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EOR Pediatrics > Chapter 10-1: Infectious Disease > Flashcards

Chapter 10-1: Infectious Disease Flashcards

1
Q

What counts as “fever of unknown origin”

A

fever for > or = 14 days, document temperature greater than 101 on multiple occasions and uncertain etiology

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2
Q

DDX of FUO

A

Infection (most common)
Connective Tissue Dz
Malignancy
Other

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3
Q

What does occult bacteremia mean

A

bacteria in the blood of a child who appears well and w/o signs of infection

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4
Q

Most cases of occult bacteremia are caused by

A

strep pneumo

most resolve spontaneously

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5
Q

What does sepsis imply?

A

bacteremia w/ evidence of a systemic response (tachypnea, tachycardia) and altered organ erfusion

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6
Q

Most common cause of sepsis in neonates

A
  • group B streptococci
  • enteric gram negative bacilli
  • listeria monocytogenes
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7
Q

Most common cause of sepsis in older children <5

A
  • s. pneumo

- neisseria meningitidis

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8
Q

Most common cause of sepsis in child > or = 5

A

-staph aureus

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9
Q

Who is AOM most common in

A

children 6-24mo

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10
Q

Most common causes of AOM

A

-Virus = #1 (RSV, parainflu, influenza)

Bacterial

  • s. pneumo (40%)
  • nontypeable h. influ (25%)
  • m. catarrhalis (10%)
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11
Q

Risk factors for AOM

A
  • caretaker smoking
  • bottle feeding
  • day-care attendance
  • allergic disease
  • craniofacial anomalies
  • immunodficiency
  • genetic tendencies
  • pacifier use
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12
Q

When can you make the diagnosis of AOM?

A
  • acute history of symptoms and bulging
  • poorly or non mobile tympanic membrane
  • presence of signs of local or systemic inflammation
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13
Q

What is otitis media w/ effusion

A

apparent fluid behind the ™ but no evidence of inflammation

does not respond to abx

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14
Q

What is myringitis

A

inflammation of the eardrum w/ normal mobility
**often accompanies a viral URI
(does not respond to abx)

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15
Q

who should be treated for AOM w/ abx

A
  • patient younger than 24mo
  • patients at risk for poor follow up
  • ill-appearing patients
  • patient’s w/ chronic illnesses
  • severe or perforated AOM

**children >24mo with less severe disease may be offered the choice of watchful waiting and pain control or immediate abx (give abx rx to fill in 48h if they choose to watch)

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16
Q

First line tx for AOM

A

amoxicillin
-patients who have even treated w/ abx within the last month, those who have not improved w/in 48 hours are eligible for amoxicillin/clanuvate aka augmentin, oral 2nd or 3rd gen cephalosporin, or IM ceftriaxone

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17
Q

Most common complication of AOM

A

-OME; if it persists longer than 3 months they should be referred for a hearing evaluation

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18
Q

What sinuses are present at birth

A

maxillary and ethmoid

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19
Q

what pathogens are responsible for sinusitis

A 
#1 = viruses
2 = s.pneumo
3 = h. influ
4 = m. catarrhalis 
(identical to those of AOM)
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20
Q

What do you treat sinusitis with?

A

Amoxicillin or Augmentin (or others used for AOM) but treatment should persist for 14-21 days

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21
Q

Children w/ recurrent or chronic sinusitis would be evaluated for

A

cystic fibrosis, ciliary dyskinesia, or primary immune deficiency

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22
Q

Herpangina=

A

symptom complex caused by enteroviruses
**groups A and B coxackie viruses
(initially have HIGH fever and sore throat)
-self limited (5-7 days) and requires no specific treatment
hand, foot, and mouth dz if also in these locations

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23
Q

Strep Pharyngitis most commonly affects

A

-school aged kids and adolescence

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24
Q

What is scarlet fever

A

Erythematous sandpaper-like rash accompanies fever and pharnygitis

  • *begins at neck and axillae and groin and spreads to the extremities
  • may desquamate 10-14 days later
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25
Q

Specificity and sensitivity of rapid antigen test for strep throat vs throat culture

A

**rapid antigen test specificity is than 95% (so false positive tests are rare)
The sensivity is more variable and highly dependent on throat swab specimen
**therefore negative rapid antigen test should be confirmed by throat culture

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26
Q

Tx of strep pharyngitis

A

10 day course of oral penicillin or single dose of IM benzathine penicillin G
(acceptable alternative for those allergic = erythromycin, azithromycin, and clindamycin)

