ID II Flashcards
1
Q
definition of a high fever?
A
- rectal temp that exceeds 100.4
- not an illness by itself but rather a sx of an underlying condition most often an infection
- normal response
- 20% of childhood fevers have no apparent cause
- risk is greatest among febrile infants and kids younger than 36 mos
2
Q
3 most common causes of FUO in order of frequency?
A
- infectious disease
- connective tissue diseases (JRA, SLE)
- neoplasms (leukemia, lymphoma)
3
Q
Bacteria that cause serious bacterial infections?
A
- S. pneumoniae leading cause of bacterial URI
- meningitidis
- Hib
- E Coli: most common cause of UTIs, 75% of UTIs have pyelonephritis can lead to scarring
- approx 13-15% of ESRD is believed to be related to undertx childhood UTI
- salmonella
4
Q
Hx questions for FUO?
A
- fever hx
- fever at presentation
- current level of activity or lethargy
- activity level prior to fever onset
- current eating and drinking pattern
- appearance: fever can make kids appear ill
- vomiting or diarrhea
- ill contacts
- medical hx
- immunization (especially recent)
- urinary output: # of wet diapers?
5
Q
Workup for FUO?
A
- lab studies based on appearance, age and temperature
- begin IV or IM abx admin for infants that appear ill once urine and blood specimens obtained
6
Q
Workup for non toxic appearing FUO?
A
- CBC with diff
- UA by bladder cath and urine culture based on following criteria:
all males less than 6 mos and all uncircum. males less than 12 mos
all females younger than 24 mos and older if sxs suggest a UTI - rapid testing for viruses (influenza, RSV)
- consider stool for WBC counts and guaiac if diarrhea is present
7
Q
Workup for toxic appearing FUO?
A
- CBC with diff and CMP
- obtain blood cultures
- consider obtaining a chest X-ray, esp for pts with elevated WBC count
- UA by bladder cath and urine culture based on:
males younger than 6 mos and uncirum. younger than 12 most
all females younger than 24 months and older if sxs suggest UTI - obtain CSF for studies and culture
- consider stool for WBCs and guaiac if diarrhea is present
- rapid testing for virus
- admit these pts for further tx
8
Q
Imaging for FUO?
A
- CXR for thorough eval of febrile child
- CXR indicated if tachypnea, retractions, focal auscultatory findings or O2 sat on RA less than 95%
- abdominal U/S
9
Q
Procedures for FUO?
A
- bladder cath
- suprapubic aspiration
- LP
10
Q
Tx FUO non toxic?
A
- after complete eval to identify source:
- pts 2-36months may not reqr admission if they meet following criteria:
pt healthy prior to fever
pt fully immunized
pt has no sig RFs
pt appears nontoxic and is otherwise healthy
pt’s parents appear reliable and have access to transportation if sxs should worsen - considerations on empiric abx therapy isn’t warranted
- schedule serial f/u w/in 24-48 hrs and instruct parents to return with child sooner if conditions worsen
- hosp admission for kids whose condition worsen or whose eval findings suggest a serious infection
11
Q
Tx for FUO toxic?
A
- admit for further tx, pending culture results, admin parenteral abx
- initially admin ceftriaxone, cefotaxime or amp/sulbactam
12
Q
Embiric antimicrobial therapy should be what?
A
- ceftriaxone (rocephin), broad spectrum, gram - coverage
- cefotaxime )claforan): for septicemia and tx, alt to ceftriaxone in infants inf 1st month or 2 in whom bili displacement from protein binding sites by latter abx may be harmful
- amp/sulbactam (unasyn): drug combo of beta lactamase inhibitor with ampicillin. Covers skin, enteric flora and anaerobes
13
Q
What is impetigo? 2 types?
A
- acute highly contagious gram + bacterial infection of superficial layers of epidermis
- occurs most commonly in kids especially in hot, humid climates
- 2 types:
- nonbullous: most common skin infection in kids, staph aureus or GABHS
- bullous: almost exclusively S. aureus
14
Q
PP of impetigo?
A
- intact skin usually resistant to colonization or infection
- factors that can modify usual skin flora:
high temp or humidity
preexisting cutaneous diseaes
young age
recent abx tx - common mech. for disruption of skin that facilitates colonization or infection:
scratching, dermatophytosis (ringworm), herpes simplex, scabies, pediculosis, trauma, insect bites
15
Q
DDx for impetigo?
A
- herpetic impetigo
- pemphigus vulgaris (rare in kids)
- follicular mucinosis
- folliculitis
- erysipelas
- insect bites
- cutaneous candidiasis
16
Q
Dx impetigo?
A
- usually based solely on:
hx and clinical appearance: erosions covered by “honey colored” crust - labs: gram stain and culture to ID bacteria
17
Q
Tx of impetigo?
A
- local wound care
- abx therapy:
topical - mupirocin (bactroban)
oral - must cover staph aureus and strep pyogenes, MRSA also:
cephalexin or dicloxacillin (1st line)
erythro and clarithro (2nd line)
Trimethroprim-sulfamethoxazole, clinda, or doxy (MRSA) - after being on abx for 24 hrs - can return to school
18
Q
What is molluscum contagiosum? Cause? Common in?
A
- benign viral infection (poxvirus)
- characteristic skin lesions
- single or must, rounded dome-shaped, pink, waxy papules, 2-5 mm, umbilicate
- common in kids and immunosuppressed
19
Q
Presentation of molluscum?
A
- usually asx
- pt may recall contact with family member or other person
- children sharing bath
- athletes sharing equip.
- parents may recally camp, school, or public recreation
- swimming pools
- sexual activity
20
Q
PE of molluscum?
A
- lesions may be located anywhere
- predilection for face, trunk and extremities
- predilection for groin, and genitalia in adults
- distribution influenced by mode of infection
21
Q
Molluscum differential?
A
- cutaneous manifestations of other opportunistic infections:
cryptococcosis
histoplasmosis
aspergillosis
other conditions: keratocathmoma, flat warts
22
Q
Dx molluscum?
A
- easily est by distinctive, central umbilication of dome shaped lesion
- if uncertain can consider bx
- if adolescent or adult - STD workup
23
Q
Tx molluscum?
A
- benign neglect: usually resolves within months
- direct lesional trauma
- antiviral: cimetidine
- topical: imiquimod, cantharidin
- cryotherapy with curettage
- activity: avoid sports, avoid physical contact b/t infected areas, sexual abstinence
24
Q
Pediculosis?
A
- lice, ectoparasites that live on body and feed on human blood after piercing skin
capitus: head lice
corporis: body lice - very common
25
Q
Pediculosis presentation?
A
- parents and teachers usually discover
- pruritis most common sx: kids have hard time sleeping b/c of itching, eyelashes, eyebrows, watch for secondary infection from scratching
- adults usually assoc with sex and have groin and body involvement
26
Q
Lice physical exam?
A
- observation of: eggs (nits) nymphs mature lice - secondary infection from excoriation - examine under microscope - wood lamp of area: yellow-green fluorescence of lice/nits
27
Q
DDx of lice?
A
- dandruff
- dried hairspray/gel
- acne
- impetigo
- scabies
28
Q
Tx of lice?
A
- use as directed to ensure eradication through their life cycle:
permethrin (nix) cream
malathion
benzyl alcohol
spinosad
ivermectin - careful combing and removal of all nits
- cleaning of other articles: hair accessories, towels, bedding, clothing
- enviro control: tx all persons who have contact with infested pts (esp sexual partners)
