Infectious Disease Flashcards

1
Q

Presentation of Otitis Media

A
Fever
Cranky
Congestion
Pulling at ear
Irritable
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2
Q

Risk Factors in Otitis Media

A

Caretaker smoking
Bottle propping
Day-care attendance

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3
Q

Most Common Bugs in OM

A

Strep pneumo
H. influenza
M. catarrhalis

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4
Q

Treatment of OM

A

Amoxicillin
Ceftriaxone- IM
Azithromycin- flavored, low maintenance
Augmentin

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5
Q

Complications of OM

A
Mastoiditis
Cavernous sinus thrombosis
Meningitis
Brain abscess
Scarring of the structures of the middle ear
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6
Q

Define Otitis Externa

A

Inflammation of the external auditory canal or auricle

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7
Q

Causes of Otitis Externa

A

Infectious
Allergic
Dermal disease

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8
Q

Risk Factors for Otitis Externa

A
Swimming
Humid environments
Sticking things in ear to clean
Allergic eczema
Immunocompromised
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9
Q

Bacterial Culprits in Otitis Externa

A

Staph aureus
Pseudomonas aeruginosa
Proteus

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10
Q

Signs/Symptoms of Otitis Externa

A
Otalgia
Tragus pain
Pain when auricle is pulled
Pruritis
Discharge
Hearing loss
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11
Q

Otoscopic Exam of a Patient with Otitis Externa

A

Edematous & erythematous ear canal
Yellow, brown, white, or grey debris
No middle ear fluid
TM should be mobile

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12
Q

Treatment of Otitis Externa

A

Cleaning of ear canal
Protect ear canal from water
Treatment of inflammation & infection

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13
Q

Treatment of Otitis Externa if TM Intact

A

Cortisporin
Cipro HC
Tobradex

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14
Q

Sore Throat

A

Inflammation or infection of the tonsils, uvula, soft palate, and posterior oropharynx

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15
Q

Viral Sore Throat Symptoms

A
Coughing
Sneezing
Dripping
Fatigue
Anorexia
Abdominal pain
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16
Q

Strep Sore Throat Symptoms

A
Toxic sensation
Muscle aches
Beefy red tonsils with exudate
Uvulitis
Plaques
Exudates
Anterior cervical lymphadenopathy
Fever
Headache
Abdominal pain
Strawberry tongue
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17
Q

Pharyngitis/Tonsillitis

A

Common in older children
Viruses
Strep pyogenes (Group A beta-hemolytic strep)

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18
Q

Complications of Pharyngitis/Tonsillitis

A

Rheumatic heart disease
Scarlet fever
Glomerulonephritis

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19
Q

How soon does Pharyngitis/Tonsillitis need to be treated?

A

Within 10 days

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20
Q

Treatment of Group A Beta-Hemolytic Strep

A

Penicillin VK
Cephalosporin
Clarithromycin
Macrolide

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21
Q

Which viruses present with beefy red tonsils plus exudate?

A

EBV
Coxsackie virus
Enterovirus
Beefreddytonsilovirus

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22
Q

EBV (Mononucleosis)

A
Malaise
Beefy red tonsils
Exudate
Diffuse lymphadenopathy
Splenomegaly
AFEBRILE
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23
Q

