ID Flashcards
VZV
Begins on face. Poss fever, malaise
Rubeola
Measles.
Paramyxovirus
3Cs: cough, coryza, conjunctivitis. +Koplik spots
Measles IgM Abs
Fifth disease
Erythema infectiosum.
Parvo B19
Starts with fever and URI the progresses to slapped cheek rash
Roseola
HHV 6,7.
Fever, URI. Then diffuse rash
Mumps
Paramyxo
Fever then parotitis and/or orchitis
May cause male infertility
Scarlet fever
Diffuse erythematous eruption concurrent with pharyngitis.
3-6 days
Pentad: fever, pharyngitis, sandpaper rash in trunk and exremities, strawberry tongue, cervical LAD
Tx w/ penicillin, azithro, or ceph
Croup
Severe inflamm upper airway-chokes off. Medical emergency.
Parainflu 1, 2
Seal-like barking cough with URI-like sxs
May have signs hypoxia, more difficult to breathe when lying down
Give racemic epi to decrease swelling to prevent asphyxiation
Steeple sign (CXR)
Croup
Epiglottitis
Truest medical emergency in paeds
Extremely irritable, refusal to eat, refuses to lean back, muffled speaking, looks extremely ill, drooling.
Look for vaccine delay w/ “hot potato” voice, fever, drooling in tripod position, refusal to lie flat.
PE: hot cherry-red epiglottitis
CXR-thumbprint sign
Tx-intubate immediately-do not even waste time with full exam. Ceftriaxone 7-10 days. Rifampicin for close contacts
Whooping cough-stages
Catarrhal stage: severe congestion, rhinorrhea. 14 days
Paroxysmal stage: severe coughing episodes with extreme gasp for air followed by vomiting. 14-30 days
Convalescent stage: Decreased frequency of coughing. 14 days
Signs whooping cough (PE, CXR)
Burst vessels in eyes
Butterfly appearance on CXR
Tx-whooping cough
Macrolide only in catarrhal stage and to contacts
How long does bronchitis last
7-10 days
Pharyngitis
Inflamm pharynx and adjacent structures
Cervical adenopathy, petechiae, fever >104, other URI sxs
Diphtheria
membranous inflamm pharynx due to bacterial invasion.
Do not scrape membrane
Tx is antitoxin–Abx don’t work
Legg-Calve-Pethes disease
Avascular necrosis femoral head.
Presents with painful limp, usu ages 2-8
XR shows joint effusions and widening
Slipped capital femoral epiphysis
Painful limp, externally rotated leg
Adolescence
XR: widening joint space.
Tx: internal fixation with pinning
Causes meningitis in newborn
Listeria
Strep agalactiae (Group B strep)
E. coli and other coliforms
Signs and sxs meningococcal disease
Non-blanching rash, purpura (>2mm)
Ill looking child
CRT >3s
Neck stiffness
Herpes simplex encephalitis-signs and sxs
Focal neuro signs
Focal seizures
Decreased level consciousness
Signs and sxs UTI (children older than 3 mo)
Vomiting Poor feeding Lethargy Irritability Abdo pain or tenderness Urinary frequency or dysuria Offensive urine or hematuria
Signs/sxs septic arthritis
Swelling of limb/joint
Not using an extremity
Non-weight bearing
Signs and sxs Kawasaki disease
Fever >5days and at least four of following:
- B/L conjunctival injection
- Change in upper resp tract mucous membranes (e.g. injected pharynx, dry cracked lips, strawberry tongue)
- Change in peripheral extremities (e.g. edema, erythema, desquamation)
- Polymorphous rash
- Cervical LAD
Pharyngitis
Inflamed pharynx and soft palate, enlarged or tender local LNs
Usu caused by resp virus, e.g. adeno, entero, rhino.
Older kids-group A beta hemolytic strep (S. pyogenes)–rapid strep test and Abx (prevent RhF)
Tonsillitis
Form of phayngitis with intense inflamm tonsils oft with purulent exudate
S pyogenes: can cause recurrent tonsillitis in some children. More commonly gives consitutional disturbances eg HA, apathy, abdo pain, white tonsillar exudate, cervical LAD
EBV has softer exudates
Penicillins will cause rash if due to infectious mononucleosis (“glandular fever” to you Brits)
Viral causes of maculopapular rash
HHV6 or 7 (Roseola),
Bacterial causes maculopapular rash
Scarlet fever (S. pyog)
Erythema marginatum–RhF
Typhoid (S. typhi), classically rose spots
Lyme disease–erythema migrans
Non-bacterial, non-viral causes maculopapular rash
kawasaki
Juvenile idiopathic arthritis
Viral causes vesicular/bullous/pustular rash
Chickenpox
Hand, foot, and mouth disease (Coxsackie)
HSV
bacterial causes vesicular/bullous/pustular rash
Impetigo Boils/folliculitis Staphylococcal bullous impetigo Staphylococcal scaled skin TEN
Non-viral, non-bacterial causes vesicular/bullous/pustular rash
Erythema multiforme, SJS
Causes petechial/purpuric rash
Meningococcal and other bacterial sepsis Infective endocarditis HSP Thrombocytopenia Vasculitis Malaria
HSV1
Gingiostomatitis is most comm manifestation in kids. Painful vesicles on mouth, hard palate, lips, and tongue.
