Pediatric Round Flashcards
(18 cards)
Tonsillitis in pediatrics overview
Ttt and complications and. Indications of tonsillitis
✅ Mnemonic – CENTOR Criteria for GAS
C – Cough absent
E – Exudate on tonsils
N – Nodes (anterior cervical) tender
T – Temperature >38°C
OR – Age <15 (+1), >44 (–1)
Grades of tonsillitis
Brodsky classification
🚨 Clinical Importance
• Grades 3+ and 4+ are often associated with:
• Obstructive sleep apnea (OSA)
• Snoring and mouth breathing
• Indications for tonsillectomy
Types of tonsillitis
✅ Mnemonic – “CAR-PMUV” for types
• Chronic
• Acute
• Recurrent
• Peritonsillar abscess
• Mononucleosis
• Ulcerative
• Viral (general)
🧠 Pediatric Obstructive Sleep Apnea (OSA) – Summary Table
✅ Mnemonic – STOP BANG Kids
• Snoring
• Tonsillar hypertrophy
• Observed apnea
• Poor school performance
• Behavior changes
• Adenoid facies
• Nasal obstruction
• Growth delay
Ttt of OSA
➤ First line: Adenotonsillectomy ➤ Weight loss if obese ➤ CPAP if surgery fails or contraindicated ➤ Intranasal steroids for mild cases
🧠 Pediatric Hydrocephalus Summary Table
✅ Mnemonic – “BIG HEAD” for infant hydrocephalus
• Bulging fontanelle
• Irritability
• Gaze (sunsetting)
• Head circumference ↑
• Empty gaze (lethargy)
• Anxiety feeding
• Delayed milestones
C.p ,ttt of hydrocephaly
🧠 Pediatric Meningitis – High-Yield Summary Table
Definition:
Inflammation of the meninges (pia, arachnoid, dura) due to infection
Etiology by Age:
<1 month: GBS, E. coli, Listeria
1–3 months: GBS, E. coli, Listeria, H. influenzae, S. pneumoniae
>3 months: S. pneumoniae, N. meningitidis, H. influenzae
Clinical Features:
• Fever, lethargy, irritability
• Bulging fontanelle (infants), poor feeding
• Vomiting, seizures, photophobia
• Neck stiffness, Kernig/Brudzinski signs (older kids)
Ttt of meningitis
✅ Mnemonic – “SEPSIS” for Meningitis Symptoms
• Seizures
• Elevated fontanelle
• Poor feeding
• Stiff neck (if older)
• Irritability
• Somnolence / shock
Diagnosis:
• Lumbar puncture (↓glucose, ↑protein, ↑WBCs)
• Blood cultures
• Head CT before LP if ↑ICP suspected
Treatment:
<1 month: Ampicillin + Cefotaxime / Gentamicin
>1 month: Ceftriaxone + Vancomycin
+ Dexamethasone to reduce hearing loss risk
Complications:
• Seizures, hearing loss (especially Hib)
• Hydrocephalus, cerebral palsy, death (esp. neonates)
🧪 CSF Findings – Meningitis Types Comparison
✅ Quick Recall Tips
• Bacterial = High WBC + Low Glucose + High Protein
• Viral = Lymphocytes + Normal Glucose + Mild ↑ Protein
• TB = Lymphocytes + Very High Protein + Very Low Glucose
Most common q about meningitis
Q1: What is the most common cause of meningitis in neonates (<1 month)?
🚩 Group B Streptococcus (GBS)
Q2: What organisms commonly cause meningitis in children >3 months?
🚩 Streptococcus pneumoniae, Neisseria meningitidis, Haemophilus influenzae type B
Q3: What is the gold standard diagnostic test for meningitis?
🚩 Lumbar puncture (LP)
Q4: When should a CT scan be done before lumbar puncture?
🚩 If signs of increased intracranial pressure are present (e.g., papilledema, focal neurologic signs, seizures)
Q5: What CSF findings suggest bacterial meningitis?
🚩 Low glucose, high protein, high neutrophils
Q6: What is the empiric antibiotic regimen for neonates?
🚩 Ampicillin + Cefotaxime or Gentamicin
Q7: What is the empiric antibiotic regimen for children >1 month?
🚩 Ceftriaxone + Vancomycin
Q8: Why is dexamethasone given in meningitis?
🚩 To reduce the risk of hearing loss, especially in H. influenzae
Q9: What are major complications of pediatric meningitis?
🚩 Seizures, hearing loss, hydrocephalus, developmental delay, death
Q10: What signs are more likely in older children but rare in neonates?
🚩 Neck stiffness, Kernig sign, Brudzinski sign
Q11: How might a newborn with meningitis present?
🚩 Lethargy, poor feeding, bulging fontanelle, temperature instability, seizures
🧠 Pediatric Encephalitis – High-Yield Overview
Def
Causes
C.p
📌 Definition:
🚩 Inflammation of the brain parenchyma itself (vs. meninges in meningitis), usually due to viral infection.
