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Laughing Pedi > ID > Flashcards

ID Flashcards

0
Q

Treatment of spontaneous peritonitis?

A

3rd gen ceph + aminoglycoside

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1
Q

Risk factors for spontaneous primary peritonitis? (2)

Specific type of bug in one.

A

Cirrhosis, nephrotic syndrome (encapsulated: pneumococcus - loss of IgG

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2
Q

common complication of chronic peritoneal dialysis

A

Staph epidermis peritonitis

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3
Q

common bug in VP shunt infx

A

staph epi

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4
Q

primary cause of occult bacteremia

A

strep pneumo

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5
Q

bug to worry about in asplenic pts

A

strep pneumo

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6
Q

Bugs causing septicemia in neonate

A

GBS, Ecoli, Strep pneumo, S aureus

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7
Q

Bug causing septicemia in infant

A

GBS, Ecoli, Strep pneumo, Saureus, salmonella

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8
Q

bugs causing septicemia in immunocompromised pts

A

GNR: pseudomonas, Ecoli, klebsiella

Staph

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9
Q

Abx for r/o sepsis in neonate

A

amp/cefotax or amp/gent

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10
Q

ecthyma gangenosum: large pustules on indurated inflamed base, think of what dz?

A

pseudomonas

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11
Q

rose spots, what dz?

A

salmonella typhosa

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12
Q

septicemia tx in >3 mo

A

vanc+CTX

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13
Q

prophylaxis for meningococcemia for who and with what?

A

all persons w/ contact w/ oral secretions, household contacts and close outside contacts
Tx w/ Rifampin q12 x2 days or CTX x1, or Cipro 500 x 1 in >18yo

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14
Q

Dx and Tx of DIC in sick kid

A

Expect low fibrinogen and high fibrin degredation products and high d-dimer.
Tx w/ ABX then clotting factors and platelets

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15
Q

what bugs does latex agglutination test for?

When to do this?

A

BINS: GBS, Influenza/H (HIB), Neisseria Mening, Strep pneumo

Helpful w/ partially treated infx when culture unreliable

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16
Q

latex agglutination caveats:
False positives in who?
cross reactivity w/ what?

A

False pos in children recently received HIB vaccine

Ecoli x-react w/ N. meningitidis.

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17
Q

transfusion related infx, esp pna?

A

CMV

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18
Q

pneumocystis jiroveci

A

PCP (pneumocystis carinii pneumonia)

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19
Q

tx for fever, neutropenia

A
  • Zosyn (piperacillin-tazobactam) + aminoglycoside

- Ceftazidime or cefapime

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20
Q

water park bug, what does it cause

A

cryptosporidium (looks like viral gastro but lasts longer)

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21
Q

Tx of cryptosporidium or Giardia in child >1 yr w/ diarrhea

Tx if crypto and immunocompromised

A

Nitazoxanide

IF immunocompromised crypto: oral human IG or bovine colostrum

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22
Q

immigration + acute abdominal obstruction

A

ascaris lumbricoides, tx: albendazole x 1, mebendazole x 3d, ivermectin x1

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23
Q

staccato cough

A

chlamydia pna

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24
Q

intracytoplasmic inclusion bodies

A

chlamydia

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25
Q

definitive dx of chlamydial pna?

A

Ab-specific test or PCR

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26
Q

4Cs of chlamydia

A

Cough, conjunctivitis, chlamydia, cixteen wks

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27
Q

lab finding and possible tx for chlamydial pna in newborn

A

eosinophilia

emycin PO or azithro. Or if needed non-macrolide, sulfonamide

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28
Q

s/e of macrolides (azithro, clarithro)

A

diarrhea, abdominal stuff

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29
Q

dx of chlamydial pna in teen?

A

immunoflourescent Abs

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30
Q

most common fatal tick-borne dz in US?
Dx?
Tx?

A

RMSF
Dx w/ direct IF or skin bx
Tx w/ Doxy RIGHT away

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31
Q

rash in RMSF?

A

mac pap –> petechial,

extr –> trunk

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32
Q

season for RMFS?

Tx?

A

May/June

Doxycycline!

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33
Q

Bug in Q fever
what does it cause
what is tx

A

Coxiella burnetti - inhalation of spore like particles, can be tick bourne
causes PNA
tx w/ doxy or supportive care

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34
Q

Bug causing amebiasis

A

entamoeba histolytica

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35
Q

Bug causing severe GI bloody diarrhea, liver and brain abscesses, and lung dz?

