Infectious Disease Flashcards
0
Q
What patient population is at increased risk for Staph aureus brain abscesses in children?
A
Cyanotic Congenital heart disease
1
Q
At what age you you start using doxycycline?
A
8
2
Q
What type of pneumonia is associated with increased risk of staph aerues emphyema?
A
Strep pneumoniae pneumonia
3
Q
What typical infection/situation can be a set up of Strep pyogenes toxic shock syndrome in children?
A
Post op with the chicken pox
4
Q
What infection causes neonatal rash called granulomatosis infantisepticum?
A
Listeria
Erythematous rash with papules
5
Q
What are risk factors for strep pneumoniae infection?
A
- Asplenia
- Very young and very old
- Hypogammaglobulinemia
- HIV
- Cochlear implants
- Alaskan natives
6
Q
What is syndrome seen with S. Pyogenes, toddler, purulent nasal discharge and pharyngitis?
A
Streptococcosis
7
Q
What timeframe do you need to start antibiotics in strep infection to alleviate risk for rheumatic fever?
A
9 days
8
Q
What are Pastia lines?
A
Scarlet fever rash lines in flexor surfaces in antecubital fossa -pathognomonic
9
Q
What post strep complication is seen with impetigo/cellulitis?
A
Post strep GN
NOT rheumatic fever
10
Q
What recurrent infection is a risk factor for development of necrotizing fasciitis in children?
A
Varicella
11
Q
When do you prophylactically treat household members with post strep rheumatic fever or GN?
A
If household contact > 65 yo with other risk factors for invasive disease like HIV, DM, varicella, chemotherapy
12
Q
What is the timeframe for early GBS disease in neonates?
A
Birth to 7 days
13
Q
What is timeframe for late GBS disease?
A
7 days to 3 months
14
Q
What is initial treatment of group B strep disease?
A
Penicillin plus aminoglycoside
15
Q
What type of disease does group C strep cause?
A
Pharyngitis in college students
16
Q
What is initial treatment for enterococcus?
A
Vancomycin or penicillin/ampicillin plus aminoglycoside
17
Q
What shaped organism is Listeria?
A
Gram positive rod but can look like a diphtheroid
18
Q
What is treatment of Listeria?
A
Ampicillin plus aminoglycoside of severe infection
19
Q
What is cardiac complication which is seen with diphtheria?
A
Myocarditis
20
Q
What is treatment of diphtheria?
A
Erythromycin plus antitoxin
21
Q
What is first antibiotic for anthrax?
A
Ciprofloxacin or doxycycline
22
Q
What patients have risk for clostridium septicum infection?
A
Underlying GI malignancy
23
Q
What age group should you NOT send C. Difficle culture due to it being a common colonizer?
A
24
What is treatment for gas gangrene and C. Perfingens?
Penicillin
25
What cultural practice can predispose an infant to neonatal tetanus?
Placing manure on umbilical stump
26
What is treatment of tetanus?
Tetanus immunoglobulin plus flagyl
27
What brain infection does citrobacter cause?
Brain abscess
28
At what age do you start giving Tdap over Dtap?
7 years old
29
Which patients require prophylaxis for exposure to Neisseria meningitidis?
Household, close contacts within past 7 days, airplane flight > 8 hrs if seated directly next to patient
30
How old can you start to vaccinate children with MCV4 if they are high risk?
Age 2 -boost every 5 years
31
Which healthcare workers need abx prophylaxis if exposed to child with meningococcemia?
Only if exposed to oral secretions like intubating child
32
What timeframe after birth do you mostly seen gonorrhea ophthalmia?
2-7 days
33
What timeframe after birth do you seen chlamydia eye infection?
7-14 days
34
What is treatment of gonorrheal ophthalmia?
Ceftiaxone 50mg/kg IM x 1 but needs eval for sepsis
35
Who requires chemoprophylaxis for exposure to pertussis?
All household/close contacts
36
What is ecthyma gangrenosum?
Round indurated black lesion cause by pseudomonas - risk of neutropenic patient with typhlitis
37
When do you give antibiotics for treatment of Salmonella?
Child < 3 months
| Immunocompromised patients
38
What location does salmonella typhi like to seed?
