ID Flashcards
What dx?
Newborn with afebrile Staccato cough?
W or wo eye discharge
Chlamydia trachomatis
Dx with intracytoplasmic inclusion bodies, (definitivie) PCR
How do you tx chlamydia conjunctivitis?
Oral erythromycin or sulfa
Dx?
Patient in May is purpuric macular rash progression to petechial that started on ankles, wrists, palms, soles with headache.
Also seen with hyponatremia, depression of 1-3 cells lines on CBC.
RMSF
Once thought of RMSF, most imp next step; test or tx?
Treat with doxy 7 days or until fever resolves for at least 3
What lab differences will u see between ehrilicia and RMSF
Ehrlicia: leukopenia and elevated LFTs
RMSF: thrombocytopenia and hyponatremia
Asplenic pt or from developing country w GN pleomorphic organism.
Bug and tx?
H influenzae
T.mx w rocephin, cefotax
What is prophy for hib with contact younger than 12mo wo primary immunization series
Rifampin
When do you use rifampin prophy for hib ?
If One household contact younger than four who is incompletely immunized,
immunocompromise child even if over four
If two or more cases within 60 days and unimmunized or in completely immunized then children/attendees/workers at childcare facility should get it
NO prophy if all members are immunocomponent and immunized OR if non typable h flu
Patient was at a picnic 1-2 days prior then Got watery loose stools with vomiting, abdominal cramps and fever.
What bug?
Salmonella
Dx stool cx
Tx only needed if infant younger than 3 or immunocompromised (tx w rocephin)
Initial presenting sign of typhoid and tx
Constipation
Rocephin or cefotax
Patient with watery diarrhea and fever several days after ingestion. Once the fever subsides then bloody diarrhea
Dx?
Shigella
(WBC or RBC in stool)
Only treat with Bactrim or amp (if susceptible) in severe disease or immunocompromised
Dx ?
Fever of unknown origin?
Patient with fever and malaise, exposure to cattle sheep or goats and unpasteurized milk or cheese
Brucellosis. Treat with Bactrim or tetracycline
What is treatment for CDIff
Metronidazole
What is the purpose in treating strep throat
Prevent rheumatic fever
What is the treatment for infantile botulism
Supportive care, unless presented with antitoxin
If mother was treated for syphilis during pregnancy, do you treat them
No if she was treated with penicillin more than a month before delivery,
yes if she was treated with in the last month of pregnancy,
yes if she was treated with erythromycin,
yes if babies titers are higher than mothers titers
What might you see in and traded infants with syphilis after two years of age
Hutchinson Triad:
interstitial keratitis,
eighth cranial nerve deafness Hutchinson teeth or Peg shaped notched central incisors
Infant with sniffles or copious nasal secretions, bolus lesions, osteochondritis and pseudo-paralysis of the joints
Congenital syphilis
May also see lymphadenopathy, Nico cutaneous lesions, pneumonia, Adema, low platelets, HSM, humility anemia, jaundice, maculopapular rash at birth or within 4 to 8 weeks of age
What is Drug of choice for king Ella
Penicillin
How to treat penicillin allergic patients with listeria
Desensitization
What is treatment of the N.meningitidis
Initial therapy with vanc and Rocephin
Then definitive tx a pen g, amp or rocephin
Who should get meningogocal prophylaxis and what is drug
HouseholdContacts especially younger than two
Preschool contacts at any time during seven days before onset of illness
Direct exposure to secretions are kissing toothbrushes or utensils at any time seven days prior to onset of illness
Anyone with mouth-to-mouth recess or Indo tracheal intubation seven days prior to illness
Passengers seated directly next to on flights lasting more than 8 hours
Slept in same house 7 days prior to onset
Rifampin
Patient with recent handling of dead animals now has painful swollen inguinal nodes.
Dx?
Bubonic plague
Patient with bloody diarrhea right lower quadrant pain and elevated white blood cells
History of drinking and pasteurize milk or eating Chitterlings
Yersinja
When is treatment indicated for cat scratch disease
Those with hepatosplenomegaly, large painful adenopathy or immunocompromised
What bug to consider if chronic diarrhea in and immunocompromise patients
Cryptosporidium
What bug to consider if diarrhea in swimming pools in municipal water
Cryptosporidium
What bug to consider if diarrhea and farm or petting zoos
Cryptosporidium And E. coli
What bug to consider with diarrhea and apple juice or under cooked beef
E. coli
What bug to consider with diarrhea and chitterlings or pork
Yersinia
What bug to consider with diarrhea and improperly cut poultry, and treated water, or dairy farm
Campylobacter
What bug to consider with diarrhea and unpasteurized milk
Campylobacter and E. coli
What is bag with 1 to 2 weeks of belly pain, diarrhea, Tenesmus, with stools of water blood and mucus?
