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21 Cards in this Set
- Front
- Back
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What is the total daily requirement of: Sodium Potassium |
Sodium: 3 mEq/kg/day K: 1-2 mEQ/kg/day |
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Signs and complications of hypernatremia |
Doughy skin, Irritable, high pitched cry, lethargic, fever Hyperglycemia, hypocalcemia, cerebral hemorrhage, thrombosis |
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What condition causes urine chloride to be >20? |
Diuretic use |
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How much oral rehydration should be given for mild vs. moderate dehydration? |
Mild dehydration - 50 mL/kg over 4 hours then do 100 mL/kg/24 hours for mild dehydration Moderate dehydration - 100 mL/kg over 4 hours 10 mL/kg for each stool |
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What electrolyte and urine abnormalities are seen in SIADH vs. hyponatremic dehydration? What is the treatment for SIADH? |
SIADH - low serum sodium, chloride and osmolality, low BUN, high urine SG and osmolality (>200) and high urine sodium (>30) Hyponatremic dehydration - low serum sodium and chloride, high BUN, high urine SG and osmolality (>200) and low urine sodium Tx for SIADH: fluid restriction. If severe hyponatremia use lasix with sodium supplementation |
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How to manage hypernatremic dehydration? |
First give LR or NS 10-20 mL/kg Then calculate free water deficit free water deficit = 0.7 x wt (1-current sodium/desired sodium) Administer free water deficit + maintanence evenly over the next 48 hours Don't increase sodium more than 10-12 mEq over 24 hr period or 0.5 mEq/L/hr |
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What are 2 causes of hypernatremia? How do you distinguish the two diagnoses? |
Diabetes insipidus and hypernatremic dehydration Both will have high sodium, chloride, BUN and osmolality DI will have low urine spec grav while hypernatremic dehydration will have high urine spec grav |
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Managment of HHS |
Fluid repletion initially with 20 mL/kg Then use 0.2 NS for fluid repletion, add D5 once dstick<300 |
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What electrolyte abnormalities are seen in CF? |
Sweat will have high chloride (>60) and high sodium so have LOW SERUM sodium and chloride + metabolic alkalosis |
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Which diseases require droplet precautions only? |
Hib, N. meningiditis, pertussis, parvovirus, diptheria, mycoplasma, strep infections (PNA, pharyngitis, impetigo, scarlet fever), adenovirus, influenza |
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What type of contact is needed for multidrug-resistant bugs? |
Contact |
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What tests should be performed in an internationally adopted child? |
tuberculin skin test, HbsAg, anti-Hbc, anti-Hbs, hep c serology, syphilis screen, stool O&P, stool Giardia and cryptosporidium, HIV, CBC |
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Which organisms are resistant to chlorination of water? |
Cryptosporidium, Giardia, norovirus |
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What is the mechanism of action for the following antibiotics: - Aminoglycoside, tetracycline - Penicillin/cephalosporin/carbapenem (same mechanism for all 3) - clindamycin and macrolides (same mechanism) - rifampin - TMP-SMX - Vancomycin |
- Aminoglycoside/tetracycline - binds to 30s subunit of bacterial ribosome and prevents protein synthesis - Penicillin - targets penicillin binding protein to prevent cell wall synthesis and activates autolytic enzymes in the cell wall - clindamycin/macrolide - inhibits 50S bacterial ribosome subunit - rifampin - inhibits DNA dependent RNA polymerase - TMP-SMX - inhibits folate pathway - Vancomycin - inhibits early steps of cell wall peptidoglycan synthesis |
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What is a side effect of carbapenem? - What is a side effect of macrolides (besides pyloric stenosis for erythromycin)? - What is a side effect of fluroquinolones? - What is a side effect of tetracyclines? - What is a side effect of amphotericin B? |
Seizures (imipenem >> meropenem) - macrolides - cholestatic hepatitis - Flouroquinolone - joint damage - Tetracycline - drug deposit in joint, dental enamel hypoplasia, coloring of teeth - amphotericin B - hypokalemia, hypomagnesiemia, renal toxicity, fever, rigors, chills |
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For which diseases is tetracycline absolutely indicated regardless of age? |
Lyme disease, ehrichliosis, RMSF and malaria |
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When can a child with varicella return to school? What are the isolation precautions for a patient with varicella in the hospital? How long should they be continued for? What are the length of isolation precautions for varicella exposed patients? What is it for patients who received IVIG or VZV IG? |
Return to school when all lesions have crusted or when no lesions have appeared for 24 hours - Airborne precautions for 5 days after onset of rash and until all lesions have crusted over - Airborne and contact isolation for 8-21 days after exposure, needs to be on isolation for 28 days after exposure if received IVIG or VZVIG |
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Management of patients exposed to varicella (immunocompromised vs. immunocompetent) |
Immunocompromised - administer VZVIG within 10 days of exposure (ideally within 96 hours) Immunocompetent - administer VZV vaccine within 3-5 days |
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Management of varicella infection in immunocompromised patients Who should be given oral acyclovir? |
IV acyclovir for immunocompromised Oral acyclovir for patients with serious skin or pulmonary disorders, unimmunized children >12 years old, chronic salicylate therapy, people receiving short intermittent or aerosolized courses of steroids, anyone who is at an increased risk of severe disease from VZV |
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Measles - Incubation period - How long are you contagious? - Isolation precautions and length of isolation in immunocompetent vs. immunocompromised - What is the post-exposure prophylaxis for immunocompetent vs. immunocompromised? - What is a long term complication of measles? |
- Incubation period - 8-12 days - Contagious for 4 days before and 4 days after rash - Airborne precautions for 4 days after rash in immunocompetent and for the whole length of illness in immunocompromised - PPE for immunocompetent - vaccine within 72 hours - PPE for immunocompromised - INTRAMUSCULAR IG within 6 days after exposure - Also give IG to household or close contacts who are <1 yo, pregnant or immunocompromised |
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What is the best test for HIV in infants? |
Test HIV DNA PCR in children <18 months of age because they may have maternal antibodies Use antibody titers for children >18 months |
