BRS Questions Flashcards
what is the most common etiology of epiglottitis?
haemophilus influenzae type b (HiB)
now rare bc of HIB immunization
-may also be caused by group A beta hemolytic streptococcus, strep pneumonia, and staphlyococcus species
how does epiglottitis present?
abrupt onset of rapidly progressive upper airway obstruction without prodrome
- high fever and toxic appearance
- muffled speech and quiet stridor
- dysphagia with drooling
- sitting forward in tripod
“thumbprint” on lateral radiograph of the neck
epiglottitis
diagnosis of epiglottitis
clinical features with visualization of a cherry red swollen epiglottis
management of epiglottitis
- medical emergency
- controlled nasotracheal intubation
- abx: 2nd or 3rd generation cephalosporin IV
- rifampin prophylaxis for unimmunized household contacts younger than 4 years old
other name for croup
laryngeotracheobronchitis
-inflammatino of the larynx, trachea and bronchi
what is the most common cause of stridor?
viral croup
epi for croup
late fall to winter, children 3months to 3 years M:F 2:1
what is spasmodic croup?
occurs in preschool age children year around
most likely secondary to a hypersensitivity reaction
-acute onset of stridor typically at night
-recurs and resolves without treatment
what are the most common causes of viral coup?
1) parainfluenza
others: RSV, rhinovirus, adenovirus, influenza A and B, mycoplasma pneumonia
how does croup present?
begins with upper respiratory infection prodrome for 2-3 days followed by stridor and cough
symptoms: inspiratory stridor, fever, barky cough, hoarse voice, lasts 3-7 days
- stridor and cough worse at night with agitation
- wheezing may occur
“steeple sign” in AP neck radiograph
croup
-subglottic narrowing
croup diagnosis
clinical
management of croup
supportive care:
- cool mist and fluids
- stridor at rest may consider systemic corticosteroids like IM dexamethosone
- in respiratory distress-racemic epinephrine aerosols (vasoconstrict subglottic vessels)
- beta2 agonists (albuterol) can be used when wheezing is apparent
- hospitalization for patients in respiratory distress
what is bacterial tracheitis
an uncommon but reemerging cause of stridor with abrupt onset of high fever, toxicity and mucus and pus in the trachea
-abx indicated
what are the causes of bacterial tracheitis
staph aureus, strep and H flu
what is the most common lower respiratory tract infection in the first 2 years of life?
bronchiolitis
when do bronchiolitis epidemics occur?
November to April
with increased risk with day care attendance, multiple siblings, exposure to tobacco smoke and lack of breastfeeding
what is the most common cause of bronchiolitis?
RSV
less common: parainfluenza, adenovirus, rhinovirus, influenza and mycoplasma pneumoniae
what is the course of bronchiolitis?
gradual onset with upper respiratory symptoms
- progression of respiratory symptoms occues leading to tachypnea, fine rales, wheezing and resp distress
- liver and spleen may appear enlarged due to lung hyperinflation
- hypoxemia
- apnea
- hyperinflation with air trapping, pathcy infiltration and atelectasis
- improvement within 2 weeks and more than 50% have recurrent wheezing
- complications: apnea, resp failure, BSI
diagnosis of bronchiolitis
clinical with possible viral serotyping
management of bronchiolitis
primarily supportive with nasal bulb suctioning, hydration and oxygen
what is the best way to prevent spread of infection?
hand hygeine
what is ribavirin?
a nucleoside analog with in vitro activity against RSV
-may be considered for very ill infants with RSV
palivizumab
may be given prophylactically by monthy IM injection during RSV season in pts with hx of prematurity, chronic lung disease or cyanotic or hemodynamically significant congenital heart disease
what is pneumonia?