A

Amebic dysetery, entamoeba histolytica

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36
Q

hematophagous trophozoites

A

E. histolytica

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37
Q

Tx of amebiasis (E. histolytica)

A

Flagyl or tinidazole –> luminal amebicide (iodoquinol, paromyin)
Can just do luminal if asx cyst excreter

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38
Q

iodoquinol or paromocyin are what?

A

Luminal amebicide

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39
Q

round worm

A

Toxocariasis

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40
Q

eosinophilia, exposure to dog/cats, preschooler eating dirt: Gi and Resp sx

A

Toxocariasis

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41
Q

3 clinical manifestations of toxocariasis?

A
  1. viscera larva migrans: fever, hepatomegaly, wheezing
  2. ocular larva migrans: visual disturbance
  3. covert toxocariasis: GI sx, pruritis, rash
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42
Q

Viscera Larva Migrans in suspected toxocariasis

Dx and Tx?

A

Dx w/ ELISA and get stool cx to r/o other parasites

Tx w/ mebendazole or thiabendazole

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43
Q

(Longhaired cats, Licking dogs/dirt, ____Dz in Lungs and Liver)
What is the dz?
Big clue?

A

Larval!! (Ls: Toxocariasis)

*hepatomegaly

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44
Q

Tx of giardia?

A

flagyl, furazolidone, albendazole

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45
Q

Tx of schisosomal, liver fluke, tapeworm?

A

Praziquantel

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46
Q

tx of strongyloidiasis

A

thiabendazole

strong guy doing bends

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47
Q

Bug in cat scratch disease
When to tx
What to tx w/?

A

bartonella henselae
tx: supportive unless hepatomegaly, large painful LAD, immunocompromise –> azithro, emycin, cipro, Bactrim, Rifampin are all choices

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48
Q

bug to cover for in cat bite and tx

A

staph and Pasteurella multocida

Tx w/ Clinda and Bactrim (for pasteurella)

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49
Q

gram negative pleomorphic org in non-immunized child

Tx

A

HIB, H flu

Tx: CTX

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50
Q

3 encapsulated bugs to think about w/ asplenia

A
  1. H flu
  2. strep pneumo
  3. N. meningitidis
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51
Q

when to give HIB prophylaxis?

with what?

A

if a child <4 incompletely immunized is in house or immunocompromised child in house.
Rifampin!
Trick: no px if non-typeable Hflu

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52
Q

dx of pertussis

Tx of pertussis

A

Dx: culture and IF nasal swabs
Tx: erythromycin estolate, or clarithro/azithro

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53
Q

how does pertussis tx help?

A
  1. catarrhal stage: shortens the URI phase

2. during paroxysmal stage: decr period of communicability but doesn’t shorten coughing ever

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54
Q

how do you handle pertussis prophylaxis

A

anyone exposed gets erythromycin to prevent spread

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55
Q

classic salmonella poisoning: timing and dx

A

1-2 d after exposure. stool culture

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56
Q

who should be treated for salmonella infx? and with what?

A

< 3 mo infant, risk for invasive dz (malignancy, colitis, immune compromise). Tx w/ amox, bactrim, cefotax, cipro in adult.

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57
Q

type of bug causing pna / death in CF?

A

pseudomonas cepacia

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58
Q

ABx for pseudomonas

A

ceftaz**

gent, tobra, cefepime

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59
Q

dairy farm, fevers, myalgias

Dx and Tx

A

brucellosis, dx w/ Ab testing, tx Doxy, Bactrim + Rifampin

Prolonged tx

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60
Q

tx of cdiff

A

flagyl

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61
Q

GBS risk fx?

A
  1. low SES
  2. multiple sex partners
  3. hx stds, young maternal age
  4. ROM >18h
  5. fetal scalp monitor/instrument breaking skin
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62
Q

indications for GBS prophylaxis in pregnant lady

A
  1. previous infant w/ invasive GBS dz
  2. GBS bacteriuria
  3. pos GBS screen
  4. unknown GBS w/ gestation < 37wk, ROM>18, fever 38
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63
Q

descending paralysis in infant

A

infantile botulism

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64
Q

mechanism of botulism

A

block release of Ach (presynaptic)

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65
Q

when to treat newborn w/syphilis?

A
  1. if mom tx in last mo of pregnancy
  2. if tx w/ emycin which doesn’t cause placenta
  3. if baby titers are higher than mothers
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66
Q

Whats the deal with newborn syphilis lab results

A

FTA-ABS are forever high

VDRL should go down

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67
Q

macular papular rash, HSM, and peeling skin in newborn

Dx?