Gallstones
39
What skin finding is seen in salmonella typhi?
Rose spots on trunk- look like small angiomas
40
Which diarrheal organisms has common complications of rectal prolapse or seizures?
Shigella
41
What are best treatment of shigella in kids?
Ceftriaxone
Cipro if older than 18
Azithromycin
42
When can a child with shigella return to daycare?
Diarrhea resolved and stool studies negative
43
Which bacterial cause of pneumonia has a "pleomorphic" appearance?
Haemophilus influenzae
44
What is the most common cause of bacterial periorbital cellulitis in children?
Pneumococcus
45
Who do you give antibiotic prophylaxis to if exposed to INVASIVE stains of H. Flu?
Rifampin 20mg/kg daily x 4 days to all household contacts and daycare attendees
46
What organism is common cause of culture negative endocarditis?
Brucellosis
47
What infection does Kingella typically cause?
Osteomyelitis in child
48
Which bacteria is associated with chitterlings?
Yersinia enterolitica
49
What rickettsia disease is associated with slaughter houses?
Q fever
| Or cats/cattle birthing products
50
What states is erlichiolisis mostly in?
Texas
Oklahoma
Missouri
Arkansas
51
What states is anaplasmosis mostly in?
Northeast
| Midwest
52
What is bacteria associated with lemierre disease?
Fusobacterium
53
How do you treat lymphadenitis cause by mycobacteria avium intracellularae?
Excision
54
What is the most common extrapulmonary manifestation of TB in children?
Lymph node involvement
TB usually bilateral
Atypical mycobacterium unilateral
55
What age group does a PPD of 10 mm equal a positive result?
56
What do you treat kids with for latent TB of isoniazid intolerant?
Rifampin x 6 months
57
Negri bodies in cytoplasm of neurons is pathognomonic for what disease?
Rabies
58
When can only 3 drug regimen (rifampin, INH, PZA) be given?
New TB pt with
59
```
What organism is:
Weakly acid fast
Branching, beaded filamentous shape
Causes thin walled cavitary lesions in lungs
Focal brain abscesses
Neutrophilic chronic meningitis
```
Nocardia
60
```
What organism is:
Microaerophilic or facultative anaerobe
Has yellow "sulfur" granules
Usual presentation is cervicofacial involvement following dental infection
Can cause PID if IUD in place
```
Actinomyces
61
What are the most common organisms that cause infections in patients with CGD?
```
Staphylococcus
Salmonella
Serratia
Burkholderia
Asperguillosis
```
62
What causes Weil Disease?
Leptospirosis
63
What do you test for leptospirosis?
Blood culture or urine culture (positive longer)
64
What is treatment of leptospirosis?
Penicillin or doxycycline
65
What is best sequence of testing for Lyme disease?
ELISA then confirm with western blot
66
What is a heart complication of Chagas' disease?
Heart block
Myocarditis
CHF
67
What HLA is associated with poor responders to abx treatment for Lyme disease?
HLA DR4
68
```
What condition is associated with:
Chronic oral and facial rash
Alopecia
Esophageal stricture
Occasionally hypothyroidism/Addison disease/DM/vitiligo/hypothyroidism
```
Chronic mucocutaneous candidiasis
68
At what age is it uncommon to have thrush in infant and should prompt consideration of other immunodeficiency?
>5 months
70
What congenital infection has 4-10x greater risk of developing IDDM?
Rubella
71
What other complications of candidal fungemia need to be checked for if positive blood culture with candida?
Retina exam- chorioretinitis
Renal fungal balls
Hepatic infiltration
72
What are 3 deadly syndromes associated with candidemia?
1. Septic peripheral thrombophlebitis
2. Septic thrombosis of great veins
3. Hepatosplenic candidiasis
73
What infection causes "cannon ball" skin lesions?
Cryptococcous
74
What is seen on India ink stain if positive for cryptococcous?
Large "halo" due to thick capsule
75
What is treatment of choice for CNS coccidiomycosis?
Fluconazole
76
```
What organism causes the following:
Interstitial pneumonia
Splenomegaly
Palate ulcers
Anemia, neutropenia or thrombocytopenia
```
Histoplasmosis
77
What organism causes disease in loggers or hunters in Arkansas or Wisconsin?