infection and inflammation of the lung parenchyma
pneumonia in 0-3 month old babies
usually
- congenital infections: toxo, syphilis, CMV, rubella, HSV, TB
- intrapartum infection: GBS< gram - rods, listeria monocytogenes
- postpartum infections: RSV and other resp viruses
- afebrile pneumonia: chlamydia trachomatis, ureaplasma urealyticum, mycoplasma hominis, CMV< PCP
pneumonia in 3month -5 years
viruses: adenovirus, influ A and B, parainfluenza, RSV
bacteria: strep pneumo, may also be staph aureus and HIB
pneumonia in kids 6+
Mycoplasma pneumonia and chlamydia pneumoniae
viruses: adenovirus, influenza A and B, parainfluenza bacteria, S, pneumoniae
what are the most common cause of pneumonia in all age groups?
viruses
Pneumonia diagnosis
viral:
sx and PE
CXR-interstitial infiltrates and WBC 20,000
CXR-lobar consolidation
management of pneumonia
viral: supportive
bacterial: abx
afebrile pneumonia
chlamydia trach is common
sx: staccato cough, dyspnea, and absence of fever,
PE: tachypnea and wheezing
DX: eosinophilia and CXR with interstitial infiltrates
-definitive dx with positive culture or direct fluorescent antibody staining of cells form conjunctiva or nasopharynx
mycoplasma pneumonia
most common in older children
- diagnosis: positive cold agglutinins
- CXR findings-bilateral diffuse infiltrates
- definitive ddx: elevation of serum IgM titres
management: erythromycin or azithromycin
whooping cough etiology
bordetella pertussis
*** very infectious
when is whooping cough immunization given?
at 2 months of age
who is a major source for pertussis infection of unimmunized or underimmunized children?
adolescents and adults whose immunity has waned
how long is the intubation period for whooping cough
7-10 days
what are the 3 stages of pertussis
1) catarrhal stage (1-2 weeks) upper URI sx, rhinorrhea, nasal congestion, conjunctival redness, low grade fever
2) paroxysmal stage (2-4 weeks) fits of forceful coughing, “whoop”-inspiratory gasp heard at the very end of a coughing fit or paroxysm
- paroxysms may occur with cyanosis, apnea, and choking and between the fits the child will appear well
3) convalescent phase (lasts weeks to months) is a recovery stage in which paroxysmal cough continues but becomes less frequent and less sever over time
what is the gold standard for diagnosis of whooping cough?
culture identification of organism of nasopharyngeal secretions plated on regan lowe or bordet gengou media or by positive direct fluorescent antibody tests of nasopharyngeal secretions
which phase of whooping cough is a child most likely to be hospitalized in?
paroxysmal stage
what is the role of antibiotics (and which abx) in whooping cough?
azithromycin or erythromycin prevent the spread of infection but DO NOT alter the patients clinical course unless in very early stages
how long should pts be on resp isolation with whooping cough?
until abx have been administered for at least 5 days
what is the most common chronic pediatric disease?
asthma
what is the pathophys of asthma?
smooth muscle bronchoconstriction, airway mucosal edema, increased secretions with mucous plugging, eventual airway wall remodeling and production of inflammatory mediators
typical features during an asthma exacerbation?
tachypnea, dyspnea, nasal flaring, retractions, multiphonic wheezing with a prolonges expiratory phase
what will an asthmatic CXR show?
hyperinflation, peribronchial thickening, and patchy atelectasis
PFTs in asthma
increased lung volumes and decreased expiratory flow rates
diagnosis of asthma
clinical features and therapeutic response to bronchodilator trial
what is the etiliology of CF?
AR disease resulting from mutation on chromosome 7, resulting in mt in CTFR transport protein causing NA CL transport dysfunction in cells
what are the classic hallmarks of CF?
