Pediatrics 2 Flashcards
(121 cards)
1
Q
What is the most common cause of Hand Foot and Mouth and how is it transmitted
A
Coxsackievirus A16
Transmission: oral-fecal
2
Q
What is seen on physical exam for Hand Foot and Mouth
A
- Vesiculopustular lesions on the palms and soles
- PO refusal due to sore throat or mouth pain
3
Q
What is the treatment for Hand Foot and Mouth and when can the child return to school
A
Treatment: Ibuprofen and Acetaminophen
Return to school: when fever resolves
4
Q
What is the post infection guidance for Hand Foot and Mouth
A
Desquamation of the hands and feet and nail shedding is expected
5
Q
What is the cause of Scarlet Fever
A
Group A Strep
6
Q
What is the rash appearance for Scarlet Fever
A
- begins around neck and spreads to trunk/extremities
- rough like sandpaper
- blanches
- looks like sunburn
7
Q
What is the treatment for Scarlet Fever
A
Low dose amoxicillin (50mg/kg/daily)
8
Q
Herpes labialis is limited to what anatomical location
A
Vermillion border
9
Q
What form of herpes involves the vermilion border plus the gingivae
A
Herpes gingivostomatitis
10
Q
What form of herpes is contracted from close contact sports such as wrestling
A
Herpes gladiatorum
11
Q
What is a herpetic whitlow
A
A painful HSV infection of the digit
12
Q
What is the treatment for HSV
A
Acyclovir, valacyclovir or famciclovir to shorten the duration of disease
13
Q
What can be done for frequent HSV recurrence
A
Prophylactic antivirals
14
Q
Pinworms (enterobius vermicularis) can be diagnosed how
A
adhesive cellophane tape pressed against anus 1st thing in the morning showing eggs
15
Q
what is the treatment for pinworms? what about the alternatives
A
First line: albendazole
Alt: mebendazole or pyrantel pamoate
morning bathing can remove large portion of eggs
16
Q
what is the most effective method of prevention for pinworms
A
hand hygiene
17
Q
Scabies (sarcoptes scabiei) can show what on physical examination of the patients skin and when is the itching worse
A
linear papule or burrows that can be seen in the axillae, umbilicus, groin, penis, or web spaces of fingers
itching worse at night
18
Q
Scabies on an infant can mimic what?
What are other clues that you are dealing with a scabies infestation?
A
diffuse eczematous eruption
Clues: poor antibiotic response and transient response to topical steroids
19
Q
What is the treatment for scabies
A
permethrin 5% applied to the whole body overnight and applied again in 1 week to kill subsequent hatched larvae
20
Q
what should be done with household members and close contacts with scabies
A
Permethrin treatment
21
Q
when treating linens, towels and clothes of a scabies patient what is the most effective scabicide
A
heat
22
Q
is prolonged pruritus after treatment of scabies considered a treatment failure
what would cause you to suspect inadequate treatment
A
no
likely a prolonged hypersensitivity reaction
Inadequate treatment: new lesions appearing
23
Q
how are lice transmitted
A
usually direct contact with infected individual
24
Q
what is the most common form of lice
A
pediculosis capitis
25
can a nit be moved/knocked off the hair shaft with fingers
no
26
where is pediculosis capitis most commonly seen
occipital region and above ears
27
what is the first line treatment for lice?
what is the second line treatment? why would you need to utilize it
first line: OTC permethrin 1% (two separate treatments)
second line: malathion .5% or ivermectin .5% (both used for resistant cases)
28
a referral to ophthalmologist is needed if a dysconjugate gaze persists at what age? what about for strabismus?
dysconjugate gaze: 4 months
strabismus: 6 months
29
how is visual acuity assessed at ages 3-5? what about after age 5?
3-5YOA: Shape chart
≥5YOA: Snellen chart
30
what is the most common cause of severe visual impairment in children
retinopathy of prematurity
31
normal 20/20 vision should be expected at what age
≥6 YOA
32
what is the rule of 8s for determining need for referral in childhood vision screening
Age + tens digit of denominator = ≤8
"if it equals 8 vision is great, 9 or more vision is poor"
33
what are the signs and symptoms of hyperopia
squinting, eye rubbing and lack of interest in reading
34
what are the signs and symptoms of myopia
holds things close to eyes, sits in front of room, uninterested in distance activities
35
what are the 3 types of amblyopia
strabismic (misalignment)
refractive (vision blurry)
deprivation (vision obstructed)
36
if inspection of eyes appears not aligned but there is a normal corneal light reflex what is this called
pseudostrabismus
37
what test confirms the eye that is affected by strabismus?
what is expected when the normal eye is used during the test?
cover test
normal eye covered: affected eye moves opposite direction of the deviation
38
how is congenital esotropia corrected?
what about onset between the ages of 2-5YOA?
onset after the age of 5 may signify what?
surgically
2-5YOA: patching or glasses
>5YOA: CNS disease
needs referral to ophthalmology
39
exotropia typically onsets around what age?
