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ID_UW Flashcards

1
Q

Most common causes of neonatal sepsis

A

GBS, E. Coli and Listeria (in that order)

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2
Q

Tx for neonatal sepsis

A

Ampilicillin + Gentamicin

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3
Q

Meningococcal meningitis most commonly affects kids what age

A

3 years to adolescence

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4
Q

What is the most common cause of sepsis in the sickle cell population

A

Srep pneumonia, H influenza type B distant second

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5
Q

Patients with functional asplenia are at risk for

A

Strep pneumo, H influenza, neisseria meningitdes, and salmonella

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6
Q

Sickle cell patients should receive what vaccines

A

All regular vaccines + 23 valent polysaccaride pneumococcal and menigococcal conjugate vaccines.

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7
Q

What propylaxis should sickle cell patients take

A

Penicillin till age 5

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8
Q

Inability to extend neck, dysphagia, fever, muffled voice and widened prevertebral space on lateral x0ray suggest?

A

Retropharyngeal abscess

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9
Q

Most common organism/cause of septic arthritis and osteomyelitis in neonates?

A

E Coli and GBS

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10
Q

Most common organism/cause osteomyelitis in

A

GBS

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11
Q

Triad of infectious mono?

A

Exudative pharyngitis/tonsillitis, diffuse or posterior cervical lymphadenopathy, and fever

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12
Q

IM is most commonly caused by and in what age group?

A

Ebstein Barr virus, 15-24 year olds

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13
Q

When does a rash occur in IM?

A

Can occur in IM but most frequently after administration of amoxicillin or ampicillin

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14
Q

Precautions for people with IM?

A

Avoid contact sports for 3 weeks due to splenomegaly

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15
Q

3 stages of whooping cough (pertussis)

A

1) Catarrhal (1-2 weeks) 2) Paroxysmal (2-6 weeks) 3) Convalescent (Week to months)

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16
Q

What are the clinical sx a/w with the 3 stages of whooping cough

A

1) Catarrhal (1-2 weeks) - rhinits, mild cough 2) Paroxysmal (2-6 weeks) - post-tussive emesis, apnea/cyanosis in infants, coughing paroxysms with inspiratory whoop 3) Convalescent (Week to months) sx resolve gradually

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17
Q

Dx of pertussis

A

Bacterial culture and/or polymerase chain reaction from nasopharyngeal secretions in patients

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18
Q

What is the treatment for pertussis

A

Macrolides such as azithryomycin, erythromycin

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19
Q

Pertussis patients can develop marked (cbc finding)

A

Lymphocytosis

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20
Q

Pertussis prevent

A

Acellular pertussis vaccine

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21
Q

Pinworm infection aka

A

Enterobius vermicularis

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22
Q

complications of pertussis

A

Subconjunctival hemorrhages, pneumonia, weight loss, pneumothorax, respiratory failure, death (infants)

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23
Q

Treatment for enterobius vermicularis

A

Abendazole or pyrantel pamoate (latter preferred for pregs). Highly contagious. All household members should get treatment

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24
Q

Asymptomatic, immunocompetent and non-immune patients should get what if exposed to varicella?

A

within 3-5 days of exposure, get the varicella vaccine for post-exposure prophylaxis. Will work if given within 5 days of exposure

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25
Q

Asymptomatic, non-immune but immunocompromised/preggos should get what if infected with varicella?

A

Varicella IVIG. Does not prevent but will reduce disease severity but have to be be monitored closely becaues can extend incubation period to a month.

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26
Q

How long is incubation period of chicken pox and when is chicken pox contagious?

A

3 weeks but most sx surface in 2 weeks. Contagious 2 weeks before rash starts and till after all lesions are crusted over.

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27
Q

What are the most common causes of viral meningitis

A

Non-polio enteroviruses such as coxsackie virus or echovirus

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28
Q

incidence of viral meningitis decreases with?

A

Increasing age. Infants most affected with highest mortality and morbidity in this group.

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29
Q

What does CSF show with viral meningitis

A

Pleocytosis with lymphocytic predominance. Protein is normal to slightly elevated, glucose is normal. CSF gram stain will not show any organism.

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30
Q

Tx for viral meningitis?

A

this is usually a self limited leptomeningeal inflammation caused by a viral infection. Tx is usually supportive and sx resolve in 7-10 days.

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31
Q

Group A strep

A

Streptococcus pyogenes

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32
Q

Patients with group A strep should get?

A

10 day treatment of oral penicillin to prevent acute rheumatic fever.

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33
Q

Rheumatic fever diagnosis

A

2 major critiera, 1 major and 2 minor, or if either sydenham chorea or carditis is present.

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34
Q

Criteria for rhematic fever.

A

JONES - joints (migratory arthritis), heart (carditis), Nodules (subcutaneous), E (erythema marginatum), S sydenham chorea. Minor: fever, elevated CRP/ESR, prolonged PR interval, arthralgias.

