BRS #1 Flashcards
causes of congenital microcephaly
TORCH toxo other- syphilis rubella CMV herpes simplex
also in utero drugs and toxins and chromosomal abnormalities
causes of acquired microcephaly- born with normal head circumference
perinatal asphyxia
intraventricular hemorrhage
craniosynostosis
late prenatal and perinatal infections
iron deficiency anemia peaks between _____ and ____ months
9 and 15
a common cause of iron deficiency anemia
introduction of cow’s milk before 9 months of age
most patients with elevated lead levels have sxs (T/F)
F
contraindications to circumcision
hypospadias, prematurity, bleeding diathesis
most common organism in nursing or bottle caries
strep mutans
oral vitamin D supplementation is recommended in patients exposed to minimal sunlight during _______
first year of life
infant walkers are helpful for developing gross motor (T/F)
F- these walkers have a risk of injury
ADHD is more common in ______ (girls/boys)
genetics play a large role (T/F)
boys
T
tx for ADHD
first line: stimulants
second line: clonidine, TCAs
ADHD and _________ may be genetically related
tourette’s
childhood hearing loss is _____% genetic and ______% others
80% genetic- autosomal recessive
20% others
good prognostic factors for hearing loss
- inherited deafness > acquired deafness
- older age of onset (acquire language structure before deafness)
- earlier interventions/diagnosis
what to check for hearing loss
H&P
genetics eval if needed
Cr (Alport syndrome)
viral serologies (TORCH)
leading causes of blindness in children
- trachoma infection in developing nations- MCC blindness worldwide
- retinopathy of prematurity
- congenital cataracts
haptic perception
feeling someone’s face to form a mental image of them (used by blind people)
define colic
crying that lasts > 3 hours/day and occurs > 3 days/week
colic occurs in __% of newborns
10%
time period of colic
begins 2-4 weeks
resolves by 3-4 months
nocturnal enuresis is more common in ____ (boys/girls)
boys
strong familial tendency for nocturnal primary enuresis is supported by a gene on chromosome ____
13
enuresis patient has large volumes of dilute urine… may be an issue with ____
vasopressin (diurnal variation)
labs to get for enuresis
UA/UCx, others as appropriate
tx for enuresis
behavioral training (alarm systems, rewards, etc)
DDAVP
imipramine (TCA)
day night reversal/random sleeping is normal during _______
first few weeks of life
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
nightmares occur during _____ and night terrors occur during ______
nightmares: REM
night terrors: stage 4 non-REM
typical age range for temper tantrums
age 1-3
breath holding spells are involuntary, harmless, and always stop by themselves (T/F)
T
cyanotic vs. pallid spells
cyanotic: cries until cyanotic –> apneic and unconscious
pallid: unexpected event –> hypervasovagal –> pale and limp
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
toilet training ages
bowel: 29 months (16-48 months)
bladder: 32 months (18-60 months)
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
unusual to see hand preference before age _____
18 months
appropriately uses household objects in imitation
what age is the child?
