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SB_Infectious Disease (Pediatrics Royal College 2018) > General > Flashcards

General Flashcards

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1
Q

Older kids sepsis Abx

A

Ceftriaxone/ Vanco or clox.

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2
Q

Orbital cellulitis abx

A

Clindamycim for staph and anaerobes,

Cefuroxime for h. Flu

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3
Q

Scarlet fever bug

A

GABHS produces 1 of 3 exotoxins A,B,C. A is most common. Can therefore have scarlet fever x3

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4
Q

How often are blood cultures positive in meingitis?

How many WBC can a normal neonate have? vs normal child?

How many WBC does it take to make the CSF turbid

A
  1. 80-90%
  2. up to 30, older is 5
  3. 200-400

can have increased lymphocytes in early bacterial meningitis and vice versa

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5
Q

Other causes of elevated PMN in CSF

A 
TB - followed by lymphocytes
fungal - followed by monocytes
Amebae
SLE
Tumour or leukmia
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6
Q

What are the enteroviruses?

A

coxsackie
echovirus
oliovirus
enterovirus

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7
Q

Treatment of meningitis

A

ceftriaxone
cefotaxime

if can’t use - meropenem instead
+/- vancomycin to cover resistant strep pneumo

treat family with rifampin

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8
Q

treatment of Campylobacter

A

supportive care
erythromycin or azithromycin- treat if have dysenteric disease, fever, or
toxic or immunocompromised.
can decrease duration and decrease shedding

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9
Q

Parvovirus B19 mortality

A

Fetal hydrops - bone marrow suppression - anemia and CHF

once rash appears, no longer infectious
for aplastic anemia - infectious for one week since presentation

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10
Q

causes of GBS

A

postinfectious polyneuropathy

  1. Campylobacter
  2. Helicobacter pylori
  3. respiratory tract (especially Mycoplasma pneumoniae)
  4. vaccines - rabies, influenza, and poliomyelitis (oral) , conjugated meningococcal vaccine, particularly serogroup C
  5. EBV
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11
Q

Can you receive live vaccines while on steroids

A

If >2mg/kg/day or 20 mg/kg/d of pred for >14 days, no live vaccines until one month post Rx
If receive less than that, can give

if less than 14 days, can give when done Rx

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12
Q

eosinophilia causes - MC and infectious

A

Allergies, asthma, eczema

Infectious causes: Ascaris because travels to other part of body ( if stay in gut/sequestered), toxocariasis, trichimosis, hookwarm, strongyloides

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13
Q

Anal warts transmission

A

Perinatal
sexual abuse
transmission - from fingers

RX- 65 % DISAPPEAR IN 2 YRS, cryoi, anti wart med, Sx

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14
Q

herpes whitlow treatment

A

HSV 1 in mouth, treat with acyclovir for 10 days

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15
Q

Hep A Vaccine - when do we give it

A

Not in less than 1 yrs but ok if above. if family member has it.if high risk, also get Ig.

only good 2 weeks post exposure

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16
Q

pleurodynia def - brochman syndrome

A

myositis caused by coxsackie

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17
Q

Familial Mediterranean fever symptoms

A

periodic fever, irregular fever episodes, painful pleuritis, peritonitis,

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18
Q

Rabies prophylaxis

A

Bats - even if in room, treat
quarantine animal and monitor - 10 d observation
if high risk - can treat and wait for results

Rx- rabies Ig in bite and Vaccine

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19
Q

PANDA

A 
Pediatric Autoimmune Neuropsychiatric Disorders Associated with Streptococcus pyogenes:
OCD/Tic/Tourette
anxiety
emotional
deterioration in hand writing
enuresis
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20
Q

HIV pathophysiology

A 
CD4 depletion
kills host cells
	Syncytium formation
	Normal host response
	CD4 cell dysregulation
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21
Q

Chronic lymphadenitis causes

A

Non TB mycopla - drains

cat scratch - MOST COMMON

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22
Q

What are RF for HIV vertical transmission?

