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CPNP AC flash cards > Infectious Disease > Flashcards

Infectious Disease Flashcards

1
Q

During an infectious process, what inflammatory marker rises earlier?

A

CRP

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2
Q

What inflammatory marker is a biomarker for early bacteremia detection? Helps predict bacterial vs. nonbacterial illness.

A

Procalcitonin

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3
Q

Due to the absence of immunologic memory and adaptive immunity, what age group is at the highest risk for bacteremia and/or sepsis?

A

Infants less than 28 days old

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4
Q

At what age does the immune system develop?

A

3 months of age

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5
Q

S/S of neonatal sepsis includes
* >
* H
*L
* poor ____
* R___ ____
* J
* I

A

fever > 38
hypothermia
lethargy
poor feeding
respiratory distress
jaundice
Irritable

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6
Q

The common etiologies for neonatal sepsis include
* U
* B
* M
* P

A

UTI
Bacteremia
Meningitis
Pneumonia

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7
Q

Work up for neonatal sepsis includes a _____ to include?

A

Full Septic Work-Up
CBC, blood culture, UA, urine culture, LP

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8
Q

Aside from a full septic workup in a neonate, What else do you need to obtain if the infant has respiratory s/s?

A

Chest x-ray
respiratory viral panel

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9
Q

Aside from a full septic workup in a neonate, What else do you need to obtain if the infant presents with a rash, vesicles, or other skin findings?

A

HSV culture

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10
Q

Common organisms for neonatal sepsis include?
*G
*E
*L
*___/____

A

GBS
E.Coli
LIsteria Monocytogenes
HSV/CMV

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11
Q

All neonates with fever require _____ and __-___ hours of empiric?

A

hospitalization,
48-72 hours of empiric broad-spectrum antibiotics

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12
Q

First-line antimicrobial therapy for neonatal sepsis includes?

A

Amp and Gent

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13
Q

When an STI is suspected, First-line antimicrobial therapy for neonatal sepsis includes?
A______
C______
A______

A

Meningitic dosing of
Ampicillin
Cefotaxmin
Acyclovir

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14
Q

In neonatal sepsis initiate acyclovir until?

A

HSV results are available and negative

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15
Q

Fever without s/s on physical examination is called a?

A

fever without a source

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16
Q

Most children with fever without a source have a _____ infection.

A

Viral

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17
Q

Organisms for infants 1-3 months of age with fever without a source include?
*G
*L
*S
*E
* N___ _____
*S___ ______

A

GBS
Listeria monocytogenes
Salmonella
E. Coli
Neisseria Meningitidis
Strep Pneumoniae

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18
Q

Organisms for infants and toddlers 3-36 months of age with fever without a source include?
*Sa
*N____ _____
*S___ ______

A

Salmonella
Neisseria Meningitidis
Strep Pneumoniae

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19
Q

What 2 etiologies should you consider in infants 1-3 months of age who aren’t vaccinated?

A

HIB
Strep Pneumoniae

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20
Q

Fever without a source diagnostic studies are usually dependent on?
This is because fever without a source is usually self-limiting.

A

physical examination findings

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21
Q

Fever without a source management is guided by risk stratification. Children may need
1)a_____
2)a____
or 3) re-______ plan if stable

A

empiric antibiotics
admission
re-evaluation plan

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22
Q

What are the 3 common causes of serious bacteremia?
B______
U____
P_____

A

bacteremia
UTI
Pneumonia

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23
Q

What is the term for a common disorder presenting in an unusual way?

A

Fever of unknown origin

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24
Q

What is the clinical definition of Fever of Unknown Origin:
* fever > ___ F or ___ C
*Lasting more then _____ days and up to ____ weeks
* No apparent ____ _____

A

101 F or 38.3 C
Lasting more than 8 days and up to 3 weeks
No apparent clinical diagnosis

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25
Q

Fever of Unknown Origin is most often caused by i____ disease and c_____ t_____ disease.

A

infectious disease and connective tissue disease

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26
Q

The most common infectious disease etiologies found in children with Fever of Unknown Origin include
*S
*T
*R
*S
*L
*C
*M

A

Salmonella
TB
Rickettsial disease
syphilis
Lyme disease
CMV
Mononucleosis

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27
Q

1/3 of children s/p chemotherapy and/or transplant will develop?

A

fever

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28
Q

Febrile neutropenia definition:
A single temp > ____ for > ___ hour with an ANC < ___ or when ANC is expected to decrease to ____ within ___ hours.

A

38 C
> 1 hour
< 500
500
48 hours

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29
Q

Patients with febrile neutropenia are most at risk for ____ and ____.

A

Bacteremia and Sepsis

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30
Q

In a child with febrile neutropenia, GI tract infection will rise from what two possible sources?

A

Oral vs intestinal mucositis

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31
Q

In a febrile neutropenic child, diarrhea will often be caused by c____ and s____

A

C. Diff and Salmonella

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32
Q

Staph, strep, and MRSA are examples of what type of bacteria?

A

Gram +

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33
Q

E. Coli, Klebsiella, pseudomonas, actinobacteria, and enterobacter are examples of what type of bacteria?

A

Gram -

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34
Q

What diagnostic test is indicated for a neutropenic febrile child presenting with an altered mental status?

A

LP

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35
Q

What diagnostic test is indicated for a neutropenic febrile child presenting with diarrhea?

A

C. Diff testing

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36
Q

What diagnostic test is indicated for a neutropenic febrile child being worked up for an abscess fluid or collection?

A

CT

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37
Q

Oral outpatient therapy for a stable child with febrile neutropenia includes f_____ monotherapy or f______ and a____-____

A

*fluoroquinolone monotherapy

*fluoroquinolone and amoxicillin-clauvanate

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38
Q

High-risk children presenting with febrile neutropenia require coverage for ______ organisms, s___ v___, and p_______ a______.

A

gram negative organisms
strep viridian
pseudomonas aeruginosa

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39
Q

Antipseudomonal beta-lactam coverage for a febrile neutropenic patient includes what antibiotic?
What is second-line treatment?

