BRS #1 Flashcards
1
Q
causes of congenital microcephaly
A
TORCH toxo other- syphilis rubella CMV herpes simplex
also in utero drugs and toxins and chromosomal abnormalities
2
Q
causes of acquired microcephaly- born with normal head circumference
A
perinatal asphyxia
intraventricular hemorrhage
craniosynostosis
late prenatal and perinatal infections
3
Q
iron deficiency anemia peaks between _____ and ____ months
A
9 and 15
4
Q
a common cause of iron deficiency anemia
A
introduction of cow’s milk before 9 months of age
5
Q
most patients with elevated lead levels have sxs (T/F)
A
F
6
Q
contraindications to circumcision
A
hypospadias, prematurity, bleeding diathesis
7
Q
most common organism in nursing or bottle caries
A
strep mutans
8
Q
oral vitamin D supplementation is recommended in patients exposed to minimal sunlight during _______
A
first year of life
9
Q
infant walkers are helpful for developing gross motor (T/F)
A
F- these walkers have a risk of injury
10
Q
ADHD is more common in ______ (girls/boys)
genetics play a large role (T/F)
A
boys
T
11
Q
tx for ADHD
A
first line: stimulants
second line: clonidine, TCAs
12
Q
ADHD and _________ may be genetically related
A
tourette’s
13
Q
childhood hearing loss is _____% genetic and ______% others
A
80% genetic- autosomal recessive
20% others
14
Q
good prognostic factors for hearing loss
A
- inherited deafness > acquired deafness
- older age of onset (acquire language structure before deafness)
- earlier interventions/diagnosis
15
Q
what to check for hearing loss
A
H&P
genetics eval if needed
Cr (Alport syndrome)
viral serologies (TORCH)
16
Q
leading causes of blindness in children
A
- trachoma infection in developing nations- MCC blindness worldwide
- retinopathy of prematurity
- congenital cataracts
17
Q
haptic perception
A
feeling someone’s face to form a mental image of them (used by blind people)
18
Q
define colic
A
crying that lasts > 3 hours/day and occurs > 3 days/week
19
Q
colic occurs in __% of newborns
A
10%
20
Q
time period of colic
A
begins 2-4 weeks
resolves by 3-4 months
21
Q
nocturnal enuresis is more common in ____ (boys/girls)
A
boys
22
Q
strong familial tendency for nocturnal primary enuresis is supported by a gene on chromosome ____
A
13
23
Q
enuresis patient has large volumes of dilute urine… may be an issue with ____
A
vasopressin (diurnal variation)
24
Q
labs to get for enuresis
A
UA/UCx, others as appropriate
25
tx for enuresis
behavioral training (alarm systems, rewards, etc)
DDAVP
imipramine (TCA)
26
day night reversal/random sleeping is normal during _______
first few weeks of life
27
sleeping through the night: sleeping more than ______ after midnight for a 4 week period
5 hours
| 50% of infants sleep through the night by 3 months
28
nightmares occur during _____ and night terrors occur during ______
nightmares: REM
| night terrors: stage 4 non-REM
29
typical age range for temper tantrums
age 1-3
30
breath holding spells are involuntary, harmless, and always stop by themselves (T/F)
T
31
cyanotic vs. pallid spells
cyanotic: cries until cyanotic --> apneic and unconscious
pallid: unexpected event --> hypervasovagal --> pale and limp
32
management of breath holding spells
it's ok... it's not harmful
+/- giving iron
if spells are precipitated by exercise or excitement, get an EKG to r/o arrhythmia
33
toilet training ages
bowel: 29 months (16-48 months)
bladder: 32 months (18-60 months)
34
discipline techniques by age
before 6 months: no discipline
6-18 months: distraction and redirection
18 months- 3 years: time out, ignoring, disapproval
preschool: logical consequences
>5 years: negotiation and restriction of privileges
35
unusual to see hand preference before age _____
18 months
36
appropriately uses household objects in imitation
| what age is the child?