A 
high maternal viral load, 
seroconversion during pregnancy, 
low maternal CD4, 
intrapartum events resulting in inc exposure of fetus to    maternal blood, 
preterm delivery, 
prolonged ROM, 
SVD
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23
Q

Prevention of Mother to Child HIV Transmission

A

Screening in pregnancy
Antiretrovirals for Mom in pregnancy: if not getting HART then zidovudine during pregnancy and IV zidovudine intrapartum
C-section before ROM (if everything is not perfect)
AZT (zidovudine) for baby x6 weeks – started ASAP within 6 hrs
No breast feeding

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24
Q

When do you test a newborn whose mom was HIV +

A

within first 48 hours (you know that there was transmission), 2 wks, 2 months, 4-6 months

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25
Q

When can you truly rule out HIV in neonate exposed

A

with 2 negative HIV PCR results at or after 1 month and 4 months of age ( most still test at 18 mo)

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26
Q

MC presentation of HIV

A

Infants - asymptomatic, LN, HSM
Older infants - FTT, candida after 1 yr, HSM, interstitial pneumonitis
Toddlers and older - LN, recurrent infections, parotitis, encephalopathy, dev regression

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27
Q

Common opportunistic infections in pt with HIV

A
  1. encapsulated org
  2. MAC
  3. Oral candida
  4. Viruses
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28
Q

Congenital syphilis

A

stillbirth, hydrops, preterm birth, IUGR, HSM, haemolytic anemia, jaundice and maculopapular rash
First 4-8 weeks : o HSM, snuffles, microcephaly, lymphadenopathy, mucocutaneous lesions (peeling hands and feet), osteochondritis, pseudoparalysis (from pain of limbs), edema, rash, haemolytic anemia, thrombocytopenia, chorioretinitis, glaucoma , nephrotic syndrome

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29
Q

Late presentation of congenital syphilis

A

Late manifestations: Hutchinson triad-interstitial keratitis, eighth cranial nerve deafness and Hutchinson teeth (peg-shapted lateral incisors)

Anterior bowing of shins, frontal bossing, saddle nose Clutton joints (symmetric painless swelling of knees), rhagades (linear scars around mouth and nose), mulberry molars (round aggregates of enamel on molars)

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30
Q

Abx for pneumonia

A

0-1 mo: amp+ gent or cefotax
1-3 mo: cefuroxime or amp. Erythro for pertussis
Rest: cefuroxime or amp, niacin

Aspiration-clindamycim
Pseudomonas: cefotax

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31
Q

IE dx criteria

A

Two major criteria, one major and three minor, or five minor criteria suggest definite endocarditis

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32
Q

What are the Duke major criteria

A

(1) positive blood cultures (two separate cultures for a usual pathogen, two or more for less typical pathogens) and
(2) evidence of endocarditis on echocardiography (or new valve regurgitation)

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33
Q

What are the Duke minor criteria

A

FIVE PM

  • Fever > 38
  • Immune complex phenomena (glomerulonephritis, arthritis, rheumatoid factor, Osler nodes, Roth spots),
  • Vascular phenomenon (Janeway, emboli)
  • Echocardiographic signs not meeting major criteria.
  • Predisposition
  • Microbi- a single + BCx or serologic evidence of infection
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34
Q

How do you differentiate orbital from preorbital cellulitis

A
  1. proptosis
  2. ophthalmoplegia
  3. vision change - blurry
  4. Chemosis
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35
Q

how do you diagnose AOM

A
  1. signs of middle ear effusion - immobile TM or TM rupture, +-opacification of TM, +-loss of landmarks, +- air fluid level
  2. signs of middle ear inflammation:bulging TM and erythema
  3. Acute onset of symptoms - otalgia, or irritability
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36
Q

When do you adopt watch and wait for AOM

A

if greater then 6 mo with no significant med issues, mild symptoms and signs for 48-72 hours and parents who can recognize if not doing well.

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37
Q

How is maternal genital HSV classified

A
  1. Newly acquired - first episode PRIMARY (60%!!! chance of transmission) or NON primary.
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38
Q

What are the types of HSV infections in neonates

A
  1. disseminated - MC liver and lungs
  2. localized CNS
  3. SEM - skin, eyes, mucous Mb
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39
Q

Most common causes of transient neutropenia

A

Viral infection - influenza, adenovirus, coxsackie, RSV, hep A and B, measles, EBV, CMV

From redistribution of neutrophils, sequestration in reticuloendothelial tissue, increased use in damaged tissue, marrow suppression

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40
Q

Management to contact TB

A

ask about symptoms

if less than 5, mantoux neg and N CXR = Rx INH 9 mo

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41
Q

INH - How to take it and SE

A

Empty stomach absorbed better.

