PAEA PEDIATRICS EOR CORRECT STUDY GUIDE
QUESTIONS AND ANSWERS SET A+
removal, suction
✔✔Dx? acute ear pain, hearing loss, break in the tympanic membrane, +/- conductive
hearing loss, +/- bloody otorrhea, +/- tinnitus & vertigo; Tx? - ✔✔dx: tympanic
membrane perforation
tx: observation (most heal spontaneously) but can do surgical repair; avoid
water/moisture/topical aminoglycoside (ototoxic) in ear
✔✔Dx: sneezing, nasal congestion/itching, clear rhinorrhea, worse in the morning,
pale/blue turbinates, +/- nasal polyps, +/- eye, ear, throat involvement; Tx? - ✔✔dx:
allergic rhinitis
tx: 1st line intranasal steroids, oral antihistamines, mast cell stabilizers (cromolyn,
nedocromil)
✔✔what are the blood vessels involved in anterior vs posterior epistaxis? which is MC
involved? - ✔✔anterior: Kiesselbach's plexus *MC type of epistaxis*
posterior: palatine artery- this one may cause bleeding in both nares and posterior
pharynx
✔✔tx for anterior epstaxis? - ✔✔-1st line is direct pressure 10-15 min in seated position
leaning forward (to reduce vessel pressure)
-topical decongestants/vasocontrictors: phenylephrine, oxymetazoline (afrin)
-cauterization: silver nitrate if cannot control bleeding and site can be seen
-nasal packing: + abx (cephalexin or clindamycin) to prevent toxic shock syndrome
-adjunct therapy: avoid exercise, spicy foods (vasodilation), moisten membranes w/
bacitracin and humidifiers
✔✔acute pharyngitis/tonsillitis is MC caused by? other causes? - ✔✔-viral is MC:
*adenovirus*, rhinovirus, enterovirus, EBV, RSV, influenza A/B, herpes zoster
,-bacterial: GABHS (strep. pyogenes "strep throat")
✔✔tx for acute viral pharyngitis/tonsillitis - ✔✔1. fever control: ibuprofen or tylenol
2. hydration
3. bed rest
✔✔Dx? pt w/ sore throat, fever >100.4F/38C, pharyngotonsillar exudates, tender
anterior cervical LAD, absence of cough and gram stain showing G+ cocci in chains -
✔✔"strep throat" streptococcal pharyngitis (strep pyogenes)
✔✔what are the Centor criteria for diagnosing strep throat? - ✔✔0-1 pts: no abx or
throat Cx (unless 3-14y get Cx anyway)
2-3 pts: Cx
4-5 pts: abx
✔✔what is the tx for strep throat? - ✔✔-1st line: PCN G or VK; others include:
amoxicillin, augmentin
-if PCN allergic = macrolides (azithromycin, erythromycin, clarithromycin) or if ADR =
cephalosporins or clindamycin
✔✔what are some complications from strep throat? - ✔✔-rheumatic fever (preventable
w/ abx)
-glomerulonerphritis (not preventable w/ abx)
-peritonsillar abscess, cellulitis
✔✔peritonsillar abscess is aka _______ that occurs after - ✔✔quinsy; tonsillitis ->
cellulitis -> abscess formation
✔✔Dx? dysphagia, pharyngitis, muffled "hot potato voice," drooling, trismus (lock jaw),
uvula deviation to contralateral side, tonsillitis, anterior cervical LAD - ✔✔peritonsillar
abscess but need CT scan to differentiate b/t cellulitis vs abscess
✔✔how is peritonsillar abscess treated? - ✔✔-abx (ampicillin/sulbactam (Unasyn),
clindamycin, PCN G + metronidazole) + aspiration or I&D
-tonsillectomy if recurrent strep infxns, peritonsillar infxns, or chronic tonsillitis
✔✔thrush is caused by? tx w/? - ✔✔candida albicans; tx is w/ nystatin mouthwash,
clotrimazole troaches or oral fluconazole
✔✔what is the most common cause of acute epiglottitis? - ✔✔H. influenzae type B infxn
(incidence has gone down d/t vaccination); other rare causes are strep pneumo, s.
