Erythema Infectiousum
Etiology: Parvovirus B19
Sx: "slapped cheek appearance"
Tx: benign - resolves on its own. Most contagious prior to rash
Mumps
Etiology: tender swelling of one or more glands.
> parotid involvement is common
> orchitis and oophoritis.
Tx:supportive - fluids and analgesics.
Measles
Sx: high fever and lethargy, cold symptoms with cough
KOPLIK spots are pathognomonic
maculopapular rash noted on face and trunk - gone in 6 days
Labs: measles IgM antibody drawn at day three
Tx: supportive (resolution in 7-10 days)
Varicella
exposure occurs 2 weeks prior to rash .
Prodrome: 1-3 days of flu like illness - red macules rapidly become vesicles with surrounding erythema. "dew drops on a rose petal"
Tx: supportive: hydration - acetaminophen for discomfort.
Parenteral acyclovir for
Strep throat < 3 yrs
sx: insidious onset - mild low grade fever, discharge and pallor with otitis media.
posisble exudative pharyngitis. (uncommon)
Tx: PCN - V
strep throat > 3 years
fever - marked malaise - often with vomit
pharynx sore and edematous with tonsillar exudates
anterior cervical lymph nodes tender and enlarged
small petechia seen on soft palate.
Labs:
- rapid detection tests and cultures
- ASO titers
- high ASO titer and
Mononucleosis
EOD:
- malaise, fever, sore throat (posisble exudates)
- palatal petechiae, splenomegaly and maculopapular rash
- positive heterophil agglutination test (monospot)
- large lymphocytes in blood smear
Complications
- hepatitis, myocarditis, neuropathy
Consi
Reye's Syndrome
EOD:
- h/o URI with salicylate ingestion &Vomit & lethargy
Sx:
- irregular respirations, sluggish pupils
- liver may be enlarged
- positive babinski, hyperreflexia and posturing with high ICP
Labs: moderate to high AST/ALT with lactate dehydrogenase
- hyp
Pinworms
EOD: ANNAL PURITIS
sx: worms can be found in the bwoel wall, lumen of appendix, bladder, etc..
Labs: transparent tape test - with drop of xlene on slide to see ova
Tx: treat all household members with and repeat in 2 weeks
1) pyrantel pamoate
2) mebendazo
Influenza
Sx: fever, diarrhea, vomiting, and abdominal pain, headache, chills, infants have sepsis like symptoms
Prevention: all children 6-23 months of age = immunized
antivirals are of some benefit if started before 24 hr
Thrush
Findings:
creamy white patches on gingival surfaces
steroid inhalation for asthma = predispose
Labs: see budding yeast
Tx:
Infants = nystatin
oral azoles - fluconazole
Lyme disease
Caused:
burrelia burgdorferi from tick
Sx:
- erythema chronicum migrans - rash
- arthritis several weeks to months bite
- neuro manifents in 20% of cases. (bell's palsy, meningitis, polyradiculitis.
Dx: Elisa and immunoblot to confirm
Tx:
Rash <8 = amoxic
Chlamydia trachomatis
most common STD
Sx: PID like sx
NAAT is the most senstive test
Tx; doxy or azithromycin
Nesseria gonorrhea
2nd most common STD
Sx: mucopurulent cervicitis with yellow d/c
Labs: first void urine
Tx: tx for chlamydiaas well as gonorrhea
> CEFTRIAXONE
Legg Calve Perthes Disease
What: vascular supply to femur head is limited = necrosis
Who: 4-8 years old
Sx: persistent pain, limp or limited ROM
Labs: xray!
Tx: surgery and protection of the joint
Osgood-Schlatter's
What: from jumping and running sports - microfx of the tibial tubercle
Who: pre-teen boys 12-15 and girls 11-13 years old
Pain: local to tibial tubercle= get an xray!
Tx: resovles spontaneously - treat pain with NSAIDs
SCFE:
What: slipped femoral ephiphysis due to disruption of the growth plate
Who: obese males with an unknown cause. Association with hypothyroidism
Condition occurs: following acute fall or trauma, vague sx- pain referred to thigh or medial side of knee
Tx: Pi
Genu Varus/Valgum
varum is normal for infants through 2 years and changes to valgum until age 8 when adult alignment is obtained.
- varum - knees out
- valgum - knees in
SIDS
sudden infantdeath syndrome < 1 year that remains unexplained.
