CLIPP 11

Question 1

main reason we tx strep throat (group a beta hemolytic strep typically)

Answer 1

to avoid rheumatic fever

Question 2

rapid strep antigen test has __sensitiviyt and __specificty

Answer 2

variable, high

Question 3

when to do strep culture

Answer 3

to confirm results of negative rapid strep

Question 4

Appropriate antibiotics started within __ days from the start of the acute illness will prevent acute rheumatic fever.

Answer 4

9

Question 5

Rx of choice in GAS infxn

Answer 5

PCN tho the liquid form tastes bad so amox is often used instead - ideally wait for documented +test before starting abx

Question 6

3 of the many things that can present as irritablity

Answer 6

fatigue, meningitis, increased ICP/intracranial irritation

Question 7

noraml 5yo HR

Answer 7

80-100

Question 8

JIA can be broken into these different categories

Answer 8

polyarticular, pauci/oligoarticular, systemic-onset (stills dz)

Question 9

Kawasaki dz is a form of __ w these sx

Answer 9

vasculiis.
non purulent conjunctiva, rash on body, arthraglia, strawberry tongue, hands and feet skin desquaamating . fever >5days. swelling and erythema of extremities.

Question 10

one example of fever for >= 5 d

Answer 10

kawaki

Question 11

osteomylitis / septic joint

Answer 11

low grade temp, pain walking if in lower extremities

Question 12

rmsf

Answer 12

rash on palsm/soles/wrists that spreads inwards

Question 13

rash on palms/soles

Answer 13

Kawasaki disease, enteroviruses, syphilis

Question 14

scarlet fever

Answer 14

Fever (generally < 5 days) (whereas MORE duration in kawsaki)!
A diffuse, erythematous, finely papular rash (described as having a “sandpaper” texture) is pathognomonic
Rash often begins at neck, axillae, and groin and then spreads over trunk and extremities, typically resolving within four or five days

Question 15

SJS

Answer 15

severe itchy rash (EM), fever <7d, mucosal changes, conjunctivitis. affects mucucutaneous things

Question 16

viral syn/ antibiotisc

Answer 16

fever 3-5 d, non desecript NONPAINFUL rash that can start plams/soles,

Question 17

does enterovirus rash hurt to walk

Answer 17

no

Question 18

leggs calves pertches

Answer 18

ccurs when blood supply is temporarily interrupted to the ball part (femoral head) of the hip joint. Without sufficient blood flow, the bone begins to die — so it breaks more easily and heals poorly. would see limp but no rash, fever or conjunctivitis

Question 19

conjuncitviits fever and rash

Answer 19

could mean measles or kawasaki. measles unlikely in fully immunzated kid

Question 20

can sinusitis cause rash?

Answer 20

nope

Question 21

7 rashes assoc w/ fever and their distinguishing signs

Answer 21

enterovirus: often maculopapular, w high fever often, and often on palms/soles
erythema infectiousom: 5th dz/parvo, low fever–>rash 7-10d later w slapped cheek look and lacey and reticular on extremities. can cause arthralgia or aplastic anemia
measles: fever, cough, coryza, conjunctivitis–>rash at top of body–>spreads down to toes
meiningococcemia: due to NM. abrupt onset often w meningitis sx. can become purpuric.
roseola: fever–>fever goes–>rash on arms.neck often in kidsextremities/head. lesions of various stages. mild fever. dz is self limited, around a week.

Question 22

koplick spots

Answer 22

in measles, erythematous spots w/ bluewhite centers in buccal mucosa

Question 23

kawasaki mneuonic

Answer 23

CRASH and Burn
Conjunctivitis- non exudative, bilateral injection. >90%
Rash- anything….. but not vesicular and not bulla. >90%
Adenopathy > 1.5cm. typically cervical and unilateral. 90%
Hand- Swelling or Erythema or hands feet. progresses to peeling but this is late. >90%

and Burn… 5 days of daily fevers.

complications: coronary aneurisms.

Treatment is high dose aspirin(to prevent clots) and IVIG(reduces aneurisms from 20%-> 3%).

