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Flashcards in Pediatric ID 2 Deck (28)
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1

Fever
-defined as
- 3MC cause of FUO
-Common bacterial causes of fever

defined as temperature as a rectal temp that exceeds 100.4F.

3 MC causes of FUO:
-infectious dz
-CT dz
-neoplasms

Bacterial:
-S pneumo** Leading cause of bacterial URI
-meningitidis
-h flu type B
-E coli
-salmonella

2

Work up for non-toxic appearing FUO

CBC w/ diff

UA by bladder catherterization and urine culture on all males younger than 6 mo and all uncircumcised males younger than 12mo & females younger than 24mo

Rapid testing for viruses

Consider stool sample for WBC counts and guaiac if diarrhea is present.

3

Work up on toxic appearing FUO

CBC w/ diff

Blood cultures

CXR; if tachypnea, retractions, focal auscultatory findings or oxygen sat on RA less than 95%

UA by bladder catherterization/suprpubic aspiration and urine culture on all males younger than 6 mo and all uncircumcised males younger than 12mo & females younger than 24mo


CSF for studies and cultures

Stool sample for WBC & guaiac if diarrhea present

rapid testing for virus

admit pt to hospital

4

Tx non toxic FUO

After thorough work-up pts ages 2-36mo may not require admission; only if they look toxic, just have F/U apt 24-48hrs. Empiric abx therapy is not warranted.

5

Tx for FUO toxic

-admit for further tx, pending culture results, administer parenteral abx
*ceftriaxone, cefotaxime, or ampicilling/sulbactam(Unasyn)

6

Impetigo
-MC in what climates?
-types
-pathophysiology
-dx
-tx

MC in hot humid climates

Types:
-nonbullous: MC, staph aureus, GABHS
-bullous impetigo: S aureus

Pathophysiology: **Highly contagious!!!!**
-scratching, dematophytosis(ring worm), herpes simplex, scabies, pediculosis(head lice), trauma, insect bites.

Dx:
-based soley on Hx & clinical appearance
-labs: gram stain and culture to identify the bacteria

Tx:
-local wound care
-abx therapy:
--Topical: Mupirocin (Bactroban)
--Oral: Cephalexin or Dicloxacillin (1st line), Erythro or clarithro (2nd line); sulfa, clinda, or doxy for MRSA coverage.

7

Molluscum Contagiosum
-what is this?
-characteristics of skin lesions
-sx
-transmission

What: benign viral infection (poxvirus)

Characteristics: single or multiple rounded dome-shaped pink waxy papules, umbilicated*

Sx: usually asymptomatic, MC on the face, trunk, and extremities in children. Groin and genitalia in adults.

Transmission:
-children sharing bath, athlettes sharing gym equipment, swimming pools, sexual activity

8

Molluscum Contagiosum
-dx
-tx

Dx:
-clinical, if uncertain do bx
-if adult consider STD workup

Tx:
-benign neglect: resolve on own in few months
-direct lesional trauma
-antiviral therapy: cimetidine
-Topical therapy: imiquimod, cantharidin
-cryotherapy w/ curettage
-Activity: avoid sports, and physical contact between infected areas, sexual abstinence.

9

Pediculosis
-aka
-what is this?
-types
-sx
-PE

aka: lice
what: ectoparasites that live on the body and feed on the human blood after piercing the skin.

Types: pediculosis capitus: head lice

pediculosis corporis: body lice

Sx:
-pruritis is MC

PE:
-observation of Eggs (nits), nymphs, mature lice
-2ndry infection from excoriation
-wood lamp of area (yellow-green flourescence of lice/nits.

10

Lice Tx

-medication:
--permethrin cream (Nix)
--malathion
--benzyle alcohol
--spinosad
--Ivermectin

11

Scabies
-caused by what parasite?
-pathophysiology of infection
-dx
-tx

caused by Sarcoptes scabiei

pathophys: linear burrows at the wrist, ankles, finger webs, axillary folds, genitalia, or face.

Dx:
-scrape unscratched papule and examine microscopically in immersion oil.

Tx:
-Permethrin creme
-Ivermectin

12

Urinary Tract Infections
-MC cause
-MC in boys at what age?
-risk factors
-signs and sx

MC cause e. Coli

MC in boys less than 1 YO.

Risk factors:
-lack of circumcision
-caucasion
-urinary obstruction
-VUR

Signs and Sx:
-poor feeding
-fever
-failure to thrive
-vomiting
-abd pain
-flank pain
-frequency, urgency, dysuria
-suprapubic tenderness

13

UTI
-dx

Dx:
-Collect urine:
--Midstream clean catch: must be toilet trained
--Clean Voided Bag collection: noninvasive, NOT used for culture, DO NOT administer abx on basis of a UA from this method.
--Bladder cath
--Suprapubic bladder aspiration: usally reserved for male in whom cath is difficult and uncircumcised boys with tight foreskin, periurethral irritation

14

UTI:
-labs
-imaging
-tx

Labs:
-CBC
-CMP
-blood cultures
-renal function studies
-electrolytes

Imaging:
- not indicated unless recurrent, may get voiding cystourethrogram or renal US

Tx:
-hospitalize if toxic/septic, urinary obstruction, infants less than 2 w/ febrile UTI, all infants younger than 1 mo with UTI even if not febrile.
-amoxicillin and bactrim are 1st line.

