Pediatric Vignettes PDF

2/12/25, 5:04 PM OneNote Assignment Info for Students (if none, leave blank) Submission Instructions, Due Date, and Time Graded-Yes or No Osmosis Playlist https://www.osmosis.org/playlist/...

2/12/25, 5:04 PM OneNote Assignment Info for Students (if none, leave blank) Submission Instructions, Due Date, and Time Graded-Yes or No Osmosis Playlist https://www.osmosis.org/playlist/hx8Gff5Dyg4 Some repeats from the case intro RAP Educational Objectives Session Objective RAP Educational Objectives Answer # Assigned Student 02-4400 Describe the approach to pediatric fever Management of Fever in Infants and Young Child Elyse Cerda Recommendations for the evaluation and treatm neonates from birth to 28 or 30 days of age young infants one to three months of age older infants and young children three to 3 Factors that suggest serious infection include age poor arousability petechial rash delayed capillary refill increased respiratory effort overall physician assessment Urinary tract infections are the most common se So evaluation for such infections should be Abnormal white blood cell counts have poor sens Procalcitonin and C-reactive protein levels, when Chest radiography is rarely recommended for chi Lumbar puncture is not recommended for childre it may also be considered for those from on Protocols such as Step-by-Step, Laboratory Score Rapid influenza testing and tests for coronavirus General Antibiotic Choices When empiric treatment is appropriate, suggeste neonates. For children three months to three years of age, Urinary infections antibiotics --> cefixime, a Choice of antibiotics should reflect local pa Epidemiology Incidence of bacteremia and meningitis has decre Rates of invasive group B streptococcal infection Illnesses caused by Listeria are also declining, coi Incidence of urinary tract infections (UTIs) is incre UTIs are currently the most common serious bact History and Physical Examination Children with known immunocompromise, prem Studies show that physicians’ global assessment t Other predictors of serious bacterial infection inc https://catmailohio-my.sharepoint.com/personal/cw427624_ohio_edu/_layouts/15/Doc.aspx?sourcedoc={434df08f-0ff3-4dc1-9da7-6963d7f38995}&ac… 5/19 2/12/25, 5:04 PM OneNote No single clinical sign has a negative likelihood ra Normal blood pressure readings are not necessar Laboratory Testing and Imaging Urinalysis and Urine Culture Urine sample should be obtained in any ch ○ pain or crying with urination ○ foul-smelling urine ○ previous UTI ○ signs of severe illness ○ absence of severe cough ○ **Not all children with UTI will develo UTI is diagnosed by the presence of both p ○ Pyuria is defined by at least five whit Urine culture is considered positive when g Samples retrieved with urine collection bag recommend obtaining urine samples with s Blood cell counts and cultures More recent studies have found that cell co Newer algorithms de-emphasize the comp Blood cultures are recommended for evalu In children three months and older without recommended without signs Inflammatory markers Inflammatory biomarkers procalcitonin (PC PCT measurements have several desirable ○ They are not affected by administrat ○ PCT values rapidly increase beyond t Lumbar puncture Lumbar puncture for cerebrospinal fluid cu The procedure is not recommended in infa Imaging Chest radiography is recommended for mo Viral Testing (Influenza, COVID, etc) During influenza season, children younger t During influenza