SE= elevated LFT, periph neuropathy so take Vit B pyroxidine

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42
Q

Which TB med gives optic neuritis

A

Ethambutol

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43
Q

Mantoux / MMR - How do you give these when both are required

A

either give it at same time or 4 weeks apart

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44
Q

recurrent N. Meningitis

A

Think complement def

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45
Q

Cystinosis

A

AR, Lysosomal, cystine accumulation - get fancony syndrome - Kidney crap

CRF, ocular abnormalities, DM, Hypothyroidism

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46
Q

Sinusitis Rx

A

amoxicillin 10-14, saline washes can recommend but not studied
Amoxiclav if less than 2 yrs, recent Abx, daycare

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47
Q

Mono signs/symptoms

A

Fever, pharyngitis, LN, splenomegaly, elevated mononuclear cells and more than 10% atypical lymphocytes, hemolytic anemia, BM suppression

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48
Q

varicella and skin infections - what bug are you worried about

A

GAS***

Nec fas - penicillin and clinda for exotoxin

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49
Q

clinical presentation of Parvo B 19

A

fifth disease -

if pregnanct mom and exposed - do Ig and serial US to monitor for hydrops

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50
Q

GBS investigations

A
  1. stools for campylo
  2. CSF for increased protein
  3. MRI to tule out others
  4. EMG
  5. Serial spyrometry
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51
Q

Pinwarm treatment

A

mebendazole x 1

hygiene, treat household

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52
Q

congenital CMV

A 
IUGR
microcephaly
hepatomegaly
eye stuff
SN hearing loss
rash
low plt
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53
Q

giardia RX

A

flagyl

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54
Q

When do you use Doxycycline

A

skin and soft tissue infection in kids > 7yrs

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55
Q

Aspergillus treatment

A

voriconazole

56
Q

Most common bugs for line infection

A

Coag neg staph - CoNS- Vancomycin

57
Q

Side effects of septra

A 
neutropenia
anemia
low plts
transient inc in creat
hyPERKalemia
58
Q

CP of mycoplasma pneumoniae

A
  1. gradual onset of headache,
  2. malaise,
  3. fever, and
  4. sore throat, followed by progression of lower respiratory symptoms, including hoarseness and cough. 5. Rash in 1/3
    Coryza is unusual
59
Q

Azithromycin - bacteriostatic or bactericidal?

A

static

60
Q

Clindamycin - bacteriostatic or bactericidal?

A

static

61
Q

what bites wounds require prophylactic antibiotics?

A 
moderate to severe tissue damage - crush
deep puncture
hand/feet/face
genitals
in immunocompromised or asplenic
62
Q

what antibiotic would you use for bites?

A

amoxiclav

if allergic - septra and clindamycin

63
Q

what are clinical features of Blastomyces Dermatitidis?

A 
Fungal infection - makes abscesses
cause a pyogranulomatous response =necrosis+fibrosis
1. pneumonia - acute /chronic
2.Skin - ulcers
3. GU - prostitis/endometritis
4. CNS - abscess
5. Bone  - osteo
Rx = Itraconazole for mild, Ampho B for severe
64
Q

what are phases of Pertussis?

A

catarrhal 1-2 wks
paroxysmal 2-6 wks
convalescent >2wks

65
Q

how do you treat pertussis?

A

0-5 mo - AZITHROMYCIN for 5 days, 10mg/kg
> 5 mo - AZITHROMYCIN 10mg/kg on D1, 5/kg until 5d
adult - 500mg d1, 250 mg for rest - 5 days

Clarithromycin for 7 d
Erythromycin for 14 d

66
Q

what are the CP and treatemnt of Brucellosis

A

GN - livestock, unpasteurized milk
fever
arthritis
HSM

RX: 8yr - Septra + rifampin for 6 weeks

67
Q

what organism is going to cause symptoms within 24 hours of an animal bite?

A

Pasteurella multocida

treat with Amoxiclav

68
Q

what is the most common side effect of clindamycin?

A

diarrhea in 20%

higher risk of C. diff

69
Q

what are extrpulmonary features of Mycoplasma

A 
pharyngitis, 
rash = Erythema multiorme
Stevens-Johnson syndrome, 
hemolytic anemia, 
arthritis, 
CNS disease = encephalitis, aseptic meningitis, cerebellar ataxia, transverse myelitis, and peripheral neuropathy
70
Q

how does TSS present?

A

multisystem disease with fever,
hypotension,
diffuse rash, and
multiple organ involvement (eg, nausea, vomiting, renal involvement, hepatitis, central nervous system dysfunction, severe myalgias).

71
Q

What are features of Chlamydia trachomatis pneumonia

A 
tachypnea, 
nasal congestion, 
otitis media, 
rales on auscultation of the lungs,
 a staccato cough that can be paroxysmal
palpable liver and spleen due to hyperinflation of the lungs.
72
Q

how do you treat Chlamydia pneumonia

A

erythromycin (PREP 2014)

73
Q

how do you Dx pertussi?

