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General Pediatrics Certifying Exam > Infectious Disease > Flashcards

Infectious Disease Flashcards

1
Q

Clindamycin coverage

A
  • Most gram positive bacteria
  • Some MRSA
  • NOT active against Enterococcus (Gram + cocci)
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2
Q

1st generation cephalosporins

A
  • Cephalexin (PO) and cefazolin (IV)
  • Good Staph and Strep coverage (NO MRSA)
  • Good activity against PEcK gram negative bacteria (Proteus, E. Coli, Klebsiella)
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3
Q

Enterococcus coverage

A
  • Ampicillin
  • Vancomycin
  • Linezolid
  • NO clindamycin OR cephalosporins!
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4
Q

2nd generation cephalosporins

A
  • Cefaclor, cefuroxime, cefotetan, cefoxitin
  • NO good coverage for gram positive bacteria - better for gran negative coverage
  • Coverage for HEN PEcK bacteria (Haemophilis influenza, Enterobacteri, Neisseria, Proteus, E. Coli, Klebsiella)
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5
Q

3rd generation cephalosporins

A
  • Ceftriaxone, cefotaxime, ceftazidime, cefpodoxime
  • Not good gram positive coverage - HOWEVER, ceftriaxone has great Strep coverage (i.e. when treating meningitis, treat with Vancomycin ONLY for possible Strep resistant to ceftriaxone)
  • Better gram negative coverage
  • Use for hospital-acquired gram-negative infections and CNS infections
  • Ceftazidime is great for Pseudomonas!
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6
Q

4th generation cephalosporins

A
  • Cefepime
  • Extended spectrum -> gram positive just as good as 1st generation + broader gram negative coverage.
  • Good CNS penetration.
  • More resistant to beta-lactamases.
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7
Q

Macrolides

A
  • Azithromycin, clarithromycin, erythromycin

- Common side effect = increased GI motility (sometimes use erythromycin for diabetic gastroparesis).

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8
Q

Carbapenems

A
  • Imipenem

- Use for extended-spectrum beta-lactamase (ESBL) producing organisms (i.e. ENTEROBACTER, gram negative)

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9
Q

Albendazole and Pyrantel Pamoate

A
  • Worm infections
  • For pinworms (Enterobius), give one dose and repeat after 2 weeks if recurs. For all other worm infections, multiple doses required.
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10
Q

Metronidazole

A
  • Tx parasite and anaerobic infections
  • Often used for intra-abdominal infections
  • GET BCG = Giardia, Entamoeba, Trichomonas, Bacteroides, Clostridium, Gardnerella
  • If breastfeeding, stop breastfeeding for 24 hours after treating with Metronidazole.
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11
Q

Enterococcus faecalis

A
  • Gram-positive diplococcus (can look similar to strep)
  • Sepsis, NEC
  • Tx with ampicillin, vancomycin or linezolid
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12
Q

Listeria Monocytogenes

A
  • Gram-positive diptheroid (rod)
  • Look for history of NODULES on PLACENTA or mild maternal fever + viral symptoms.
  • Treat with ampicillin
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13
Q

Neonatal sepsis antibiotics

A
  • Ampicillin covers GBS, enterococcus and listeria

- Gentamicin covers some gram negatives

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14
Q

Clostridium tetani

A
  • Gram positive anaerobe
  • Common hx of puncture wound
  • Uncontrollable muscle spasms and contractions. Locked jaw, arched back.
  • Treat with debridement of infected tissue, TIG + metronidazole or penicillin
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15
Q

Clostridium botulinum

A
  • Gram positive
  • Common presentation: child < 6 months with progressive DESCENDING weakness (i.e. progressive ptosis and poor suck to urinary retention). Progresses quickly (within hours).
  • Toxin inhibits release of acetylcholine
  • Tx with supportive care or antitoxin (if available)
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16
Q

Corynebacterium diphtheriae

A
  • Gram-positive rod
  • Low fever + URI symptoms -> pseudomembrane forms on tonsils and pharynx. Can also cause motor and sensory problems as well as areflexia.
  • Tx with erythromycin or penicillin G.
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17
Q

Streptococcus

A
  • Gram-positive cocci in pairs & chains.
  • Alpha-hemolytic = S. viridans and S. pneumoniae
  • Beta-hemolytic = S. agalactiae (GBS) and S. pyogenes (GAS)
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18
Q

Peritonsillar abscess

A
  • Unilateral tonsillar swelling -> deviated uvula, trismus, “hot-potato voice”, drooling.
  • Usually caused by GAS
  • Tx with IV antibiotics with anaerobic coverage (clindamycin, ampicillin-sulbactam), though once drainaged and patient can swallow, treat with Augmentin.
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19
Q

Retropharyngeal abscess

A
  • Usually presents in child < 6 years old
  • Fever, lymphadenopathy, odynophagia, difficulty swallowing, drooling, HYPEREXTENSION of neck
  • Usually 2/2 GAS
  • Lateral neck XR reveals widening of retropharyngeal space
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20
Q

Occult bacteremia

A
  • S. pneumo is most common cause.