A

cefepime
carbapenem

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40
Q

In a febrile neutropenic patient, antibiotics should cover g____ and ___ bacteria, s____ v____, and p____

A

gram - and +
strep viridians
pseudomonas

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41
Q

When a febrile neutropenic patient becomes unstable while on current anti-microbial management, suspect resistant pathogens and add a g_____ such as v____ and a____ coverage such as with f___

A

glycopeptide
—vancomycin

anaerobic coverage
flagyl

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42
Q

in a febrile neutropenic patient, antibiotics can be discontinued when c___ s___, if there is no m_____ i_____ after __-___ hours, and if the patient has been afebrile for ___ hours

A

clinically stable
microbiologic indication after 24-72 hours
the patient has been afebrile for 24

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43
Q

Treat a febrile neutropenic patient presenting with cellulitis with? and pneumonia with ?
v____ or l____

A

vancomycin
linezolid (zyvox)

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44
Q

Treat a febrile neutropenic patient presenting with gram-negative bacteremia or pneumonia with an a_____ such as g____and car_____

A

aminoglycoside
—-gentamicin
carbapenem

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45
Q

Treat a febrile neutropenic patient presenting with abdominal s/s, mucosal impairment, or c.diff with an anaerobe such as m____

A

metronidazole (flagyl)

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46
Q

If you febrile neutropenic patient on broad-spectrum antibiotics remains febrile for > __-___ days consider adding _____ coverage.

In this situation obtain a s__/c___/a____ ___ to rule out the presence of fungal lesions.

A

4-7 days
antifungal

sinus/chest/abdominal CT

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47
Q

The phases of sepsis include
1)S____
2)S___
3)s___ ____
4) s___ ____

A

SIRS
sepsis
severe sepsis
septic shock

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48
Q

SIRS is defined as a n___ s____ inflammatory response which can lead to ____

A

non specific
sepsis

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49
Q

Sepsis is defined as a life threatening o___ d____ caused by a d____ host response to i____

A

organ dysfunction
dysregulated
infection

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50
Q

The lastest s/s in the sepsis continuum is?

A

hypotension

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51
Q

Septic shock is defined as a profound underlying c___, c____, and m____ abnormality that drastically increased mortality

A

cellular, circulatory, metabolic

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52
Q

Patients in septic shock will present with persistent ____ often require v____ to maintain M___

A

hypotension
vasopressors
MAP

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53
Q

The following conditions are risk factors for the development of what?
immune problems
musculoskeletal/neuro disease
prematurity
chromosomal/genetic disease
chronic disease states

A

SIRS

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54
Q

SIRS pathology
Infection leads to the release of t____ that initiate a c___ c____ leading to f____, v____, and h____ instability

A

toxins
cytokine cascade
fever, vasodilation, hemodynamic

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55
Q

What clinical manifestation increases the septic child’s risk for death?

A

low cardiac output

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56
Q

septic neonates are more at risk for a____ and h____

A

acidosis and hypoxia

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57
Q

Acidosis and hypoxia presence in a newborn with septic shock increases the infants p___ v_____ r____ leading to p___ h____ and lifelong sequelae or disability

A

PVR (pulmonary vascular resistance)
pulmonary hypertension

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58
Q

The presentation of septic shock includes
f___ or s___ temp
i___, l____, a____
t___ and respiratory d____
t_____, g____ rhythm with m____, poor p____ and h____
h____ or J____
o____ and/or
r____

A

fever or subnormal temp
irritability, lethargy, anxiety
tachypnea and respiratory distress
tachycardia, gallop rhythm with myocarditis, poor perfusion and hypotension
hepatomegaly or JVD
oliguria and/or rash

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59
Q

Septic shock Hour 1 bundle management
* obtain ___ and ___ ___
*Give ____
—–preferably 3rd or 4th gen c___, c____, extended range p___, or b___ l___ inhibitors
*F___ resuscitation __ ml/kg over __-___ minutes

A

obtain labs and blood cultures
give antibiotics, cephalosporins, carbapenem, penicillins, beta-lactam
fluid, 20 ml/kg over 5-10 minutes

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60
Q

Children in septic shock unresponsive to fluid resuscitation will require the addition of?

A

vasopressors

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61
Q

Septic workup includes
*both peripheral and central ___ ___
*u__ and __
*l___
* if ETT in place, an ET ___ ___
*c__, c__, l__ ___
*___ of wounds or draining body fluids
*___ if respiratory s/s present
*__ or ___ of involved body organ

A

blood cultures
UA and urine culture
LP
sputum culture
CBC, CMP, lactic acid
culture
chest x-ray
US or CT

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62
Q

septic shock management
*optimize ___ delivery
*h___ monitoring
*treat anemia with ____
*correct coagulopathies with ____
*add ____ if anemia and coagulopathies are refractory

A

oxygen
hemodynamic
PRBCs
FFP
corticosteroids

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63
Q

What is the most frequent cause of DIC?

A

infection

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64
Q

DIC is an alteration in c___ r/t t__ injury

A

clotting
tissue injury

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65
Q

Initial DIC s/s include b___ or t___ with tissue i____

A

bleeding or thrombosis
tissue ischemia

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66
Q

What is the gold standard diagnostic test for DIC?

A

D. Dimer

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67
Q

In DIC, the D. Dimer will be?

A

prolonged

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68
Q

DIC management Goal
1) manage s___
2)address c___ by administration of v___ _, c____, f___ or p___

A

shock
coagulopathies
vitamin k, cryoprecipitate, FFP, or platelets

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69
Q

Meningococcal infections are an acute ____ illness s/p viral infection

A

bacterial

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70
Q

What is the most common organism that causes meningococcemia?

A

Neisseria Meningitidis

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71
Q

Neisseria meningitidis is a gram __ and e___ bacteria

A

negative
encapsulted

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72
Q

What are the most common Neisseria meningitidis serogroups in the U.S.?

A

B and C

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73
Q

The Neisseria Meningitides toxin load is __-___ X more than other gram-negative bacteria, leading to more severe d____

A

50-100
disease

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74
Q

The greatest prevention against Neisseria meningitidis is the?