aureus, GABHS (strep pyogenes)
,✔✔Dx? dysphagia, drooling, distress, fever, odynophagia, inspiratory *stridor*,
dyspnea, hoarseness, muffled voice, *tripod position*, *thumbprint sign* on lateral XR,
laryngoscopy gold standard showing cherry-red edematous epiglottis; Tx? - ✔✔dx:
acute epiglottitis
tx: maintain airway (comfort and keep child calm, dexamethasone to reduce airway
edema, tracheal intubation for severe cases) and supportive mgmt
if bacterial cause is suspected can start on 2nd/3rd gen cephalosporin ceftriaxone or
cefotaxime
✔✔diaper rash is MC caused by? tx? - ✔✔candida albicans
tx: topical antifungals, frequent diaper changes to reduce dampness in that area
can also be a contact dermatitis d/t prolonged exposure to urine/feces; tx w/ freq diaper
changes, petroleum or zinc oxide
✔✔an immediate drug reaction such as urticaria or angioedema that is Ig-E mediated is
a type ___ hypersensitivity rxn - ✔✔type I
✔✔a cytotoxic, Ab-mediated drug reaction is a type ___ hypersensitivity rxn - ✔✔type II
✔✔a drug reaction caused by immune antibody-antigen complex deposition is a type
___ hypersensitivity rxn - ✔✔type III
✔✔a delayed (cell mediated) drug reaction like erythema multiforme is a type ___
hypersensitivity rxn - ✔✔type IV
✔✔what is the most common type of cutaneous drug eruption? tx? -
✔✔exanthematous/morbiliform rash- generalized distribution of "bright-red" macules &
papules that coalesce to form plaques- usually begins 2-14 days after medication
initiation (abx, NSAIDs, allopurinol, thiazide diuretics)
tx: oral antihistamines
✔✔what is the 2nd Mc type of cutaneous drug eruption that occurs w/i minutes to hrs
after drug administration? tx? - ✔✔urticarial or angioedema (type I)- triggers include
abx, NSAIDs, opiates, radiocontrast media
tx: systemic corticosteroids, antihistamines
✔✔what is the 3rd MC cutaneous drug eruption that is characterized by target lesions?
tx? - ✔✔erythema multiforme (type IV)- triggered by sulfonamines, PCNs,
phenobarbital, dilantin
tx: symptomatic therapy
, ✔✔in regards to urticaria, local pinpoint pressure that results in the skin to wheal in that
area is called? local rubbing causing urticaria is called? - ✔✔dermatographism
Darier's sign
✔✔how is urticaria treated? - ✔✔removal of offending agent, antihistamines (H1
blockers), corticosteroids, or H2 blockers as adjuvant therapy (cimetidine, ranitidine,
famoidine)
✔✔erythema multiforme is MC associated with - ✔✔*HSV*, mycoplasma, s. pneumo,
sulfa drugs, beta-lactams, phenytoin, phenobarbital, malignancies, autoimmune
✔✔red purpuric papules and macules with a hypopigmented rim around the center and
a erythematous halo around that span the palms and soles of the feet? same lesions
but involving 1 or more mucous membranes (oral, genital, or ocular mucosa) and <10%
BSA with no epidermal detachment. - ✔✔erythema multiforme minor; major
✔✔what is the treatment for erythema multiforme? - ✔✔symptomatic- d/c offending
drug, antihistamines, analgesics, steroid/lidocaine/diphenhydramine mouthwash for oral
lesions, and systemic steroids if severe
✔✔Steven-Johnson Syndrome and TEN are usually due to what offending agents? -
✔✔MC d/t drug eruptions from *sulfa*, *anticonvulsants*, NSAIDs, allopurinol, abx,
infxns like mycoplasma, HIV, HSV, malignancy, or idiopathtic
✔✔SJS is defined as sloughing of ____% BSA where are TEN is defined as sloughing
of ____% BSA - ✔✔SJS <10%
TEN >30%
✔✔Dx? fever, URI, widespread blisters, erythematous/pruritic papules with 1 or more
mucous membranes involved with epidermal detachment (+ Nikolsky sign), <10% BSA;
tx? - ✔✔dx: SJS (if >30% = TEN)
tx: treat like severe burn- admit to burn unit, pain control, withdrawal of offending meds,
