Pediatric Infectious Disease Lecture Powerpoint

Question 1

Most common type of infectious illness in children

Answer 1

Upper respiratory infections, common viral colds are common because kids don’t have the acquired immunity, will frequently have 6-10/year

Question 2

Symptoms of a URI (3)

Answer 2

• Fever, headache, malaise
• nasal stuffiness, sneezing, sore throat, cough
• nasal discharge initially clear and watery but soon thick and colored either yellow, white, or green, returns to watery before resolving

Question 3

Color of snot and pathogen identification

Answer 3

Not indicative of anything

Question 4

Unilateral foul smelling nasal discharge in child should raise suspicion for….

Answer 4

….foreign body obstruction

Question 5

3 distinct criteria in diagnosis of acute bacterial sinusitis (differing it from a URI, only 6-7%)

Answer 5

• persistent symptoms (nasal discharge/congestion and or cough for >10 days without improvement)
• severe symptoms (temp >38.5 with purulent rhinorrhea for at least 3 days
• worsening symptoms after initial improvement, (worsening of nasal congestion, rhinorrhea, cough, and fever after a 3-4 improved period

Question 6

Maxillary and frontal sinuses do not grow in anatomically until…

Answer 6

….7-8 years

Question 7

Acute bacterial sinusitis treatment (1)

Answer 7

-amoxicillin with or without clavulanate

Question 8

Common cold treatment options (2)

Answer 8

• supportive

- ipratroprium bromide (atrovent) may help

Question 9

Common causes of acute pharyngitis (2)

Answer 9

• viruses (rhinovirus, influenza, etc)

- bacteria (GABHS, niesseria gonorrhoae, diptheria)

Question 10

Clinical presentation of GABHS pharyngitis (5)

Answer 10

• sudden onset
• sore throat
• fever
• tonsillar hypertrophy
• strawberry tongue

Question 11

Lab tests for GABHS (3)

Answer 11

• Rapid strep test (high sensitivity low specificity)
• throat culture follow up (doesn’t differentiate between acute strep and strep carriers)
• ASO titer in suspected rheumatic fever or acute glomerulonephritis

Question 12

Erythromycin resistant GABHS and treatment option in PCN allergic patients (1)

Answer 12

Identified in some parts of the world, in patients that cannot tolerate B lactam antibiotics a good choice would be clindamycin

Question 13

Retropharyngeal abscess definition

Answer 13

GABHS infeciton occurs in retropharyngeal space posterior to pharynx and can cause airway /swallow compromise and eventually progression to sepsis if left untreated, most common in 6 months to 6 years

Question 14

Retropharyngeal abscess diagnostic study (2) and treatment

Answer 14

• x ray or CT

- Drainage and clindamycin (need gram + and - coverage)

Question 15

Peritonsillar abscess definition

Answer 15

GABHS infection located in palatine tonsil, results in fever, dyspnea, trismus, and muffled potato voice, can spread to salivary glands

Question 16

Peritonsillar abscess diagnostic study and treatment options (3)

Answer 16

-CT imaging

• Drainage
• PCN oral outpatient or IV
• alternatively clindamycin

Question 17

Treatment failure of GABHS (3)

Answer 17

• noncompliant patient
• previously unknown carrier state
• inactivation by PCN resistant strain

Question 18

Are follow up throat cultures necessary in GABHS patients?

Answer 18

No, noncontagious 24 hours after initiation of therapy unless continue to be symptomatic

Question 19

2 most common causative pathogens of acute otitis media

Answer 19

H influenzae

S pneumoniae

Question 20

Acute otitis media vs otitis media with effusion

Answer 20

Collection of fluid in middle ear alone without signs or symptoms of acute infection including changing coloration/opacification is otitis media with effusion, while acute otitis media has bulging** tympanic membrane with color change

Question 21

Tympanography

Answer 21

A tool to look for middle ear effusion based on tympanic membrane compliance, in a normal eardrum it is tent shaped and peaks at 0, if the compliance is low and the tent is small this indicates high probability of effusion, if the tent peak is shifted negatively to the left this indicates eustachian tube dysfunction

Question 22

Antibiotic therapy for acute otitis media is only recommended if the patient is ___ or ____

Answer 22

under 24 months, if the child worsens or fails to improve

Question 23

1st and 2nd line treatment and 3rd line treatment for acute otitis media

Answer 23

• amoxicillin 80-90mg/kg/day in 2 doses
• amoxicillin-clavulanate (augmentin) 90mg/kg/day
• tympanocentesis

