PEDS

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Author:
ckitejr
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295518
Filename:
PEDS
Updated:
2015-02-11 11:43:26
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pediatric illnesses
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pediatric illnesses
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  1. Otitis Media etiology
    RSV, Streptococcus pneumoniae, Haemophilus influenzaeo, Moraxella Catarrhalis
  2. OM Risk Factors
    • 6-18 months
    • Parental Hx of OM
    • Day Care attendance
    • smoking no breast feeding
  3. OM Manifestations
    • Acute onset pain
    • Middle ear effusion--bulging of tympanic membrane
    • immobile membrane
    • air/fluid behind TM, otorrhea
  4. OM Tx
    • AMX 90mg/kg Q 12 or 8
    • Pen Allergic Macrolide or clindamycin
  5. OM Complicaitons
    Hearing loss, rupture TM, Facial Paralyisis, Petrositis, Meningitis, brain abscess
  6. Erythema Infectiosum
    Etiology
    • Parovirius 19
    • late winter and spring
    • "Fifth's disease"
  7. Erythema Infectiosum
    Manifestations
    • Fever, Coryza (), HA, Mild GI distress
    • "Slapped-cheek" rash 1 week of symptoms
  8. Erythema Infectiosum
    Tx
    Supportive--Tylenol or motrine
  9. Erythema Infectiosum
    Prognosis
    transient aplastic crisis may occur
  10. Varicella
    etiology
    human herpesvirus
  11. Varicella
    prevalence
    • decreased with immunization, otherwise universally communicable
    • winter-spring
    • high rates in families
    • contagious 24-48hrs before rash and until vesicles are crusted
  12. Varicella
    manifestations
    • fever (100-102)
    • malaise, anorexia, HA
    • lesions appears on scalp, face, or trunk 1st
  13. varicella
    Tx
    • Supportive--fever reduction
    • Rarely Acyclovir
  14. Coxsackie
    etiology
    • enteroviruses
    • droplet contact (fecal-oral, in developing countries)
  15. Coxsackie
    prevalence
    • Mc in children <10yo
    • most contagious during 1st week
    • more common in summer
    • infection --> immunity, but several serotypes
  16. Coxsackie
    manifestations
    • 4-6 day incubation period
    • odynophagia, sore throat, malaise, and fever
    • 75% of cases have lesions on hand and feet
    • "hand foot mouth" disease
  17. Coxsackie
    Tx
    • palliative therapy
    • hydration
    • magic mouthwash
    • IV fluids for dehydration
  18. Coxsackie
    prognosis
    rare CNS or cardiac involvement
  19. Pneumonia
    etiology
    • Group B strep in neonates
    • RSV 3wk-4yo
    • >5yo M. pneumonia, S. pneumoniae
  20. Pneumonia
    risk factors
    • more common in males
    • lower socioeconomic status
    • CHF, CF, asthma, sickle cell
  21. Pneumonia
    prevelence
    Haemophilus B (Hib) vaccine has greatly decreased
  22. Pneumonia
    manifestations
    • symptoms preceded by URI
    • Fever (MC in bacterial)
    • Tachypenea MC finding
    • Crackles or wheezing
  23. Pneumonia
    tx
    • Empiric Tx based on organism, age, Op vs Inpatient (ceftriaxone or Vancomycin if staphylococcal pneumonia)
    • Amoxicillin
    • Zithromax (Macrolide) C. pneumonia, mycoplasma pneumoniae
  24. Pneumonia
    Admit?