⸻
🦠 Common Causes:
• Viral (most common):
• Herpes Simplex Virus (HSV) — most severe
• Enteroviruses, Arboviruses (West Nile), CMV, EBV
• Post-infectious or autoimmune (e.g., ADEM – acute disseminated encephalomyelitis)
⸻
💡 Clinical Features:
• Fever
• Headache
• Altered mental status (confusion, lethargy, behavioral change)
• Seizures
• Focal neurologic deficits (e.g., hemiparesis)
• Photophobia or nuchal rigidity (may overlap with meningitis)
Pediatric Encephalitis – High-Yield
Diagnosis
Ttt
Complications
🔬 Diagnosis:
• MRI brain ➡️ temporal lobe involvement = HSV
• Lumbar puncture: lymphocytic pleocytosis, normal glucose
• EEG: temporal spikes in HSV
• CSF PCR for HSV = gold standard
• Rule out bacterial meningitis
⸻
💊 Treatment:
🚨 IV Acyclovir immediately (don’t wait for PCR)
• Supportive care
• Anticonvulsants if needed
⸻
⚠️ Complications:
• Seizures
• Cognitive deficits
• Paralysis or speech delay
• Death (if untreated HSV encephalitis)
Key Diagnostic Clues::of types of encephalitis
Key Diagnostic Clues::
• HSV: Temporal lobe + seizures
• Anti-NMDA: Young females, psychosis, dyskinesia
• ADEM: Post-viral/vaccine onset, multifocal signs
• Arboviral: Travel history, mosquito exposure
• Rabies: History of bite, hydrophobia
• HIV: Immunosuppression, opportunistic CNS infection
Summary Table::
1. HSV Encephalitis – MRI (temporal lobe), CSF PCR positive for HSV
2. Autoimmune (Anti-NMDA) – CSF/serum Abs, ovarian teratoma screen
3. Post-infectious (ADEM) – MRI: diffuse white matter lesions
4. Arboviral (e.g., West Nile) – IgM serology, CSF/serum
5. HIV-related – CMV, JC virus (PML), CSF PCR
6. Rabies – Clinical signs + saliva/CSF testing
Mnemonic – HARPAH:
H – HSV Encephalitis: Temporal lobe seizures, hallucinations, altered sensorium
A – Autoimmune (Anti-NMDA): Psychiatric symptoms, seizures, movement disorders
R – Rabies: Hydrophobia, hypersalivation, agitation
P – Post-infectious (ADEM): Ataxia, encephalopathy after infection or vaccination
A – Arboviral: Fever, flaccid paralysis, seasonal mosquito exposure
H – HIV-related: Progressive confusion, seizures in immunocompromised patients
🧠 Types of Encephalitis – Summary Table
Hsv
Autoimmune
Post infectio
✅ Mnemonic: “HARPAH” – for Types of Encephalitis
H – HSV Encephalitis
🚩 Temporal lobe seizures, hallucinations, altered sensorium
🧪 PCR for HSV, MRI temporal lobe
A – Autoimmune (Anti-NMDA)
🚩 Psychiatric signs, abnormal movements, seizures
🧪 Anti-NMDA antibodies, ovarian teratoma association
R – Rabies Encephalitis
🚩 Hydrophobia, agitation, hypersalivation
🧪 Exposure history, CSF/saliva tests
P – Post-infectious (ADEM)
🚩 Ataxia, multifocal deficits after infection/vaccine
🧪 MRI: diffuse demyelination
A – Arboviral Encephalitis
🚩 Fever, seasonal outbreaks, flaccid paralysis
🧪 IgM serology, mosquito exposure
H – HIV-related / Immunocompromised
🚩 Progressive confusion, seizures in AIDS
🧪 JC virus (PML), CMV, MRI, CSF PCR
🧠 Types of Encephalitis – Summary Table
✅ Mnemonic: “HARPAH” – for Types of Encephalitis
H – HSV Encephalitis
🚩 Temporal lobe seizures, hallucinations, altered sensorium
🧪 PCR for HSV, MRI temporal lobe
A – Autoimmune (Anti-NMDA)
🚩 Psychiatric signs, abnormal movements, seizures
🧪 Anti-NMDA antibodies, ovarian teratoma association
R – Rabies Encephalitis
🚩 Hydrophobia, agitation, hypersalivation
🧪 Exposure history, CSF/saliva tests
P – Post-infectious (ADEM)
🚩 Ataxia, multifocal deficits after infection/vaccine
🧪 MRI: diffuse demyelination
A – Arboviral Encephalitis
🚩 Fever, seasonal outbreaks, flaccid paralysis
🧪 IgM serology, mosquito exposure
H – HIV-related / Immunocompromised
🚩 Progressive confusion, seizures in AIDS
🧪 JC virus (PML), CMV, MRI, CSF PCR
✅ Key Differences: Encephalitis vs Meningitis??
