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Infectious Disease Flashcards

1
Q

Tonsillar pharyngitis
Posterior cervical lymphadenopathy
Fever

+maculopapular rash after amoxicillin or ampicillin administration

What is it?

A

EBV

Not a true allergy! Ok to take drug later

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2
Q

Common pathogens in cystic fibrosis related PNA

A

Gm - rod

  • P. aeruginosa
  • Burkholderia cepacia
  • Stenotrophomonas

Hib, nontypeable

Strep pneumo

Staph aureus

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3
Q

Child with:

  • fever
  • rash (maculopapular) starting on face –> trunk and extremities

Prior to rash:

  • cough
  • coryza
  • sneezing
  • tearing

What is it?
What has been shown to reduce morbidity and mortality rates of pts w/ this infection?

A

Measles

– can see leukopenia and thrombocytopenia

Vit A to reduce mortality

  • helps immune enhancement
  • helps GI and resp epi to regenerate
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4
Q

1 cause otitis media

Treatment?

A

Strep pneumo (#1)

Then:
Hib
moraxella

Tx w/ amoxicillin x 10d

If tx and doesn’t get better, conclude is HIb or Moraxella and give augment

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5
Q

Acute unilateral lypmhadenitis

Cause?
Most common cause?

A

Usually bacterial infection

#1 = Staph aureus
#2 = Group A strep

Tx = dicloxacillin to cover strep and staph

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6
Q

Prevent neonatal ophthalmic chlamydial infection

A

ONLY prenatal maternal testing + tx

Erythromycin is only effective for gonococcal conjunctivitis

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7
Q

Infant botulism transmitted by…

A

Ingesting food contaminated with C botulinum

Germ grows in gut –> makes toxin –> clinical signs

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8
Q

When do pts with genetic B cell deficiency begin to develop recurrent infections?

A

After 6 mo

No more passive ab from mom

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9
Q

3 most common causes of conjunctivitis in neonates

A

Chemical (via silver nitrate) - tx supportive management!
Gonococcal
Chlamydial

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10
Q

Gonococcal conjunctivitis (ophthalmia neonatorum)

A

Present at 2-5 day old

Copious purulent exudates
Eyelid swelling
Eyelid exudates

Dx:

  • Gm stain w/ intracellular Gm- diplococci
    • Cx on THAYER MARTIN media

Tx:

  • IM or IV ceftriaxone or cefotaxime
  • hospitalization to assess tx response

Ppx:
- Erythromycin ophthalmic ointment within 1 hr birth

…if untreated –> corneal ulceration, scarring, blindness

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11
Q

Chlamydia vs Gonorrhea conjunctivitis

A

Chlamydia happens later (5-14 d) vs 2-5 d for gonorrhea

Chalmydia has more chemosis

  • less eyelid swelling
  • less purulent d/c - it is more mucoid
  • blood stained eye discharge is characteristic

Tx:
- oral erythromycin

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12
Q

How do you dx early localized lyme disease?

A

Based solely on presence of erythema chronicum migrans

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13
Q

Tx lyme disease

A

Doxycycline
Amoxicillin
Cefuroxime

  • Doxy used more b/c can also tx anaplasma phagocytophilum

DO NOT use doxy in kids < 8 yo and preggers

–> Oral amox or cefuroxime for kids < 8 yo and preggers

Disseminated dz –> ceftriaxone or penicillin G
DO NOT use steroids for bells palsy - just use same for erythema migrans

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14
Q

When is it ok to use tetracycline?

A

> 8 yo kid

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15
Q

What is the incubation period of varicella?

A

3 weeks

Most pts develop sx within 2 weeks of exposure

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16
Q

How effective is varicella vaccine after exposure?

