ID Flashcards
1
Q
Most common swimming pool illnesses
A
- crypto and giardia
- then shigella and E coli 0157
- norovirus
2
Q
Infections related to asplenia
A
- n meningitidis
- h influenza type b
- s pneumo
3
Q
Who is at the highest risk for invasive infections seconday to asplenia
A
kiddos less than 2 years old
4
Q
Most common pathogen for indwelling catheter infection
A
-GPC (CONS are over half)
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
6
Q
Which third generation cephalosporin has pseudomonal coverage
A
cetaz
7
Q
major side effects of aminoglycosides
A
ototoxic and nephrotoxic
8
Q
Major side effect clinda
A
c. diff colitis
9
Q
Bugs targeted with aminoglycoside synergy to beta lactams
A
- pseudomonas
- listeria
- GBS
- s epi
- viridians
- enterococcus
10
Q
Uses and MOA Rifampin
A
- inhibit bacterial RNA polymerase
- tuberclosis
- synergy for s. aureus
- close contacts to n meningitidis and h influenza
11
Q
Treatment rocky mountain fever
A
doxycycline regardless of age
12
Q
DOC for kids > 8 with lyme
A
doxy
13
Q
side effects tetracyclines
A
- teeth staining and enamel hypoplasia especially under 8
- photosensitvity
- pseudotumor cerebri
14
Q
Minocycline can cause what specific syndrome
A
SLE like syndrome
15
Q
Presentation Polio
A
- acute asymmetric flaccid paralysis and areflexia
- can have cranial nerve involvement
- respiratory muscle paralysis
16
Q
Dx and Tx Polio
A
- viral culture of stool and throat
- supportive care
17
Q
Presentation Herpangina
A
-posterior pharyngeal vesicles! (in contrast to hand foot mouth where it can be anywhere)
18
Q
What is pharyngoconjunctival fever?
A
- fever, pharyngitis, and conjunctivitis
- due to adenovirus and usually related to swimming pools or fomites
19
Q
What is epidemic keratoconjunctivitis
A
- conjunctivitis that involves cornea
- usually due to opthalmologic equipment or healthcare workers
- adenovirus
20
Q
how long is influenza contagious
A
7 days from onset
21
Q
What are antigenic shift and drift
A
- shift ar enew hemagluttinin or neuraminidase
- drift are minor variations of same subtype (influenza A)
22
Q
What is a concern for Zanamivir for influenza?
A
can cause bronchospasm so can’t give to asthmatics
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
24
Q
How long is measles contagious
A
1 to 2 days before onset of symptoms. 4 days after appearance of rash
25
Measels Presentation
- 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
26
When does SSPE occur
7 to 10 years after measles (neurodeneration and death)
27
Mumps Exanthem and ocmplications
parotid enlargment and tenderness; peaks in 3 days and resolves over a week
- orchitis in males
- opophoritis in females (sterility uncommon)
- can cause pancreatitis
28
How long is mumps contagious
1 to 2 days before disease. 5 days after parotitis
29
Contagion Rubella
3 days before to 7 days after rash onset
30
Presentation of Rubella
- 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
31
Treatment for Measles
-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
32
PEP for Measles
- 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
33
Mumps PEP
- there really isn't any
| - if school outbreak best thing is to exclude susceptible children until immunization
34
Breakthrough Varicella
- vaccinated at least 42 days prior to rash onset caused by wild-type virus
- keep out of school until all lesions have crusted
35
When can you get varicella lesions from vaccine
within 42 days of administration
36
Who do you treat for varicella
- if > 12 years old, chronic lung or skin disorders, long term ASA, corticosteroids including inhaled
37
Complications Mono
- GBS
- splenic rupture
- thrombocyotpniea, hemolytic anemia
- myocarditis
38
Best initial test for Mono; if thats negative...?
