Your host: Andy HSI family medicine resident school 13 April 2016 SEASONAL YUCK JEOPARDY Your host: Andy HSI family medicine resident school 13 April 2016

100 200 300 400 500 ‘Tis the Season When to call in sick Into the cave Critters Carpet bombing Something for the Soul?

What is the University of Washington? Example A public institution in the Pacific Northwest with a Husky named “Dubs” as its mascot What is the University of Washington?

Childhood before 6 years 100 For 100 in the season, most common ages affected by this condition. Childhood before 6 years

For 200, these people have 2 to 4 per year Adults

300 For 300, number of events for children per year. 3.2/year; cohort study from Pediatrics Vol 137, Article 45, Chonmaitree et al.

For 400, number of events in US estimated per year. 1 Billion

For 500, setting that increases risks. Daycare

100 200 300 400 500 ‘Tis the Season When to call in sick Into the cave Critters Carpet bombing Something for the Soul?

For 100 for calling in, usual duration of this condition 5 to 14 days

For 200, possible numbers of illnesses in first 2 years of life. 6-24

24-48 hours before typical symptoms 300 For 300, usual onset of viral shedding 24-48 hours before typical symptoms

41% and 33% for type 16 and type 55 rhinovirus 400 For 400, chances of getting a URI from your toddler (partner). 41% and 33% for type 16 and type 55 rhinovirus

For 500, these conditions seem to increase chances of transmission High counts in nasal washings, on hands of donor, moderate sx, greater hours in contact (>3)

100 200 300 400 500 ‘Tis the Season When to call in sick Into the cave Critters Carpet bombing Something for the Soul?

100 Into the cave for 100, www.cholesteatomasurgery.org Normal TM

200 For 200, nrsmedic.blogspot.com Retracted

300 For 300 Bulging red AOM

46%; 6% at 3 months, 23% by 6 months 400 For 400, chances of having AOM by 12 months of age. 46%; 6% at 3 months, 23% by 6 months

4-5; 4.7 compared to 2.3 for infants w/o AOM 500 For 500, infants who developed AOM had this many URIs in a year. 4-5; 4.7 compared to 2.3 for infants w/o AOM

100 200 300 400 500 ‘Tis the Season When to call in sick Into the cave Critters Carpet bombing Something for the Soul?

Bulb insufflator. How many use it? 100 In critters, for 100, this is a? intl.welchallyn.com Bulb insufflator. How many use it?

For 200, most common cause of AOM among infants without vaccines is? Strep pneumococcus

60% for cohort with AOM by 5 mos vs. 50% without AOM 300 For 300, the colonization rate by critters increases risks of AOM 60% for cohort with AOM by 5 mos vs. 50% without AOM

RSV, influenza, rhino, metapneumo, adeno; +PCR does not predict AOM 400 For 400, these critters cause most of URIs RSV, influenza, rhino, metapneumo, adeno; +PCR does not predict AOM

Moraxella catarrhalis; greater with RSV present, no rhino effects 500 For 500, the presence of this bacteria has higher association with AOM. Moraxella catarrhalis; greater with RSV present, no rhino effects

100 200 300 400 500 ‘Tis the Season When to call in sick Into the cave Critters Carpet bombing Something for the Soul?

Amoxicillin 80-100 mg/kg/day in 2 doses For 100 in bombing, this is the first line choice Amoxicillin 80-100 mg/kg/day in 2 doses

S pneumococcus, H influenza, Moraxella catarhalis 200 For 200, the spectrum of organisms covered are? S pneumococcus, H influenza, Moraxella catarhalis

For 300, my child got a rash the last time he had amoxicillin Could be amoxicillin rash (not allergic) or Cefdinir (14 mg/kg per day in 1 or 2 doses) 125/5 or 250/5 Alternatives: Cefuroxime (30 mg/kg per day in 2 divided doses) Ceftin, Zincacef Cefpodoxime (10 mg/kg per day in 2 divided doses) Vantin Ceftriaxone (50 mg/kg IM or IV per day for 1 or 3 days, not to exceed 1 g per day)

Amoxicillin-clavulinate (80-100 mg/kg amoxicillin 2 times per day 400 For 400, I started the amoxicillin 3 days ago and she’s still having a fever Amoxicillin-clavulinate (80-100 mg/kg amoxicillin 2 times per day

For 500, main reasons to treat aggressively Reduce ear pain and prevent persistent effusion with hearing loss and speech delay

100 200 300 400 500 ‘Tis the Season When to call in sick Into the cave Critters Carpet bombing Something for the Soul?

Chicken broth, maybe with wonton 100 For 100 in the soul kitchen, recommended for this condition Chicken broth, maybe with wonton

Saline nose drops; see Pediatric Advisor for recipe under “colds” 200 For 200, most recommended symptomatic treatment Saline nose drops; see Pediatric Advisor for recipe under “colds”

Aspirin, association with Reye Disease, 300 For 300, should not “Take 2 and call me in the morning.” Marcus Welby, MD Aspirin, association with Reye Disease, no roles for OTC cough and cold stuff, homeopathic meds

For 400, families always ask “cool or hot?” Humidifier or Vaporizer

Fluids and rest, no OTC children’s cough and cold meds 500   For 500, treatment of choice Fluids and rest, no OTC children’s cough and cold meds

Learners will participate in understanding; a)  epidemiology of seasonal diseases in children b) co-occurring risks of URIs and Acute Otitis Media based on new cohort study c) review of treatment approaches