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ID Flashcards

1
Q

Most common swimming pool illnesses

A
  • crypto and giardia
  • then shigella and E coli 0157
  • norovirus
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2
Q

Infections related to asplenia

A
  • n meningitidis
  • h influenza type b
  • s pneumo
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3
Q

Who is at the highest risk for invasive infections seconday to asplenia

A

kiddos less than 2 years old

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4
Q

Most common pathogen for indwelling catheter infection

A

-GPC (CONS are over half)

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5
Q

Brun Care

A
  • third degree and second degree burns > 10% of body need grafted and excision
  • can treat with silver nitrate, silver sulfadiazine, or mafenide acetate
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6
Q

Which third generation cephalosporin has pseudomonal coverage

A

cetaz

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7
Q

major side effects of aminoglycosides

A

ototoxic and nephrotoxic

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8
Q

Major side effect clinda

A

c. diff colitis

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9
Q

Bugs targeted with aminoglycoside synergy to beta lactams

A
  • pseudomonas
  • listeria
  • GBS
  • s epi
  • viridians
  • enterococcus
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10
Q

Uses and MOA Rifampin

A
  • inhibit bacterial RNA polymerase
  • tuberclosis
  • synergy for s. aureus
  • close contacts to n meningitidis and h influenza
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11
Q

Treatment rocky mountain fever

A

doxycycline regardless of age

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12
Q

DOC for kids > 8 with lyme

A

doxy

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13
Q

side effects tetracyclines

A
  • teeth staining and enamel hypoplasia especially under 8
  • photosensitvity
  • pseudotumor cerebri
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14
Q

Minocycline can cause what specific syndrome

A

SLE like syndrome

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15
Q

Presentation Polio

A
  • acute asymmetric flaccid paralysis and areflexia
  • can have cranial nerve involvement
  • respiratory muscle paralysis
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16
Q

Dx and Tx Polio

A
  • viral culture of stool and throat

- supportive care

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17
Q

Presentation Herpangina

A

-posterior pharyngeal vesicles! (in contrast to hand foot mouth where it can be anywhere)

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18
Q

What is pharyngoconjunctival fever?

A
  • fever, pharyngitis, and conjunctivitis

- due to adenovirus and usually related to swimming pools or fomites

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19
Q

What is epidemic keratoconjunctivitis

A
  • conjunctivitis that involves cornea
  • usually due to opthalmologic equipment or healthcare workers
  • adenovirus
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20
Q

how long is influenza contagious

A

7 days from onset

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21
Q

What are antigenic shift and drift

A
  • shift ar enew hemagluttinin or neuraminidase

- drift are minor variations of same subtype (influenza A)

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22
Q

What is a concern for Zanamivir for influenza?

A

can cause bronchospasm so can’t give to asthmatics

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23
Q

Indication for tamiflue

A
  • less than 2 years old
  • underlying heart or pulmonary disease
  • DM
  • immunocompromised
  • neurodevelopment conditions
  • american indians or alaskan natives
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24
Q

How long is measles contagious

A

1 to 2 days before onset of symptoms. 4 days after appearance of rash

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25
Q

Measels Presentation

A
  • fever, cough, coryza, and conjunctivitis
  • koplik spots (red with blue central clearing on buccla surface) 1 to 4 days prior to rash
  • rash spreads downward from hairline
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26
Q

When does SSPE occur

A

7 to 10 years after measles (neurodeneration and death)

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27
Q

Mumps Exanthem and ocmplications

A

parotid enlargment and tenderness; peaks in 3 days and resolves over a week

  • orchitis in males
  • opophoritis in females (sterility uncommon)
  • can cause pancreatitis
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28
Q

How long is mumps contagious

A

1 to 2 days before disease. 5 days after parotitis

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29
Q

Contagion Rubella

A

3 days before to 7 days after rash onset

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30
Q

Presentation of Rubella

A
  • posterior auricular, occipital and posterior cervical LAD
  • rose colored lesions on soft palate
  • can have polyarthrlagia (small hand joints)
  • erythematous macules going from face down for 3 days
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31
Q

Treatment for Measles

A

-vitamin A for children who are 6 months to 2 yeras and hospitalized because of complications, greater than 6 months with immunodeficiency, vitamin A deficiency, malabsorption or malnutrition, recent immigration from areas with high measles mortality