- heterophile antibody (monostpot) and atypical lymphocytosis
- then IgM to viral capsid antigen (VCA)
- -positive in first 4 weeks to month
39
Labs showing past mono infection
-+IgG VCA and EBNA, negative IgM VCA and early antigen
40
Congenital CMV treatment
gancyclovir reduces hearing deterioration
41
what is the most common cause of recurrent aseptic meningitis
HSV
42
Tx HSV Gingivostomatitis
-oral acyclovir within 72 hours
43
Tx genital herpes
-acyclovir; decreases severity and duration but has not effect on subsequent infections
44
What are the low risk HPV
6 and 11
45
What are the high risk HPV
16 and 18
46
Dx of Cervical HPV
- pap smear
- if positive with atypical squamous cells repeat in 4 to 6 months
- is positive again coloposcopy
47
Most common cause of rabies in US
rabies
48
Most commonly infected animals with rabies
1. rabies
2. skunks
3. bats
4. foxes
5. coyotes
49
What bites are higher risk for rabies transmission?
bites on hands or face
50
How does rabies replicate?
replicates in muscle and then travels along peripheral nerves to the brain and spinal cord; then goes back along nerves to organs
51
Rabies Presentation
- 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
52
Atypical Rabies Presentation
ascending motor paralysis of extremities and cranial nerves; some encephalopathy
53
How to tx rabies
- 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
54
Dx Arbovirus
IgM serum 5 days after onset of illness
55
What is the most common way HIV is transmitted in peds
vertical (most common intrapartum)
56
What are risk factors for vertical transmission of HIV
< 34 weeks, birth weight < 2500g, >4 hours ROM
57
Clinical Presenation HIV
- Neonates are normal but develop LAD/hepatosplenomegaly, chronic diarrhea, FTT, oral candidiasis, or interstitial pneumonitis
- can have chronic parotid enlargement, recurrent bacterial infections
58
Malignancy related to HIV
non hodgkin lymphoma and leiomyosarcoma
59
What is the most common lower respiratory tract abnormality in HIV+
- lymphocytic interstitial pneumonitis (chronic, diffuse reticulonodular pattern with mild to moderate hypoxemia)
- s pneumo is most common bacterial pathogen
- increased risk pseudomonas and TB
60
Most common parasitic infections in HIV
- crypto and giardia
| - -will cause chronic diarrhea with malnutrition; chornic liver inflammation that can cause failure and cholestasis
61
What opportunistic infections are related to low CD4
- pneumocystis carinii
| - MAC
62
How do you test for HIV < 18 month old?
HIV nucleic acid aka HIV DNA PCR
| --transplacental HIV ab positive for up to 18 months
63
How do you test with HIV positive mom?
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
64
How do you test for HIV in kiddo greater than 18 months?
1. EIA
| 2. if positive, western blot
65
How do we treat HIV positive?
HAART
- -any child less than 1 and goal is within first 3 months
- -older child who is symptomatic or immune dysfunction
66
Bactrim PCP PPX HIV
- all children less than 1 year
- age 1 to 6 with CD4 < 500
- children 6years+ with CD4 < 200
67
What are the types of CONS
- saprophyticus
- Haemolyticus
- epidermidis
68
Most common cause late onset sepsis in premie
staph epi
69
What is toxic shock syndrome from staph related to?
- tampons / vaginal device
- staph infection lol
- nasal packing
70
What are signs of toxic shock syndrome?
fever with rapid onset of hypotension, water diarrhea, myalgia, conjunctival hyperemia, strawberry tongue, erythematous rash with hand/foot desquamation
71
What are the severe invasive GAS infections?
bacteremia, toxic shock, and nec fasc
72
What skin infection is assd with varicella?
GAS
73
What is PANDAS
- pediatric autoimmune neuropyschiatric disorder associated with strep pyogenes aka GAS
- OCD, tic, tourette
74
Tx C diptheriae
erythromycin or penicillin (eliminate and prevent)
75
Complications of C. diptheriae
- cardiomyopathy
| - neuropathy: cranial nerve, polyneuropathy, diaphragm paralysis
76
When is b. pertussis contagious
during catarrhal stage and 2 weeks after onset of cough
77
What is the most important preventable cause of blindness in the world?
c. trachomatis
78
Spread of C trachomatis conjunctivtis
flies are a common vector; tx with azithro x 1
79
Tx Listeria
ampicillin and aminoglycoside due to synergy; can stop aminoglycoside if good clinical response
80
What infections does kingella cause?
osteo and septic joint
81
tx kingella
penicillin
82
What is parinaud oculoglandular syndrome?
bartonella henselae causing infection in conjunctiva and ipsi preauricular and submandibular adenopathy
83
Location and incidence of Lyme
- northeast and upper midwest (also west coast)
- age 5 to 9
- april to october
84
Early Localized Lyme
erythema migrans; red macule or papules that expands over days to weeks to form an annular erythematous macular lesion
85
Early disemminated lyme disease
- multiple erythema migrans
- CN VII palsy
- conjunctivitis and anterior uveitis
86
Late Lyme disease
recurrent pauciarticular arhtritis in large joints (loves knees)
87
How do you test for lyme?