Diagnostics of EBV

A

Monospot- heterophile antibody testing

CBC

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24
Q

Management of EBV

A

Education

No contact sports 6-8 weeks

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25
Herpangina Culprit
Enterovirus
26
Signs/Symptoms of Herpangina
High fever Small ulcers on erythematous base on tonsillar pillars Soft palate Uvula
27
Treatment of Herpangina
Acyclovir
28
Hand, Foot, & Mouth Disease Culprit
Coxsackie virus
29
Sings/Symptoms of Hand, Foot, & Mouth Disease
Vesicles/red papules on tongue, oral mucosa, hands, & feet Mild fever Malaise
30
Sore Throat Serious Infections
Peritonsillar abscess Retropharyngeal abscess Epiglottitis
31
Treatment of Peritonsillar Abscesses
IV antibiotics | Surgical drainage
32
Signs/Symptoms of Epiglottitis
``` High fever Sore throat Stridor Drooling Respiratory distress ```
33
Main Signs of Aphthous Stomatitis (Canker Sore)
Small ulcers on the insides of lips or elsewhere in the mouth
34
Management of Aphthous Stomatitis (Canker Sore)
Topical preparations
35
Gingivostomatitis Culprit
Herpes Simplex
36
Signs/Symptoms of Gingivostomatitis
Ulcers Fever Tender cervical lymphadenopathy
37
Where can ulcers occur for gingivostomatitis?
``` Buccal mucosa Anterior pillars Inner lips Tongue Gingiva ```
38
Management of Gingivostomatitis
Topical preparations
39
Treatment of Gingivostomatitis
Early: Acyclovir
40
Who does oral candidiasis (thrush) affect most?
Infants Older children Patients with broad spectrum antibiotics or steroids
41
Symptoms of Oral Candidiasis (Thrush)
Mouth soreness Refusal of feedings Curd-like plaques on buccal mucosa
42
Treatment of Oral Candidiasis (Thrush)
Nystatin oral suspension | Sterilize pacifiers
43
Pathophysiology of Sinusitis
Mucociliary clearance & drainage are impaired by a URI or allergic rhinitis or obstruction from some other cause
44
Signs/Symptoms of Sinusitis
``` Persistent symptoms Worsening symptoms following stability Facial pain Maxillary teeth pain Malodorous breat ```
45
Treatment of Sinusitis
Augmentin | Amoxicillin
46
Define Croup (Laryngotracheobronchitis)
Infection causing inflammation of the larynx trachea and bronchi
47
Croup Culprits
Parainfluenza virus RSV Influenza Adenovirus
48
Key Features of Croup
URI symptoms Barking cough Stridor Low grade fever
49
Treatment of Croup
``` Steroids Supportive therapy Hydration Minimal handling Mist therapy Cold air Oxygen Racemic epi ```
50
Sings/Symptoms of Epiglottits
``` Fever Dysphagia Drooling "Hot potato" voice Inspiratory retractions Soft stridor ```
51
Signature Croup Sign
Steeple sign
52
Signature Epiglottis Sign
Thumb print
53
Treatment for Epiglottitis
Ceftriaxone Clindamycin Steroids Aminoglycosides
54
Presentation of Mumps
``` Parotid gland sweeling Aseptic meningitis Transietn pancreatitis Orchitis/oophoritis Epididymitis ```
55
Treatment of Mumps
Supportive
56
Four Keys with Group A Beta-Hemolytic Strep
Fever Severe sore throat Tender anterior cervical adenopathy ABSENCE OF URI SYMPTOMS
57
Define Kawasaki Disease
Vasculitis of unknown etiology affecting medium sized arteries
58
Lab Results for Kawasaki Disease
Hypoalbunemia Thrombocytosis Elevated ESR
59
Sings/Symptoms of Kawasaki Disease
``` Fever 5+ days Rash Mucous membrane involvement Unilateral cervical adenopathy Nonpurulent bilateral conjunctivitis Swollen hands & feet Strawberry tongue Vascular aneurysms Abdominal pain Swollen, reddened joints ```
60
Complications of Kawasaki Disease
``` Coronary vasculitis Aneurysm formation Arrhythmias Infarction CHF Death ```
61
Treatment of Kawasaki Disease
High dose aspirin | IVIG
62
Signs/Symptoms of Rubeola (Measles)
``` High fever Dry cough Rhinitis Conjunctivitis with clear discharge Distinctive rash Koplik spots ```
63
How does rash present?
Head to toe
64
Why do we vaccinate against Rubella (German Measles)?
Pregnant women | Congenital rubella syndrome
65
Signs/Symptoms of Rubella (German Measles)
``` Rash Low-grade fever Malaise URI symptoms Lymphadenopathy ```
66
Complications of Rubella (German Measles)
Arthritis | Arthralgia
67
Diagnostics of Rubella (German Measles)
Serum IgM
68
Congenital Manifestations of Rubella (German Measles)