A

Meningococcal B vaccine

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75
Q

Meningococcemia is the presence of n____ m___ in the s___ c____

A

Neisseria Meningitidis
systemic circulation

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76
Q

The onset of Meningococcemia is _____

A

rapid

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77
Q

Meningococcemia s/s include
f___
poor _____
h____
i____
altered ___ ____
t____
t____ and
p_____

A

fever
poor perfusion
hypotension
irritability
altered mental status
tachypnea
tachycardia
purpura

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78
Q

Meningococcemia laboratory work-up includes obtaining a
c__
s__ work up
L____
r___ function
L__ ____

A

CBC
septic
LFTs
renal function
lumbar puncture

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79
Q

What precautions should children with Meningococcemia be placed on?

A

droplet

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80
Q

The recommended antibiotics for Meningococcemia include __ generation cephalosporins which include r___ or cef____

A

3rd
Rocephin
cefotaxime

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81
Q

The close contacts to include family and healthcare workers of a Meningococcemia patient require prophylaxis with a ___ dose of c____ or r_____

A

single dose of
ciprofloxacin or Rocephin

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82
Q

HAI host components include
* Impaired i____ s___ or r___
*a___ associated vulnerabilities

A

immune system or response
age

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83
Q

HAI environment components include
*b___ colonies
*s___
*r____
*g__/g___ tract

A

bacterial colonies
skin
respiratory tract
GI/GU

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84
Q

HAI agent components include
*p_____
*prolonged _____ therapy
*i____ devices

A

procedures
antibiotic
invasive

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85
Q

The definition of an HAI is an infection not p___ at a___.
*Develops within ____ hours of a___
*Not present at ___ but develops within ___ days

A

present at admission
48 hours of admission
discharge, 10 days

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86
Q

The top 4 HAI infection sites include
c___
c____
v____
s____

A

CLABSI
CAUTI
VAP
SSI (surgical)

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87
Q

HAI s/s include
*new ___
*___ instability
* increase ____ need
* wound _____

A

fever
temperature
oxygen
purulence

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88
Q

HAI risk factors include
i____ lines
i____ states
E___
E__/v___
f___
P___ infusions and
P___ nutrition

A

invasive lines
immunocompromised states
ECMO
ETT/Ventilator
Foley
PRBCs
Parenteral

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89
Q

What is the best way to prevent a CLABSI?

A

provide bundle care

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90
Q

What is the best way to prevent VAP
*elevate ___
*good ____ hygiene
*provide o___ care
*I__-___ suctioning

A

HOB
hand hygiene
oral care
In-line

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91
Q

What is the best way to prevent SSI (surgical infections)
*administer p____ antibiotics
*d___ and d___ wounds

A

prophylactic antibiotics
drain and debride wounds

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92
Q

What type of organisms are these?

Strep, Staph, Enterococcus, Listeria, Mycobacteria, Pneumococcus, Corynebacteria, Bacillus, Nocardia

A

Gram Positive bacteria

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93
Q

What type of organisms are these?

E. Coli, Pseudomonas aeurginosa, Klebsiella, Actinobacter, Neisseria
Enterobacter, H. Flu, Legionella
Salmonella

A

Gram-negative

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94
Q

Examples of Beta Lactams include
P______
c_____
c_____
and monobactams

A

penicillins
cephalosporins
carbapenems

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95
Q

Examples of penicillins include
*a_____
*a_____
*z_____
*p_____

A

augmentin
amoxicillin
zosyn
penicillin, Pen-V

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96
Q

Penicillins are b_____

A

bacteriocidal
-meaning they directly kill the organism

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97
Q

Penicillins cover gram __ and ___, as well as non b____ l____

A
  • and +
    beta lactamase
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98
Q

Penicillins are good to treat
U_____
s____
o___ ____ and
l___ r____ t____ infections

A

UTI’s
sinusitis
Otitis Media
lower respiratory tract infections

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99
Q

What antibiotic class is good to use for bacterial prophylaxis?

A

penicillins

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100
Q

Cephalosporins are b____

A

bacteriocidal
-meaning they directly kill the organism

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101
Q

Cephalosporin coverage increased with each?

A

generation class

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102
Q

What generation cephalosporins cover gram +, gram -, and pseudomonas?

A

4th generation

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103
Q

What is the only 3rd generation cephalosporin that also covers gram +, gram -, and pseudomonas?

Ceft

A

Ceftazodine

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104
Q

1st generation cephalosporins include
cefa____ and an____

A

cefazolin or ancef

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105
Q

The first-generation cephalosporins Cefazolin and Ancef are good to treat?

A

surgical prophylaxis

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106
Q

3rd generation cephalosporins include c_____, Ceft____, or cefo_____

A

ceftriaxone, ceftazidine, and cefotaxime

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107
Q

3rd generation cephalosporins are able to cross the?

A

blood brain barrier

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108
Q

The third generation cephalosporins ceftriaxone and cefotaxime are good to treat m____ or s_____

A

meningitis or sepsis

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109
Q

4th generation cephalosporins are good to treat s____ associated with f____ n_____

A

sepsis associated with febrile neutropenia

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110
Q

There is an increased risk of an allergic reaction to cephalosporins if the patient has had an anaphylactic reaction to?

A

penecillins

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111
Q

monobactams only cover what type of bacteria?

A

gram-negative
–the only antibiotic example in this class is aztreonam

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112
Q

Carbapenems provide coverage for gram ___ and ____, p___, and _____ activity

A
  • and +, pseudomonas, anaerobic
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113
Q

Examples of carbapenems include m____, erdipenem, and idipenem

A

meropenem

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114
Q

Carbapenems are used to treat m____, g__ vs. h___, E____ gram -, and m___ infections

A

mucositis
graft vs. host
ESBL (infections such as e. coli)
mixed

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115
Q

What antibiotic is part of the glycopeptide class?

A

Vancomycin

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116
Q

Glycopeptides such as Vancomycin provide coverage for gram ___ bacteria and a____

A

+
anaerobes

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117
Q

Glycopeptides such as Vancomycin are good to treat M____ and M_____

A

MRSA
MRSE

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118
Q

Lipopeptides only provide coverage from gram ___ bacteria to include V___

A

+
VRE (vancomycin resistance enterococcus)

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119
Q

What antibiotic is a Lipopeptide?
Da_______

A

Dactinomycin

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120
Q

The Lipopeptide Dactinomycin can be used to treat v___ if it is resistant to vancomycin

A

VRE
(vancomycin resistance enterococcus)

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121
Q

Tetracyclines provide coverage for
gram __ and ___ bacteria, as well as a____ coverage

A

+ and -
anaerobic

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122
Q

What antibiotic is an example of tetracycline?

