Infectious Disease

Question 1

IgM

Answer 1

First immunoglobulin to appear in the blood after initial exposure to an antigen (primary antibody response)

Question 2

IgA

Answer 2

Secretory antibody response

Question 3

IgG

Answer 3

Major antibody to protein antigens

Question 4

What antibodies are transferred from mother to baby?

And how long will they protect baby?

Answer 4

IgG can be transferred across placenta and will protect from birth to 6 mo

IgA transferred via breast milk

Question 5

Type I hyper sensitivity rxn

Answer 5

IgE, mast cells, hay fever and anaphylaxis

Question 6

Type II hyper sensitivity rxn

Answer 6

IgM, IgG, cytotoxic, goodpastures Syndrome

Question 7

Type III hyper sensitivity rxn

Answer 7

IgM, IgG, AG-AB complex, serum sickness

Question 8

Type IV hyper sensitivity rxn

Answer 8

T cell infiltrate, Posion ivy dermatitis, PPD positivity

Question 9

Epi pen jr

Answer 9

33 to 66 lbs

Question 10

Urticaria rash

Answer 10

Migratory, waxing and waning, IgE mediated

Question 11

Serum sickness

Answer 11

Type III hypersensitivity rxn does not require prior sensitization

Onset 1-3 wks after initial exposure, fever, lymphadenopathy, rash

Question 12

Food allergy

Answer 12

IgE mediated

Start within minutes

Question 13

What is the MC cause of neonatal bacteremia and sepsis?

Answer 13

Group B strep

Question 14

Define occult bacteremia

Answer 14

Fever without obvious source of infection in a well appearing child with a positive blood culture for bacterial pathogen

Question 15

MC etiology of occult bacteremia in neonates?

In children?

Answer 15

Neonates- GBS

Children- strep pneumo

Question 16

SE of rifabutin

Answer 16

can color body secretions like urine, sweat and tears bright orange

can also dec serum levels of clarithromycin and will be less effective if used with fluconazole

Question 17

Atypical Mycobacterial Infections tx and pphx

Answer 17

Two drug regimen

Either clarithrymycin OR azithromycin

PLUS ethambutol, rifabutin, rifampin, ciprofloxacin OR amikacin

Pphx for CD4 <50: Azithromycin qweek

Question 18

Tx for mumps

Answer 18

MMR vaccine, supportive tx

Question 19

Mumps presentation

Answer 19

Rare viral prodrome

Swelling and tenderness in one or both parotid glands, difficulty opening mouth

Question 20

Mumps etiology

Answer 20

Paramyxovirua (RNA virus)

Spread via respiratory secretions w/ incubation period of 14-24 days

Question 21

Measles (rubeola) presentation

Answer 21

High fever, conjunctivitis with yellow exudate, croup like cough, stuffy/runny nose

Maculopapular rash that starts on face and spreads to trunk, Koplik’s spots

Question 22

Measles (rubeola) tx

Answer 22

Supportive + vitamin A

Live attenuated vaccine given at 12-15 mo with booster at 4-6 yrs

Question 23

Flu tx

Answer 23

Symptomatic tx- fluids, rest acetaminophen or ibuprofen

At rist pts: Type A >1 amantadine, >12 rimantadine
Type A and B >18 peramivir, >7 zanamivir, >2 ws oseltamivir

If pregnant→ 5 day course of aniviral tx (oseltamivir)

IM Vaccine for all childrren >6 mo

Question 24

HSV cutaneous vs encephalitic vs disseminated

Answer 24

Cutaneous- involves skin, mouth and eyes w/ vesicular eruptions around 7-10 days of life usually on presenting part

Encephalitic- occurs at 3rd wk of life presents with lethargy, irritability, poor suck and seizures

Disseminated- sepsis like clinical picture (apnea, irritability, hypotonia, hypotension)

Question 25

Tx for occult bacteremia by age: <60 days 61-90 days 3-36 mo

Answer 25

<60 days- hospitalize and abx, ampicillin and gentamicin for newborns, ampicillin + cefotaxime 2nd mo of life 61-90 days- output web or w/o 1 dose of ceftriaxone 3-36 mo- ceftriaxone optional if Non-septic, if fever > 102 get blood and urine cx

Question 26

What is a good first line tx for UTI in pediatrics?

Answer 26

Cephalosporins

Question 27

Erythema infectioum presentation

Answer 27

fifth disease 1 wk of low grade fever, HA, malaise, myalgia and mild URI sx "Slapped cheeks" Lacy maculopapular rash spreads to trunk and extremities

Question 28

Erythema infectiosum tx

Answer 28

Supportive (antipyretics, ↑ fluid intake) IVIG if immunocomp

Question 29

Pertussis presentation

Answer 29

Cough on expiration and whoop on inspiration Post-tussive emesis Catarrhal: congestion, rhinorrhea, mild persistent cough Paroxysmal: cough and posttussive emesis Convalescent: plateaus Duration: 6 wks

Question 30

Pertussis tx

Answer 30

Abx do not help in paroxysmal stage which is toxin mediated Macrolide abx for pt and household contacts Isolation until 5 days of therapy DTap

Question 31

Roseola presentation

Answer 31

High fever (may be >104) for 3-5 days followed by a maculopapular rash that spreads to neck, face and proximal extremities Mild URI sx

Question 32

Roseola tx

Answer 32

Supportive (antipyretics, ↑ fluid intake, rest)

Question 33

Rubella presentation

Answer 33

Mild fever prodrome for 1-2 days Rash begins on face and spreads quickly to trunk (shower distribution) Clears on face as it spreads to trunk Conjunctivitis Polyarthritis in adolescent females

Question 34

Rubella tx

Answer 34

Supportive (usually lasts 3 days)

Question 35

Varicella presentation

Answer 35

May have prodrome of fever w/ URI sx ro malaize, anorexia, HA and abd pain 24-48 hrs beforerash Dew drops on rose petal (vesicles on erythematous base) Rash initially on face and spreads to trunk and extremities sparing palms and soles

Question 36

Tx for pinworms

Answer 36

Albendazole wih repetition in 2 wks

Question 37

otitis media tx

Answer 37

1st line: amoxicillin Antipyretics: ibuprofen/acetaminophen Benzocaine drops for anesthetic

Question 38

Otitis externa tx

Answer 38

Topical abx and steroids to ↓ edema (cortisporin suspension) Neo/poly/HC only if TM intact FQ (use a wick if canal is swollen)

Question 39

Epiglotitis tx

Answer 39

True medical emergency Secure airway Ceftriazone (100 mg/kg/day) x 7-10 days Rfampin pphx for close contacts

Question 40

HFM etiology

Answer 40

coxsackie virus

Question 41

Mumps etiology

Answer 41

Paramyxovirua (RNA virus)

Question 42

Measles etiology

Answer 42

Paramyoxvirus (RNA virus)

Question 43

Erythema Infectiosum | (Fifth disease) etiolog

Answer 43

Parovirus B19

Question 44

Pertussis etiology

Answer 44

Bordetella pertussis (gram-neg coccobacilli)

Question 45

Roseola etiology

Answer 45

HHV 6 and 7

Question 46

Rubella etiology

Answer 46

Togavirus (RNA virus)