season, children younger t Risk Assessments Step-by-Step had greater sensitivity for invasive b Table 3 shows the management of unexplained f https://catmailohio-my.sharepoint.com/personal/cw427624_ohio_edu/_layouts/15/Doc.aspx?sourcedoc={434df08f-0ff3-4dc1-9da7-6963d7f38995}&ac… 6/19 2/12/25, 5:04 PM OneNote 02-4401 Describe the presentation of pediatric chlamydial pneumonia and treatment Background Matt Rohl Chlamydiae are small obligate, gram-negative, in pathogenic to humans: Chlamydia trachomatis, the genera Chlamydia, and C pneumoniae and C pneumoniae can cause sinusitis, bronchitis, pneu C. trachomatis Chlamydia trachomatis is primarily transmitted p It is a common cause of neonatal pneumonia in S/S Gradual onset with persistent staccato cough. Tachypnea (rapid breathing). Absence of fever (differentiating it from bacteria Rales (crackles) on auscultation, but wheezing is 50% of cases have a history of conjunctivitis Labs/CXR Chest radiography reveals hyper-infation with b Laboratory testing reveals an eosinophilia (eosin Tx Erythromycin (50 mg/kg/day divided into 4 dose https://catmailohio-my.sharepoint.com/personal/cw427624_ohio_edu/_layouts/15/Doc.aspx?sourcedoc={434df08f-0ff3-4dc1-9da7-6963d7f38995}&ac… 7/19 2/12/25, 5:04 PM OneNote - Monitor for infantile hypertrophic py - Alternative: Azithromycin for 5 days. If patient is > 8 y/o recommended to use Doxycy S. Pneumonia Infects the respiratory tract epithelium, causing pneumonia. The organism can result in an illness with a prolo Airborne transmission S/S Infections occur most commonly in late winter a May be asymptomatic Mild to severe respiratory symptoms. Prolonged dry cough (often lasting weeks). Pharyngitis, sinusitis, and bronchitis may preced Can mimic pertussis (whooping cough). Possible association with asthma. Labs/CXR · Chest X-ray: Bilateral nodular or ground-glas · Serologic testing (MIF test): IgM titer ≥1:16 Tx A high percentage of children will have their clin most fluoroquinolones but not ciprofoxacin. Erythromycin (40–50 mg/kg/day for 14 days). Alternative regimens: - Clarithromycin (15 mg/kg/day for 7 - Azithromycin (10 mg/kg on day 1, th - Doxycycline (for children >8 years; 4 Feature Chlamydia trachom Transmission Perinatal Age Group Neonates (3–19 weeks) Onset Gradual Fever Absent Cough Staccato (nonproductive) X-ray Hyperinflation, interstitia Findings infiltrates Diagnosis eosinophilia Treatment Erythromycin or Azithro 02-4402 Describe the presentation and management of common pediatric viral infections There is a lot of information, but Dr. Guilonard said Breanna Vance in the pre-record :) Virus Presentation Measles 3 days of the 3 Cs and fever The 3 Cs Cough Coryza ○ Runny nose Conjunctivitis ○ Non-purulent ○ "Watery, not goop (Doesn’t look like Koplik spots Bluish-white spots are slightly raised ○ By upper mo https://catmailohio-my.sharepoint.com/personal/cw427624_ohio_edu/_layouts/15/Doc.aspx?sourcedoc={434df08f-0ff3-4dc1-9da7-6963d7f38995}&ac… 8/19 2/12/25, 5:04 PM OneNote Pathognomonic (c measles ○ Resolve 1-2 onset Rash Dark red/erythem Maculopapular Starts on face, mo and chest, than ou days ○ Then it is co together eve ○ Per pre reco know that th "cephalocau centrifugally Kids look SICK and MISERABL Possible Complications ○ Otitis media ○ Croup ○ Bronchitis ○ Pneumonia ○ Encephalitis Either from the m ○ Subacute sclerosing pa Chronic and prog Always fatal 7-11 years after ○ Occurs in 4-11 per 100 ○ Death 1 in 1000 in deve Pneumonia, enc