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Pediatric EOR

Disease State Bugs/Etiology Diagnostics Treatment Extra


ENOT
Conjunctivitis Viral: MC adenovirus - Preauricular Supportive (cool compress)
lymphadenopathy
- Watery discharge
Allergic - Red eyes Topical antihistamines
- “Cobblestone - Olopatadine
mucosa” - Pheniramine/ Naphazoline
- Conjunctival swelling
(chemosis)
Bacterial: MC S. aureus, - Purulent discharge Topical antibiotics Chlamydia or gonorrhea
Strep pneumoniae; - Lid crusting - Erythromycin ophthalmic emergency
Pseudomonas (contact - Fluoroquinolones for
wearers) contact wearers

Neonatal conjunctivitis Day 2-5: Gonococcal Gonorrhea: ceftriaxone Erythromycin topical given at
Day 5-7: Chlamydia Chlamydia: azithromycin birth for prophylaxis
Day 7-11: HSV

Orbital Cellulitis 2/2 sinus infections High resolution CT scan IV ABX - Decreased vision
(Ethmoid MC) - Pain with ocular
movement
Strabismus D/t misalignment of Hirschberg corneal light Patch therapy (cover normal Esotropia: inward
eyes reflex testing, cover- eye); corrective surgery if Exotropia: outward
uncover test severe
Acute otitis media - Strep pneumo MC Otoscope: TM bulging, Amoxicillin tx of choice - MC preceded by viral URI
- H. flu, M. cat, S. erythematous, decreased Cefixime in children  edema of Eustachian
pyogenes mobility Erythromycin-Sulfisoxasole if tube
PCN allergy - If bullae on TM, suspect
Mycoplasma pneumoniae
Allergic rhinitis IgE-mediated mast cell Pale/violaceous, boggy Intranasal steroids most Mast cell stabilizers or
histamine release turbinates, nasal polyps, effective anticholinergics may also be
cobblestone mucosa of helpful
conjunctiva
Disease State Bugs/Etiology Diagnostics Treatment Extra
Mastoiditis - Strep pneumo MC CT scan IV ABX + middle ear/ mastoid Complication of prolonged or
- H. flu, M. cat, S. drainage inadequately treated AOM
pyogenes Mastoid tenderness with
Same as AOM deep ear pain

Otitis externa Pseudomonas MC - Ciprofloxacin/ - Pain on traction


- Swimmer’s ear dexamethasone - Ear pain, pruritis,
- Ofloxacin safe if TM auricular discharge
rupture
- NO aminoglycosides if TM
rupture
TM Perforation Penetrating or noise Otoscopic examination Heal spontaneously Avoid water, moisture,
trauma +/- conductive hearing topical aminoglycosides
loss
Epistaxis Anterior MC - Direct pressure w/ leaning
- Kiesselbach’s plexus forward
Posterior: Palatine a. - Topical decongestants
- Bleeding in both - Cauterization, nasal
nares and posterior packing if severe
pharynx
Acute - Viral MC - Rapid antigen test Pen G 1st line Centor criteria: sore throat,
pharyngotonsillitis - Bacterial: GABHS only 55-90% sensitive Macrolides if PCN allergy fever, exudates, tender
(Strep pyogenes) - Throat culture anterior cervical LN, cough
definitive diagnosis Viral: supportive absent
Complications:
- Rheumatic fever
(preventable w. abx
- Glomerulonephritis (not
preventable)

Epiglottitis H. flu type B (HIB) MC Lateral cervical Xray Maintain airway via - Hib vaccine
(Thumbprint sign) intubation/dexameth. - 3D’s: Dysphagia, Drooling,
- Laryngoscopy Distress
definitive dx but may ABX: Ceftriaxone or - Inspiratory stridor
provoke spasm cefotaxime - Tripoding
Disease State Bugs/Etiology Diagnostics Treatment Extra
Oral candidiasis Candida albicans KOH Smear: budding Nystatin liquid Part of normal flora but can
yeast/pseudohyphae become pathogenic d/t
- White curd-like immunocompromised state
plaques with
underlying erythema
Peritonsillar abscess MC Strep pyogenes, S. CT scan ABX + aspiration or I&D - Muffled “hot potato
aureus, polymicrobial - Unasyn or Clinda voice”
- Uvula deviation to
contralateral side
Pulmonary
Acute bronchiolitis Lower airway disease Wheezing, rales, signs of Supportive: O2, IVF, Affects children < 2yrs
RSV MC, human respiratory distress APAP/Motrin for fever Palivizumab prophylaxis in
metapneumovirus, CXR: hyperinflation, high risk patients
adenovirus, influenza peribronchial cuffing Pulse ox best predictor

Croup Upper airway disease Clinical diagnosis Mild: cool air, hydration, Barking cough
(laryngotracheitis) Parainfluenza 1 MC, - Frontal cervical xray dexamethasone Stridor (rest vs agitation)
adenovirus, RSV, shows steeple sign Moderate: racemic epi, Hoarseness
rhinovirus, etc. dexamethasone Dyspnea (worse at night)
Severe: dexamethasone + Respiratory distress possible
nebulized epi

Pneumonia Typical: S. pneumo, S. Clinical diagnosis Typical: amoxicillin outpatient, Viral MCC < 5yrs
aureus, H. flu - Crackles, signs of ampicillin inpatient (Vanco if S. pneumo MC bacteria
consolidation MRSA suspected) H. flu, psuedomonas MC in CF
pts
Atypical: Mycoplasma PE often normal Atypical: macrolides “afebrile pneumonia of
pneumonia, Chlamydia, Extrapulmonary sx infancy” – chlamydia
Legoniella common Mycoplasma MC >5yrs

