Complication of pneumonia
a. collection of infected fluid in the body cavity (in pleura) or lung abscess
b. dilation of bronchi d/t longstanding infection
c. replacement of inflamed tissue w/ connective tissue
What is the treatment for a viral URI (common cold)? What are the complications of this?
"Vicky's SOAP Bar"
Whooping cough, a primarily tracheobronchial highly contagous infection by Bordetella.
a. When does the catarral stage of pertussis present?
b. When does the paroxysmal stage of pertussis present?
a. 1-2 weeks, URI-type symptoms
b. 2-6 weeks, thick mucous secretions
What is the treatment for pertussis?
Erythromycin & Zithromax are the DOC
Immunization for prevention
A misalignment of the eyes in which one looks crossed it can be either eso or exo tropia.
Unilateral or bilateral reduction in central visual acuity due to sensory deprivation of retinal image.
What is the most common pediatric ocular problem?
What are the causes of neonatal conjunctivitis based on the time of onset?
a. day 1
b. day 2-4
c. day 3-10
d. day 2-16
e. 10% regardless of time of onset
b. N. gonorrhea 15%
c. chlamydia 30% mostly at 5 days
e. S. aureus
How can you prevent neonatal conjunctivitis?
Hand washing at the nursery and at home
Newborn prophylaxis: Erythromycin ointment
What is the treatment for N gonorrhea induced neonatal conjunctivitis?
Single dose of ceftriaxone
Persistent watery discharge, inflamed conjunctiva that appears at 5 days to several weeks and is the major cause blindness world-wide. What causes this? What is the tx?
Erythromycin PO, Topical tx alone does not eradicate the nasopharyngeal carriage, leaving them at risk for pneumonia
How can you treat Herpes simplex virus in the eye of an infant?
How can you treat a bacterial infection in the eye of an infant?
Viroptic solution plus Acyclovir
Ocuflox or Vigamox Drops
What are the causes of bacterial conjunctivitis?
HISAP - H. Influenza, Staph Aureus, Pneumococcus
Scant watery discharge and often seen w/URI, pre-auricular lymphadenitis common, that resolves in 5-10 days. DX? TX?
Adenovirus induced conjunctivitis
Patanol allergy drops are soothing, supportive, cool compresses, topical abx for children, home/day-care hygiene measures
Itchy, watery/mucoid discharge, eyelid edema usally bilateral at onset, often associated with hay fever. DX? TX?
Topical vasoconstrictors, topical cromolyn, antihistamine PO
Inflammation of the eye lid margins and can be caused by bacteria (staph) infection, non- allergy or exposure to dust or irritating chemicals. DX? TX?
Antibiotic ointment/Gentle cleansing
Infected gland (of Zeis) at base of the eyelash
A hard benign tumor and chronic inflammatory lesion formed by secretions and distention of the memobian gland. DX? TX?
may require surgical removal
Improper drainage of aqueous fluid causing enlargement of eye and inc. pressure
Infection of orbital contents caused by H. influenzae, S. pyogenes, Pneumococcus or S. aureus with sx of mod to severely ill child w/fever, eye pain, worsens with eye movement, eyelid and periorbital edema/erythema, proptosis, & decreased eye movement. DX? TX?
Hospitalization: IV antibiotics Ceftriaxone and Vancomycin, Ampicillin
Surgical drainage if required
Inflammation of subcutaneous tissues of eyelids, brow, forehead
preseptal (preorbital) cellulitis
Infection of nasolacrimal duct, due to Staph, Strep or Haemophilus. DX? TX?
Antibiotic Rx (oral) and May require surgical removal of obstruction afterwards
Caused by allergic rhinitis, URI, day care, passive smoke, or congenitally by Down' syndrome, Treacher-Collins (turns other tissues into bone). DX? TX?
Amoxicillin #1 or Augmentin
Alternates: 2ND & 3RD GENERATION CEPHALOSPORINS IM/IV Ceftriaxone (1 dose)
Analgesia: Acet, Ibu, topical if no perforation, warm compress, oral decongestant NOT helpful
What are the bacterial causes of acute otitis media?
S. Pneumococcus #1
What is the prophylaxis for recurrent acute otitis media?
Daily dose of abx for 3 to 6 mos: Amoxicillin 20 mg/kg/d HS
Consideration for ENT referral
What is the most common cause of conductive hearing loss in childern?
Inflammation of skin of ear canal, secondary infection: S. aureus, Pseudomonas causing otalgia, pruritis, pain with movement, and pressure on ear. How can this be prevented?
