Peds

Front 1

What is the tylenol dose for peds

Back 1

40mg/kg every 4 hours, not more than 5 doses/day

Front 2

What does TORCH stand for?

Back 2

Toxoplasmosis
Other (such as syphilis, varicella, mumps, parvovirus, and HIV)
Rubella
CMV
Herpes simplex

Front 3

first line treatment for AOM

Back 3

amoxicillin 80-90mg/kg/day dosed BID

Front 4

what is the cause of most cases of AOM?

Back 4

respiratory viruses - they are self limiting

Front 5

what is the most common bacteria associated with AOM?

Back 5

strep pneumoniae ~40%
H. influenzae ~25-30%
Moraxella catarrhalis 10-15%

Front 6

what are the most common pathogens for EOM?

Back 6

pseudomonas aeruginosa
Staph aureus
fungal = aspergillus

Front 7

how does EOM present?

Back 7

rapid onset of ear pain, tenderness, itching, aural fullness and hearing loss

Front 8

what is the treatment for uncomplicated EOM?

Back 8

cleaning of the ear canal and application of topical anti-infective agents.

Front 9

what are currant jelly stools associated with?

Back 9

Intussusception

Front 10

How is Intussusception diagnosed?

Back 10

barium or air-contrast enemas. They are both diagnostic and therapeutic

Front 11

What is the common presentation of a child with AOM?

Back 11

Fever, Irritability, Poor sleep, Appetite decrease
Ear pain, feeling of fullness
Upper resp. symptoms

Front 12

Findings on PE of AOM?

Back 12

bulging TM
decreased landmark visibility
light reflex dull or missing
mobility decreased
Neurologically - may see decreased balance

Front 13

Treatment of pain of AOM

Back 13

topical benzocaine (auralgan) DO NOT USE if TM perforated

Front 14

If you suspect AOM in kids ______ age, treat with antibiotics, do not wait for observation first

Back 14

<6months

Front 15

What is this a picture of?

Back 15

mastoiditis

Front 16

Cystic mass of epithelial cells and cholesterol

Back 16

Cholesteatoma

Front 17

Presentation of sinusitis with gradual onset

Back 17

Post nasal drainage, rhinorrhea, daytime cough (may be worse at night) longer than 10-14 days
Pain: forehead, retro-orbital, tooth or maxillary pain

Front 18

Sudden presentation with sinusitis

Back 18

High fever
Nasal discharge
Headache in older children
Periorbital inflammation

Front 19

Physical Examination findings with sinusitis

Back 19

Nasal mucosa inflamed
Nasal or postnasal discharge
Sinus percussion
Periorbital swelling or cellulitis, pressure to palpation over medial canthus of eye (ethmoiditis)

Front 20

DDx with sinusitis

Back 20

Sequential viral upper respiratory
tract infections

Front 21

Important to know if the symptoms of sinusitis have improved and then gotten worse, if so it is probably?

Back 21

viral that turns into bacterial

Front 22

treatment of sinusitis

Back 22

Oral antibiotics: 10-21 days
Symptomatic care
OTC decongestants (NOT for kids <2)
Inhaled corticosteroids
Pain relief
Hospitalization / Referral for signs of complications

Front 23

sinusitis - refer to ENT if

Back 23

Not improving after two courses of appropriate antibiotics

Signs of complications

Front 24

Periorbital (preseptal) cellulitis treatment

Back 24

Mild - oral antibiotics w/close F/U
Severe: hospitalization for iv antibiotics

Front 25

Orbital (postseptal) cellulitis s/s

Back 25

Proptosis
Pain with eye movement
Limited extraocular movements
Impaired vision

Front 26

how is Orbital (postseptal) cellulitis diagnosed?

Back 26

CT scan

Front 27

Treatment of Orbital (postseptal) cellulitis

Back 27

IV antibiotics
Ophthalmology referral
Some need surgical intervention, debridement and drainage

Front 28

Complications of Orbital (postseptal) cellulitis

Back 28

Central nervous system
Meningitis
Subdural abscess
Epidural abscess
Brain abscess
Vascular
Cavernous sinus thrombosis
Bone
Osteomyelitis frontal bone (Pott’s puffy tumor)

Front 29

Second line treatment for AOM?

Back 29

Amoxicillin-clavulanate: 80-90 mg/kg/day amoxicillin 6.4mg/kg/day clavulanate in 2 doses (Augmentin ES)
Cefdinir 14mg/kg/day daily or divided BID
Cefpodoxime 10mg/kg/day daily
Cefuroxime 30mg/kg/day divided BID

Front 30

treatment for AOM if PCN allergy with type 1 rxn?