A

PCR ( and culture)

74
Q

at the beginning of a viral illness, what might you see on BW

A

lymphopenia

can see inc in neutrophils too

75
Q

what do atypical lymphocytes refer to?

A 
mature T lymphocytes with larger Nu
seen in:
EBV
CMV
Toxo
viral hepatitis
rubella
roseola
mumps
some drugs
76
Q

what is the management after a ? rabies exposure?

A
  1. if domestic anaimal - observe animal for 10 d. if no signs of rabies = all good
  2. if wild animal and caught = euthenise and look at brain
  3. if wild animal known to harbor rabies and not captured = prophylaxis
77
Q

who should get tetanus IG?

A

if received

78
Q

what is the rabbies prophylaxis treatment

A
  1. clean wound with soap
  2. clean with virucidal agent
  3. rabies IG administered into the wound and rest IM
  4. rabbies vaccine day 0, 3, 7, 14
79
Q

what is the definition of fever of unknown origin

A

> 14 d without etiology despite investigations

80
Q

when is a patient with measles contagious?

A

5 days before the rash (1-2 days before onset of symptoms)

4 days after the rash

81
Q

what are the MC features of measles?

A

Cough
Coryza
Conjunctivitis - stimson lines
Koplik spots

82
Q

what is the post exposure mgnt for measles

A

Ig within 6 days of exposure

+ Vaccine within 72 hrs

83
Q

what is german measles?

A

rubella

84
Q

when is rubella contagious?

A

2 days pre rash

1 week post rash

85
Q

are babies who had congenital tubella contagious

A

yes

They can shed the virus in their nasal secretions and urine for up to 12 months

86
Q

what are clinical features of rubella

A 
3 day rash
LN - retroauricular, post cervical, post occipital
conjunctivitis
sore throat
low grade T
87
Q

what is the usual presentation of roseola

A 
peak 6-9 mo
very high temps for 3-5 days
look unwell
can get febrile seizure
rash appears as they get better - can spare the face
Caused by HHV6/7
88
Q

what does Parvo B19 cause?

A
  1. Slapped cheek
  2. fetal anemia or hydrops
  3. Aplastic crisis
89
Q

what is the typical rash of Parvo?

A

slapped cheek and circumoral pallor
erythematous maculopapular truncal rash which fades and followed by a lacy reticulated rash that can be pruritis and can recur with exercise, bathing or rubbing

90
Q

when is a child with varicella contagious?

A

2 day pre rash

7 days post rash

91
Q

which CN is involved in Ramsay Hunt

A

CN VII

92
Q

what are the 2 MC secondary bacterial infections that can complicate Varicella?

A

GAS

Staph aureus

93
Q

what are common complications of varicella

A 
INFECTION - GAS
cerebellar ataxia
encephalitis
pneumonia
Nephritis/NS
orchitis
pancreatitis
MSK
pericarditis/myocarditis
94
Q

who should get treated with oral acyclovir for Varicella

A

non pregnant > 12 yrs
chronic cutaneous or pulm disease
ASA therapy
on steroid

95
Q

when do we worry if a pregnant mom at end of pregnancy develops varicella

A

if she has Varicella (not shingles)
5 days pre delivery to
2 days post delivery
Gets a lot of virus but mom has not had time to make Ab

Baby needs VZIG

96
Q

who can receive VZIG

A
  1. newborn whose mom had varicella 5 days pre or 2 days post delivery
  2. hospitalized prem > 28 wks whose mom lacks Hx or serology
  3. Hospitalized prem
97
Q

what is the efficacy of varicella vaccine

A

85% in preventing any disease

97% effective in preventing moderate to severe

98
Q

What is the daycare exclusion rule for impetigo

A

return 24 hr after start of Rx

99
Q

how do you treat impetigo?

A

2% mupirocin TID x 10d
or if extensive, or around eyes or bullous
Cephalexin for 7 d

100
Q

what usually causes cellulitis?

A

GAS = strep pyogenes - more spread

staph aureus - more localized

101
Q

what is Erysipelas?

A

dermis infection
GAS
sharp margins with orange peel quality
may need IV

102
Q

what is ecthyma?

A

GAS
dermis infection
painful ulcers
need PO abx

103
Q

what is ecthyma gangrenosum?

A

systemic infection in immunocompromised pt
PSEUDOMONAS aeruginosa throws septic emboli to skin
deep ulcers

104
Q

what causes Nec fasciitis

A 
polymicrobial
Staph aureus
GAS
E.Coli
Klebsiella
C. perfringens
105
Q

what is nec fasciitis

A

subcutaneous infection + superficial fascia

106
Q

how does necrotizing fasciitis present?