Rubella (German Relatively mild (as long as pa Measles) Slight fever Conjunctivitis, cough, ○ Some cases: cory Lymphadenopathy ○ Sometimes befo ○ Usually posterio Rash kind of looks like ○ Starts on face, sp ○ Lasts 3 days Milder and Congenital Rubella: Maternal rubella durin ○ High rate of misc Congenital anomalies ○ Ophthalmologic, ○ Can present with Blueberry https://catmailohio-my.sharepoint.com/personal/cw427624_ohio_edu/_layouts/15/Doc.aspx?sourcedoc={434df08f-0ff3-4dc1-9da7-6963d7f38995}&ac… 9/19 2/12/25, 5:04 PM OneNote Mumps Fever for 3-5 days Anorexia Trismus (spasm of jaw musc Salivary gland swelling Usually parotid gland For 7-10 days Orchitis Testicular pain and sw Possible testicular atro Happens in 1/3 of post Rotavirus Fever Vomiting For 1-2 days Followed by stinky, pro ○ Dehydration and diarrhea Human Grouped into 2 types: Papillomavirus Cutaneous (HPV) ○ Common ○ Skin warts, plantar w ○ Benign ○ Mucosal ○ Low risk Upper respira ○ High risk Can cause pre Cervica Hepatitis B Symptoms vary Subacute Anorexia, nausea, mal Clinical hepatitis with j Fulminant hepatitis ○ Rare ○ Severe liver failu Can have non-hepatitis symp Arthralgia, arthritis Rash Glomerulonephritis Risk for chronic hepatitis inc Can lead to hepatic fai https://catmailohio-my.sharepoint.com/personal/cw427624_ohio_edu/_layouts/15/Doc.aspx?sourcedoc={434df08f-0ff3-4dc1-9da7-6963d7f38995}&a… 10/19 2/12/25, 5:04 PM OneNote Hepatitis A Acute, self-limiting Doesn't cause chronic Fulminant hepatitis ve ○ Only in people w Symptoms Fever, malaise, jaundic Usually lasts less than ○ 10-15% relapse u Cytomegalovirus 10% of infants with congenit Jaundice (conjugated h Petechiae from throm (Herpesvirus 5) ○ Little red spots ○ Non-blanching (Doesn't g ○ Pools of blood d Most severe: purpura ○ "Blueberry muff ○ Microcephaly Leading cause of nongenetic 20% have hearing loss 25% have hearing loss Herpes Simplex Usually establishes lifelong la Virus 1 and 2 Might not always show Frequent reactivation HSV-1 Traditionally thought o Face/mouth lesions Secondary tran finger ○ Nail biter Called herpetic ○ Primary infection: Gingivostomatitis Children: Fe submandibu https://catmailohio-my.sharepoint.com/personal/cw427624_ohio_edu/_layouts/15/Doc.aspx?sourcedoc={434df08f-0ff3-4dc1-9da7-6963d7f38995}&a… 11/19 2/12/25, 5:04 PM OneNote Red, swollen and mucous Sometimes lesions Pain someti dehydration Pain c HSV-2 Traditionally thought o ○ Genital Both HSV-1 and HSV-2 cause Neonatal HSV (3 common m Disseminated Involves multiple orga Localized CNS disease May still have skin, eye Localized to skin, eyes, and/o Can occur anytime between Influenza Begins with onset of fever Accompanied with: ○ Cough ○ Chills ○ Myalgia ○ Headache ○ Malaise Can also include respir GI symptoms not com ○ Might be more c Infants and young children Otitis media Croup Bronchiolitis Pneumonia https://catmailohio-my.sharepoint.com/personal/cw427624_ohio_edu/_layouts/15/Doc.aspx?sourcedoc={434df08f-0ff3-4dc1-9da7-6963d7f38995}&a… 12/19 2/12/25, 5:04 PM OneNote Adenovirus Can be subclinical When clinical Mild cold symptoms More severe Mimic flu symptoms Fever, malaise, myalgi Can include… ○ Exudative tonsili ○ Follicular conjun ○ Gastroenteritis ○ Clinical pearl: Kid routinely has ad ○ Young infants or immunocom Disseminated infection Severe lower respirato ○ Pneumonia, bro Hepatitis Meningitis, encephalit Respiratory Per Dr. Guilonard: "disease o Syncytial Virus All ages: respiratory tract inf Most infants: URI