    • age < 6mo
    • sickle cell anemia
    • immunocompromised
    • supplemental O2 required
    • inability to tolerate fluids
    • social factors
  25. Respiratory Distress
    • 0-2mo-- >60
    • 2-12mo-- >50
    • 1-6yo -- >40
    • >5yo -- >20
  26. Pneumonia
    prognosis
    • most patients improve in 48-96 hours of Tx
    • no improvement-->empyema, bacterial resistance, virial etiology, Fb aspiration, bronchial obstruction
  27. Pneumonia
    complicaitons
    pleural effusions, pneumoa throax, lung abscess, acute respiratory failure, meningitis, pericarditis, endocarditis, septic arthritis, hemolytic uremic syndrome
  28. Respiratory Syncytial Virus (RSV)
    epidemiology
    • peak 2-6mo age
    • late fall and early spring
    • M>F
    • spread via infective secretions
  29. RSV
    manifestations
    • bronchiolitis, cough, wheezing, respiratory distress, hypoxemia, hypercapnia, interstitial infiltrates and pulmonary collapse
    • duration of acute illness 10-14 days
  30. RSV
    diagnosis
    • Rapid RSV
    • CXR--peri-bronchial cuffing, hyperexpansion
  31. Measles
    etiology
    • cause--Morbillivirus
    • humans are only host
    • droplet contact
    • infectious form 3 days prior to 4-6 days post rash
    • decreased prevalence b/c of vaccine
  32. Measles
    vaccine
    • MMR given at 12-15mo 95% effective
    • second dose confers 99% immunity
  33. Measles
    phases
    • incubation 8-12 days
    • prodromal illness--viral shedding begins
    • exanthematous phase--Ab production begins
    • Recovery
  34. Measles
    manifestations
    • high fever, exanthema, cough, coryza, conjunctivitis
    • KOPLIK SPOTS occurs 1-4 days after onset of rash
  35. Measles
    Tx
    Supportive--antipyretics, hydration, ventilator support w/ pneumonia
  36. Measles
    prognosis
    encephalitis and pneumonia are most common complications--fatal
  37. Mumps
    etiology
    • Rubulavirus
    • winter and spring months
    • droplet contact
  38. Mumps
    manifestations
    • symptomatic 16-18d post exposure
    • virus targets salivary glands, CNS, pancreas, testes
    • fever, HA, vomiting
    • Parotitis
    • PACREATITIS
  39. Mumps
    tx
    • prevention with MMR vacine
    • hydration, pain reduction, antipyretics
  40. Mumps
    prognosis
    • excellent
    • mortality in encephalitis
  41. Rubella
    etiology
    • Rubivirus
    • incubation 2-3 weeks
    • viral shedding in nasopharynx 10 days post infection
    • 5-6 days after rash is most contagious
  42. Rubella
    risk factors
    • mild disease
    • rash similar to measles
  43. Rubella
    prevalence
    • rare since vaccine
    • < 10/yr
  44. Rubella
    Tx
    • supportive
    • vaccination
  45. Rubella
    prognosis
    • thrombocytopenia
    • arthritis
    • encephalitis (HA, confustion, coma, ataxia)
  46. Congenital Rubella Syndrome
    cataracts, congenital heart disease, hearing loss, microcephaly
  47. Roseola
    etiology
    • herpesvirus (HSV 6/7)
    • incubation 5-15 days post exposure
  48. Roseola
    prevalence
    • viral illness found in infants
    • 1/3 of all infants develop (peak 6-9mo)
    • 90% of children >2yo are seropositive
    • no predilection for gender or time of year
  49. Roseola
    manifestation
    • fever up to 104 lasting 3-5 d
    • runny nose, irritability, fatigue
    • maculopapular rash that blanches
    • anorexia
    • cervical adenopathy, seizures
  50. Pharyngitis
    etiology
    • adenoviruses, coronarviruses, RSV, shinoviruses
    • Group A Beta hemolytic streptococcus
    • Group C strep
  51. Pharyngitis
    prevalence
    • occurs in close contact
    • Fall>winter>spring
    • uncommon before 2-3years of age
  52. Pharyngitis
    clinical manifestations
    • rapid onset for strep
    • sore throat
    • fever Hx CC
    • absence of cough CC
    • yellow tonsils, exudates CC
    • anterior cervical lymph nodes enlarged and tender CC
    • Rash Scarlitina "Scarlet Fever"
  53. Pharyngitis
    Tx
    • Penicillin V
    • Macrolide, Erythromycin, Azithromycin
  54. Pertussis
    etiology
    • caused by Bordetella pertussis
    • G- coccobacillus
    • droplet precautions
    • invades epithelium via toxins
    • highly contagious
  55. Pertussis
    manifestations
    • Catarrhal phase--lasts 1-2 weeks, generalized malise, mil cough, rhinorrhea, conjuntival injection, excessive lacrimation
    • Paroxysmal phase--2nd week of illness, PAROXYSMAL COUGH, post-tussive syncope, cough may last 2-3 months
    • Convalescent phase--gradual reduction of cough 1-2 weeks
  56. Pertussis
    risk factors
    unvaccinated, early feeding difficulties, tachypnea
  57. Pertussis
    DDx
    viral URI, bacterial URI, Gerd, Asthma, Post-nasal drip
  58. Pertussis
    Dx
    • Culture takes 3 days and is affected byt prior ABX use
    • Polymerase chain reaction (PCR) tests for toxin presence--not affected by ABX use
  59. Pertussis
    Tx
    • 80-90% will improve w/o Tx
    • early Tx in catarrhal phase speeds recovery
    • Later Tx won't speed recovery, but will reduce spread
    • Azitrhromycin (Zithromax), Clarithromycin, Trimethoprim-sulfamethoxazole (Bactrim)
  60. Pertussis
    prognosis
    • MC complication--pneumonia
    • Vaccination prevents part of DTaP
    • Immunity wanes after 5 years
  61. Kawasaki disease
    manifestations
    fever (MC), mucous membrane findings, ocular changes, cervical lyphadenopathy
  62. Kawasaki disease
    risk factors
    • children who lve in East Asia or of Asian ancestory
    • kids <5yo
    • M>F
  63. Kawasaki disease
    etiology
    • Vasculitis of unknown origin
    • immunologic response?
