Flashcards in Pediatric ID 2 Deck (28)
- 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:
-S pneumo** Leading cause of bacterial URI
-h flu type B
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.
Work up on toxic appearing FUO
CBC w/ diff
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
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.
Tx for FUO toxic
-admit for further tx, pending culture results, administer parenteral abx
*ceftriaxone, cefotaxime, or ampicilling/sulbactam(Unasyn)
-MC in what climates?
MC in hot humid climates
-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.
-based soley on Hx & clinical appearance
-labs: gram stain and culture to identify the bacteria
-local wound care
--Topical: Mupirocin (Bactroban)
--Oral: Cephalexin or Dicloxacillin (1st line), Erythro or clarithro (2nd line); sulfa, clinda, or doxy for MRSA coverage.
-what is this?
-characteristics of skin lesions
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.
-children sharing bath, athlettes sharing gym equipment, swimming pools, sexual activity
-clinical, if uncertain do bx
-if adult consider STD workup
-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.
-what is this?
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
-pruritis is MC
-observation of Eggs (nits), nymphs, mature lice
-2ndry infection from excoriation
-wood lamp of area (yellow-green flourescence of lice/nits.
--permethrin cream (Nix)
-caused by what parasite?
-pathophysiology of infection
caused by Sarcoptes scabiei
pathophys: linear burrows at the wrist, ankles, finger webs, axillary folds, genitalia, or face.
-scrape unscratched papule and examine microscopically in immersion oil.
Urinary Tract Infections
-MC in boys at what age?
-signs and sx
MC cause e. Coli
MC in boys less than 1 YO.
-lack of circumcision
Signs and Sx:
-failure to thrive
-frequency, urgency, dysuria
--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.
--Suprapubic bladder aspiration: usally reserved for male in whom cath is difficult and uncircumcised boys with tight foreskin, periurethral irritation
-renal function studies
- not indicated unless recurrent, may get voiding cystourethrogram or renal US
-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.
-what is SIRS?
-what is Sepsis?
SIRS: systemic inflammatory response syndrome widespread inflamm response that may/may not be associated with infection.
-SIRS in the presence of suspected or proven infection.
-bacteria: Staph, strep, klebsiella, e. coli
-viruss: RSV and influenza
Signs and Sx of sepsis
-tachypnea, labored breathing
-mental status changes
-renal/liver function tests
-culture blood, urine, CSF
-serology for viral
-CXR, US, CT, Echo
*do US 1st!
-fluid resuscitation and support of CO
-ventilatory support w/ supplemental O2
-maintenance of Hgb
-correction of physiologic and metabolic derangements
-monitor Urine Output
---ampicillin and gentamicin/ceftriaxone
--Older infants and children:
---Ceftriaxone + vancomycin ...add clinda if S aureus or GABHS
-sx (make sure to list the triad)
-non infectious: cancers, SLE, head injury
Triad of bacterial: fever, HA, neck stiffness
- CBC w/ diff*
- serum electrolytes
- serum glucose
- BUN or creatinine and liver profile*
Blood cultures*, nasopharynx, resp secretion, urine or skin lesion cultures
LP and CSF analysis
Neuroimaging (CT of head and MRI of brain)
-IV fluids for shock or hypotension
-Start abx immediately after LP and blood cultures (vanco + rocephin)
- 1st sx is sore on genitals or mouth
- fever, sore throat, HA, joint pain
-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.
Congenital syphillis sx:
-pseudoparalysis of arms/legs
-rash on palms and soles
-bilateral interstital keratitis (opacification of cornea)
-periosteum thickening of tibias
Dx: dark field microscope*
-serologic testing (VDRL and RPR, FTA-ABS)
Sx: asymptomatic 75%, may have:
*treat pt and partner
-Doxycyline x 7d OR azithromycin PO once.
-sites of infection
-painful or swollen testicles
-first catch urine for NAAT
-Culture (Thayer-Martin Agar)
-Ceftriaxone IM PLUS Azithro I gram single dose.
What is the MC STI?
-1d -2wks develop small papule in genitals that becomes ulcer.
-azithromycin 1g single dose OR Ceftriaxone single dose.
-what types cause genital warts?
-what type cause cervical cancer?
Genital warts: Types 6 & 11
Cervical dysplasia: 16 & 18
-develop lesion on genitals