Infections and infectious diseases, should expect 10 questions on the final Flashcards
Erythematous, maculopapular rash begins on the face and spreads to body and may end in desquamation
A. Rubeola
B. Fifth’s Disease
C. Scarlet fever
Rubeola or measles
Rash that is maculopapular and appears after fever and fades in 24 hours
Roseola
Dont forget to ask if if had recent travelling? when taking history
in roseola you dealing with someone with 6-12 montns up to 4 years but 90% before 2
A child is brought up to your clinic with symptoms of high fever of 106 lasting 3-5 days, lethargic, irritable
What is your diagnosis and treatment plan?
Roseola
Supportive care and observe for febrile seizures
pastia’s lines (petechiae) in neck, axillary folds and groin
strawberry tongue following strep infection
sandpapery rash that blanches on pressure
Scarlet fever
Which infectious disease in infants cause high fevers and can result in febrile seizures?
Roseola—- is viral illness caused by human herpes viride virus (HHV)-6
Complications from measles(rubeola) are
diarrhea
otitis media
most severe- pneumonia and death
Kopliks spots are associate with…..
Measles(rubeola)
Rash that starts on the face and moves down….
Measles(rubeola)
Maculopapular rash that starts on trunk then moves to face, upper arms and fades within days hint: ( this rash appears after fever )
Roseola
Management of the measles(rubeola)
immunize
report fever over 103F/39.4 C
acetaminophen for fever/ discomfort
No aspirin
encourage clear fluid intake
cool mist vaporizer for cough
rest until feeling better
What infection causes puffy cheeks and tender swollen jaw? Swelling of salivary glands (Stensen’s duct)
Mumps
What are the symptoms that patients with mumps will present?
Signs of aseptic meningitis such as fever, stiff neck, HA
How mumps spread?
Direct contact and respiratory route
What are serious complications of mumps in adults?
Orchitis and Epididymitis
What are the CDC recommendations for MMR vaccine ?
CDC recommends all children get two doses of MMR (measles-mumps-rubella) vaccine, starting with the first dose at 12 through 15 months of age, and the second dose at 4 through 6 years of age. Children can receive the second dose earlier as long as it is at least 28 days after the first dose.
Which infectious disease is mainly in infants and children and has honey-colored crusts from pustules that rupture?
Impetigo caused by S. aureus (gram positive) and Strep. pyogenes.
What is one topical tx for impetigo?
Mupirocin ointment tid x 10 days and to nares for 10-14 days
What abx would be your option for impetigo?
Cephalexin (Keflix) 250-500 g qid x 10 days for adults
children 40-50 mg/kg/day x 10 days
Augmentin 20 mg/kg tid x 10 days
Emycin 1-2 gm/day qid x 10 days for pcn allergic pt
40 mg/kg/day qid—–kids
Painful mouth ulcers followed by painful white vesicles with surrounding erythema on fingers, palms, toes, soles……..
hand-foot-and- mouth. disease
What other conditions would you consider if you see pt with rash on palms and soles
syphilis
meningococcemia
RMSF-rocky mountain spotted fever
What other symptoms will you see in hand-foot-and-mouth disease?
low grade fever
sore throat
malaise
submental and cervical lymphadenopathy
Herald patch papulo-squamous eruption that is rapidly evolving and viral cause
The patch is faintly reddened patches on trunk and upper extremities
looks like “T-shirt and shorts” presentation
What condition is described above?
Pityriasis rosea——- adolescents most common
——mild to severe pruritis
Unilateral rash that is painful and may be preceded by severely painful area with tingling
contagious by direct contact and to a degree by air
What condition described above?
Herpes Zoster (shingles)
Treatment options for herpes zoster(shingles)
acyclovir, famcyclovir, valcyclovir
po steroids over 3 weeks
analgesics
topical zovirax cream
domeboro soaks
narcotics
What would be given for pts with tinea capitis?
Griseofulvin for 2-4 months, teach pt to take this me with high fat to help the absorption
What is most common causative agent of Lyme disease
Borrelia burgdorferi
What other symptoms except classic bull’s eye rash will you note in patients infected with Lyme disease?
Malaise
fatigue
HA
fever
chills
stiff neck
myalgia and arthralgia
lymphadenopathy
n, v, abd pain
Neuro exam is vital
What is the treatment for Lyme disease?
doxycycline/tetracycline 100 mg bid x 14-21 days
or emycin or amoxicillin if allergic
What is your diagnosis for pt that presenting with retro-orbital pain, severe joint and muscle pain, abd and back pain
Saddleback fever lowers on day 3 then rises again 4-5 th day
Dengue fever ——–no ASA and NSAIDs ONLY supportive treatment
The disease that is similar to dengue fever but in this disease NSAIDs are helpful for arthralgias
CHIKV
What is the most common organism responsible for diarrhea in6-24 months old and usually seen in winter?