symptoms 20-30%: Lower respira ○ Bronchiolitis Starts with Progresses Incre Whe Rale Crac Inte Grun Nasa +/- fever Neonates and preterm infan Very sick Lethargy Irritability, poor feedin Apnea ○ Even without ot Rhinovirus Sore throat Nasal congestion Nasal discharge Starts clear, becomes ○ Color of nasal di Fever, malaise, headache, co Can lead to otitis media and Can also cause asthma Norovirus Abrupt vomiting And/or watery diarrhe Abdominal cramps Nausea Can include: Fever, myalgia, malais https://catmailohio-my.sharepoint.com/personal/cw427624_ohio_edu/_layouts/15/Doc.aspx?sourcedoc={434df08f-0ff3-4dc1-9da7-6963d7f38995}&a… 13/19 2/12/25, 5:04 PM OneNote Epstein Barr Asymptomatic to fatal Virus Aka Mononucleosis Human Herpesviru Symptoms s 4 (HHV4) Fever Pharyngitis ○ Can be exudative ○ Lymphadenopathy Hepatosplenomegaly Rash in 20 % (rash also Atypical: lymphocytosis Important to remembe Parvovirus B19 Characteristic rash preceded "Fifth Fever, malaise, myalgi disease" "Erythema Rash Infectiosu Very erythematou m" circumoral pallor ○ "slapped che Rash appears on b ○ Symmetric, ○ Often prurit ○ Moves to ar thighs ○ Can look wo sunlight ○ Can last for Stops RBC production for 10 Usually okay, since RB Sickle cell anemia ○ RBCs only last 10 ○ Severe aplastic c Human HHV6B causes Roseola in 20 Herpesviruses 6 20% are asymptomatic and 7 Roseola Rhinitis, sore throat, co High fever (103F/39.5 ○ May cause febri ○ Do not look as si When fever resolves (w Rash Maculopapu Or ma Mildly eryth Nondescript Diffuse on c abdomen May s and ex Not uncomf https://catmailohio-my.sharepoint.com/personal/cw427624_ohio_edu/_layouts/15/Doc.aspx?sourcedoc={434df08f-0ff3-4dc1-9da7-6963d7f38995}&a… 14/19 2/12/25, 5:04 PM OneNote Enteroviruses Usually a nonspecific febrile Respiratory (upper and (Specifically Skin symptoms non-polio ○ Non-specific enteroviruses) ○ Hand, foot, and Vesicular e soles of fe Underlying Can also cause neurolo ○ And cardiac issu Varicella Zoster Primary infection: chickenpo Virus Shingles/Herpes Zoste Pregnant women can have s Can lead to fetal demis Chickenpox Rash ○ "Dewdrop on a ○ Erythematous, ○ Hundreds of les stages Low grade fever +/- systemic symptom Complications Secondary bacterial in Sepsis Pneumonia CNS involvement thrombocytopenia Shingles After initial infection ○ VZV is latent in Reactivation often ha or illness Vesicular skin lesions together ○ Dermatomal (1- ○ 3+ = might be im Prodrome ○ Pain and pruriti ○ Where vesicles Recurrent shingles is ○ Evaluate for im occurs Molluscum Benign infection that can las Contagiosum Rash Discrete flesh colored ○ Central umbilica https://catmailohio-my.sharepoint.com/personal/cw427624_ohio_edu/_layouts/15/Doc.aspx?sourcedoc={434df08f-0ff3-4dc1-9da7-6963d7f38995}&a… 15/19 2/12/25, 5:04 PM OneNote One Drive Pdf link of the Pediatric Vaccine Schedul Vaccine and Immunization Schedule_0-18yrs-child-c Session Objectives Session Objective # Session Objectives Facilitator Notes 4410 * Describe an approach to fever in a neonate < 1 month of age 1. Recognition and Initial Assessment Maura Donnelly Definition of Fever: Temperature ≥ 100.4°F rectally History: ○ Perinatal history (e.g., maternal infections, premature rupture ○ Symptoms (poor feeding, lethargy, irritability, respiratory dist ○ Sick contacts or recent exposures Physical Exam: ○ Assess for signs of sepsis (poor perfusion, hypotonia, tachypne ○ Look for localized infections (umbilical stump, skin, ears, joints 2. Laboratory and