Peak age = 2-4 months usually occuring between midnight and 8am when both infant and parents are sleeping.
Risk: low birth weight, teenage or drug addicted mothers, maternal smoking, and famil
Juvenille Rheumatoid Arthritis
What: mono/poly arthropathy with a tendency to involve large joints or poximal interhapalngeal joints and lasting > 3 months
Sx: systemic with fever, erythematous rashes nodules, fatigue
Labs: HLA-DR5 associated with iritis and antinuclear antibodies
HLA-
Scoliosis
who: girls 8-10
associated disease: neurofibromatosis, marfan, CP, muscular dystrophy, poliomyleitis, myelodysplaisa
Sx: pain is present there is a strong chance that scoliosis is secondary to another disease
Treatment:
- < 20 degrees - not require
- 20-4
Hip dislocation
Ususally POSTERIOR dislocation (shoudler - anterior)
* leg is flexed, aDDucted, and externally rotated
**
emergency!
**
transport to ortho surgeon to reduce. protected weight bearing.
complications: severe bleeding, avn, and nerve damage.
hip dysplasia
what: abnormal growth or development.
Dx:
- ortolani (ouch) - pushing hip back into place
Barlow back - pressure with hip coming out of the joint
Tx: pavlik harness - first few eeks of life. Puts patietn in a flexed position
Hip Spica! - surgery
foreign bodies
Where: lodge at cervical esophagus, aortic arch, and LES
Sx: substernal chest pain, and increased salivation secondary to instability to swallow.
PE: normal unless perforation
Labs: xray of chest will normally identify foreign body (not if radiolucent lik
gastric and small bowel foreign bodies:
**most pass thorugh esophagus will go the rest of the way without difficulty
** if it doesn't pass within three days it should be removed via endoscopy
Obstruction:
> may occur if item becomes lodged at ileocecal valve
Small disk batteries: "button" batte
Juvenille DM- type 1
IDDM
associated with dimished isulin production with patients who are ketosis prone. Damage to islet producing B cells of pancreas.
Sx: polyuria, polydipsia, and weight loss, glycosuria on routine UA in office or random glucose > 300.
Tx: regular insulin
Type 2 DM
insulin 12-19 yrs old - < 7.5
insulin 6-11 yrs old - < 8%
< 5 yrs - 7.5-8%
PKU
D/T decreased activity of phenalalanine hydroxylase
Sx: pts with untreated PKU exhibit mental retardation, hyperactivity, seizures, light complexion and eczema
> screen for PKU 24 hrs post birth
Dx: high levels of serum phenylalanine
causes mental retarda
Hyperbilirubinemia
...
Syphillis
trans: in utero by tranplacental passage of treponema pallidum
Complications; still birth or prematurity
Sx in infant < 2 yrs - mucocutaneous lesions, lymphadenopathy, hepatosplenomegaly, bony changes,
Sx in >2 yrs- hutchinson teeth, mulberry molars, chor
Fetal Alcohol Syndrome
Dx: facial abnormaliteis (short palprebral fissures, thin upper lip and indistinctive or smooth philtrum) growth deficiency, and evidence of CNS damage and neuro abnormalities
Tx: Psychopharmacologic intervention needed to address issues like mood
Urinary Tract Infections
Cause - fecal flora (E. Coli)
Sx: newborns and infants, hypothermia, poor feeding, vomiting, strong, foul-smelling urine
Labs: midstream clean catch (pyuria > 5), urine function assessed with BUN/Cr
Imaging: U/S of kidneys if suspect pyelo/voiding cystour
Hemolytic Uremic Syndrome
What: most common glomerular vascular cause of acute renal failure in childhood (diarrhea = shigella or e.coli)
Source: ingestion of undercooked ground beef E. coli 157: h7
Presenting complaint: bloody diarrhea, hemolysis and renal failure
S&S: prodrome o
Testicular torsion
types
1) intravaginal torsion (bell-clapper deformity) - most common
2) extravaginal torsion - neonates and those with undescended testicles
S&S:
scrotal or testicular pain to lower abdomen
cremesteric reflex = absent
prehn sign (lifting of the testicles
phimosis
What: inability to retract foreskin to epxose the glans
can be d/t recurrent balanitis
Treatment: circumcision
paraphimosis
what: inability to reduce a previously retracted foreskin. Prepuce is fixed in a retracted position.