Back 30

Azithromycin 10mg/kg/day day 1, 5mg/kg/day days 2-5 (Not a first line drug for otitis media)
Clindamycin 30-40mg/kg/day divided TID (horrible tasting, lots of GI upset

Front 31

What makes resistance a higher risk for kids with AOM?

Back 31

Daycare attendance
Recent antibiotics (<30days)
Age less than 2 years

Front 32

AOM with ipsilateral conjunctivitis more likely caused by?

Back 32

H. influenzae

Front 33

treatment of Otitis media with PE tubes in place?

Back 33

Ciprofloxacin otic drops: 5 drops BID – don’t need oral antibiotics. Can still get otitis media w/tubes

Front 34

Hand/foot/mouth disease is caused by?

Back 34

coxsackie virus

Front 35

Physical Examination findings with tonsillitis

Back 35

Oropharynx
Tonsil size and presence or absence of exudate
Palatal petechiae
Peritonsillar swelling
Uvula deviation
Cervical adenopathy
Sandpaper rash
Tympanic membrane evaluation
Hepatosplenomegaly

Front 36

How long is strep pyogenes Contagious?

Back 36

24 hours after treatment started

Front 37

treatment of strep pyogenes

Back 37

Penicillin VK
<13 years 250mg bid 10 days
>13 years 500mg bid 10days
amoxicillin 40mg/kg daily divided bid 10 days
Benzathine penicillin G
<27kg 600,000 units IM
> 27 kg 1.2 million units IM
Penicillin allergic:
Azithromycin 12mg/kg daily for 5 days
Cephalosporins

Front 38

complications of strep pyogenes

Back 38

Peritonsillar abscess, otitis media, cervical adenitis
Rheumatic fever
post-strep glomerulonephritis -Hematuria with RBCs and RBC casts
Decreased complement levels (C3 and sometimes C4)

Front 39

Glomerulonephritis s/s and characteristics

Back 39

Recent strep infection (throat or skin, present w/tea or coke colored urine – take their BP)
3-7 years of age
Hematuria, hypertension, edema
Self-limiting

Front 40

Infectious Mononucleosis is caused by?

Back 40

Epstein-Barr virus

Front 41

S/S of Mononucleosis

Back 41

Exudative tonsillitis
Fever
Cervical adenopathy
Hepatosplenomegaly and generalized adenopathy may be present

Front 42

Lab test for Mononucleosis

Back 42

Monospot
Positive heterophile antibody test and serologic test for antibodies against EBV are usually diagnostic.

Front 43

Pathogen associated with Epiglottitis

Back 43

Haemophilus influenzae type b

Front 44

Epiglottitis S/S

Back 44

drooling, stridor,

Front 45

Age group most likely to see epiglottitis?

Back 45

Toddlers

Front 46

What does the classic thumbprint sign indicate?

Back 46

epiglottitis

Front 47

Common name for laryngotracheobronchitis?

Back 47

croup

Front 48

Most common age group to see croup?

Back 48

< 2 years old – older than 2 yrs, think about asthma

Front 49

etiology of croup

Back 49

usually viral, most often parainfluenza, also RSV, flu, adenovirus, mycoplasma

Front 50

Presentation of croup

Back 50

Prodrome: Upper respiratory symptoms
Respiratory
Barky cough – worsens at night
Inspiratory stridor – is at rest?
Fever

Front 51

How long does croup usually last?

Back 51

Resolves in 1-2 days.

Front 52

Physical findings with croup

Back 52

Barky cough
Inspiratory stridor
Signs of respiratory distress – nasal flaring, retractions

Front 53

treatment of croup

Back 53

Mild
Symptomatic – Cold air, humidity
Moderate to severe
Symptomatic – even in the office
Dexamethasone 0.6 mg/kg po/im
Nebulization

Front 54

3 stages of pertussis

Back 54

1. Catarrhal stage – treat at this stage! URI symptoms 1-2 weeks
2.Paroxysmal stage -Paroxysmal cough 1-2 weeks
3. Convalescent stage -Milder cough

Front 55

Diagnosis of pertussis

Back 55

Nasal swab for culture, DFA or DNA amplification
CBC: leukocytosis with lymphocytosis

Front 56

Treatment of pertussis

Back 56

Supportive
Antibiotics
Azithromycin 10mg/kg daily 5-7 days, adult 500mg daily 5-7 days
Erythromycin 40-50mg/kg/day divided QID 14 days
Trimethoprim-sulfamethoxazole one DS tab BID 14 days
Hospitalization
Droplet precautions for five days