Otitis externa "swimmers ear"
Dry ears and apply ear drops before/after swimming
Avoid vigorous cotton-tip cleaning of ear canals
Traction on pinna is painful
Ear canal swollen
Lab tests: Gram-stain/culture, KOH
Otitis externa "swimmers ear"
Occurs commonly in patients age 6-10 yrs, in the fall and winter d/t low humidity, indoor heat, cool & dry air, or when there is inflammation/drying of vascular mucosa in Kiesselbach's plexus. DX? TX?
Epistaxis >90% anterior
Head forward, nose pinched for 5-20 minutes if persists - insert pledget soaked w phenylephrine, lidocaine 1%, epi
Can cauterize w/ silver nitrate or can pack & give 3 day abx
What is the treatment for a posterior epistaxis?
Consult ENT, may require Posterior Pack
Inflammation of paranasal sinuses. ____ is caused by pneumococcus, H. flu, and m. catarrhalis; _____ is caused mainly by anaerobes.
Purulent Rhinorrhea, headache/facial ache, fever, nasal swelling, hx of "Double-Sickening"- URI that gets better, than worsens. DX? TX?
Antibiotics: Biaxin, Augmentin, Cefzil x 10-14 days
Decongestants - Oral or Nasal Spray bid
Re-examine if not better in 48 hrs May need to chg. antibiotic
An abscess of frontal sinusitis causing erosion through anterior wall
Pott's puffy tumor
What is the presentation of pharyngitis or tonsillitis? What causes it?
S - ore throat
T - onsillar exudate in bacterial infections
R- ise in temperature
E - nlarged, tender anterior cervical nodes
P - haryngeal/Tonsillar erythema
P - etechiae on palate
90% viral- Group A Beta Hemolytic Strep (GABHS)
History: URI makes viral pharyngitis more likely than bacterial (which lacks cough, coryza) Lab Tests: Quik Strep, culture, CBC, Mono spot test for Strep neg pt.
Antibiotics: Bicillin IM plus 5-10 days of oral
Supportive: Antipyretics, Analgesics, Throat lozenges, sprays, Magic Mouthwash
Pharyngitis, fever, malaise, anorexia, Lymphadenopathy, headache, chills and Splenomegaly, Negative strep, culture, no response to PCN, Monospot false negative first 1 to 2 wks, Lymphocytosis instead of increased neutrophils. DX?
What are common causes of infant vomiting?
Overfeeding: baby's stomach can hold so much
GER (Gastroesophageal Reflux) usually due to immature LES
Soy or cow's milk formula allergy
Viral gastroenteritis or sepsis
Normal regurgitation with no signs or sx seen in 20-40% of newborns that resolves between 6-12 mos d/t maturation of the LES, introduction of solid food, and increased upright position of infant. DX? TX?
Hold infant in vertical position for 20 min after feeding, diet changes, 2-3 tsp cereal in bottle to thicken formula.
Regurgitation with poor weight gain, persistent irritability of esophagus, lower chest pain, dysphasia, deficiency anemia, apnea & cyanosis in infants, wheezing, aspiration or recurrent pneumonia, chronic cough, stridor, and neck tilting in infants. DX? TX?
Ranitidine- can cause headaches and malaise
Metoclopromide- Drowsiness, restlessness, dystonic reaction, extrapyramidal sx (TD)
What type of formula can be used to treat GER that empties from stomach faster than other formulas?
What are the common causes of childhood vomiting?
What are some rare causes of childhood vomiting?
Common: Gastroenteritis (usually viral), Otitis Media, UTI, pneumonia, or Medications (such as Augmentin)
Rare: appendicitis, intussusception, infections, diabetic ketoacidosis, migraines
PE findings associated with vomiting:
b. Vital Signs
a. lethargy suggests dehydration
b. fever, tachycardia, wt. loss
c. OM, dry oral mucosa, sunken anterior fontanelle in babies, lack of tearing
f. UTI, high specific gravity, ketones
g. capillary refill >2 sec
When do you hospitalize a child that is vomiting?
If child is severely ill, refuses all oral fluids, very persistent vomiting or if parent unable to cope (social admission)
What is the oral rehydration therapy for vomiting?
Pedialyte/Infalyte: best for infants contains Na+, K+ & HCO3
Mild dehydration- 50ml/kg over 4 hrs.
Mod dehydration- 100ml/kg over 6 hrs.
When can you use Phenergan for childhood vomiting? Why?
