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USMLE2 Pediatrics 01
| Question | Answer |
|---|---|
| Differential for salmon colored rash | 1. Typhoid fever, 2. juvenile rheumatoid arthritis, 3. Adult Stills (rheumatoid arthritis) |
| Diagnosis of SLE | MD SOAP N HAIR. Malar rash, Discoid rash, Serositis, Oral ulcers, Arthritis, Photosensitivity, Neuro disorders (sz's), Heme disorders (anemia), ANA Ab, Immune (anti-dsDNA - sensitive and follows dz activity, anti-Smith - sensitive), Renal (nephrotic) |
| Diagnosis criteria for juvenile rheumatoid arthritis | 1. onset <16yo, 2. arthritis >1 joint, 3. duration >= 6 wks, 4. exclusion of other arthritis |
| How does juvenile rheumatoid arthritis present? | 1. morning stiffness, 2. easy fatigue, 3. as day progresses, increased joint swelling, warmth, and decreased motion with increased pain (no redness) |
| Diagnosis criteria for Kawasaki disease | Vasculitis of medium and coronary vessels. Fever for >= 5days AND 4 of the following: 1. BL conjunctivitis, 2. strawberry tongue/cracked lips, 3. hands and feet - eryth, swelling, desquamation, 4. rash, 5. cervical LAD |
| Encapsulated Bacteria | Some Killers Have Pretty Nice Big Capsules: S. PNA, Salmonella, Klebsiella, Hflu, Pseudomonas, Neisseria mening, GBS, Cryptococcus |
| In a child with fever without a focus, who should get empiric abx? | Rectal T > 38C (100.4F) OR [ CBC > 15,000 and >1500 Bands ] |
| Definition of fever without a focus | fever >38C for < 1 week in child < 3yo |
| How to manage a neonate (<28d) with fever without a focus | Admit to hospital for Cx and prophylactic abx - covering for BEL (GBS, E.coli, Listeria) |
| In an infant (1mo to 3 months old), what is the most common organism causing fever without a focus? | Strep PNA |
| In an infant (1 mo to 3 months old), what is the workup for fever without a focus if the child appears well? | 1. Cx, 2. IM CTX x1, 3. CXR, 4. fu in 24h |
| In an infant (1mo to 3 months old), what is the workup for fever without a focus if the child appears toxic? | 1. Admit to hospital, 2. obtain Cx, 3. empiric IV abx with vanc and CTX |
| In an infant/toddler (>3mo to 3yo), what is the workup for fever without a focus if the child appears toxic? | 1. Admit to hospital, 2. obtain Cx, 3. empiric IV abx with vanc and CTX |
| In an infant/toddler (>3mo to 3yo), what is the workup for fever without a focus if the child appears healthy AND T<39C/102.2F? | no wu indicated |
| In an infant/toddler (>3mo to 3yo), what is the workup for fever without a focus if the child appears NOT toxic AND T>39C/102.2F? | 1. Cx (UCx+UA, Stool Cx, BloodCx if WBC>15K), 2. IM CTX x1, 3. CXR, 4. fu in 24h |
| Definition of fever of unknown origin | T>38C/100.4 AND no origin found after [3wk outpt wu OR 1wk inpt wu] |
| In an infant/toddler (>3mo to 3yo), fever without a focus, child is NOT toxic AND T>39C/102.2F. You've started empiric abx. W/u shows +UCx, but child is afeb. What should you do? | Give outpt abx. |
| In an infant/toddler (>3mo to 3yo), fever without a focus, child is NOT toxic AND T>39C/102.2F. You've started empiric abx. W/u shows +BCx with S.PNA, child is afeb and well appearing. What should you do? | Repeat BCx. Consider LP. |
| In an infant/toddler (>3mo to 3yo), fever without a focus, child is NOT toxic AND T>39C/102.2F. You've started empiric abx. W/u shows +BCx and child has persistent fever. What should you do? | Admit. |
| In an infant/toddler (>3mo to 3yo), fever without a focus, child is NOT toxic AND T>39C/102.2F. You've started empiric abx. W/u shows -BCx. What should you do? | Careful obs and close f/u |
| In infant 0-2mo, what are the most likely organisms in bacterial meningitis? | Baby BEL - GBS, E.coli, Listeria |
| In child 2mo to 12 yo, what are the most likely organism in bacterial meningitis? | Strep PNA and N. meningitidis. HiB uncommon now due to immunizations. |
| Child coming in with bacterial meningitis - sudden or gradual onset more likely? | Gradual more likely with several days of fever, lethargy, irritability, anorexia, nausea, and vomiting. Then meningeal irritation. |
| What are the clinical signs of meningeal irritation | photophobia, neck and back pain, rigidity, Kernig sign (leg raise flexing at hip causes pain), brudzinski (invol flex knees and hip when passive neck flexion) |
| Signs of increased ICP | HA, emesis, bulging anterior fontanelles, oculomotor or abducens palsy, HTN with bradycardia, apnea, decorticate or decerebrate, stupor, coma |
| What are the contraindications to an LP in diagnosing meningitis? | 1. evidence of increased ICP, 2. severe cardiopulm prob requiring resuscitation, 3. infection over skin site, 4. bleeding diathesis (PT/PTT/INR) NOTE: if need CT before LP, DO NOT delay starting abx treatment. Start abx before CT. |
| For an infant, what is the empiric tx for bacterial meningitis? | IV vanc + [cefotaxime OR CTX] |