2 YOA
needs referral to ophthalmology
40
leukocoria (white reflex) of the eye can be indicative of what
cataracts
retinoblastoma
chorioretinitis
retinopathy of prematurity
41
if there is history of premature birth, cerebral palsy, down syndrome or poor school performance you should consider a referral to
ophthalmology
42
what anatomical area of the eye does conjunctivitis not contact
limbus
43
what are the four categories of conjunctivitis
neonatal
infectious (viral or bacterial)
allergic
chemical
44
dendritic lesions of the cornea should make you suspect what
HSV
45
what are the specific treatments for the following:
- gonorrhea
- chlamydia
- pseudomonas
- HSV
- Staph aureus
Gonorrhea: Ceftriaxone
Chlamydia: Erythromycin
Pseudomonas: Gentamicin IV and topical
HSV: acyclovir
Staph aureus: erythromycin or polysporin
46
what is the most common cause of viral conjunctivitis?
what type of discharge is typically noted with viral conjunctivitis?
adenovirus
discharge: watery
47
what are the most common causes of bacterial conjunctivitis?
what type of discharge is typically noted with bacterial conjunctivitis?
H. influenzae, S. pneumoniae, M. catarrhalis
discharge: purulent
48
what is the best first line antibiotic for bacterial conjunctivitis for ≤ 1 YOA
erythromycin
49
what are the physical exam findings and signs and symptoms of allergic conjunctivitis
- bilateral onset
- pruritus
- eyelid edema with cobblestoning
- blebs
50
what is the treatment for allergic conjunctivitis
NSAIDS
antihistamines
topical cromolyn
nasal steroids
51
what are the signs and symptoms of blepharitis?
what is the treatment?
SxS: photophobia, burning, foreign body sensation
Treatment: warm compress, topical antibiotic, baby shampoo
52
what are the signs and symptoms of dacryostenosis?
what is the treatment?
what should you monitor for?
SxS: overflow of tears, erythema, presents around birth
Treatment: duct massage
Monitor for: dacryocystitis
53
what are the signs and symptoms of dacryocystitis?
what is the treatment if uncomplicated? what about if there is mucopurulent drainage?
when should you refer?
SxS: swollen sac, erythema, tenderness
Uncomplicated treatment: nasolacrimal massage
Mucopurulent drainage treatment: topical antibiotics
Refer if: no improvement in 24hrs
54
what are the signs and symptoms of a hordeolum?
what is the treatment?
when should you refer?
SxS: tenderness and erythema (external: infected gland of Zeis; internal: infected meibomian gland)
treatment: warm compress and NSAIDs
Refer if: no improvement in 1-2 weeks
55
what are the signs and symptoms of a chalazion?
what is the treatment?
when should you refer?
SxS: swollen, nontender, nonerythematous
treatment: warm compress
refer if: no resolution or symptomatic
56
what are the signs and symptoms of a periorbital (pre septal) cellulitis?
what is the treatment?
when should you refer?
SxS: skin infection anterior to septum, no proptosis or ophthalmoplegia, kid under 5 YOA
treatment: keflex, clindamycin, augmentin (MRSA: clindamycin or bactrim)
refer if: no improvement in 24 hours
57
what are the signs and symptoms of a orbital cellulitis?
what is the treatment?
when should you refer?
SxS: skin infection posterior to septum, proptosis, chemises, vision loss, ophthalmoplegia
treatment: admission for IV vancomycin + cefotaxime or ceftriaxone
refer: immediately
58
what are the complications associated with orbital cellulitis?
cavernous sinus thrombosis (CN 3,4,5,6 palsy)
subperiosteal abscess
vision loss
59
what type of otitis media is often seen with concurrent URI or pharyngitis
otitis media with effusion (OME)
60
what is the most common cause of acquired hearing loss in children
acute otitis media (most commonly bacteria)
61
what is the main indication for myringotomy with insertion of tympanostomy tubes +/- adenoidectomy
recurrent otitis media
62
the diagnosis of acute otitis media can be made with the presence of what 3 things
acute onset of symptoms
middle ear effusion
middle ear inflammation
63
what is the treatment of acute otitis media
Tylenol or ibuprofen for pain
antibiotics
64
what are the first line antibiotics for AOM?
what are the alternatives for PCN allergy?
what are the alternatives for PCN and cephalosporin allergy?
