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infection Flashcards

1
Q

wright stain

A

WBC

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2
Q

wright stain

A

WBC

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3
Q

fluorecent ab staining

A

herpes, VZV, repsatory virus like RSV, adenovirus, influenza

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4
Q
A

most likely viral. nonspecific sx- fever, decr appetite, irritability, cough, rhinorrhea, v, d, apnea
hospitalize if

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5
Q

bacteria by age

A

0-1mo: GBS, ecoli, listeria=amp/Gent or cef
1-3: GBS, strep pneumoniae, listero: amp/cef/vanc if bacteiral meningitis suspected
3mo-3y: strep pn, influencae type b, neisseria meningitis- cef+vanc if meningitis
>3yo; strep p, neisseria mengitis-cef+vanc if meningitis

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6
Q

low risk of bacterial infection in

A

if appear well, no focal site of infection. WBC: >5,

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7
Q

fluorecent ab staiining

A

herpes, VZV, repsatory virus like RSV, adenovirus, influenza

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8
Q

bacterial meningitis

A

highest incident in 1st mo. RF- ventriculoperioneal shunt, basilar skull fracture
sx- may have fever, bulging fontanelle
older- alt lcl of consciousness, nuchal rigidity, pos kerning and brudzinski sign, seizure, photophobia, emesis, HA
dx- LP, blood culture, CT w contrast for abscess
complications- most in gram neg, then s pneumonia, HIB, Neisseria meningitis. hearing loss most common-25% pt, global brain injury 5%, SIADH, seizure, hydrocephalus, brain abscess, CN palsy, learning disability

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9
Q

bacteria by age

A

0-1mo: GBS, ecoli, listeria=amp/Gent or cef
1-3: GBS, strep pneumoniae, listero: amp/cef/vanc if bacteiral meningitis suspected
3mo-3y: strep pn, influencae type b, neisseria meningitis- cef+vanc if meningitis
>3yo; strep p, neisseria mengitis-cef+vanc if meningitis

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10
Q

low risk of bacterial infection in

A

if appear well, no focal site of infection. WBC: >5,

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11
Q

btw 3-36mo fever

A

pneumoniae most common.
if toxic-need hospitalization, IV antibiotics, eval for sepsis
102.2 -urine culture, blood culture if wbc>15, cxr if RD, stool culture if blood or mucus or >5 WBC on wright test, empire antibody for abc >15

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12
Q

fever of unknown origin

A

fever 8d-3wk with no dx. most is unusual presentation of common infection. 25% spontaneously resolve w/o dx. causes by common-infection, rheumatoloic d, malig (lymphoma, leukemia),

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13
Q

meningitis

A

highest incident in 1st mo. RF- ventriculoperioneal shunt, basilar skull fracture
sx- may have fever, bulging fontanelle
older- alt lcl of consciousness, nuchal rigidity, pos kerning and brudzinski sign, seizure, photophobia, emesis, HA

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14
Q

LP for meningitis

A

look for pleohypoglycorrhachia, incr protein, pos gram stain and culture, cytosis with prelim neutrophil, WBC>5K,
bacteria- PMN predoc, high protein, low flu, pos gram stain
viral- PMN early then mono and lymph (HSV-RBC), normal to high protein, normal flu, ~culture/PCR
TB: lymph predoc, very high protein, low flu, AFB smear rarely pos, PCR pos
fungal- lymph predoc, normal to high protein, low flu, culture pos, india ink for cryptococcus
parameningeal focus- poly or monos prelim, high protein, normal flu, neg culture

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15
Q

bacterial meningitis tx

A

antiobiotics. corticosteroid bf 1st dose decr hearing loss, supportive care- monitor for SIADH

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16
Q

aseptic miningitis

A

inflm of meninges with CSF lymphocytic pleocytosis. if viral, normal CSF flu, min elevated protein.
if TB- in 2nd wk become CN palsy, alter consciousness, coma, paraplegia, death
can be bacterial- tb, lyme, syphilus

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17
Q

simple URI (common cold)

A

present, low grade fever, rhinorrhea, cough, sore throat, resolve 7-10d
tx- hydrate. dd otitis, sinusitis

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18
Q

sinusitis

A

acute: pneumonia, influence, catarrhalis, amoxilin, or 2nd ten cephalosporin 10-14d
subacute: same as acute but 30-90d
chronic: >90d, CF, allergy, immune def, s aureus, anaerobes, trial of broad spectrum oral antibiotics, CT image sinuses, IV antibiotics
. no imaging, dx base on clinical press

