Master the board step 3

Pediatrics
Antibiotics to treat CF:
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Mild disease: Give macrolide, trimethoprim-sulfamethoxazole (TMP-
SMX), or ciprofloxacin.
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Documented infection with Pseudomonas or S. aureus: Treat aggressively
with piperacillin plus tobramycin or ceftazidime.
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Resistant pathogens: Use inhaled tobramycin.
Other important management considerations:
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Give all routine vaccinations plus pneumococcal and yearly flu vaccines.
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Never delay antibiotic therapy (even if fever and tachypnea are absent).
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Steroids improve PFTs in the short term, but there’s no persistent benefit
when steroids are stopped.
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Expectorants (guaifenesin or iodides) are not effective in the removal of
respiratory secretions.
Cardiology
Congenital Heart Disease (CHD)
The most common symptom of acyanotic defects is congestive heart failure.
The most common acyanotic lesions are these:
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Ventricular septal defect
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Atrial septal defect
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Atrioventricular canal
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Pulmonary stenosis
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Patent ductus arteriosus
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Aortic stenosis
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Coarctation of the aorta
In infants with cyanotic defects, the primary concern is hypoxia. The most
common defects associated with cyanosis are these:
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Tetralogy of Fallot
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Transposition of the great arteries (TGA)
Because functional closure of the ductus arteriosis may be delayed in CHD:
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CHDs that rely on the ductus will present within 1 month
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Infants with left-to-right shunting lesions will present at 2–6 months of age
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