A

Syphilis

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68
Q

sniffles, bullous lesions, osteochonditis, HSM in newborn

Dx and Tx

A

syphilis, PCN

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69
Q

white nodules on placenta in sick newborn

A

listeria (microabscesses)

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70
Q

Listeria vs GBS regarding mom in pregancy

A

ASX during pregnancy: GBS

Flu like: listeria

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71
Q

the buzz words for campylobacter fetus

A

family w/ animal exposure

premature delivery

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72
Q

Tx for strep throat in pcn allergy

Why

A

erythromycin, clindamycin

TO prevent ARF

73
Q

gram negative bacteria from rabbits

A

tularemia (francisella tularensis)

74
Q

Remembering treatment for Tularemia?

A

Rabbits: gentle, Gentle-mycin (Gentamicin)

75
Q

Cause of bubonic plague
Sx?
How do you get it

A

yersinia pestis
sx: buboes: inguinal painful LN, other LAD
from handling dead animals

76
Q

three types of Bubonic plague?

A
  1. sepsis
  2. meningeal
  3. pneumonic
77
Q

Tx of bubonic plague (Yersinia)

A

gentamicin / streptamycin

OR doxy,chloramphenicol, tetracycline

78
Q

resistance in hospital acquired MRSA?

A

multidrug: beta lactamase ABs and cephalosporins. NEED vanc

79
Q

ABx that can be used in community MRSA

A

bactrim, gent, doxy

80
Q

Causes of systemic candiasis?

A

YEAST: Widespread immunosuppression, Extensive burns, Abx, Suppressed immunity, TPN use

81
Q

encapsulated yeast causing pulm dz and meningitis

A

cryptococcus

82
Q

exposure in cryptococcus

A

bird droppings, pigeons

83
Q

Tx of cryptococcus

if resistant?

A 
amphotericin B + fluconazole
ADD 5FC (flucytosine) for resistant infx
84
Q

tx of Crypto in pt w/ renal dz?

A

liposomal form of amphotericin B

85
Q

California, Arizona, Texas travel. Think what dz?

A

Cocciciomycosis

86
Q

sx of coccidiodomycosis?

A

vague influenza sx, but severe

87
Q

Tx of aspergillosis?

A

Vorixonazole or amphotericin B

88
Q

Influenza sx + HSM in recent travel to mississippi or missouri, or ohio

A

Histoplasmosis

89
Q

crypto vs histo?

A

both bird droppings, but histo gives HSM

90
Q

tx of histo?

A

supportive unless complicated or immunocompromised, then amphotericin b or fluconazole

91
Q

lymphocutaneous manifestations after gardening. chain of nodules, bone/joint sx, superficial/deep tissues.
Tx.

A

Sporothrix schenckii: sporotrichosis

Itraconazole

92
Q

Dx of CMV?

A

Urine culture for CMV w/in first 3-4 wks of life

93
Q

Sx of congenital CMV

A

5Cs: chorioretinitis, cerebral calcifications (periventricular=center), censorineural hearing loss, urine Culture

94
Q

blueberry muffin baby

A

congenital CMV

95
Q

Tx of CMV

A

Gangciclovir

96
Q

Diagnosing arbovirus meningitis

A

CSF virus specific IgM or 4x elevation of IgG from acute to convalescent

97
Q

type of virus mumps is

A

paramyxovirus

98
Q

Complications of MUMPS?

A

meningitis, underwear (orchitis), muscle ache, pancreatitis, swelling of parotid

99
Q

is infertility a complication of Mumps?

A

very uncommon

100
Q

cause of intermittent parotid swelling?

A

salivary gland stone

101
Q

HHV-6

102
Q

exanthum subitum

A

HHV-6, Roseola

103
Q

fever then rash

104
Q

rate of congenital rubella in affected mother during T1?

105
Q

Congenital Rubella sx

A

cataracts, PDA

106
Q

rubeola

107
Q

when most contagious with measles?

A

5 days before and after rash

108
Q

timeline of measles

A

prodrome x 2 days, Koplik spots, rash day 5-10

109
Q

HIV pt w/ exposure to measles (rubeola)

A

IM immunoglobulin

110
Q

who should get measles IM Immunoglobulin?

What else can you do?

A

HIV, child < 1 who is exposed within 6 days of exposure! Also immunocompromised and pregnant ladies.
Can also give MMR w/in 3 days of exposure

111
Q

When to revaccinate after MMR or IM immunoglobulin after measles exposure?

