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Pediatric Outpatient > Infections > Flashcards

Infections Flashcards

1
Q

AOM v. Otitis Media w/ Effusion

A
  • If see middle ear effusion on exam must then determine if inflammation present or not
  • Middle ear effusion + inflammation = AOM
  • Middle ear effusion w/o inflammation = otitis media w/ effusion
  • Effusion alone causes dec mobility, color change and opacity
  • Signs of acute infection/AOM include fullness, bulging, ear pain (otalgia) and redness of TM (redness only seen in 20% cases)
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2
Q

Aspects of Otoscope Exam

A
  • C - color
  • O - other conditions (perforation, atrophy, sclerosis, fluid level)
  • M- mobility of TM
  • P- position (bulging, full, neutral, retracted)
  • L-lighting
  • E- entire surface
  • T- translucency (translucent, semi-opaque or opaque)
  • E - external auditory canal (note if displaced, inflamed, deformed or has foreign body)
  • S - seal
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3
Q

Tx AOM

A
  • high dose amoxicillin; second line is amox-clavulanic acid or cephalosporin (esp in kids < 24 mo)
  • If > 24 mo and mild symptoms may opt for watchful waiting; because of antiobiotic resistance
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4
Q

Sinusitis in Kids (organisms)

How can you tell viral v bacterial?

A

Most often viral (parainfluenza or RSV) but may have superimposed bacterial infection (strep pneumo, m cat, H flu)

Bacterial - URI symptoms 10-14 days w/o improvement OR severe symptoms of high fever and purulent drainage for 3 days

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5
Q

Differential for Sinusitis

A

foreign body in nose

URI

allergic rhinitis

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6
Q

Tx Bacterial Sinusitis

A

amoxicillin or cephalosporins for 14-21 days

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7
Q

Herpangina

A

Hand-Foot-Mouth (Herpangina)

  • Viruses - coxsackie, enteroviruses
  • High fever and sore throat –> vesicles on pharynx/ soft palate / tonsils –> ulcers
    (v. Herpes which is more widespread in mouth like gums)
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8
Q

Scarlet Fever

A

Strep Throat + sand paper rash (esp on butt)

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9
Q

Complications of Strep Pharyngitis

A
  • Glomerulonephritis (hematuria, edema, low C3 and hypertension 10 days after); not prevented by antibiotic use
  • Peri-tonsillar or retropharyngeal abscesses (are they having trouble turning neck both ways?)
  • Rheumatic fever (occurs 3 wks after) - JONES criteria; use antibiotics, anti-inflammation drugs and manage any heart symptoms
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10
Q

Mononucleosis

A
  • Present w/ severe pharyngitis, lymphadenopathy, fatigue and fever (sore throat goes away but fatigue may persist for weeks)
  • Mucosal contact
  • Dx
    • Heterophile antibody test (may be neg in young kids)
    • Atypical lymphocytes
  • Tx - self limited; just limit contact sports due to splenomegaly
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11
Q

Croup Presentation and Tx

A

PRESENTS WITH

  • Upper airway obstruction - inspiration stridor
    • Seal like barking cough
    • Prodrome of fever and rhonorrhea for 12-24 hours before
    • Retractions, nasal flaring as airway become compromised
    • Inflammation of laryngotracheal tissues (v. Epiglossitis which is life threatening)
    • Steeple sign from narrow subglottic airway on imaging of chest
  • Tx - supportive (nebulizer, humidifier), if bad then may need to support airway, maybe steroids
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12
Q

Epiglossitis

A
  • Seen in 3-5 yr olds in winter
  • Emergency - need intubation before airway becomes completely obstructed
  • Presentation - drooling, thumb print sign on chest X-ray, look toxic, lean forward to breath
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13
Q

RSV Bronchiolitis

A
  • Fever, cough, rhinorrhea and respiratory distress
  • May have rhonchi or crackles
  • Hypoxia if severe
  • Tx - may need to hospitalize infants; supportive treatment w/ hydration and oxygen (apnea is common complication esp in young infants)
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14
Q

Pavilizumab

A

IM monoclonal antibody for certain babies < 2 yo who may be at risk for severe RSV infection (heart or lung problems, premature)

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15
Q

Pertussis

A

(whooping cough)