Tx: manual reduction (if fails - dorsal slit)
Cryptorchidism
what: undescended testicles is common. often unilateral and right sided. Infertility and testicular malignancy are risk factors
Findings: 2-6 mo
LH, FSH, and testosterone determine whether the testis are present
> HCG test is done to confirm teh asbence o
Acute glomerulonephritis (post strep)
post strepdisease in recent history (7-14 days) documented by culture of ASO titer
Presentation: gross hematuria (coffee/tea colored urine) with / without edema
abx therapy if strep inf is still present
acute abnormalities resolve in 2-3 wks
Enuresis
what: urinary incontinence in a child > 5 yrs of age
no real cause.
common in boys with FH of bed wetting issues
tx: fulis limited before bed.
Desmopressin acetate intranasally at bedtime
Wilm's tumor
WAGR synrome (wilms tumor, aniridia, ambiguous genitalia, mental retardiation) - most common in 2-5 yrs of age (not common after 6
Sx: increasing size of abdomen or asx abdominal mass incidentally discovered by parent or health care provider.
> smooth, fi
Down Syndrome
1:600 newborns (risk factor if mom is > 35)
mental retardation is characteristic
Physical findings: brachycephalic head, characteristic facies (up-slanting palprebral fissure, epicanthal folds, midface hypoplaseia, and small dysplatic pinna)
* 1/3 have co
Sickle Cell disease EOD
> neonatal screening test FS, FSC, or FSA
> african, middle eastern, idian, carribian, mediterranean
> anemia, elevated reticulocyte count, jaundice
> recurrent episodes of muskuloskeletal or abdominal pain.
> Hemoglobin electrophoresis with S > F
> splen
S&S of sickle cell
> children normal at birth and sx unusual before 4 mo b/c of high fetal hemoglobin that inhibits sickling
> increase chance of gall stones due to severe sickling
> slenomegaly resulting in functional asplenia = greater risk for infection with encapsulated
Tx of sickle cell
> pt and family education
> prophylactic PCN started at 2 mo and continued till age 5
> red cell transfusion
> daily hydroxyurea increases levels of fetal hemoglobin
ITP: idiopathic thrombocytopenia purpura
Decreased platelet count, petechiae, ecchymoses
> most common bleeding disorder of chidhood (2-5 yrs)
> follows viral infection
> petechiae on lips, bucal mucoasa and epistaxis
Labs
> platelet count is low, bleeding time prolonged.
Tx
> none, <10,000 uL r
Thrombocytopenia in a newborn
most common cause of purpura in a newborn.
> consider with petechiae or significant bleeding tendency
> platelet count less than 150,000 uL = dx
> Inf and intervascular coagulation syndormes are most common causes of thrombocytopenia
Disorders of platelet function
inherited or acquired (acquired is more common)
> acquired disorders may occur secondary to uremia, cirrhosis, sepsis, myeloproliferative disorders, acyonotic heart disease and viral infection
> Tx: desmopressin acetate
Factor 8 deficiency (hemophilia A)
CLASSIC
> BRUISING, BLEEDING, HEMARTHROSES
> prolonged PTT and reduced factor 8 activity
> males, x linked disorder
Tx
> attempt to prevent and stop bleeding, desmopressing, admin factor 8
Factor 9 deficiency (hemophilia B)
Christmas disease
> similar to factor 8
Treatment
> factor 9 concentrate
Factor 11 deficiency (hemophilia C)
> danger if trauma or surgery - need intervention
> treatment = FFP or desmopressin
Von Willebrand disease
easy bruising and epistaxis from early childhood. Also menorrhagia
> bleeding tim eusually prlonged
> platelet count usually normal
> reduced activity or abnormal structure of vonwillibrand factor
> abnormality in vWF a plasma protein that forms a multime
Acquired Bleeding disorders- DIC
> prolonged Pt, PTT or thrombin time, decreased fibrinogen and platelets> primary mediator of DIC is interleukin 6
> leads to thrombin generation, intravascular fibrin deposition, and platelet consumption.