Enzyme immunoassay followed by wester blot to confirm
88
Tx for lyme
> 8 years old is doxy; less than 8 you can use amoxicillin or cefuroxime
89
Tx Rickettsial / RMSF
doxycycline regardless of age
90
Where does RMSF usually happen?
southeastern US or nothern rocky mountain states
91
Pathophys of RMSF
vascular obstruction / vasculitis --> DIC, gangrene, death
92
Presentation RMSF
- 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
Dx RMSF
indirect immunofluorescenLce antibody assay
94
Lab findings in ehrlichiosis (tick dz)
- leukopenia
- neutropenia
- anemia
- thrombocytopniea
- hepatitis
- hyponatremia*
- rash
95
Presentation and tx of ehrlichiosis
similar to RSMF but with hyponetremia; lasts 4 to 12 days
| -tx doxy
96
How do we get brucellosis
wild animals or unpasteurized dairy products
97
Presentation brucellosis
fever, malaise, night sweats, weight loss, arthralgia, myalgia with hepatosplenomegaly, LAD, and arthritis
98
Tx Brucellosis
- doxy + rifampin plust streptomycin or gentamicin
- if < 8 years, bactrim and rifampin
- both for 4 to 6 weeks
99
Typhoid fever
- 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
Tx Shigella
CTX
101
Complications of campylobacter
- reactive arthritis
- reiter syndrome: arthritis, urethritis, conjunctivitis
- IgA nephropathy
- erythema nodosum
102
Where do you get campylobacter
- unpasteurized dairy, untreated water, food
| - in GI tract of animals and wild birds
103
Where do you get yersinia enterocolitica?
feral animals (swine!) and pets
104
Presentation of y. enterocolitica
- 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
Presentation of infantile botulism
- 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
What drug is wound botulism assd with?
heorine
107
Tx infant botulism
botulims immune globulim
108
Tx botulism in older kiddo
equine botlinum antitoxin
109
General presentation botulism
- asymmetric, DESCENDING, flaccid paralysis
| - -starts with cranial nerve so multiple bulbar palsies
110
Presentation and tx clostridium perfringens
sudden water diarrhea with severe crampy midepigastric pain without fever
-resolves in 24 hours without tx
111
Presentation neonatal tetanus
- 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
Presentation tetanus
- trismus and severe muscle spams
- sardonic smiles that leads to extreme hyperexnsion (opisthotonos)
- laryngeal and airway contraction wit high fever
113
Dx tetanus
clinical
114
Tx tetanus
- human tetanus immune globulin
- pencillin G for flagyl
- diazepam
115
Primary Syphilis
- genital chancre with painless papule --> painless ulcer
* *super contagious
- regional adenitis
- heals in 4 to 6 weeks
116
Secondary Syphilis
- 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
How to best definitively dx syphilis
darkfield microscopy or direct immunofluorescent staining
118
How to screen for syphilis
VDRL or RPR
| --nontreponemal test
119
How do you monitor response to treatment of syphilis
RPR or VDRL
120
How do you confirm syphilis
- antibody specific treponemal test (hemagluttination assay, FTA ABS, TPPA)
- -positive for life
121
How do you treat neurosyphilis in pcn allergic patient
oral penicillin desensitization
122
PCN allergy and greater than 8 years old
doxycycline
123
What is latent TB
positive TB skin test with no physical or radiographic evidence of active disease
124
Where does extrapulmonary TB like to go?