15-18 months
37
cerebral palsy leads to loss of milestones (T/F)
F
| it is non progressive
38
language development
13 months- uses 3 words that the parents understand, play peek-a-boo and patty-cake
15 months- understand > 20-30 words but only use 12-15 words
18 months- can point to 3-5 body parts, uses 20-30 words, beginning to put together 2-word phrases
24 months- multiple telegraphic two-word sentences
30 months- adjectives and adverbs, ask questions, sentences longer than two words
39
age range for symbolic play
24-30 months
40
cause and effect starts around _____
9 months
41
object permanence age
9 months
42
mama and dada age
9-12 months
| usually have 1-3 additional words by 12 months
43
separation anxiety age
6-18 months
44
immature pincer (can hold small object between thumb and index finger) age
9 months
45
transfer objects and sit alone age
6 months
| -babbling
46
parachute reaction age
8 months
47
average duration of growth spurt
2-3 years
48
growth is mainly controlled by this hormone
growth hormone
49
growth spurt occurs _______ earlier in females than in males
18-24 months
50
average duration of puberty
3-4 years
51
adrenarche
onset of adrenal androgen steroidogenesis
| occurs 2 years before maturation of HPG axis
52
puberty begins ______ later in males than in females
6-12 months
53
________ at age 11-12 is the first sign of puberty in males
testicular enlargement
54
facial and axillary hair growth starts _____ after pubic hair growth
2 years
55
puberty begins with _________ at age 9.5 in females
thelarche (development of breast buds)
56
menarche generally occurs at age _____, 2-3 years after thelarche
12.5
57
3 stages of adolescence
early (10-13)
middle (14-17)
late (18-21)
58
FSH in males and females
males: induces spermatogenesis
females: stimulates ovarian follicle development, stimulates ovarian granulosa cells t to produce estrogen
59
LH in males and females
males: induces testicular Leydig cells to produce testosterone
females: stimulates ovarian theca cells to produce androgens, corpus luteum to produce progesterone, midcycle surge results in ovulation
60
testosterone in males and females
males: linear growth and muscle mass, hair growth, increases libido, depends voice, external genitalia development
females: linear growth, pubic and axillary hair
61
estradiol in males and females
males: increases rate or epiphyseal fusion
females: breast development, triggers mid-cycle LH surge, labial/vaginal/uterine development, growth of proliferative endometrium, linear growth
62
progesterone
no male function
| females: converts endometrium to a secretory endometrium
63
adrenal androgens in males and females
males: pubic hair, linear growth
females: pubic hair, linear growth
64
tanner stages for testes and pubic hair
1: preadolescent, no hair, prepubertal testes
2: testes larger, sparse long downy hair
3: testes further enlarged, penis length enlarged, darker coarser and curlier hair
4: darkening of scrotal skin, penis enlarges, coarse and curly pubic hair extending over symphysis pubis
5: adult size testes and penis, adult type pubic hair spreads to medial surface of thighs
65
tanner stages of breast development
1: preadolescent
2: elevation of breast and nipple as small projections (breast bud)
3: enlargement of breast, no separation of areola and breast, areola enlarges
4: areola and nipple project to form secondary mound above level of breast
5: only nipple projects, areola recess to contour of breast
66
tanner stages for female pubic hair
1: nothing
2: sparse, long, downy hair along labia
3: darker, coarser, curlier hair
4: coarse and curly adult-type hair covering symphysis pubis
5: adult type hair spread to medial thighs
67
STDs to test for in adolescent who is sexually active
```
gonorrhea
chlamydia
syphilis
trichomonas
HPV
```
68
3 most common causes of death in teens
unintentional injuries, homicide, suicide
69
MC drug of abuse in teens
| MC illicit drug of abuse in teens
alcohol
| marijuana
70
binge drinking: _____ or more drinks at one time
5
71
____of teens are sexually active by the end of high school
| ____of teens do not use any contraception
50% for both questions
72
3 MC STDs in the US
HSV, HPV, chlamydia
73
3 causes of vaginitis
trichomonas, bacterial vaginosis, candidal vulvovaginitis
74
malodorous, profuse, yellow green discharge
strawberry cervix
vulvar inflammation and itching
dyspareunia
trichomonas vaginalis
75
how to dx trichomonas vaginalis
wet mount
culture
vaginal pH > 4.5
76
tx for trichomonas vaginalis
oral flagyl (metronidazole)
77
grey white thin vaginal discharge
pungent fishy odor --> whiff test
little vaginal or vulvar inflammation
clue cells
bacterial vaginosis
78
how to dx BV
whiff test with KOH
clue cells on wet mount
vaginal pH > 4.5
79
tx for BV
oral metronidazole or topical intravaginal therapy with 2% clindamycin or 0.75% metronidaole gel
*unlike with trich, partners don't need to be treated
80
severe itching
white cur like vaginal discharge
vulvar and vaginal inflammation