chronic progressive pulmonary insufficiency, pancreatic insufficiency and high sweat eletrolytes
-meconium illeus in 20% pts at birth
what is the deifinition of FTT
growth below 3-5% or crosses two growth curves in a short period of time
non-organic FTT
psychosocial, 1/3-1/2 of all FTT pts,
organic ftt
poor growth caused by an underlying medical condition like IBS, renal disease or congenital heart problems
daily caloric intake of infant in first year of life
120-100kcal/kg/d
caloric intake in FTT infants
additional 50-100% of 120-100kcal/kg/d
cmv infection
iugr including microcephaly, catratcs, seizures, hepatosplenomegaly, prolonged neonatal jaundice and purpura
signs of DS
usplanting palpebral fissures, brushfield spots-white or grey spots in periphery of iris, flat facial profile, small and rounded ears, excess nuchal skin, widespread nipples, pelvic dsplasia, jiunt hyperflexibility, fifth finger clinodactyly, single transverse palmar crease, hypotonia, poor moro reflex
resp distress, localized chest radiograph findings, recurrence of pneumonia, hempotysis, digital clubbing. microcytic hypochromic anemia, low serum iron levels, occult blood in stool,
idiopathic pulmonary hemosiderosis (IPD)
bronchoalveolar lavage for diagnosis-reveals hemosiderin-laden macrophages
(some have hypersensitivity to cows milk)
tension pneumothorax
commonly seen in staph pneumonia, toxin production by the bacteria leads to rupture of the alveoli in the pleural space, can be lethal if not diagnosed right away, –>insert needle or catheter into the 2nd/3rd intercostal space in the midclavicular line with the patient supine
bacterial tracheitis
uncommon but severe and life threatening complication of croup–> pt has several days of upper resp symptoms followed by an acute elevation of temp and increase in resp pressure, biphasic stridor (insp strido in croup) no drooling and dysphagia lets you rule out epiglottitis, must establish an airway with endotracheal intubation and IV antibiotics, must preserve the airway
epiglottitis
used to be caused by hib but now bc of the vaccination is caused by group A beta hemolytic strep, moraxella catarrhlais or s pneumoniae
-thumb sign
toxocara canis
dog parasite, dirt eating kids get it, larvae penetrate the intestine and migrate to visceral parts like the liver, lung and brain but do not return to the intestine so not in stool o&p
dx by elisa for toxacara
sinusitis in kids
- maxillary and ethmoid since kids, frontal not large enough and sphnedoid not unilt 3rd-5th year of life-cold lasting loger tahn 10-14 days indicative of sinusitis
- sphenoid not frontal facial pain and no middle meatus drainage
mycoplasm pnuemoniae
in olderchidlren and young adults, lobar pneumonia or interstitial infiltrate, can produce upper respiratory infections, GBS, otitis media and externa, bronchiolitis and hemolytic anemia
s pneumonia
sudden onset of high fever and lobar pneumonia
primary ciliary dyskinesia
immotile ciliary syndrome
dysfunctional cilia and andomral airway clearance
-abnml airway clearance
-abnormal cytoskeletal proteins and defect in dyeniein arms
-nml lifespan
katagener syndrome
triad of situs inversus, chronic sinusitis and otitis media and airway disease
-assocaited with immotile ciliary syndrome in 50%
allergis rhintis nasal smear
eosinophili and can see polyps
retropharyngeal abscess
infection of chain of lymph nodes between posterior pharyngeal wall and the prevertebral fascia
- most common S aureus, group A beta hemolytic strep, and oral anaerobes,
- hisotry of pharyngitis, abrupt onset of fever, sore throat, drooling, refusal of food, and muffled/noisy breathing, bulge in posterior pharyngeal wall,
- fluctuant mass
chlamydiae in infants
sites of infection: conjunctivae and lunggs causing inclusion conjunctivtitis and afebrile pneumonia
-dx by culture
-treatment: macrolide antibiotics clears conjunctivits and prevents future pneumonia,
topical macrolide will not prevent future pneumonia
N gonorrhoeae
can cause a sepsis syndrome in children and would present in first few days of life not weeks
buccal cellulitis
hib associated, unilateral bluish discoloration on the cheeck of young immunized child
- febrile and may be toxic appearing