Rotavirus
What medication can cause prolonged QT in persons on SSRIs as well as Achilles tendon rupture?
Cipro
What abx would you rx for pt with food poisoning such as vibrio cholerae and staph or bacillus poisoning
Cipro 500 mg daily or azithromycin 500 mg x 3 days
Bactrim can be used as well
Be careful with cipro of its side effects and interaction
What should you not give to stop diarrhea?
Kaopectate
What is a complication of lyme disease and in some cases the first and only sign?
arthritis
What is the treatment of lyme disease?
Doxycycline/tetracycline 100 mg bid x 14-21 days
or emycin or amoxicillin if allergic
What is most lethal and most frequently reported rickettsial illness in the U.S?
RMSF- rocky mountain spotted fever
What is the diagnostic tests for Lyme disease( bull’s eye rash)
ELISA test followed by Western blot for confirmation and detects IgM and IgG antibodies for B. burgdorferi
Which medications you do not want to give in dengue fever?
aspirin and NSAIDS
Which type of meningitis is contagious and deadly?
Bacterial meningitis
What are the organisms responsible for bacterial meningitis?
Strep
Neisseria (Meningitis B)
H. flu
Listeria
Signs and symptoms of meningitis
Severe headache different than normal
sensitivity to light
lethargy
skin rash
What are the risk factors of meningitis?
Viral- under age 5
Bacterial- under age 20
Pregnancy
Weakened immune system
What is the sign of meningitis that when you flex neck leads to flexion of knees?
Brudzinski’s signs
B—brain flexion
B—- leads to to bending of knees
Pneumonic’s: B.B.B brudzinski sign- brain flexion- bending of knee
What is another sign of meningitis when knee extension causes back pain?
KErnig sign
K—- knee
E—- extension,,,,, knee extentsion causes pain thus kernig sign positive
What would be supportive management for viral meningitis?
Antipyretics
Fluids
Rest
What are the difference between bacterial and viral meningitis?
The symptoms of viral and bacterial meningitis can be similar, including headache, fever, stiff neck, nausea, and vomiting. However, bacterial meningitis may be associated with more severe symptoms such as confusion, seizures, and a rash.
When will you stat send pt with shingles (herpes zoster virus) to ER>
Medical emergency—- if pt presents with vesicles in the face and eyes—– pt may have stroke
Maculopapular rash usually affecting one side of the body or face, pain can last weeks to months after blisters healed….. what condition described here?
Herpes zoster virus(shingles)
We know that early treatment imperative ASAP after onset of symptoms-within 72 days for shingles management
What antivirals would you rx and what dosages?
Acyclovir. 800 mg po q 4 h (five times daily) for 7-10 days
Valcyclovir 1 G po three times per day for 7 days
Famcyclovir 500mg PO three times per day for 7 days
What would you recommend for shingles pt for home management hint: non-pharmacological?
- Apply cold compresses to rash
- Apply calamine lotion on rashes to help dry and reduce itching
- Rest and try to decrease stress
Rubeola (Measles) is characterized by….
fever
malaise
cough
coryza……acute inflammation of nasal passages
conjunctivitis
What is the most common cause of measles associated death in children
Diarrhea
Encephalitis
Pneumina
Though all these are complications of measles, of course pneumonia is the main cause death,,,, airway comes first
Diagnostic tests for measles are
serum measles IgM antibody
significant rise in measles IgG antibody between acute and convalescent titers
isolation of measles virus culture
detection of mealses virus RNA by RT-PCR
What are some differential dx for pt coming with pertussis symptoms whooping cough
mycoplasma pneumoniae
chlamydia
TB
Viral pathogens
Common causes of cough
Cigarette smoking
GERD
Asthma
Postnasal drip
ACE inhibitors
most causes of cough self limiting and from viral upper respiratory infection
When can children with pertussis infection return to school or day care ?
They can return when they have completed 5 days of effective antimicrobial treatment or if they are not treated 21 days after the onset of symptoms
Can adults especially elderly get RSV ( respiratory synctial virus)
Yes, remember that patients over 65 y.o can get RSV.
What population is at risk for RSV? Select all that apply
A. Older adults patients with chronic pulmonary disease and functional disability
B. Residence at altitude > 2500 m
C. Institutionalized older adults
All of these are right answers
In what infectious disease of skin erythematous maculopapular rash that begins on face and spreads to body and may end in desquamation?
Rubeola-measles
What condition describes Koplik spots, highly communicable viral disease, low grade mod fever 104-105, hacking cough, corzya, conjunctivitis
Rubeola-measles
This condition follows pharyngitis, strawberry tongue is a classic finding, fine erythematous rash that blanches on pressure, sandpapery better felt than seen
Scarlet fever
This condition has sudden abrupt high fever of 106 lasting 3-5 days and rash that is maculopapular appears after fever and fades in 24 h
Roseola