15-18 months
cerebral palsy leads to loss of milestones (T/F)
F
it is non progressive
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
age range for symbolic play
24-30 months
cause and effect starts around _____
9 months
object permanence age
9 months
mama and dada age
9-12 months
usually have 1-3 additional words by 12 months
separation anxiety age
6-18 months
immature pincer (can hold small object between thumb and index finger) age
9 months
transfer objects and sit alone age
6 months
-babbling
parachute reaction age
8 months
average duration of growth spurt
2-3 years
growth is mainly controlled by this hormone
growth hormone
growth spurt occurs _______ earlier in females than in males
18-24 months
average duration of puberty
3-4 years
adrenarche
onset of adrenal androgen steroidogenesis
occurs 2 years before maturation of HPG axis
puberty begins ______ later in males than in females
6-12 months
________ at age 11-12 is the first sign of puberty in males
testicular enlargement
facial and axillary hair growth starts _____ after pubic hair growth
2 years
puberty begins with _________ at age 9.5 in females
thelarche (development of breast buds)
menarche generally occurs at age _____, 2-3 years after thelarche
12.5
3 stages of adolescence
early (10-13)
middle (14-17)
late (18-21)
FSH in males and females
males: induces spermatogenesis
females: stimulates ovarian follicle development, stimulates ovarian granulosa cells t to produce estrogen
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
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
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
progesterone
no male function
females: converts endometrium to a secretory endometrium
adrenal androgens in males and females
males: pubic hair, linear growth
females: pubic hair, linear growth
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
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
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
STDs to test for in adolescent who is sexually active
gonorrhea chlamydia syphilis trichomonas HPV
3 most common causes of death in teens
unintentional injuries, homicide, suicide
MC drug of abuse in teens
MC illicit drug of abuse in teens
alcohol
marijuana
binge drinking: _____ or more drinks at one time
5
____of teens are sexually active by the end of high school
____of teens do not use any contraception
50% for both questions
3 MC STDs in the US
HSV, HPV, chlamydia
3 causes of vaginitis
trichomonas, bacterial vaginosis, candidal vulvovaginitis
malodorous, profuse, yellow green discharge
strawberry cervix
vulvar inflammation and itching
dyspareunia
trichomonas vaginalis
how to dx trichomonas vaginalis
wet mount
culture
vaginal pH > 4.5
tx for trichomonas vaginalis
oral flagyl (metronidazole)
grey white thin vaginal discharge
pungent fishy odor –> whiff test
little vaginal or vulvar inflammation
clue cells
bacterial vaginosis
how to dx BV
whiff test with KOH
clue cells on wet mount
vaginal pH > 4.5
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
severe itching
white cur like vaginal discharge
vulvar and vaginal inflammation
candidal vulvovaginitis
how to dx candidal vulvovaginitis
wet mount of KOH shows fungal hyphae
normal vaginal pH < 4.5
positive yeast culture
how to tx candidal vulvovaginitis
oral fluconazole or topical intravaginal anti yeast therapies
*partners don’t need to be treated
causes of cervicitis
gonorrhea, chlamydia, HSV, syphilis
dx and tx chlamydia
dx with PCR
tx with oral doxycycline, erythromycin, or azithromycin
*partners need to be treated
tx for gonorrhea
IM ceftriaxone OR
single dose oral therapy with ofloxacin, cefixime, or ciprofloxacin
*partners need to be treated
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
causes of genital ulcers
HSV 1 and 2, syphilis, H ducreyi (chancroid)
MC STD
genital warts
strains of HPV that cause cervical cancer
16 and 18
Tzanck smear for diagnosing ____
HSV 1 and 2
tx for HSV caused genital ulcers
acyclovir
tx for primary syphilis ulcer
IM penicillin or oral doxycycline if allergic to penicillin
tx for chancroid
oral azithromycin, erythromycin, or IM ceftriaxone
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
primary vs. secondary dysmenorrhea
primary- pain not associated with nay pelvic abnormality
secondary- pain due to pelvic abnormality (endometriosis, PID, bicornuate uterus, etc)
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
secondary amenorrhea
no menses for 3 cycles or 6 months after having had regular cycles
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
frequent, irregular menstrual periods, often associated with prolonged painless bleeding
dysfunctional uterine bleeding (DUB)
polymenorrhea
regular intervals of < 21 days
menorrhagia
prolonged or excessive uterine bleeding that occurs at regular intervals
metrorrhagia
uterine bleeding that occurs at irregular intervals
menometrorrhagia
prolonged or excessive bleeding that occurs at irregular intervals
oligomenorrhea
bleeding that occurs at regular intervals but no more often than every 35 days
DUB can result from ______ cycles
anovulatory
______ should be used for all DUB associated with anemia
hormonal therapy (ex. OCPs) iron
if hormonal therapies fail for DUB, can do this
D&C
how to tx gynecomastia in teenage boy who is otherwise normal
reassurance
resolves in 12-15 months
absent cremasteric reflex on side of testicular pain
torsion of the spermatic cord
how to tx testicular torsion
surgical detorsion and fixation within 6 hours
how to dx testicular torsion
physical exam
decreased uptake on radionuclide scan or decreased pulsations on doppler ultrasound
blue dot sign assoc with ______
torsion of testicular appendage
radionuclide scan and doppler are ____ in torsion of testicular appendage
normal or increased
how to tx torsion of testicular appendage
reassurance, rest, analgesia
radionuclide scan and doppler are ____ in epididymitis
increased
cryptorchidism
undescended testes
risk of testicular cancer
hydroceles
collections of fluid in tunica vaginalis
dx and tx of hydroceles
dx: H&P, transillumination of scrotum reveals cystic mass
tx: reassurance
dilation and tortuosity of veins in the pampiniform plexus
varicoceles
varicoceles are most common on the _____ (left/right) and feel like _______
left
bag of worms
how to tx varicoceles
reassurance
puberty in boys begins with _______ and in girls begins with _________
testicular enlargement
breast enlargement
menarche occurs _______ after thelarche
2-3 years
STD- single painless ulcer with well-demarcated border and non purulent base, painless inguinal adenopathy
syphilis chancre
STD- painful ulcers that have irregular borders and a purulent base, painful inguinal adenopathy
chancroid
STD- multiple painful shallow ulcers, but base is not purulent
HSV
ziehl-neelsen stain
acid fast bacilli
silver stain
fungal elements
wright stain
stool WBCs
fever in children
> 100.4 (38) by rectal measurement
high fever in children
> 102.2 (39)
evaluation of fever in infants < 3 months
what tests do you send?