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27
Q

What is acute rheumatic fever

A

Occurs about 3 weeks after strep pharyngitis in a small percentage of untreated patients

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28
Q

What is criteria for rheumatic fever diagnosis

A

2 or mor major or one major and 2 minor plus supportive evidence of group A strep infection
Major:
-carditis, polyarthritis, sydenham choea, erythema marginatum, subQ nodules
Minor
-fever, arthralgia, elevated ESR, C-reactive protein, prolonged PR interval on EKG

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29
Q

Mono clinical manifestations

A

**predominant symptom = severe, exudative, pharyngitis
-fever, generalized lymphadenopathy, and profound fatigue
(malaise may persist for several weeks)
-other manifestations = hepatosplenomegaly, palatal petechiae, jaundice, rash
**rash involves the face and trunk and is usually maculopapular (those diagnosed w/ bacterial infection and treated w/ amoxicillin or ampicillin are more likely to get rash)

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30
Q

Diagnosis of Mono

A 
heterophile antibody (monospot) for EBV
-limited sensitivity in those <4y/o
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31
Q

Tx of Mono

A

Supportive

-avoid contact sports (until splenomegaly resolves)

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32
Q

Croup is caused by

A

Most commonly caused by parainfluenza virus (next is other viruses like RSV, influenza)

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33
Q

Signs and Symp of Croup

A
  • hoarse voice, seal like cough, inspiratory stridor

- steeple sign on CXR

34
Q

Txx of croup

A

-cool air or humidity

If in ER: racemic epi, oral/iv/im corticosteroids

35
Q

Epiglottitis cause and symp

A

H. influ

  • **failure to maintain Hib vaccination status is the biggest risk factor for developing epiglottitis
  • child appears toxic, leaning forward with chin extended, drools
  • thumbprinting on CXR (but not recommended b/c delays tx)
36
Q

Tx of Epiglottitis

A

-IV ampicillin/sulbactam or 3rd gen cephalosporin provides appropriate empirical coverage until the organism is identified by culture

37
Q

Bronchiolitis is caused by

A 
RSV = #1
(others = parainflu, flu, adenovirus)
38
Q

Risk factors for

A

chronic lung dz
congenital heart dz
congential or acquired immunodeficiencies

39
Q

When does bronchiolitis occur

A

-between november and april

40
Q

Signs and symptoms of bronchiolitis

A
  • lasts 5-10 days acutely and recover over next 1-2 wks
  • *infected neonates may develop life threatening apnea**
  • fever, tachypnea, mild to severe respiratory distress
  • lung hyperinflation, peri-bronchial thickening “cuffing” and increased interstitial markings
41
Q

Treatment of bronchiolitis

A
  • Hypoxic or ill-appearing children require hospitalization
  • *most of these only require supportive care

palivizumab is an IM RSV monoclonal antibody that provides passive prophylaxis and is recommended during theindter months for selected patients younger than 2 who are at risk for severe dz

-if not so ill and oxygen >94% and reliable caretakers can be treated outpatient

42
Q

Pertussis clinical manifestations

A

1) Catarrhal phase: 1-2 weeks of low grade fever, cough, coryza; post-tussive emesis is common; facial petechiae and scleral hemorrhages from cough
2) Paroxysmal phase: intense spasms of coughing followed by sudden inhalation (causes whoop)
3) Convaslecent phase: most symptoms remit but cough can last for 2-8 weeks

43
Q

Treatment of pertussis

A
  • hospitalize if apnea, cyanosis, hypoxia, feeding difficulties
  • erythromycin estolate, or azithromic shortens the duratio not illness if given early in the catarrhal phase
  • a 14 day course of erythromycin or a 5 day course of azithromycin completely irradiates organism from the nasopharynx and respiratory tract; household and other close contacts require chemophrophylaxis with erythromycin or azithromycin regardless of immunization status
44
Q

Most common cause of pneumonia in young children

A

Viruses

45
Q

When does chylamida trachoma tis pneumonia manifest in infants born to women w untreated genital chlamydia infections?

A

AT 2-3 months of age

-afebrile w/ w/ conjunctivitis and staccato cough

46
Q

Most common cause of pneumonia in 1mo to 5yr old

A

S. pneumoniae

47
Q

Most common cause of pneumonia in school age/adolescent children?

