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What are the most common causes of acute otitis media?
- Strep pneumonia
- nontypable H. influenzae
- Moraxella catarrhalis
A patient presents with exudative pharyngitis, generalized lymphadenopathy, fever, and profound fatigue. What diagnostic measures would be useful?
- dx: infectious mono (EBV)
- CDC w/diff: lymphocytosis with high percentage (10%) of atypical lymphocytes
- (+) heterophile antibody test
- PCR serology
What is the classic presentation of a kid with croup?
- dx: parainfluenza infection
- barking cough
- inspiratory stridor
- respiratory distress
A patient presents with a barking cough, severe inspiratory stridor, and epiglottitis. What should you do?
- immediate treatment: prevent respiratory distress
- nebulized epinephrine
- sedation: endotracheal intubation (direct visualization)
What is the classic presentation of bronchiolitis?
- respiratory distress
- (neonates: apnea)
Who should receive palivizumab treatment for suspected RSV infection?
- <24mo in winter months
- chronic lung disease (bronchopulmonary dysplasia) who require oxygen
What is the most common cause of bacterial pneumonia in all age groups?
What are common pathogens of pneumonia in older children?
- M. pneumoniae
- C. pneumoniae
Which microbe causes the majority of large pleural effusions complicating pneumonia?
Which antibiotics are used to empirically treat suspected bacterial meningitis?
- neonate: ampicillin, cefotaxime
- child: 3rd gen cephalosporin, vancomycin
Which pathogens are associated with hemolytic uremic syndrome?
- S. dysenteriae
- E. coli OH157:H7
A child presents with bloody, watery stool and seizures. What is the likely pathogen?
How many children with hepatitis A infection are asymptomatic?
What are the different transmission routes of Hep A-E?
- Hep A: oral, fecal
- Hep B: body fluids
- Hep C: body fluids
- Hep D: body fluids, previous Hep B infection
- Hep E: oral, fecal, parenteral
How does a child with congenital symphils present?
- saddle-nose (destruction of nasal bridge)
- mucocutaneous lesions
A neonate presents with snuffles, hx of persistent rhinitis, hepatosplenomegaly, lymphadenopathy, and maculopapular rash. What test would best diagnosis his condition?
What is the preferred treatment for someone with suspected (mild) PID?
- dx: C. trachomatis and/or N. gonorrhoeae infection
- single dose parenteral cephalosporin
- 14d oral doxycycline
How long will ELISA and Western blot tests show positive HIV reactions in a neonate?
- dx: IgG antibodies to HIV
- positive for up to 18mo in neonate
If you have a newborn baby with an HIV positive mother, what is the best way to detect if the infant has been infected?
- HIV PCR
- (ELISA/Western blot = false positive reaction to maternal IgG)
A patient presents with fever, headache, and a rash that starts on the extermities and moves towards her trunk. All of this started after a trip to the woods and a tick bite. What should you do?
- treat for suspicion of Rocky Mountain Spotted Fever
- tx: doxycycline
What rash is associated with Lyme disease?
- dx: Borellia infection
- erythema migrans
- bulls-eye appearrance
- annular erythema, central clearing, central erythema/purpura
How would you treat Lyme disease?
- <8yo: oral amoxicillin
- >8yo: oral doxycycline
- Lyme meningitis: IV ceftriaxone
Which vaccines are contraindicated in someone with severe immune deficiency?
- live attenuated flu vaccine (i.e. flu mist)
What is an absolute contraindication to the DTap vaccine?
previous development of encephalopathy in <7d after DTap
Which vaccines are contraindicated in pregnant women?
Who should receive polysaccharide pneumococcal and polysaccharide meingococcal vaccines at 2yo?
- asplenic patients
- e.g. Sickle Cell Anemia
At what age is the risk of occult bacteremia greatest?
What is the most common cause of sepsis in the nenoate?
- Group B strep
- enteric gram (-) bacilli
- Listeria monocytogenes
What is the most common cause of sepsis in kids between 1mo to 5yo?
- Strep pneumoniae
- Neisseria meningitidis
What is the most common cause of sepsis in kids >5yo?
- Staph aureus
- Pseudomonas aeruginosa
- viridans Streptococci
What structural physiology predisposes children to ear infections?
- eustachian tube dysfunction
- angle of entry
- short length
- decreased tone
- concurrent URI: edema narrows E tube and creates vacuum
What are common viral causes of otitis media?
How does myringitis present?
- viral URI
- TM is inflammed but has normal mobility
Which patients with otitis media should be prescribed antibiotics?
- chronic illnesses/immunodeficiencies
- recurrent/severe/perorated acute otitis media
Which kids with otitis media qualify for more antibiotics?
- treated <1mo ago and have not improved in 48hrs
- tx: amoxicillin/clavulanic acid
- tx: oral 2nd/3rd cephalosporin
- tx: IM ceftriaxone
What is the most common complication of acute otitis media?
otitis media with effusion
Who should receive a tympanostomy tube?
- AOM that lasts for >3mo
- >4 AOM in 6mo
- >5 AOM in 12mo
What are complications of chronic otitis media with effusion?
- permanent hearing loss
- delay of language acquisition
What are complications of frequent AOM?
- excessive scarring (tympanosclerosis)
- cholesteatoma formation
- chronic suppurative AOM
What is the diagnosis and treatment of a child with recent AOM that presents with high fever, tenderness of the skull behind the ear, and anterior displacement of the external ear?
- dx: mastoiditis
- tx: IV antibiotics, +/- surgical drainage
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