A

Doxycycline

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123
Q

Macrolide antibiotics provide coverage for both gram __ and ___ bacteria. Macrolides also provide coverage for a____ bacteria

A
  • and +
    atypical
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124
Q

Macrolide atypical coverage includes the treatment for
C__ M___ and
L_____

A

CAP mycoplasma
Legionella

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125
Q

Macrolide antibiotic examples include
e____ and a______

A

erythromycin
azithromycin

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126
Q

The antibiotic class lincomycins provide coverage for gram ___ bacteria and a____

A

+
anaerobes

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127
Q

What antibiotic is an example of a Lincomycin?

A

clindamycin

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128
Q

The antibiotic class Aminoglycosides only provide gram ___ coverage

A

negative

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129
Q

What antibiotics are a part of the aminoglycoside class?
g____
t_____
amik_____

A

gentamicin
tobramycin
amikacin

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130
Q

The aminoglycosides gentamycin, tobramycin, and amikacin are used to treat s___, e___, and U____

A

sepsis
endocarditis
UTIs

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131
Q

The sulfonamide class of antibiotics provides coverage for gram __ and ___ bacteria

A

gram - and gram +

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132
Q

What antibiotic is an example of a sulfonamide?

A

Bactrim or Sulfa-TPMX

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133
Q

The Fluoroquinolone antibiotic class provides coverage for gram __ and ___ bacteria, as well as coverage for a____ organisms.

A

Gram + and -
atypical

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134
Q

What is the only fluoroquinolone that additionally provides anaerobic coverage?
moxif_____

A

moxifloxacin

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135
Q

What antibiotics are fluoroquinolones?
ci____
le______

A

ciprofloxacin
levofloxacin

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136
Q

The Fluoroquinolones ciprofloxacin and levofloxacin are good to treat
U____
bacterial d____ as well as
s___ t____ or b___ i____

A

UTIs
bacterial diarrhea
soft tissue or bone infections

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137
Q

In pediatrics, the use of Fluoroquinolones such as ciprofloxacin and levofloxacin can increase the child’s risk for?

A

tendon rupture

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138
Q

What is the most common cause of community-acquired pneumonia in children less than 5 YOA?

A

strep pneumoniae

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139
Q

CAP is treated with __ dose ____ when outpatient

A

high dose amoxicillin

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140
Q

CAP is treated with _____ if the patient is admitted

A

ampicillin

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141
Q

If Staph or MRSA is suspected as the cause of CAP add v____ or cl____ to the ampicillin course

A

vancomycin
clindamycin

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142
Q

In children > 5 YOA consider a____ organisms as the cause for CAP

A

atypical

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143
Q

In children > 5 YOA add a m_____ such as a____ to the ampicillin course

A

macrolide
azithromycin

144
Q

What antibiotic provides no coverage for Strep pneumonia?

A

azithromycin

145
Q

Otitis media guidelines recommended treating a child with antibiotics when
*____ s/s are presentt
*or when the child is __-___ months of age with ____ disease

A

severe
6-23 months of age with bilateral disease

146
Q

Common otitis media pathogen include
s___ ____, h___ ___, and m. c_____

A

strep pneumonia
h. flu
catarrhalis

147
Q

What is the first-line therapy for Otitis Media?

A

high dose amoxicillin

148
Q

What are the common organisms of skin and soft tissue infections?
s__ ____ and g___ __ ____

A

staph aureus
group A strep

149
Q

Treat skin and soft tissue infections with __ generation ____

A

1st generation cephalosporins

150
Q

What antibiotics are good treatment options for skin and soft tissue infections
c____
b_____
v_____ or
L______

A

clindamycin
bactrim
vancomycin
linezolid (zyvox)

151
Q

In the case of skin and soft tissue infections, 1st generation cephalosporins will not cover an ____ infection

A

MRSA

152
Q

Skin and Soft tissue infections may initially be treated with an __ and ___

or topically if stable

A

I & D (incision and drainage)

153
Q

What is the most common organism to cause bone and joint infections?

A

staph aureus

154
Q

In a sickle cell patient, what is the most common organism to cause a bone and joint infection?

A

salmonella

155
Q

Bone and Joint infection may occur as a secondary infection to
G___ ___ ____
Ki____
S__ ____
H__ ___ and
N. g____

A

Group A strep
Kingella
Strep Pneumoniae
H. flu
N. gonorrhoea

156
Q

When a bone and joint infection occurs, it is prudent to consult with?

A

infectious disease

157
Q

It is important to educate parents that bone and joint infections will require p____ treatment with _____

A

prolonged treatment with antibiotics

158
Q

What two antibiotics are the preferred initial treatment for bone and joint infections?
cl___ or cefa_____

A

clindamycin or
cefazolin

159
Q

If a child with a bone and/or joint infection is toxic appearing and has + cultures, initial treatment should include IV v____ and r_____

A

vancomycin and rocephin

160
Q

MRSA treatment should be based on?

A

Local susceptabilities

161
Q

Antibiotics that can treat MRSA include
B____
c_____
d___
and v_____

A

Bactrim
Clindamycin
Doxycycline
Vancomycin

162
Q

Meningitis is defined as meninge inflammation related to a ____ or ____ infection

A

bacterial or viral

163
Q

What type of meningitis is considered an emergency?

A

Bacterial Meningitis

164
Q

Bacterial meningitis is severe and considered an emergency due to the child’s risk of cerebral e____ leading to increased ____, h___, c___ and/or d____

A

cerebral edema
increased ICP
herniation
coma
death

165
Q

Meningitis clinical presentation includes
f___
c____
H____
__/___
L____
ph____
altered n___ status
decreased f____
a_____
and in infants a b___ f____

A

fever
chills
headache
n/v
lethargy
photophobia
neuro status
feeding
agitation
bulging fontanelle

166
Q

In infants, the most common cause of meningitis is U____ b___ c____

A

URI bacterial colonization

167
Q

What is this sign:
The child is laying supine with knees and hips flexed, but unable to extend without pain

A

kernigs

168
Q

What is this sign:
The child is supine trying to raise or flex their neck but c/o pain.