fluid & electrolyte replacement, wound care
+ Nikolsky sign is when rubbing of skin exfoliates the outer layer
✔✔what is the pathophysiology behind the 4 causes of acne vulgaris? - ✔✔1. inc
sebum production (d/t inc androgens)
2. clogged sebaceous glands
3. propionibacterium acne overgrowth (nml flora that overgrows in blocked pores and
causes an inflammatory response)
4. inflammatory response
QUESTIONS AND ANSWERS SET A+
removal, suction
✔✔Dx? acute ear pain, hearing loss, break in the tympanic membrane, +/- conductive
hearing loss, +/- bloody otorrhea, +/- tinnitus & vertigo; Tx? - ✔✔dx: tympanic
membrane perforation
tx: observation (most heal spontaneously) but can do surgical repair; avoid
water/moisture/topical aminoglycoside (ototoxic) in ear
✔✔Dx: sneezing, nasal congestion/itching, clear rhinorrhea, worse in the morning,
pale/blue turbinates, +/- nasal polyps, +/- eye, ear, throat involvement; Tx? - ✔✔dx:
allergic rhinitis
tx: 1st line intranasal steroids, oral antihistamines, mast cell stabilizers (cromolyn,
nedocromil)
✔✔what are the blood vessels involved in anterior vs posterior epistaxis? which is MC
involved? - ✔✔anterior: Kiesselbach's plexus *MC type of epistaxis*
posterior: palatine artery- this one may cause bleeding in both nares and posterior
pharynx
✔✔tx for anterior epstaxis? - ✔✔-1st line is direct pressure 10-15 min in seated position
leaning forward (to reduce vessel pressure)
-topical decongestants/vasocontrictors: phenylephrine, oxymetazoline (afrin)
-cauterization: silver nitrate if cannot control bleeding and site can be seen
-nasal packing: + abx (cephalexin or clindamycin) to prevent toxic shock syndrome
-adjunct therapy: avoid exercise, spicy foods (vasodilation), moisten membranes w/
bacitracin and humidifiers
✔✔acute pharyngitis/tonsillitis is MC caused by? other causes? - ✔✔-viral is MC:
*adenovirus*, rhinovirus, enterovirus, EBV, RSV, influenza A/B, herpes zoster
,-bacterial: GABHS (strep. pyogenes "strep throat")
✔✔tx for acute viral pharyngitis/tonsillitis - ✔✔1. fever control: ibuprofen or tylenol
2. hydration
3. bed rest
✔✔Dx? pt w/ sore throat, fever >100.4F/38C, pharyngotonsillar exudates, tender
anterior cervical LAD, absence of cough and gram stain showing G+ cocci in chains -
✔✔"strep throat" streptococcal pharyngitis (strep pyogenes)
✔✔what are the Centor criteria for diagnosing strep throat? - ✔✔0-1 pts: no abx or
throat Cx (unless 3-14y get Cx anyway)
2-3 pts: Cx
4-5 pts: abx
✔✔what is the tx for strep throat? - ✔✔-1st line: PCN G or VK; others include:
amoxicillin, augmentin
-if PCN allergic = macrolides (azithromycin, erythromycin, clarithromycin) or if ADR =
cephalosporins or clindamycin
✔✔what are some complications from strep throat? - ✔✔-rheumatic fever (preventable
w/ abx)
-glomerulonerphritis (not preventable w/ abx)
-peritonsillar abscess, cellulitis
✔✔peritonsillar abscess is aka _______ that occurs after - ✔✔quinsy; tonsillitis ->
cellulitis -> abscess formation
✔✔Dx? dysphagia, pharyngitis, muffled "hot potato voice," drooling, trismus (lock jaw),
uvula deviation to contralateral side, tonsillitis, anterior cervical LAD - ✔✔peritonsillar
abscess but need CT scan to differentiate b/t cellulitis vs abscess
✔✔how is peritonsillar abscess treated? - ✔✔-abx (ampicillin/sulbactam (Unasyn),
clindamycin, PCN G + metronidazole) + aspiration or I&D
-tonsillectomy if recurrent strep infxns, peritonsillar infxns, or chronic tonsillitis
✔✔thrush is caused by? tx w/? - ✔✔candida albicans; tx is w/ nystatin mouthwash,
clotrimazole troaches or oral fluconazole
✔✔what is the most common cause of acute epiglottitis? - ✔✔H. influenzae type B infxn
(incidence has gone down d/t vaccination); other rare causes are strep pneumo, s.