Only for kids >2 years old
It can suppress breathing
How can you manage vomiting?
a. rehydration/calming the stomach
b. do not give
c. when vomiting subsides
a. ice chips - cold leaves stomach quickly & prevents nausea
b. milk, formula or juice for 6 hrs.
c. may try small amts of flat Sprite or pedialyte. Breastfed babies may be fed when vomiting has stopped.
What are the causes of diarrhea?
c. food poisoning
a. Rotavirus #1
b. Campylobacter, Salmonella, Shigella, Yersinia enterocolitica (Mod-hi fever, blood present, stomach cramps)
c. caused by toxins
d. Giardia, Entamoeba, cryptosporidium
e. excessive sugar load, allergies to new foods
What are malabsorption syndromes seen with children?
Enzyme deficiencies (Lactase, CF*)
Allergies (Celiac disease, Milk protein)
Chronic GI infections
Inflammatory Bowel Diseases - Crohn's
Onset in early infancy, small ribbon-like stool, chronically ill appearance, GTT is common, tight anal tone, empty rectum, soiling is rare.
A congenital condition that is the most common cause of lower GI obstruction in neonates and the blockage of the large intestine due to improper nerve impulses to muscle movement in the bowel. DX? TX?
A condition assoc w/constipation & fecal retention in which watery contents bypass hard fecal material and pass thru the rectum. Often confused w/diarrhea.
Abdominal pain: Real Pain, variable/paroxysmal, relationship to meals, activity, subtle onset that may or may not interfere w/daily activities.
Functional recurrent abdominal pain
Abdominal pain: Recurrent UTI's, gastritis, IBD, constipation, GYN abnormalities, GB disease, or psychological- school, home.
Organic recurrent abdominal pain
What are GI disorders that require surgery? 7
Inherited polyps of sm. Intestines w/melanin of lips, mucosa, fingers and toes; anemia due to bleeding from polyps
What are the types of UTI's seen in children?
Cystitis & Pyelonephritis
What factors predispose females to UTI's?
Anatomical: shorter urethra
Toilet training: teach wiping front to back
What is the most common pathogenic cause of UTI?
E. Coli - 90%
Gain access from perineum to bladder via urethra
What is the outpatient treatment for a UTI?
What is the inpatient treatment for a UTI?
Amoxicillin, Augmentin, Cephalosporin, Bactrim X10D BID
IV Antibiotics if sepsis or pyelonephritis suspected: also if patient is ill and <2 mo old
What follow up should be done for UTI's?
R/O Structural abnormality (stasis) & bladder dysfunction
1. VCUG (voiding cystourethrogram)
2. ULTRASOUND OF KIDNEYS
3. Boys checked to detect in posterior uretheral valves
What should parents of female patients be made aware of with regard to UTI's?
No tub baths, no caffeine, monitor for constipation, teach proper wiping after BM
Patient presents with irritability, poor feeding, strong smelling urine,vomiting, hematuria, diarrhea, and FEVER. DX?
What findings lead you to suspect a UTI?
Fever with a lack of other source of fever
Labs- UA w/WBC's, bacteria
What gender would be more likely to develop cystitis (< 6 mos) and what other predisposing factors contribute to this?
Male 2x greater > Female
Uncircumcised 10x greater > Circumcised
What age group has the highest ratio of UTI's in children?
Females 1-3 10:1
Females 3-11 9:1
Excessive urinary excretion of plasma proteins sufficient to cause hypoalbuminemia. What causes this?
kidneys with damaged filters leak protein into the urine, so not enough protein is left in the blood to soak up the water, which moves from blood into body tissues and causes swelling.
Edema (mild to anasarca)
Minimal change disease - no definite microscopic changes in the glomeruli
What is the treatment for nephrotic syndrome?
Till trace or neg protein (max 8wks)
Then every other day x6 weeks
Then taper off over 1-2 months
What condition has the same s/sx as minimal change disease, but microscope changes show glomerular damage and cause lead to renal failure (poor prognosis)?
Focal Segmental Glomerular Sclerosis
What is the most common post infectious glomerulonephritis in children?
Acute post strepto glomerulonephritis (Group A Beta Hemolytic Strep)
Greatest incidence ages 2-5 yrs, usually asymptomatic except for hematuria, occurrence 10-14 days after GABHS, about 95% resolve spontaneously in 2-3 wks if no sign of Strep still exist and there is no fever, must confirm Dx with ASO Titer.