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19
Q

pharyngitis

A

viral- same as common URI-cox, EBV, CMV
bacteria- strep pyrogenes = GAS= common pediatric infection (self limiting usually but tx to prevent serious complication ~ rheumatic fever), diptheria, GABHS
sx btw viral and bacterial overlap

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20
Q

EBV pharyngitis

A

may have enlarged posterior cervial LN, malaise, hepatosplenomegaly
corticosteroids

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21
Q

coxsackievirus

A

painful vesicles or ulcer on posteiror pharynx and soft palate- herpanginia, hand foot mouth disease- blisters

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22
Q

GABHS

A

lack other URI sx, exudate on tonsils, petechiae on soft palate, strawberry tongue, enlarged tender anterior cervical LN, fever, scarlatiniform rash
need oral penicillin, IM penicillin, or erythromycin or macrocodes

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23
Q

GAS

A

if suspect, do rapid strep test to detect strep ag from throat swap. if neg, do throat culture
starting antibiotics w/in 9d of acute illness prevents rheumatic fever.
oral amoxicillin. IM for child who refuse PO.

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24
Q

systemic onset juvenile idiopathic arthritis (JIA)

A

a rheumatic disease
subdiv: oligoarthritis, polyarthritis, or systemic onset disease (still’s disease)
P: Prolonged fever could suggest Still’s disease
Rash
Arthritis (although active arthritis in Still’s disease often presents months to years after onset)
Visceral involvement (e.g., hepatosplenomegaly, lymphadenitis, serositis)

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25
Q

kawasaki disease

A

vasculitis.
to Dx need
1) fever>5d.
2)nonpurulent conjectivitis.
3) mucosal changes o oropharynx (strawberry tong, red cracked(fissured) lips)
4) maculopapular rash
5) swelling and erythema of extremities
6) lymphadenopathy (cervical, unilateral)
labs: predom neutrophils, normochromic, normocytic anemia, MCV normal, elevated plt, elevated LFT, ERS/CRP incr (sensitive, not specific), sterile pyuria with WBC
need to evaluate all for coronary artery aneurysm so get echo then f/u echo in 1-2wk
other complication: CNS manifestation, liver dysfunc, arthritis, hydrous of GB. Cause inflm = vasculitis -can cause acute coronary artery dilation and aneurysm formation- can be screened for using echo in kids. incidence of aneurysm decr if tx w/in 7d of sx
Tx: aspirin (6-8wks) + IVIG (can decr aneurysm)

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26
Q

osteomyelitis/ septic J

A

bacteria. 80% LE.

P: low grade fever, painful walking

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27
Q

Rocky mountain spotted fever (RMSF)

A

tick borne bacterial infection (rickettsia rickettsii). SE america
Fever
Headache
Rash (typically starts on ankles and wrists and progresses centrally and to palms and soles*; may be maculopapular at first, quickly becoming petechial; in 5% of cases, there may be no rash)
Myalgias
hepatosplenomegaly and jaundice
CNS- HA, sx
hypotension
Labs: thrombocytopenia, incr LFT, hyponatremia. aspectiv meningitis
dx- clinical.
management- oral doxy + supportive care

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28
Q

palm and sole rash dd

A

kawasaki, enterovirus, RMSF, syphilis

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29
Q

scarlet fever

A

GAS. fever

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30
Q

steven johnson syndrome

A

mucocutaneous D cause by HS to med, infection, other illness. severe pruritic rash (erythema multiform) fever

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31
Q

enterovirus

A

fever 3-5d.
non descript, non painful rash
b/l lymphadenopathy

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32
Q

meningococcemia

A

neisseria meningitis. acute onset of fever, chills, malaise, prostration
rash- urticarial, maculopapular or petechial- prplish, hemorrhagic spots. fulminant- prpuric + large hemorrhage into skin.
immunization prevent infection

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33
Q

roseola

A

This macular or maculopapular rash, also called exanthem subitum, starts on the trunk and spreads to the arms and neck.
There is usually less involvement of the face and legs.
The rash is preceded by three or four days of high fevers, which end as the rash appears.
Usually seen in children less than two years old.