Blastomycosis
78
What fungus has a "spaghetti and meatball" appearance on skin scraping?
Malassezia furfur
79
What two disease entities does malassezia furfur cause?
1. tinea versicolor
| 2. Bilateral interstitial pulmonary infiltrates in NICU babies on TPN and lipids (needs olive oil to grow in lab)
83
What are the 4 forms on sporotrichosis?
1. Cutaneous form
2. Lymphatic form
3. Pulmonary
4. Disseminated
84
What does a positive IgG VCA antibody mean in EBV infection?
That they have been exposed at some point in their life. Does not help with acute or past infection. If the only antibody positive is this one it does mean they are in convalescent period
85
What is treatment of sporotrichosis?
Cutaneous/lymphatic - oral potassium iodide or itraconazole
| Pulmonary/disseminated - amphoB or itraconazole
87
What is the treatment of congenital toxoplasmosis?
Pyrimethamine, sulfadiazine, leucovorin x 12 months
89
What is antifungal for mucormycosis?
AmphoB or posaconazole
90
What infection in pregnancy can cause
- mental retardation
- chorioretinitis/retinochoroiditis
- microcephaly
- hydrocephalus
- HSM
- cerebral calcifications
- TTP
Congenital toxoplasmosis
91
What are two treatments for chloroquine resistant P. falciparum?
1. Mefloquine
| 2. Pyrimethamine/sulfadoxine
92
What blood disorder do you need to screen for prior to starting primaquine?
G6PD deficiency - can get hemolytic anemia
93
What is main malaria prophylaxis for chloroquine resistant areas?
Mefloquine
Doxycycline
Atovaquone/proguanil
94
How long should you take malarial prophylaxis in relation to traveling?
1-2 weeks prior to arrival to endemic area and 4-6 weeks after leaving
95
What organism causes major outbreaks of diarrhea in Wisconsin associated with swimming pools/ contaminated city water?
Cryptosporidium
96
What is the treatment of diarrhea caused by Isospora belli?
TMP/SMX
97
What organism causes diarrhea with raspberries from Guatemala?
Cyclospora
98
Which type of malaria is most commonly associated with nephrotic syndrome?
P. malariae
99
What medication helps eradicate the hypnozoites (causes relapses) from the liver in P. ovale and P. Vivax infections?
Primaquine
100
What are Osler nodes?
Tender nodules on palms finger tips and soles associated with endocarditis
100
What are Osler nodes?
Tender nodules on palms finger tips and soles associated with endocarditis
102
What is the 2nd most common infectious cause of HUS after E. coli O157:H7?
S. pneumoniae
103
What trimester is congenital toxoplasmosis cause the most severe infection?
1st
104
What organism can be mistaken for malaria and more common in asplenia patients?
Babesia
105
What is the treatment of babesia?
Clindamycin and quinine
106
How do you diagnosis a liver ameba abscess?
Serology. Aspirate usually does not show organisms
107
What are drugs used to treat Giardia?
Metronidazole
Tinidazole
Nitrazoxanide
108
What is Romana sign in Chagas' disease?
Unilateral firm edema of the eyelids
109
What worm infestation can cause a Loeffler syndrome (eosinophilic hypersensitivity reaction in lungs)?
Ascaris
110
Which worm infection can often cause rectal prolapse?
Whipworm (trichuriasis trichiura)
111
```
What congenital infections presents with:
Blueberry muffin baby
Cataracts/glaucoma
Sensorineural deafness
Cardiac defect
Radiolucencies in long bones
HSM
Bulging anterior fonts belle
Hemolytic anemia
```
Congenital rubella
112
Which is the only helminthic infection that DOES replicate in the body?
Strongyloides
113
What organism causes Chagas' disease?
T cruzi
114
What organism causes elephantiasis (lymphatic filariasis)?
Wuchereria bancrofti
115
What is larva currens?
Serpiginous rash with erythematous tracks caused by strongyloides infection
116
What causes VISCERAL larva migrans?
Toxocariasis
117
What organism can cause
- migratory pneumonia
- hypergammaglobulinemia
- eosinophilia
- fever
- HSM
Toxocara canis
118
What form of Taenia solium is ingested to get an intestinal tapeworm?