A

70-100% 3-5 days of exposure

Not ok for > 5 days after exposure

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17
Q

Potential complications of varicella infection

A

Children - bacterial superinfection

Adults - pneumonia

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18
Q

Orbital cellulitis features

A

Pain w/ eye mvmts

Proptosis

Ophthalmoplegia

Diplopia

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19
Q

Most common predisposing factor for orbital cellulitis

A

Bacterial sinusitis

Use contrast CT to ID abscesses needing surgery

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20
Q

TORCH infections

A 
Toxo
CMV
Congenital rubella
HSV
Syphilis
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21
Q

Toxoplasmosis

  • risk
  • effect on baby
  • dx
  • tx
A
  • raw meat eating or cat feces
  • intracranial calcifications***
  • chorioretinits
  • hydrocephalus 2/2 aqueductal stenosis

Dx IgM immunosorbent agglutination assay

  • -> Tx mom spiramycin for 1st sem, pyrimethamine + sulfonamide afterward
  • -> Tx baby pyrimethamine + sulfonamide leucovorin
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22
Q

CMV

  • risk
  • effect on baby
  • dx
  • tx
A

1 congenital infection

  • periventricular calcifications*******
  • chorioretinitis
  • # 1 cause sensorineural hearing loss
  • seizures
  • IUGR
  • hepatosplenomegaly
  • microcephaly

Dx culture or PCR

Prognosis poor

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23
Q

Rubella

  • risk
  • effect on baby
  • dx
  • tx
A

If 1st trimester infection –> 80% babies affected
- transmitted via resp droplets

  • cataracts*****
  • PDA, pulmonary stenosis
  • blueberry muffin lesions 2/2 dermal erythropoiesis
  • sensorineural hearing loss

Dx IgM titers

Prevent w/ immunizations

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24
Q

HSV

  • risk
  • effect on baby
  • dx
  • tx
A

Usually 2/2 passage through infected canal
Primary dz in mother has high rate of transmission