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34
Q

VZV

A

erythematous macule to papule to vesicle to pustule then crust over. mild fever. week

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35
Q

generalized lymphadenopathy 2/2 infection

A

measles (+ splenomegaly), CMV, EBV, HIV, histoplasmosis, toxo, mycobacteria (also localized)

36
Q

generalized lymphadenopathy 2/2 non infectious

A

lymphoma, leukemia, histiocytosis, metastic neurblastoma, rhabdomyosarcoma

37
Q

cervical lymphadenopathy

A

bacterial cervical adenitis, cat scratch disease, mycobacterial infection,

38
Q

bacterial cervical adenitis

A

1-5yo +hx of URI
S. aureus, Strep pyrogenes.
high fever+ toxic
overlying cellulitis and fluctuant on lymphadenopathy

39
Q

cat scratch disease

A

bartonella henselae. asx or sx.
self limited in 4-6wk
regional lymphadenopathy. papule first. fever in 1/3. uncommon- paranoid oculoglandular syndrome (conjunctivitis, pre auricular lymphadenitis)
dx: elevated IgM to B henselae
tx: supportive. antibiotics if systemic sx (azythromycin, TMP/SMX)

40
Q

mycobacterial infection v lymphadenopathy

A

12yo- lymphadenitis is most common P of TB
erythematous then violaceous as nodes enlarge- may rupture and drain through sinus tract
tx- surgical excision. no I&D bc make sinus tract

41
Q

strawberry tongue

A

GAS, kawasaki, toxic shock syndrome

42
Q

reye syndrome

A

long term aspirin in children + influenza virus A or B cause multi organ damage. so bf start aspirin tx (kawasaki), vaccinate.

43
Q

AMS dd

A

hypoxia, hypoglycemia, poisoning

acidosis/shock: intussucpetion, sepsis, DKA, renal failure

44
Q

encephalitis

A

AMS and fever but no tachypnea.

45
Q

tachycardia

A

1st sign of inadequate perfusion.

46
Q

acute otitis media (AOM)

A

acute infection of middle ear space.
agents: bacteria- s pneumoniae, non typeable H influenze and moraxella catarrhalis. virus of simple URI= why often dev during or after URI..
sx- fever, ear pain, decr hearing
if tympanic me perforates, see pus or fluid drain from ear
dx- ID fluid in middle ear space with sx of infection. pneumatic otoscope see abn mV of tympanic me = best . erythema and loss of TM landmarks-unreliable
tx: antibiotics-amoxicillin

47
Q

otitis media with effusion (OME)

A

fluid w/i middle ear space wo sx of infection

48
Q

otitis externa

A

infection of external auditory canal (EAC)
patho: cerumen removal, trauma, maceration of skin from swimming, excessive moisture or humidity
etio- p. aeruginosa, s. aureas, gandida albicans. can dev 2/2 AOM
cP: pain, itching, drainage from ear. no systemic sc. AOM ~hx determine whether TM perforation occurred
dx- PE= erythema and edema of EAC, tenderness on palpation of tragus
tx: retore EAC to natural acidic enviro with acetic acid in mild and topical antibiotics with corticosteroid in severe or TM perforated.

49
Q

middle and lower respiratory infection

A

penumonia, bronchiolitis, epiglottis,croup, bacterial tracheitis

50
Q

cervical lymphadenitis etio

A

1) localized abcteria infection. s aureas most common. can be s pyrogens, TB, B henselae= cat scratch disease
2) reactive lymphadenitis in response to infection of pharynx, teeth, soft tissue of head and neck
3) viral infection- EBV, CMV, HIV
4) kawasakii- unilateral
5) T gondii~ mono
6) structural lesions- branchial cleft cyst that gets infected

51
Q

cervical lymphadenopathy P, Dx, Tx

A

mobile, tender, warm node. overlying erythematous skin. may have fluctuant. systemic sx-fever
dx: clinical. if unresponsive to tx, get CBC, tuberculin skin test, antibody titer for viruses if diffuse and persistent. image if need drainage and airway
tx- emperic antibiotics for s aureus and pyyrogenes. 1st gen cephalosporin or penicillin. IV if toxic

52
Q

parotitis. etio

A

inflm of parotid salivary glands
etio: mumps (most common bf vaccine) and other virus cause bl. . acute suppurative parotitis (bacteria like s bureaus s pyrogens, tb)- unilateral and uncommon in kids. RF- decr salivary flow or stone

53
Q

parotitis P, dx, tx

A

P: swelling above angle of jaw. fever. pus in oropharynx from stoniness’ duct
dx: ct, culture, viral serology
tx: viral-supportive. bacterial- antibiotics
complicaiton- abscess, osteomyelitis of jaw in bacteria