Foreign body Bronchoscopy: MC on right side


visualization and removal
of object Can cause stridor, respiratory
CSR: regional distress
hyperinflation
Disease State Bugs/Etiology Diagnostics Treatment Extra
Hyaline membrane Disease or premature Respiratory distress Exogenous surfactant to open Prevention: corticosteroids
disease (Infant infants 2/2 insufficiency shortly postpartum alveoli, CPAP given to mature lungs if
Respiratory Distress of surfactant premature delivery expected
Syndrome) (production begins 24- CXR: reticular ground- (24-36 wks)
28 weeks, enough glass opacities + air
produced by 35 wks) bronchograms
Cystic fibrosis Autosomal recessive Newborn screening Airway clearance treatment - GI: meconium ileus at
d/o of defective CFTR birth
preventing chloride Elevated sweat chloride Pancreatic enzyme - Pancreatic insufficiency
transport  buildup of test >60mmol/L replacement; supplementation steatorrhea, bulky
thick mucus in lungs, of fat soluble vitamins (ADEK) pale/foul-smelling stools,
pancreas, liver, CXR: bronchiectasis; Vit ADEK def.
intestines  hyperinflation Lung/pancreatic/liver - Pulm: recurrent
obstructive lung dz, transplantation eventually respiratory infections (esp
exocrine (eventually PFTs: obstructive pseudomonas); chronic
pancreatic endocrine) sinusitis
gland dysfunction - Infertility

Increased incidence in
caucasians, N. European
Infectious Disease
Atypical mycobacterial Micobacterium Culture Tetracylines Inoculation of skin abrasion
disease marinum – found in Erythematous bluish Fluoroquinolones or puncture in contact with
fresh and salt water papule or nodule at Macrolides aquarium, salt water, marine
trauma site  more Sulfonamides animals (fish/turtles)
lesions may occur on 4-6 weeks
lymphatic path
Pinworms Enterobius vermicularis Scotch tape test (in AM) Albendazole or mebendazole Fecal oral transmission
to look for eggs under (NOT in children under 2 yrs) MC in school-aged children
microscope
Epstein-Barr disease HHV-4 Infectious Heterophile (Monospot) Supportive treatment Fever, sore throat, posterior
mononucleosis Ab test cervical LN, splenomegaly
Peripheral smear: Petechial rash if given Transmitted via saliva
atypical lymphocytes ampicillin Avoid contact sports 1 month
if splenomegaly
Disease State Bugs/Etiology Diagnostics Treatment Extra
Erythema infectiosum Parvovirus B19 Serologies Supportive, anti- May cause aplastic crisis in
Coryza, fever  slapped inflammatories patients with sickle cell
cheek rash with disease or G6PD deficiency
circumoral pallor  lacy
reticular rash on
extremities
- Arthropathy/
arthralgias in older
children and adults
Herpes simplex Acute herpetic PCR most sensitive and Acyclovir Fever, anorexia, gingivitis,
gingivostomatitis MC in specific (Ganciclovir eye drops for mouth vesicles
children Tzanck smear conjunctivitis)
Influenza Influenza A or B Clinical diagnosis or rapid Supportive in healthy patients Influenza trivalent vaccine
influenza Oseltamivir in high risk given yearly as early as 6
patients w/in 48hrs months old
Mumps Paramyxovirus Serologies, increased Supportive Complications:
amylase - Orchitis in males
Low grade fever, - MC cause of acute
myalgias, HA  parotid pancreatitis in kids
gland pain and swelling Prevention: MMR at 12-15mo
then at 4-6yr

Roseola Human herpes virus 6 High fever 3-5 days  Supportive, antipyretics to Only childhood viral
or 7 – Sixth disease then rose, pink prevent febrile seizures exanthema that starts on
blanchable rash on trunk
MC < 5 yrs trunk/back  face Well and alert during febrile
stage
Rubella (German Rubella virus (Togavirus Clinical Anti-inflammatories, Generally no complications
Measles) family) Low grade fever, cough supportive Teratogenic esp. 1st trimester:
 lymphadenopathy congenital syndrome –
(posterior cervical and Lasts 3 days sensorineural deafness,
post. auricular)  pink cataracts, TTP (blueberry
maculopapular rash on muffin rash), mental
face  extremities retardation, heart defects -
TORCH
Disease State Bugs/Etiology Diagnostics Treatment Extra
Measles (Rubeola) Paramyxovirus URI prodrome (3 Cs: Supportive, anti-inflammatory Complications: diarrhea, otitis
cough, coryza, media, pneumonia,
conjunctivitis)  Koplik Vitamin A reduces mortality conjunctivitis, encephalitis
spots (small red spots in
buccal mucosa w/ pale MMR @ 12-15mo and 4-6yrs
blue/white center)
precedes rash 
morbiliform brick-red
rash on face beginning at
hairline  extremities
Varicella infection Varicella zoster (HHV-3) Clusters of vesicles on an Symptomatic treatment Fever, malaise, pruritis
Chicken pox: primary erythematous base
infection (“dew drops on a rose Begins on face, trunk and
petal”) in different stages spreads to extremities
Hand-foot-and-mouth Coxsackie virus A Oral enanthem (vesicular Supportive: antipyretics, MC in children < 5yrs
disease lesions w/ erythematous topical lidocaine
halos)  exanthema 1-2 MC late summer/early fall
after on distal extremities
Pertussis Bordetella pertussis PCR of nasopharyngeal Supportive treatment Catarrhal phase (1-2wks): URI
swab ABX used to decrease sx  most contagious
Lymphocytosis contagiousness and given to Paroxysmal phase (2-4wks):
exposed contacts – coughing fits with inspiratory
Erythromycin whooping and post coughing
emesis
Convalescent phase (up to
6wks): resolution of cough