  • Encephalitis
  • herpetic (vesicular) lesions

Tx acyclovir

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25
Syphillis - risk - effect on baby - dx - tx
Transplacental transmission Often result in stillbirth, hydrops fetalis Usually asymptomatic If sx... Early stage - appear before 2 yo - FTT - maculopapular rash (esp on palms + soles) - thrombocytopenia - hepatosplenomegaly Late stage - skeletal --> saber shin, hutchinson teeth, saddle nose, clutton joints Dx: - VDRL or RPR first - confirm w/ FTA-ABS Tx: - Parenteral PCN G
26
Causes of neonatal bacterial sepsis + associations
Group B strep & E. coli - #1 causes of early and late onset sepsis Staph aureus - skin, bone, joint infections Listeria - early onset sepsis Enterococcus - sepsis in preterm Coag-negative staph - in intravascular catheters that are indwelling Other Gm - bacteria (Klebs, Enteriobacter, P. aeruginosa) - late onset sepsis, esp in infants in ICU
27
Fever of unknown origin
Lasting > 14 days in child < 36 > 21 days in adolescent or adult
28
Fever without a focus
Lasting < 1 week in children < 36 mo old
29
Occult bacteremia (bacteremia w/o obvious focus) is usually 2/2 to
S pneumo N meningitidis H influenzae B Salmonella
30
Fever in pts < 3 mo old..should consider what?
Meningitis UTI PNA
31
Tx bacteremia in children
< 1 mo old - admit - ppx abx for group B strep, listeria, e coli Ceftriaxone if: - look ok - no source of fever - WBC > 15,000
32
Causes of meningitis
< 3 mo old - Group B strep - Listeria - E. coli > 3 mo - N. meningitides - S. pneumo - H. influenzae B Sickle cell - pneumococcal CSF shunt infection - Staph epi
33
Physical signs of meningitis
Bulging fontanelle in infants + Brudzinski (involuntary flexion of knees + hips after flexion of neck while supine) + Kernig (flexion of hip 90 deg w/ subsequent pain on extension of leg)
34
When does aseptic meningitis usually happen?
Summer Fall Origin usual viral
35
ppx for family contacts of pts w/ what meningitis causing organisms?
Give rifampin for contacts of: H. influenza N. meningitides
36
What are causes of arboviral encephalitis? Which one has worst prognosis?
St louis encephalitis (birds) California encephalitis (rodents --> mosquitoes --> baby) Western equine encephalitis (mosquitoes + birds) Eastern equine encephalitis (mosquitoes + birds) --> poor prognosis Colorado tick fever
37
Most common days osteo spreads in kids #1 pathogen
Acute hematogenous spread Staph aureus
38
Associations of osteo...
Sickle cell - Staph aureus, salmonella Dog or cat bites - pasteurella puncture wounds of foot through sneaker - pseudomonas
39
Dx osteo
Periosteal bone culture Radiographs are only + 10-14 days after showing soft tissue swelling and periosteal elevation MRI if radiographs neg but strong suspicion
40
How to determine response to therapy in osteo?
ESR | CRP
41
Hip pathology refers pain to..
the knee!
42
Dx septic arthritis
Arthrocentesis WBC and ESR will be elevated US good for septic arthritis of hip!
43
Reading ppd
>=5 mm ---> + if exposed to TB or immunocompromised >=10 mm --> + if high risk (health care, homeless) >=15 mm ---> + if low risk prior BCG vaccine never contraindication for ppd
44
Side effects of Tb drugs ``` INH Rifampin Pyrazinamide Streptomycin Ethambutol Ethionamide ```
INH - hepatotoxicity - neuritis Rifampin - hepatotoxicity - thrombocytopenia Pyrazinamide - Hepatotoxicity Streptomycin - ototoxicity - nephrotoxicity Ethambutol - ocular toxicity Ethionamide - hepatitis
45
Stages of pertussis infection
Stage 1 - catarrhal - last 1-2 wks - rhinorrhea, conj injection, cough Stage 2 - paroxysmal stage - 2-4 wks - coughing spasms, inspiratory whoop, facial petechiae Stage 3 - convalescent stage - 1-2 weeks - dec freq of sx
46
Dx pertussis
1st 4 weeks: - Culture from nasopharyngeal secretions******** of B. pertussis is gold standard After 4 wks: - serology
47
Tx pertussis
Suppportive Severe dz --> hospitalize Erythromycin to shorten period of communicability but does not affect paroxysmal stage Ppx ALL close contacts w/ erythromycin, even if immunized
48
Bartonella hensalae
Small red papules at site of inoculation appearing in LINEAR fashion Chronic regional lymphadenitis - start enlarging in 1-4 weeks and stay that way for 2 months Parinaus oculoglandular syndrome happens after rubbing eye with hands after cat contact sometimes happen - unilateral conjunctivitis - preauricular lymphadenopathy - cervical lymphadenopathy
