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Pediatrics > BRS7 > Flashcards

BRS7 Flashcards

1
Q

ziehl neelsen stain is for

A

acid fast TB

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2
Q

silver stain is for

A

fungal elements

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3
Q

Wright stain is for

A

stool white blood cells

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4
Q

definition of fever in a child

A

38 or 100.4 or greater. must be a rectal temp

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5
Q

which groups are high risk for infection

A

young infants (less than one month), older infants with very high fevers (greater than 39) and infants and children who are immunodeficient, sickle cell disease or chronic illness

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6
Q

most common infecitous agent in child less than 3 months

A

virus

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7
Q

bacterial pathogens in 0-1 month old

A

group B strep, E coli and Listeria

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8
Q

antibiotics to treat bacterial infections in 0-1 month old

A

ampicillin and gentamicin or cefatoxine

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9
Q

bacterial infections in 1-3 months

A

group B, strep pneumonia, listeria

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10
Q

antibiotics to treat bacterial infections in 1-3 months

A

ampicillin plus cefotaxime. (use vanco if you suspect viral meningitis)

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11
Q

bacterial infections to treat 3 months-3 yrs

A

Strep pneumonia, H flu, Neisseria M

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12
Q

antibiotics to treat bacterial infections in 3 months- 3 yrs

A

cefotaxime (add vanco if you suspect viral meningitis)

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13
Q

which patients with fever get admitted

A

1) babies less than 28 days
2) infants between 29 days and 3 months who are either toxic appearing, suspected meningitis, pneumonia, pyelonephritis, bone or soft tissue infections unresponsive to PO abx,
3) unclear about follow-up bc of social situation

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14
Q

most common organism in children 3-36 months

A

strep pneumonia. H flu used to be but less bc of vaccination

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15
Q

definition of fever of unknown origin

A

fever lasting more than 8 days to 3 weeks when all prior testing and history have not produced a diagnosis. 1/4 resolve spontaneously

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16
Q

tests for fever of unknown origin

A

make sure to look at mucous membranes, skin, hepatosplenomegaly, joints and bones. check CBC, ESR, serum transaminases, and UA with culture, blood cultures, anti strep O titer, ANA, anti RF, stool for O and P and cdiff, TB skin test and HIV test.

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17
Q

meningitis definition

A

inflammation of the meninges. can be bacterial or aseptic

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18
Q

when do you see most bacterial meningitis

A

first month of life

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19
Q

3 risk factors for bacterial meningitis

A

1)young age 2)immunodeficiency (asplenia, terminal complement deficiency) 3)anatomic defects

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20
Q

clinical features of bacterial meningitis

A

most often non specific. may or MAY NOT be febrile. often have poor feeding, irritability, lethargy, and resp distress. older children present with fever and meningeal signs.

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21
Q

signs of meningeal irritation

A

change in consciousness, nuchal rigidity, seizures, photophobia, emesis, headache.

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22
Q

lumbar puncture for bacterial meningitis

A

high white count in CSF (mostly neutrophils, often greater than 5000), low glucose in CSF (.4), increased protein, positive gram stain and culture.

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23
Q

meningitis picture with focal neurological findings

A

CT scan with contrast- to evaluate for brain abcess

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24
Q

what drug to give to reduce hearing loss in H influenza meningitis

A

corticosteroids. given with the first dose of abx

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25
Q

high protein CSF?

A

acute bacterial meningitis, TB or brain abscess

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26
Q

normal glucose on CSF

A

this is viral meningitis

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27
Q

if you see predominantely lymphocytes on CSF

A

this is either fungal or TB

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28
Q

how do you diagnose HSV encelphalitis from CSF

A

RBCs in the CSF

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29
Q

which types of meningitis give worst complications

A

gram negative organisms, then strep pneumonia, HIB and finally Neiserria

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30
Q

most common complication in meningitis

A

hearing loss, then global brain injury, then other things like siADH, seizures, hydrocephalus, brain abscess, cranial nerve palsy, learning issues and focal neurologic deficits.

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31
Q

CSF for aseptic meningitis

A

pleocytosis, normal CSF glucose, and normal to low high CSF protein.

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32
Q

most causes of aseptic meningitis

A

viral

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33
Q

which viruses can be detected by PCR on CSF fluid

A

Epstein Barr (EBV), CMV, HSV, and enteroviruses

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34
Q

very high protein, very low glucose and high white count with lymphs mostly on CSF

A

this is TB

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35
Q

brain imaging classic finding in TB meningitis

A

basilar enhancement.

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36
Q

when are enteroviruses most common

A

summer and fall. most common cause of viral mengitis in US

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37
Q

viruses commonly causing encephalitis

A

arboviruses, influenza, and HSV

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38
Q

TB meningitis in a child less than 5

A

produces an aseptic meningitis.