CBC bcx UA/ucx CXR CSF
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
abx management of infants < 28 days with infection
IV abx in hospital until cultures clear
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
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
most likely organism causing fever in children 3-36 months
strep pneumo
HIB is on the decline since the vaccine
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
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)
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)
suspected sepsis or meningitis in 3 months-3 years
pathogens and empiric abx
strep pneumo
HiB
N meningitidis
-cefotaxime (+ vanco if bacterial meningitis suspected)
suspected sepsis or meningitis in 3 years-adult
pathogens and empiric abx
streppneumo
N meningitidis
-cefotaxime (+ vanco if bacterial meningitis suspected)
FUO duration
at least 8 days-3 weeks
3 most common general causes of FUO
infectious disorders
rheumatologic disorders
malignancy
fever, peritonitis, pleuritis, and monoarthritis
familial mediterranean fever
period fever, pathos stomatitis, pharyngitis, cervical adenitis (PFAPA)
period fever syndrome
for FUO, when to hospitalize
generally recommended for children with fever > 2 weeks
highest incidence of bacterial meningitis is during _____
first month of life
fever may be absent or minimal in very young infants with bacterial meningitis (T/F)
T
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
steroids can be given with first dose of abx with _____ meningitis
HIB
most common complication of bacterial meningitis in a child
hearing loss (up to 25%)
LP findings in viral meningitis
10-1000 WBC (mostly lymphs)
RBCs if HSV encephalitis
normal to high protein
normal glucose
LP findings in TB meningitis
10-500 WBCs (mostly lymphs)
very high protein!
low to very low glucose
**note, imaging will show basilar enhancement
LP findings in fungal meningitis
25-500 WBCs (mostly lymphs)
normal to high protein
low glucose
LP findings with parameningeal focus (brain abscess)
10-200 WBCs (can be polys or lymphs)
high protein
normal glucose
MCC of viral meningitis in the US (common in summer and fall)
enterovirus
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
when do various sinuses develop?
ethmoid and maxillary present at birth
sphenoid: 3-5 years
frontal: 7-10 years
acute, subacute, and chronic sinusitis
acute: up to 30 days
subacute: 30-90 days
chronic: > 90 days
top 3 organisms implicated in sinusitis
strep pneumo
H flu
Moraxella catarrhalis
tx for acute and subacute sinusitis
amox, amoxicillin-clavulanate or second gen cephalosporin for 10-14 days
tx for chronic sinusitis
trial of broad spectrum oral abx
ct IMAGING
IV abx may be beneficial
common viral and bacterial causes of pharyngitis
coxsackievirus, EBV, CMV strep pyogenes (group A beta hemolytic strep aka. GABHS or "strep throat")
pharyngitis with enlarged posterior cervical lymph nodes, malaise, hepatosplenomegaly
EBV pharyngitis
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
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
what kind of pharyngitis has “gray, adherent tonsillar membrane”
diphtheria
tx GAHBS pharyngitis
oral penicillin VK
single dose of IM benzathine penicillin
if penicillin allergic –> oral erythromycin or macrolides
tx EBV pharyngitis
may consider steroids if it’s really severe
tx diphtheria pharyngitis
oral erythromycin or parenteral penicillin and a specific antitoxin
respiratory isolation!