``` Hearing loss Cardiac Cerebral Blueberry muffin rash Growth retardation ```
69
Roseola Culprit
HHV-6
70
Sign/Symptoms of Roseola
High fever | Rash after fever
71
Other Names for Fifth Disease
Erythema infectious | Slapped cheeck disease
72
Fifth Disease Culprit
Parvovirus B19
73
Signs/Symptoms of Fifth Disease
Low-grade fever URI symptoms Mild malaise
74
Definition of Rash in Fifth Disease
``` Flat Lacy Reticular Pruritic On cheeks, trunk, extremities ```
75
Define Varicella (Chickenpox)
Pruritic vesicular rash beginning on face, neck, upper trunk
76
Symptoms of Varicella (Chickenpox)
Fever Malaise Hx of contact with another infected person Lesions
77
What are the lesions described as?
Dew drop on a rose petal
78
Management of Varicella (Chickenpox)
Supportive | Acyclovir- immunocompromised patients
79
First Sign of Pityriasis Rosea
Herald patch
80
Other Signs of Pityriasis Rosea
Lesions appear around herald patch | "Christmas tree" appearance
81
Define Bronchiolitis
Inflammatory process of the smaller lower airways
82
Presentation of Bronchiolitis
Fever URI symptoms Tachypnea Wheezing
83
Management of Bronchiolitis
Supportive care
84
Viruses which cause Bronchiolitis
RSV Adenovirus Parainfluenza virus
85
IM Monoclonal Antibody for Prophylaxis against RSV?
Palivizumab (Synagis)
86
Symptoms of Bronchitis
URI symptoms Cough Malaise
87
Prodrome of Pneumonia in Children
``` Rhinorrhea Cough Low-grade fever Pharyngitis Tachypnea ```
88
Bacteria Pneumonia Symptoms
``` High fever Cough Chest pain Shaking chills Tachypnea ```
89
Treatment Considerations for Pneumonia
``` Antibiotics Bronchodilators Steroids Fluids Oxygen therapy ```
90
Course of Pertussis (Whooping Cough)
URI symptoms Slight fever Cough (becomes whoop)
91
Guidelines for Diagnosis
Immunization status Classic presentation Cough >2 weeks Nasal swab for culture
92
Treatment of Pertussis (Whooping cough)
Erythromycin (14 days) | Azithromycin (5-7 days)
93
Bronchiectasis Characterized by:
Abnormal dilation and distortion of the bronchial tree
94
Who is Bronchiectasis Common in?
CF patients
95
Two Key Factors in Bronchiectasis
Infectious insult Impaired mucus clearance Impaired airway obstruction Defect in host defense
96
Define Fever of Unknown Origin
High fever or high temperature and defined as a rectal temp that exceeds 101 for 8 consecutive days
97
Common Causes of Fever of Unknown Origin
Infections disease: drugs, fictitious, CNS dysfunction Connective tissues disorders Neoplasms: leukemia, lymphomas
98
Common Bacteria that could Cause Serious Bacterial Infections
``` S. pneumo Meningitidis HiB E. coli Salmonella ```
99
Important for History of Fever of Unknown Origin
``` Fever history Fever at presentation Current activity level Activity level prior to fever Current eating/drinking pattern Appearance Vomiting/diarrhea Ill contacts Medical history Immunization history Urinary output ```
100
Workup for Fever of Unknown Origin
``` CBC CMP Blood cultures Sed. rates UA Urine cultures Stool specimens Rheumatoid factors Chest x-ray CSF Rapid virus testing Abdominal US ```
101
What ages do we need to catheterize to obtain a UA?
Males
102
Why would you order a chest x-ray in a fever of unknown origin?
Tachypnea Rotractions Focal auscultatory findings Oxygen sat on RA
103
Procedures for Fever of Unknown Origin
Bladder cauterization Suprapubic aspiration LP
104
Treatment for Non-Toxic Fever of Unknown Origin
Patient fully immunized No significant risk factors Appears non-toxic Other healthy Parents appear reliable Follow up in 24-48 hours-sooner if worsen Hospital admission if findings suggest serious infection
105
Treatment for Toxic Fever of Unknown Origin
Admit child Obtain cultures Administer antibiotics
106
What antibiotics would we administer in Toxic Fever of Unknown Origin
Ceftriaxone Cefotaxime Ampicillin/sulbactam (Unasyn)
107
What does ceftriaxone (Rocephil) cover?
Broad spectrum | Gram-negative
108
What is cefotaxime (Claforan) for?
Septicemia
109
What does Ampicillin/sulbactam (Unasyn) cover?
Skin Enteric flora Anaerobes
110
Define Impetigo
Acute highly contagious gram positive bacterial infection of the superficial layers of the epidermis