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39
Q

3 bacteria that cause aseptic meningitis

A

1) TB, 2)borelia burgdorfi (lyme) and 3) syphillis

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40
Q

3 fungal causes of aseptic meningitis

A

coccidiodes immitis
cryptococus neoformans
histoplasmosis capsulatum

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41
Q

parasitic causes of aseptic meningitis

A

taenia solium

toxoplasma gondii- immunocompromised patients

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42
Q

4 drugs used to treat TB meningitis

A

isoniazid, rifampin, pyrazinamide, and streptomycin

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43
Q

common cold causes

A

rhinovirus, parainfluenza virus, coronavirus, and RSV

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44
Q

when to re-assess the common cold

A

after 10 days, check for superimposed bacterial infection. like sinusitis or AOM

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45
Q

sinuses present at birth

A

Ethmoid and maxillary

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46
Q

sinuses appear between 3-5

A

sphenoid

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47
Q

sinuses appear between 7-10 yrs

A

frontal

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48
Q

should you use imaging for initial diagnosis and management of uncomplicated sinusitis

A

NO

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49
Q

most common bugs for sinusitis

A

S pneumonia, H influenza and M catarrhalis

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50
Q

viral causes of pharyngitis

A

URI viruses plus coxsackie virus, EBV and CMV

51
Q

bacterial causes of pharyngitis

A

Strep pyogenes (group A strep), arcanobacterium hemolyticum and corynebaterium diptheriae

52
Q

can you see tonsilar exudates with viral pharyngitis

A

YES

53
Q

presentation EBV pharyngitis

A

enlarged cervical lymph nodes, malaise and hepatosplenomegaly

54
Q

strep throat symptoms

A

lack of other URI symptoms like runny nose, often has exudates on the tonsils, petechiae on soft palate, strawberry tongue, enlarged anterior cervical nodes. can have fever, scarlatiniform rash

55
Q

gray adherent tonsillar membrane?

A

diptheria. can have cardiac and neuro side effects

56
Q

gold standard strep test

A

culture (not rapid strep which is antigen testing)

57
Q

treatment of strep throat

A

oral penicillin, single dose IM penicillin or in allergic patients, erythromycin or macrolides

58
Q

treatment of diptheria

A

oral erythromycin or parenteral penicillin with anti-toxin

59
Q

acute otitis media infection definition

A

acute infection of the middle ear space

60
Q

otitis media with effusion

A

fluid within the middle ear space without symptosm of infection

61
Q

bacterial pathogens of AOM

A

Strep pneumonia
H flu (non typeable)
Moraxella catarrhalis

can also be caused by viruses

62
Q

symptoms of AOM

A

develops often after an URI

fever, ear pain and decreased hearing

63
Q

can you use erythema and loss of tympanic membrane landmarks to diagnose fluid in middle ear space

A

NO. use pneumatic otoscopy to show abnormal movement of the tympanic membrane and fluid in the middle ear

64
Q

abx (if used) for AOM

A

amixicillin. if got abx recently in the past, possible S pneunaie that is resistant is possible. then use higher dose or cephalosporin.

65
Q

treatment of AOM in pen allergic patient

A

macrolides

66
Q

otitis externa definition

A

infection of the external auditory canal

67
Q

pathogens in otitis externa

A

pseudomonas, staph aureus, candida albicans

68
Q

symptoms of otitis externa

A

pain, itching and drainage from the ear. will see erythema and edema of the external auditory canal

69
Q

treatment for otitis externa

A

restore to the acidic environment. use acetic acid solution to relieve the discomfort and restore environment. more severe cases need abx.

70
Q

cervical lymphadenitis

A

enlarged, inflamed, tender lymph node or nodes in cervical area

71
Q

most common bacterial agent for lymphadenitis

A

S aureus. Strep pyogenes is also common. TB and atypical TB can be seen. B henselae (cat scratch) is also seen.

72
Q

reactive lymphadenitis

A

response to infections in pharynx, mouth, teeth etc

73
Q

viral infections and cervical lymphadenitis

A

EBV, CMV, HIV

74
Q

unilateral cervical lymphadenitis with rash on palms and soles, conjunctivitis and strawbery tongue

A

kawasaki disease

75
Q

toxoplasma gondii infection and neck mass

A

T gondii can cause a mono like illness with cervical lymphadenopathy

76
Q

clinical features cervical lymphadenitis

A

mobile, tender, warm, enlarged nodes. can be fluctuant (compressible)

77
Q

when to check antibody titers to viruses in cervical lymphadenopathy

A

when it is diffuse and persistent

78
Q

parotitis infection definition

A

inflammation of the parotid salivary glands

79
Q

etiology of bilateral parotid gland enlargement

A

mumps, CMV, EBV, HIV, influenza etc.

