management

Question 1

diphtheria

pharmacologic treatment (2) plus duration

Answer 1

• diphtheria antitoxin x 1 dose to neutralize free toxins
  < 2 days: 40-60k units; > 2 days: 80-120k units
• antibiotic - to erradicate organism, prevent spread
  erythromycin 50 mkday q6 x 14 days
  aqueous penicillin G 100-150k u/kg/da q6 x 14 days

Question 2

diphtheria

nonpharmacologic tx

Answer 2

• droplet and contact prec
• bed rest x 2 weeks
• immunization upon recovery

Question 3

diphtheria

asymptomatic case contacts, first & second line

Answer 3

• monitor x 7 days
• culture nose, throat, cutaneous lesions
• Erythromycin 40-50 mkda q6 x 10 days OR
• Benzanthine Pen G 600k to 1.2 M IU x 1 dose

Question 4

Acute pharyngitis

Answer 4

• Penicillin V 25-50 mkday q6 x 10 days
• Amoxicillin 50 mkday q8-12 x 10 days

allergic:
azithromycin 12 mkday x 5 days

Question 5

Peritonsillar abscess

first line IV + stepdown; second line

Answer 5

• IV ampicillin-sulbactam 100 mkday q6
  then coamox 40 mkday q8
• ceftriaxone 50 mkday + metro 30 mkday

Question 6

Peritonsillar abscess

indications for tonsillectomy

Answer 6

• no improvement after 24 hrs of abx and drainage
• recurrent
• complications from peritonsillar abscess

Question 7

Retropharyngeal abscess

first line, stepdown

Answer 7

• IV ampicillin-sulbactam 100 mkday q 6 then
• coamoxiclav 40 mkday q6

Question 8

EBV

nonpharma, pharma

Answer 8

• rest, supportive, avoid contact sports x 2-3 wks
• PREDNISONE 1 mkda x 7 days (airway obst, thrombocytopenia, hemorrhage, anemia, seizure, mening)

Question 9

Croup

Answer 9

• racemic epinephrine 0.5ml in 3ml NSS q 20 mins
• dexamethasone 0.15 - 0.6 mkdose x 1 dose

Question 10

Bacterial tracheitis

Answer 10

• ceftriaxone 50-75 mkday q 12-24 PLUS
• clinda 30-40 mkday q 6-8 or vanco 15 mkdo q 6

Question 11

Acute epiglotitis

Answer 11

• Ceftriaxone 50-75 mkday q12 x 10 days

Question 12

Acute epiglottitis

prophylaxis - tx, who

Answer 12

Rifampicin 20 mkda x 4 days
- all household members
- < 4 yo, incomplete Hib
- < 12 mos, incomplete primary series
- immunocompromised

Question 13

PCAP, nonsevere

Answer 13

duration of tx - 7 days
- amoxicillin 40-50 mkday q 8
- coamox 80-90 mkday q 12
- cefuroxime 20-30 mkday q 12

Question 14

PCAP, severe
complete Hib

Answer 14

Penicillin G 200k IU q6

Question 15

PCAP, severe
incomplete/unknown hib

Answer 15

Ampicillin 200 mkday q6

Question 16

PCAP, severe
high level of pcn resistance

Answer 16

Cefuroxime 100-150 mkday q8;
ceftriaxone 75-100 mkday q12-24;
ampisul 200 mkday q 6

Question 17

PCAP, influenza severe

Answer 17

Oseltamivir within 48 hrs of sx; BID x 5 days
> 1yo, 15 kg: 30 mg
15-23 kg: 45 mg
23-40 kg: 60 mg
>40 kg: 75 mg

Question 18

Pertussis

Answer 18

Azithromycin x 5 days
< 6 mos: 10 mkday
> 6 mos: 10 mkday D1, 5 mkday D2-5

Question 19

Hydration for mild to moderate dehdydration

Answer 19

rehydration: 75 ml/kg ORS x 4 hrs
replacement:
< 10 kg: 50-100ml/kg per loose stool, max 500
> 10 kg: 100-200 ml/kg; max 1L
adolescents: ad libitum, max 2L