A 
local swelling, 
erythema, 
tenderness 
Fever 
Constitutional signs are out of proportion to cutaneous signs, especially with involvement of fascia and muscle
107
Q

how do you manage nec fasc

A
  1. support
  2. Sx
    3.Clindamycin and penicillin as per review course
    pip taz or
    Ceftriaxone and Vanco
108
Q

what causes hot tub folliculitis?

A

P. aeruginosa

109
Q

CP of EBV

A 
fever
lymphadenopathy
exudative pharyngitis
splenomegaly
hepatomagaly
petechia on soft palate
110
Q

what are hematological complications of EBV

A

low Plt
hemolytic anemia
hemophagocytic syndrome
splenic reupture

111
Q

EBV has been linked with some Ca, such as

A

nasopharyngeal CA
Burkitt lymphoma
Hodgkin

112
Q

What patient with EBV should receive steroids

A 
tonsillar inflammation and potential airway issues
massive splenomegally
myocarditis
hemolytic anemia
HLH
113
Q

what is the organism that causes cat scratch

A

BArtonella Henselae

114
Q

what are the MC affected LN in cat scratch

A
  1. axillary
  2. cervical
  3. submand
115
Q

How do you treat cat scratch?

A

most don’t need treatment - resolves 2-4 month

azithromycin for 5 days

116
Q

what are possible complications of EBV

A 
aseptic meningitis
seizures
transverse myelitis
encephalitis
GBS
coombs + hemolytic anemia
Ab mediated thrombocytopenia
HLH
117
Q

what CSF findings would be consistent with encephalitis?

A

increased lymphocytes
normal glucose
slight elevation in protein

118
Q

MC cause of croup

A

laryngotracheobronchitis
parainfluenza
RSV

119
Q

most common age group for croup

A

6 mo to 3 years

120
Q

what is spasmodic croup?

A 
6mo to 3 yrs
sudden onset
usually at night
NO prodrome
unclear etiology
manage the same
121
Q

What is the age group for epiglottitis?

A

3-4 yrs

122
Q

what are features of epiglotittis

A 
3-4 year old
H. influenza type b - much less now
GAS
Staph aureus
STRIDOR
drooling
sniffing position and tripod
XRAY - thickened and bulging epiglotittis = thumb sign
123
Q

how do you manage epiglotittis

A
  1. intubate
  2. IV cetriaxone
  3. If Hib - some family mb may need prophylaxis ( if less than 2 and not fully vaccinated, if unvaccinated, if immunocompromised) Rifampin 4 d
124
Q

what causes infective endocaditis in all children

A

strep vididens - alpha hemolytic - usually subacute

125
Q

if pt is known to have congenital heart disease and has never had Sx, what bug is the cause

A

strep viridens

126
Q

what bugs cause endocarditis in pt who have had cardiac surgery, have valve replaces and endovascular materials?

A

Staph aureu - usually acute EI

staph epidermidis

127
Q

what cardiac lesions are most at risk of infective endocarditis

A 
left sided lesion:
AS
TOF
PDA
VSD
128
Q

what are clinical features of IE

A 
FROM JANE:
Fever
Roth's spots
Osler's nodes
Murmur
Janeway lesions
Anemia
Nail hemorrhage (splinter hemorrhages)
Emboli
\+
malaise
wgt loss
heart failure
splenomegaly
129
Q

what is your initial Abx choice for IE

A

Vancomycin and gentamycin

if confirm strep - do pen g or ceftriaxone for 4 weeks

130
Q

what are the clinical features of bacterial tracheitis

A 
Staph aureus  most common
Moraxella catarrhalis, H. influenzae
usually post viral croup
brassy cough
high temp
toxic
not the posturing of epiglottitis
clinical Dx
131
Q

how do you manage bacterial tracheitis

A

ceftriaxone + vanco

132
Q

In what age group is strep most likely to cause pharyngitis?

A

School age

less likely before 3

133
Q

airborne

A

measles
TB
varicella
zoster

134
Q

who should get post exposure varicella vaccine?

A

within 72 hrs
if susceptible
if older than 12 mo
no contraindications

135
Q

how do you manage TSS

A

Empiric therapy with cloxacillin (or cefazolin) plus clindamycin for most cases

Penicillin + clindamycin ± IVIG for TSS due to group A strep

SB_Infectious Disease (Pediatrics Royal College 2018) (10 decks)

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