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35
Q

Pasteurella multocida

A

Gram negative, non motile, penicillin sensitive coccobacillus

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36
Q

Cat bites are concerning for infection with?

A

eg. Pasteurella multocida

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37
Q

Prophylactic tx of cat bites

A

five day course of amoxillin / clavulanate.

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38
Q

Dangerous complications of orbital cellulities?

A

Cranial infection and blindness

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39
Q

Tx difference between preseptal and orbital cellulitis?

A

Preseptal can be outpatient oral abx tx, orbital has to be iv antibiotics and admitted for careful observation

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40
Q

Acute unilateral cervical lymphadenitis in children is usually caused by?

A

Bacterial infection

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41
Q

What is the most common cause of acute unilateral cervical lymphadenitis

A

Staph aureus followed by Group A Strep

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42
Q

Age and ppt of bacterial lymphadenitis?

A

Usually less than 5 years old, non toxic appearing, warm, tender, erythematous node measuring 3-6cm in size.

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43
Q

Most common cause of osteomyeolitis in children and infants

A

Staph Aureus

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44
Q

Other common organisms that can cause osteomyelitis

A

Group B strep and E. Coli in infants, Strep pyogenes in children.

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45
Q

What is one of the most frequent compliations of mumps?

A

Orchitis, most commonly in men between the ages of 15-29. Other common complications are aseptic meningitis and encephalitis

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46
Q

Bactrim has good effect against ? And poor effect against ?

A

Good affect against Staph, including MRSA but poor effect against GAS.

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47
Q

Tx for acute uniliateral cervical adenitis

A

Usually due to staph or strep so tx with Clindamycin with I&D

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48
Q

How does meningococcal meningitis present?

A

Fever, headache, neck stiffness, AMS, petechial or purpuric rash on axilla, wrists, ankles, flanks. Rash appears wtihin 24 hours of infection.

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49
Q

Most common predisposing factor for bacterial sinusitis

A

Viral URI

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50
Q

Patients with deficient cell immunity are at risk for infections with fungi such as

A

Cryptococcus neoformans, histoplasma capsulatum, pneumocystic jiroveci

51
Q

Most common pneumonia in CF patients - infants and young children

A

Staph aureus

52
Q

Most common pneumonia in CF patients - adolescents and young adults

A

Pseudomonas aeruginosa

53
Q

E Coli is what kind of bacteria

A

Gram negative rod

54
Q

Klebsiella and legionella pneumophilia are what kind of bacteria

A

Gram negative rod

55
Q

Listeria is what kind of bacteria

A

Gram positive rod

56
Q

Diagnosis of malaria

A

Thick and thin peripheral blood smears

57
Q

Cyclic fevers in malaria correlate to what

A

Wave of rbc invasion when parasites are released from liver

58
Q

Anti malarial drugs

A

Doxycycline, mefloquine, atovaquone-proguanil, hydroxychloroquine

59
Q

Protective factors for malaria

A

Previous infection - therefore conferred immunity, hemoglobinopathies (Hgb S, Hgb C, thalassemias)

60
Q

Congenital rubella ppt?

A

sensorineural hearing loss, intellectual disability, cardiac anomalies, cataracts (shows up as leukocoria which is white pupillary reflex), glaucoma,thrombocytopenic rash blueberry muffin rash.

61
Q

Presentation of rubella in children?

A

low grade fever, cephalocaudal rash, blanching, maculopapular; conjunctivitis, coryza, cervical lypahdenopathy, Florscheimer spots

62
Q

Dx of rubella

A

PCR, and acute and convalescent serology of anti-rubella IgM and IgG

63
Q

Congenital toxoplasmosis presentation

A

Chorioretinitis, hydrocephalus, intracranial calcifications, hepatosplenomegaly Also a/w sensorineural hearing loss but not cardiac defects

64
Q

Maternal fetal transmission of rubella is most teratogenic when

A

First trimester

65
Q

What should be done ASAP in order to prevent long term joint destruction in septic arthritis

A

Surgical drainage of the joint, debridement and irrigation

66
Q

Fluid description, WBC count and PMN% in septic arthritis?

A

Turbid, 50,000-150,000 and often>80-90%

67
Q

Congenital syphillis presentation

A

If presenting early, presents with hepatosplenomegaly, cutaneous lesions (like ulcerative lesions on feet), jaundice, anemia, thrombocytopenia. Metaphyseal dystrophy and periostitis seen on radiography

68
Q

What is the most prevalent rabid animal in the US

A

Raccoons

69
Q

What are pathognomic features of encephalitic rabies

A

Hydrophobia and aerophobia => sends patient into involuntary pharygneal spasms. Patients usally die within weeks

70
Q

What is the post exposure prophylaxis for rabies

A

Rabies Immunoglobulins and vaccine immediately after exposure

71
Q

Common reservoirs for rabies

A

Wild carnivores, raccoons, and bats

72
Q

Encephalitic and paralytic features of rabies

A

Encephalitic: Hydrophobia and aerophobia, pharyngeal spasms, spastic paralysis, agitation. Paralytic: ascending flaccid paralysis.