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32
Q

PEP for Measles

A
  • immunocompetent: vaccine within 72 hours; can give monovalent to children as young as 6 months
  • IG up to 6 days if immunocompormised, pregnant or less than 1 year of age
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33
Q

Mumps PEP

A
  • there really isn’t any

- if school outbreak best thing is to exclude susceptible children until immunization

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34
Q

Breakthrough Varicella

A
  • vaccinated at least 42 days prior to rash onset caused by wild-type virus
  • keep out of school until all lesions have crusted
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35
Q

When can you get varicella lesions from vaccine

A

within 42 days of administration

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36
Q

Who do you treat for varicella

A
  • if > 12 years old, chronic lung or skin disorders, long term ASA, corticosteroids including inhaled
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37
Q

Complications Mono

A
  • GBS
  • splenic rupture
  • thrombocyotpniea, hemolytic anemia
  • myocarditis
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38
Q

Best initial test for Mono; if thats negative…?

A
  • heterophile antibody (monostpot) and atypical lymphocytosis
  • then IgM to viral capsid antigen (VCA)
  • -positive in first 4 weeks to month
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39
Q

Labs showing past mono infection

A

-+IgG VCA and EBNA, negative IgM VCA and early antigen

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40
Q

Congenital CMV treatment

A

gancyclovir reduces hearing deterioration

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41
Q

what is the most common cause of recurrent aseptic meningitis

A

HSV

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42
Q

Tx HSV Gingivostomatitis

A

-oral acyclovir within 72 hours

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43
Q

Tx genital herpes

A

-acyclovir; decreases severity and duration but has not effect on subsequent infections

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44
Q

What are the low risk HPV

A

6 and 11

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45
Q

What are the high risk HPV

A

16 and 18

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46
Q

Dx of Cervical HPV

A
  • pap smear
  • if positive with atypical squamous cells repeat in 4 to 6 months
  • is positive again coloposcopy
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47
Q

Most common cause of rabies in US

A

rabies

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48
Q

Most commonly infected animals with rabies

A
  1. rabies
  2. skunks
  3. bats
  4. foxes
  5. coyotes
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49
Q

What bites are higher risk for rabies transmission?

A

bites on hands or face

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50
Q

How does rabies replicate?

A

replicates in muscle and then travels along peripheral nerves to the brain and spinal cord; then goes back along nerves to organs

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51
Q

Rabies Presentation

A
  • note: incubation can be days to months
  • fever and paresthesias or pruritis at the bite and along the extremity
  • followed by intermittent encephalopathy then coma
  • hydrophobia and aerophobia due to brain stem involvement; choking and aspiration
  • death in a couple of weeks
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52
Q

Atypical Rabies Presentation

A

ascending motor paralysis of extremities and cranial nerves; some encephalopathy

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53
Q

How to tx rabies

A
  • observe household dogs for 10 days and see if develops signs
  • if uknown or wild animal,immediate immunization and rabies immune globulin (distant from vaccine arm)
  • vaccines day 3, 7, 14 and 28
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54
Q

Dx Arbovirus

A

IgM serum 5 days after onset of illness

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55
Q

What is the most common way HIV is transmitted in peds

A

vertical (most common intrapartum)

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56
Q

What are risk factors for vertical transmission of HIV

A

< 34 weeks, birth weight < 2500g, >4 hours ROM

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57
Q

Clinical Presenation HIV

A
  • Neonates are normal but develop LAD/hepatosplenomegaly, chronic diarrhea, FTT, oral candidiasis, or interstitial pneumonitis
  • can have chronic parotid enlargement, recurrent bacterial infections
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58
Q

Malignancy related to HIV

A

non hodgkin lymphoma and leiomyosarcoma

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59
Q

What is the most common lower respiratory tract abnormality in HIV+

A
  • lymphocytic interstitial pneumonitis (chronic, diffuse reticulonodular pattern with mild to moderate hypoxemia)
  • s pneumo is most common bacterial pathogen
  • increased risk pseudomonas and TB
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60
Q

Most common parasitic infections in HIV

A
  • crypto and giardia

- -will cause chronic diarrhea with malnutrition; chornic liver inflammation that can cause failure and cholestasis

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61
Q

What opportunistic infections are related to low CD4

A
  • pneumocystis carinii

- MAC

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62
Q

How do you test for HIV < 18 month old?

A

HIV nucleic acid aka HIV DNA PCR

–transplacental HIV ab positive for up to 18 months

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63
Q

How do you test with HIV positive mom?