> trigger DIC: endothelial cell damage, tisseu de
Acquried bleeding disorders and liver disease
> liver is the major synthetic site of prothrombin, fibrinogen, and many other factors
> it also produces plasminogen and three physiologic anticoagulants
Tx:
replace with FFP and platelets, desmopressin may shorten bleeding time
Acquried bleeding disorders and Vitamin K def
all newborns have a depressed activity of vitamin K - if vit K is not given at birth a bleeding diathesis may occur
uremia
bleeding occurs in 50% of renal fialure patients
manifests as purpura, menorrhagia, or GI bleeding
Tx: infusion of desmopressin, red blood cells and FFP
Klinfelter's syndrome
tall, thin and long limbed obese adults (scoliosis)
> mild developmental delays, hypogonadism
Turner Sydrome
> monosomy X
> short stature, webbed neck, prominent earls, low hairline, broad chest with widely spaced nipples, amenorrhea, horsehoe kidney, CoA
Fragile X syndrome
pale blue irises, long narrowed facies, autism, MVP, protruding ears
iron def anemia
> pallor, fatigue, irritability, delayed motor developmen
> history of pica
Labs: decreased serum ferritin and low serum iron, elveated total iron binding capcity, and decreased transferring stauration
Tx:
> oral dose of elemental iron is 6 mg/kg/d in thr
ALL
acute lyphoblastic leukemia
> most common in kids (25% lymphoblasts) age 4 = peak
Sx:
pallor, petechiae, purpura
hepatosplenomegaly, lyphadenlpathy
Labs
multiple cytopenias (1/2 with leukocytosis)
Dx: confirmed by bone marrow examination
Induction therapy
AML- acute myeloid luekemia
more common in adults
> auer rods
Sx: fatigue, bleeding inf, adenopathy, hepatosplenomegaly, skin nodules
Cytopenia (neutropenia)
Long term survival = 50%
Overall < response to treatment and requires chemo
Chronic Myelogenous Leukemia
Philadelphia chromosome
> nonspecific complaints - massive splenomegaly, variable hepatomegaly
> Marked leukocytosis, elevated platelets, decreased to absent leukocytes alk phos
Tx:
> hydroxyuria used to reduce or elminate Ph+ cells
Hematopoietic stem cel
Lead poisioning (plubism)
Sx: vague. include weakness, irritability, weight loss, vomiting, personality changes, ataxia, constipation, colicky abdominal pain
late manifestations: include retarded development, convusions, and coma
Labs: blood lead levels , CBC, serrum ferritin, nor
Hemachromatosis
EOD
- dx b/c of elevated iron saturation or serum ferritin or FH
- most pts are asx, recognized ebfore the fourth decade
- hepatic abnormalities and cirrhosis, congestive heart failure, hypogonadism, and arthirtis
- HFE gene mutation found in most cases
-
HSP
- with strep infection and PCN
- small vessel vasculitis with purpura of LE/buttocks
- IgA depsoits in glomeruli
- palpable prupura - non blanchable red papules over extremiteis
Tx: systemic corticosteroids
Gastroesophageal Reflux
LES relaxation
GER vs. GERD - concerned for dz if there is wt loss, blood
Complications
> ALTE - baby turns blue post vomitus
Tx: keep baby upright (PPIs don't work as well)
* non-bilious vomiting is from above the ampulla
Pyloric Stenosis
Occurs b/t 4-6 wks of age, mostly males
> projectile nonbilious emesis = olive, peristalsis
> metabolic derangements- creates an alkalotic state, loss of K+ and HCl (hypokalemic, hypochloremic metabolic alkalosis)
> u/s diameter of pylorus 4-14mm
> pyloro
Congential obstructive lesions
> atresias - esophageal and duodenal
> annualar pancreas
> webs
> swallowed items: lactobeazor, coins, etc.
Dx: clinical or xray
Tracheoesophageal fistulas
most common - blind pouch
dx: feeding tube put in, visible on xray
Infections (that cause vomiting)
gastroenteritis - rotavirus most common
labrynthitis, otitis media
pancreatitis
UTIs or Pyelonephritis
appendicitis, helicobacter pylori
pneumonia, sinusitis (from post-nasal drip, post tussive
meningitis
Metabolic/endocrinologic
(inborn errors of metabolism)
& vomiting
diabetes: vomiting is a common complication of type 1
congenital adrenal hyperplasia
addison's disease
Neurologic issues & vomiting
>> increased ICP, hydrocephalus
>> meningitis: babies are born with only two sinuses (maxillary and ethmoid)
>> brain abscess
>> encephalitis
>> brain tumors
bilious vomiting
always pathological
duodenal atresia
usually second portion of the duodenum
1 in 7500 births
failure of recanalization of intestines during early gestation
malrotation
during embyrology, fibers attach to liver instead of attaching to spleen
volvulus
twisting of bowel on itself
it is a medical emergency, may become necrotic and lead to short gut syndrome
Hirshbrung disease
absence of ganglionic cells
- CLINICALLY suspect if they have not had a BM within the first 48 hrs of life
Transition zone - area without ganglionic cells will always be in contraction, shows "STRING sign"
Diagnosis - barium swallow
Tx: pull through proce
Intussusception
telescoping of one portion of the bowel into its distal segment
> MC terminal ileum into the cecum
> result of lymphatic hypertrophy in the pyer's patches from a recent viral infection
Age: 2 yrs is average.
