peds80

Question 1

management of dog bite wounds

Answer 1

sutured; also give antibiotics like amoxicillin-clavulanic acid; tetanus prophylaxis if needed

Question 2

victims of cat bites have a high risk of infection of what orgnism?

Answer 2

P. multicoda

Question 3

cat scratch disease

Answer 3

regional lymphadenitis

Question 4

metcarpophalyngeal joint

Answer 4

remember three phalanges and then the metacarpal

Question 5

infections in human bites

Answer 5

infecton rate is high! Mixed bacterial infection is often present; other systemic infections like hep B, HIV, and syphillis may be transmitted

Question 6

black widow spider- what does it look like

Answer 6

red or orange hour glass marking on its ventral surface

Question 7

clinical features of a black widow spider bite

Answer 7

few local sx except for burning or a sharp pinprick; pathognomonic sx are severe htn and muscle cramps

Question 8

management of black widow spider bite

Answer 8

local wound care (tetanus if needed); benzos or narcotics to relieve muscle cramps; lactrodectus antivenin is given for signs and sx suggestng severe envenomation

Question 9

brown recluse spider- what does it look like?

Answer 9

brown violin shaped marking on the dorsum of the thorax

Question 10

brown recluse spider bite clinical features

Answer 10

cytotoxic compound that destroys the tissues; bite initially little pain then 1-8 hrs later, a painful itchy papule that increases in size and discolors during the course of 3-4 days develops

Question 11

systemic symptoms in brown recluse spider bite

Answer 11

may develop 24-48 hours after the bite

Question 12

management of recluse spider bite

Answer 12

wound care and tetanus prophylaxis if needed; there is no antivenom

Question 13

pit viper snake bite

Answer 13

venom is a mixture o proteolytic enzymes; local puncture marks and progressive swelling and ecchymosis

Question 14

systemic effects of pit viper snakes

Answer 14

paresthesias of the scalp, periorbital fasciculations, weakness, diaphoresis, dizziness, nausea, and a metallic taste in the mouth; coagulopathy, thrombocytpenia, hypotension, and shock also

Question 15

management of pit viper snake bite

Answer 15

immediate transport to closest Er; use crotalidae polyvalen antivenin within 4-6 hours; kids need more

Question 16

complications of the pit snake antivenin

Answer 16

common; serum sickness and anaphylaxis

Question 17

coral snake venom

Answer 17

neurotoxic venum; mild local swelling and severe systemic sx (paresthesias, vomiting, weakness, diplopia, fasciculations, confusion, resp distress)

Question 18

management of coral snake bite

Answer 18

antivenon, local wound care, and supportive care

Question 19

Ziehl-Neelson stain

Answer 19

for acid-fast bacili

Question 20

silver stain

Answer 20

for funghi

Question 21

Wright stain

Answer 21

stool white blood cells

Question 22

intradermal tests

Answer 22

for TB and coccidioides immitis

Question 23

antibody testing

Answer 23

for vruses (EBV, CMV, VZV, and HIV), toxoplasma gondii, bartonella henselae, and mycoplasma pneumonia

Question 24

fever is defined as what?

Answer 24

rectal temp of 100.4 (38 deg) or higher

Question 25

what are high risk groups that should be evaluated for serious infection?

Answer 25

infants less than 28 days because of immaturity of immune sys; older infants with fecers over 39 deg who appear ill; infants and kids who are immunodef, have SS disease, or chronic liver, renal, pulm, or cardiac dz

Question 26

toxic appearance

Answer 26

child appearing extremely ill with diminished interactivity or poor peripheral perfusion

Question 27

normal band count

Answer 27

a band is a young neutrophil; less than 3% is normal

Question 28

normal urinalysis

Answer 28

less than 10 WBCs per HPF

Question 29

normal stool analysis WBC count

Answer 29

less than 5 WBCs per hpf on stool Wright stain

Question 30

when do you hospitalize a kid with a fever?

Answer 30

all infants less than 28 days; infants between 29 days and 3 months with any of the following: toxic appearance, suspected meningitis, pneumonia, pyeloneph, or bone or soft tissue infections unrespons to oral antibiotics; patients in social circumstances in which there is uncertain follow up

Question 31

antibiotic management for infants less than 28 days

Answer 31

IV in the hospital until cultures of blood, urine, CSF, and stool, if diarrhea is present, are neg

Question 32

antibiotic management of infants 29days to 3 mos

Answer 32

empiric outpatient parenteral antibiotic therapy on a daily basis while cultures are pending; unless they are high risk, and those need to be hospitalized

Question 33

most common bacterial pathogens in 0-1 month olds

Answer 33

Group B strep, E. coli, listeria

Question 34

most common bacteria in 1-3 month olds

Answer 34

group B strep, strep pneumonia, listeria

Question 35

most common bacteria in 3 months-3 years

Answer 35

strep pneumonia, Haemophilus influenza type B, neisseria meningitidis

Question 36

most common bacteria in 3 years to adults

Answer 36

strep pneumoniae, neisseria meningitidis

Question 37

empiric IV antibiotics for 0-1 month old

Answer 37

Ampciillin + gentamycin or cefotaxime; IV acyclovir if kid has apnea, seizures, or cutaneous vesicles for HSV

Question 38

empiric IV antibiotics for 1-3 month olds

Answer 38

ampciillin + cefotoxamine (+ vanc if bacterial meningitis suspected, given that strep pneumo can be resistant to cef)

Question 39

empiric IV antibiotics for 3 months to 3 yeasr

Answer 39

cefotoxamine (+vanc if bacterial mening suspected)

Question 40

empiric IV antibiotics for 3 years to adults

Answer 40

cefotoxamine (+vanc if bacterial meningitis suspected)

Question 41

definition of fever of unknown origin

Answer 41

greater than 8 days in length; prior history, physical exam,a dna prelim lab eval all fail to lead to diagnosis

Question 42

when is the highest incidence of bacterial meningitis?

Answer 42

first month of life

Question 43

what could potentially meningitis do to a fontanelle?

Answer 43

bulging fontanelle

Question 44

signs suggestive of meningeal irritation

Answer 44

alteration in level of consciousness; nuchal rigidity (pos Kernig’s sign and Brudzinski’s sign); seizures; photophobia; emesis; headache

Question 45

kernig’s sign

Answer 45

severe stiffness of the hamstrings causes inability to straighten the leg when the hip is flexed

Question 46

brudzinski sign

Answer 46

severe neck stiffness causes a patient’s hips and knees to flex when the neck is flexed

Question 47

LP of meningitis has a predom of what type of cell?

Answer 47

neutrophils

Question 48

blood culture in bacterial meningitis?

Answer 48

yes, do it; because usually positive

Question 49

do you need to do a brain CT scan with contrast for suspected meningitis?

Answer 49

yes, because you might have a brain abscess