  • 1-2 wk incubation period w/ low grade fever, cough and coryza
  • 2-6 wks intense coughing spasms (emesis and petechiae from force) - spreads by droplets during coughing fits
  • Tx
    • May hospitalize infants for support of cyanosis
    • Antibiotics in initial 1-2 wks before cough can shorten length of disease; give erythromycin or azithromycin
    • NO antibiotics once coughing
    • Protect contacts
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16
Q

Pneumonia Etiology by Age

A
  • Neonate - Group B strep, E. coli (vaginal canal), H flu, Listeria, CMV
  • 1-6 mo - strep pneumo, staph aureus, m catarhallis, H flu, chlamydia trochamatis
  • 6 mo to 5 yr - strep pneumo, m cat, h flu, staph aureus
  • School aged - mycoplasma and chlamydia pneumonia most common (viral) then strep pneumonia
17
Q

Causes of Meningitis

A
  • Viral > bacterial
  • Viral - enterovirus
  • Bacterial - strep pneumo, neisseria meningitis, Lyme
  • In infants < 1 mo - Listeria, group B strep, E Coli, HSV
  • Incidence of Hib has greatly decreased due to vaccine
18
Q

Kernig and Brudzinski Signs

A
  • Kernig Sign - pain when move from flexing leg to extending leg
  • Brudzinski Sign - when pt automatically flexes leg in response to bending their neck
19
Q

How do you diagnose meningitis?

A
  • Dx - want to do CT or MRI if having neuro symptoms first; then do LP and analyze CSF; may do viral PCR for herpes and others
  • CSF
  • Viral - WBC < 500, lower neutrophils <50% and normal glucose / protein
  • Bacterial - high WBC, high neutrophils, high protein and low glucose
  • Lyme - <100 WBC, <30% neutrophils and normal glucose/protein
20
Q

How do you treat pinworm?

A
  • albendazole, mebendazole or pyrantel pamoate 1X then repeat in 2 wks (treat household contacts)
21
Q

Rocky Mt Spotted Fever

A
  • Tick bite –> spreads via lymphatics and blood vessels –> replicates in endothelial cells –> thrombosis and vasculitis w/ increased permeability
  • Esp in April thru September in South Atlantic states
  • Presentation = Fever, chills, malaise, headache, arthralgias 7 days after tick bite then rash appears 2-5 days in (maculopapular blanching red rash to petechiae that starts on wrists then moves proximally)
  • Dx
    • Clinical because antibodies do not develop until 10 days after symptoms
    • May have hyponatremia and thrombocytopenia (not reliable)
  • Diff
    • Looks exactly like erlilchiosis (also tick-borne) and meningiococcus maculopapular rash so start antibiotics against Neisseria if no history of tick bite
  • Tx - doxycycline; add ceftriaxone if suspect meningitis
22
Q

Lyme Disease

A
  • Eastern states (New England, NJ, PA, NY, etc) in April thru October
  • Deer tick must attach for > 48 hrs to transmit
  • Presentation
    • Erythema migrans (bulls eye) at bite site in 3-30 days
    • May be accompanied by myalgias, fever, malaise, headache
    • Early dissemination in days to weeks - multiple target lesions, heart block, cranial nerve palsy, meningitis
    • Late - usually > 6 wks after bite present w/ arthritis (usually in 1 knee)
  • Dx - mainly clinical diagnosis
    • ELISA has high false positive rate
    • IgM titers take several weeks to increase
  • Tx
    • Early - oral amoxicillin or cefuroxime In younger kids and doxycycline in kids > 8 yo
23
Q

HUS

A

hemolytic anemia, thrombocytopenia, nephropathy

occurs after shigella or EHEC

24
Q

Tularemia

A
  • lone star tick
  • regional tender adenopathy; may even have ulcerative LN’s
  • IV gentamicin for 7 days
25
Q

Babesiosis

A
  • Ixodes tick (NW US)
  • infects RBCs which can lead to hemolysis and acute renal failure BUT many cases asymptomatic
  • Tx = Quinine + clindamycin for 7+ days (usually do not require tx unless splenic dysfunction)
26
Q

STARI

A

(southern tick associated rash illness)

