Infectious Disease Flashcards
1
Q
Common bacterial organisms for neonates (< 1 mo)
A
GBS
E. coli
Strep pneumo
Staph aureus
2
Q
Common bacterial organisms for infants (1-12 mo)
A
GBS
E. coli
Strep pneumo
Staph aureus
Salmonella
3
Q
Common bacterial organisms for immunocompromised
A
Gram-negative bacilli
(Pseudomonas, E. coli, Klebsiella)
Staph
4
Q
Common bacterial organisms for asplenic patients
A
Encapsulated organisms
(strep pneumo, H flu, N meningitidis)
5
Q
Usual bugs for neonatal meningitis
A
GBS
Listeria
E. coli
Enterovirus (spring/summer)
6
Q
Usual bugs for meningitis in young children
A
Strep pneumo
N meningitis
Enterovirus
Borrelia
Rickettsia
7
Q
Most common reportable STD in US
A
Chlamydia trachomatis
8
Q
Newborn
Afebrile
Staccato cough
Tachypnea
Intracytoplasmic inclusion bodies
A
Chlamydia trachomatis
9
Q
Diagnostic test and management for Chlamydia trachomatis
A
PCR
PO erythromycin or azithromycin
Erythromycin eye ointment for Chlamydia conjunctivitis ppx
10
Q
Diagnostic test for chlamydiphilia pneumonia and management
A
Immunoflourescent antibodies
Azithromycin x 5 days
Or
Erythromycin x 14 days
11
Q
Purpuric macular rash that starts on wrists/ankles or palms/soles and spreads centrally
Thrombocytopenia
Hyponatremia
Occurs in spring and summer
Most common fatal tick-borne disease in US
A
Rocky Mountain Spotted Fever
12
Q
Diagnosis and management for RMSF
A
Direct immunofluorescence of skin biopsy
Doxycycline (even for < 8 yo)
13
Q
Similar to RMSF
No rash
Leukopenia
Elevated LFTs
Inclusion bodies
A
Human erlichiosis
14
Q
Neonatal sepsis
Childhood meningitis
Periorbital cellulitis
Pyogenic arthritis
Epiglottitis
Unimmunized
Management
A
H flu type B
Tx ceftriaxone or cefotaxime
Steroids can decrease risk of hearing loss
15
Q
Prophylaxis for Hib exposure
A
Rifampin
If anyone in household is < 12 mo who has not received primary series of Hib vaccine or < 4 yo who is partially immunized or immunocompromised
16
Q
Post exposure management for Hib
A
Unimmunized or incompletely immunized should receive Hib vaccine and proceed with regular vaccine series
17
Q
Stage of pertussis
Typical cold-like symptoms
1-2 weeks
A
Catarrhal
18
Q
Stage of pertussis
Paroxysms of coughing
Inspiratory whooping
4 weeks
A
Paroxysmal
19
Q
Stage of pertussis
100 day cough
Waning symptoms
1-2 mo
A
Convalescent
20
Q
Unimmunized
Coughing
Respiratory distress/failure
Lymphocytosis
A
Pertussis
21
Q
Diagnosis and management of pertussis
A
PCR
Erythromycin, clarithromyxin, or azithromycin
Pertussis vaccine boosters: pregnant women, teenagers, all adults in contact of newborn infant
22
Q
Post-exposure ppx
A
Asymptomatic close contacts
Erythromycin, clarithromycin, or azithromycin
23
Q
Loose watery diarrhea
Vomiting
Abdominal
Cramps
Fever
Summer picnic
A
Salmonella
24
Q
Carriers of salmonella
A
Chicken
Egg
Red meat
Unpasteurized milk and ice cream
Raw fruits and vegetables
Turtles, snakes, hedgehogs
25
Management for uncomplicated (non-invasive) Salmonella gastroenteritis
Supportive
26
Indications for salmonella treatment
Treatment
< 3 mo
Hemoglobinopathies
Malignancies
Severe colitis
Immunocomprmised
Ceftriaxone, azithromycin, quinolones
27
Headache
Abdominal pain
Malaise
High fever
HSM
Red or rose spots
Fever pulse dissociation
Immigrant
Management
Typhoid fever
Cefotaxime and ceftriaxone
28
Watery/bloody diarrhea
Fever
Seizure
Left shift on CBC
Pools, hot tubs, lakes, oceans
Shigella
29
Management for Shigella
Oral rehydration
Treatment only recommended for severe disease, dysentery, immunosuppressive
-ceftriaxone, azithro in children
-Cipro in non-pregnant > 18 yo
30
Osteomyelitis/osteochondritis
Puncture wounds
Otitis externa
Mechanical ventilators
Immunocompromised
CF
Pseudomonas
31
