Peds CE 3

Question 1

acute OM best predictor s/sx

Answer 1

cloudy, bulging TM with impaired mobility

Question 2

OME is

Answer 2

otitis media with effusion is fluid accumulation in the middle ear without evidence of infection

Question 3

OM etiology

Answer 3

most often viral - RSV and influenza
bacterial - strep pneumonia (50%), H. influenza, moraxella catarrhalis

Question 4

what has decreased the incidence of AOM

Answer 4

PCV7

Question 5

AOM - redness

Answer 5

redness alone is not clinically signifianct

Question 6

AOM dx is made when

Answer 6

bulging of the tympanic membrane plus new onset ear pain and/or otorrhea (ear drainage)

Question 7

AOM is considered severe if

Answer 7

there is bilateral, severe pain or fever

Question 8

AOM mgmt

Answer 8

pain with OTC meds
antibiotics vs obs

Question 9

mgmt of definite OM by ages < 6 months, 6-24 months, > 24 months

Answer 9

< 6 months mild-sev = abx
6-24 months only give abx for severe
>24 months only give abx for severe

Question 10

mgmt of AOM if diagnosis is uncertain, < 6 months, 6-24 months, > 24 months

Answer 10

< 6 months mild-sev = abx
6-24 months only abx give if severe
> 24 observe only

Question 11

AOM abx initial choice

Answer 11

amoxicillin 80-90 mg/kg/d

Question 12

AOM abx choice if received abx within last 1-3 months

Answer 12

Augmentin

Question 13

AOM abx choice if mild PCN reaction or questionable

Answer 13

cephalosporins - cefdinir, ceftriaxone

Question 14

AOM abx choice if severe PCN allergy

Answer 14

macrolides - azithromycin, clindamycin

Question 15

when to refer for OM
3

Answer 15

three or more well documented episodes in a 6 month period
OR
4 episodes in 12 months
OR
failure of tx after ceftriaxone (cephalosporin) or oral levofloxacin

Question 16

PNA - most pathogens 6 months to 5 years are what

Answer 16

viral

Question 17

PNA - most common bacteria is

Answer 17

step pneumoniae

Question 18

S. Pneumoniae immunizations
2

Answer 18

PCV13 - 2, 4, 6 months, & 12-15 months
PCV13 plus PPSV23 in high risk children > 2

Question 19

what is the most sensitive sign of PNA in an infant

Answer 19

increased RR

Question 20

PNA assessment findings
5

Answer 20

1. many nonspecific findings
2. vital signs; fever is inconsistent sing
3. cough
4. malaise
5. increased RR - most sensitive sign

Question 21

PNA chest x ray - infiltrates

Answer 21

may be normal in early PNA, especially if dehydrated

Question 22

dx study - may be normal in early PNA, especially if dehydrated

Answer 22

infiltrates on cxr

Question 23

dx studies - PNA cxr f/u

Answer 23

no necessarly if it resolsves

Question 24

PNA - dx study labs

Answer 24

CBC w/ diff - can help differentiate viral and bacterial PNA

Question 25

PNA - if bacterial, CBC shows what

Answer 25

left shit (increase segs/bands) and usually WBC >15000

Question 26

elevated poly and decreased lymphs can indicate what

Answer 26

bacterial infection

Question 27

PNA - if bacterial tx with
3

Answer 27

amoxicillin first line
augmentin or 3rd gen cephalosporin if recent AB exposure
if type 1 reaction to PNC, then macrolide (clindamycin)

Question 28

cough suppressants

Answer 28

AAP recommends against cough suppressants in children <4 and use in caution until over age 6

Question 29

bronchiolitis

Answer 29

lower respiratory tract infection that obstructs the small respiratory airways (bronchioles)

Question 30

lower respiratory tract infection that obstructs the small respiratory airways

Answer 30

bronchiolitis

Question 31

bronchiolitis progression
3

Answer 31

1. self limited syndrome
2. URI for 1-3 days then progresses to lower respiratory tract infection
3. wheezing peaks day 3-5, then resolves 2-4 weeks

Question 32

bronchiolitis assessment findings
7

Answer 32

1. URI 1-3 days then lower respiratory tract
2. wheezing days 3-5
3. increased RR (40-60/min)
4. fever (lower temps RSV, higher temps adenovirus)
5. cough - hoarse then productive
6. respiratory distress
7. thick, purulent nasal secretions

Question 33

bronchiolitis dx

Answer 33

clinical dx

Question 34

bronchiolitis mgmt
3

Answer 34

1. no BD
2. no steroids
   these have shown only modest short-term clinical improvement, does not affect overall outcome
3. mod-severe sx - usually inpatient, nebulized BDs

Question 35

croup aka

Answer 35

laryngotracheitis

Question 36

laryngotracheitis

Answer 36

croup

Question 37

croup

Answer 37

inspiratory stridor, barking cough, hoarseness

Question 38

inspiratory stridor, barking cough, hoarseness

Answer 38

croup

Question 39

croup cause most common 6 mo - 3 years

Answer 39

viral

Question 40

croup is usually what (course)

Answer 40

self limited - fever, congestion, cough usually 3 days

Question 41

fever, congestion, cough usually 3 days

Answer 41

croup

Question 42

croup AP x ray

Answer 42

steeple sign - tapering of upper trachea

Question 43

spasmodic croup occurs when

Answer 43

at night