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36 Cards in this Set

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Most common cause of a UTI

E. coli




Other causes include: klebsiella, proteus, enterobacter, enterococcusand Stapylococcus saprophyticus.

How are UTIs treated in kids

Patients that are older than 2 months and arenot toxic appearing can be treated as outpatients with antimicrobial therapyand followed up closely. UpToDate suggests using a third generationcephalosporin such as cefixime as first line empiric therapy. Patients withpenicillin or cephalosporin allergy can be treated with TMP/SMX orciprofloxacin (risk for tendinitis and Achilles tendon rupture). Therapy should be initiated within 3 days of symptoms to preventrenal damage. Febrile UTIs in children is treated with a longer course of about10 days and is preferred over the shorter course used in afebrile UTIs. Mostpatient’s fever and symptoms will improve in 24-48 hrs. If the patient fails torespond, you should do a repeat urine culture to do antibiotic susceptibility.

consequences of untreated UTIs

the most acute consequence would be urosepsis. More long term consequences include renal scarring, hypertension and impaired growth (in kids).

In a patient that is suspected of having a UTI, what do you look for on physical exam

look at temperature (> 102.2 is associatedwith renal scarring), blood pressure (high blood pressure can be an indicationof recurrent or chronic UTI), growth/weight gain (poor development can indicaterecurrent or chronic UTI), suprapubic/costovertebral tenderness, abdominal examfor mass (bladder or kidney obstruction), and genital exam to look for thingsthat can predispose to UTI.

What tests can be ordered in kids that have recurrent UTIs

Renal and bladder ultrasonography playsa role in looking for anatomical abnormalities that can cause UTIs such asduplicated or dilated ureters, size and shape of the kidneys, obstructiveuropathies and abscesses. RBUS is usually reserved for patients that fail torespond to antibiotics or those that have recurrent UTIs.




VUR can cause retrograde transport ofurine into the kidneys and cause UTIs and the test of choice for this isvoiding cystourethrogram.

signs and symptoms of a UTI

An urinalysis in patient's with a UTI can show positive nitrites and/or leukotriene esterase (the presence of both is more predictive of a UTI. Nitrites alone is more predictive tan LE alone), elevated WBCs and bacteruria.

An urinalysis in patient's with a UTI can show positive nitrites and/or leukotriene esterase (the presence of both is more predictive of a UTI. Nitrites alone is more specific than LE alone, but nitrites are not as sensitive in children as they require the urine to be in the bladder for > 4 hrs and children void frequently), elevated WBCs and bacteruria.




To establish diagnosis: pyuria and presence of 50,000 cfu/mL of a single uropathogen.

What can imitate UTI signs and symptoms

Vulvovaginitis, Irritant urethritis (can get this from bubble baths), bowel and bladder dysfunction, STIs, urinary calculi, appendicitis, and kawasaki disease (appendicitis and KD may present with fever, abdominal pain and WBCs in the urine)

can nitrofurantoin be used to treat pyelonephritis or urosepsis

no. only used in cystitis as it does not have adequate tissue and serum levels.

In what case would you admit a kid to the hospital that has a UTI

infants less than 2 months of age, those that appear toxic/dehydrated, and those that are unable to retain oral intake.

which drugs have high resistance rates in the treatment of cystitis

Amoxicillin and TMP/SMX. TMP/SMX has variable resistance rates and can be used as empiric treatment if the local resistance does not exceed 20%.




Nitrofurantoin is the preferred DOC.

In what case is asymptomatic bacteriuria treated

It is treated in pregnancy and screening for asymptomatic bacteriuria should be done at the first prenatal visit.




asymptomatic bacteriuria is defined as two consecutive voided urin specimens with isolation of the same bacterial strain > 100,000 cfu/mL or a single catheterized urine specimen with one bacterial species isolated with > 100 cfu/mL




Complications of untreated bacteriuria include preterm birth and low birth weight.

what agents are used to treat asymptomatic bacteriuria in pregnant women

beta lactams (avoid ceftriaxone), fosfomycin and nitrofurantoin.

algorithm for a patient with a skin/soft tissue infection

Patients with a draining skin/soft tissue infection are more likely to have S. aureus
Patients with a draining skin/soft tissue infection are more likely to have S. aureus

How is S. aureus classified as MRSA

If S. aureus produces penicillin-binding protein then it is MRSA. The mecA gene encodes the PBP and mecA gene is carried by the mobile genetic element SCCmec.

CA-MRSA tends to be susceptible to which types of antibiotics

clindamycin, TMP/SMX, and the tetracycline class of antibiotics.

what bacteria is likely to cause infection in a patient that has a cat/dog bite

Pasteurella.




Afebrile patients that are stable can be treated with outpatient oral augmentin (amoxicillin/clavulanate).




Patients requiring hospitalization can get IV Unasyn (ampicillin/sulbactam).

What bacteria is likely to cause infection from a wound infected with freshwater

Aeromonas spp

What infections can mycobacterium marinum and mycobacterium chelonae cause

M. marinum: associated with fishtanks

M. chelonae: associated with tattoos. 

M. marinum: associated with fishtanks




M. chelonae: associated with tattoos.

Signs and symptoms of Kawasaki Disease

To remember imagine a little asain kid (most common in asain boys) riding a Kawasaki motorcyle and then CRASHInG and falling on his ASs. 

C: conjuctivitis (bilateral)
R: rash
A: adenopathy (cervical)
S: strawberry tongue
H: hands/feet changes (...

To remember imagine a little asain kid (most common in asain boys) riding a Kawasaki motorcyle and then CRASHInG and falling on his ASs.