- If S. pneumo bacteremia is found incidentally and patient is asymptomatic, NO NEED to treat!

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21
Q

Pneumonia

A
  • S. pneumo most common cause.

- If patient has CF, S. aureus or Pseudomonas aeruginosa

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22
Q

GBS Sepsis

A
  • Early = within first 3 days of life. Usually 2/2 GBS PNA.
  • Late = >3 days - 90 days. More focal infections - most concerning is meningitis, but also cellulitis and osteomyelitis.
  • Treat with penicillin G.
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23
Q

GBS screening and prophylaxis

A
  • Screening occurs at 35 - 37 weeks gestation
  • Prophylaxis = penicillin at least 4 hours prior to delivery.
  • Give prophylaxis if Mom previously had a baby with GBS disease, evidence of GBS (i.e. UTI or screening) OR if status is unknown & < 37 weeks, ROM > 18 hours, intrapartum fever, rapid test positive.
  • DO NOT treat if delivery by C/S with intact membranes, previous + screening or UTI (only focus on current pregnancy results) UNLESS previous baby with GBS, or screening cultures negative.
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24
Q

Early discharge in GBS positive Mom

A
  • Term (> 37 weeks)
  • Asymptomatic
  • Mom receive adequate intrapartum prophylaxis
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25
Q

Blood culture positive for S. aureus

A
  • Gram positive organisms in clusters

- Prolonged IV antibiotics and ECHOCARDIOGRAM

26
Q

Coagulase-negative Staph

A
  • Staph epidermidis
27
Q

Blood culture positive for coagulase-negative Staph

A
  • Treat with vancomycin
  • Extremely resistant to common antibiotics
  • Final culture may reveal MRSA
28
Q

Secondary bacterial periotonitis and VP shunt infections

A
  • Assume methicillin-resistant S. epidermidis

- Treat with vancomycin pending culture results

29
Q

Strep bacteria causing endocarditis

A

Viridans&raquo_space; mutans or bovis

30
Q

Rocky Mountain Spotted Fever

A
  • Rikettsia rickettsii
  • Most common tick-borne illness
  • S/S: Thrombocytopenia, petechiae, headache, lethargy, altered mentation, muscle pain, rash that starts and palms/soles/wrists and spreads centrally
  • Treat with doxycycline
  • Ehrlichiosis presents similarly BUT may have associated liver dysfunction and possible leukopenia/lymphopenia - tx is the same w/ doxycycline
31
Q

Enterobacter

A
  • Usually hospital-acquired, leading to urinary tract or respiratory tract infections
  • May treat with cephalosporins, though commonly ESBL and requires imipenem
32
Q

Cat Scratch Disease

A
  • Bartonella henselae
  • Draining and tender lymphadenopathy and possible history of cat/dog exposure
  • NO NEED to treat unless immunocompromised or has severe symptoms (i.e. HSM).
  • Tx with macrolides, cephalosporins, doxycycline or Bactrim
33
Q

Citrobacter Freundii

A
  • Brain abscess (think Freundii = Freud - a psych/brain doc!)
  • Can be hospital-acquired, especially in neonates
34
Q

Chlamydia trachomatis

A
  • Urethitis, conjunctivitis, PID, staccato cough in neonates, lymphogranuloma venereum
  • Most common STD
  • Obligate intracellular anaerobe (look for intracytoplasmic inclusions)
  • Dx with PCR of cells, secretions or urine
  • Tx with azitromycin x 1. May tx with doxycycline x 7 days, though if recurrence, tx failure or noncompliance, tx with azithromycin, eryth, levo, oflox x 7 days.
35
Q

Lymphogranuloma venereum

A
  • STD
  • Starts with small, nontender papules or shallow ulcers that resolve –> tender unilateral inguinal lymph node appears and can rupture (relieving pain), then can drain for months
36
Q

Chlamydia pneumoniae

A
  • Atypical pneumonia
  • Often < 2 months
  • Tachypnea, STACCATO cough +/- eye discharge, may be afebrile
  • Tx with doxycycline or macrolide
37
Q

Chlamydia psittaci

A
  • Bird exposure + atypical PNA

- Tx with doxycycline or macrolide

38
Q

Gram stain characteristics of H. flu

A
  • Pleomorphic organisms

- Tx with ceftriaxone

39
Q

Bordatella pertussis

A
  • Paroxysmal cough
  • High WBC
  • Dx with PCR or culture with NP swab
  • Tx with erythromycin, clarithromycin or azith (especially for children < 1 month)
  • ALL contacts (even if immunized) should be given prophylaxis
40
Q

Pseudomonas

A
  • Can cause skin infections, PNA, OE, UTI, osteomyelitis, sepsis, other
  • Tx with ceftazidime, cefepime, ticarcillin, carbenicillin, piperacillin, gentamycin, tobramycin
41
Q