A
  1. first HIV DNA PCR within 48 hours
  2. if negative, re-test at ages 1 to 2 months
  3. if negative, re-test at ages 4 to 6 months
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64
Q

How do you test for HIV in kiddo greater than 18 months?

A
  1. EIA

2. if positive, western blot

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65
Q

How do we treat HIV positive?

A

HAART

  • -any child less than 1 and goal is within first 3 months
  • -older child who is symptomatic or immune dysfunction
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66
Q

Bactrim PCP PPX HIV

A
  • all children less than 1 year
  • age 1 to 6 with CD4 < 500
  • children 6years+ with CD4 < 200
67
Q

What are the types of CONS

A
  • saprophyticus
  • Haemolyticus
  • epidermidis
68
Q

Most common cause late onset sepsis in premie

A

staph epi

69
Q

What is toxic shock syndrome from staph related to?

A
  • tampons / vaginal device
  • staph infection lol
  • nasal packing
70
Q

What are signs of toxic shock syndrome?

A

fever with rapid onset of hypotension, water diarrhea, myalgia, conjunctival hyperemia, strawberry tongue, erythematous rash with hand/foot desquamation

71
Q

What are the severe invasive GAS infections?

A

bacteremia, toxic shock, and nec fasc

72
Q

What skin infection is assd with varicella?

A

GAS

73
Q

What is PANDAS

A
  • pediatric autoimmune neuropyschiatric disorder associated with strep pyogenes aka GAS
  • OCD, tic, tourette
74
Q

Tx C diptheriae

A

erythromycin or penicillin (eliminate and prevent)

75
Q

Complications of C. diptheriae

A
  • cardiomyopathy

- neuropathy: cranial nerve, polyneuropathy, diaphragm paralysis

76
Q

When is b. pertussis contagious

A

during catarrhal stage and 2 weeks after onset of cough

77
Q

What is the most important preventable cause of blindness in the world?

A

c. trachomatis

78
Q

Spread of C trachomatis conjunctivtis

A

flies are a common vector; tx with azithro x 1

79
Q

Tx Listeria

A

ampicillin and aminoglycoside due to synergy; can stop aminoglycoside if good clinical response

80
Q

What infections does kingella cause?

A

osteo and septic joint

81
Q

tx kingella

A

penicillin

82
Q

What is parinaud oculoglandular syndrome?

A

bartonella henselae causing infection in conjunctiva and ipsi preauricular and submandibular adenopathy

83
Q

Location and incidence of Lyme

A
  • northeast and upper midwest (also west coast)
  • age 5 to 9
  • april to october
84
Q

Early Localized Lyme

A

erythema migrans; red macule or papules that expands over days to weeks to form an annular erythematous macular lesion

85
Q

Early disemminated lyme disease

A
  • multiple erythema migrans
  • CN VII palsy
  • conjunctivitis and anterior uveitis
86
Q

Late Lyme disease

A

recurrent pauciarticular arhtritis in large joints (loves knees)

87
Q

How do you test for lyme?

A

Enzyme immunoassay followed by wester blot to confirm

88
Q

Tx for lyme

A

> 8 years old is doxy; less than 8 you can use amoxicillin or cefuroxime

89
Q

Tx Rickettsial / RMSF

A

doxycycline regardless of age

90
Q

Where does RMSF usually happen?

A

southeastern US or nothern rocky mountain states

91
Q

Pathophys of RMSF

A

vascular obstruction / vasculitis –> DIC, gangrene, death

92
Q

Presentation RMSF

A
  • fever, headache, myalgia, n/v/d

- rash before day 6 that starts on wrists and ankles (petechial with possible palpable pupura) and then spreads inwards

93
Q

Dx RMSF

A

indirect immunofluorescenLce antibody assay

94
Q

Lab findings in ehrlichiosis (tick dz)

A
  • leukopenia
  • neutropenia
  • anemia
  • thrombocytopniea
  • hepatitis
  • hyponatremia*
  • rash
95
Q

Presentation and tx of ehrlichiosis

A

similar to RSMF but with hyponetremia; lasts 4 to 12 days

-tx doxy

96
Q

How do we get brucellosis

A

wild animals or unpasteurized dairy products

97
Q

Presentation brucellosis

A

fever, malaise, night sweats, weight loss, arthralgia, myalgia with hepatosplenomegaly, LAD, and arthritis

98
Q

Tx Brucellosis

A
  • doxy + rifampin plust streptomycin or gentamicin
  • if < 8 years, bactrim and rifampin
  • both for 4 to 6 weeks
99
Q