Management for pseudomonas
Zosyn
Gentamicin
Carbapenems and ceftazidime (pulmonary)
Cipro
Levo
32
Unpasteurized milk and dairy products
Exposure to cattle, sheep, goat
fever
Malaise
Management
Brucellosis
Tetracycline or Bactrim
33
Bloody/watery diarrhea
Recent antibiotic use
Pseudomembranous colitis
C diff
34
Diagnosis and management for c diff
Enzyme immunoassay
PO flagyl or PO vancomycin
Soap and water
Alcohol does not kill c diff
35
Sunburn-like sandpaper rash that blanches
Spares the face, palms, soles
Pastia lines
Perioral pallor
Scarlet fever
36
Skin rash
We’ll-defined borders
Develops quickly
Erysipelas
37
Skin rash
Ill-defined borders
Develops slowly
Cellulitis
38
Sore throat
Fever
Erythema/edema of posterior pharynx
Palatal petechiae
Strawberry tongue
Strep pharyngitis
39
Fever
Pharyngeal exudate
LAD
rash
No palatal petechiae or strawberry tongue
Arcanobacterium harmolyticum
Tx: erythromycin, azithro, clarithro
Not pencillin
40
Rapidly evolving rash
Erythema
Marked inflation
Bullous formation
Pain out of proportion
Necrotizing fasciitis
41
Well known risk factor for invasive GAS and necrotizing fasciitis
Varicella
42
Fever
Nausea, vomiting
Diarrhea
Erythroderma
Shock, organ failure
Toxic shock syndrome
43
Management for hospital acquired MRSA
Vancomycin
44
Management for community acquired MRSA
Bactrim or clindamycin
45
Management for MRSA abscesses < 5 cm
I&D only
No antibiotics
46
Three types of botulism
Food-borne
Wound
Infantile
47
6 Ds of Botulism
Diploplia
Dysphagia
Dysarthria
Dying to pee and poop (retention)
Dysphonia
Descending symmetrical paralysis
48
Pathophysiology of botulism toxin
Blocks release of acetylcholine into the synapse
49
Anaerobic, gram positive, spore forming rods
Clostridium tetani, botulinum, perfringens
50
Management for botulism
Supportive
Antibiotics not indicated
Aminoglycosides can potentiate paralytic effect
Antitoxin for infant botulism
Penicillin or Flagyl for wound botulism
51
Painless indurated ulcer (chancre)
Erythematous, rounded slightly raised
Clean edges/base
Primary syphilis
52
Polymorphic rash that includes palms and soles
Mucocutaneous lesions
LAD
Condylomata lata
Secondary syphilis
53
Gumma
Neurosyphylis
Tertiary syphilis
54
Testing for syphilis
RPR
VDRL
If history of syphilis +/- treatment, FTA-ABS positive for life
55
Management for syphilis
Penicillin G
(Cross placenta)
56
When to treat newborn if mother who was treated for syphilis during pregnancy
If mother treated within 1 mo of delivery
If mother treated with anything other than penicillin
If baby’s tigers higher than mother’s
57
Snuffles
Bullous lesions
Osteochondritis
Pseudoparalysis
Hutchinson triad (interstitial keratitis, CN 8 deafness, Hutchinson teeth)
Congenital syphilis
58
Membranous nasopharyngitis
Bloody nasal discharge
Bull neck
Irregular staining, gram positive, non spore-forming, nonmotile, pleomorphic bacillus
Corynebacterium diphtheria
59
Treatment for C diphtheria
Erythromycin or PCN x 14 days
Plus
Single dose of equine antitoxin
60
Gram positive cocci in chains
Neonatal and catheter associated bacteremia
Management
Enterococci
Ampicillin and vancomycin
61
Gram negative coccobacilli
Suppurative arthritis
Osteomyelitis
Bacteremia
Management
Kingella kingae (moraxella)
Cephalosporin or Unasyn
62
Facultative anaerobic, nonspore forming, motile, gram positive bacillus
Multiplies intracellularly
Food borne (lunch meat, cheese, ice cream)
Pregnant women
Advanced age
Newborns
Immunocompromised
Management
Listeria monocytogenes
IV ampicillin + aminoglycoside (gentamicin)
Not cephalosporins
63
Aerobic, nonmotile gram negative catalase and oxidase positive diplococci
Grown in chocolate or blood agar
Meningitis
Petechial/purpuric rash
Management
Neisseria meningitidis