candidal vulvovaginitis
81
how to dx candidal vulvovaginitis
wet mount of KOH shows fungal hyphae
normal vaginal pH < 4.5
positive yeast culture
82
how to tx candidal vulvovaginitis
oral fluconazole or topical intravaginal anti yeast therapies
*partners don't need to be treated
83
causes of cervicitis
gonorrhea, chlamydia, HSV, syphilis
84
dx and tx chlamydia
dx with PCR
tx with oral doxycycline, erythromycin, or azithromycin
*partners need to be treated
85
tx for gonorrhea
IM ceftriaxone OR
single dose oral therapy with ofloxacin, cefixime, or ciprofloxacin
*partners need to be treated
86
tx for PID
inpatient:
outpatient:
inpatient: IV cefoxitin + oral doxycycline OR IV clindamycin + IV gentamicin
outpatient: 14 days ofloxacin and clindamycin OR single dose IM ceftriaxone and 14 days doxycycline
this may all be outdated
87
causes of genital ulcers
HSV 1 and 2, syphilis, H ducreyi (chancroid)
88
MC STD
genital warts
89
strains of HPV that cause cervical cancer
16 and 18
90
Tzanck smear for diagnosing ____
HSV 1 and 2
91
tx for HSV caused genital ulcers
acyclovir
92
tx for primary syphilis ulcer
IM penicillin or oral doxycycline if allergic to penicillin
93
tx for chancroid
oral azithromycin, erythromycin, or IM ceftriaxone
94
3 phases of the menstrual cycle
follicular (proliferative) phase
-begins with pulsatile release of GnRH --> release of FSH and LH
ovulation phase
-LH surge secondary to peaking estradiol levels
luteal (secretory) phase
-corpus luteum makes progesterone --> secretory endometrium --> as corpus luteum involutes, progesterone and estradiol decrease, leading to endometrial sloughing and GnRH release
95
primary vs. secondary dysmenorrhea
primary- pain not associated with nay pelvic abnormality
| secondary- pain due to pelvic abnormality (endometriosis, PID, bicornuate uterus, etc)
96
primary amenorrhea
no menstrual bleeding by age 16 if normal secondary sexual characteristics
no menstrual bleeding by age 14 if no normal secondary sexual characteristics
97
secondary amenorrhea
no menses for 3 cycles or 6 months after having had regular cycles
98
in amenorrhea, what does FSH and LH being high or low indicate
high FSH and LH- ovarian failure --> check for Turners
| low FSH and LH- hypothalamic or pituitary suppression or failure --> check visual fields and neuroimaging
99
frequent, irregular menstrual periods, often associated with prolonged painless bleeding
dysfunctional uterine bleeding (DUB)
100
polymenorrhea
regular intervals of < 21 days
101
menorrhagia
prolonged or excessive uterine bleeding that occurs at regular intervals
102
metrorrhagia
uterine bleeding that occurs at irregular intervals
103
menometrorrhagia
prolonged or excessive bleeding that occurs at irregular intervals
104
oligomenorrhea
bleeding that occurs at regular intervals but no more often than every 35 days
105
DUB can result from ______ cycles
anovulatory
106
______ should be used for all DUB associated with anemia
```
hormonal therapy (ex. OCPs)
iron
```
107
if hormonal therapies fail for DUB, can do this
D&C
108
how to tx gynecomastia in teenage boy who is otherwise normal
reassurance
| resolves in 12-15 months
109
absent cremasteric reflex on side of testicular pain
torsion of the spermatic cord
110
how to tx testicular torsion
surgical detorsion and fixation within 6 hours
111
how to dx testicular torsion
physical exam
| decreased uptake on radionuclide scan or decreased pulsations on doppler ultrasound
112
blue dot sign assoc with ______
torsion of testicular appendage
113
radionuclide scan and doppler are ____ in torsion of testicular appendage
normal or increased
114
how to tx torsion of testicular appendage
reassurance, rest, analgesia
115
radionuclide scan and doppler are ____ in epididymitis
increased
116
cryptorchidism
undescended testes
| risk of testicular cancer
117
hydroceles
collections of fluid in tunica vaginalis
118
dx and tx of hydroceles
dx: H&P, transillumination of scrotum reveals cystic mass
tx: reassurance
119
dilation and tortuosity of veins in the pampiniform plexus
varicoceles
120
varicoceles are most common on the _____ (left/right) and feel like _______
left
| bag of worms
121
how to tx varicoceles
reassurance
122
puberty in boys begins with _______ and in girls begins with _________
testicular enlargement
| breast enlargement
123
menarche occurs _______ after thelarche
2-3 years
124
STD- single painless ulcer with well-demarcated border and non purulent base, painless inguinal adenopathy
syphilis chancre
125
STD- painful ulcers that have irregular borders and a purulent base, painful inguinal adenopathy
chancroid
126
STD- multiple painful shallow ulcers, but base is not purulent
HSV
127
ziehl-neelsen stain
acid fast bacilli
128
silver stain
fungal elements
129
wright stain
stool WBCs
130
fever in children
> 100.4 (38) by rectal measurement
131
high fever in children
> 102.2 (39)
132
evaluation of fever in infants < 3 months
| what tests do you send?
```
CBC
bcx
UA/ucx
CXR
CSF
```
133
fever in infants < 3 months
| when to hospitalize?