Cysticerci
119
What form of Taenia solium is ingested causes cysticercosis/neurocyctercerosis?
Egg
120
What organism is the common cause of tapeworm in humans?
T. saginata - beef tapeworm
121
What is preferred treatment of intestinal tapeworms?
Praziquantal
122
What causes katayama fever?
Schistosomiasis
123
What is the most serious complication that can occur with schistomatosis?
Cirrhosis/esophageal varices
125
What is treatment of schistomatosis?
Praziquantel for 1 day!
126
What is drug of choice for acyclovir resistant HSV?
Foscarnet
128
How long are children with chickenpox contagious?
Until all lesions crusted over
| If in hospital for 21 days or 28 if VariZIG given
129
What is the most common complication of chicken pox?
Secondary bacterial infections of the skin
130
What is most common CNS complication of chicken pox?
Cerebellar ataxia and encephalitis
131
What congenital infection presents with
- cicatricial skin scarring
- limb atrophy
- cortical atrophy
- seizures
- chorioretinitis
- neurologic defects
Congenital varicella
132
What is prophylaxis for maternal/pregnant woman exposed to varicella?
VariZIG within 4 days of exposure
| NOT vaccine as it is live
133
What organism is common with:
Meningitis
7th nerve palsy
Foot drop
Lyme
134
What pts need VariZIG if exposed?
1. Immunocompromised
2. Pregnant
3. Newborns whose mothers develop varicella
135
What organism is common with:
Meningitis
7th nerve palsy
Foot drop
Lyme
136
What fluke can cause biliary obstruction?
Clonorchis sinensis
137
What antivirals decrease the chance of post hermetic neuralgia?
Famciclovir
| Valacyclovir
138
What is another name for HHV5?
CMV
139
Which HIV drug is most likely the cause of a macrocytosis?
AZT
140
What infection is increased if you give ibuprofen to kids with chicken pox?
S pyogenes
141
What congenital infection has
- HSM
- IUGR
- jaundice
- blueberry muffin baby
- microcephaly
- chorioretinitis
- sensorineural hearing loss
- periventricular intracranial calcifications
CMV
142
What causes heterophile negative mononucleosis like syndrome?
CMV
143
Which antibiotics bind IRreversibly to 30S subunit to work?
Amino-glycoside
144
What is seen in biopsy specimen if CMV pneumonitis?
Inclusion bodies
146
Which antibiotics bind IRreversibly to 30S subunit to work?
Amino-glycoside
147
How long should people avoid contact sports after EBV infection?
1-3 months
148
Which HIV is associated with kidney stones?
Indinavir
149
What does the EBNA+ mean with EBV infection?
Convalescent or post EBV infection.
150
What does a patient likely have if they have mononucleosis symptoms but heterophile negative?
CMV
151
What virus causes Forchheimer spots (pinpoint red spots on soft palate)?
Rubella
152
Which HIV is associated with kidney stones?
Indinavir
153
Which enterovirus is most responsible for herpangina?
Coxsackie A
154
What viruses have giant multinucleated cells in Tzanck smear?
HSV
| VZV
155
What virus is classically associated with post auricular lymphadenopathy, macular rash that starts on face that spreads to neck then trunk then arms then legs?
Rubella
157
What are the three C's of measles?
Coryza
Conjunctivitis
Cough
158
What vitamin deficiency causes worsening measles infection?
Vitamin A
159
Do Koplik spots occur before after the rash of measles?
2-3 days before
160
Where does measles rash start?
Hairline and spreads downward
161
Within how many days of exposure to measles can you give IVIG ?
6
162
What are 3 types of pneumonia that can complicate influenza?
1. Viral bronchopneumonia
2. Secondary bacterial
3. Diffuse viral hemorrhagic alveolitis
163
What is a severe neurologic complication of congenital rubella?
Progressive rubella Panencephalitis - presents 2nd decade of life
164
Which serotypes of adenovirus are most likely to cause severe infections?
3, 7, 21
165
What is contraindication to using zanamivir for influenza?
Chronic lung disease or asthma
166
If an epidemic of influenza A or B threatens an unimmunized nursing or children's home, who should receive zanamivir?