Cefotaxime or ceftriaxone
64
Risk factors for N meningitidis
Dormatories
Military boot camps
Terminal complement component deficiencies
Asplenia
Overcrowding
Poverty
Malnutrition
65
Meningococcal prophylaxis criteria and treatment
Household contacts
Child care/preschool within 7 days of illness
Direct exposure to secretions within 7 days
Slept in same area within 7 days
Prolonged contact in close proximity within 7 days
Health care workers exposed directly to secretions without mask in first 2 days of therapy
Rifampin
66
Most common cause of bacterial gastroenteritis in the developed world
Campylobacter jejuni
67
Blood diarrhea
Spiral-shaped
Daycare centers
Animals
Improperly cooked poultry
Untreated water
Can mimic intussusception and appendicitis
Management
Campylobacter jejuni
Hydration + Azithromycin
68
Bloody diarrhea
Pseudoappendicitis
Management
Yersinia enterocolitis
Supportive
Bactrim, cefotaxime, aminoglycosides if < 1 yo or with predisposing condition
69
Cat scratch
Swollen, tender LAD
Several cutaneous papules
Parinaud occuloglandular syndrome
Bartonella henselae
Cat Scratch Disease
70
Diagnosis and management for cat scratch disease
Serologic testing
Enzyme immunoassay
Or immunofuorescent antibody test
Supportive +/- azithromycin
Antibiotics if HSM, large painful LAD, or immunocompromised
71
PPD, quantiferon, or T spot positive
CXR negative
Latent TB ( aka TB infection)
72
PPD, quantiferon, or T spot positive
CXR positive
Pulmonary TB disease
73
Manage my for Latent TB (TB infection)
Isoniazid x 9 mo
Rifampin x 6-9 mo (if INH not tolerated)
Isoniazid + Rifapentine weekly x 12 wks (> 12 mo age)
74
Side effect of isoniazid
Peripheral neuritis
Seizure
Prevented by B6 (pyridoxine)
75
Classic symptoms of pulmonary TB
Low grade fever
Weight loss
Cough +/- hemoptysis
76
Management for TB disease
Rifampin
INH
Pyrazinamide
Ethambutol
77
Non-TB mycobacteria
SSTI
Lymphadenitis, pulmonary, disseminated
M marinum
M avium complex (MAC)
78
Respiratory distress
Ground glass opacities
Perihilar/interstitial infiltrates
Immunocompromised/HIV
Management
Pneumocystis jiroveci (carinii) pneumonia
Bactrim (ppx)
79
Chronic diarrhea
Immunocompromised
Swimming pools
Livestock
Child care
Cryptosporidium
80
Measurement of aminoglycoside effectiveness and toxicity
Effectiveness = peak levels
Toxicity = trough levels
81
Adverse effects of aminoglycosides
Ototoxicity
Nephrotoxicity
82
Mechanism of action for penicillins
Beta-lac ram antibiotics
Bind to penicillin-binding proteins on bacteria
Inhibit bacterial cell wall formation
83
Mechanism of action for clindamycin
Bacteriostatic
Binds to 50S subunit of bacterial ribosomes
Inhibits protein synthesis
84
Target bacteria for macrolides
Mycoplasma
Chlamydia
Legionella
85
Indications for Rifampin
Meningococcal or Hib exposure ppx
Invasive/resistant staph
TB
86
Indication for tetracycline/doxycycline
RMSF
Lyme
Caution in < 8 yo - risk of teeth staining
87
Dysentery
Tenesmus
Liver, brain abscesses
Lung disease
Entamoeba histolytica
88
Diagnosis and management of E histolytica
Enzyme immunoassay in stool
Stool exam may identify hematophagous trophizoites or cysts
Liver US - liver abscess
Symptomatic: Flagyl or tinidazole + iodoquinol
Asymptomatic: iodoquionol
89
Fever, chills
Sweats, rigors
Tropical areas
Management
P. Falciparum (malaria)
Most deadly parasite in the world
Quinidine
90
Diagnosing malaria
Peripheral smear
Visualizing plasmodia within the erythrocytes
91
Microcephaly
Hydrocephaly
Chorioretinitis
Diffuse Cerebral calcifications
Jaundice
Thrombocytopenia
HSM
Congenital toxoplasmosis
92
Treatment for HSV
Acyclovir
93
Fever
Tonsillitis
LAD
HSM
Atypical lymphocytosis
Infectious Mono (EBV)
94
Confirmatory test for EBV in > 4 yo