fluid within the middle ear space w/o sxs of infection
otitis media with effusion (OME)
bacterial causes of acute otitis media
strep pneumo
non typeable H flu
moraxella catarrhalis
most reliable method of detecting middle ear fluid
pneumatic otoscopy
tx for AOM (acute otitis media)
abx are controversial but if you give anything, give amoxicillin
-no abx for OME (otitis media with effusion)
common pathogens in otitis externa
pseudomonas
staph aureus
candida albicans
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
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
initial management of cervical lymphadenitis
tx for the most common cause: staph
first ten cephalosporin or anti-staph penicillin for 7-10 days
common causes of parotitis
mumps and CMV, EBV, HIV, influenza –> bilateral
bacteria such as staph aureus, strep progenies, and mycobacteria tuberculosis –> unilateral
how to tx parotitis
viral and bacterial
viral- supportive care
bacterial- abx that cover staph aureus and strep pyogenes
superficial skin infection involving the upper dermis, honey colored crust
impetigo
causes and tx of impetigo
staph aureus, GABHS (strep pyogenes)
tx with topical mupirocin, oral abx such as dicloxacillin, cephalexin, or clindamycin
skin infection involving the dermal lymphatics
tender erythematous skin with a distinct border- face and scalp are common places
erysipelas
common cause of erysipelas
GABHS
tx of erysipelas
abx against GABHS
skin infection occurring within the dermis
infected skin border is indistinct
cellulitis
common causes of cellulitis
staph aureus and GABHS
tx for cellulitis
first gen cephalosporins or anti-staph penicillins
unilateral bluish discoloration on the cheek of a young unimmunized child… what is it and what is the causative agent?
buccal cellulitis
HIB
how to manage buccal cellulitis
IV abx against H influenza (2nd or 3rd gen cephalosporin like cefuroxime or cefotaxime)
LP to eval for meningitis
most common cause of perianal cellulitis
GABHS
cause of nec fasc is often _________ but may involve _____ and ______
polymicrobial
GABHS
anaerobic bacteria
in staph scalded skin, you may see ______ sign
how to tx?
Nikolsky
good wound care, IV abx against staph aureus
scarlet fever is caused by a toxin produced by _______ infection
GABHS
can be impetigo, cellulitis, pharyngitis, etc
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
how to tx scarlet fever
oral penicillin VK
IM benzathine penicillin
if PCN allergic –> erythromycin or macrocodes
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
fever, shock, desquamating skin rash, multi organ dysfunction
toxic shock syndrome
bacteria that cause TSS
staph aureus > GABHS
how to tx TSS
-supportive measures
-anti-staph abx
-removal of nidus of infection if applicable
+/- IVIG
6 criteria of TSS
6/6 = confirmed
5/6 = probable
- temp > 101 (38.5)
- hypotension (SBP < 90 or < 5th percentile for age)
- diffuse macular erythroderma (looks like sunburn)
- desquamation 10-14 days after onset of illness
- 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 - negative cultures of blood, CSF, and pharynx (except for positive blood cx for staph aureus)
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
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
electrolyte finding in diarrhea
non anion gap hyperchloremic metabolic acidosis
when should you do a stool culture?