49
How do you dx Bartonella hensalae?
Usually hx Warthin Starry stain can see the gram negative bacilli
50
Tx bartonella hensalae
No tx usually resolves spontaneously
51
Complications of parvovirus B19
Aplastic crisis, esp if sickle cell + Fetuses --> can develop fetal hydrops and death
52
Tx measles
Supporive Vitamin A Isolation
53
Complications w/ measles
Otitis media #1 PNA Subacute sclerosing panencephalitis (1/1000 get this after measles)
54
Tx rocky mountain spotted fever
Rickettsia rickettsii Pale rose-red maculopapular rash Starts and palms and soels and spreads to entire body Tetracycline Doxycycline --> ok in kids < 8 yo since only 1 dose Chloramphenicol for tetracycline allergic
55
Complications of rocky mountain spotted fever
Rickettsial vasculitis causing gangrene fo digits, ear lobes, nose, scrotum, entire limbs Neuro sequelae
56
Complications of varicella
2/2 infection w/ group A strep and staph aureus PNA Guillain Barre encephalitis Cerebellar ataxia
57
Tx scarlet fever
Penicillin Erythromycin Clindamycin 1st gen cephalosporins
58
Mumps
Viral infection Painful enlargement of salivary glands (mainly parotid) - can have erythema and swelling around Stenson's duct Dx with hx; serum amylase elevation common Tx - supportive Complications - menigoencephalitis - orchitis (infertility rare) - mild pancreatitis - sensorineural deafness (very common with infection)
59
Dx HIV of newborns
All infants born to HIV + moms have + antibody test at birth b/c of passive transfer - detection of antibody by ELISA and Western Blot - passive antibodies last 15 months Do HIV DNA PCR for infants
60
Mononucleosis - sx - dx - tx - complications
EBV spread via intimate contact and saliva Dx - typical clinical sx (fever, malaise, fatigue, HA, nausea) - atypical lymphocytosis in periph blood Tx - supportive - avoid contact sports for 2-3 weeks or until splenomegaly resolved Complications: - ampicillin rash
61
Pinworm
Enterbiasis (parasite) Worms live in cecum, appendix, ileum, ascending colon Hx of nocturnal pruritus ani --> suggest infection Dx: - inspection of worm under microscope - tape test - NO eosinophilia in enterbiasis Tx: - albendazole - mebendazole - pyrantel pamoate
62
Ascariasis
2/2 ascaris lumbricoides Helminth Human host ingests eggs --> larvae released and penetrate intestinal wall --> larvae migrate to lungs via venous circulation --> larvae break through lung tissue into alveolar spaces --> larvae travel up bronchial tree and are reswallowed --> adult worms formed Colicky ab pain Bile stained emesis Tx: - albendazole - pyrantel pamoate - mebendazole - PIperazine if intestinal obstruction
63
Scabies
2/2 Sarcoptes scabiei Transmission depends on extent and duration of physical contact Fomite transmission rare Burrow is classic lesion - face spared in adults and older children Tx: - permethrin cream - lindane (not for small infants) - sulfur in petrolatum for < 2 mo old Pruritus can persist for up to 2 weeks after treatment because of hyperssensitivity to mite antigens
64
Lice
Pediculus humanus corporis Obligate parasites of human host Risks: - poor hygiene - sex contact with infested person Tx: - Permethrin cream for body lice - Petrolatum for eyelashes - permethrin rinse for head lice and remove nits from hair with fine tooth comb - launder all sheets in hot water
65
Hookworm
Ancylostoma duodenale Necator americanus Helminth Causes: - blood loss - iron deficiency - anemia - protein malnutrition Can have yellow-green pallor = chlorosis Dx - fecal exam for eggs Tx: - mebendazole - albendazole - pyrantel pamoate
66
Tx oral candidiasis
Topical nystatin solution
67
Tinea corporis
Ringworm 2/2 tricophyton rubrum Dx: - hyphae on KOH - should not fluoresce with wood's lamp in corporis Tx: - topical antifungal
68
Tinea capitis
2/2 trichophyton tonsurans and microsporum canis Wood's lamp: - fluoresce blue-freen with Microsporum - no fluorescence in Tricophyton Tx: - oral griseofulvin Complications: - inflammatory rxn can produce boggy granulomatous mass = kerion - tx w/ griseofulvin + tapering dose steroid
69
Tx Coccidiomycosis
Primary dz is self limiting - no tx needed Amphotericin B for severe Fluconazole for meningitis 2/2 coccidiodes Will have permanent immunity in normal host after recovery
70
Histoplasma