| For an infant, what is the tx for bacterial meningitis if organism is S. PNA? | PCN or CTX x 2 weeks |
| For an infant, what is the tx for bacterial meningitis if organism is N. meningitidis? | PCN or CTX x 1 wk |
| For an infant, what is the tx for bacterial meningitis if organism is HiB? | Ampicillin x 1 wk + initial IV dexamethasone (dec fever and 8th cranial nerve damage) |
| For an infant, what is the tx for bacterial meningitis if abx were started before cx and no org found on cx? | CTX x 1 wk |
| For an infant, what is the tx for bacterial meningitis if organism is gram neg (i.e. E.coli)? | CTX x 3 wks |
| What tx should family members of infants with meningitis get? | If N. meningitidis or HiB, prophylax with rifampin. DO NOT prophylax if S.PNA. (all close contacts should be prophylaxed regardless of age or immune status) |
| Meningitis that has temporal lobe involvement (focal sz's, CT, MRI, EEG) | should think HSV |
| What is the most common presentation of pt with VZV meningitis? | cerebellar ataxia and acute encephalitis |
| What is the most common presentation of pt with CMV meningitis? | someone who is immunocompromised has disseminated dz. can also be congenital. NOT in someone who is immunocompetent. |
| What is the most common presentation of pt with EBV meningitis? | 8th nerve damage - hearing loss |
| What are common presenting signs of viral meningitis in older child? in infant? | Older: HA and hyperesthesia. Infant: irritability and lethargy. |
| What are common presenting signs of viral meningitis? | Fever, n v, photophobia, neck/leg/back pain, rash |
| What organisms cause rash in meningitis? | purpuric - N mening; viral exanthems - echo or coxsackie; VZV, measles, rubella |
| What is best test to dx viral meningitis? | PCR of CSF |
| 3 phases of whooping cough | 1. catarrhal (2 wks) - rhin, conj inj, cough, 2. paroxysmal (2-5wks) - coughing paroxysms and petechiae, 3. Convalescent (2wks) - gradual resolution of cough |
| How to dx whooping cough? | nasopharyngeal cx |
| How to tx whooping cough? | erythromycin x 2wks for pt AND close contacts |
| warthin-starry stain | G- bacilli --> Bartonella (cat-scratch dz) |
| Lyme disease | CRAB - Carditis, Rash, Arthritis, Bell's palsy |
| Tx for Lyme disease | <8yo: amoxicillin. >8yo: Doxycycline x 2-3wks. |
| Tx for Lyme disease with meningitis or carditis | CTX OR PCN x2-4 wks |
| Tx for Lyme disease with Bell's palsy | Doxycycline OR amoxicillin x 3wks |
| Tx for late-diagnosed Lyme disease (has arthritis) | Doxycycline OR amoxicillin x 4wks |
| deer tick on East Coast | Lyme disease - Borrelia burgdorferi |
| ticks from Southeast US | RMSF - rickettsia rickettsii |
| Triad of RMSF | Hot Rocky Fever - 1. HA, 2. Rash (pale, rose colored, maculopapular, palms and soles), 3. Fever |
| Tx for RMSF | Doxycycline OR Tetracycline in all pts |
| Tibial erythema nodosum | Coccidioidomycosis |
| Disseminated Coccidioidomycoses | FEM - 1. Flu-like sx's +/- CP, 2. Erythema nodosum on tibia, 3. Maculopapular Rash |
| Measels Triad | CCC - Coryza (head cold), Cough, and Conjuntivitis |
| Koplik spots | white gray dots on buccal mucosa - measels |
| paramyxovirus | measels or mumps |
| Rubella triad | LAR - 1. Lymphadenopathy (posterior cervical, occipital, auricular), 2. Arthritis (multiple joints), 3. Rash (starts on face, pinpoint, with rose spots on palate) |
| Forscheimer spots | rose-colored spots on soft palate in rubella, appears before body rash |
| diseases that have rose-colored spots on soft palate | MRS. Rose - Measels, Rubella, Scarlet fever |
| Roseola Triad | FOR Rose. high Fever (3d) preceding rash, Occipital LAD, Rash (ROSE colored papules on trunk, arms, neck and face). |
| face with parotid swelling | mumps |
| Rash in various stages of macules, papules, vesicles, pustules | Varicella |
| Varicella triad | PCR - Pruritis, Crops of lesions, Rash in various stages |
| Tzank prep showing multinucleated giant cells | Herpes viruses: VZV, HSV |
| Fifth's Disease | 5th graders have bad teeth. must become a flosser - FLASSA - Fetal hydrops, Lacy reticular rash on trunk and extremities, Arthritis, Spare palms and soles, Slapped cheeks, Aplastic crisis in pts with hemolytic anemia |
| Scarlet Fever | PSPS: Pharyngitis, Sandpaper rash, Pastia lines (petechiae in skin creases), Strawberry tongue |
| Mono | FLiP iT! Fatigue, LAD (esp cervical, epitrochlear - medial bicep), Pharyngitis, Tonsillar swelling) |
| Onset of rash after taking ampicillin or amoxicillin for URI sx's | Mono - EBV |
| Diagnosis of EBV mono | Monospot (heterophile antibody), WBC lymphocytosis, elevated LFT's. Gold standard is IgM to viral capsid antigen. |
| EBV associated with which cancers? | Burkitt's lymphoma, Nasopharyngeal CA, Hodgkin's lymphoma (RS cells). |
Created by:
christinapham
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