if < 28 days, hospitalize no matter what
if between 28 days and 3 months, hospitalize if:
-toxic appearance
-suspected meningitis
-pna, pyelonephritis, bone and soft tissue infection unresponsive to oral abx
-patients in unstable social circumstances
134
abx management of infants < 28 days with infection
IV abx in hospital until cultures clear
135
abx management of infants 29 days-3 months with infection
if high risk, then hospitalize and give IV abx
| if low risk, then outpatient and give IM abx
136
low risk criteria for children < 3 months with infection/fever
```
well appearing
previously healthy
no recent abx
no site of focal infection
WBC between 5000 and 15000
absolute band count < 1500
normal UA (< 5 WBCs
normal CSF
```
137
most likely organism causing fever in children 3-36 months
strep pneumo
| HIB is on the decline since the vaccine
138
how to manage kids 3-36 months with fever
-if toxic --> complete eval, admit, abx
-if nontoxic and temp < 102.2 (39) --> monitor at home
-if nontoxic and temp > 102.2 (39) --> do the tests below
ucx for males < 6 months and females < 2 years
bcx
CXR if respiratory distress, rales, tachypnea
stool cx if blood or mucus in stool
empiric abx (for all children or for those WBC > 15,000)
re-eval in 24-48 hours
139
suspected sepsis or meningitis in 0-1 month
| pathogens and empiric abx
group B strep
E Coli
Listeria
-ampicillin + gentamicin or cefotaxime (+ acyclovir if concerned for HSV infection)
140
suspected sepsis or meningitis in 1-3 months
| pathogens and empiric abx
group B strep
strep pneumo
listeria
-ampicillin + cefotaxime (+ vanco if bacterial meningitis suspected)
141
suspected sepsis or meningitis in 3 months-3 years
| pathogens and empiric abx
strep pneumo
HiB
N meningitidis
-cefotaxime (+ vanco if bacterial meningitis suspected)
142
suspected sepsis or meningitis in 3 years-adult
| pathogens and empiric abx
streppneumo
N meningitidis
-cefotaxime (+ vanco if bacterial meningitis suspected)
143
FUO duration
at least 8 days-3 weeks
144
3 most common general causes of FUO
infectious disorders
rheumatologic disorders
malignancy
145
fever, peritonitis, pleuritis, and monoarthritis
familial mediterranean fever
146
period fever, pathos stomatitis, pharyngitis, cervical adenitis (PFAPA)
period fever syndrome
147
for FUO, when to hospitalize
generally recommended for children with fever > 2 weeks
148
highest incidence of bacterial meningitis is during _____
first month of life
149
fever may be absent or minimal in very young infants with bacterial meningitis (T/F)
T
150
LP findings in bacterial meningitis
lots of WBCs (100-50,000) predominantly neutrophils (PMNs)
hypoglycorrhachia (low CSF glucose)
increased protein
positive gram stain and culture
151
steroids can be given with first dose of abx with _____ meningitis
HIB
152
most common complication of bacterial meningitis in a child
hearing loss (up to 25%)
153
LP findings in viral meningitis
10-1000 WBC (mostly lymphs)
RBCs if HSV encephalitis
normal to high protein
normal glucose
154
LP findings in TB meningitis
10-500 WBCs (mostly lymphs)
very high protein!
low to very low glucose
**note, imaging will show basilar enhancement
155
LP findings in fungal meningitis
25-500 WBCs (mostly lymphs)
normal to high protein
low glucose
156
LP findings with parameningeal focus (brain abscess)
10-200 WBCs (can be polys or lymphs)
high protein
normal glucose
157
MCC of viral meningitis in the US (common in summer and fall)
enterovirus
158
how to tx aseptic meningitis
most viral meningitis is self-limited, exception: tx HSV encephalitis
tx with TB meningitis with isoniazid, rifampin, pyrazinamide, and streptomycin, +/- steroids
159
when do various sinuses develop?
ethmoid and maxillary present at birth
sphenoid: 3-5 years
frontal: 7-10 years
160
acute, subacute, and chronic sinusitis
acute: up to 30 days
subacute: 30-90 days
chronic: > 90 days
161
top 3 organisms implicated in sinusitis
strep pneumo
H flu
Moraxella catarrhalis
162
tx for acute and subacute sinusitis
amox, amoxicillin-clavulanate or second gen cephalosporin for 10-14 days
163
tx for chronic sinusitis
trial of broad spectrum oral abx
ct IMAGING
IV abx may be beneficial
164
common viral and bacterial causes of pharyngitis
```
coxsackievirus, EBV, CMV
strep pyogenes (group A beta hemolytic strep aka. GABHS or "strep throat")
```
165
pharyngitis with enlarged posterior cervical lymph nodes, malaise, hepatosplenomegaly
EBV pharyngitis
166
pharyngitis with painful vesicles or ulcer on posterior pharynx and soft palate (herpangina), +/- blisters on palms and soles
coxsackievirus pharyngitis
| +/- hand foot and mouth disease
167
signs that it's GAHBS pharyngitis > viral cause
```
lack of other URI sxs (no rhinorrhea or cough)
exudates on tonsils
petechiae o n soft palate
strawberry tongue
enlarged tender anterior cervical LNs
fever
scarlatiniform rash
```
168
what kind of pharyngitis has "gray, adherent tonsillar membrane"
diphtheria
169
tx GAHBS pharyngitis
oral penicillin VK
single dose of IM benzathine penicillin
if penicillin allergic --> oral erythromycin or macrolides
170
tx EBV pharyngitis
may consider steroids if it's really severe
171
tx diphtheria pharyngitis
oral erythromycin or parenteral penicillin and a specific antitoxin
respiratory isolation!