Diagnostic Workup All febrile neonates should undergo a full sepsis workup, including: Blood culture and CBC with differential Urinalysis and urine culture (via catheterization or suprapubic aspir Lumbar puncture (LP) with CSF analysis and culture Inflammatory markers: CRP, procalcitonin (can aid in risk stratificat Chest X-ray (if respiratory symptoms) Viral testing (if clinically indicated, e.g., RSV, enterovirus, HSV PCR if 3. Empiric Antibiotic Therapy Ampicillin + Gentamicin or Ampicillin + Cefotaxime (for broad Gram Consider Acyclovir if HSV is suspected (maternal history of HSV, ves 4. Hospital Admission All neonates 2 seconds, lethargy Local signs of infection: Redness, tenderness, or purulent discharge at th 2. Initial Management Obtain cultures: Blood cultures from both the central line and a peripheral vein (if Consider cultures from multiple areas of the central line. Assess for other sources of infection: Urinalysis, chest X-ray, and other 3. Empiric Antibiotic Therapy Start broad-spectrum IV antibiotics ASAP (after cultures are drawn). Options depend on the child’s risk factors: Low-risk, stable child: Vancomycin + Cefepime OR Vancomycin + P High-risk (septic shock, immunocompromised): Add an aminoglyc Consider antifungal therapy (e.g., echinocandins) if prolonged cen https://catmailohio-my.sharepoint.com/personal/cw427624_ohio_edu/_layouts/15/Doc.aspx?sourcedoc={434df08f-0ff3-4dc1-9da7-6963d7f38995}&a… 16/19 2/12/25, 5:04 PM OneNote 4. Central Line Management If the child is stable, do not remove the line immediately. If there are signs of severe sepsis, purulence at the site, or persistent ba If Gram-negative rods (high-risk for antibacterial resistance – E. coli, P. a 5. Further Workup & Monitoring Daily blood cultures if bacteremia is confirmed. Monitor WBC, CRP, procalcitonin, and organ function. Assess response to treatment within 24-48 hours. Adjust antibiotics based on culture results. 6. Long-Term Considerations Prevent recurrence: Good central line care, sterile dressing changes. Duration of therapy: Uncomplicated CLABSI (no endocarditis, osteomyelitis): 7-14 day Complicated cases: May require 4-6 weeks of therapy. 4412 * Discriminate childhood exanthems: Roseola, Rubella, Measles, and Sumana Pothrai Fifth's disease Exanthem: Clinical Manifestations: Roseola (clinical erythematous maculopapular rash app manifestation of human once fever resolves herpesvirus 6 and sometimes can last hours to days 7) appears in ~ 20% of HHV-6B infections Rubella Postnatal Rubella: 20-50% of adults with postnatal rubell asymptomatic generalized erythematous maculopapu rash, lymphadenopathy, and slight feve Starts on face, becomes generalized in hours, lasts ~3 days Lymphadenopathy of posterior auricul suboccipital lymph nodes can be gener and lasts ~5-8 days Cough, headache, coryza, and palatal enanthema 1-5 days before rash Encephalitis and thrombocytopenia are complications Congenital Rubella Syndrome: Maternal rubella during pregnancy can to miscarriage/fetal death/congenital anomalies (ophthalmologic, cardiac, auditory, neurological) Neonatal growth restriction, interstitial pneumonitis, radiolucent bo disease, hepatosplenomegaly, thrombocytopenia and dermal erythropoiesis One of thew few known causes of autis https://catmailohio-my.sharepoint.com/personal/cw427624_ohio_edu/_layouts/15/Doc.aspx?sourcedoc={434df08f-0ff3-4dc1-9da7-6963d7f38995}&a… 17/19 2/12/25, 5:04 PM OneNote Measles Fever, cough, conjunctivitis, and a maculopapular