CMN 568 MODULE 5
UTI in children - answerE. coli/fecal flora most common organism
Newborn UTI symptoms - answerfever, hypothermia, jaundice, poor feeding, irritability,
FTT, vomiting & sepsis
Preschool UTI symptoms - answerabdominal & flank pain, vomiting, fever, urinary
frequency, dysuria, urgency or enuresis
School age UTI symptoms - answerfrequency, dysuria, urgency; CVA tenderness
Gold standard for UTI - answerUrine culture
Renal U/S recommended in all infants after first febrile UTI
UTI tx - answeramoxicillin, trimethoprim-sulfamethoxazole, or first get cephalosporin x
7-10 days
Glomerulonephritis features - answerhematuria, edema, HTN & RBC casts in urine
Glomerulonephritis assessment - answeruof B/P, renal function, serum albumin & urine
protein excretion
Acute postinfectious glomerulonephritis - answerdiagnosis related to recent infection of
group A B hemolytic strep; no tx
Cryptorchidism - answerundescended testis
can cause infertility and testicular malignancy if untreated
measurement of LH, FSH, inhibin B & testosterone can help determine if testes are
present in infants between 2 to 6 months of age
surgical orchidoplexy if descent not occurring before 6-12 mo
Anxiety in children - answerCBT w/ exposure has the most evidence regarding
successful tx
SSRIs can be started in as young as 6 yo (not fda approved tho)
, Low dose fluoxetine or sertraline first line; check for suicidal thoughts or agitation w/in 1-
2 weeks; try second SSRI if first doesn't work
SSRIs can work within days
Stranger anxiety - answer5 mo-2½ y, with a peak at 6-12 mo
Separation anxiety - answer7 mo-4 y, with a peak at 18-36 mo
GAD - answerhighly heritable; the symptoms must cause significant distress or
disturbance of function and be present for at least 6 months
fatigue, restlessness or poor concentration, irritability, feeling on edge, or sleep
disturbance
Tx = Duloxetine, must be >7;
SSRIs (escitalopram or paroxetine) or SNRI (venlafaxine or duloxetine) 1st line
Benzos - answerfor acute anxiety relief in adults
OCD - answersudden onset should alert pediatrician for group A strep infections
psychoeducation first step in tx, best treated w/ CBT + meds, exposure and response
prevention
fluvoxamine and sertraline (SSRI) approved for peds ocd
clomipramine (TCA) for adults
Depression in children - answerdysphoric mood (tearful, sad, downturned expression,
anger, quick temper, slumped posture, unhappiness), mood lability, irritability or
depressed appearance, persisting for weeks to months at a time
tx = lexapro, must be >12 or fluoxetine, must be >8
Depression signs - answerChildren and younger adolescents are more likely to present
with an irritable mood state and older adolescents with a sad mood more similar to
adults
Major depressive disorder - answerwhen several depression symptoms cluster together
over time (2 weeks or more), are consistent & cause impairment
Dysthymic disorder - answerwhen depressive symptoms are of lesser severity but have
persisted for a year or more
PHQ-9A - answerself reporting scale / annual screen for depression starting at 12 yo