Entire population. Also give all the flu shot
167
What age do you stop giving a 2 shot series for first time immunization against influenza?
9 yo
168
What is a potential liver complication of congenital coxsakievirus B?
Hepatic necrosis
169
What is the typical paralysis caused by polio?
Asymmetric
Flaccid
NO reflexes
Descending
170
How do you diagnose rabies?
Biopsy of nerves in nape of neck
| Also available is PCR of saliva, CSF and blood
171
What is treatment of possible rabies exposure?
```
Rabies IVIG (RIG) and vaccinate
Infiltrate wound with RIG and administer the rest IM
```
172
Who should get pre exposure prophylaxis for rabies?
Veterinarians or cave explorers
173
What are common complications of mumps?
1. Deafness
2. Sterility
3. Mastitis
174
What is possible complication of Parvovirus B19 infection in pregnancy?
Fetal hydrops
175
What are Roth spots?
Pale retinal lesions with surrounding hemorrhage
| Endocarditis
176
What is best was to diagnosis an acute infection of parvovirus?
IgM
177
Where is hantavirus most prevalent?
Western and southwest US
178
What is reservoir for hantavirus?
Deer mouse
179
What virus classically has a "saddleback" fever?
Dengue
180
What are Roth spots?
Pale retinal lesions with surrounding hemorrhage
| Endocarditis
181
What is a rare form of encephalopathy thought related to measles virus?
Subacute sclerosing panencephalitis
182
Are immunoglobulin levels in AIDS increased or decreased?
Increased
183
What is the earlier detectable level for HIV transmission in newborn?
HIV DNA by PCR
184
How can you determine if a child was NOT infected by HIV?
3 negative HIV DNA PCR testings with the last one > 4 months of age
185
What are 2 major side effects of didanosine?
1. Pancreatitis
| 2. Peripheral neuropathy
186
What are major side effects of protease inhibitors?
Lipodystrophy
| Diabetes development
187
When do you institute HAART therapy in children?
1. AIDS defining illness
| 2. CD4
188
What is standard post exposure prophylaxis for needle stick injuries?
ZDV, lamivudine, lopinavir/ritonavir
189
What is the threshold for starting PCP prophylaxis in HIV in children?
All HIV positive 6 yo
190
What is potentially fatal side effect of abacavir?
Hypersensitivity reaction
191
Which abx bond REVERSIBLY to 30S subunit to function?
Tetracyclines
192
What criteria do you need to add corticosteroids to treat PCP PNA?
PaO2 35
193
What is possible GI side effect of recurrent courses of pentamidine?
Islet cell destruction causing irreversible hypoglycemia
194
```
What infection is associated with:
HIV +
Palate ulcers
Splenomegaly
Bone marrow suppression
Interstitial pneumonia
```
Histoplasmosis
195
When can you stop PCP prophylaxis is AIDS patients?
CD4 > 200 for at least 3 months
196
What HIV drug is teratogenic?
Efavirenz
197
When can you stop MAC prophylaxis in AIDS patients?
CD4 >100 for 3 months
198
What is most common organism to cause endocarditis of a prosthetic valve?
S epidermidis
199
Which meningococcal strain causes most meningitis cases?
B
200
What organism should you consider in:
Meningitis
Swimming in brackish water (cow ponds)
Amebic meningitis
201
What is diagnosis of choice for neurosyphilis?
CSF-VRDL
202
What is treatment of ETEC diarrhea?
Azithromycin or Ciprofloxacin
203
Which adenovirus subtypes are associated with diarrhea?
40 and 41
204
Which diarrheal illness is prolonged with antibiotics?
Salmonella
205
What infections is ampicillin still the drug of choice?
Listeria
Enterococcus
Salmonella
206
Which carbapenum lowers seizure threshold?
Imipenum
207
Which carbapenum is NOT effective against pseudomonas?
Ertapenum
208
What is an acute renal complication of acyclovir?
IV form can Precipitate in renal tubules and cause renal failure
209
What antibiotic must be avoided in 3rd trimester of pregnancy secondary to increase risk of kernicterus?
Bactrim
210
Which antibiotics block DNA gyrase of bacteria?