Clinical - severe abdominal pain and vomitting
Necrotizing entercolitis
deadly disease seen in premature babies whose intestines are not yet fully developed. Wall is susceptible to infx. Stomach appears purpuric
Hematemesis
usually benign in chlidren
> naspharynx, resp.
> esophageal
> gastroduodenal - from H. pylori
> maternal - not a problem, swallowed during birth
> maternal - not a porblem, swallowed during birth
> coagulopathy
History of vomitus
character of vomiting
> degree
> force
> frequency
> duration
> timing
> appearance
associated sx - fever, h/a dizzy, pain, jaundice, nasuea, change in mental status
Malrotation
> midgut extends from duodenojejunal junction to the mid transverse colon (suppled by SMA) which runs root of the mesentary
Sx:
infants present within first three weeks with bile stained vomit
> ascites or meconium peritonitis
> malsabsorption, protein lo
Umbilical Hernia
more common in preterm infants and black
> if it persitsafter four yearsof age it should be repaired surgically
Inguinal Hernia
Indirect - process vaginal remains open - peritoneal fluid may go into it. *most common
Direct - less common
Sx: most cases - painless inguinal swelling. "fullness" with periods of standing or coughing.
Tx: incarceration of hernia is likely to occur in bo
Protein deficiency
Causes: severe skin disease and burns, CF
Impaired growth, lethargy, irritability, edema, hepatomegaly
Tx: adjust treatment
carb deficiency
causes: diarrhea, malabsorption, improper diet, excess results in DM and obesity
Tx: diet adjust
Vitamin K deficiency
aids in formulation of coagulation
hemorrhagic purpura
vitamin K levels, prolonged PT time
Tx: IM, vitmain K injection
Fluroide deficiency
Incorporated into tooth matrix, resistance to dental caries
> found in most public water sources.
> increased dental caries, discolored, teeth
Tx: supplementation after 6 mo
Iron deficiency
Causes: breast fed infants, untreated maternal aemia
pallor, fatuge, pica, increased ferritin, TIBC, decreased iron
Tx: food high in iron, supplementation
Gastroenteritis
viruses are the most common cause
> rotavirus is the most common (affects small intestine causing voluminous watery diarrhea
> trasnmitted fecal oral route
Sx: low grade fever, watery diarrhea
Diagnosis and treatment of rotavirus gastro
> incubation for 24-48 hrs
> vomiting is the first symptom in most pateints followed by low grade fever and watery diarrhea
> diarrhea lasts 4-8 days (no blood or white cells)
> metabolic acidosis results from bicarb loss in the stool
> rotavirus identifi
E. Coli Gastroenteritis
E. coli may cause diarrhea of varing types
Tx: seldom requires antimicrobial treatment
fluid and electrolyte therapy
bismuth subsalicylate reduces stool volume by 1/3 in infants with watery diarrhea
traveler's diarrhea with bactrim in chidlren with fluroq
enterotoxigenic e. coli
mild self limiting illness without sig fever or systemic toxicity
> known as traveler's diarrhea
HUS - short cut
hemolytic uremic syndrome
> 2-5% of children and is characterized by microangiopathic hemolytic anemia, thrombocytopenia and renal failure
Salmonella Gastroenteritis
Sx: n/v/headache, meningismus
fever, diarrhea, abdominal pain
culture or organism from stool, blood or other specimens
Consider: > fowl and reptiles carry transmit to humans by fecal oral route
Sx:
> fever, vomiting, diarrhea
> stools watery and have mucu
Peritonsillar Cellulitis or Abscess (Quinsy)
Most common pathogen: B hemolytic strep
C/O: severe sore throat, high fever, tonsil bulges and anterior tonsillar pillar is prominent, uvula displaces towards uninvolved side, fullness and tenderness, can cause airway obstruction
Tx: aspirate, admit w/ IV
Acute Viral Pharyngitis & Tonsillitis
90% due to viral infections
Infectious Mononucleosis
exudative tonsillitis, generalized cervical adenitis, and fever (older than 5 yrs) w/ palpable spleen or axillary adenopathy.