172
fluid within the middle ear space w/o sxs of infection
otitis media with effusion (OME)
173
bacterial causes of acute otitis media
strep pneumo
non typeable H flu
moraxella catarrhalis
174
most reliable method of detecting middle ear fluid
pneumatic otoscopy
175
tx for AOM (acute otitis media)
abx are controversial but if you give anything, give amoxicillin
-no abx for OME (otitis media with effusion)
176
common pathogens in otitis externa
pseudomonas
staph aureus
candida albicans
177
tx for otitis externa
if mild --> acetic acid to restore natural environment of the external auditory canal
if more severe --> topical abx +/- topical steroid
if caused by perforated AOM --> oral and topical abx
178
common causes of cervical lymphadenitis
staph aureus is most common
strep pyogenes
mycobacteria
bartonella henselae (cat scratch disease)
EBV, CMV, HIV
kawasaki disease- unilateral cervical lymphadenitis
Toxoplasma gondii- looks like mono with cervical LAD
179
initial management of cervical lymphadenitis
tx for the most common cause: staph
| first ten cephalosporin or anti-staph penicillin for 7-10 days
180
common causes of parotitis
mumps and CMV, EBV, HIV, influenza --> bilateral
| bacteria such as staph aureus, strep progenies, and mycobacteria tuberculosis --> unilateral
181
how to tx parotitis
| viral and bacterial
viral- supportive care
| bacterial- abx that cover staph aureus and strep pyogenes
182
superficial skin infection involving the upper dermis, honey colored crust
impetigo
183
causes and tx of impetigo
staph aureus, GABHS (strep pyogenes)
| tx with topical mupirocin, oral abx such as dicloxacillin, cephalexin, or clindamycin
184
skin infection involving the dermal lymphatics
| tender erythematous skin with a distinct border- face and scalp are common places
erysipelas
185
common cause of erysipelas
GABHS
186
tx of erysipelas
abx against GABHS
187
skin infection occurring within the dermis
| infected skin border is indistinct
cellulitis
188
common causes of cellulitis
staph aureus and GABHS
189
tx for cellulitis
first gen cephalosporins or anti-staph penicillins
190
unilateral bluish discoloration on the cheek of a young unimmunized child... what is it and what is the causative agent?
buccal cellulitis
| HIB
191
how to manage buccal cellulitis
IV abx against H influenza (2nd or 3rd gen cephalosporin like cefuroxime or cefotaxime)
LP to eval for meningitis
192
most common cause of perianal cellulitis
GABHS
193
cause of nec fasc is often _________ but may involve _____ and ______
polymicrobial
GABHS
anaerobic bacteria
194
in staph scalded skin, you may see ______ sign
| how to tx?
Nikolsky
| good wound care, IV abx against staph aureus
195
scarlet fever is caused by a toxin produced by _______ infection
GABHS
| can be impetigo, cellulitis, pharyngitis, etc
196
exanthem of scarlet fever
- begins on trunk and moves peripherally
- skin is erythematous with tiny skin colored papules and has the texture of sandpaper
- rash blanches with pressure
- petechiae distributed in skin creases (pastia's lines)
- desquamation as it's resolving
197
how to tx scarlet fever
oral penicillin VK
IM benzathine penicillin
if PCN allergic --> erythromycin or macrocodes
198
complications of GABHS infections (4)
| -which ones can you prevent with abx?
- post strep glomerulonephritis: HTN and coca colored urine, can NOT be prevented
- rheumatic fever- CAN be prevented
- post strep arthritis- can NOT be prevented
- PANDAS- OCD or tic disorder after strep infection... CAN be prevented
199
fever, shock, desquamating skin rash, multi organ dysfunction
toxic shock syndrome
200
bacteria that cause TSS
staph aureus > GABHS
201
how to tx TSS
-supportive measures
-anti-staph abx
-removal of nidus of infection if applicable
+/- IVIG
202
6 criteria of TSS
6/6 = confirmed
5/6 = probable
1. temp > 101 (38.5)
2. hypotension (SBP < 90 or < 5th percentile for age)
3. diffuse macular erythroderma (looks like sunburn)
4. desquamation 10-14 days after onset of illness
5. multisystem involving, including 3 or more:
- GI- N/V/D, abdominal pain
- myalgias or elevated CK
- hyperemia of mucous membranes
- pyuria in presence of negative urine cultures or elevated BUN and Cr to 2x normal
- thrombocytopenia
- CNS dysfunction
6. negative cultures of blood, CSF, and pharynx (except for positive blood cx for staph aureus)
203
2 most common viral causes of diarrhea
rotavirus- most common agent causing gastroenteritis, common in winter months, lasts 4-7 days, positive stool ELISA, supportive tx
norwalk virus- common in all age groups esp daycares, schools, cruises, lasts 48-72 hours, supportive tx
204
diarrhea assoc with lizards and turtles, eggs, poultry, milk
- can be bloody or non bloody
- can be WBCs or not
- only treat if invasive (3rd gen cephalosporin)
salmonella
205
electrolyte finding in diarrhea
non anion gap hyperchloremic metabolic acidosis
206
when should you do a stool culture?