Bird droppings! Acute pulm histoplasmosis - flu like sx Chronic pulm histoplasmosis - opportunistic infection w/ centrilobular emphysema Progressive disseminated histoplasmosis - infants + immunosuppressed --> fever, hepatosplenomegaly, anemia Tx: - disseminated histoplasmosis - amphotericin - ppx itraconazole if immunodepressed and in prevalent area - NSAID for sarcoid like disease
71
Otitis Media
Craniofacial anatomy adn eustachian tube dysfunction are responsible for development of OM ``` Otalgia FEver Ear pulling Vomiting + diarrhea Drainage not common ``` Tx: - Amoxicillin for uncomplicated - amoxicillin + clavulanic acid or cephalosporins if fail tx
72
Complications of otitis media
Recurrent OM - tx w/ myringotomy + tubes Hearing loss Perforation MAstoiditis (redness and tenderness over mastoid bone) Cholesteatoma (pocket of squamous epithelium in TM - need surgery) Meningitis Labyrinthitis (vertigo, nystagmus, tinnitus, hearing loss, vomiting)
73
Otitis Externa
Swimmer's ear Usually 2/2 pseudomonas Sx: - ear pain worse by moving ear canal Tx: - topical abx
74
#1 cause of bacterial pharyngitis
Group A beta hemolytic Strep Tx - PCN amoxicillin
75
Peritonsillar abscess
Usually 2/2 pharyngitis Drooling TOnsil bulges medially Uvula deviates to NONinvolved side Hot potato voice IV abx needed Surgical drainage may be needed
76
Retropharyngeal abscess
S. aureus usually causes Lateral films revel soft tissue mass Tx IV abx and drainage
77
Cervical lymphadenitis ddx
``` Ddx: thyroglossal duct cyst brainchial cleft cyst cystic hygroma mumps ```
78
12 mo old child brought to office because of barky cough Fever Runny nose Sx getting worse Trouble breathing
Laryngotracheobronchitis (Croup) - usually 2/2 parainfluenza virus Dx - roentgenograms of nasopharynx and upper airway can show STEEPLE sign = narrow subbglotic space Tx: - tx at home - watch for respiratory distress - if stridor at rest --> racemic epinephrine + dexamethasone Ddx: - spasmodic croup (usually 2/2 allergy, GERD) - bacterial tracheitis (usually 2/2 staph) DIptheric croup Epiglottitis
79
2 yo child p/w high fever + difficulty swallowing ``` Hoarse voice Seated in tripod position Drooling Expiratory stridor Nasal flaring Retractions of suprasternal notch + supraclavicular and intercostal spaces ```
Epiglottitis - acute inflamm of epiglottis --> respiratory distress + airway obstruction - HiB #1 cause Dx: - history - will see thumb print sign on xray Tx: - secure airway no matter what (intubation) - 3rd gen cephalosporin (cefotaxime or ceftriaxone) - ampicillin + sulbactam (Unasyn) Notes: DO NOT use tongue depressor to examine --> can have laryngospasm and cardiopulm arrest
80
6 mo old infant p/w 3 d hx of URI, wheezy cough, dyspnea Tachypnic Alae nasi flare Accessory muscle usage Desaturation of O2 to 92%
Bronchiolitis! - lower respiratory infection - usually 2/2 RSV - peak incidence 6 mo age CXR - hyperinflation of lungs - peribronchial thickening - atelectasis Virus detection in nasopharyngeal secretions Tx - supportive - trial of bronchiodilator - aerosolized epi - NOT steroids - Ribavirin if impending respiratory failure
81
Pneumonia
Inflammation of pulmonary tissue assoc w/ consolidation of alveolar spaces Classic triad: - fever - tachypnea - cough
82
Staccato cough pneumonia....
Chlamydia
83
CXR appearance of PNA - vira - bacterial - myco - chlamydia - aspiration
Viral = diffuse streaky infiltrates Bacterial = lobar consolidation Mycoplasma = interstitial most common in lower lobes Chlamydia = hyperinflation or ground glass appearance Aspiration = alveolar and reticular infiltrates
84
Dx Mycoplasma pneumonia
Serum cold hemagluttinin + IgM M. pneumo titer
85
Tx chlamydia pneumonia
Usually in 6wks-6mo old kids Erythromycin ethyl succinate drops PO
86
Tx Group B strep, E. coli, Listeria PNA
Usually in birth - 2 mo old kids Ampicillin + aminoglycoside Ampicillin + 3rd gen cephalosporin IV
87
Tx S. pneumo, H. influenzae, and Staph PNA
Usually 2mo-5yo babies Cephalosporin (cefuroxime or ceftriaxone) IV Amoxicillin Amoxicillin clavulanate Erythomycin + sulfasoxazole
88
Tx M. pneumoniae PNA
Usually > 5 yo Erythromycin Azithromycin Clarithromycin
89
Cause of acute rheumatic fever
Infection w/ group A beta-hemolytic strep
90
Presentation of acute rheumatic fever
Presents 1-3 weeks after preceding strep pharyngitis
91
JONES criteria