- IV abx against H influenzae -2nd or 3rd gen cephaloispoin
- high concomitant bactermia and meningitis-LP should be performed
perianal cellulitis
well demarcated erythema involving the skin around the anus
- may present with constipation
- GABHS-visual inspection or positive rectal swab or culture for GABHS
- oral antibiotics
staph scalded skin syndrome
s aureus that produces exfoliative toxin,
-fever tender skin, bullae
Nikolsky sign present-extension of bullae when pressure applied to the skin
-wound care and IV antibiotics
scarlet fever
toxin mediated bacterial illness resulting in characteristic rash
-GABHS s pyogenes
-winter/spring
exanthem-begins on trunk, skin is erythematous with tiny skin colored papules and has texture of sandpaper
-rash blanches with pressure
-petechiae localized within the skin creases in a linear distribution (pastia’s lines)
-desquamation of dry skin occurs as the infection resolves
-clinical diagnosis with postive s pyognees culture
-prevent development of rheumatic fever
-abx-oral penicllin WK, IM benzathie penicillin
hypertension and cola colored urine
post streptococcal glomerulonephritis
-not prevented with antibiotic therapy
acute onset of obsessive compulsive symptoms or a tic disorder after streptococcal infection
PANDAS pediatric autoimmune neuropsychiatric disorders associated with streptococcal infection
TSS
s aureus
cruise ship/daycare virus
norwalk virus
traveler’s diarrhea
enterotoxigenic E coli ETEC
- noninvasive watery diarrhea
- clinical dx
- abx-quinolones or sulfonamides
most common gastroenteritis
rotavirus
-ELISA dx
noninvasive watery diarrhea in preschoolers
enteropathogenic e coli
EPEC
-dx on stool culture
-abx oral sulfonamides or quinolones indicated
hemolytic uremic syndrome cause
enterohemorrhagic E COLI (ehec) strain 0157:H7
via endotoxin release,
stool WBC present, culture is diagnositc
-if HUS present antibiotic therapy is avoided, (HUS may worsen as a result of enhanced endotoxin release)
-
bloody diarrhea, seizures
shigella
- seizures secondary to neurotoxin release
- stool WBCs present–>culture diagnostic
- third generation cephalosporin or fluoroquinolones are indicated
bloody or nonbloode diarrhea, fecal oral or poultry, milk, eggs, and exposure to lizards or turtles
Salmonella
-esp in pts with sickle cell may progress to bacteremia or osteomyelitis
stool WBCs may be absent or present
-culture diagnostic
-tx not indicated for uncomplicated gastroenteritis in immunocompetent hosts >3 months of age bc it increase carriage time
-treatment for invasive disease involves a third generation cephalosporin
most common cause of bloody diarrhea in US
campylobacter jejuni
- self limited and spread by contaminated food
- stool WBC are usually present if blood is present
- stool culture diagnostis
- oral erythromycin indicated but sx commonly resolve without antimicrobial intervention
mesenteric adenitis along with gastroenteritis (looks like appendicitis)
yersinia enterocolitica
- stool culture or mesenteric node culture grows the organism
- abx may benefit pts-third gen cephalosporins commonly used
diarrhea after abx
c diff
- id toxin in stool, pseudomembranes on endoscopy
- oral IV metronidazole
- oral vanc for resistant cases
massive water loss diarrhea
vibrio cholerae
- seen in developing countries
- may be cultures from stool or serologic testing
- fluid replacement is critical
- abx may shorten the duration but are not really used
FTT
HIV infection
- all infants with HIV infected mothers have transplacentally acquired maternal antibody that may persist for as long as 18-24 months
- negative HIV specific DNA PCR at 4 months is consistent with an infant who has not been infected
- if negative follow antibody until negative y
HIV babies prophylactic treatment
Bactrim for PCP until HIV DNA pcr at 4 months negative
zidovudine for 6 weeks postexposure
urine CMV
no breastfeeding
most common opportunistic infection in kids with HIV
pcp-fever, hypoxia, interstitial pulmonary infiltrates
fever, weight loss, night sweats, abdominal pain, bone marrow suppression and elevated liver tansaminases in HIV kids
M avium complex
fever, mailaise, fatigue, pharyngitis, posterior cervical lymphadenopathy, hepatosplenomegasy, macular or scarlatiniform rash
EBV