Question 20

Hydration for severe dehydration

Answer 20

20-30 ml/kg over 30-60 mins then
70 ml/kg over 2.5-5 hrs

10ml/kg for malnourished

Question 21

tetanus

Answer 21

• human tetanus immunoglobulin 500 U IM x 1 dose to neutralize toxin
• metronidazole 30 mkday q6 x 7-10 days to decrease organism
• ms. relaxant: diazepam 0.1-0.2 mkdo
• dark, quiet, secluded setting

Question 22

botulism

Answer 22

• human botulism immune globulin 50-100 mkdo x 1 dose
• no antibiotics

Question 23

GBS

Answer 23

• IVIG 0.4 g/kg/day x 5 days or 1 g/kg/day x 2 days for severe or rapidly progressive weakness
• steroids, narcotic analgesic for pain

Question 24

osteomyelitis

Answer 24

clindamycin 30 mkday q8 +/- ceftri 100 mkday
mrsa: vancomycin 20 mkdose q8
* 4-6 wks

Question 25

septic arthritis

Answer 25

empiric - clindamycin 30-40 mkday q6 or vancomycin 20 mkdo q8 - shift to oxacillin 150-200 mkday q6 if mssa * 3 wks

Question 26

reactive arthritis

Answer 26

NSAIDS - naproxen 10-15 mkda BID RTC x 2 wks - ibuprofen for younger kids - treat infection if still ongoing

Question 27

myasthenia gravis

Answer 27

pyridostigmine bromide 0.5-1 mkdose q4-6 longterm prednisone treatment

Question 28

MIS-C

Answer 28

- IVIG 2g/kg over 8-12 hrs - Methylprednisolone 1-2 mg/kg/day q12 then shift to pred 1-2 mkda once afebrile - aspirin 3-5 mkday

Question 29

Kawasaki

Answer 29

- IVIG 2 g/kg over 8-10 hrs within 10 days - high dose aspirin 80-100 mg/kg/day q6 until afebrile for 48 hr then reduce to 3-5 mkda x 6-8 wks

Question 30

Kawasaki, IVIG resistant

Answer 30

- 2nd dose IVIG 2g/kg OR - methylpred 20-30 mg/kg x 3 days then taper over 2-3 weeks OR - infliximab 5 mg/kg x 1 dose

Question 31

COVID, severe to critical

Answer 31

- Dexamethasone 0.15 mkda IV OD up to 10 days OR methylpred 0.8 mg/kg IV OD - Remdesivir 5 mg/kg D1 then 2.5 mg/kg D2 onwards x 5-10 days (for O2 requ, not intubated)

Question 32

TTN

Answer 32

- O2 support - salbutamol - facilitates fluid clearance by activating NaKATPase and ENaC

Question 33

RDS | prophylaxis, treatment, prevention

Answer 33

- ncpap - prophylactic, or if FiO2 40-70% needed to maintain sats > 90% - INSURE intubate, surfactant, extubate SURFACTANT 4 ml/kg q6-12 up to 2-4 doses - antenatal corticostaroids at 24-36 weeks

Question 34

breast feeding jaundice

Answer 34

- admit - ensure adequate breastfeeding at least 10 times per day - start intensive phototherapy - ensure adequate UO and BM - repeat bili after 6 hrs of intensive phototherapy

Question 35

orbital cellulitis

Answer 35

IV ampisul 200 mkda q6 or clinda 40 mkda q6-8 PLUS ceftriaxone 100-200 mkda q8 /cefotaxime 75-100 mkda q 12-24 add vancomycin 15 mkdo q6 and metro 30 mkda q8 if with CNS extension

Question 36

ophthalmia neonatorum prophylaxis | all bbs, mom w gonococcal infection

Answer 36

- 0.5% erythromycin ointment, 1 strip to both eyes - 1% silver nitrate - ceftriaxone 50 mkdo IM for infants born to mothers with untreated gonococcal infection

Question 37

ophthalmia neonatorum N. gonorrhea

Answer 37

- eye irrigation with normal saline q10-30 mins until discharge is clear - ceftriaxone 25-50 mkday q24 IM/IV x *1 DOSE* if w sepsis: cefotaxime 50 mkdo q12 x 7 days if w meningitis: cefotax 10-14 days

Question 38

ophthalmia neonatorum Chlamydia

Answer 38

- eye irrigation with normal saline q10-30 mins until discharge is clear - erythromycin 50 mkday q6 x 14 days

Question 39

acute purulent conjunctivitis

Answer 39

tobramycin eye drops, 1-2 drops q4 x 7 days