only if WBCs are present
- major cause of traveler’s diarrhea
- no stool WBCs
- abx may shorten duration of sxs
ETEC
- watery diarrhea often in preschoolers
- no stool WBCs
- tx with oral sulfonamides or quinolones
EPEC
- bloody diarrhea
- can cause HUS if it’s strain 0157:H7
- stool WBCs present
EHEC
how to tx EHEC if it gives you HUS
don’t give abx as it may worsen endotoxin release
- bloody diarrhea, may have seizures
- stool WBCs present
- tx with 3rd gen cephalosporins or fluroquinolones
shigella sonnei
- 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
- mesenteric adenitis, can mimic acute appendicitis
- 3rd gen cephalosporins can be used
yersinia enterocolitica
- diarrhea after abx use
- pseudomembranes
- tx with flagyl (+PO vanco for resistant cases)
c diff
- watery diarrhea with massive water loss in foreign country
- tx with fluid replacement, abx generally not used
vibrio cholerae
factors that decrease vertical HIV transmission
- low maternal viral load
- c section
- adherence to therapy and postexposure ppx
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
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
what to give to babies at risk for HIV
- zidovudine for 6 weeks
- bactrim until negative at 4 months
- no breastfeeding
- urine CMV culture
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
ppx and tx for PCP
ppx: bactrim
tx: bactrim, pentamidine, atovaquone
risk for MAC when CD4 < _______
50
-fever, weight loss, night sweats, abdominal pain, bone marrow suppression, elevated LFTs
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)
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
most common cause of mono spot negative infectious mononucleosis in older children
CMV
how to tx EBV infectious mononucleosis
supportive tx
if severe pharyngitis, then can give steroids
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
virus of the paramyxoviridae family
measles (aka rubeola)
incubation period of measles
8-12 days
3 C’s of the classic prodrome of measles
cough, conjunctivitis, coryza
also photophobia and low grade fever may be present
enanthem of measles
koplik spots- small gray papules on an erythematous based located on the buccal mucosa
***these are pathognomonic of measles
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
do you see a fever with measles?
yes, usually T > 101 (38.3)
_______ is the MC complication and MC cause of mortality with measles
bacterial pneumonia
other complications of measles:
otitis media
laryngotracheitis
encephalomyelitis
subacute sclerosing panencephalitis- rare and late
how to tx measles
- supportive tx
- vitamin A
- IG ppx for high risk individuals who have been exposed
togavirus
rubella/German measles
unlike measles, rubella is often _______ and the exanthem only lasts ______
asymptomatic
3-4 days
- 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
meningoencephalitis and polyarteritis can be complications of _______
rubella
congenital rubella syndrome occurs when mother is infected during __________. _____% of infected fetuses have anomalies
first trimester
30-50%
- thrombocytopenia
- HSM
- jaundice
- purpura (blueberry muffin baby)
- congenital cataracts
- PDA
- sensorineural hearing loss
- meningoencephalitis
- MR, HTN, DM1, autoimmune thyroid disease
congenital rubella syndrome
- 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
coccidiomycosis occurs in this geographic area
SW US and Mexico
how you contract entamoeba histolytica
ingestion of cyst in contaminated food or water
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
how to dx amebiasis
stool cysts or trophozoites
how to tx amebiasis
metronidazole
+/- iodoquinol (luminal amebicide)
how you get giardia
drinking contaminated water for the most part
sxs of giardia infection
voluminou watery and foul smelling diarrhea
bloating, flatulence, weight loss
how to dx giardia
look at stool for cysts and trophozoites, stool ELISA
how to tx giardia
metronidazole
______ is the most important parasitic cause of morbidity and mortality in the world
which species is responsible for most severe dz?
malaria
plasmodium falciparum
transmission of malaria is via _______
anopheles mosquito
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
how to dx malaria
thin and thick giemsa stained peripheral blood smears
- thick for screening
- thin for species and stage identification
medications for malaria
chloroquine, quinine, quinidine gluconate, mefloquine, doxycycline depending on resistance patterns and species
-can do pox with chloroquine, mefloquine, doxyclycline, or atovaquone
toxoplasmosis can be transmitted via contact with ______ but also with undercooked meats and contaminated fruits and veggies
cat feces
most cases of toxoplasmosis are asymptomatic unless you’re immunocompromised… then you might present with ________
focal seizures
ocular toxo is the most common cause of __________
infectious chorioretinitis
triad of congenital toxo
hydrocephalus, intracranial calcifications, choreoretinitis
when should you tx for toxo?
