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What are the most common causes of acute otitis media?
- Strep pneumonia
- nontypable H. influenzae
- Moraxella catarrhalis
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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
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What is the classic presentation of a kid with croup?
- dx: parainfluenza infection
- barking cough
- inspiratory stridor
- epiglottitis
- respiratory distress
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A patient presents with a barking cough, severe inspiratory stridor, and epiglottitis. What should you do?
- immediate treatment: prevent respiratory distress
- nebulized epinephrine
- corticosteroids
- sedation: endotracheal intubation (direct visualization)
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What is the classic presentation of bronchiolitis?
- fever
- wheezing
- tachypnea
- rhinorrhea
- respiratory distress
- (neonates: apnea)
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Who should receive palivizumab treatment for suspected RSV infection?
- <24mo in winter months
- chronic lung disease (bronchopulmonary dysplasia) who require oxygen
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What is the most common cause of bacterial pneumonia in all age groups?
Strep pneumonia
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What are common pathogens of pneumonia in older children?
- M. pneumoniae
- C. pneumoniae
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Which microbe causes the majority of large pleural effusions complicating pneumonia?
S. aureus
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Which antibiotics are used to empirically treat suspected bacterial meningitis?
- neonate: ampicillin, cefotaxime
- child: 3rd gen cephalosporin, vancomycin
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Which pathogens are associated with hemolytic uremic syndrome?
- S. dysenteriae
- E. coli OH157:H7
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A child presents with bloody, watery stool and seizures. What is the likely pathogen?
Shigella
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How many children with hepatitis A infection are asymptomatic?
30-70%
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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
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How does a child with congenital symphils present?
- "snuffles"
- saddle-nose (destruction of nasal bridge)
- hepatosplenomegaly
- mucocutaneous lesions
- jaundice
- lymphadenopathy
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A neonate presents with snuffles, hx of persistent rhinitis, hepatosplenomegaly, lymphadenopathy, and maculopapular rash. What test would best diagnosis his condition?
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What is the preferred treatment for someone with suspected (mild) PID?
- dx: C. trachomatis and/or N. gonorrhoeae infection
- tx:
- single dose parenteral cephalosporin
- 14d oral doxycycline
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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
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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)
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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
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What rash is associated with Lyme disease?
- dx: Borellia infection
- erythema migrans
- bulls-eye appearrance
- annular erythema, central clearing, central erythema/purpura
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How would you treat Lyme disease?
- <8yo: oral amoxicillin
- >8yo: oral doxycycline
- Lyme meningitis: IV ceftriaxone
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Which vaccines are contraindicated in someone with severe immune deficiency?
- MMr
- varicella
- rotavirus
- live attenuated flu vaccine (i.e. flu mist)
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What is an absolute contraindication to the DTap vaccine?
previous development of encephalopathy in <7d after DTap
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Which vaccines are contraindicated in pregnant women?
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Who should receive polysaccharide pneumococcal and polysaccharide meingococcal vaccines at 2yo?
- asplenic patients
- e.g. Sickle Cell Anemia
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At what age is the risk of occult bacteremia greatest?
2-24mo
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What is the most common cause of sepsis in the nenoate?
- Group B strep
- enteric gram (-) bacilli
- Listeria monocytogenes
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What is the most common cause of sepsis in kids between 1mo to 5yo?
- Strep pneumoniae
- Neisseria meningitidis
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What is the most common cause of sepsis in kids >5yo?
- Staph aureus
- Salmonella
- Pseudomonas aeruginosa
- viridans Streptococci
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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
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What are common viral causes of otitis media?
- RSV
- parainfluenza
- influenza
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How does myringitis present?
- viral URI
- TM is inflammed but has normal mobility
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Which patients with otitis media should be prescribed antibiotics?
- <24mo
- ill-appearing
- chronic illnesses/immunodeficiencies
- recurrent/severe/perorated acute otitis media
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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
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What is the most common complication of acute otitis media?
otitis media with effusion
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Who should receive a tympanostomy tube?
- AOM that lasts for >3mo
- >4 AOM in 6mo
- >5 AOM in 12mo
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What are complications of chronic otitis media with effusion?
- permanent hearing loss
- delay of language acquisition
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What are complications of frequent AOM?
- excessive scarring (tympanosclerosis)
- cholesteatoma formation
- chronic suppurative AOM
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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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