only if WBCs are present
207
- major cause of traveler's diarrhea
- no stool WBCs
- abx may shorten duration of sxs
ETEC
208
- watery diarrhea often in preschoolers
- no stool WBCs
- tx with oral sulfonamides or quinolones
EPEC
209
- bloody diarrhea
- can cause HUS if it's strain 0157:H7
- stool WBCs present
EHEC
210
how to tx EHEC if it gives you HUS
don't give abx as it may worsen endotoxin release
211
- bloody diarrhea, may have seizures
- stool WBCs present
- tx with 3rd gen cephalosporins or fluroquinolones
shigella sonnei
212
- most common cause of bacterial bloody diarrhea in the US
- often in poultry
- stool WBCs are present if blood is present
- tx with oral erythromycin but sxs often resolve anyways
campylobacter jejuni
213
- mesenteric adenitis, can mimic acute appendicitis
| - 3rd gen cephalosporins can be used
yersinia enterocolitica
214
- diarrhea after abx use
- pseudomembranes
- tx with flagyl (+PO vanco for resistant cases)
c diff
215
- watery diarrhea with massive water loss in foreign country
| - tx with fluid replacement, abx generally not used
vibrio cholerae
216
factors that decrease vertical HIV transmission
- low maternal viral load
- c section
- adherence to therapy and postexposure ppx
217
asymptomatic in first year but
- failure to thrive
- thrombocytopenia
- recurrent infections
- LAD
- parotitis
- recurrent difficult to treat thrush
- loss of developmental milestones
- severe varicella infection or zoster
signs of HIV in babies
218
how to monitor for HIV in babies born to infected moms
maternal antibodies persist unti 18-24 months
-do PCR monthly until 4 months --> if negative at 4 months, then infant has not been infected --> follow until they lose their maternal antibodies
219
what to give to babies at risk for HIV
- zidovudine for 6 weeks
- bactrim until negative at 4 months
- no breastfeeding
- urine CMV culture
220
what to do for babies infected with HIV
- start HAART
- ppx for opportunistic infections per age and CD4 count
- give all immunizations except the varicella (MMR is ok)
- monitor CD4 and viral load
- annual eye exam for CMV retinitis
221
ppx and tx for PCP
ppx: bactrim
tx: bactrim, pentamidine, atovaquone
222
risk for MAC when CD4 < _______
50
| -fever, weight loss, night sweats, abdominal pain, bone marrow suppression, elevated LFTs
223
adolescent with fever, malaise, fatigue, pharyngitis, posterior cervical LAD, hepatosplenomegaly, macular or scarlatiniform rash, resolves in weeks to months
infectious mononucleosis caused by EBV (can also be todo, CMV, and HIV)
224
dx EBV mononucleosis
- labs: atypical lymphocytes (esp B lymphocyte), neutropenia, thrombocytopenia, elevated transaminases
- first line is mono spot looking for heterophile antibody
- this is less sensitive in kids < 4 years
- for kids less than 4 years, get EBV antibody titers
- acutely: positive IgM-VCA and negative Ab to EBNA
- 2-3 months later: positive Ab to EBNA
225
most common cause of mono spot negative infectious mononucleosis in older children
CMV
226
how to tx EBV infectious mononucleosis
supportive tx
| if severe pharyngitis, then can give steroids
227
complications of EBV infectious mono
- neurologic complications: CN palsies, encephalitis
- amox associated rash if mistaken for strep throat
- splenic rupture
- malignancy: nasopharyngeal carcinoma, Burkitt's lymphoma
228
virus of the paramyxoviridae family
measles (aka rubeola)
229
incubation period of measles
8-12 days
230
3 C's of the classic prodrome of measles
cough, conjunctivitis, coryza
| also photophobia and low grade fever may be present
231
enanthem of measles
koplik spots- small gray papules on an erythematous based located on the buccal mucosa
***these are pathognomonic of measles
232
describe the exanthem of measles
maculopapular starts around neck and ears and spreads down to chest and upper extremities by day 1, LE by day 2, confluent by day 3, lasts 4-7 days
233
do you see a fever with measles?