transmission: saliva
diagnosis: CBC–>atypical lymphocytes, neutropenia, thrombocytopenia and elevated transaminases
-monospot first line test tests agglutination to sheep red blood cells-85% sensitive but less in children under the age of 4 (use EBV antibody titers), acute infecteion elevated IgM VA (viral capsid antigen), PCR testing may also be used,
-supportive management
-neuro complications, cranial nerve palsies and encephalitis, upper airways obstructive pharyngitis -
-if misdiagnosed as GABHS and given amoxicillin get an amoxicillin assocaited rash-diffuse pruritic maculopapular rash, not allergic reaction, splenic rupture-restricted form contact sports until spleen is normal size,
infects B lymphocytes -has been isolated from nasophayrnheal carcinoma and burkitts lymphoma resulting in a lymphoproliferative disease-lymphoma like illness
ddx: toxo, CMV, HIV
classic clinical prodrome followed by transient enanthem (rash on mucous membranes) and exanthem (rash on skin)
measles-rubeola, RNA virus of paramyxoviridae family
-HIGHLY INFECTIOUS
-8-12 day incubation period
“cough, conjunctivitis, coryza” classic prodome
-koplik spots: enanthem, small gray papules on an erythematous base located on the buccal mucosa, pathognomonic of measles and are present before the generalized exanthem
-exanthem-erythematous maculopapular eruption that begins around the neck and ears and spreads down the chest and upper extremities during the subsequent 24 hours
-fever usually with onset of symptoms
complications: bacterial pneumonia most common complication and cause of mortality, otitis media, laryngotreacheitis, encephalomyelitis (inflammation of brain and spinal cord), subacute sclerosing panencephalitis rare and late complication,
-diagnosis: serologic testing
-managemtn: supportive care, vitamin A may improve outcome, immunoglobulin cen be used for post-exposure prophylaxis in high risk individuals who are exposed to measles
upper resp symptoms (mild) and low grade fever, painful lymphadenopathy, exanthem following adenopathy-nonpuritic, maculopapular and confluent
rubella “German measles”
-togavirus,
-highly enfectious,
longer than measles incubation period 14-21 days (vs 8-12 days)
usually mild fever
complications: meningoencephalitis, polyarteritis (primarily in teenage girls and young women and may last several weeks)
-congenital rubella syndrome is the most serious complication
thrombocytopenia, hepatosplenomegaly, jaundice, purpura “blueberry muffin baby”
congenital rubella, occurs after primary maternal infection in the first trimester, fetal anomalies in 30-50% infected,
-structural abnormlaities: congenital cataracts, PDA, sensorineural hearing loss and menigoencephalitis,
late complications: mental retardation, hypertension, T1Diabetes and autoimmune thyroid disease
diagnosis by viral culture and supportive therapy
wheezing, eosinophilia and pulmonary infiltrates in a pt with chronic lung disease
allergic bronchopulomary aspergillosis
have elevated Ig E to aspergillosis
drink contaminated water in western US or at a day care center
giardiasis
- from asymptomatic to explosive diarrhea, symptoms 1-2 weeks following ingestion,
- voluminous, watery foul smelling diarrhea, abdominal pain, bloating, flatulence, weight loss and low grade fever
- stool for cysts and trophozoites, stool ELISA tests
treatment: metronidazole or furazolidone
vague flulike symptoms-headache, malaise, anorexia, fever then leading to chills, vomitting, headache, and abdominal pain 48-72 hours later
Malaria-Plasmodium falciparum, vivax, ovale, malariae
-most impt parasite causing morbidity and mortality in the world
-endemic to tropical and subtropical regions of the workd
-transmitted through bite of amopholes mosquito
may see hemolytic anemia, splenomegaly, jaundice and hypoglycemia
diagnosis via: think and thick giemsa-stianed peripheral blood smear
management: chloroquine, quinine, quinidine gluconate, mefloquine and doxycycline
-mainstay of prevention is avoidance of mosquito bite
mononucleosis like illness-malaise, fever, sore throat, myalgias, lymphadenopathy, rash, hepatosplenomegaly, OR asymptomatic
toxoplasmosis gondii from direct ingestion of cat feces
-can be self limited