111
In what climates is impetigo commonly found?
Hot, humid climates
112
What are the two types of impetigo?
Nonbullous impetigo | Bullous impetigo
113
What are the common bacteria in nonbullous impetigo?
Staph aureus | Group A beta hemolytic strep
114
What is the common bacteria in bullous impetigo?
Staph aureus
115
Risk Factors for Impetigo
Overcrowding Scabies Poverty
116
In what age group does impetigo usually present?
Children 2-5 year olds
117
Factors that can modify usual skin flora
``` High temp Humidity Preexisting cutaneous disease Young age Recent antibiotic treatment ```
118
Common Mechanisms for Disruption of Skin that Facilitates Infection
``` Scratching Dermatophytosis Herpes simplex Scabies Peduclosis Trauma Insect bites ```
119
Impetigo Differential Diagnosis
``` Herpetic impetigo Pemphigus vulgaris Follicular mucinosis Folliculitis Erysipelas Insect bites Cutaneous candidiasis ```
120
Diagnosis of Impetigo
History Clinical appearance- "honey-colored" crust Labs
121
Treatment of Impetigo
Local wound care | Antibiotic therapy
122
Antibiotic Therapy
Topical: Mupirocin (Bactroban) Oral: Cephalexin or Dicloxacillin (1st) Erythromycin & Clarithromycin (2nd) Bactrim, clindamycin, doxycycline (MRSA)
123
Prevention of the Spread of Impetigo
Hand washing Don't scratch Cover draining lesions Return to school 24 hours after start of antibiotic
124
Molluscum Contagiosum Virus
Poxvirus
125
Defined Molluscum Contagiosum
Single or multiple Rounded dome-shaped Pink, waxy papules Umbilicated
126
Molluscum Presentation
``` Asymptomatic Contact with family member or other person Children sharing bath Athletes sharing gym equipment Parents may recall public recreation Swimming pools Sexual activity ```
127
Mulluscum Differential
``` Cryptococcosis Histoplasmosis Aspergillosis Keratocanthoma Flat warts ```
128
Mulluscum Diagnosis
Distinctive, central umbilication Biopsy STD workup
129
Treatment of Molluscum
``` Usually resolves within months Direct lesional trauma Antiviral: cimetidine Topical: Imiquimod, Cantharidin Cryotherapy with curettage Avoid sports Avoid physical contact between infected areas Sexual abstinence ```
130
Types of Pediculosis (Lice)
Pediculosis capitus: head lice | Pediculosis corporis: body lice
131
Pediculosis Presentation
Parents/teachers usually discover Pruritis Groin/body involvment- adults
132
Lice Physical Exam
Observation of eggs, nymphs, mature lice Secondary infection Examine under microscope Wood lamp of area
133
Differential Diagnosis for Pediculosis (Lice)
``` Dandruff Dried hairspray/gel Acne Impetigo Scabies ```
134
Treatment of Pediculosis (Lice)
``` Permethrin (Nix) cream Malathoin Benzyl alcohol Spinosad Ivermectin Cleaning of hair accessories, towels, bedding, clothing Environmental control ```
135
Where does scabies burrow?
``` Wrist Ankle Finger Webs Axillary folds Genitalia Face ```
136
Diagnosis of Scabies
Scrap unscratched papule
137
Treatment of Scabies
Permethrin creme Ivermectin Wash everything in hot water
138
What is the most common bacterial cause of a UTI?
Escherichia coli
139
Host Factors of UTI's
Age: males
140
Define Vesicoureteral Reflux
Retrograde passage of urine from the bladder into the upper urinary tract
141
Signs & Symptoms of a UTI
``` Poor feeding Fever Failure to thrive (FTT) Vomiting Abdominal pain Flank pain Frequency, urgency, dysuria Suprapubic tenderness ```
142
Diagnosis of UTI
Midstream clean catch "Clean voided" bag for collection Bladder catheterization Suprapubic bladder aspiration
143
"Clean-voided" Bag Collection
Properly clean, rinse, and dry perineum before applying | Bag must be immediately removed
144
Why would you do a suprapubic bladder aspiration?
Catheterizing is difficult Tight foreskin Tight labial adhesions Significant periurethral irritation
145
Labs for a UTI
CBC CMP Blood cultures Renal function studies
146
Imaging for a UTI
``` Voiding cystourethrography (VCUG) Renal US ```
147
Hospitalization of UTI
``` Toxemic or septic Urinary obstruction Underlying disease Unable to tolerate adequate oral fluids/meds Age ```
148
Treatment of UT
``` Amoxicillin Bactrim Ceftriaxone Cefotaxime Ampicillin 1st or 3rd cephalosporin Amoxicillin/clavulanate ```