yes, usually T > 101 (38.3)
234
_______ is the MC complication and MC cause of mortality with measles
bacterial pneumonia
235
other complications of measles:
otitis media
laryngotracheitis
encephalomyelitis
subacute sclerosing panencephalitis- rare and late
236
how to tx measles
- supportive tx
- vitamin A
- IG ppx for high risk individuals who have been exposed
237
togavirus
rubella/German measles
238
unlike measles, rubella is often _______ and the exanthem only lasts ______
asymptomatic
| 3-4 days
239
- prodrome: URI, low grade fever
- painful LAD
- non pruritic, maculopapular rash that spreads from face to trunk to extremities and lasts 3-4 days
- mild fever < 101
rubella
240
meningoencephalitis and polyarteritis can be complications of _______
rubella
241
congenital rubella syndrome occurs when mother is infected during __________. _____% of infected fetuses have anomalies
first trimester
| 30-50%
242
- thrombocytopenia
- HSM
- jaundice
- purpura (blueberry muffin baby)
- congenital cataracts
- PDA
- sensorineural hearing loss
- meningoencephalitis
- MR, HTN, DM1, autoimmune thyroid disease
congenital rubella syndrome
243
- invasive aspergillosis occurs in ________ pts... tx with amphotericin B and surgery
- allergic bronchopulmonary aspergillosis occurs in pts with ________... tx with steroids and maybe anti fungal drugs
immunocompromised
| chronic lung dz such as CF
244
coccidiomycosis occurs in this geographic area
SW US and Mexico
245
how you contract entamoeba histolytica
ingestion of cyst in contaminated food or water
246
symptoms and signs of entamoeba histolytica infection
- most pts are asymptomatic
- can get cramping abdominal pain, tenesmus, diarrhea that may contain blood or mucus
- may form abscess in liver and other organs
247
how to dx amebiasis
stool cysts or trophozoites
248
how to tx amebiasis
metronidazole
| +/- iodoquinol (luminal amebicide)
249
how you get giardia
drinking contaminated water for the most part
250
sxs of giardia infection
voluminou watery and foul smelling diarrhea
| bloating, flatulence, weight loss
251
how to dx giardia
look at stool for cysts and trophozoites, stool ELISA
252
how to tx giardia
metronidazole
253
______ is the most important parasitic cause of morbidity and mortality in the world
which species is responsible for most severe dz?
malaria
| plasmodium falciparum
254
transmission of malaria is via _______
anopheles mosquito
255
sxs of malaria
flu-like prodrome
cyclical fevers 48-72 hours correlating with RBC rupture and subsequent parasitemia
can have hemolytic anemia, splenomegaly, jaundice, etc
256
how to dx malaria
thin and thick giemsa stained peripheral blood smears
- thick for screening
- thin for species and stage identification
257
medications for malaria
chloroquine, quinine, quinidine gluconate, mefloquine, doxycycline depending on resistance patterns and species
-can do pox with chloroquine, mefloquine, doxyclycline, or atovaquone
258
toxoplasmosis can be transmitted via contact with ______ but also with undercooked meats and contaminated fruits and veggies
cat feces
259
most cases of toxoplasmosis are asymptomatic unless you're immunocompromised... then you might present with ________
focal seizures
260
ocular toxo is the most common cause of __________
infectious chorioretinitis
261
triad of congenital toxo
hydrocephalus, intracranial calcifications, choreoretinitis
262
when should you tx for toxo?
congenital toxo
pregnant women with acute todo
immunocrompromised ppl with reactivated brain lesions
-tx with sulfadiazine and pyrimethamine
263
general concept of dx for helminth infections
3 separate stop examinations
| can use cellulose tape test for pinworms
264
MCC epilepsy in places like Mexico and Central America
neurocysticercosis
265
signs and sxs of cysticercosis
subcutaneous nodules
4th vetnricle
seizures, hydrocephalus, stroke
266
how to dx cysticercosis
stool exam only sensitive 25% of time
serology
head CT or MRI
267
how to tx cysticercosis
meds for ppl with the adult tapeworm
| if old cysts on brain imaging, can give anti-epileptics
268
```
fever
petechial rash that begins on extremities and moves in a caudal and centripetal direction
myalgias
HSM and jaundice
CNS sxs
hypotension
```
rocky mountain spotted fever caused by rickettsia rickettsii (transmitted via tick bite)
269
RMSF is most common in _____ region of US
southeast
270
dx RMSF
thrombocytopenia, elevated transaminases, hyponatremia
| serologic tests
271
how to tx RMSF
oral or IV doxycycline and supportive care
| *note: ppx abx after tick bites are not indicated
272
what is spotless RMSF
ehrlichiosis
- occurs in SE US as well-same sxs but no rash
- dx with serology or PCR
- tx with doxycycline and supportive care
273
what bacteria causes cat scratch disease
bartonella henselae
274
regional LAD after cat or kitten scratch
- papule at initial scratch followed by LAD 1-2 wks later
- can see Parinaud oculoglandular syndrome
cat scratch disease
275
dx cat scratch dz
elevated IgM antibody to B henselae
276
how to tx cat scratch dz
supportive unless pt has systemic dz or is immunocompromised
- then give oral azithromycin, bacterium, or cipro
- don't do surgery
277
children < 12 years of age with TB are generally not contagious (T/F)
T
278