congenital toxo
pregnant women with acute todo
immunocrompromised ppl with reactivated brain lesions
-tx with sulfadiazine and pyrimethamine
general concept of dx for helminth infections
3 separate stop examinations
can use cellulose tape test for pinworms
MCC epilepsy in places like Mexico and Central America
neurocysticercosis
signs and sxs of cysticercosis
subcutaneous nodules
4th vetnricle
seizures, hydrocephalus, stroke
how to dx cysticercosis
stool exam only sensitive 25% of time
serology
head CT or MRI
how to tx cysticercosis
meds for ppl with the adult tapeworm
if old cysts on brain imaging, can give anti-epileptics
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)
RMSF is most common in _____ region of US
southeast
dx RMSF
thrombocytopenia, elevated transaminases, hyponatremia
serologic tests
how to tx RMSF
oral or IV doxycycline and supportive care
*note: ppx abx after tick bites are not indicated
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
what bacteria causes cat scratch disease
bartonella henselae
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
dx cat scratch dz
elevated IgM antibody to B henselae
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
children < 12 years of age with TB are generally not contagious (T/F)
T
this age of children are most at risk for TB disease
infants < 12 months
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
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
how to dx TB disease in children
positive culture from gastric aspirate
positive AFB stianing
positive histology from bx specimen
how to tx latent TB
isoniazid for 9 months
-give pyridoxine (vitamin B6) to prevent neuro sxs of tx
how to tx TB disease
2 months INH, rifampin, pyrazinamide
4 months of INH and rifampin
what to do for fever in baby < 28 days
total eval
IV abx
hospitalization
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
early in viral meningitis, WBC may be PMN predominant with subsequent shift to lymphocyte predominant (T/F)
T
steroids can reduce incidence of hearing loss in meningitis caused by _____
HIB
which 2 post-strep complications can be prevented with abx
PANDAS and rheumatic fever
bulky foul smelling stools, weight loss, day care attendance
giardia
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
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
E Tox is associated with which cells in the lesions
eosinophils
what is D-penicillamine used for
increases copper clearance in Wilson’s disease
_____ can help eliminate tyrosine in transient tyrosinemia of the newborn
vitamin C
peripheral precocious puberty
hyperthyroidism
coast of Maine spots
fibrous dysplasia of bones –> fxs
mccune-albright syndrome
hypogonadotropic hypogonadism
anosmia (absent sense of smell)
kallman syndrome
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
ovarian dysgenesis short stature webbing of the neck left sided congenital heart disease hypothyroidism
Turner syndrome
hypogonadism
retinitis pigmentosa
obesity
polysyndactyly
laurence-moon-biedl syndrome
infants of diabetic mothers may have ______ cardiomyopathy
hypertrophic
causes of dilated cardiomyopathy
virral myocarditis
carnitine deficiency
anomalous origin of the left coronary artery <– can present with MI
how to tx 7 day old boy with b/l conjunctival discharge
oral erythromycin b/c it’s most likely chlamydia infection
unilateral parotitis is most likely caused by infection with _____
staph aureus
strep pyogenes
mycobacterium tuberculosis
cataracts, congenital heart disease (often PDA), sensorineural hearing loss, thrombocytopenia and extramedullary hematopoiesis manifesting as blueberry muffin
congenital rubella
hydrocephalus, intracranial calcifications, chorioretinitis assoc with congenital ______
toxoplasmosis
microcephaly, HSM, cerebral calcifications but no cataracts or congenital heart disease
this is most likely congenital _______
CMV infection
can sit with support
vocalize with mixed vowel and consonant sounds
just learned to transfer objects from hand to hand
6 months of age
dancing eyes and dancing feet
neuroblastoma with acute cerebellar atrophy
hemihypertrophy, aniridia, GU malformation, abdominal mass
Wilms tumor
prognosis for neuroblastoma for children < 1 year
quite good
can spontaneously regress
what endocrine abnormality to look for in Turner syndrome
hypothyroidism
in pts with OI, screen for this
early conductive hearing loss
how to tx early localized Lyme disease
if < 9 years
if > 9 years
< 9 years –> amoxicillin
> 9 years –> doxycycline
GBS is often associated with a recent _____ infection
campylobacter
myoclonic seizures, progressive neuro degenerations, MR, pale kinky friable hair
what is it, what lab abnormality
menkes kinky hair disease
low serum copper level
symmetric dry vesiculobullous scaly rash, FTT, chronic diarrhea
what is it, what lab abnormality
acrodermatitis enteropathica
zinc deficiency
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
interrupted aortic arch
recurrent fungal infections
small chin
short palpebral fissures
digeorge syndrome
12 month old boy with vesicles and scales in the diaper area, FTT, chronic diarrhea
acrodermatitis enteropathica- zinc deficiency