149
Define Infection
Insult caused by any pathogen
150
Define Systemic Inflammatory Response Syndrome (SIRS)
Widespread inflammatory response that may or may not be associated with an infection
151
Define Sepsis
SIRS in the presence of suspected or proven infection
152
Risk Factors for Pediatric Sepsis
Age
153
Pathogens for Pediatric Sepsis
``` Strep Staph Pseudomonas Influenza Adenovirus RSV Fungi Parasites ```
154
Signs/Symptoms of Pediatric Sepsis
``` Fever Racing heart Rapid or labored breathing Cool extremities Color changes Activity level Mental status Urine output Immunizations Exposures to infectious disease Drug allergies ```
155
Physical Exam Findings in Sepsis
``` Subtle change in vitals Hypotension Mental status change Anuria Hypothermia Localizing signs of infection ```
156
Diagnostics of Sepsis
``` CBC PT/PTT/INR CMP UA Sed. rates Blood, urine, CSF cultures ```
157
Imaging for Sepsis
CXR: infiltrates US: abscesses CT Echo: endocarditis
158
Management of Sepsis
``` Aggressive fluid resuscitation Support of cardiac output Ventilatory support Supplemental oxygen Maintenance of hemoglobin Correction of physiologic & metabolic derangements Monitor urine ouput ```
159
Common Antibiotics for Sepsis
3 months: 3rd generation cephalosporin + vanco
160
Define Meningitis
inflammation of the meninges
161
Types of Meningitis
``` Bacterial Viral Fungal Parasitic Non infectious: CA, SLE, head injury ```
162
Sign/Symptoms of Meningitis
``` Fever Headache Neck stiffness N/V Sleepiness Irritability Delirium ```
163
Diagnostics of Meningitis
``` CBC CMP Cultures Syphilis testing LP CSF analysis CT/MRI ```
164
Sexually Transmitted Diseases in Children
Unusual injury pattern/behavior Discloses to care giver Sexual assault
165
Sexually Transmitted Diseases in Adolescents
Screen appropriately
166
Types of STD's
``` Syphilis Chlamydia Gonorrhea Chancroid HPV Herpes ```
167
Sign/Symptoms of Syphilis
``` Sore that forms on genitals/mouth Fever Sore throat Headache Joint pain ```
168
Stages of Syphilis
Primary: 1+ painless sores Secondary: copper penny rash hands & feet Latent: inactive Tertiary: severe problems with heart, brain, nerves
169
Presentation of Congenital Syphilis
``` Asymptomatic Jaundice Hepatosplenomegaly Edema Signs of meningitis Mucocutaneous lesions Pseudo paralysis of arms/legs Hepatomegaly Rash on palms/soles Bilateral interstitial keratitis Periosteum thickening of tibias ```
170
Diagnostics of Syphilis
Darkfield microscope | Serologic testing
171
Treatment of Syphilis
Penicllin G
172
Symptoms of Chlamydia
``` Dysuria Vaginal discharge Cervicitis PID Epididymitis ```
173
If Chlamydia is not treated in women, it can cause what?
Infertility
174
Labs for Chlamydia
UA | Culture
175
Treatment of Chlamydia
Doxycycline Azithromycin Abstain from sex (7 days)
176
What is the second most common bacterial STI in the US?
Neisseria Gonorrhea
177
Sites of Gonorrhea Infection
Cervix Urethra Rectum Pharynx
178
Symptoms of Gonorrhea
Dysuria White, yellow, or green discharge Painful/swollen testicles
179
Diagnostics of Gonorrhea
First-catch urine for NAAT Culture Gram stain
180
Treatment of Gonorrhea
Ceftriaxone + Azithromycin
181
Where is chancroid mainly found?
Developing | Third world countries
182
Symptoms of Chancroid
Small papule which changes to ulcer in 1 day to 2 weeks Painful ulcer Sharply defined borders Base bleeds easily
183
Diagnostics of Chancroid
Gram stain
184
Treatment of Chancroid
Azithromycin | Ceftriaxone
185
Types of HPV in genital warts
6 | 11
186
Types of HPV in cervical dysplasia
16 | 18
187
Symptoms of HPV
Asymptomatic | Lesions on genitals
188
Diagnosis of HPV
Biopsy | Pap Smear
189
Treatment of HPV
Podofilox Trichloroacetic acid Cryotherapy Laser surgery
190
Vaccines Against HPV
Gardasil: 6, 11, 16, 18 Gardasil 9 Cervarix: 16 and 18
191
Types of Herpes Viruses
HSV-1: oral | HSV-2: genital
192
Signs/Symptoms of Herpes
Grouped vesicles on erythematous base Fever Malaise Tender regional adenopathy
193
Diagnosis of Herpes
Cultured vesicles from epithelial sites Immunofluorescent stains ELISA
194
Treatment of Herpes
Acyclovir Famciclovir Valacyclovir