1st line: amoxicillin or augmente
PCN allergy: cefdinir or ceftriaxone
PCN and cephalosporin allergy: azithromycin
65
AOM can be associated with with type of hearing loss
conductive
66
when should you refer a patient with AOM
- bilateral hearing loss
- effusion persists at 3 months
67
recurrent otitis media is treated how if recurrence in ≤ 1 month?
≥ 1 month?
≥ 3 episodes in 6 months; ≥ 4 episodes in 12 months; OME ≥ 3months?
≤ 1 month: next line antibiotic
≥ 1 month: same antibiotic
≥ 3 episodes in 6 months; ≥ 4 episodes in 12 months; OME ≥ 3months: ENT referral for PE tubes
68
what are some urgent complications of AOM
mastoiditis
cholesteatoma
intracranial extension
69
what are the signs and symptoms of a otitis externa (swimmer's ear)?
what is the treatment?
SxS: otalgia, otorrhea, pinna TTP, tragus pain with chewing
treatment: ibuprofen or acetaminophen for pain, ofloxacin or ciprofloxacin with steroid, polymyxin b-neosporin-hydrocortisone
70
how is otitis externa prevented
avoid excessive cleaning
avoid swimming
dry ears with rubbing alcohol or acetic acid
71
what is the most common cause of epistaxis?
how is it treated?
where are the majority of bleeds from anatomically?
- trauma via nose picking
- kiesselbach's plexus
72
what is initial the treatment for epistaxis?
persistent bleeding and site not seen?
bleeding posterior?
initial: direct pressure
persistent & site not seen: afrin, phenylephrine, oxymetazoline with lidocaine
posterior: ENT referral
73
what should be applied to the nares if there is concern for staph aureus infections
mupirocin
74
What is the most common cause of the common cold
rhinovirus
75
what is the most common complication of the common cold
otitis media
76
when treating the common cold, what age group should not get antihistamines or decongestants
< 6 YOA
77
what are the common pathogens implicated in acute sinusitis
strep pneumoniae
h. influenzae
m. catarrhalis
s. aureus
group a strep
78
what are the signs and symptoms of sinusitis?
what is the first line treatment?
what if there is PCN allergy?
SxS: mucopurulent rhinorrhea, nasal congestion, cough, persists > 10-14days
First line treatment: high dose augmentin
PCN allergy: levofloxacin or clindamycin + 3rd gen cephalosporin
79
what are the signs and symptoms of allergic rhinitis (hay fever)?
what is the first line treatment?
second line treatment?
what about if medications are ineffective?
SxS: sneezing, itching, rhinorrhea, nasal congestion, cobblestoning, transverse nasal crease. associated with atopic triad (eczema, asthma, hay fever)
First line treatment: INCS (most potent therapy)
second line: oral antihistamine (2nd gen)
Medication failure: immunotherapy
80
what is the most common cause of pharyngitis
viral
81
what are the signs and symptoms of GAS?
how is it tested and what's the gold standard?
what is the treatment?
PCN allergy?
B-lactam allergy?
SxS: sore throat, fever, no cough, tonsillar exudate, anterior cervical lymphadenopathy
Testing: rapid strep, strep culture (gold standard). get mono spot & CBC w/diff if mononucleosis suspected
Treatment: amoxicillin, PCN V, benzathine PCN G
PCN allergy: keflex, cefadroxil or clindamycin
b-lactam allergy: erythromycin or azithromycin
82
during which phase of breathing is stridor more commonly heard?
what about wheezing?
Stridor: inspiration
Wheezing: expiration
83
what is the most common cause of stridor in infants
laryngomalacia (floppy larynx)
84
what are the most common causes of croup
PAIR
- parainfluenza
- adenovirus
- influenza A/B
- RSV
85
what are the signs and symptoms of croup?
what can be seen on CXR?
what is the treatment?
SxS: barking/brassy cough that's worse at night, FmHx of laryngitis, fever
CXR: subglottic narrowing (steeple sign)
treatment: racemic epinephrine, dexamethasone or prednisolone
86
what are some admission considerations for croup
< 6 months of age
recurrence
stridor at rest
secondary bacterial infection
87
what are the signs and symptoms of epiglottis?
what can be seen on lateral c-spine plain films?
what is the treatment?
what vaccination can assist with prevention?