rash, starting on the fac Koplik spots may appear during t prodromal period Common complications are otitis medi bronchopneumonia, croup and diarrhe Acute encephalitis occurs in 1 in 1,000 and death in 1-3 per 1,000 Higher fatality rates in children under 5 pregnant women, and immunocompro children Measles inclusion body encephalitis oc in immunocompromised individuals, w subacute sclerosing panencephalitis (S develops 7-11 years after infection Measles weakens the immune system, increasing susceptibility to other infect Fifth's Disease (Parvovirus Erythema infectiosum/Fifth disease B19) "Slapped cheek" rash, followed by a maculopapular rash Mild systemic symptoms like fever may precede the rash by 7-10 days Arthralgia and arthritis are common in adults, especially women Other manifestations: asymptomatic infections, mild respiratory illness, atyp rashes, PPGSS, polyarthropathy, chron anemia in immunocompromised patien and transient aplastic crisis in hemolyti anemia Rare complications: acute hepatitis, myocarditis, encephalopathy, and hemophagocytic lymphohistiocytosis During pregnancy, infection can cause hydrops, growth restriction, and fetal d (2-6% risk), but not congenital anomali 4413 * Discriminate HSV infections Herpes Simplex Virus Sam Zemis Manifestation: Hallmarks of common HSV infection: skin vesicles and shallow evolving into shallow minimally erythematous ulcers, vesicular nonclassic presentations. Acute Oropharyngeal infections: Her onset, pain in mouth, drooling, refusal to eat or drink, and feve may be more extensively distributed than typically seen with e may manifest as pharyngitis and tonsillitis rather gingivostoma infections, most common site is vermilion border of the lip, bur complete healing w/o scarring occurs usually w/in 6-10 days. Herpes Whitlow-term generally applied to HSV infection of fing fingers, HSV-2 herpes whitlow occasionally develops in an ado tender and may appear to contain pus, little flude is present (a days; Genital Herpes-common in sexually experienced adoles transmission, symptomatic and asymptomatic individuals perio https://catmailohio-my.sharepoint.com/personal/cw427624_ohio_edu/_layouts/15/Doc.aspx?sourcedoc={434df08f-0ff3-4dc1-9da7-6963d7f38995}&a… 18/19 2/12/25, 5:04 PM OneNote may be proceeded by a short period of local burning and tende progressing to the pustular stage and then crusting, may expe MOST SEXUAL TRANSMISSIONS AND MATERNAL-NEONA SHEDDING EPISODES, genital infections caused by HSV-1 a may involve the conjunctiva, cornea, or retina and may be prim rarely purulent discharge, lesions may be seen on lid margins can produce ulcers that are escribed as appearing dendritic or common cause of recurrent aseptic meningitis (Mollaret Menin birth process, or during the neonatal period, most cases of neo genital herpes), transmission is well documented in infants del of infection, portal of entry, and extent of spread, intrauterine in that are present at delivery, few survive without therapy, skin, e encephalitis typically present at 8-17 days of life with clinical fin Treatment: three antiviral drugs are available in the US-acyclovir, valacycl whitlow: no clinical trials assessing the benefit of antivirals; ecz strategic options regarding the management of recurrent infect suppressive therapy-with acyclovir, famciclovir, valacyclovir https://catmailohio-my.sharepoint.com/personal/cw427624_ohio_edu/_layouts/15/Doc.aspx?sourcedoc={434df08f-0ff3-4dc1-9da7-6963d7f38995}&a… 19/19