A

brudzinski

169
Q

Meningitis complications include
loss of h____
n___ i___
s____
d____

A

hearing
neurologic impairement
seizures
death

170
Q

Meningitis LP evaluation will reveal elevated o___ p______

A

elevated opening pressures

171
Q

If LP CSF results show a significant amount of RBC’s consider h___ s____ as a cause for meningitis

A

herpes simplex

172
Q

Viral meningitis presents with
* ___ WBC usually < _____
*High p____
*normal g____
* n____ gram stain result

A

low, < 500
high protein
normal glucose
negative gram stain

*viral meningitis may be self-limiting or severe

173
Q

Bacterial meningitis presents with
*___ WBC, usually > ____
*high p____
*low g____
*c___/p____ drainage

A

high, > 1000
protein
glucose
cloudy/purulent

174
Q

80-90% or bacterial meningitis gram stains will be?

A

positive

175
Q

viral meningitis is commonly caused by e___

A

enterovirus

176
Q

What viral organism should be suspected in neonates admitted for meningitis with high CSF RBC?

A

HSV (herpes simplex virus)

177
Q

In the summer, viral meningitis is commonly caused by a___

A

arbovirus

178
Q

Hallmark s/s of viral meningitis include
H___
f____
altered L____ without n___ r___

A

Headaches
fever
altered LOC without nuchal rigidigy

179
Q

In neonates, the most common cause of bacterial meningitis is?

A

GBS

180
Q

Other causes of neonatal bacterial meningitis include
e___ and
L___ m____

A

E. Coli
Listeria Monocytogenes

181
Q

Neonates with bacterial meningitis will present with
f___
L____
decrease in f____
j____
and b____ f_____

A

fever
lethargy
decrease in feeds
jaundice
bulging fontanelle

182
Q

What is the most common cause of bacterial meningitis in kids 2 months of age through 23 months of age?
s__ p___
n___ m_____

A

strep pneumonia
Neisseria meningitis

183
Q

What is the most common cause of bacterial meningitis in unvaccinated children 2 months of age through 23 months of age?

A

H. Flu

184
Q

S/s of bacterial meningitis in children 2-23 months of age include?
f____
h____
n___ r____
+ k___ and b____ sign
decrease in f___
and poor m___ t____

A

fever
headache
nuchal rigidity
kerning and brudzinskis
decrease in feeds
poor muscle tone

185
Q

What is the most common cause of bacterial meningitis in kids 2 YOA and older?
n__ M____
s___ p___
H__ ____

A

Neisseria Menigitidins
strep pneumoniae
H. flu

186
Q

s/s of bacterial meningitis in children 2 YOA and older include
a__ m___ status
H____
decreased ____
P____ and
exan_____

A

altered mental status
hypertension
decreased heart rate
petechiae
exanthems (diffuse rash, anywhere)

187
Q

Neonatal meningitis management
1) a___ and g____
2) a___ and c____

+ HSV coverage with a_____

A

amp and gent
amp and cefotaxime

acyclovir

188
Q

Infant meningitis management includes
v____ + c_____ + a____

A

vancomycin
ceftriaxone
acyclovir

189
Q

Meningitis treatment for kids 2 YOA and older includes
c___ and v_____

A

ceftriaxone and vancomycin

190
Q

Children presenting with bacterial meningitis s/s should have antibiotics administered within?

A

1 hour of admission

191
Q

In any child with meningitis, consider the addition of _____ to preserve hearing

A

dexamethasone

192
Q

Meningitis supportive care may include
a______ therapy or
e___ I___ management

A

anticonvulsant
elevated ICP

193
Q

S/P meningitis, children will require long-term follow-up to assess h___ and d___ to rule out L___ and b___ issues

A

hearing and development
learning and behavioral issues

194
Q

Opportunistic infections occur when the host is _____

A

immunocompromised
—- examples include children with HIV or primary/secondary immunodeficiencies

195
Q

What are the most common opportunistic infectious organisms?
t___
c____
ca____
cry_____
and toxoplasma cry____

A

tuberculosis
CMV
candida
cryptococcus
cryptosporidium

196
Q

80% of opportunistic infections are caused by c____ leading to an invasive f____ infection

A

candida, fungal

—- Children with fungal infections often have a nonspecific presentation

197
Q

Consider candida and/or a fungal infection when a child remains sick despite n____ c____

A

negative cultures

198
Q

All children at high risk for fungal infection, require _____ prophylaxis when febrile

A

fungal

199
Q

Pneumocystis Jirovecii (PCP) is and opportunistic a____ pathogen

A

airborne

200
Q

Pneumocystis Jirovecii (PCP) prophylaxis includes the administration of ____, __-___ times a week

A

bactrim
2-3 times a week

201
Q

Pneumocystis Jirovecii (PCP) s/s include
c___
f____
weight ____
d____ and
c____

A

cough
fever
weight loss
dyspnea
crackles

202
Q

Pneumocystis Jirovecii (PCP) chest x-ray will reveal bilateral g___ g____ O_____

A

ground glass opacities

203
Q

What is the diagnostic test for Pneumocystis Jirovecii (PCP)?

A

Lung biopsy

204
Q

Pneumocystis Jirovecii (PCP) treatment includes a ___ day course of ____.

A

21-day course of bactrim
—consider also treating with pentamidine and dapsone

205
Q

Nontuberculous Mycobacterium is an opportunistic infection that enters via s___, i____, i___, or m____ translocation

A

skin
inhalation
ingestion
mucosal

206
Q

Nontuberculous Mycobacterium invades the _____ system and thus spreads to d___ o_____

A

lymphatic system
distal organs

207
Q

Nontuberculous Mycobacterium presentation is often nonspecific, parents may c/o that their child’s illness has p____ for w_____

A

persisted for weeks

208
Q

Nontuberculous Mycobacterium management includes starting the patient on cla___ and eth_____

A

clarithromycin and
ethambutol

209
Q

If Nontuberculous Mycobacterium treatment with clarithromycin and
ethambutol is unsuccessful consider adding r____

A

rifampin

210
Q

Resistant organisms evade antibiotic activity. What are the two most common resistant organisms?