SxS: fever, hot potato voice, drooling, tripod positioning, ill-appearing child
Plain films: bulging epiglottis (thumb sign)
treatment: airway control, ceftriaxone +/- steroids
Vax: HiB vaccination
88
what are the signs and symptoms of an airway obstruction?
who is at highest risk?
what can assist with diagnosis?
what is the treatment?
SxS: sudden onset of choking, stridor or wheezing
Highest risk: < 5 YOA
DX assistance: CXR
Treatment: control airway, no blind finger sweep, pulmonology referral
89
what is the most common cause of chronic disease of childhood in industrialized countries
asthma
90
what is the first line medication for persistent asthma
inhaled corticosteroid (ICS)
91
what medication is effective for exercise induced asthma with concurrent allergic rhinitis
leukotriene receptor antagonists (montelukast)
92
Long acting B2 agonists have a black box warning for what
asthma exacerbation and death with single therapy
must combine with inhaled steroid and refer to pulmonology
93
what is the goal for treatment regarding SABA (albuterol) use
reduce need to ≤ 2 days/week
94
what does the rule of 2s determine regarding asthma?
Daytime symptoms ≥ 2 per week
Nighttime awakening ≥ 2 per month
need for daily inflammatory medication
95
Are MDIs with spacers as effective as nebulizers
yes
96
what does tachypnea and a normal pCO2 equate to
impending respiratory arrest
97
what is the treatment for status asthmatics and what is something to be avoided if possible
Treatment: Continuous albuterol, IM steroids, PICU admission
Avoid: intubation
98
What are the three classic stages of pertussis seen in children 1-10YOA
Catarrhal
Paroxysmal
Convalescent
99
what does the distinctive stage within paroxysmal stage of consist of symptomatically
-Paroxysmal cough (expiratory)
-Loss of breath (clustered violent coughing fits)
-Posttussive emesis
-Exhaustion
100
For pertussis in children under 3 months of age the are no [____________]. Won't have the classic [________] cough. [____] and [____] can follow a coughing paroxysm or apnea alone. There is a risk of [___] damage if this occurs.
For pertussis in children under 3 months of age the are no [CLASSICAL STAGES]. Won't have the classic [WHOOPING] cough. [APNEA] and [CYANOSIS] can follow a coughing paroxysm or apnea alone. There is a risk of [CNS] damage if this occurs.
101
For adolescents presenting with pertussis they may experience a feeling of [_____] or [______], posttussive [____] and usually lasts longer than [___] days.
For adolescents presenting with pertussis they may experience a feeling of [SUFFOCATION] or [STRANGULATION], posttussive [EMESIS] and usually lasts longer than [21] days.
102
Regarding pertussis the clinician should be suspicious of prominent cough with NO [____], at least 1 paroxysm lasting longer than [__] days, an [____] cough at 7-10 days, coughing in [___] or respiratory complaints in infants younger than [__] months
Regarding pertussis the clinician should be suspicious of prominent cough with NO [FEVER], at least 1 paroxysm lasting longer than [14] days, an [ESCALATING] cough at 7-10 days, coughing in [SPURTS] or respiratory complaints in infants younger than [3] months
103
A chest x-ray of a patient with pertussis may demonstrate segmental lung [________] or [_____] infiltrates
A chest x-ray of a patient with pertussis may demonstrate segmental lung [ATELECTASIS] or [PERIHILAR] infiltrates
104
For treatment of pertussis children younger than [__] months of age need to be admitted for monitoring, older children can be managed outpatient. [______] is the antibiotic of choice for all patients. Alternative antibiotics are [_______] or [______] which shouldn't be given to children under [__] month of age due to associated infantile [___________]
For treatment of pertussis children younger than [3] months of age need to be admitted for monitoring, older children can be managed outpatient. [AZITHROMYCIN] is the antibiotic of choice for all patients. Alternative antibiotics are [ERYTHROMYCIN] or [CLARITHOMYCIN] which shouldn't be given to children under [1] month of age due to associated infantile [HYPERTROPHIC PYLORIC STENOSIS]
105
What available vaccinations assist with the prevention of pertussis
DTap
Tdap
106
Underimmunized close contacts with pertussis under the age of 7 should get the [___] booster while those older than 7 should get the [___] booster
Underimmunized close contacts with pertussis under the age of 7 should get the [DTAP] booster while those older than 7 should get the [TDAP] booster
107
What is the most common complication of pertussis
pneumonia
108
Bronchiolitis occurence peaks between [__ to __] months of age. Risks include male gender, [_______] exposure, [____] fed, [____] during pregnancy. The number one cause of bronchiolitis is [______].