73
Q

What is the gold standard for HIV testing in new infants?

A

PCR testing from birth to 18 months

74
Q

HIV antibodies don’t’ get picked up for how many months?

A

3 months = “window”

75
Q

Preferred antifungals for chronic pulmonary aspergillosis

A

Itraconazole, voriconazole.

76
Q

Preferred antibiotic for community acquired strep pneumoniae?

A

high dose oral amoxacillin

77
Q

Non-bullous vs bullous impetigo ppt

A

Non-bullous: Painful pustules and honey crusted lesions. Bullous: flaccid bullae with yellow fluid, collarette of scale at the periphery of lesions.

78
Q

Non-bullous vs bullous impetigo microbiology

A

Non-bullous: Staph aureus, GAS Bullous: Staph aureus

79
Q

Clindamycin MOA

A

Binds to the 50s ribosomal subunit of bacteria, disrupts protein synthesis by interfering with transpeptidation rxn.

80
Q

Non-bullous vs bullous impetigo tx

A

Topical mupirocin; oral antibiotics like clindamycin, cephalexin, dicloxacillin

81
Q

Cephalexin MOA

A

Binds to one of the penicillin binding proteins => inhibits final step of the transpeptidation of peptidoglycan synthesis in bacterial cell walls. Inhibits cell wall synthesis.

82
Q

Dicloxacillin MOA

A

Binds to one of the penicillin binding proteins => inhibits final step of the transpeptidation of peptidoglycan synthesis in bacterial cell walls. Inhibits cell wall synthesis.

83
Q

Septic arthritis is often preceded by

A

Skin or upper respiratory tract infections

84
Q

Septic arthritis most often caused by which organisms. Abx coverage

A

Strep pneumo, Group A strep, Staph aureus. Nafcillin, clinda, cefazolin or vanco

85
Q

Septic arthritis in kids younger than 3 months usually caused by? Abx coverage

A

Staph, group B strep, and gram negative bacilli. Anti staph (nafcillin or vanco) plus gentamicin or cefotaxime

86
Q

Lab findings for septic arthritis

A

Elevated WBC, elevated CRP and ESR, >50,000 cells/microL

87
Q

PE findings for septic arthritis

A

Erythema, warmth and swelling of joint, pain with active and passive motion

88
Q

Initial management for septic arthritis

A

Arthrocentesis, blood an synovial fluid cultures, empiric antibiotic coverage

89
Q

viral vs bacterial pharyngitis findings

A

Viral: cough, rhinorrhea, exanthem, conjunctivitis, oral ulcers. Bacterial: tonsillar exudates, erythema, tender anterior cervical nodes, palatal petechiae.

90
Q

Abx of choice for streptococcal pharyngitis

A

Covering for Group A Strep - penicillin or amoxicillin

91
Q

Gold standard for diagnosing strep throat

A

Throat culture

92
Q

Common findings between herpangina and herpetic gingivostomatitis

A

Fever, pharyngitis and oral lesions in children

93
Q

Different clinical features between herpangina and herpetic gingivostomatitis

A

Herpangina: Gray vesicles/ulcers on posterior oropharynx and tonsillar pillars that progress to fibrin coated ulcerations. Herpetic gingivo: clusters of small vesicles on anterior oropharynx and lips.

94
Q

Seasonality of herpangina and herpetic gingivostomatitis

A

Summer/early fall but for herpetic: all year

95
Q

Treatment for lyme disease?

A

Amoxicillin (tx of choice for kids under 8 yo), doxycycline, and cefuroxime.

96
Q

Doxycycline is contraindicated in which patients?

A

Under 8 and pregnant women. Under 8 because it causes enamel hypoplasia and permanent teeth stains during tooth development in children.

97
Q

Doxy is often used to treat lyme disease because?

A

It also treats coexisting anaplasma phagocytophilum also transmitted by the Ixodes tick.

98
Q

Mumps presentation

A

Swelling moves to opposite side in a day after sx appear on first side. Other findings, redness and swelling around Stensen’s duct, edema and swelling in pharynx, displacement of uvula on the side.

99
Q

Presentation of diptheria? What bacteria is it caused by?

A

Corynebacterium diptheria. Starts with mild fever and sore throat (50%) but progresses quickly with an adherent membrane that covers and can extend over glottic area, uvula, palate, posterior oropharynx, hypopharynx and potential airway compromise

100
Q

What kind of propylaxis is good for infants born to HIV mothers

A

Bactrim for prophylaxis against pneumocystis jiroveci

101
Q

If children with HIV are exposed to measles, they should get?