Heterophile antibody test
95
EBV infection
Viral capsid antigen positive
Early antigen positive
EBNA negative
Acute infection
96
EBV infection
Viral capsid antigen positive
Early antigen low
EBNA positive
Convalescent/past infection
97
EBV infection
Viral capsid antigen positive
Early antigen high
EBNA positive
Reactivation
98
Complications of EBV infection
Lymphoma
Lymphoproliferative disorders
99
Rash after ampicillin/amoxicillin
Infectious mono
100
Leading nongenetic cause of sensorineural hearing loss in children in US
CMV
101
Thrombocytopenia
Blueberry muffin baby (petechiae/purpura)
HSM, jaundice
SGA, microcephaly
Periventricular calcifications
Chorioretinitis
Congenital CMV
102
Definitive diagnostic study for congenital CMV
Urine culture or PCR for CMV in urine or saliva within first 3 weeks of life
103
Chorioretinitis
Cerebral calcifications (periventricular)
Urine culture
Sensorineural hearing loss
Management
CMV
ganciclovir
104
Like mono
But not EBV
Acquired CMV
Diagnose with viral culture and PCR
105
3-5 days of high fever
Followed by maculopapular rash
Palpebral/periorbital edema
Bulging fontanelle
Roseola (HHV6)
Exanthem subitum
106
Low grade fever
Cataracts
PDA
Reddish-pink spot (Forchheimer spots) on soft palate
Rubella
107
Confluent macular papular rash
Koplik spots
Conjunctivitis
Fever
Cough
Coryza
Photophobia
Measles (Rubeola)
108
Post exposure management for measles
Immune globulin if within 6 days to infants < 12 mo, pregnant, immunocompromised
Vaccine within 3 days if incomplete immunization
109
Time period between IM immunoglobulin and measles vaccine
5 months
(Must be > 12 mo age)
110
Complication of measles
Subacute sclerosing panencephalitis
111
Fever, headache, malaise
Muscle aches
Unilateral facial swelling anterior to ear
Difficulty opening mouth
Mumps
(Paramyxovirus)
112
Complications of mumps
Parotitis
Meningitis/encephalitis
Orchitis
Epididymoorchitis (most common)
Pancreatitis
113
Parotid tenderness and swelling
High grade fever
Toxic
Bacterial parotitis
114
Parotid tenderness and swelling
Low grade fever
Not toxic
Mumps
115
Parotid tenderness
Intermittent swelling
Salivary gland stone
116
Hydrops fetalis
Aplastic crisis in sickle cell disease
Polyarthropathy
Erythema infectiosum
(Parvovirus B19)
117
Management for immunocompromised exposed to varicella
Varicella zoster immuno globulin (VZIG)
118
Most common complication of varicella
Superinfection with staph aureus
119
Indication for VZIG in newborn
If mother develops chickenpox between 5 days before delivery through 2 days after
120
Management for varicella
Acyclovir or valacyclovir
if unvaccinated > 12 yo, immunocompromised, chronic cutaneous or pulmonary disorders, long-term salicylate therapy, chronic corticosteroids
121
Indications for palivizumab (Synagis)
CLD
Preterm
CHD
122
1-2 days fever
Watery stools
Intermittent vomiting
Dehydration
Rotavirus
123
Chronic weight loss, fevers, night sweats
Recurrent or persistent thrush
HIV
Lentivirus in the retrovirus family
124
Most common mode of transmission of HIV in kids
Vertical transmission
125
Preventing neonatal HIV if
Mother has HIV
Maternal ART
Intrapartum maternal zidovudine (AZT)
Neonatal AZT
Not breastfeeding
Routine maternal HIV screening
C-section
126
Gold standard HIV testing < 18 mo old
HIV DNA PCR
127
Gold standard HIV test > 18 mo old
Enzyme immunoassay
128
Infectious contraindications to breastfeeding
Maternal HIV
Active TB
Active HSV lesion in nipple
129
High fever
Rash
Viral meningitis in the summer
Myocarditis
Coxsackie virus
130
Conjunctivitis
Pharyngitis
LAD
otitis media
Hemorrhagic cystitis
Adenovirus
131
Rabies prophylaxis
4 dose rabies vaccine series
HRIG infiltrating the wound
Only if animal is suspected of being rabid