A

if MMR before age 1, need to repeat after 1y birthday

if IM Ig, give MMR 5 mos later

112
Q

5th dz?

113
Q

DX of HIV In newborn

A

Ab crosses placenta, so need HIV DNA PCR

114
Q

Rx to prevent vertical HIV trm

Rate of trm?

A

ziduvodine (AZT), nevirapine

Actual rate: 5% developed, or 30-40%

115
Q

HIV buzzword mnemonic?

A

H: HSM
I: intellectual
V: very poor Abx, frequent bact infx

116
Q

testing and tracking for HIV seroconversion?

A

6 wks, 3 mos, 6 mos

117
Q

needlestick by HIV person contam vs high risk exposure?

A

2 drugs for contaminated needlestick for 4 wks

3 drugs for hi risk for 4 wks

118
Q

infant screening for HIV?

A

birth, 2, 4, 6, mos

119
Q

What is foscarnet for?

A

CMV retinitis, severe mucocutaneous dz in acyclovir resistant HSV, Zoster in acyclovir resistance

120
Q

HIV, MMR and VAricalla vaccines

A

YES if not markedly immunosuppressed

121
Q

tx of infant exposed to varicella (time period of risk for newborn?)

A

VZIG: mother develops it between 5 days before delivery to 2 days after

122
Q

type of precautions for mumps, rubella, pertussis

123
Q

precautions for aspergillosis, TB, measles, varicella

A

airborne: need special units

124
Q

most common cause of PNA in school aged child

A

mycoplasma pna

125
Q

two bugs in cervical adenitis and how to distinguish

tx?

A

s. aureus: in younger, more indolent, more likely to supporate
GAS in older kids, more acute
Often need surgical drainage

126
Q

treatment of most cases of cat scratch adenitis?

A

usually self limited, and can observe

127
Q

most common associated sx in Pertussis in 1 mo

A

pna (25%), 4% get sz

128
Q

Heterophil antibodies are specific to what virus in mono?

A

EBV, not CMV/Toxo/HIV

129
Q

viral capsid antibody for EBV shows what compared to EBNA (nuclear antigen)

A

EBNA: old infx

viral capsid Ab: acute infx

130
Q

staph scalded skin, recover organism (which) from where?

A

Staph aureus from nasopharynx (toxin mediated skin rxn)

131
Q

poor prognosis in meningococcemia (4)

A
  1. hypotn
  2. WBC <10,,000
  3. petechiae w/in 12 h
  4. NO meningitis…
132
Q

erythema multiforme w/ what bug

A

mycoplasma pneumoniae, HSV

133
Q

koplik spots appear when in measles

A

after rash

134
Q

brain abscess in neonate bug

A

citrobacter koseri (diversus)

135
Q

scarlet fever and rheumatic fever mechanisms

A

scarlet fever: toxin mediated

rheumatic fever: immune complex mediated

136
Q

meningitis after head trauma

?bug

137
Q

Pregnant woman exposed to parvo B19

Recommendation?

A

-risk to fetus is low, but needs more monitoring.

She’s already exposed, so no need to take leave of absence from work

138
Q

Best HIV testing for infant

A 
Viral PCR (DNA)
Viral load (RNA)
Elisa at 18 mos x 2...
139
Q

biggest bacterial infection concern in HIV+ infant

rare things for HIV only (2)

A

S. pneumo
PCP
Lymphoid interstitial pneumonitis (real bad CXR)

140
Q

When to start Bactrim prophylaxis (3)

A

<1500 CD4 count, infants born to HIV mom, or child after episode PCP

141
Q

Positive PPD?

A

> 15mm in normal no risk kids >4y, but >10 if younger or chronic dz or incr risk.
The >5 PPD is only for immunocompromise or high suspicion for TB/known exposure

142
Q

diarrhea + seizure?

A

think shigella (lots of extraintestinal manifestations)

143
Q

Yersinia enterocolitica causes severe infx in who?

A

mostly a dz of toddlers from ingestions (pork intest) BUT can be very severe in iron overload states: thal or hemolytic anemia
RLQ pain…

144
Q

Suspect what immune issues / lab findings in someone with chronic giardiasis

A

HIV, IgA def, Hypogammaglobulinemia (low IgG or IgA)

145
Q

How do you dx Giardia?

A

cysts or trophozoites in stool (3 stools for 95% sens)

IF or enzyme immunoassay less sensitive

146
Q

Treatment of Cryptosporidiosis

A

Niazoxanide x 3 d

Avoid recreational water: chloride won’t kill it!

