1. Exudative pharyngitis in a child, think: group A strep, strep pneumo, EBV, adenovirus. Adenovirus also causes conjunctivitis, otitis, gastroenteritis, and hemorrhagic cystitis. If a child does not have any URI symptoms, its more likely to be strep, but if they have any URI symptoms, its much more likely to be viral, and hence antibiotics would not be indicated. Testing for ASO is not particularly useful, since there is a high carrier rate in the general population.
2. The reason for giving high-dose amoxicillin for acute otitis media is to overcome whatever resistance the bacterial strains may carry.
3. The treatment for scarlet fever is bicilin (pencillin g benzathine) a long-acting injectable penicillin. IM, in the gluteus. If you give this, watch them for 30 minutes for an adverse drug reaction: rigors, nausea. The pills (penicillin V) are large, hard to swallow, and taste bad.
4. Otitis externa is associated with pain upon movement of the pinna, and is common after swimming. Cover for pseudomonas. If you're sure its not a ruptured OM, treat with ciprodex drops: ciprofloaxcin + dexamethasone. You don't want steroids in the inner ear.
5. Ruptured tympanic membrane after AOM is not that uncommon: treat with ofloxacin.
6. For nasal congestion in a child, nasal steroids (flonase) are first-line, oral antihistamines (zyrtec) are second-line. You can also run saline through their nose, and then suction it out with a bulb-- the saline loosens up the mucus.
7. Acute liver failure in pediatric populations: think viral hepatitis, wilson's disease, toxins. To track liver synthetic function, follow coags. For this reason, do not transfuse FFP/cryo or platelets in someone who's coags are down unless they have clinically significant bleeding. Use vitamin K as your main/only treatment. In liver failure, gluconeogenesis is the last synthetic function to go.
8. You cannot diagnose (or rule out) Wilson's disease based on serum Cu or ceruloplasmin levels. Serum Cu is not always elevated, and ceruloplasmin is not always low-- in fact, it is an acute phase reactant, so it may be high or normal. Cu+ is toxic to RBCs, so you will get hemolytic anemia in wilson's.
9. Kayser-Fleischer rings are the best way to diagnose wilson's disease: it will be present in 50% of kids with abdominal signs of wilson's, and nearly 100% of kids with neurological or psychiatric symptoms of wilson's.
10. Serum VMA is not a sensitive test for pheochromocytoma. You want to use serum and urine metanephrines and normetanephrines, which have sensitivities in the 95-100% range. Normetanephrines are more likely to be elevated in extra-adrenal pheo.