A

immunoglobuliens REGARDLESS OF vaccine history

102
Q

Death from Reye syndroem is usually from

A

Cerebral edema and herniation

103
Q

Bactrim used for?

A

UTIs, shigella, salmonella, PNEUMOCYSTIC JIROVECI PROPHYLAXIS, PNEUMONIA TX AND PROPHYPYLAXIS AND TOXOPLASMOSIS PROPHYLAXIS

104
Q

Shigellosis presentation

A

Wide range of presentations from days of watery stool for several days to severe infection with high fever, seizures, and abdominal pain. Often seizures precede diarrhea. Most common presenting sx is seizures and diarrhea. Diarrhea usually resolves in 1-2 weeks.

105
Q

Scarlet fever is caused by?

A

Group A beta hemolytic strep

106
Q

Scarlet fever and Kawasaki presentation similarities?

A

Rash, desquamation, erythema of mucus membranes that can cause injected pharynx and strawberry tongue, cervical lympathdenoapthy. Most serious complication of both is cardiac involvement.

107
Q

How would you distinguish between scarlet fever and kawasaki?

A

You can isolate the organism from nasopharynx and rise in antistreptolysin titers will confirm diagnosis of Group A strep. Etiology of Kawasaki is sill unknown.

108
Q

How to tx tinea capitis?

A

Does not respond to topicals, need to treat with long-term oral therapy with griseofulvin or another antifungal.

109
Q

Roseola is caused by?

A

Human herpes virus 6

110
Q

Hand foot mouth disease caused by?

A

Coxsackie virus A16

111
Q

Infection with Parvovirus B19 causes what in 1) non-immunocompromised patient 2) sickle cell patient 3) pregnant patient 4) immunodeficient patient

A

1) Fifth disease - benign mild exanthem 2 ) can cause transient aplastic crisis. 3) can cause severe anemia in infectued fetus with secondary hydrops fetalis and death 4) chronic anemia

112
Q

Leptospirosis?

A

Found in contaminated water with animal urine. Most common zoonotic infection in the world

113
Q

Leptospirosis presentation?

A

most cases are mild/sub-clinical. Flu like sx (high fever, chills, muscle pain, pharyntitis), conjuctival injection without the exudate, photophobia, cervical adenopathy. After a few days of sx reolstuion, then patients can go on to a phase where meningitic sx can return and last up to a month. less than 10% of leptospirosis cases are icteric but these patietns go on to hae liver and kidney dysfunctiion.

114
Q

Kawasaki presents at what age

A

80% present at lower than 5

115
Q

What medication may be effective in preventing or shortening the duration of pertussis?

A

Erythromycine => achieves high concentrations in respiratory secretions and can eliminate organisms from respiratory tract. In exxposed peope, may prevent or lessen severeity of disease if adminstered during the parapaxosymal stage.

116
Q

Triad of findings for mono

A

1) PE - diffuse adenopathy, enlarged spleen, small hemorrhages on soft palate, tonisllar enlargement 2) predominance of lymphocytosis 3) characteristic antibody response - traditionally heterophil antibodies can be deteceted when confirming a dx of IM

117
Q

Streptococcis

A

Low grade fever, prolonged insidious nasopharyngitis that sometimes occurs in infected patients with group A beta hemolytic strep

118
Q

Pneumococcal bactermia presentation

A

High grade fever, marked elevation and shift to left of WBC counts

119
Q

Rubella in child presents with?

A

Mild URI sx, retroauricular, posterior cervical and postoccipital lymphadenopathy, diffuse erythematous maculopapular rash that clears in 72 hours.

120
Q

What is the post exposure prophylaxis for rabies

A

wound cleansing (if wound is obvious), rabies immunogloblin, and 5 injection vaccine serires.

121
Q

Clinical course of RMSF

A

brief prodromal period of headache and malaise, followed by abrupt onset of fever and chills, maculopapular rash starts on 2nd to 4th day of illness on flexor surfaces of writs and ankles before moving in centra direction. Palms and soles are involved. rash can become hemorrhagic wtihin 1 to 2 days. hyponataremia and thrombocytopenia can be seen.

122
Q

How to treat RMSF?

A

Doxycycline

123
Q

Wiskot Aldrich Syndrome, inheritance and immunity problems?

A

X linked recessive. Combined immunodeficiency problem. They have 1) thrombocytopenia 2) impaired humoral with low IgM and normal to low IgG 3) impaired cellular immunity with decreased T cells and decreased lymphocytic response.

124
Q

Presentation of Wiskot Aldrich

A

Eczema, thromobocytopenia (bleeding from circumcision site) and increased susceptibility to infection. Most don’t live past teens.

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