PSGN (post strepto glomerulonephritis)
What are the different types of proteinuria?
Orthostatic proteinuria: Present w/upright posture Dx: compare 1st morning urine specimen w/later
Benign Proteinuria, seen w/sports PE screening
Exercise induced proteinuria- benign
Febrile induced proteinuria
What is due to inc GFR w/febrile, that causes a hypermetabolic state and resolves with return to norm temperature?
Febrile induced proteinuria
What is the most common cause of hematuria?
UTI (Cystitis) 50%
Glomerular inflammation & damage resulting in microscopic or gross hematuria with or w/o systemic symptoms (tea colored urine) or asymptomatic hematuria.
What is the most common chronic nephritis in children?
IgA Nepropathy (Berger's Disease)
Presents w/ asymptomatic gross hematuria, initial onset usually 1-2 days after febrile URI. How is DX made? TX? Prognosis?
DX: biopsy showing IgA deposits in glomerul
TX: corticosteroids may be helpful if severe
90% resolve over 1-5 years and 10% progress to HTN and renal failure.
Microscopic or gross hematuria presentation, mild to severe, significant HTN , may respond to steroids, diagnosed by biopsy.
membranoproliferative G glomerulonephritis
Progressive HTN, deafness, renal failure, autosomal dominate X-linked, no useful meds; treat HTN & renal failure.
Hereditary Nephritis (Alports)
What is the most common cause of acute renal failure due to glomerular vascular injury in children that causes abd pain, N/V/D, oliguria, pallor, cutaneous & GI bleeding, HTN, seizures, in which renal failure follows. DX? TX? What bacteria is it associated with?
Hemolytic uremic syndrome
Correct Fluid and electrolytes: Dialysis, Transfusion, Observe and treat for infection
E. coli 0157, or Shigella
What are the types of structual congenital GU defects? 5
Polycystic Kidney Disease
Renal Aplasia- failure to develop
Hypoplasia - underdevelopment
Dysplasia - abn development
Atresias/Stenoses of ureters or urethra
Renal tubular acidosis presents in infancy what 3 symptoms? TX?
FTT, anorexia, vomiting.
oral alkali supplements (bicarb or citrate)
Sudden, intense scrotal/abdominal pain that is triggered by anything, including exercise and standing up. DX? TX?
Failure of the testicles to descend into the scrotum, most common in premature infants, concern for testicular CA. DX? TX?
Observation or orchidopexy- Suturing undescended testicle to hold it in place
The urethral opening is on the underside of the penis as opposed to the glands penis.
Weight should be at or above birth weight and regards faces.
Smiles, Coos, Finger grasp, AAP recommends Vitamin supplementation for strictly breast fed infants (TriViSol 1 ml per day)
Begins rolling/stomach to back, laughs, lifts head 90 degrees w/o lag, babbles/makes "raspberry sound", sits w/support, anticipates food on sight, check for strabismus, introduce solids for formula fed babies.
Sits momentarily, reaches/scoops up cheerios using thumb, imitates "bye-bye", transfers objects, rolls from back to stomach, AAP recommends fluoride supplementation PRN, and screen anemia.
Crawls, pulls to stand, sits well, feeds self, imitates pat-a-cake/peek-a-boo, begins to use pinchers
Stands, cruises/begins walking, good pincer grasp, 2-3 words/points to desired things, table food and milk, screen: lead & anemia
Walks well, builds tower of 2 cubes, understands simple commands.
Walks upstairs, throws a ball, seats self in chair, says 4 - 20 words, understands 2 step commands, builds 4 cube tower, imitates housework, and knows body parts.
Runs well, handles a spoon well, 2-3 word phrases/uses pronouns, jumps off floor w/both feet, verbalizes toilet needs, dresses self, turns pages of book, independence issues, kicks ball on request, last time to measure head.
Balances on 1 foot, knows age and gender, makes sentences, potty trained, holds crayon with fingers, copies a circle, knows first and last name, rides a tricycle, screening - B/P, hearing and vision.
3 years old
Hops on one foot, throws ball, cuts with scissors, copies circle/cross, counts/recognizes colors, understands the word "stranger", dresses self except for tying shoes, self care at toilet.
4 years old
Skips, runs and turns w/o losing balance, prints name, copies square, cuts shapes, counts 10 pennies, ABC's, fluent speech, defines words, draws a recognizable person, reads single words.
5 years old
Knows borrowing/carrying process in math, knows month, day, year, names months in order, comprehends reading composition.
8-9 years old