A

MRSA and
Strep pneumoniae

211
Q

Treat drug-resistant MRSA with
1) c___ or v____
2)s___ or l____
3) or dap_____

A

clindamycin or vancomycin
Septra or linezolid
daptomycin

212
Q

Treat drug-resistant strep pneumonia with ___ dose beta-lactams such as
cl____
v____
or flu_____

A

high-dose
clindamycin
vancomycin
fluoroquinolones

213
Q

Toxic shock syndrome is a m_____ febrile illness due to s___ and/or s____

A

multisystem
staph or strep

-toxins trigger a cellular host response

214
Q

Patient with toxic shock syndrome will begin with nonspecific s/s, but then progress to f___, h____, and o___ dysfunction

A

fever
hypotension
organ dysfunction

215
Q

Toxic shock syndrome clinical criteria include
* fever > ____ C
*h____
*diffuse m____ e____-d___rash
*p___ and s___ d____, __-___ weeks after s/s onset

A

38.9 C
hypotension
macular erythroderma (body-wide skin redenning)
palm and sole desquamation, 1-2 weeks

216
Q

Toxic shock syndrome clinical criteria include presenting with at least 3 of the following s/s.

GI = __/___
muscular= m____, c__ > __x the normal
mucous= c___/o___/v___ h___
kidney= B__ and c___ > __x the normal, p___
LIver= a__, a___, b___ > __x the normal
Heme= p___ less than ___
Neuro= a___ m___ status without fever or hypotension

A

n/v

myalgias, CK > 2x

conjunctival/oropharynx/vaginal hyperemia (excess blood buildup)

BUN and Creatinine >2x, pyuria (pus in urine)
AST, ALT, bili > 2x
platelets less than 100,000
altered mental status

217
Q

Children with Toxic shock syndrome will have negative cultures. Toxic shock syndrome is a probable diagnosis when there is __ clinical criteria + ___ criteria

A

4 + lab

218
Q

Toxic shock syndrome is confirmed when there is ___ clinical criteria + ___ criteria

A

5 + lab

219
Q

Workup of a female with toxic shock syndrome includes obtaining b___, c___, u___, sp___, t___ and v___ cultures

A

blood, CSF, urine, sputum, throat, vaginal

220
Q

Toxic shock syndrome treatment includes the immediate administration of c_____ and v____

A

ceftriaxone and vancomycin

221
Q

When toxic shock syndrome diagnosis is confirmed, add c____ to ceftriaxone and vancomycin regimen

A

clindamycin

222
Q

Aside from ATBx, toxic shock syndrome treatment will include the removal of t___ and d___ of site

A

tampon
debridement

223
Q

Aside from ATBx what other medication can be used to treat toxic shock syndrome?

A

IVIG

224
Q

What is the most common organism found in dental plaque?

A

streptococcus

225
Q

Dental infection prevention includes f___, avoidance of s___, and good oral h____

A

fluoride
sugar
oral hygiene

226
Q

What infections are common in immunocompromised children, neonates, critically ill, and kids on long-term antibiotics?

A

fungal infections

-children may present asymptomatic or critically ill

227
Q

What are the 3 most common fungal infections?
h_____, c____, b_____

A

histoplasmosis
coccidioidomycosis
blastomycosis

228
Q

What fungal infection is most often seen in Mississippi, Ohio, and the Missouri river valley?
H________

A

histoplasmosis

229
Q

What fungal infection is most often seen in hot + cold arid regions of the southwest
C_____

A

coccidioidomycosis

230
Q

What fungal infection is most often seen in the Mississippi River, Ohio, lake Michigan, and southern states?

A

Blastomycosis

231
Q

Fungal infection diagnoses are often delayed due to nonspecific findings. What is the gold standard diagnostic test?

A

fungal culture
–txt dependent on organism and ISDA guidelines

232
Q

What treatment is best for serious fungal infections such as aspergillosis?
Vo_______

A

Voricanozole

233
Q

What is the first-line treatment for Histoplasmosis?

Am_____-___

A

Amphotericin B

234
Q

After inpatient treatment with amphotericin B, children with Histoplasmosis require oral a____ therapy once discharged.

A

azole

235
Q

What is the first-line treatment for coccidioidomycosis?

A

azoles

236
Q

What is the first-line treatment for mild-moderate blastomycosis?

___-___ months of I_____

A

6-12 months of itraconazole

237
Q

What is the first-line treatment for severe blastomycosis?

1) am_____ -__ until s/s improve
followed by
2) o__ i____ x __-___ months

A

amphotericin B
*prolong IV amphotericin if CNS disease is present

oral itraconazole x 6-12 month

238
Q

What is the most prevalent STI?

A

HPV

239
Q

HPV may be acquired g____ or r____

A

genitally or respiratory

240
Q

Children with HPV can be asymptomatic. Or they may present with g___ vs t___ w____

A

genital vs. throat warts

241
Q

HPV is diagnosed with
1)v___ i___ and
2) HPV p___ testing

A

visual inspection
HPV pap

242
Q

Malaria is a plasmodium species most often found in ____ regions

A

tropical

243
Q

In America, malaria cases are seen in i____ or t_____

A

immigrants or travelers

244
Q

Malaria is caused by a m____ transmitted p____

A

mosquito-transmitted parasite

245
Q

Once malaria is contracted, the parasite travels into the l___ where is divides and multiplies over - days

A

liver
7-10

246
Q

Malaria s/s begin once e____ become infected

A

erythrocytes

247
Q

Malaria s/s include
p___ f____, c____, h___, m___, c____, h___a___, and t_____

A

paroxysmal fever, chills, headache, malaise, cough, hemolytic anemia and thrombocytopenia

248
Q

Malaria urine s/s include
p____ and h____

A

proteinuria
hemoglobinuria

249
Q

Severe malaria s/s include
c___ s/s
severe a____
A___
h____ instability and
severe acute k___ i____

A

cerebral s/s
severe anemia
ARDS
hemodynamic instability
severe acute kidney injury

250
Q

The gold standard malaria diagnostic test includes t___ and t___ b___ s____

A

thick and thin blood smears
-which identify the parasite

251
Q

Once malaria is confirmed, obtain thick and thin blood smears every __-__ hours until they are n____