132
Undercooked pork
Severe eye pain
Trichinella spiralis
133
Traveling from endemic area
Bowel obstruction or abdominal pain
Pica or ingesting dirt
Management
Ascaris lumbricoides
Albendazole
Ivermectin
Pyrantel pamoate
134
Loeffler syndrome
Ascaris lumbricoides
Cough
Transient pneumonia
Larva moving through lungs
135
Hypochromic Microcytic anemia
Growth/developmental delay
Seroiginous, papulovesicular rash
Necator americanus (hookworm)
136
Immigrant
Seizures
Multiple cystic lesions with calcifications on CT head
Neurocysticercosis
T solium (pork tapeworm)
137
Eating dirt
Eosinophilia
Exposure to dogs/cats
Fever
Hepatomegaly
Wheezing
Visceral larval migrants
Toxocara canis
138
Eating dirt
Eosinophilia
Exposure to dogs/cats
Visual disturbances
Ocular larval migrans
Toxocara canis
139
Eating dirt
Eosinophilia
Exposure to dogs/cats
GI symptoms
Pruritus, rash
Covert toxocariasis
140
Diagnosis for visceral larva migrans and management
ELISA
Albendazole
Mebendazole
141
Perianal or perivulvar itching
Enterobius vermicularis (pinworm)
142
Diagnose and management for pinworm
Direct visualization of adult worms or scotch tape test 2 to 3 hours after child is asleep
Pyrantel pamoate
Albendazole
143
Most likely cause of mild candidal infection
Antibiotic use
144
Most likely cause of chronic or systemic candidiasis
Immunosuppression
145
Management for candida
PO nystatin - oral candida in immunocompetent host
Fluconazole/itraconazole - immunocompromise
IV Amphotericin- neonates with invasive disease
146
Encapsulated yeast
Pulmonary and CNS disease
AIDS
Bird (pigeon) dropping
Cryptococcosis
147
Diagnosis and management for cryptococcosis
India ink stain
Narrow base budding
Amphotericin B + PO flucytosine or fluconazole
148
Southwest US
Fever, night sweats, headaches
Chest pain, muscle aches
Management
Coccidiomycosis
Amphotericin B, fluconazole, or itraconazole
149
Worsening asthma symptoms
Eosinophilia
Aspergillosis
150
Diagnosis and management for aspergillosis
Positive serum galactomannan
Voriconazole (invasive)
Amphotericin B (neonates)
151
Ohio, Missouri, Mississippi River valleys
Hilar or mediastinal LAD
HSM
Bird droppings
Cave exploring
Management
Histoplasmosis
Supportive care (immunocompetent)
Amphotericin B +/- fluconazole (disseminated or immunocompromised)
152
Most common infectious causes of bloody or serosanginuous vaginal discharge and vulvovaginitis
Shigella flexneri
Shigella sonnet
Group A strep
153
Ring abscess formation in cornea
Bacillus cereus
154
Papular purpuric gloves and socks syndrome
Parvovirus B19
155
Most common bacteria in discitis
Staph aureus
156
Most common bacteria recovered from
Breast abscesses in newborns
Staph aureus
157
Juvenile recurrent respiratory papillomatosis
Vocal cord lesion
HPV
158
Microcephaly
Cataracts
Hypoplastic extremities
Congenital varicella syndrome
159
Papular acrodermatitis
EBV
160
Spaghetti and meatballs appearance on scrapings
Malassezia
Tinea (pityriasis) versicolor
161
Treatment of choice for tularemia
Gentamicin or streptomycin
162
Antibiotic for Listeria
Penicillin
Ampicillin
163
Chemoprophylaxis for close contact of meningococcal meningitis
Single dose of ciprofloxaxin (> 1 mo)
164
Management for cat scratch disease
Azithromycin
165
Serpiginous
Migratory
Caribbean, Mexico, south/central americas, southeastern US
Cutaneous larva migrans
(Dog/cat hookworms)
166
Side effect of erythromycin
Hypertrophic pyloric stenosis
167
Protracted nasal congestion
Thick yellowish nasal discharge
Low grade fever
Tender anterior cervical LAD
1-3 yo
Streptococcal fever (GAS)
168
Most common bacteria in septic arthritis for children < 5 yo
Kingella kingae
169
Sulfur granules
Beaded, branching
Gram positive bacilli
Actinomyces israelli
