- if initial treatment: just ONE dose
-- if treatment failure: 3 doses

34

Avoid Ceftriaxone in what age and why?

avoid in < 1 month of age
because gets to brain and cant get out of BBB = kernicterus aka neurological damage

35

Cautions of ceftriaxone?

avoid co-admin with Ca2+ in the line
and C.Diff risk (?)

36

AOM Follow UP:
when to check in for young infants with severe episode or kids of any age with continuing age

within DAYS

37

AOM Follow UP:
when to check in for infants/kinds with hx of frequent recurrences

within 2 weeks

38

AOM Follow UP:
when to check in for kids with only a sporadic episode of AOM

1 month after initial exam

39

UTIs in Peds:
most common pathogen

E.Coli :0

40

Signs/Sxs of UTI in newborns?

Jaundice
Sepsis
failure to thrive
vomiting
fever

41

Signs/Sxs of UTI in Infants/young kids?

fever
strong smelling urine
hematuria
abdominal/flank pain
new onset urinary incontinence

42

Signs/Sxs of UTI in school-aged children?

Dysuria
Frequency
urgency
(similar to adults!)

43

Urinalysis:
when leukocyte esterase is present ---- it suggests ________ and presence of _____

inflammation; WBCs

44

To have nitrite:
process takes 4Hours -- why is this helpful to know when looking at urinalysis

aka so hard to see nitrite levels in babies because they empty their bladders so often

45

Nitrire is made from dietary nitrates in the presence of most _______ bacteria in urine

gram negative

46

how long to treat kids with UTIs when age 2 - 24 months?

7 - 14 days

47

Treatment options for UTIs:
what is 1st line

amoxicillin

48

Treatment options for UTIs:
what are other options than amoxicillin

cephalexin
SMX-TMP

49

most common cause of bronchiolitis?

RSV (respiratory syncytial virus)

50

risk factors for bronchiolitis?

Age < 6 mos
pre-term birth
cyanotic/complicated CHD
Chronic lung disease
weakened immune system

51

treatment of bronchiolitis?

its just viral...so NO ABX!!!
do supportive care (Oxygen, hydration, mechanical ventilation, ECMO)

52

Yay or Nay:
Use of beta adrenergic agonist in bronchioliotis?

Nay (no data)

53

Yay or Nay:
Use of corticosteroids in bronchioliotis?

Nay (no data)

54

Non-Pharm Prevention options for Bronchioliotis?

hand washing
isolation
"sick pods"?

55

Pharmacologic Prevention strategies of bronchioliotis?

flu vaccine
Palivizumab (Synagis)

56

Palivizimuab:
what is it?

NOT A VACCINE!
it is a humanized murine monoclonal antibody

57

Palivizimuab:
decreases rate of _________

RSV-associated hospitalization

58

Palivizimuab:
stop it when?

stop prophylaxis if RSV hospitalized

59

Palivizimuab:
not indicated for _______

RSV treatment

60

Dosing of Palivizimuab:
dosed how often?

once a month

61

Dosing of Palivizimuab:
does how many times

max of 5 doses!!!