A

12-24 hours until they are negative

252
Q

In severe cases, individuals with malaria may require e___ t____

A

exchange transfusions

253
Q

Dengue is present in the tropic and subtropic regions of p___ r___, the v___ i___ and s____

A

Puerto Rico
virgin islands
samoa

254
Q

Dengue is a v___ illness transmitted via a m____

A

viral
mosquito

255
Q

Dengue s/s include a nonspecific f____, retro-o____ h___, and a tr___ m___-p____ r____

A

fever
retro-orbital headache
transient maculopapular rash

256
Q

Dengue severe s/s include c___ release, v____ p____, c____ and s_____

A

cytokine release
vascular permeability
coagulopathies and
shock

257
Q

The gold standard Dengue diagnostic test is via E____ anti-dengue __ and ___ antibodies

A

ELISA
anti-dengue IgG + IgM antibodies

258
Q

The CBC of a patient with Dengue will show
L____
t_____
and increased h____

A

leukopenia
thrombocytopenia
Hct

259
Q

Dengue management includes
h____
avoidance of N___ and a___ to prevent bleeding and good supportive care because it is a viral infection and antibiotics are not indicated.

A

hydration
NSAIDS and aspirin

260
Q

The Salmonella organism Salmonella eterica enters human hosts via the g__ t___

A

GI tract

261
Q

Once Salmonella enters the GI tract, it travels into the l_____, b____, l___ and s_____

A

lymphatics
blood
liver
and spleen

262
Q

Salmonella causes widespread b____ and e_____ release

A

bacteremia and endotoxin

263
Q

Salmonella s/s include
f_____, h____, a__ p___, __/__/__, c____, h_____, and s_____

A

fever
headache
abdominal pain
n/v/d
constipation
hepatomegaly
splenomegaly
*CNS s/s may also be present

264
Q

Upon diagnostic evaluation, salmonella is best detected via b___ c____

A

blood culture

265
Q

Less than 50 % of salmonella can be detected in the ____

A

stool

266
Q

Salmonella may increase what lab?

A

LFTs

267
Q

Salmonella can be treated with ce___ or cip______

A

ceftriaxone or
ciprofloxacin

268
Q

Due to a 10% chance of refractory salmonella, pediatric patients will require?

A

close follow up

269
Q

West Nile virus is a m___ borne vector illness that causes v____ i______

A

mosquito
viremic inflammation

270
Q

West Nile virus can enter the b____ via a blood-brain barrier alteration.

A

brain

271
Q

West Nile Virus s/s include
abrupt f____, h____, d____, and M____ r____

A

fever, headache, diarrhea, maculopapular rash

272
Q

West Nile virus neuroinvasion s/s include e____, m____ and f___ P_____

A

encephalitis, meningitis, flaccid paralysis

273
Q

West Nile Virus diagnostic evaluation includes obtaining an I___ and n___ a____ levels

A

Igm
neutralizing antibody

274
Q

In a child with HPV, no treatment is indicated if there is no?

A

warts

275
Q

In a child with HPV, treat external warts with t__ p____

A

topical podofilox

276
Q

HPV warts can be removed with c____ or l___ surgery
*** Ensure to consult OB

A

cryotherapy or laser surgery

277
Q

What is the best preventative measure against HPV?

A

HPV vaccination

278
Q

What is the second most common STI?

A

gonorrhea

279
Q

Gonorrhea is a gram ___ bacteria

A

negative

280
Q

females with gonorrhea are often asymptomatic until the following complications occur
d___
f_____
u____
d____

A

dysuria
frequency
urgency
discharge

281
Q

Gonorrhea diagnostic testing includes a b___ c___, g___ s___, and N___

A

bacterial culture, gram stain, NAAT

282
Q

What is the most common cause of pelvic inflammatory disease?

A

chlamydia

283
Q

Chlamydia is caused by the bacteria c__ t___

A

c. trachomatis

284
Q

Children with chlamydia may be asymptomatic. S/s of chlamydia may include v___, u____, e____ or P___

A

vaginitis
urethritis
endometriosis
PID

285
Q

The gold standard diagnostic test for chlamydia is?
N___

A

NAAT (nucleic acid amplification)

286
Q

Chlamydia is treated with
a___ or d______

A

azithromycin
doxycycline

287
Q

The organism treponema pallidum causes what STI?

A

syphilis

288
Q

Primary syphilis s/s include a mouth or anogenital u___ or c___

A

ulcer or chancre

289
Q

secondary syphilis s/s include m___, f___ s/s, l____, and r_____

A

myalgias
flu-like s/s
lymphadenopathy
rash

290
Q

tertiary syphilis s/s include c__ and n___ s/s

A

cardiac and neurological s/s

291
Q

Diagnostic testing for syphilis may include
R____ p_____ r_____

A

RPR (rapid plasma reagin)

292
Q

What is the gold standard syphilis diagnostic test?
non-t___ and t____ testing

A

non-treponemal and
treponemal

293
Q

What is the gold standard treatment for syphilis?
b___ p___ _

A

benzathine penicillin g

294
Q

In a child with HPV, no treatment is indicated if there is no?

A

warts

295
Q

In a child with HPV, treat external warts with t__ podo____

A

topical podofilox

296
Q

HPV warts can be removed with c____ or l___ surgery
*** Ensure to consult OB

A

cryotherapy or laser surgery

297
Q

What is the best preventative measure against HPV?

A

HPV vaccination

298
Q

What is the second most common STI?

A

gonorrhea

299
Q

Gonorrhea is a gram ___ bacteria

A

negative

300
Q

Males with gonorrhea are often _____

A

asymptomatic

301
Q

females with gonorrhea are often asymptomatic until the following complications occur
d___
f_____
u____
d____

A

dysuria
frequency
urgency
discharge

302
Q

Gonorrhea diagnostic testing includes a b___ c___, g___ s___, and N___

A

bacterial culture, gram stain, NAAT

303
Q

Gonorrhea txt includes IM c____ or cefi____

*cover for chlamydia as well until chlamydia cultures are negative

A

ceftriaxone or cefixime

304
Q

What is the most common cause of pelvic inflammatory disease?