To dx rheumatic fever 2 major criteria 1 major + 2 minor + preceeding strep infection + chorea w/o explanation ``` Joints (migratory polyarthritis) Carditis Nodules (SubQ) Erythema marginatum Sydenham chorea ``` Minor: - fever - arthralgia - elevated ESR, CRP - prolonged PR - evidence of preceding strep pharyngitis
92
Tx acute rheumatic fever
Tx strep Monthly PCN ppx Steroids if there is carditis w/ heart failure
93
Causes of endocarditis
Strep viridans #1 Dental procedures - Strep virdans IVDU - Pseudomonas, Serratia Open heart surgery - fungal causes
94
Presentation of endocarditis
Fever Chills New murmurs Osler nodes (tender nodules on finger and toe pads) Janeway lesions (painless hemorrhage lesions on palms and soles) splinter hemorrhages
95
Dx and Tx endocarditis
Dx - + blood cx Tx - 4-6 weeks abx
96
Cardiac conditions recommended to ppx against endocarditis
Prosthetic valves Previous endocarditis Pulm shunts or conduits Congenital heart disease MVP w/ regurg or thickened valves
97
Not needed for ppx against endocarditis
Isolated secundum ASD Surgical repair ASD, VSD, PDA CABG MVP w/o regurg or thickened valves Kawasaki w/o valvular dysfunction Rheumatic fever w/o valve issues Pacemakers Defibrillators
98
Abx to ppx against endocarditis if undergoing dental, oral, resp, or esophageal procedure
Amoxicillin NPO - ampicillin
99
Abx to ppx against endocarditis if undergoing GI or GU procedure
Ampicillin + gentamicin or Vanco + gentamicin
100
Rotavirus
Watery diarrhea 7-10 d +/- 3-4 d vomiting +/- Fever
101
Which e. coli is seen where?
Enteropathogenic - nurseries + day care Enterotoxigenic - traveler's Enterohemorrhagic - HUS
102
How do you get Salmonella food poisoning?
Infected animals Eggs Milk Poultry
103
How do you get shigella?
Person to person Food
104
How do you get Campylobacter?
person to person Food
105
How do you get Yersinia?
Pets Food Can develop arthritis + rash
106
How fast does food poisoning w/ staph aureus happen?
12h
107
Giardia sx
``` Anorexia Nausea Ab distention Watery diarrhea Wt loss ```
108
Cryptosporidium presentation
mild diarrhea in immunocompetent infants Severe diarrhea in AIDS
109
When do you tx pathogenic diarrhea w/ abx? ``` Salmonella Shigella Campylobacter Yersinia C. diff Entamoeba Giardia ```
NOT Salmonella - can prolong carrier state - but can tx if < 3 mo age - toxic pt - disseminated dz - salmonella typhi Shigella - TMP/SMX Campylobacter is self limited - erythromycin can speed recovery and limit carrier state Yersinia - none - can give aminoglycosides + 3rd gen cephalosporin for < 3 mo C diff - metronidazole - vanco Entamoeba - metronidazole Giardia - metronidazole - furazolidone
110
Common causes of chronic diarrhea
Lactase deficiency IBS IBD Giardiasis CF Celiac Lactose intolerance
111
Incidence of UTIs in age groups - which sex is more?
< 2 yo - boys, esp uncirc > 2 yo - girls
112
Sx UTI
Cystitis (dysuria, urgency, frequency) often absent in children UTI in infants - fever, FTT, wt loss, vomiting, diarrhea Older kids - fever, ab pain, hematuria, enuresis
113
Dx UTI
Urine cx
114
Tx UTI
Neonate - hospitalize - IV ampicillin + gentamicin Older kids - IV ceftriaxone/ampicillin + aminoglycoside if need hospitalization - TMP/SMX or amoxicillin if outpatient
115
UTI follow up
Repeat UA 1 wk after complete therapy Renal US to r/o hydronephrosis or abscesses ``` VCUG in:: - < 5 yo - febrile UTI - girls with > 2 UTI - boy w/ UTI ...if suspect reflux, test with DMSA to see if there is renal scarring ``` RIsk developing renal insufficiency
116
Why do you give high dose amoxicillin for otitis media?
High resistances of Strep pneumo - via penicillin binding protein Hib and Moraxella via beta lactamases
117
If see an ear and it is not bulging, it is just fluid behind the ear, what is it?
Viral If it is bulging and erythematous, it is ear infection!
118
Gonorrhea - presentation - Dx - Tx - complications
Neisseria gonorrhae Presentation: - varies - urethritis - cervicitis - dyuria - asymptomatic - polyarthralgias if disseminated Dx: - cx for gonorrhea - Gm stain --> Gm - intracellular diplococci in PMN cells - also test for syphilis and HIV Tx: - ceftriaxone - doxy or azithro for concaminant Chlamydia Complications - fitz hugh curtis - PID
119
Fitz Hugh Curtis
Complication of gonococcal infection RUQ pain +/- salpingitis Seeds liver capsule --> perihepatitis
120
Chlamydia - presentation - Dx - Tx - complications