-reactivation of disease may occur if patients are immunosuppressed-more severe and may include encephalitis, focal brain lesions, pneumonitis, opportunistic infection in HIV and commonly present with focal seizures
-most common cause of infectious chorioretinitis
-dx: serologic testing, PCR< id on culture of amniotic fluid, CSF blood
management: do not require specific therapy, treatment indicated for infants with congenital, pregnant, immunocompromised and in reactivated cases-treat with
sulfadizaine and pyrimethamine
-prevent with pregnant women and immunocopormed as highest reisk-AVOID CAT FECES and undercooked meats and clean all vegetables/fruits before consumption
-gloves while gardening or preparing meat
congenital hydrocephalous, intracranial calcification and chorioretinitis
toxoplasmosis
can present with epilepsy, hydrocephalus and stroke-in mexico
cysticerosis
-fecal oral route
no symptoms until encysts in muscles or subcutaneous tissue or brain, subq nodules, fourth ventricle is most common site of involvement
dx: stool for o and -detects taenia eggs
-head ct or MRI may show solitary parenchymal cyst or single multiple/calcifications-calcified areeas are areas of old nonviable parasitic infection
-anticonvulsant therapy
most common helminthic infection in US, anal or vulvar pruritis
enterobius vermicularis (pinworm)
- fecal oral transmission of eggs, preschool adn school aged childres,
- also haev insomnia, anorexia, enuresis, nightime teeth grinding, tx: single dose of mebendazole, albendazole or pyrantel pamoate treating close contacts as well
loffler syndrome-transient pneumonitis as larvae migrate through lungs causing gever, cough, wheezing and eosinophilia-small bowel obstruction
ascaris lumbricoides (roundworm)
- largest and most common intestinal roundworm
- fecal oral transmission of eggs
- treat with mebendazole, albendazole or pyrantel pamoate
asymptomatic or abdominal pain, tenesmus, bloody diarrhea, rectal prolapse, may be seen with ascaris infection
trichuris trichuria (whipworm) treat with mebendazole or albendazole or pyrantel pamoate
rash and pruritius at site of penetration, iron deficiency anemia with fatigue, pallor, and FTT
nectar americanus and ancylostoma duodenale (hookworm)
-areas where soil infected with human fecel, infection through bare foot, larvae migrate through luns and are coughed up then swallowed,
treatment: mebendazole, or albendazole or pyrantel pamoate
screen close contacts and iron supplementaiton
transeint pruritic papules at the site of penetration, pneumonitis, gastrointestinal symptoms, eosinophilia
stronyloides stercolais
-tropics, subtropics and southern.wouthwestern US, life cycle same as hook worm,
treatmentL: IVERMECTIN, thiabendazole or albendazole
mirgrating purirtic serpinginous erythematous tracks on skin
cutaneous larva migrans
- self limited lasting weeks to months, intradermal migration of dog or cat hookworms, contact with feces contaminated soil
- resolves without treatment in most cases or can give ivermection, thiabendazole, or albendazole for severe disease
general VLM: fever, eosinophilia, leukocytosis, hepatomegaly, malaise, anemia, cough, myocarditis
-children 1-4 with PICA
toxocara canis or cati (toxocariasis or visceral larva migrans)
- ingestion of eggs in contaminated soil or dog fur, larvae released from eggs and migrate through tissues
- treat with albendazole or mebendazole-steroids may also be used for ocular involvement
fever, petechial rash that begins on extremities (ankles and feet) and moves in a caudal and centripetal direction, myalgias, hepatosplenomegaly and jaundice, CNS symptoms-headache, coma seizures, hypotension
rocky mountain spotted fever due to rickettsia rickettsii
- lab findings: thrombocytopenia, elevated transaminaes and hyponatremia, CSF may show aseptic meningitis
- diagnosis made clinically and confirmed with serologic tests for rickettsia
- treatment: oral or IV doxy and supportive care-antibiotics started empirically on clinical basis
- tick avoidance and prompt tick removal for prevention
spotless RMSF
many of the same symptoms as RMSF but no rash
- fever, headache, myalgias and lymphadenopathy
- thrombocytopenia, elevated transaminases and hyponatremia, csf may show aseptic meningitis