Question 24

is generalized LAD w or w/o splenomegaly more or less concerning than isolated LAD

Answer 24

more

Question 25

infectious and non infectious causes of generalized LAD

Answer 25

histo, myco (local or isolated), toxo, hiv, measles, mono

leuk, lympho, metastatic neuro, rhabdo, histio

Question 26

causes of unilateral cervical LAD

Answer 26

Bacterial cervical adenitis
Cat scratch disease
Reactive node from an oral inflammatory or infectious process
Kawasaki disease
Mycobacterial infection (both tuberculosis and atypical mycobacteria) can present with unilateral cervical lymphadenopathy, but the course of this illness is more indolent than Jason’s

Question 27

bacterial cervical adenitis

Answer 27

in younger children (1-5yo) after URI. often strep pyo or staph aureus. can have high fevers and look toxic and can get abscesses/celutlis

Question 28

if kid has myobacterial lymphadenitis, most likely ___ in 2-4 yo children and __ in kids>12yo

Answer 28

non tuberculoous, tuberculousis

Question 29

in PPD test, what do we measure? in normal people, what is a +result?

Answer 29

measure diameter NOT redness of induction. >=15mm

Question 30

strawberry tongue w/ prominent pappilae

Answer 30

streptococcal pharyngitis (C), Kawasaki disease (E), and toxic shock syndrome (F).

Question 31

kawasaki cbc

Answer 31

high wbc, normocytic normochromic anemia, normal mcv, normal plt until second week of dz where it rises

Question 32

kawasaki lft

Answer 32

elevated, can have low albumin

Question 33

elevated lfts in these two conditions w fever and rash, among others

Answer 33

sjs, kawasaki

Question 34

kawasaki esr

Answer 34

neg esr would strongly argue against this

Question 35

UA kawasaki

Answer 35

sterile pyruia - clea catch urine will show wbc while a cath urine won’t since the wbc are from the urethra. sterile pyuria means +UA but -UC. leak esterase not as specific as #wbc.

Question 36

kawasaki dx criteria

Answer 36

In addition to high fever for at least five days, four of the following five criteria are needed for a diagnosis of Kawasaki disease:

Changes in oral mucosa (A)
Extremity changes (redness/swelling) (B)
Unilateral cervical lymphadenopathy (C)
Rash (D)
Conjunctivitis (E)

The one least likely to be present is cervical adenopathy.

Question 37

biggest complication in kawasaki

Answer 37

coronary artery aneurysm - do echo at acute phase to look for them and to make baseline, often the aneurysms are there by end of week 4.

Question 38

general tx approach of kawasaki

Answer 38

echo, ekg, asrpiin (high dose 80-100mg/kg/day in 4 doses and then low dose after defervesence of 3-5mg/kg/day once for anti platelet effect and discontinue after 6-8 weeks if no aneurysm seen, but continue if seen aneurysm for anti platelet nature), iviv (helped decrease coronary aneurysm incidence and is given in single dose of 2g/kg over 10-12h)

Question 39

aspirin in kawasaki does..

Answer 39

not help aneurysm dvpt control. helps fever and anti platelet

Question 40

med to avoid in kawasaki and why

Answer 40

ibuprofen - antgaonizes aspirins anti platelet effect

Question 41

f/u for kawasaki (4 things)

Answer 41

• w/ cardiology in 1-2 weeks bc if they are gonna have an aneurysm, its often within 4 weeks of acute illness
• 6-8w of low aspirin so check for GI bleeds, Reyes and get flu shot
• can have NSAIDS if arhtraglias are bad
• monitor for fever

Question 42

issue w/ aspirin in kids

Answer 42

reyes syndrome (multi organ failure) if get certain viruses while on aspirin. thus docs should make sure kid has flu shot /chiekn pox shot etc before staring aspirin .

Question 43

cocksackie A is __

Answer 43

enterovirus

Question 44

is there dysuria in kawasaki?

Answer 44

no - there is pyuria but dsyuria is related to UTI

Question 45

systemic onset JIA

Answer 45

also known as Still’s disease, is a subset of JIA describing patients with intermittent rash, fever and arthritis. While our patient does present with rash and fever, as well as refusal to walk (potentially a sign of arthritis), systemic onset JIA tends to present with a history of spiking fevers and “salmon” rash occurring when the child is febrile, and disappearing as the fever fades.

Question 46

two key modalities for JIA patients to f/u w.

Answer 46

optho (uveirits) and PT

Question 47

one key modality for SJS pt to f/u w/

Answer 47

optho