A

chlamydia

305
Q

Chlamydia is caused by the bacteria c__ t___

A

c. trachomatis

306
Q

Children with chlamydia may be asymptomatic. S/s of chlamydia may include v___, u____, end____ or P___

A

vaginitis
urethritis
endometriosis
PID

307
Q

Chlamydia is treated with
a___ or d______

A

azithromycin
doxycycline

308
Q

The gold standard diagnostic test for chlamydia is?

A

NAAT (nucleic acid amplification)

309
Q

Primary syphilis s/s include a mouth or anogenital u___ or c___

A

ulcer or chancre

310
Q

secondary syphilis s/s include m___, f___ s/s, l____, and r_____

A

myalgias
flu-like s/s
lymphadenopathy
rash

311
Q

tertiary syphilis s/s include c__ and n___ s/s

A

cardiac and neurological s/s

312
Q

Diagnostic testing for syphilis may include?

A

RPR (rapid plasma reagin)

313
Q

What is the gold standard treatment for syphilis?
b___ p___ _

A

benzathine penicillin g

314
Q

Lyme disease is a t___ borne illness

A

tick

315
Q

Lyme disease presents with an e____ m____ with c___ of c___ known as e____ m____ or a t___ lesion

A

erythematous macule with the clearing of the center known as
erythema migrans
target lesion

316
Q

Lyme disease s/s include f____, a____, h_____, f___ p___, and m_____

A

fever
arthralgias
headache facial palsy
myalgias

317
Q

Lyme disease treatment includes
d_____ x __ days
a____ x __ days or
cefur_____ x __ days

A

doxycycline x 10 days
amoxicillin x 14 days
cefuroxime x 14 days

318
Q

Rocky mountain spotted fever is a t__ borne illness that causes systemic v_____

A

tick
systemic vasculitis

319
Q

Rocky mountain spotted fever incubation is __-___ days

A

2-14

320
Q

Rocky Mountain spotted fever s/s include
f____, severe h___, m____, v___ and decreased o___ i____

A

fever
severe headache
myalgias
vomiting
decreased oral intake

321
Q

In Rocky Mountain spotted fever, a r___ will develop about __-__ days s/p fever

A

rash
2-5 days s/p fever

322
Q

The Rocky Mountain spotted fever rash begins on the w___, a___, p___, and s___. Will eventually spread to the t___

A

wrists, ankles, palms, soles
trunk

323
Q

What is the gold standard diagnostic test for Rocky Mountain Spotted fever?
R___ sero____ as____

A

Rickettsial serologic assay

324
Q

Do not delay Rocky Mountain spotted fever treatment. Treat Rocky Mountain Spotted fever with d____ for __-__ days.

A

doxycycline, 7-10 days

325
Q

Doxycycline treatment for Rocky Mountain Spotted fever should be continued until there is no f___ x __ days

A

fever x 3 days

326
Q

Untreated Rocky Mountain Spotted fever can progress to D___, s___ ___, and c___ sequela

A

DIC
septic shock
CNS

327
Q

Adenovirus is a r___, o____, and g____ illness. Adenovirus requires what type of precautions?

A

respiratory, oral, gastrointestinal

contact

328
Q

CMV is a c____ i____ infection

A

congenital infant

329
Q

In infants, CMV can lead to s____ h___ l___

A

sensorineural hearing loss

330
Q

CMV risk increases in adolescence due to their c___ c___ with c____

A

close contact with classmates

331
Q

Treat immunocompromised patient with CMV with g____, v____, or f____

A

ganciclovir, valganciclovir, foscarett

332
Q

EBV spread into the host __ cells increasing the child’s risk for l____ disorders such as P___

A

b
lymphoproliferative
PLTD

333
Q

Children with EBV will often have an enlarged _____. Children are at greatest risk for rupture when engaging in c___ s____

A

spleen
contact sports

334
Q

Enterovirus enters via the f___ o___ route. Treatment is s____. Place the child on c____ precautions.

A

fecal-oral route
supportive
contact

335
Q

Herpes simplex virus enters via m____ m___ or s____

A

mucous membranes or skin

336
Q

What herpes is acquired in childhood?

A

HSV-1

337
Q

What herpes is acquired sexually?

A

HSV-2

338
Q

In neonates, HSV can cause c___ and d___ disease

A

CNS
disseminated

339
Q

Immunocompromised patients with HSV will develop g____

A

gingivostomatitis

340
Q

When HSV vesicles are present, treat with a____. Place patient on c___ precautions

A

acyclovir
contact

341
Q

Treat HSV resistant disease with f_____

A

foscarnet

342
Q

What is the HSV diagnostic test?
E____ and
C___ P____

A

ELISA
CSF PCR

343
Q

Parvovirus B19 requires ____ precautions

A

droplet

344
Q

Parvovirus B19 enters via the r___ tract and invades e___ cells

A

respiratory tract
erythroid cells

345
Q

Parvovirus may lead to ___ disease

A

5ths disease

346
Q

5ths disease is characterized by c___ e____ and a___ s/s

A

cheek erythema
arthritis

347
Q

Children with Parvovirus may present in an a____ crisis. Reticulocyte count will often be ___

A

aplastic crisis
0

348
Q

Hepatitis causes L____ i_____

A

liver inflammation

349
Q

Children with hepatitis will present with an acute onset of
__/___, f____, tra____, a___ p___, h_______, b____ disorder s/s, and a____ m____ status

A

n/v
fever
transaminitis
Abdominal pain
hepatosplenomegaly
bleeding
altered mental

350
Q

Hepatitis lab workup is to include
a____, f___ levels, c___ levels

A

albumin
factor levels
coagulation levels (Pt-INR)

351
Q

In a child with hepatitis, evaluate their liver status by obtaining an?

A

ultrasound

352
Q

What is the gold standard syphilis diagnostic test?
non-t___ and t____ testing

A

non-treponemal and
treponemal

353
Q

The organism treponema pallidum causes what STI?

A

syphilis

354
Q

Gonorrhea txt includes IM c____ or cefi____

*cover for chlamydia as well until chlamydia cultures are negative

A

ceftriaxone or cefixime

355
Q

Males with gonorrhea are often _____

A

asymptomatic

CPNP AC flash cards (10 decks)

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