    • affects medium-sized arteries
  64. Kawasaki disease
    labs
    • No specific labs
    • increased ESR
    • Increased platelets
    • +/- leukocytosis
    • normocyctic, normochromic anemia
  65. Kawasaki disease
    Dx
    • fever plus 4/5 of the following
    • bilateral conjunctival injection
    • oral mucous membrane changes
    • peripheral extremity changes
    • polymorphous rash
    • cervical lymphadenopathy
  66. Kawasaki disease
    Tx
    IVIG within the first 10 days reduces coronary artery aneurysms
  67. Kawasaki disease
    DDx
    • scarlet fever
    • stevens-Johnson syndrome
    • drug eruption
    • Rocky Mountain Spotted fever
  68. Fever
    defined
    • 100.4 rectally
    • 99.5 orally
    • 99.0 axillary
    • 100.4 tympanic
  69. Fever without a source
    fever lasting 1 week or less without localizing SS
  70. Fever of Unknown Origin (FUO)
    7 days or > without source despite workup
  71. Fever
    infants
    • associated symptoms
    • ill contacts
    • maternal fever
    • Mom's group B strep status--prophylaxis
    • Mom's STI Hx
  72. Fever
    etiology--infants
    • MC infectious process
    • drug fever
    • immunization reactions
    • malignancy
    • inflammatory conditions
  73. Fever
    unimmunized/incompletely immunized
    • WBC >14,999
    • ABX therapy pending blood and urine cultures
    • Tx-ceftriaxone, clindamycin
    • If OP follow up is questionable--ADMIT
  74. Fever
    worrisome SS
    • buldging fontanels
    • vomiting
    • irritability
    • > 1 febrile seizure
    • petechiae
  75. Fever
    Tx OP
    • Actaminophen 15mg/kg Q4
    • Ibuprofen 10mg/kg Q6
    • Or alternate every three hours
  76. Intussusception
    etiology
    ileocolonic is most common in 1-2yo and mostly idopathic
  77. Intussusception
    manifestations
    abdominal pain, GI bleeding currant jelly stool, lethargy
  78. Intussusception
    Tx
    • pneumatic reduction with surgeon present 90% effective
    • if unsuccessful emergency surgery fluid resuscitation to correct dehydration
  79. Appendicitis
    etiology
    • most common surgical emergency in children
    • peak 10-12yo
  80. Appendicitis
    manifestations
    • Alvarado/MANTRELS rules
    • 1pt for RLQ pain, amprexoa. nausea/vomiting, rebound pain, temp >100.4, WBC shift >75% neutrophils
    • 2pts for RLQ tenderness and leukocytosis > 10,000/uLL
    • >7 pts increased likelihood
  81. Appendicitis
    Dx & Tx
    UA to rule out UTI

    Appendectomy to Tx
  82. Rheumatic fever
    etiology
    • most common in 6-15years of age
    • sequel of Beta hemolytic strep
    • lower socioeconomic status
  83. Rheumatic fever
    manifestations
    • murmurs
    • arthritis
    • fever and rash
  84. Rheumatic fever
    dx
    • Jones criteria
    • Polyarthritis
    • Carditis
    • w/ fever, arthralgias, previous rheumatic fever, leukocytosis, elevated ESR, C-reactive, prolonged PR interval
  85. Rheumatic fever
    Tx
    • benzathine penicillin w/ salicylates and bed rest
    • penicillin prophylaxis IM every 28 days
  86. poison
    manifestations
    • AMS
    • seizure
    • cardiovascular compromise
    • metabolic abnormality
  87. poisoning
    labs
    toxin-drug assay, ABG, electrolytes, glucose, 12-lead
  88. Poisoning
    Tx
    • supportive care
    • decontamination
    • enhanced elimination
    • specific antidotes
  89. Wilms tumor
    presentation
    • abdominal pain
    • abdominal mass
  90. Wilms tumor
    Dx
    • CBC
    • UA
    • LFTs
    • Creatine
    • abdominal ultrasound-->CT?
  91. Wilms tumor
    Tx
    nephrectomy
  92. Tanner stage
    • 1-elevation of papilla/childsized penis testes
    • 2-breast bud stage/enlargement of scrotum (reddens)
    • 3-enlargement of areola/enlargement of penis
    • 4-hair covers but not onto thighs/penis increases in breadth
    • 5-hair extends down thighs/genitalia are adult size and shape

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