147
Q

Diarrhea and liver abscess?

A

THink entamoeba histolytica

“amebic dysentery”

148
Q

bug in human bites? (3)

A

streptococci, S. aureus, anaerobes like Eikenella

149
Q

Test to look for inducible clinda resistance in MRSA

A

D-test… clinda resistance common in hospital acq MRSA
If there is a “D” its inducible to clinda, then don’t give Clinda
(erythro Resistant but Clinda suscept but inducible… )

150
Q

most common but in osteomyelitis or septic joint?

A

S. aureus (all ages)

151
Q

osteomyelitis in chronic granulomatous disease? (2 bugs)

A

Serratia, Aspergillus

152
Q

radiograph of choice for suspected osteo?

153
Q

Ohio or Mississippi valley // cave bug?
Sx clues
Tx?

A

Histoplasmosis
hilar adenopathy, 95% asx, may have disseminated in young kids
Tx: amphotericin B with severe dz

154
Q

Southwest US, sanJoaquin, northern Mexico bug
high risk groups
sx
tx

A

Coccidiomycosis
neonates, pregnancy, immunocompromised, Fillipinos!
Asx common, acute pulm, meningitis (subacute)
AMphotericin / Fluconazole

155
Q

parasite to cause rectal prolapse and dysentery

A

Trichuris trichuria (whipworm)

156
Q

parasite causing Fe def anemia, edema,

A

Necator americanus (hookworm)

157
Q

parasite causing wheezing, eos, hypergammaglobulinemia

A

Toxocara canis (visceral larva migrans) dog ascaris worm. Not in stool

158
Q

parasite causing acute intest obstrx, also eosinophilic pneumonitis

A

Ascaris lumbricoides, Loeffler’s (eos pneumonitis)

159
Q

parasite causing fever, myalgias, periorbital edema, conjunctival hemorrhages
After eating pork

A

Trichonosis: trichinella spiralis (tissue nematode)

160
Q

dx in child
smear shows intraleukocytic includiosn (morulae)
looks like RMSF but less prominent rash and very anemic and TCP. HypoNa

Tx?

A

Ehrlichiosis

Tx doxy also

161
Q

What looks like catscratch but has bld cx with gram-neg coccobacillus? Bug?
Transmission?
Where most common?

A

Tularemia - Francisella tularensis

central states, tick biet most common. Also rabbits.

162
Q

bug that invades skin from contaminated water (farm pond, slaughter house -dog/rodent) through cut in skin or mucus membranes
Tx?

The severe liver disease high mortality form? Tx?

A

leptospirosis: self limited or doxy, CTX

Weil’s disease: PCN G for severe disease

163
Q

what causes rat bite fever?

Tx

A

Streptobacillus moniliforis

Tx: PCN G or Doxy if allergic

164
Q

Isoniazid s/e

A

peripheral neuritis esp if B6 def

165
Q

Rifampin s/e

A

staining of tears / contact lenses

166
Q

Pyraxinamide s/e?

A

hyperuricemia

167
Q

s/e ethambutol

A

optic neuritis

168
Q

methicillin, oxacillin, nafcillin s/e

A

interstitial nephritis

169
Q

s/e of ctx?

A

biliary sludging (not to use in newborn)

170
Q

skin lesion in sick, neutropenic chemo patient?

A

pseudomonas: ecthyma gangrenosum

171
Q

pin point red spots rash, fever syndrome with GNR

A

Salmonella typhi

172
Q

meningitis after head trauma /CSF leak?

A

Pneumococcus! H flu

173
Q

top bugs in afebrile PNA syndrome in baby 4-12 wks (4)

A

Chlamydia, u. urealyticum, CMV, viral.

174
Q

shunt infx bug/

A

COag neg staph, skin orgs

175
Q

travel hx to Africca, fever, anemia, splenomegaly, CNS/Sz

A

cerebral malaria: plasmodium falciparum

176
Q

chronic sinusitis, bronchiectasis with signet ring, situs inversus

A

Kartageners

177
Q

painful regional LAD and pna, what bioterrorism

A

yersinia pestis

178
Q

respiratory distress then shock and wide mediastinum in bioterror

A

inhalation anthrax

179
Q

papular lesion and cervical LAD in bioterror

180
Q

sheet like pseudomembrane looks like epiglottitis, ragged air column

dx and bug

A

bact tracheitis, S. aureus

181
Q

IgA def incr risk of what infx?

Laughing Pedi (24 decks)

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