Treatment of unstable or ICU patient with fungemia

A
  • Amphotericin B

- If liver disease - tx with liposomal amphotericin

42
Q

Cryptococcus

A
  • Hx bird exposure or travel to NORTHWESTERN US
  • PNA or meningitis
  • Dx with india ink staining
  • For meningitis or disseminated infection, tx with amphotericin, then may switch to fluconazole.
  • For isolated PNA, treat with fluconazole
43
Q

Blastomycosis

A
  • Broad-based, budding yeast, usually found near water
  • PNA or flu-like illness, skin lesions
  • Treat with azoles (itraconazole)
  • Key point: used to be caused Chicago disease and solution was to move sewage from drinking water
44
Q

Coccidioidomycosis

A
  • AKA Valley Fever can present with PNA or flu-like symptoms
  • PNA may have pulmonary nodules
  • Hx living or travel to western UC (AZ, CA, TX)
  • Tx with amphotericin or azoles (fluconazole or ketoconazole)
45
Q

Histoplasmosis

A
  • Flu-like illness
  • Most clear infection without intervention
  • Calcifications on CXR (may look like tuberculosis), pulmonary fibrosis, HSM, mediastinal/hilar calcifications
  • Hx exposure to bird droppings or travel to OHIO (OHIO-plasmosis) or Mississippi
46
Q

Fungal infections caused by exposure to exposure to birds

A
  • Cryptococcus

- Histoplasmosis

47
Q

Allergic Bronchopulmonary Aspergillosis (ABPA)

A
  • May occur in immunocompetent patients
  • Hypersensitivity reaction
  • Particularly in patients with asthma or CF
  • Eosinophilia and lung infiltrates
  • Tx with itraconazole and steroids. If disseminated, tx with amphotericin. May required long-term steroids.
48
Q

Mycobacterium tuberculosis

A
  • BACTERIA (not fungus)
  • Acid-fast staining used because does not allow for gram staining
  • Prolonged illness, fever, cough, chills, night sweats, weight loss, immigrant status, travel to endemic area, hilar adenopathy, apical infiltrate, pleural effusion, supraclavicular lymphadenopathy
  • Dx with AFB smears of sputum/secretions, + PPD or + Quantiferon Gold
49
Q

PPD interpretation

A

< 5 mm = negative. If induration present and < 5 mm, consider atypical mycobacteria.
5-10 mm = Positive IF X-ray findings present, hx close contact with patient with TB or immunocompromised
> 10 mm = positive IF risk factor
>15 mm = positive for lowest-risk patients with zero RFs

50
Q

Treatment after +PPD

A
  • Normal CXR = isoniazid for 9 months

- Positive CXR = 3 or 4 drug therapy (RIP or RIPE = rifampin, isoniazid, pyrazinamide, ethambutol)

51
Q

Newborn with +PPD Mom

A
  • Mom asymptomatic and negative CXR = check baby’s PPD q3 months. If PPD positive, tx INH x 1 year if CXR negative. If CXR positive, tx with 4 drug therapy.
  • Mom with active disease OR positive CXR = consider baby positive and tx with 3 or 4 drug therapy
52
Q

Treatment for older children with ACTIVE TB in household contacts

A
  • PPD and CXR negative = INH x 12 weeks
  • +PPD and CXR negative = INH x 9 months
  • +PPD and +CXR = 3-4 drug therapy
53
Q

Tx for TB meningitis

A
  • 3-4 drug therapy + steroids + streptomycin
54
Q

Assess for infectivity

A
  • DO NOT get a CXR

- Obtain sputum samples or gastric aspirates for AFB smear

55
Q

Arbovirus encephalitis

A
  • S/S of encephalitis (confusion, lethargy) + mention of mosquitoes (California, STL)
  • Dx with virus-specific ACUTE AND CONVALESCENT antibitody titers
56
Q

TORCH infections

A
  • Toxoplasma
  • Other (varicella, syphilis)
  • Rubella
  • CMV
  • HSV
57
Q

Toxoplasma Gondii

A
  • Protozoan
  • Transmitted via cat litter
  • Classic triad = diffuse intracerebral calcifications (“RING-ENHANCING LESIONS”) + hydrocephalus + unilateral/bilateral chorioretinitis
  • may also see addnopathy, thrombocytopenia, HSM, jaundice or Blueberry Muffin Syndrome
58
Q

Diagnosis of Toxoplasma

A

IgM tiger or immunofluorescence

59
Q

Treatment of Toxoplasma

A
  • Sulfadiazine OR pyrimethamine
60
Q

Long-term effects of Toxoplasma in neonate

A

Even if child is normal at birth, may later develop seizures, cognitive issues and/or deafness

61
Q

MRI findings in Toxoplasma vs CMV

A
  • Toxoplasma = diffuse ring-enhancing lesions

- CMV = periventricular, non-enhancing lesions

General Pediatrics Certifying Exam (13 decks)

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