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1
Q

What bacteria is responsible for ecthyma gangrenosum (round, indurated black lesion with central ulceration)?

A

Pseudomonas

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2
Q

Who to prophylax for meningococcemia (4)?

A

1) Household contacts
2) Close contacts outside the home
3) Contact with oral secretions
4) Anyone who examined the throat

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3
Q

What prophylaxis for meningococcemia?

A

Rifampin for children; rifampin, ceftriaxone, cipro, azithro for >18yo

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4
Q

Risk factors for SBP?

A

Nephrotic syndrome and cirrhosis of liver

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5
Q

Bacteria responsible for SBP?

A

Enteric flora; in nephrotic syndrome–encapsulated organisms (loss of IgG in urine)

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6
Q

Treatment of SBP?

A

3rd gen cephalosporin and aminoglycoside

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7
Q

Bacteria responsible for secondary peritonitis?

A

GNR and anaerobes; consider staph epi in PD patients

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8
Q

Infections that latex agglutination can test for (BINS)?

A

B (Group B strep)
Influenza, haemophilus
Neisseria meningitidis
Strep pneumo

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9
Q

What is cryptosporidium?

A

Protozoan causing severe, watery, non-bloody diarrhea mostly in immunocompromised (but also immunocompetent) patients

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10
Q

How long does cryptosporidium diarrhea last?

A

Self-limiting in immunocompetent (~10 days); much longer in immunocompromised–can be indefinite and resistant to treatment

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11
Q

Treatment for cryptosporidium?

A

Nitazoxanide or paromomycin+azithro

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12
Q

What is cryptococcus?

A

Encapsulated yeast causing pulmonary disease and meningitis/meningoencephalitis–think AIDS!

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13
Q

Risk factors for cryptosporidium?

A

Contaminated pools

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14
Q

Risk factors for cryptococcus?

A

Exposure to bird-droppings (pigeons)

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15
Q

Treatment of cryptococcus?

A

Ampho B +/- flucytosine, then fluconazole

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16
Q

Classic CXR finding on active TB?

A

Hilar adenopathy

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17
Q

Treatment of active TB pulmonary disease?

A

2 months of RIP (rifampin, INH, pyrazinamide) then 4 months of rifampin and INH

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18
Q

Other sites of TB infection?

A

Meningitis
Adenitis
Pleuritis
Disseminated (Miliary disease)

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19
Q

Treatment of TB meningitis?

A

2 months of RIPS (rifampin, INH, pyrazinamide, and streptomycin) then 10 months of rifampin and INH; always use steroids

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20
Q

What is constitutes a positive PPD?

A

5mm–HIV+, abnormal CXR, close contacts, severely immunocompromised
15mm– >/= 4yo and no risk factors
10mm–everyone else

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21
Q

Presentation of chlamydia trachomatis pneumonia?

A

Afebrile, staccato cough, tachypnea, +/- eye discharge

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22
Q

Treatment of chlamydia trachomatis conjunctivitis?

A

PO erythromycin or sulfonamides; NOT topical treatment

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23
Q

Treatment of chlamydia trachomatis pneumonia?

A

Azithromycin x5 days, erythromycin x14 days

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24
Q

Treatment of chlamydia genital infections?