54
Q

bacterial skin infection

A

impetigo, erysipelas, cellulitis, scarlet fever, toxic shock syndrome

55
Q

impetigo

A

superficial skin infection of upper dermis
etio: s. aureaus most common
P: honey colored crusted or bullus lesion. face, nares. no fever. easily transmitted infection
dx- visual no culture
tx- topical mupirocin or antibiotics
complication- bacteremia, SSSS, glomerulnephritis

56
Q

erysipelas

A

skin infection of dermal lymphatics
etio- GABHS
P: tender, erythematous skin with distinct border. face, scalp
dx- visual
tx- systemic tx with antibiotics
Complication: bacteremia, post strep glomerulonephritis, necr fas

57
Q

cellulitis

A

skin infection in dermis
etio: GABHS and s aureus. break in epidermis
P: warm, erythema, tenderness. indistinct skin border
dx- visual.
tx: PO antibiotics

58
Q

buccal cellulitis

A

HIB. unilateral bluish discoloration of cheek of unimmunized

59
Q

perianal cellulitis

A

well remarked. GABHS

60
Q

Nec Fas

A

pain and systemic sx out of proportion to physical findings. crepitus and hemorrhagic bull

61
Q

staphylococcal scalded skin syndrome (SSSS)

A

S aureus, make exfoliative toxin.
fever, tender skin, bulla. large sheets of skin slough off in days
nikolsky sign- bulla extends with pressure)
wound care and IV antibiotics

62
Q

scarlet fever, etio, epi, P

A

etio- GABHS makes erythrogenic toxin
epi-peak winter and spring. transmit by respiratory dropout
P: exanthum. fever, chillsm, malaise, exudative pharyngitis
exanthem- begin on trunk and mover peripherally, erythematous skin with tiny skin colored papule- scarlatinigorm, sandpaper rash. blanches with pressure. petechiae in skin creases = linear= pasta’s lines. desquamation of dry skin as infection resolve

63
Q

scarlet fever dx, tx, complications

A

dx- clinical, throat culture for S pyrogens, pos rapid strep test for GABHS antigen
tx: prevent rheumatic fever. antibiotics- penicillin VK, I’m benzathine penicillin
complicaiton- post strep GN, rheumatic fever, post strep arthitis (not prevented by antibiotics), PANDAS- dev OCD or tic D (prevented by antibiotics)

64
Q

toxic shock syndrome (TSS)

A

toxin mediated S aureus, increasing GABHS.
fever, shock, desquamating skin rash, multigrain dysfunction
tampon use.
Dx: need 5/6:
1) fever>38.5-101
2) hypotension SBP

65
Q

diarrhea

A

viral- rotavirus, norwalk virus
bacteria- ETEC (ecoli= traveler’s diarrhea, no wbc in stool), ehec (e coli, wbc present in stool, cause hemolytic uremic syndrome via endotoxin= avoid antibiotics), shigella (bloody diarrhea, then seizure), salmonella (bloody or non bloody), campylobacteria (most common cause of bloody diarrhea), yersinia (mesenteric adenines - mimic acute appendicitis), c dif (after antibiotics, pseudomembrane on endoscopy), vibe choral (massive water loss)

66
Q

rotavirus

A

most common infectious agent causing gastroenteritis. winter
V/D/dehydration. self limit in 4-7d
dx- ELISA stool. no wbc in stool
tx- supportive. transient lactose intolerance

67
Q

norwalk virus

A

epi- closed populations
vomiting is prominent. 48-72hr.
dx-clinical
tx-supportive

68
Q

diarrhea labs and tx

A

anon anion gap hypercholoremic metabolic acidosis bc bicarb loss in stool. WBC in stool predicted by gross or occult blood
fluid management, and antibiotics

69
Q

HIV

A

> 95% kids is perinatal. 5% transmission. so all infant need 6wk zidovudine for post exposure prophylaxis and trimethoprim/ sulfamethoxazole for pneumocystis carinii pneumonia (PCP) prophylaxis until HIV DNA PCR neg at 4mo
first y- asx
early sx: failure to thrive, thrombocytopenia, recurrent infection, lymphadenopathy, parotitis, recurrent thrush, loss of dev milestones, severe VZV or zoster
dx: HIV materal ab persist as long as 18-24mo in infant so HIV dna pcr at birth and monthly. neg PCR at 4mo = noninflected
don’t get VZV and MMR bc live vaccine.
annual ophthalmologic exam for CMV retinitis