  • lone star tick; erythema migrans + fever + constitutional sx
  • Presents like Lyme but in S central US (diff area)
  • Tx is same as Lyme - doxycycline 14-21 days unless < 8 yo (amoxicillin or cefuroxime)
27
Q

PreSeptal v. Orbital Cellulitis

A

Pre-Septal

* Infection of anterior eyelid NOT orbit itself (spares ocular muscles) 
* Eyelid edema, erythema, warmth, tenderness +/- fever
* Tx - oral antibiotics including CA MRSA coverage (clindamycin)

Orbital

* Bacterial infection of orbit posterior to orbital septum 
* Often a complication of acute or chronic sinusitis 
* Also eyelid edema, erythema, warmth, tenderness +/- fever
* BUT w/ dec eye movement, proptosis, decreased vision and papilledema, pain w/ eye movements 
* Tx - admission w/ IV abx (similar - clindamycine or amp-sulbactam); may drain if severe

**Can distinguish between them via CT of orbit

28
Q

What are the indications for renal US or VCUS in kids?

A

RENAL US

* < 2 yo 
* Poor response to abx
* Recurrent febrile UTI
* HTN
* Family hx of renal or urological abnormalities

VCUS (voiding cystourethrogram) - detects VUR

* Multiple UTIs
* Family hx abnormalities
* HTN
* Poor growth 
* Unusual pathogen 
* Abnormal finding on renal US
29
Q

How do you decide when to switch from IV to PO abx in septic arthritis or osteomyelitis?

A
  • Once pt shows clinical improvement

* Guided by serial CRP measurements; want to see decline in CRP

30
Q

HIV Tx in Infants (3 options)

A
  • Zidovudine 6 wks
  • OR 3 doses nevirapine then 6 wks zidovudine
  • OR 2 wks nelfinavir and lamivudine then 6 wks zidovudine (AZT)
31
Q

Toxic Shock Syndrome (presentation, dx, tx)

A
  • Presentation - fever + sun burn like rash (desquamation) + hypotension + end-organ damage
  • Must have involvement of 3+ organs
    * GI - vomiting or diarrhea
    * Muscle - CPK 2X ULN or severe myalgia
    * Mucous membrane hyperemia
    * Renal - Cr 2X ULN
    * Hepatic - LFTs 2X ULN
    * CNS - altered mental status
    * Thrombocytopenia < 100,000
  • Throat cx, CSF cx and blood cx should be negative (rule out other sources)
  • Tx - fluid and BP support; remove tampons or drain any assesses (remove source); IV vancomycin or clindamycin
32
Q

Shunt Infection (pathophysiology, presentation, dx, tx)

A

CAUSES

  • Proximal infection (in ventricle) - colonization during placement
  • Distal infection (peritoneum) - hematogenous seeding or colonization w/ bowel flora
  • May lead to obstruction of shunt itself from the inflammation –> sx consistent w/ inc ICP (headache, vomiting, lethargy)
  • Cushing Triad - HTN, bradycardia, abnormal respiratory pattern (means in ICP)
  • “Shampoo Sign” - compressing shunt at ventricle releases more bacteria into bloodstream causing fever and chills (as in when rubbing in shampoo)
  • Dx - pos blood cx, CSF cx (from shunt NOT LP) or inc CSF WBCs + one of the following …
    * Fever, peritonitis signs, neuro sx or evidence of shunt malfunction
  • May get head CT or Xray shunt series (from skull - chest - abdomen) to look for kinks or discontinuity
  • Tx - remove shunt (external replacement if needed), IV abx, then get daily CSF gram stain and culture and can replaced shunt after CSF cultures neg for 7-14 days
33
Q

What is the definition of FUO? What is the work-up in infants?

A

DEFINITION
> 100.4 (rectal in infants) for 8+ days and no apparent source after initial evaluation

WORK UP

* CBC w/ diff
* Blood cx
* Urine cx and UA
* LP w/ CSF stain, culture, differential, glucose, protein, maybe HSV PCR 
* CXR - esp if resp symptoms 
* Low threshold for HSV in infants < 21 days
34
Q

HACEK Organisms

A

Infective Endocarditis

  • Haemophilus parainfluenza
  • Aggregatibacter
  • Cardiobacterium hominis
  • Eikenella corrodens
  • Kingella kingae

Pediatric Outpatient (13 decks)

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