A

Azithromycin x1 or doxycycline x7 days

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25
Presentation of chlamydia pneumoniae pneumonia?
>5yo (usually adolescent), low grade fever, infiltrates, bronchospasm
26
Presentation of RMSF?
Fevers, myalgias, headache, petechial rash (starts peripheral-->central), May/June
27
Bug causing RMSF?
Rickettsia rickettsii
28
Treatment of RMSF?
Doxycycline (even if <8yo)
29
Other presenting lab abnormalities of RMSF?
Thrombocytopenia and hyponatremia
30
What other tick-born illness presents like RMSF?
Ehrlichiosis (more likely to have leukopenia and elevated LFTs)
31
What is Q fever?
Rickettsial illness (Coxiella) causing pneumonia, no rash, spread by inhalation of infected animal particles; not caused by tick bite
32
The 4 C's of Coxiella?
Cattle Cats Cilled (killed--slaughterhouses) Conception (exposure to infected animal products during birthing)
33
Treatment of Q fever and ehrlichiosis?
Doxycycline
34
Treatment of cat scratch disease?
Supportive mostly; don't I&D; azithro and rifampin can reduce time to lymph node resolution or in immunocompromised patients
35
Bacteria and treatment of cellulitis from cat or dog bite?
Pasteurella multocida; Augmentin (Bactrim + clinda if PCN allergic)
36
Possible infections from HiB?
Meningitis, pneumonia, periorbital cellulitis, pyogenic arthritis, epiglottitis
37
Treatment of HiB?
Ceftriaxone (meropenem if PCN allergic)
38
What to use for ppx of HiB close contacts?
Rifampin
39
Who and how to treat Salmonella gastroenteritis?
Infants <3mo, immunocompromised; treat with ceftriaxone
40
Presentation of typhoid fever (Salmonella typhi)?
Fever, malaise, HSM, "rose spots" on trunk
41
Diagnosis of typhoid fever?
3 sets of blood cultures; bone marrow culture is best
42
Treatment of typhoid fever?
Ceftriaxone, ampicillin, Bactrim, fluoroquinolones based on sensitivity
43
Types of infections with Pseudomonas?
Pneumonia, sepsis, nail-puncture cellulitis/osteomyelitis, endocarditis (IV drug user), bacteremia in burn patient, ecthyma gangrenosum
44
Presentation of brucellosis?
Fever, malaise, mylagias, LAD, HSM
45
Transmission of brucellosis?
Unpasteurized milk and cheest, inhalation (cows, dairy farm), or handling carcasses
46
Treatment of brucellosis?
Doxy + aminoglycoside or doxy + rifampin or Bactrim + rifampin (high rate of relapse--must use combo)
47
What virus can be superinfected to cause strep TSS or necrotizing fasciitis?
Varicella
48
Can strep cellulitis cause rheumatic fever?
No--only post-strep GN (strep throat can cause both)
49
Why treat strep?
To prevent rheumatic fever (does not prevent post=-strep GN)
50
Presentation of early onset GBS infection (up to 7 days of life)?
Sepsis, pneumonia, meningitis
51
Presentation of late onset GBS infection (7 days - 3 months?
Bacteremia, meningitis, osteomyelitis
52
What give pregnant moms GBS ppx?
Decreases early onset GBS, but not late onset
53
Who to give GBs ppx to (4)?
1) GBS+ this pregnancy 2) GBS bacteriuria this pregnancy 3) Previous infant with invasive GBS disease 4) Unknown GBS and 18hrs, or intrapartum fever
54
Diagnosis of botulism?
Organisms and/or toxin in blood or stood
55
How does botulinum toxin work?
Blocks release of Ach into synapse
56
Treatment of infantile botulism?
Supportive care or anti-toxin (NO antibiotics)
57
Treatment of campylobacter?
Azithromycin
58
Presentation of tularemia (Francisella tularensis)?
Fevers, HSM, LAD, irregular ulcer at site of innoculation
59
Transmission of tularemia?
Rabbits, transmitted by tick or fly bites
60
Treatment of tularemia?
Gentamicin, doxycycline, or streptomycin
61
Presentation of bubonic plague (Yersinia pestis)?
Septicemia (with buboes--large, suppurative, painful LN); pneumonic form; meningeal form
62
Transmission of bubonic plague?
Wild rodents is reservoir; transmitted by fleas or direct contact; pneumonic form transmitted to bystanders by coughing (bioterrorism)
63
Geographical difference between tularemia and plague?
Tularemia--midwest (AK, MO, OK) | Plague--desert southwest
64
Treatment of plague?
Streptomycin (2nd line--gent, doxy, fluoroquinolones)
65
Presentation of anthrax?
Cutaneous--painless papules->paniless vesicle->painless ulcer->painless black eschar
66
Treatment of anthrax?
Cipro or doxy (ppx with cipro)
67
In what patient is rifampin contraindicated?
Pregnant patient (known teratogen)
68
Treatment of shigella?
Ceftriaxone, cipro, or azithro (all patients should be treated)