2 weeks.
Acyclovir if bad.
Herpetic whitlows-pustules on broken skin on fingers
EBV
Cause of infectious mononucleosis.
Not monocytes, but look like them–atypical reactive T lymphos.
Monospot test.
Parvo B19
Infects erythroblasts, hence why dangerous (aplastic anemia) in those with hemolytic anemias or less reserve
“Slapped cheeks”, fever, malaise, myalgia
Bad in utero–fetal hydrops and death due to anemia
Hand, foot, and mouth disease
Coxsackie A16 most common cause
Painful vesicular lesions on hands, feet, and mouth, and often on buttocks. Subsides within few days. Mild systemic features.
Chickenpox
VZV
Papules start on head and trunk and progress to peripheries
Vaccine exists.
If new lesions beyond ten days, suggests defective cellular (T cell) immunity
Lyme disease
Borrelia burgdoferi via ticks
Erythema migricans: red, painless, expanding (“target lesion”)
Fever, HA, myalgia, arthralgia, malaise LAD. Can cause myocarditis, heart block, meningoenceph, cranial and periph nerve neuropathies
Impetigo
S. aureus>S. pyogenes
More common if pre-existing skin disease, e.g. eczema
Erythem macules to vesicles which rupture causing HONEY COLORED CRUSTING.
Spreads via self-inoculation
Tx: topical Abx e.g. mupirocin
Peri-orbital cellulitis
Tenderness and edema of eyelid, erythema, and fever
Infants: Hib
Older child: dental abscess or paranasal sinus infection
Orbital cellulitis if left untreated. Can cause visual problems, abscess formation, meningitis, cavernous sinus thrombosis
Tx: CT to assess posterior spread, LP to exclude meningitis
Immediate IV abx
Scalded skin syndrome
S aureus: exfoliative toxin causes separation epidermis
Fever; malaise; purulent crusting infection around eyes, nose, and mouth with subsequent spread
Nikolsky positive
Tx: IV Abx, analgesia, fluid maintenance
Necrotizing fasciitis
Staph or S pyogenes
Severe skin infection extending from dermis to fascia to muscle
Systemically unwell, severe pain, necrotic center with damaged tissue
Medical emergency
IV Abx, surgical debridement, consider admission to intensive care. May require amputation
Complications meningitis
hearing loss Local vasculitis Local cerebral infarction Subdural effusion Hydrocephalus Cerebral abscess
Cushing triad (meningitis)
Bradycardia, hypertension, abnormal pattern breathing
Bad news bears
Late signs meningitis
Papilledema, bulging fontanelle in infants, opisthotonus (hyperextension head and back)
Tx meningococcal disease
IM benzylpenicillin immediately and urgent transfer to hospital
Third generation ceph (e.g. ceftriaxone), dexamethasone
Contraindications to LP
Cardiorespiratory instability Focal neuro signs Signs raised ICP: coma, high BP, low heart rate, papilledema Coagulopathy Thrombocytopenia Local infection at site LP
CSF findings: bacterial meningitis
Turbid appearance
Neutrophils
Increased protein
Decreased glucose
CSF findings: viral meningitis
Clear appearance
Increased lymphocytes
Normal/increased protein
Normal/decreased glucose
CSF findings: TB meningitis
Turbid, clear, or viscous appearance
Increased lymphos
Very high protein
Very low glucose
Encephalitis
- definition
- Etiologies
- Sxs
- Tx
Inflamm of brain parenchyma
- Direct invasion cerebrum by neurotoxic virus (e.g. HSV)
- Delayed brain swelling from neuroimmunological response (e.g. post-infectious encephalopathy e.g. post-chickenpox)
- Slow virus infection e.g. HIV or subacute sclerosing panenceph following measles
Sxs may be indistinguishable from meningitis: fever, altered consciousness, often seizures
Tx: high dose acyclovir IV
Malaria
Plasmodium protozoa
Think Falciparum if fatal or involves brain
Other types: vivax/ovale (tertian), malariae
Sxs: HA, cough, fatigue, malaise, shaking chills, arthralgia, myalgia, diarrhea, N&V, anorexia, lethargy, jaundice
Thick and thin blood film: thick confirms dx, thin identifies species
Quinine for falcip, chloroquine for others
Dengue fever
Dengue virus, transmitted by Aedes aegypti mosquito
“Break bone fever”.
Erythem rash, high fever, HA, arthritis, myalgia, vomiting, hemorrhagic signs, lethargy, hepatomegaly, abdo distention
Can cause hemorrhagia–severe capillary leak syndrome
Tx: fluid resusc, monitoring, blood transfusion if severe
