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56 Cards in this Set
- Front
- Back
What is the tylenol dose for peds
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40mg/kg every 4 hours, not more than 5 doses/day
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What does TORCH stand for?
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Toxoplasmosis
Other (such as syphilis, varicella, mumps, parvovirus, and HIV) Rubella CMV Herpes simplex |
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first line treatment for AOM
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amoxicillin 80-90mg/kg/day dosed BID
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what is the cause of most cases of AOM?
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respiratory viruses - they are self limiting
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what is the most common bacteria associated with AOM?
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strep pneumoniae ~40%
H. influenzae ~25-30% Moraxella catarrhalis 10-15% |
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what are the most common pathogens for EOM?
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pseudomonas aeruginosa
Staph aureus fungal = aspergillus |
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how does EOM present?
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rapid onset of ear pain, tenderness, itching, aural fullness and hearing loss
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what is the treatment for uncomplicated EOM?
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cleaning of the ear canal and application of topical anti-infective agents.
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what are currant jelly stools associated with?
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Intussusception
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How is Intussusception diagnosed?
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barium or air-contrast enemas. They are both diagnostic and therapeutic
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What is the common presentation of a child with AOM?
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Fever, Irritability, Poor sleep, Appetite decrease
Ear pain, feeling of fullness Upper resp. symptoms |
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Findings on PE of AOM?
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bulging TM
decreased landmark visibility light reflex dull or missing mobility decreased Neurologically - may see decreased balance |
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Treatment of pain of AOM
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topical benzocaine (auralgan) DO NOT USE if TM perforated
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If you suspect AOM in kids ______ age, treat with antibiotics, do not wait for observation first
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<6months
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What is this a picture of?
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mastoiditis
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Cystic mass of epithelial cells and cholesterol
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Cholesteatoma
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Presentation of sinusitis with gradual onset
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Post nasal drainage, rhinorrhea, daytime cough (may be worse at night) longer than 10-14 days
Pain: forehead, retro-orbital, tooth or maxillary pain |
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Sudden presentation with sinusitis
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High fever
Nasal discharge Headache in older children Periorbital inflammation |
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Physical Examination findings with sinusitis
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Nasal mucosa inflamed
Nasal or postnasal discharge Sinus percussion Periorbital swelling or cellulitis, pressure to palpation over medial canthus of eye (ethmoiditis) |
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DDx with sinusitis
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Sequential viral upper respiratory
tract infections |
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Important to know if the symptoms of sinusitis have improved and then gotten worse, if so it is probably?
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viral that turns into bacterial
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treatment of sinusitis
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Oral antibiotics: 10-21 days
Symptomatic care OTC decongestants (NOT for kids <2) Inhaled corticosteroids Pain relief Hospitalization / Referral for signs of complications |
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sinusitis - refer to ENT if
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Not improving after two courses of appropriate antibiotics
Signs of complications |
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Periorbital (preseptal) cellulitis treatment
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Mild - oral antibiotics w/close F/U
Severe: hospitalization for iv antibiotics |
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Orbital (postseptal) cellulitis s/s
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Proptosis
Pain with eye movement Limited extraocular movements Impaired vision |
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how is Orbital (postseptal) cellulitis diagnosed?
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CT scan
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Treatment of Orbital (postseptal) cellulitis
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IV antibiotics
Ophthalmology referral Some need surgical intervention, debridement and drainage |
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Complications of Orbital (postseptal) cellulitis
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Central nervous system
Meningitis Subdural abscess Epidural abscess Brain abscess Vascular Cavernous sinus thrombosis Bone Osteomyelitis frontal bone (Pott’s puffy tumor) |
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Second line treatment for AOM?
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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 |
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treatment for AOM if PCN allergy with type 1 rxn?
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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 |
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What makes resistance a higher risk for kids with AOM?
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Daycare attendance
Recent antibiotics (<30days) Age less than 2 years |
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AOM with ipsilateral conjunctivitis more likely caused by?
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H. influenzae
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treatment of Otitis media with PE tubes in place?
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Ciprofloxacin otic drops: 5 drops BID – don’t need oral antibiotics. Can still get otitis media w/tubes
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Hand/foot/mouth disease is caused by?
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coxsackie virus
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Physical Examination findings with tonsillitis
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Oropharynx
Tonsil size and presence or absence of exudate Palatal petechiae Peritonsillar swelling Uvula deviation Cervical adenopathy Sandpaper rash Tympanic membrane evaluation Hepatosplenomegaly |
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How long is strep pyogenes Contagious?
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24 hours after treatment started
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treatment of strep pyogenes
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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 |
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complications of strep pyogenes
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Peritonsillar abscess, otitis media, cervical adenitis
Rheumatic fever post-strep glomerulonephritis -Hematuria with RBCs and RBC casts Decreased complement levels (C3 and sometimes C4) |
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Glomerulonephritis s/s and characteristics
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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 |
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Infectious Mononucleosis is caused by?
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Epstein-Barr virus
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S/S of Mononucleosis
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Exudative tonsillitis
Fever Cervical adenopathy Hepatosplenomegaly and generalized adenopathy may be present |
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Lab test for Mononucleosis
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Monospot
Positive heterophile antibody test and serologic test for antibodies against EBV are usually diagnostic. |
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Pathogen associated with Epiglottitis
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Haemophilus influenzae type b
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Epiglottitis S/S
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drooling, stridor,
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Age group most likely to see epiglottitis?
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Toddlers
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What does the classic thumbprint sign indicate?
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epiglottitis
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Common name for laryngotracheobronchitis?
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croup
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Most common age group to see croup?
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< 2 years old – older than 2 yrs, think about asthma
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etiology of croup
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usually viral, most often parainfluenza, also RSV, flu, adenovirus, mycoplasma
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Presentation of croup
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Prodrome: Upper respiratory symptoms
Respiratory Barky cough – worsens at night Inspiratory stridor – is at rest? Fever |
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How long does croup usually last?
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Resolves in 1-2 days.
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Physical findings with croup
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Barky cough
Inspiratory stridor Signs of respiratory distress – nasal flaring, retractions |
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treatment of croup
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Mild
Symptomatic – Cold air, humidity Moderate to severe Symptomatic – even in the office Dexamethasone 0.6 mg/kg po/im Nebulization |
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3 stages of pertussis
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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 |
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Diagnosis of pertussis
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Nasal swab for culture, DFA or DNA amplification
CBC: leukocytosis with lymphocytosis |
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Treatment of pertussis
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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 |