Intracellular obligate parasites Presentation: - Urethritis - FHC syndrome - PID - asymptomatic - mucoid dicharge Dx: - chlamydia cx Tx: - azithromycin or doxy - erythromycin for preggers - test and tx all sex partners Complications - fitz hugh curtis - salpingitis
121
Trichomoniasis - presentation - Dx - Tx - complications
Trichomonas vaginalis (protozoa) Presentation: - pruritus - foul smelling vaginal d/c - males usually no sx - strawberry cervix Dx - motile protozoan on wet mount Tx: - metronidazole Complications: - premature rupture of membranes, LBW infants, infertility - epididymitis, prostatic involvement, penile ulceration
122
Herpes - presentation - Dx - Tx - complications
Double stranded Enveloped DNA virus HSV2 is more genital HSV1 is more lips Presentation: - fever - dysuria - ulcers - regional adenopathy Dx: - Tzanck stain (multinuclear giant cells + intranuclear inclusions) Tx: - acyclovir - valacyclovir Complications: - risk factor for HIV - perinatal transmission
123
Pupura fulminans
Life threatening condition Seen w/ bacteria infections - N. meningitidis - strep pneumo P/w blue or black hemorrhagic purpuric lesions
124
Types of Croup
spasmodic croup (recurrent croup) - type of croup that develops quickly and may happen in a child with a mild cold. - The barking cough usually begins at night and is not accompanied by fever. - Spasmodic croup has a tendency to come back again (recur). - those who are prone to spasmodic croup often still develop the disease into late childhood and even into adulthood vs infectious... laryngotracheitis (viral croup) laryngotracheobronchitis (viral) laryngotracheobronchopneumonitis (bacterial)
125
Tx croup
Supportive Steroids, racemic epi prn
126
Risk to fetus if mom gets parvovirus
Hydrous fetalis This is generalized edema High output congestive failure due to aplastic anemia causes edema
127
New dx of rhemumatic fever - waht do you do?
Tx w/ anx to eradicate GAS regardless of presence or absence of pharyngitis at time of dx
128
When do you ppx w/ abx in pts w/ hx of rheumatic fever against recurrent GAS pharyngitis?
IM penicillin G q4 weeks Rheumatic fever 1/o carditis - ppx 5 years or utnil 21 yo (whichever longer) Rheumatic fever w/ carditis but no residual heart or valvular dz by clinical or echo criteria - ppx 10 years or until 21 yo (whichever longer) Rheumatic fever w/ carditis + persistent heart or valvular dz - ppx 10 years or until 40 yo whichever is longer
129
Tx enterobium vermicularis
Mebendazole
130
Seizure causing pathogens
HHV 6 Shigella
131
Tx listeria
Ampicillin
132
#1 cause of sepsis in < 1 mo
Group B strep
133
Blood in CSF + encephalitis...what do you suspect?
HSV
134
Tx pasturella multocida
Augmentin If allergy --> clinda
135
Parinaud's Oculoglandular syndrome associated with...
Bartonella henselae Is is a combo of granulomatous conjunctivitis in one eye, and swollen lymph nodes in front of the ear on the same side
136
When do you follow up on elevated LFTs in EBV?
1-2 weeks If still elevated (usually is transient), trend out
137
Tx Rickettsia
Doxycycline no matter how old the patient
138
Pathogen giving you anuria + diarrhea
E. coli O157:H7 - HUS - Enterohemorrhagic diarrhea
139
Follicles + inflammatory changes in conjunctiva of eye Neovascularization in cornea Immigrant
Trachoma 2/2 C. trachomatis serotype A-C Can also cause nasal discharge as it moves Tx: Topical tetracycline or oral azithromycin
140
Cholesteatomas
Can be congenital or aquired 2/2 chronic middle ear dz New onset hearing loss or chronic ear drainage despite abx are typical presenting sx Granulation tissue and skin debris may be seen within retraction pockets of TM on otoscopy
141
1 predisposing factor for acute bacterial sinusitis
Viral URI
142
Tx minor cat bite wounds
Amoxicillin/clavulanate Pasturella!
143
Tx bacterial menigitis in infants and children > 1 mo
IV vanco + ceftriaxone/cefotaxime - vanco for s. pneumo - ceftriaxone for neisseria Consider dexamethasone for Hib
144
Tx GBS + mothers
2 doses ampicillin 4 hrs before birth
145
TB meningitis CT with contrast finding
CT with contrast is good for dx! Exudate in basal cisterns that shows enhancement by contrast material is typical
146
Leptospirosis
#1 zoonotic infection worldwide Often mild or subacute Hx exposure to dogs, cats, levestock 2 phases: anicteric and icteric Can have meningitic sx Tx: - PCN - tetracycline

Pediatrics (17 decks)

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