cat scratch disease
bartonella henselae: gram negative bacteria
-regional lymphadenopathy after cat or kitten scratch,
-initial scratch has papule along the line of the scratch and the lymphadenopathy progresses 1-2 weeks later
-involved node commonly erythematous, warm, tender
-fever
-complication: parinaud oculoglandular syndrome with conjunctivitis, preauricular lymphadenitis, encephalitis, osteomyelitis, hepatitis, pneumonia and hepatic or splenic lesions
diagnosis with serology that demonstartaes elevated IgM antibody to B henselae
-supportive care
fever, chills, wieght loss, cough, night sweats and if extrapulomnary involvement: cervical lymphadenitis (scrofula), meningitis, abdominal involvement, skin and joint involvement, skeletal disease (Pott’s disease)
on x ray: hilar or mediastinal lymphadenopathy, Ghon complex, lobar involvement, pleural effusion, or cavitary disease,
tb: mycoplasm tuberculosis
-latent tuberculosis asymptomatic individual with normal exam and chest radiograph-no regional lymph nodes
-tb disase may or may not have signs and symptoms on the chest x ray
-risk factors: immigrants, homeless, jails, immunodefiecent,
treatment INH (isoniazid), rifampin, pyrazinamide
–definitive diagnosis
-in kids confirmatory positive culture for gastric tube acquired aspirate
-postive staining of fluid for acid fast bacili
-positive histology
montoux test
PPD test, 5 tuberculin units of purified protein derivatice (PPD)
-intradermal and read 48-72 hours later by health care profesional,
-becomes positive 2-12 weeks after exposure
>5mm postive with clinical or radiographic consistencies
>10mm positve if younger than 4 years old have a chronic medical condition of live in an area endemic for TB
rubella
mild disease, diffuse maculopapular rash lasting 3 days, marked enlargement of posterior cervical and occipital lymph nodes, low grade fever, mild sore throat and occasionally conjunctivitis, arthraligia or arthritis
roseola
viral exanthem of infants in which high fever abriptly abates as rash appears
erythema infectiosum
(fifth disease, parvovirus B19) begins with bright erythema on checks, followed by red maculopapular rash on trunk and extremities, which faced centrally at first
decreased RBC production at first for about a week-uaully not noticeable in normal children but may become apparent in a child with a hemolytic condition (like sickle cell disease)
erythema multiforme
poorly understood syndrome of skin lesions and involvement of mucous membranes
-associated with a number of infectious agents
infection of the nasolacrimal sac
dacryocystitis
in newborns associated with congenital nasolacrimal duct obstruction-seen in 6% of normal infants
-failure of epithelial cells to canalize
-benign, self limited
rabies
most common in raccoons in the US
- also in skunks, bats, foxes, coyotes, (rare in small rodents)
- PEP recommended which includes rabies immune globulin and the 5 rabies injection series
- uniformly fatal no medications have been effective at treating
prodrom of HA, mailaise, maculopapular rash 4 fays later on the flexor surfaces of the wrists and ankles before moving centrally with palsma nd soles involved
Rocky mountain spotted fever
hyponatremia dn thrombocytopenia may be seen
-doxycycline is the appropriate treatemtn
wiskott aldrich syndrome
X linked recessive combined immunodeficiency with thrombocytopenia, eczema, infections, problems early and frequently-prolonged bleeding from circumcision site is the first clue
-impaired humoral immunity with low serum IgM
DRESS
drusg rash, eosinophilia, and systemic symptoms
associated with anticonvulsants and has been associated with antibiotics
-same as erythema multiforme but the patient may also have lymphadenopathy, eos, leukocytois, fever and liver, kidney and lung involvement
abd pain, nausea, vomiting, malaise
–> muscle invasion causing edema of eyelids, myalgia, weakness, fever and eosinophilia
trichinella spiralis
-associated with the ingestion of pork
digeorge
t cell disease defective embryologic development of the third and foruth pharyngeal pouches results in hypoplasia of both thymus and parathyroid glands CATCH: C: cardiac A: abnormal faces T: thymic hypoplasia C: cleft palate H: hypocalcemia