69
Diagnosis of neonatal CMV?
Urine CMV culture in first 3-4 weeks of life
70
4C's of CMV?
Chorioretinitis Cerebral calcifications (periventricular) Censorineural hearing loss Culture, urine for dx (Also thrombocytopenia, blueberry muffin lesions, HSM, jaundice, SGA, microcephaly, seizures, hypotonia)
71
Infection with blood transfusion (especially pneumonia)?
CMV
72
Coxsackie B can cause what "-itis"?
Myocarditis
73
Presentation of mumps?
Fever, headache, malaise, myalgias, swelling of parotid gland and/or testicles
74
Complications of MUMPS?
``` Meningitis Underwear (orchitis) Muscle aches Pancreatitis Swelling of the parotid gland ```
75
What causes intermittent parotid swelling?
Stone in the salivary gland
76
Which is more common from mumps--orchitis, meningitis, pancreatitis?
Orchitis
77
Presentation of congenital rubella infection?
Cataracts, glaucoma, hearing loss, PDA, thrombocytopenia, blueberry muffin lesions, HSM, hepatitis
78
What are blueberry muffin lesions?
Extramedullary hemotopoiesis
79
Presentation of measles?
Cough, coryza, conjunctivitis, fever, Koplik spots, rash at hairline
80
Who should get measles immunoglobulin?
Infants <12 months, pregnant women, immunocompromisde individuals (give within 6 days of exposure)
81
Does delivery via C-section rule out HSV transmission with active infection?
NO--can still be transmitted as ascending infection (although it does decrease the risk)
82
Best test for HIV in children 18 months and younger?
HIV DNA by PCR
83
When to test for HIV after exposure?
At exposure, 6 weeks, 12 weeks, and 6 months
84
Presentation of childhood HIV?
Recurrent bacterial infections, recurrent or persistent thrush, HSM, FTT, DD, cognitive impairment
85
When to screen infants for HIV (with PCR)?
Birth, 2 months, 4 months, and 6 months
86
Buzzword for PCP on CXR?
Ground glass opacities or appearance
87
What vaccines to give kids with HIV?
All except live viruses
88
Complications of VZV infection?
Secondary bacterial infection (staph and strep), pneumonia, encephalitis, transient cerebellar ataxia
89
What is VZV exposure for a neonate (to treat with VZIG)?
Mom develops VZV between 5 days before delivery through 2 days after delivery (treat with VZIG within 96 hours of exposure)
90
When are children with VZV contagious?
1-2 day prior to rash until all lesions are crusted over
91
Treatment for rabies exposure?
Rabies Ig and vaccine within 7 days of exposure
92
Presentation of ascaris lumbricoides (parasite)?
Returning from endemic area, abdominal pain, bowel obstruction (travel through GI to blood to lungs then are swallowed)
93
Treatment of ascaris lumbricoides?
Albendazole, mebendazole, or ivermectin
94
Non-dysentery presentation of entamoeba histolytica?
Liver abscess, brain abscess, lung disease
95
Treatment of entamoeba histolytica?
Iodoquinol, paromomycin, or diloxanide; metronidazole 1st if severe or extraintestinal disease
96
Presentation of toxocara canis?
1) Visceral larbal migrans--GI symptoms (hepatomegaly and abdominal pain) and respiratory symptoms (wheezing) 2) Ocular larval migrans--visual disturbances 3) Covert toxocariasis--GI symptoms and pruritic rash - Eosinophilia!
97
Risk factors for toxocara canis?
Exposure to cat and dogs; preschooler eating dirt
98
Diagnosis of visceral larval migrans?
ELISA and stool culture (to rule out other infections)
99
Treatment of toxocara canis?
Mebendazole or thiabendazole
100
Treatment of schistosomal/liver fluke/tapeworm?
Praziquantel
101
Treatment of strongyloidiasis?
Ivermectin
102
Treatment of enterobius vermicularis (pinworms--scotch tape test!)?
Menbendazole, pyrantel pamoate, or albendazole (treat whole family)
103
Presentation of coccidioidomycosis?
Vague flu-like illness, travel to CA, AZ, or TX
104
Treatment of coccidioidomycosis?
Amphotericin B or fluconazole
105
Presentation of aspergillosis?
"Asthmatic" with worsening symptoms despite tx; increased eosinophilias and CXR infiltrates
106
Who develops invasive aspergillosis?
Immunocompromised patients
107
Treatment of aspergillosis?
Voriconazole or amphotericin B
108
Presentation of histoplasmosis?
Flu-like illness; HSM; OH, MO, MS
109
Transmission of histoplasmosis?
Bird droppings; cave exploration
110
Treatment of histoplasmosis?
Supportive care for healthy kids; amphotericin B for immunocompromised patients

Pediatric Boards (12 decks)

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