Quinolones
211
What organism is associated with
Meningitis
6th nerve palsy
Basilar enhancemt on head CT
TB
212
Where do Janeway lesions present with endocarditis?
Palms and soles
213
What are two major side effects of zidovudine or AZT?
Bone marrow suppression
| Myopathy
214
If a child wakes up and there had been a bat in the room do they need rabies prophylaxis?
Yes
215
What immunodeficiency is associated with more severe CNS consequences of enteroviral meningitis?
Agammaglobulinemia
216
What are major side effects of protease inhibitors?
Lipodystrophy
| Diabetes development
217
When do you institute HAART therapy in children?
1. AIDS defining illness
| 2. CD4
218
What is standard post exposure prophylaxis for needle stick injuries?
ZDV, lamivudine, lopinavir/ritonavir
219
What is the threshold for starting PCP prophylaxis in HIV in children?
All HIV positive 6 yo
220
What are 5 types of syndromes caused by adenovirus?
1. Pharyngoconjunctivitis
2. Epidemic keratoconjunctivitis
3. Diarrhea
4. Acute hemorrhagic cystitis
5. Meningoencephalitis
221
What HIV drugs have an increased risk of lactic acidosis in pregnant women?
Stavudine/zalcitabine combo
222
Which abx bond REVERSIBLY to 30S subunit to function?
Tetracyclines
223
What criteria do you need to add corticosteroids to treat PCP PNA?
PaO2 35
224
What is possible GI side effect of recurrent courses of pentamidine?
Islet cell destruction causing irreversible hypoglycemia
225
```
What infection is associated with:
HIV +
Palate ulcers
Splenomegaly
Bone marrow suppression
Interstitial pneumonia
```
Histoplasmosis
226
When can you stop PCP prophylaxis is AIDS patients?
CD4 > 200 for at least 3 months
227
Which trimester is most likely to cause defects if congenital rubella occurs?
1st
228
When can you stop MAC prophylaxis in AIDS patients?
CD4 >100 for 3 months
229
What is most common organism to cause endocarditis of a prosthetic valve?
S epidermidis
230
Which meningococcal strain causes most meningitis cases?
B
231
What organism should you consider in:
Meningitis
Swimming in brackish water (cow ponds)
Amebic meningitis
232
What is diagnosis of choice for neurosyphilis?
CSF-VRDL
233
What is treatment of ETEC diarrhea?
Azithromycin or Ciprofloxacin
234
Which adenovirus subtypes are associated with diarrhea?
40 and 41
235
Which diarrheal illness is prolonged with antibiotics?
Salmonella
236
What infections is ampicillin still the drug of choice?
Listeria
Enterococcus
Salmonella
237
Which carbapenum lowers seizure threshold?
Imipenum
238
Which carbapenum is NOT effective against pseudomonas?
Ertapenum
239
What is an acute renal complication of acyclovir?
IV form can Precipitate in renal tubules and cause renal failure
240
What antibiotic must be avoided in 3rd trimester of pregnancy secondary to increase risk of kernicterus?
Bactrim
241
Which antibiotics block DNA gyrase of bacteria?
Quinolones
242
What organism is associated with
Meningitis
6th nerve palsy
Basilar enhancemt on head CT
TB
243
Where do Janeway lesions present with endocarditis?
Palms and soles
244
What virus causes exanthem subitum (roseola infantum)?
HHV6
| Sixth disease
246
What antimalarial agent is plasmodium falciparum almost universally resistant to?
Chloroquine
252
What HIV drugs have an increased risk of lactic acidosis in pregnant women?
Stavudine/zalcitabine combo
253
Which organism causes cutaneous larva migrans?
Hookworm (necator americanus)
274
What meat is trichinosis usually caused by?
Pork
275
What is classic triad for legionella?
Pneumonia
Diarrhea
CNS symptoms (headache, confusion)
276
What is a positive PPD in children
10 mm
277
What organism is associated with PID in adolescents with an IUD?
Actinomyces
278
What organism is associated with pneumonia with a staccato cough in a neonate?
Chlamydia trachomatis
279
What kind of mouth finding can help differentiate between histoplasmosis and C. Psittaci infections?
Palatal ulcers in histoplasmosis
280
What type of bacteremia is common in iron overload states?
Yersinia enterocolitica