Question 24

Croup presentation (3)

Answer 24

• barking cough
• subglottic narrowing on x ray
• preceding upper respiratory infection (ecvept in spasmodic croup)

Question 25

epiglottitis

Answer 25

More severe emergency than croup and more rare in time sinc HIB vaccine, URI infection that doesn't have stridor or prodrome, presents with characteristic thumb sign on x ray, progressive swelling (supraglottic stenosis), sore throat, drooling, with airway management being utmost priority

Question 26

croup treatment options (6)

Answer 26

- comfort child - crying will make it worse - humidified o2 up to intubation if severe - racemic epi - nebulized budesonide - dexamethasone oral or im - admit if moderate to severe

Question 27

Epiglottitis treatment options (2)

Answer 27

- airway preservation | - ceftriaxone

Question 28

Bronchiolitis 3 most common causative agents

Answer 28

- RSV - human metapneumovirus - parainfluenza virus

Question 29

Bronchiolitis clinical presentation (3)

Answer 29

- chest x ray with lung hyperinflation and flattened diaphragm - history of rhinorrhea and cough - fine crackles on inspiration indicating lower lung infection

Question 30

Bronchiolitis diagnosis (3)

Answer 30

- clinical diagnosis - CXR in severe cases - ABG's to determine severity

Question 31

Bronchiolitis hospitalization treatment options (4) (remember most mild cases can be handled outpatient)

Answer 31

- supportive care including o2 - nebulized racemic epi (used to be bronchodilators back in the day) - ribavirin in severe RSV infection or immunocompromised - antibiotics if concomitant otitis media

Question 32

3 common findings of pneumonia

Answer 32

Fever, shallow respirations, cough

Question 33

Foreign body aspiration management

Answer 33

Endoscopic removal with a rigid bronchoscope followed by corticosteroids if inflammation presents and same day discharge

Question 34

Clinical signs and symptoms of pneumonia in children (6)

Answer 34

- cough day and night, often productive - fever - tachypnea - retractions - hypoxia and cyanosis - crackles and wheezes

Question 35

Pneumonia diagnostic studies (3)

Answer 35

- x ray in children who do not improve on initial antibiotic therapy (ground glass appearance) - cbc with diff - first morning sputum and culture

Question 36

Pneumonia treatment options (chidren) (4)

Answer 36

- amoxicillin - azithromycin (coverage against mycoplasm and chlamydia pneumoniae in teens!) - macrolide or doxy - fluorquinolones

Question 37

Blood pressure dropping in a child with dehydration is a...

Answer 37

....late stage finding, children have excellent compensatory mechanisms

Question 38

Lab tests for childhood diarrhea (4)

Answer 38

Normally not necessary but can get CBC, BMP, urinalysis, stool culture

Question 39

Fluids not recommended for acute diarrhea in kids (7)

Answer 39

- tea - juice - cola - chicken broth (just going to cause hypernatremia) - sports drinks such as gatorade and powerade (not ideal, has some k and na+ and lower amount of sugar in it but not good) - koolaid - water alone!!! (want carb to sodium ratio between 1.2-3.1)

Question 40

Carb to sodium ratio and base levels in commercial oral electrolyte solutions that are best for children and some products that meet this balance (2)

Answer 40

1.2-3.1, 30, pedialyte, infalyte, gatorade gets to 13 CHO-Na, so its closer than not

Question 41

Number 1 cause of viral childhood diarrhea

Answer 41

norwalk (norovirus), used to be rotavirus but then we got that sick vaccine yo

Question 42

Degree of dehydration and corresponding signs and symptoms

Answer 42

1-3% not noticable 3-5% mild, thirsty and slightly dry 6-9% moderate, blood pressure starts to drop >10% severe, skin cold clammy, tenting, etc

Question 43

Treatment principles for diarrhea in children (4)

Answer 43

- most is self limiting - replace fluid and electrolytes - avoid fatty foods or foods high in simple sugars - drinks made with unsweetened yogurt, unsweetened juice, mashed bananas, mashed potatoes, soda crackers, pretzels, beans, pastas, chicken, fish, eggs are all foods they can eat (go beyond the brat diet) - small portions frequently every 3-4 hours - avoid antibiotics, if its vira may cause harm, or may increase risk of hemolytic uremic syndrome