Bronchiolitis occurence peaks between [2 to 6] months of age. Risks include male gender, [SECONDHAND SMOKE] exposure, [FORMULA] fed, [SMOKING] during pregnancy. The number one cause of bronchiolitis is [RSV].
109
Clinically, bronchiolitis may present like an [__] with intercostal/suprasternal [_____], prolonged expiration or [______] of the lungs, nasal [____] or if severe: cyanosis and [____]. Auscultation of the lungs may reveal diffuse [___], [____], [____] or squeaks
Clinically, bronchiolitis may present like an [__] with intercostal/suprasternal [RETRACTIONS], prolonged expiration or [HYPERINFLATION] of the lungs, nasal [FLARING] or if severe: cyanosis and [GRUNTING]. Auscultation of the lungs may reveal diffuse [WHEEZING], [CRACKLES], [RHONCHI] or squeaks
110
What type of imaging should be obtained when considering admission of a patient with bronchiolitis
CXR
111
Treatment of bronchiolitis is mostly supportive with supplemental oxygen with an SPO2 goal of [___] and assess for [_____].
Treatment of bronchiolitis is mostly supportive with supplemental oxygen with an SPO2 goal of [>90%] and assess for [DEHYDRATION].
112
Consider admission for a patient with bronchiolitis if there is [______] (<90%), apnea, inability to tolerate [____], lack of care at home or [______] infants.
Consider admission for a patient with bronchiolitis if there is [HYPOXEMIA] (<90%), apnea, inability to tolerate [ORAL FOOD/LIQUIDS], lack of care at home or [HIGH-RISK] infants.
113
What vaccinations can assist in the prevention of bronchiolitis
Palivizumab
Influenza
114
In neonates or young infants the clinical manifestations of pneumonia often only involve what three things
fever, apnea and hypoxia
115
The outpatient management of a child under 5YOA who is immunized involves high dose [______] and for a non-immunized 3rd gen cephalosporin, [_____] or [____]
The outpatient management of a child under 5YOA who is immunized involves high dose [AMOXICILLIN] and for a non-immunized 3rd gen cephalosporin, [AUGMENTIN] or [CLINDAMYCIN]
116
The outpatient management of a child between 6-18YOA who is immunized involves high dose [______] and for a non-immunized 3rd gen cephalosporin or [____]. If atypical bacteria is suspected give amoxicillin plus [____] or [____]. Doxycycline can be used in children older than [__]. If lab has confirmed atypical bacteria you may use [_____] alone.
The outpatient management of a child between 6-18YOA who is immunized involves high dose [AMOXICILLIN] and for a non-immunized 3rd gen cephalosporin or [AUGMENTIN]. If atypical bacteria is suspected give amoxicillin plus [AZITHROMYCIN] or [CLARITHROMYCIN]. Doxycycline can be used in children older than [7]. If lab has confirmed atypical bacteria you may use [AZITHROMYCIN] alone.
117
Hospitalization of a child with pneumonia should be considered if the child is younger than [__] months old, immunocompromise, [__] appearance, respiratory distress, [___], [____] anemia with acute chest, dehydration, oral antibiotic failure
Hospitalization of a child with pneumonia should be considered if the child is younger than [6] months old, immunocompromise, [TOXIC] appearance, respiratory distress, [HYPOXEMIA], [SICKLE CELL] anemia with acute chest, dehydration, oral antibiotic failure
118
Inpatient management of a neonate with pneumonia involve IV [___/____] or oral [____]. If there is concern for S. Aureus give IV [____]. If there is an HSV concern give IV [___].
Inpatient management of a neonate with pneumonia involve IV [AMPICILLIN/GENTAMYCIN] or oral [PENICILLIN G]. If there is concern for S. Aureus give IV [VANCOMYCIN]. If there is an HSV concern give IV [ACYCLOVIR].
119
Inpatient management of an older child with pneumonia involve [____] plus [___]. If admitted to PICO will likely get a [______].
Inpatient management of an older child with pneumonia involve [AMPICILLIN] plus [AZITHROMYCIN]. If admitted to PICO will likely get a [3RD GEN CEPHALOSPORIN].
120
What is the most common chronic relapsing skin disease seen in infancy and childhood
atopic dermatitis
121
