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)
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
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
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
5
Q
Differential for Sinusitis
A
foreign body in nose
URI
allergic rhinitis
6
Q
Tx Bacterial Sinusitis
A
amoxicillin or cephalosporins for 14-21 days
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)
8
Q
Scarlet Fever
A
Strep Throat + sand paper rash (esp on butt)
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
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
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
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
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)
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)
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
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