C: conjuctivitis (bilateral)


R: rash


A: adenopathy (cervical)


S: strawberry tongue


H: hands/feet changes (desquamation)


IG: give IVIG


AS: give aspirin




An important complication is myocardial infarction. Any kid with heart/coronary artery problems/fever over 5 days should be suspected of having Kawasaki's.

Patient with a strawberry tongue, conjunctivitis and desquamation of the palm and soles is started on treatment for his disease. What test should be ordered to look for complications?

an echo. It is used to measure the coronary arteries to look for the complication of coronary aneurysms or ectasia (larger than normal vessel without a discrete area of enlargement). There may also be a pericardial effusion that can be seen with an echo.


What symptoms are seen in GAS pharyngitis

fever, tonsillar exudate/swelling, swollen/tender anterior cervical nodes, and absence of cough.




GAS pharyngitis should not be treated empirically. Diagnosis requires confirmation by rapid testing or culture.

What symptoms are seen in a URI

cough, nasal congestion, conjunctivitis, hoarseness, diarrhea and oropharyngeal lesions. These symptoms are more typical of a viral infection and no testing is needed.

what is the most common infectious serotype of N. meninigitidis

Serotype B is most common in infants < 1 year and Serotype C is seen in patients between 15-24 yrs old.




B = babies


C = college students.

signs and symptoms of meningococcal septicemia

rash that begins as macules, papules or urticaria but progresses to petechiae within hours, fever, hypotension, meningeal symptoms and sometimes seizures.




meningococcemia has a fatality rate of up to 40%.

which drug is used for meningococcal prophylaxis of close contacts

rifampin. Other drugs that can be used are ciprofloxacin and 3rd gen. cephalosporins such as ceftriaxone.

signs and symptoms of acute bacterial rhinosinusitis in children

very similar to a viral URI. patients will have cough, nasal symptoms, fever, headache, facial pain/swelling, and sore throat. What helps differentiate a viral URI from ABRS is the duration and severity. Viral URIs typically resolve within 10 day...

very similar to a viral URI. patients will have cough, nasal symptoms, fever, headache, facial pain/swelling, and sore throat. What helps differentiate a viral URI from ABRS is the duration and severity. Viral URIs typically resolve within 10 days with symptoms peaking around day 6. Viral URIs may be complicated by ABRS.

Presentation of acute bacterial rhinosinusitis in children

Three potential clinical presentations:




1) Persistent symptoms: Most common. The cardinal features are nasal symptoms, cough, or both that persist for more than 10 but less than 30 days and are not improving (this point is very important).




2) Severe symptoms: ABRS can manifest with severe symptoms at onset. In children this is a fever > 39 C with concurrent purulent nasal discharge for a least 3-4 consecutive days and ill-appearance. Persistent high fever distinguishes this from viral as with viral URIs it is a low grade fever that only lasts for 1-2 days.




3) Worsening symptoms: ABRS also can present with worsening symptoms. Starts similar to a viral URI but symptoms get worse around day 6 (exacerbation of nasal discharge or cough, new headache or fever or recurrence of fever.

What bacteria cause acute bacterial rhinosinusitis

S. pneumoniae (30%), H. influenzae, nontypeable (20-40%, up to 50% Blac +), Moraxella catarrhalis (10-20%, >90% Blac +), GAS (<5%), anaerobes (usually seen with a dental infection).




Of note: these are same organisms (and roughly the same percentages) that cause acute otitis media.

DOC in acute bacterial rhinosinusitis in children

Most kids can be treated as an outpatient. Kids that are toxic appearing or have complications should get parenteral treatment.



Outpatient: Augmentin (amoxicillin/clavulanate) 45 mg/kg/day PO BID for patients that are > 2 yrs, mild-moderate severity, had no antibiotics in last 4 weeks and no daycare attendance.




In patients that are < 2 yrs, moderate-severe illness, had antibiotics in last 4 weeks, goes to daycare, recent hospitalization, immunocompromised or lives in an area with high rates of S. pneumo PCN resistance, give Augmentin 90 mg/kg/day PO BID




Clavulanate is used to overcome the Blac + organisms (H. influenza and moraxella). Treatment usually lasts for 2 weeks in children.




Inpatient: Unasyn (ampicillin/sulbactum) 200-400 mg/kg/day IV q6 or a third gen cephalosporin



what are the risk factors for getting TB

Foreign born where it has high prevalence, IV drug abuse, FHx of TB, contact with HIV + individuals, contact with jail or nursing homes, and healthcare workers.

is bacterial or viral pneumonia more common in children

viral. Up to 2/3 of pneumonia in children is due to viruses. This can be even higher in children under age 2.

DOC for community acquired pneumonia

amoxicillin 90 mg/kg/day PO div tid for bacterial pneumonia (most likely S. pneumoniae). High dose amoxicillin is divided three times a day in order to achieve appropriate concentration in the serum (short half-life in serum) in order to get a MIC high enough in the lungs to kill the pathogen. Of note: in otitis media, amoxicillin is given b.i.d because the half life is greater in the ear.




For atypical pneumonia, empiric treatment is Azithromycin 10 mg/kg PO on day 1, followed by 5 mg/kg/day PO d. for 2-5 days.

DOC for inpatients with pneumonia

In hospitalized patients that are fully immunized, ampicillin or penicillin G is recommended. Patients that are not immunized for Hib and S. pneumonia should receive ceftriaxone. Vancomycin can be added if CA-MRSA is suspected.

When is augmentin indicated for the treatment of acute otitis media

If the child: has received amoxicillin in previous 30 days, has concurrent purulent conjunctivitis or has history of recurrent acute otitis media unresponsive to amoxicillin.

what vaccinations are required in infants and children


what vaccinations are required for adults