Typhoid fever

A
  • high fever and constitutional symptoms followed by
  • abdominal pain / tedneress, hepatosplenomegaly, mental status and
  • rose spots: erythematous maculopapular lesions in lower chest and abdomen on days 7 to 10; comes in crops
100
Q

Tx Shigella

A

CTX

101
Q

Complications of campylobacter

A
  • reactive arthritis
  • reiter syndrome: arthritis, urethritis, conjunctivitis
  • IgA nephropathy
  • erythema nodosum
102
Q

Where do you get campylobacter

A
  • unpasteurized dairy, untreated water, food

- in GI tract of animals and wild birds

103
Q

Where do you get yersinia enterocolitica?

A

feral animals (swine!) and pets

104
Q

Presentation of y. enterocolitica

A
  • can mimic appendicitis as mesenteric adenitis; espeically < 7 years old
  • otherwise a diarrheal illness that does not have to be treated unless ill (Bactrim)
105
Q

Presentation of infantile botulism

A
  • between 3 weeks and 6 months
  • start with constipation, weak cry, feeding difficulty
  • leads to drooling, diminished gag and suck, oculomotor palsies, poor head control, and respiratory arrest
106
Q

What drug is wound botulism assd with?

A

heorine

107
Q

Tx infant botulism

A

botulims immune globulim

108
Q

Tx botulism in older kiddo

A

equine botlinum antitoxin

109
Q

General presentation botulism

A
  • asymmetric, DESCENDING, flaccid paralysis

- -starts with cranial nerve so multiple bulbar palsies

110
Q

Presentation and tx clostridium perfringens

A

sudden water diarrhea with severe crampy midepigastric pain without fever
-resolves in 24 hours without tx

111
Q

Presentation neonatal tetanus

A
  • days 3 to 12
  • decreased ability to suck / swallow
  • constant cry
  • decreased movement with spasms and rigidity
  • Africa due to lack of immunity and nonsterile umbilical cord practices
112
Q

Presentation tetanus

A
  • trismus and severe muscle spams
  • sardonic smiles that leads to extreme hyperexnsion (opisthotonos)
  • laryngeal and airway contraction wit high fever
113
Q

Dx tetanus

A

clinical

114
Q

Tx tetanus

A
  • human tetanus immune globulin
  • pencillin G for flagyl
  • diazepam
115
Q

Primary Syphilis

A
  • genital chancre with painless papule –> painless ulcer
  • *super contagious
  • regional adenitis
  • heals in 4 to 6 weeks
116
Q

Secondary Syphilis

A
  • 2 to 10 weeks after healing of chancre
  • maculopapular rash over body including palms and soles
  • condyloma lata (wart like anus and vagina)
  • generalized lymphadenitis
117
Q

How to best definitively dx syphilis

A

darkfield microscopy or direct immunofluorescent staining

118
Q

How to screen for syphilis

A

VDRL or RPR

–nontreponemal test

119
Q

How do you monitor response to treatment of syphilis

A

RPR or VDRL

120
Q

How do you confirm syphilis

A
  • antibody specific treponemal test (hemagluttination assay, FTA ABS, TPPA)
  • -positive for life
121
Q

How do you treat neurosyphilis in pcn allergic patient

A

oral penicillin desensitization

122
Q

PCN allergy and greater than 8 years old

A

doxycycline

123
Q

What is latent TB

A

positive TB skin test with no physical or radiographic evidence of active disease

124
Q

Where does extrapulmonary TB like to go?

A
  • vertebral
  • scrofula: superficial lymph nodes (firm, non tender, usually unilateral; caseating necrosis)
  • meningitis
  • renal disease
  • middle ear and mastoid
125
Q

Tx Latent TB

A

INH for 9 motnhs (rifampin 6 if resistant)

126
Q

Tx TB Pulmonary and EP disease (no CNS)

A

-2months of RIP then 4 months of RI

127
Q

Tx CNS TB

A

-RIPE x 2 months (can do streptomycin instead of ethionamide), prednisolone, then RI

128
Q

Side Effects INH

A
  • hepatitis (monitor LFTs)

- peripheral neuritis (so can give pyridoxine)

129
Q

Side effects rifampin

A
  • hepatitis
  • flu like illness
  • orange discoloration of secretions
  • thrombocytopenia
130
Q