A

mycoplasma pneumoniae

48
Q

Onset of viral pneumonia

A

develops gradually over 2-4 days

49
Q

Onset of bacterial pneumonia

A

abrupt onset of fever, chills, dyspnea, and chest pain

50
Q

What does bacterial pneumonia look like on CXR

A

lobar consolidation

-sometimes atypical mycoplasma presents this way too

51
Q

What does viral or atypical pneumonia look like on CXR

A

diffuse or interstitial infiltrates

52
Q

Outpatient rx for bacterial pneumonia

A

amoxicillin or amoxicillin/clanuvate

53
Q

what rx for walking pneumonia

A

erythromycin, azithromycin, clarithromycin

54
Q

what rx for chlyamdia tachomatis pneumonia

A

azithromycin or clarithromycin

55
Q

Iv abx for bacterial pneumonia

A

ampicillin/sulbactam, clindamycin, cefuroxime, ceftriaxone, azithromycin, vancomycin

56
Q

Most frequent complication of pneumonia

A

development of a pleural effusion large enough to compromise respiratory effort (when lung infection drains into pleural space)
-large effusions more likely to result from staph aureus (but can happen with all)

57
Q

Most common pathogens of meningitis

A

1) viruses

2) s. pneumoniae and n. meningitidis

58
Q

What increases risk of meningitis in neonates?

A

low birth weight, prolonged rupture of membranes, chorioamnionitis (predispose to septicemia and meningitides)
meningomyelocele also increases the risk

59
Q

Lyme meningititis presentation

A

low grade fever, headache, stiff neck, photophobia developing over the course of 1-2 weeks

60
Q

Kernig signs

A

flexion of the leg at the hip w/ subsequent pain on knee extension (rarely present in <1y/o)

61
Q

Brudzinski sign

A

involuntary leg flexion on passive neck flexion (rarely present in <1y/o)

62
Q

How to diagnose meningitis

A

CSF fluid (lumpar puncture)

  • Bacterial = >1000 WBC, >75% neutrophils, high protein, low glucose
  • Viral = <30% neutrophils, Normal or high protein, normal glucose
63
Q

Treatment of meningitis

A

Vancomycin plus a third generation cephalosporin (cefuroxime, ceftriaxone)

  • bacterial meningitis tx = 10-14 days
  • meningococcal meningitis = 5-7 days
  • lyme meningitis = 14-28 days
  • neonatal meningitis = 14-21 days
64
Q

Most common bacterial cause of gastroenteritis

A

-salmonella
-shigella
-e.coli
yersinia enterocolititica
-campylobacter
-vibrio cholerae

65
Q

Patient’s w/ bacterial diarrhea symp

A
  • fever, abdoinal cramps, malaise, tenesmus

- vomiting is less common

66
Q

patients w/ shigellosis sometimes present w/

A

neurologic manifestations (lethargy, seizures, mental status changes)

67
Q

What causes HUS

A

shigella dysenteriae

e. coli

68
Q

What causes erythema nodosum

A

y.enterocolitica

69
Q

colorless flecked with mucus stools “rice water”

A

cholera

70
Q

major cause of non-bacterial gastroenteritis

A

rotavirus

-occurs in later months

71
Q

Most common intestinal parasite dz in the US

A

Giardiasis

-frequent foul smelling watery stools rarely contain blood or mucus

72
Q

Tx of shigellosis

A

TMP/SMX

azithromycin

73
Q

tx of giardia

A

metronidazole

74
Q

Pinworm infection

A

itching in the perianal and vulvar regions

-touch perianal skin w/ transparent adhesive tape to collect eggs

75
Q

Drugs of choice for pinworm infection

A

Mebendazole, prantel pamoate, albedazole

  • treat all members of family
  • hand washing is most effective way to prevent
76
Q

Which hepatitis are most common

A

A, B, C

77
Q

Which are transmitted fecal oral

A

A, E

78
Q

Which cause chronic illness

A

B, C

79
Q

What other viruses can cause hepatitis

A

EBV, CMV, enterovirus, other final infections

80
Q

Diagnostic eval of Hep A

A

Anti-HAV IgM

81
Q

Diagnostic eval of acute Hep B

A

HBsAG positive
antiHBc ositive
Negative AntiHBe
(chronic looks similar)

82
Q

Diagnostic eval of resolved Hep B

A

HBsAG negative

AntiHBs positive

EOR Pediatrics (16 decks)

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