80
Q

unilateral parotid gland enlargement etiology

A

bacterial. S aureus, S pyogenes, M tb. increased risk with decreased salivary flow from stone formation. rarer than viral in kids.

81
Q

in parotitis where would you see drainage

A

if you see it, the mouth may show pus form Stensen’s duct

82
Q

how to diagnose MUMPS

A

viral serology or urine

83
Q

complications of mumps

A

meningoencephaliis, orchitis, epididymitis, pancreatitis.

84
Q

impetigo

A

superficial infection of upper dermis

85
Q

most common bug for impetigo

A

S. aureus

86
Q

impetigo features

A

honey colored crusted or bullous lesions. face, around nose.

87
Q

erysipelas

A

skin infection of dermal lymphatics

88
Q

most common bug causing erysipelas

A

GABHS

89
Q

clinical features erysipelas

A

tender, erythematous skin with distinct border

90
Q

cellulitis

A

skin infection within the dermis

91
Q

most common cause of cellulitis

A

GABHS and Staph aureus

92
Q

is there a distinct border of erythma with cellulitis

A

no. it is indiscrete

93
Q

buccal cellulitis

A

this is cellulitis in a unilateral bluish discoloration on the cheek of a young unimmunized child from HIB

94
Q

cause of perianal cellulitis

A

usualy GABHS

95
Q

necrotizing fascitis symptoms

A

deep cellulitis presenting with pain and systemic symptoms out of proportion to physical findings.

96
Q

staph scalded skin syndrome

A

S. aureus infection that produces an exfoliative toxin. fever, tender skin and bullae. Nikolsky sign is present.

97
Q

scarlet fever rash

A

this starts on the trunk, moves peripherally, skin colored papules, sandpaper rash. rash blanches with pressure.

98
Q

pastia’s lines

A

petechiae localized within the skin creases in alinear distribution in Scarlet fever

99
Q

organism of GABHS

A

Strep pyogenes group A

100
Q

fever, shock, desquamating skin rash and multi organ failure

A

this is toxic shock syndrome

101
Q

most common organism for TSS

A

S aureus

102
Q

two most common viruses causing diarrhea

A

Rotavirus and Norwalk virus

103
Q

when do you see rotavirus

A

winter months

104
Q

do you see WBCs in stool for rotavirus

A

no

105
Q

treatment of rotavirus

A

supportive

106
Q

prominent symptoms of norwalk virus

A

vomiting (unlike diarrhea for rotavirus)

107
Q

diarrhea with lizards or turtles as pets

A

think salmonella

108
Q

electrolyte findings in diarrhea from infection

A

non anion gap hyper-chloermic metabolic acidosis. from bicarbonate loss in stool.

109
Q

how to predict WBCs in stool without checking for them

A

presence of RBcs. they tend to go together

110
Q

when does HIV transmission occur

A

in pregnancy, or post partum through breast feeding

111
Q

early symptoms of HIV

A

FTT, thrombocytopenia, recurrent infections, lymphadenopathy, parotitis, recurrent hard to treat thrush, loss of milestones, severe varicella infection

112
Q

infants born to HIV pos mom have antibodies for how long

A

can persist for 18-24 months

113
Q

how to detect HIV at birth

A

HIV specific DNA PCR from birth to 4 months

114
Q

medications given to baby born to HIV pos mom

A

zidovudine for 6 months porophylaxis as well as trimethoprim tmp smx for pneumocystis pneumonia and urine CMV testing.

115
Q

should HIV patients recieve their vaccines

A

YES. crucial. not the live ones!

116
Q

infectious agent in mono

A

EBV. others include toxoplasmosis, CMV and HIV

117
Q

symptoms of mono in older kids

A

young kids are often asymptomatic. older kids have fever, malaise and fatigue, pharyngitis, posterior cervical lymphadenopathy, hepatosplenomegaly. some get rash.

118
Q

CBC in mono

A

shows atypical lymphocytes

119
Q

how does the monospot test work

A

first line test in diagnosing EBV infections. measures the presence of heterophile antibodies ability to agglutinate sheep red blood cells.

120
Q

is monospot good for all ages

A

not good for kids less than 4

121
Q

mono spot negative mononucleosis

A

this is mostly from CMV

122
Q

how to diagnose mono in child less than 4 yrs

A

EBV anitbody titers. acute infection is rise in IgM and ebstein barr nuclear antigens are for more chronic- 2-3 months after infection

123
Q

amoxicillin and EBV

A

can cause a rash. diffuse pruritic maculopapular rash1 week after starting antibiotic.

Pediatrics (3 decks)

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