Side effect ethambutol

A
  • optic neuritis
  • decrease red/green discrimination
  • GI
131
Q

Side effects pyrazinamide (P in RIPE)

A

hepatotoxic

hyperuricemia

132
Q

Tx Congenital TB

A
  • cultures including placental, LP, PPD, CXR

- RIP and streptomycin

133
Q

Tx newborn of mother with evidence of active TB

A

-INH until mother’s sputum cultures are negative x 3 months; re-test PPD and if positive 9 months

134
Q

Presentation MAC

A
  • usually with HIV and CF kids

- cervical lymphadenitis, otisi media, skin, central catheter, lung disease, osteo

135
Q

Tx Candidal bacteremia with central line

A

-remove catheter and anti-fungal

136
Q

Who gets flucon prophylaxis

A

-bonemarrow transplant and solid organ transplant patients

137
Q

What are asperillomas assd with

A

fungal balls in bronchi; assd with TB, pulmonary cysts, bronchiectasis, and CHD

138
Q

Tx aspergillosis

A

voriconazole

139
Q

ABPA

A
  • eosinophilia
  • IgE
  • reversible airway obstruction
    • scratch test
  • IgG anbitbodies
  • pulmonary infiltrates
  • can cause bronchiectasis
140
Q

Where is histo?

A

ohio, missouri, and mississippi

  • -moist soil, bird and bat dropping
  • -inhaled; no person to person transmission
141
Q

s/s histo

A
  • flulike with chest symptoms, pulmonary infiltrates, hilar adenopathy
  • can cause erythema nodosum and prolonged fever
142
Q

Tx histo in HIV patient

A

itraconazole

143
Q

Tx enterobius aka pinworm

A

albendazole or mebendazole x 1; repeat in 2 weeks

144
Q

How do you get ascaris

A
  • hand mouth

- raw fruits or vegetables

145
Q

Pathogenesis Ascaris lumbricoides

A

ova hatch in small intestine –> larvae penetrate intestinal wall –> migrate to lungs –> cough and swallow larvae –> hatch into adult worms in intestine

146
Q

Presentation ascaris

A
  • pulmonary infiltrates with eosinophilia

- cholecystitis and pancreatitis due to biliary obstruction

147
Q

Dx Ascaris

A

eggs in stool

148
Q

Pathogenesis Necator (hookworm)

A

-feces contaminated soil –> penetrate skin -> veins –>lungs –> swallow (or may initially ingested at this point) –> attach and deposit eggs in intesinal wall

149
Q

Presentation necator

A
  • iron deficiency anemia
  • hypoalbuminemia and edema
  • GI symptoms
150
Q

Tx Necator and ascaris

A

albendazole or mebendazole

151
Q

How you get taenia

A

raw or undercooked infected meat; pork and beef

152
Q

Cysticercosis presentation and tx

A
  • eggs from adults go across intestine into CNS and muscle
  • presents with seizures, eye disease, myositis, carditis, spinal cord, behavior changes
  • get an MRI; serum is sensitive
  • tx: seizure treatment and albendazole
153
Q

Presentation and tx amebiasis (entamoeba histolytica)

A
  • fever and enlarged, tender liver
  • increased ESR and anemia
  • few leukocytes

tx: flagyl

154
Q

tx toxo

A

pyrimethamine plus sulfadiazine (with folinic acid)

155
Q

Presentation Plasmodium aka alaria

A
  • paroxyms of high fever with rigors
  • pallor
  • jaundice
  • hepatosplenomegaly, anemia, thrombocytopnia
156
Q

Dx Malaria

A

Thick and thin RBC smears for 3 consecutive days

157
Q

Malaria that presents with symptosm every 3 to 4 days

A

malariae

158
Q

malaria that presents with periodicty ever other day

A

vivax and ovale

159
Q

tx malaria

A
  • chloroquine; quinidine; atovaquone
160
Q

complications of malaria

A
  • hypersplenism
  • nephrotic
  • renal failure, respiratory fail
  • pulmonary edema
161
Q

Ppx malaria withou chlorquine resistance

A

once weekly chloroquine starting 2 weeks before and through 4 weeks after leaving; atovaquone is substitute

162
Q

Ppx resistant malaria

A

atovaquone daily; doxy daily; mefloquine

163
Q

Primquine can exacerbate what condition

A

G6PD deficiency (for p vivax and ovale)

164
Q

What is safest resistant malaria drug pregnancy

A

mefloquine

Kaplan (8 decks)

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