Entomeba histylotica
Complications liver and Brian abscess
Tx symptomatic pts w metronidazole followed by IOdinoquil or paromomycin
If asympatomatic. Then no metro
What is bug? Acute onset of watery diarrhea fell smelling stalls flatulence abdominal distention and weight loss with anemia
Giardia diagnosed with Eia. Treat with metronidazole or nitazoxanidd
What is severity of toxo pregnancy both early and late
If early, lower chance of infection the consequences are more severe. If later greater chance of infection but complications or less severe
What are congenital findings of toxo
Microcephaly, hydrocephaly, chorioretinitis, cerebral calcifications, Jaundicd, HSM
What is the difference between CMV and toxo
CMV calcifications are periventricular
Toxo are diffuse
What are later complications of toxo
Tremors, zero hearing, blindness, zero intelligence
T0X0
What are the five C’s with CMV
Chorioretinitis, cerebral calcifications, urine culture diagnosis, potential for Censouinral hearing loss
What are additional findings with cmv (HUman herpsevirus 5)
HSM, jaundice, SGA, seizures, hypotonia, weeks that
Think CMV with transfusion related info, esp pna
What confirms EBV or human herpesvirus four diagnosis
Heterophile in antibody
If neg then serum is esp if <4yo
What is human herpesvirus six
Roseola
Often associated with febrile seizure
What is associated with congenital rubella
Cataracts and PDA
Name the back. Unknown immunized patient with low-grade fever generalized maculopapular rash and enlarged occipital and preauricular lymph nodes.
Rubella
What is bug? Patient with confluence macular papular rash with conjunctivitis and koplik
Rubeola
Three C’s cough coryza and conjunctivitis
Most contagious 4 days before and 4 days after rash appears
What is bug patient with cough coryza vomiting and diarrhea
Flu
Post exposure prophy for measles
If exposure has been within six days, give immunoglobulin especially to infants under 12 pregnant women and immunocompromise.
Who should receive vaccine ?
Persons exposed that are not completely immunized including 6 to 12 month olds
When should revaccination for Measels occur after immunoglobulin
Five minutes after immunoglobulin was given if child is at least 12 months
Should mild or asymptomatic HIV patients be given the MMR vaccine
Yes
What is the most common complication of mumps
Orchitis
Disease associated with hydrops fetalis, aplastic crisis and sickle cell
Parville be 19, erythema infectious
What is gold standard for infant HIV testing and when
HIV dx w DNA PCR is gold standard in neonatal period.
For 18mo+ can get EIA as initial test w positive verified with western blot
What do you see on chest x-ray with pneumocystis jiroveci
Ground glass appearance
HIV children receive all vaccines except what
Measles and vera Cella or contra indicated with kids who have CD4 count less than 15% of normal age
When is the VZIG treatment of choice for a newborn exposed to chickenpox
If mother developed chickenpox between five days before delivering in two days postpartum
When should you get rabies prophylaxis
If an animal is suspected to be rabbid after bite especially ferrets cats dogs wolves coyotes raccoons skunks possums and bat
If presented with patient who woke up in a room with bat should you treat even if no bite
Yes treatment is indicated
What infection if patient from faraway place has signs of obstruction or abdominal pain
Ascadis lumbriocoides
What is infection? Preschooler who has been eating dirt with exposure to dogs and cats and associated HEpatmegaly/abdominal pain and wheezing. Eosinophilia noted
Toxocara canoe
Visceral larval migrants
Ocular w eye
Covert w GI and rash symptoms
Dx w Elisa
Tx w albendazole
What is bug? AIDS patient with exposure to bird or pigeon droppings
Ripped a caucus. Treat with ampho and flucystine or fluconzole
What is bug? Influenza like symptoms with recent travel to California Arizona and Texas
Coccidio
CATccido
Tx ampho fluconazole or ketacon
What is bug?
Asthmatic with worsening symptoms, is infiltrated, infiltrate on chest x-ray
Aspergillosis. Diagnosed with positive serum galactomannan. Treat with Vori or ampho in infants
What bug?
Flu like symptoms with recent travel to Ohio Missouri and Mississippi Valley. Also HSM
Histoplasmosis. Treat with ampho or azole