15

Sepsis:
-what is SIRS?
-what is Sepsis?
-Pathogens

SIRS: systemic inflammatory response syndrome widespread inflamm response that may/may not be associated with infection.

Sepsis:
-SIRS in the presence of suspected or proven infection.

Pathogens:
-bacteria: Staph, strep, klebsiella, e. coli
-viruss: RSV and influenza
-Fungi
-parasites

16

Signs and Sx of sepsis

PE findings

Dx

-fever
-increased HR/tachycardia
-tachypnea, labored breathing
-cool extremities
-color changes


PE findings;
-hypotension
-mental status changes
-anuria
-hypothermia

Dx:
-CBC
-PT,PTT/INR
-electorlytes
-renal/liver function tests
-UA
-inflamm markers
-culture blood, urine, CSF
-serology for viral
-CXR, US, CT, Echo
*do US 1st!

17

Sepsis
Tx

Tx:
-fluid resuscitation and support of CO
-ventilatory support w/ supplemental O2
-maintenance of Hgb
-correction of physiologic and metabolic derangements
-monitor Urine Output
-Meds:
--Newborns/infants
---ampicillin and gentamicin/ceftriaxone

--Older infants and children:
---Ceftriaxone + vancomycin ...add clinda if S aureus or GABHS

18

Meningitis:
-cause
-sx (make sure to list the triad)
-dx

Cause:
-bacterial
-viral
-fungal
-parasitic
-non infectious: cancers, SLE, head injury

Sx:
Triad of bacterial: fever, HA, neck stiffness
-n/v
-sleepiness
-irritability
-delirium

dx:
- CBC w/ diff*
- serum electrolytes
- serum glucose
- BUN or creatinine and liver profile*
-PT/INR, PTT

Blood cultures*, nasopharynx, resp secretion, urine or skin lesion cultures

syphilis testing

LP and CSF analysis

Neuroimaging (CT of head and MRI of brain)

19

Meningitis Tx

MAINTAIN ABC's.
-IV fluids for shock or hypotension
-seizure precautions
-airway protection
-Start abx immediately after LP and blood cultures (vanco + rocephin)

20

Syphillis
-sx
-stages
-cause
-transmission

Sx:
- 1st sx is sore on genitals or mouth
- fever, sore throat, HA, joint pain

Stages:
-primary: one or more painless sores on
-2ndry: copper penny rash on palms and soles.
-latent: inactive and lies dormant
-tertiary: severe problems with heart, brain, nerves if not treated.

Cause:
-treponema pallidum

Transmission:
-sexual contact
-congenital

21

Congenital syphillis sx:
-newborn
-young infants
-children

Newborn:
-jaundice
-hepatosplenomegaly
-edema
-bulging fontonelle

Young infants:
-mucocutaneous lesions
-pseudoparalysis of arms/legs
-hepatomegaly
-rash on palms and soles

Children:
-bilateral interstital keratitis (opacification of cornea)
-periosteum thickening of tibias

22

Syphillis
-dx
-tx

Dx: dark field microscope*
-serologic testing (VDRL and RPR, FTA-ABS)

Tx:
-Penicillin G

23

Chlamydia
-sx
-labs
-tx

Sx: asymptomatic 75%, may have:
-dysuria
-vaginal discharge
-cervicitis
-PID
-epididymitis

Labs:
-urine specimen
-culture

Tx:
*treat pt and partner
-Doxycyline x 7d OR azithromycin PO once.

24

Neisseria Gonorrhea
-sites of infection
-sx
-dx

sites:
-cervix
-urethra
-rectum
-pharynx

Sx:
-dysuria
-white/yellow/green discharge
-painful or swollen testicles

Dx:
-first catch urine for NAAT
-Culture (Thayer-Martin Agar)
-Gram stain

Tx:
-Ceftriaxone IM PLUS Azithro I gram single dose.

25

What is the MC STI?

chlamydia

26

Chancroid :
-cause?
-sx
-dx
-tx

Cause:
-haemophilus ducreyi

Sx:
-1d -2wks develop small papule in genitals that becomes ulcer.
-PAINFUL ulcer
-sharp borders
-easily bleeds

Dx:
-gram stain

Tx:
-azithromycin 1g single dose OR Ceftriaxone single dose.

27

HPV
-what types cause genital warts?
-what type cause cervical cancer?
-sx
-dx
-tx
-vaccines

Genital warts: Types 6 & 11

Cervical dysplasia: 16 & 18

Sx:
-asymptomatic
-develop lesion on genitals

Dx:
-biopsy
-pap smear

Tx:
-podofilox
-trichloroacetic acid
-cryotherapy
-laser therapy

Vaccine:
-Gardasil
-Gardasil 9
-Cervarix

28

Herpes:
-types 1 & 2 lesions located where?
-signs and sx
-dx
-tx

Type 1: oral herpes
Type 2 genital herpes

Signs and sx:
-group vesices on erythematous base*
-fever and malaise
-tender regional adenopathy

Dx:
-cultured vesicles from epithelial sites
-immunoflourescent stains
-ELISA

Tx:
-acyclovir
-famciclovir
-valacyclovir