aureus, GABHS (strep pyogenes)
,✔✔Dx? dysphagia, drooling, distress, fever, odynophagia, inspiratory *stridor*,
dyspnea, hoarseness, muffled voice, *tripod position*, *thumbprint sign* on lateral XR,
laryngoscopy gold standard showing cherry-red edematous epiglottis; Tx? - ✔✔dx:
acute epiglottitis
tx: maintain airway (comfort and keep child calm, dexamethasone to reduce airway
edema, tracheal intubation for severe cases) and supportive mgmt
if bacterial cause is suspected can start on 2nd/3rd gen cephalosporin ceftriaxone or
cefotaxime
✔✔diaper rash is MC caused by? tx? - ✔✔candida albicans
tx: topical antifungals, frequent diaper changes to reduce dampness in that area
can also be a contact dermatitis d/t prolonged exposure to urine/feces; tx w/ freq diaper
changes, petroleum or zinc oxide
✔✔an immediate drug reaction such as urticaria or angioedema that is Ig-E mediated is
a type ___ hypersensitivity rxn - ✔✔type I
✔✔a cytotoxic, Ab-mediated drug reaction is a type ___ hypersensitivity rxn - ✔✔type II
✔✔a drug reaction caused by immune antibody-antigen complex deposition is a type
___ hypersensitivity rxn - ✔✔type III
✔✔a delayed (cell mediated) drug reaction like erythema multiforme is a type ___
hypersensitivity rxn - ✔✔type IV
✔✔what is the most common type of cutaneous drug eruption? tx? -
✔✔exanthematous/morbiliform rash- generalized distribution of "bright-red" macules &
papules that coalesce to form plaques- usually begins 2-14 days after medication
initiation (abx, NSAIDs, allopurinol, thiazide diuretics)
tx: oral antihistamines
✔✔what is the 2nd Mc type of cutaneous drug eruption that occurs w/i minutes to hrs
after drug administration? tx? - ✔✔urticarial or angioedema (type I)- triggers include
abx, NSAIDs, opiates, radiocontrast media
tx: systemic corticosteroids, antihistamines
✔✔what is the 3rd MC cutaneous drug eruption that is characterized by target lesions?
tx? - ✔✔erythema multiforme (type IV)- triggered by sulfonamines, PCNs,
phenobarbital, dilantin
tx: symptomatic therapy
, ✔✔in regards to urticaria, local pinpoint pressure that results in the skin to wheal in that
area is called? local rubbing causing urticaria is called? - ✔✔dermatographism
Darier's sign
✔✔how is urticaria treated? - ✔✔removal of offending agent, antihistamines (H1
blockers), corticosteroids, or H2 blockers as adjuvant therapy (cimetidine, ranitidine,
famoidine)
✔✔erythema multiforme is MC associated with - ✔✔*HSV*, mycoplasma, s. pneumo,
sulfa drugs, beta-lactams, phenytoin, phenobarbital, malignancies, autoimmune
✔✔red purpuric papules and macules with a hypopigmented rim around the center and
a erythematous halo around that span the palms and soles of the feet? same lesions
but involving 1 or more mucous membranes (oral, genital, or ocular mucosa) and <10%
BSA with no epidermal detachment. - ✔✔erythema multiforme minor; major
✔✔what is the treatment for erythema multiforme? - ✔✔symptomatic- d/c offending
drug, antihistamines, analgesics, steroid/lidocaine/diphenhydramine mouthwash for oral
lesions, and systemic steroids if severe
✔✔Steven-Johnson Syndrome and TEN are usually due to what offending agents? -
✔✔MC d/t drug eruptions from *sulfa*, *anticonvulsants*, NSAIDs, allopurinol, abx,
infxns like mycoplasma, HIV, HSV, malignancy, or idiopathtic
✔✔SJS is defined as sloughing of ____% BSA where are TEN is defined as sloughing
of ____% BSA - ✔✔SJS <10%
TEN >30%
✔✔Dx? fever, URI, widespread blisters, erythematous/pruritic papules with 1 or more
mucous membranes involved with epidermal detachment (+ Nikolsky sign), <10% BSA;
tx? - ✔✔dx: SJS (if >30% = TEN)
tx: treat like severe burn- admit to burn unit, pain control, withdrawal of offending meds,
fluid & electrolyte replacement, wound care
+ Nikolsky sign is when rubbing of skin exfoliates the outer layer
✔✔what is the pathophysiology behind the 4 causes of acne vulgaris? - ✔✔1. inc
sebum production (d/t inc androgens)
2. clogged sebaceous glands
3. propionibacterium acne overgrowth (nml flora that overgrows in blocked pores and
causes an inflammatory response)
4. inflammatory response
