Measles
3 C's of measles
cough, coryza, conjunctivitis
What score do you use to determine testing for strep
CENTOR
concerning look of TM indicating infection
amber color TM, or white/yellow TM. Increase vascularity, absent landmarks, thin wall, sagging bullae with fluid seen, red or purple TM.
Should be should be pearly, grey, translucent, no bulging. Should see cone of light and bony landmarks.
What age would you start using spirometry as a diagnostic
5
Tylenol and Advil dosing
Tylenol: 10 to 15 mg/kg/dose every 4 to 6 hours
Advil: Age > 6 months: Oral: 4 to 10 mg/kg/dose (maximum dose: 600 mg/dose) every 6 to 8 hours
where are Koplik spots
inside mouth by lower molars. pinpoint usually
What are cardinal signs of strep pharyngitis
fever
age 3-15
tonsillar exudate
NO cough
Anterior cervical lymphadenopathy
Treatment with TM perf or tympanostomy tubes
ciprodex 4 drops BID x 5days
Important to manage this with asthma
allergy symptoms and triggers
Prednisone dosing
Oral: 1 to 2 mg/kg/day (dosing UID or BID)
diagnostics for measles
ESR/CRP (inflammation)
Measles & rubella serology IGM (if 3 or more days after rash onset).
CXR- if suspect pneumonia.
Urine specimen or throat swab- measles viral testing. (within 4-7 days of rash onset)
Treatment for strep pharyngitis
Amoxicillin 40mg/kg/day divided BID x 10 days
If allergy: Cephalexin 25-50 mg/kg/day divided QID
Supportive: salt water gargle, lozenges, antipyretics
Treatment without TM perf
amoxicillin 80mg/kg/day divided BID
allergy: cefuroxime 40mg/kg/day divided BID
rescue inhaler and dosing
Ventolin MDI 100mcg Children 4-11 years: 1 inhalation q4-6h as needed. Increase to 2 inhalations if required.
who should receive prophylaxis after measles exposure and when
Everyone exposed within 72 hours of exposure
3 differentials for measles
Varicella or other viral exanthem
Kawasaki disease
Scarlet fever
Viral respiratory infection - rhinovirus, influenza, rsv
Infectious mononucleosis
Complication of strep throat
Scarlet fever: diffuse erythematous sandpaper like rash and strawberry tongue.
Post-streptoccocal reactive arthritis
Acute glomerulonephritis.
Peritonsillar abscess.
PANDAS
How long would you expect an effusion to last after an AOM
1-3 months
Maintenance therapy
MDI Fluticasone: Children 4-16 years: 100mcg twice daily
can you do a "watch and wait" approach in a one year old with AOM
typically do this approach in older than 2, mild cases
Treatment
Supportive: Pain management, hydration, air humidifier.
Vitamin A: Infants ≥12 months and children: 200,000 units/day PO for 2 days
Isolation x 4 days after rash.
fever above 40 degrees, signs of respiratory distress, altered mental status
when to consult ENT for tubes
Bilateral OME for 3 months of more, OR unilateral OME for 6 months or more, OR recurrent episodes of OME with cumulative duration of OME for more than 6 of the previous 12 months.
differentials
URTI
LRTI
Foreign body aspiration
Allergic reaction
GERD
Pneumonia