- vertebral
- scrofula: superficial lymph nodes (firm, non tender, usually unilateral; caseating necrosis)
- meningitis
- renal disease
- middle ear and mastoid
125
Tx Latent TB
INH for 9 motnhs (rifampin 6 if resistant)
126
Tx TB Pulmonary and EP disease (no CNS)
-2months of RIP then 4 months of RI
127
Tx CNS TB
-RIPE x 2 months (can do streptomycin instead of ethionamide), prednisolone, then RI
128
Side Effects INH
- hepatitis (monitor LFTs)
| - peripheral neuritis (so can give pyridoxine)
129
Side effects rifampin
- hepatitis
- flu like illness
- orange discoloration of secretions
- thrombocytopenia
130
Side effect ethambutol
- optic neuritis
- decrease red/green discrimination
- GI
131
Side effects pyrazinamide (P in RIPE)
hepatotoxic
| hyperuricemia
132
Tx Congenital TB
- cultures including placental, LP, PPD, CXR
| - RIP and streptomycin
133
Tx newborn of mother with evidence of active TB
-INH until mother's sputum cultures are negative x 3 months; re-test PPD and if positive 9 months
134
Presentation MAC
- usually with HIV and CF kids
| - cervical lymphadenitis, otisi media, skin, central catheter, lung disease, osteo
135
Tx Candidal bacteremia with central line
-remove catheter and anti-fungal
136
Who gets flucon prophylaxis
-bonemarrow transplant and solid organ transplant patients
137
What are asperillomas assd with
fungal balls in bronchi; assd with TB, pulmonary cysts, bronchiectasis, and CHD
138
Tx aspergillosis
voriconazole
139
ABPA
- eosinophilia
- IgE
- reversible airway obstruction
- + scratch test
- IgG anbitbodies
- pulmonary infiltrates
- can cause bronchiectasis
140
Where is histo?
ohio, missouri, and mississippi
- -moist soil, bird and bat dropping
- -inhaled; no person to person transmission
141
s/s histo
- flulike with chest symptoms, pulmonary infiltrates, hilar adenopathy
- can cause erythema nodosum and prolonged fever
142
Tx histo in HIV patient
itraconazole
143
Tx enterobius aka pinworm
albendazole or mebendazole x 1; repeat in 2 weeks
144
How do you get ascaris
- hand mouth
| - raw fruits or vegetables
145
Pathogenesis Ascaris lumbricoides
ova hatch in small intestine --> larvae penetrate intestinal wall --> migrate to lungs --> cough and swallow larvae --> hatch into adult worms in intestine
146
Presentation ascaris
- pulmonary infiltrates with eosinophilia
| - cholecystitis and pancreatitis due to biliary obstruction
147
Dx Ascaris
eggs in stool
148
Pathogenesis Necator (hookworm)
-feces contaminated soil --> penetrate skin -> veins -->lungs --> swallow (or may initially ingested at this point) --> attach and deposit eggs in intesinal wall
149
Presentation necator
- iron deficiency anemia
- hypoalbuminemia and edema
- GI symptoms
150
Tx Necator and ascaris
albendazole or mebendazole
151
How you get taenia
raw or undercooked infected meat; pork and beef
152
Cysticercosis presentation and tx
- 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
Presentation and tx amebiasis (entamoeba histolytica)
- fever and enlarged, tender liver
- increased ESR and anemia
- few leukocytes
tx: flagyl
154
tx toxo
pyrimethamine plus sulfadiazine (with folinic acid)
155
Presentation Plasmodium aka alaria
- paroxyms of high fever with rigors
- pallor
- jaundice
- hepatosplenomegaly, anemia, thrombocytopnia
156
Dx Malaria
Thick and thin RBC smears for 3 consecutive days
157
Malaria that presents with symptosm every 3 to 4 days
malariae
158
malaria that presents with periodicty ever other day
vivax and ovale
159
tx malaria
- chloroquine; quinidine; atovaquone
160
complications of malaria
- hypersplenism
- nephrotic
- renal failure, respiratory fail
- pulmonary edema
161
Ppx malaria withou chlorquine resistance
once weekly chloroquine starting 2 weeks before and through 4 weeks after leaving; atovaquone is substitute
162
Ppx resistant malaria
atovaquone daily; doxy daily; mefloquine
163
Primquine can exacerbate what condition
G6PD deficiency (for p vivax and ovale)
164
What is safest resistant malaria drug pregnancy
mefloquine