70
Q

PCP

A

most common opportunistic infection in HIV kids

P: fever, hypoxia, interstitial pulmonary infiltrates

71
Q

infectious mononucleosis

A

saliva- infect B lymphocyte
P: young- sx. older- fever up to 2wks, malaise and fatigue, pharyngitis, posterior cervical lymphadenopathy, hepatosplenomeglay (in 80%), macular or scarlatiniform rash, sx resolve in wks to mo
dx: CBC -atypical lymphocytes, inct LFT, thrombocytopenia, neutropenia. monospot
tx: supportive
complication: neuro - CN palsies, encephalitits. upper airway obstruction, amoxillin associated rash in misdx- idiosycratic not allergic- diffuse pruritic maculopapular rash. splenic rupture, malignancy

72
Q

measles

A

rubeola. 10d. highly infectious
8-12d incubation. prodrome( 3C: cough, conjunctivitis and coryza. ) then transient enanthes (rash on mucous me) and activistic exanthema (rash on skin). photophobia and low grade fever
enanthem- kopek spots- small gray papuls on erythematous base on buccal mucosa- pathonogmonic
fever>101
compilcation- bacterial pneumonia most common and deadly.
tx- supportive, vit A, ig for post exposure prophylaxis

73
Q

rubella

A

3 day measles. highly infectious
often asx. prodrome- upper respiratory sx and low grade fever. painful lymphadenopathy. exanthema- nonpruritic, maculopapular, confluent. fever

74
Q

allergic bronchopulmonary aspergillosis

A

wheezing, eosinophilia, pulmonary infiltrates. common in pt with chronic lung disease ~ CF

75
Q

ambiasis

A

protozoan entamoeba histolytica. ingest cyst in contaminated food and water. most asx. sx- mild colitis to severe dysentery
cramping abd pain, tenesmus, diarrhea with blood or mucus. wt los, fever, hepatomegaly, chest pain, respiratory distress, jaundice may be present
complication- ameboma- local inflm mass
dx- cyst or trophozoites in stool. serum ab assay. US or CT for abscess in liver
tx- metronidazole

76
Q

giardiasis

A

G lamblia. fecal oral. in SB, diarrhea -voluminous, watery, foul smelling. bloating flatulence, wt loss, fever.
dx- stool for cyst and trophozoites, ELISA,
tx- metronidazole

77
Q

malaria

A

flu like. cyclical fever correlate with RBC rupture and parasitemia. hemolytic anemia, splenomegaly jaundice, hypoglycemia
dx- thick and thin giemsastained peripheral blood smears
tx- dep on strain. chloroquine, quinine, doxy

78
Q

toxoplasmosis

A

t gondii. cat feces
most asx or ~mono. present as focal seizure.2nd most common cause of infectious chorioretinits- ocular toxoplasmosis.
congenital: triad- hydrocephalus ,intracranial calcification, chorioretinitis
dx: sero, pcr, culture amniotic fluid, csf, blood
tx: if congenital, preg or imunocomp- sulfadiazine and pyrimethamine.

79
Q

helminth

A

most asx. dx with 3 sep stool exam for ova and parasites.

pinworm-cellulose tape test on perianal region bf sleep

80
Q

cystercosis

A

mexico. 20-50% epilepsy. taenia solium
4th ventricle-most common in neuro. hydrocephalus, stroke.
antiparasitic med for idivi with adult tapeworm
anticonvulsants for neurocysti

81
Q

rickettsial infection

A

lyme, rocky mountain spotted fever, ehrlichoiosis (spotless- RMSF)

82
Q

TB

A

children

83
Q

fever w/o source

A

in 3-36mo age group, surly viral. pre-vaccine was due to pneumococcal and HIB. almost never bacteria now so no antibiotics

84
Q

occult bacteremia

A

has dropped since vaccinate against pneumococcal and HIB

85
Q

incr WBC with left shift

A

incr polys nd bands. concern for invasive bacterial infection

86
Q

urine nitrite

A

made by gram neg bacteria.

87
Q

pyelonephritis tx

A

amp/gent or cetriaxone. need to cover coli. enteric gram neg (klebsiella or proteus) and enterococcus. PO- cephalexin. Get US at end of antibiotic course. a RF is reflux so get VCUG to test for it if US is suspicious

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