this age of children are most at risk for TB disease
infants < 12 months
279
most common form of extra pulmonary TB disease in children
```
cervical lymphadenitis (scrofula)
other extrapulm: meningitis, abd involvement, skin and joint, Pott's disease (vertebrae), disseminated or miliary disease
```
280
PPD readings based on risk factors
> 5 mm: close contact with TB disease, clinical or radiographic findings of TB, immunocompromised
> 10 mm: younger than 4 years, chronic medical condition, live in TB endemic area
> 15 mm: older than 4 years, no other risk factors
281
how to dx TB disease in children
positive culture from gastric aspirate
positive AFB stianing
positive histology from bx specimen
282
how to tx latent TB
isoniazid for 9 months
| -give pyridoxine (vitamin B6) to prevent neuro sxs of tx
283
how to tx TB disease
2 months INH, rifampin, pyrazinamide
| 4 months of INH and rifampin
284
what to do for fever in baby < 28 days
total eval
IV abx
hospitalization
285
what to do for fever in baby 7 months old
ucx, UA, CBC, blood cx
if WBC > 15,000 then IM ceftriaxone
no hospitalization unless toxic, dehydrated, or poor followup
*doesn't need CXR or LP in a nontoxic pt with no respiratory signs
286
early in viral meningitis, WBC may be PMN predominant with subsequent shift to lymphocyte predominant (T/F)
T
287
steroids can reduce incidence of hearing loss in meningitis caused by _____
HIB
288
which 2 post-strep complications can be prevented with abx
PANDAS and rheumatic fever
289
bulky foul smelling stools, weight loss, day care attendance
giardia
290
gray white malodorous vaginal discharge, fishy odor, little vaginal or vulvar inflammation
what is it, what do you see on microscopy, do you need to tx partners
BV
clue cells
no need to tx partners
no abx or antiyeast meds are indicated
291
MCC FUO
| in what % of cases is a cause found
uncommon presentation of common thing
infectious > rheumatologic
75% of cases, a cause is found eventually
292
E Tox is associated with which cells in the lesions
eosinophils
293
what is D-penicillamine used for
increases copper clearance in Wilson's disease
294
_____ can help eliminate tyrosine in transient tyrosinemia of the newborn
vitamin C
295
peripheral precocious puberty
hyperthyroidism
coast of Maine spots
fibrous dysplasia of bones --> fxs
mccune-albright syndrome
296
hypogonadotropic hypogonadism
| anosmia (absent sense of smell)
kallman syndrome
297
hypotonia, hypogonadism, small hands and feet, growth problems in first year of life 2/2 feeding problems, hyperphagia and obesity later in childhood
Prader-Willi syndrome
298
```
ovarian dysgenesis
short stature
webbing of the neck
left sided congenital heart disease
hypothyroidism
```
Turner syndrome
299
hypogonadism
retinitis pigmentosa
obesity
polysyndactyly
laurence-moon-biedl syndrome
300
infants of diabetic mothers may have ______ cardiomyopathy
hypertrophic
301
causes of dilated cardiomyopathy
virral myocarditis
carnitine deficiency
anomalous origin of the left coronary artery <-- can present with MI
302
how to tx 7 day old boy with b/l conjunctival discharge
oral erythromycin b/c it's most likely chlamydia infection
303
unilateral parotitis is most likely caused by infection with _____
staph aureus
strep pyogenes
mycobacterium tuberculosis
304
cataracts, congenital heart disease (often PDA), sensorineural hearing loss, thrombocytopenia and extramedullary hematopoiesis manifesting as blueberry muffin
congenital rubella
305
hydrocephalus, intracranial calcifications, chorioretinitis assoc with congenital ______
toxoplasmosis
306
microcephaly, HSM, cerebral calcifications but no cataracts or congenital heart disease
this is most likely congenital _______
CMV infection
307
can sit with support
vocalize with mixed vowel and consonant sounds
just learned to transfer objects from hand to hand
6 months of age
308
dancing eyes and dancing feet
neuroblastoma with acute cerebellar atrophy
309
hemihypertrophy, aniridia, GU malformation, abdominal mass
Wilms tumor
310
prognosis for neuroblastoma for children < 1 year
quite good
| can spontaneously regress
311
what endocrine abnormality to look for in Turner syndrome
hypothyroidism
312
in pts with OI, screen for this
early conductive hearing loss
313
how to tx early localized Lyme disease
if < 9 years
if > 9 years
< 9 years --> amoxicillin
| > 9 years --> doxycycline
314
GBS is often associated with a recent _____ infection
campylobacter
315
myoclonic seizures, progressive neuro degenerations, MR, pale kinky friable hair
what is it, what lab abnormality
menkes kinky hair disease
| low serum copper level
316
symmetric dry vesiculobullous scaly rash, FTT, chronic diarrhea
what is it, what lab abnormality
acrodermatitis enteropathica
| zinc deficiency
317
parathyroid hypoplasia
cellular mediated immunodeficiency --> recurrent fungal infections
cardiac findings- aortic arch abnormalities
defect in structures derived from 3rd and 4th pharyngeal pouches
what is it and what lab abnormality might you find?
digeorge
| hypocalcemia
318
interrupted aortic arch
recurrent fungal infections
small chin
short palpebral fissures
digeorge syndrome
319
12 month old boy with vesicles and scales in the diaper area, FTT, chronic diarrhea
acrodermatitis enteropathica- zinc deficiency