Labs
> positive monospot (false - in children less than 5)
> EBV shows elevated IgM
> amoxicillin is contraindicated in patietns
Herpangina
What:
> 3 mm in size surrounded by a halo found on anterior tonsillar pillars, soft palate and uvula.
> anterior mouth and tonsils are spared
Caused by Coxsackie A group of viruses, and a patient may have several bouts of ulcers.
Tx: self limiting
Hand, Foot and Mouth Disease
D/t Enteroviruses
> vesicles, pustules or papules found in palms, soles, interdigital areas and butt, mouth and face
Pharyngoconjunctival fever
> d/t adenovirus - can be epidemic
Sx: exudative tonsillitis, conjunctivitis, lyphadenopathy, and fever
Tx: symptomatic
Acute Bacterial Pharyngitis
10% with sore throat & fever =group A strep infection
Untx strep can result in = acute rheumatic fever, glomerulonephritis, and suppurative complciations.
Sx: > SOre throat, odynophagia, fever, h/a, cervical node,s palatal petechiae, beefy red uvula, and
Epiglottitis
D/T = H. influenzae type B
Sx: sudden onset of fever, dysphagia, drooling, muffled voice, inspiratory retractions, cyanosis and soft stridor, sit in the "sniffing dog position"
Dx: made by inspection of the epiglotitis = cherry red
Imaging: lateral radiog
Otitis Externa
> inflammation of the skin lining the ear canal. loss of protective function of cerumen. swimming is common culprit
> Staph aureus or pseudomonas aeruginosa
Sx: pain and itching when chewing or pressure on tragus. swollen
Tx: topical treatment with floqro
Otitis Media
Most common ear infection in young chidlren
Sx: pain, fever, decreased hearing often happens after a cold
Tx: abx, decongestants, nasal irrigation, steroid
amoxicillin - covers Strep pnumo, H. influ, moraxella ?
Augmentin
Surgery: myringotomy
Myringotomy limitations
> average tube stays in 9-12 months, comes out on own
> enlarged adenoids
- adenoidectomy - proven to decrease incidence of OM
Indications for tonsillectomy and adneoidectomy
> seven epsidoes of tonsillitis in the past year
> five episodes of tonsillitis each year for teh past two years
> three episodes of tonsillitits each year for the past three years
Indications for myringotomy
>> severe oitits media (middle ear inf)
> hearing loss greater than 30dB with effusion present for greater than three months
> poor response to abx
> impending mastoiditis or intracranial complications
> recurrent AOM (> 3 eipsodes in 6 mo or more than 4
anterior epistaxis
Cause: kisselbach's plexus
Dx: H&H, CBC, bleeding time
Management:
> ABC
> direct pressure. Pinch nostrils and sit forward
> cautery - chemical, electric, thermal, silver nitrate sticks
> use of vasoconstrictors sprays, anesthetic agets.
> atnerior packin
Posterior epistaxis
Cuase: branch of the sphenopalatine artery
Dx: H&H, CBC, bleeding time
Management:
> attempt to locate source
> vasocnstrictive agetns
> posterior nasal packing
> otolaryngologist referral
> prophylactic abx
> hospitalziation and monitoring
> surgery / em
acute viral rhinitis (common cold)
What; virual upper respiratory infection) - most common pediatric infectious disease
> children younger than 5 yrs typically have 6-12 colds per year
EOD
> clear or mucoid rhinorrhea, nasal congestion, sore throat
> possible fever, particfularly in young
Rhinorsinusitis
sinusitis
Acute bacterial Rhinosinusitis
> ALWAYS proceeded by viral URI
> diagnosis made hwen child does not improve 10-14 days
> maxillary and ethmoid isnuses are most commonly invovled
> S pneumoniae, H. flu, M catarrhalis, and B hemolytic strep
Complications
> eyelid edema, restricted EOM, p