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Pediatrics > Infectious Disease > Flashcards

Infectious Disease Flashcards

1
Q

Treatment Options for Group A Strep Pharyngitis

A
  1. 10-day course of oral penicillin V.
  2. 10-day course of once-a-day amoxicillin
  3. a single dose of intramuscular benzathine penicillin G.
  4. 10-day course of an oral cephalosporin
  5. 10-day course of clindamycin
  6. Oral macrolide (though has 20% resistance))
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2
Q

Incubation period for pharyngitis & peak age

A

2-5 days
Peak age 7 & 8yo

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3
Q

Treatment for recurrent Group A Strep Pharyngitis

A

Controversial
Likely retrial of 10 day course of another agent if patient did not finish course

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4
Q

Top causes of bronchiolitis in young children <12yo

A
  1. RSV
  2. human metapneumovirus

Difference: human metapneumovirus can happen year round; otitis media is common in hMPV

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5
Q

Management of Otitis media with effusion OME (recurrent)

A
  • Otitis media with effusion (OME) may occur spontaneously, be the result of acute otitis media, or associated with other conditions.
  • Conditions associated with OME include allergic rhinitis, adenoidal hypertrophy, eustachian tube abnormalities, and craniofacial anomalies.
  • In children with OME who are not at risk for language delay, watchful waiting with follow-up in 3 months is appropriate.
  • Children with OME persisting longer than 3 months; suspected hearing loss, language delay, or learning problems; and those at risk for language delay should undergo HEARING TEST
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6
Q

Patients who should get immunoprophylaxis for varicella

A
  1. Immunocompromised patients (individuals with a congenital or acquired T-lymphocyte immunodeficiency, neoplasms affecting the bone marrow or lymphatic system, those who have received a hematopoietic stem cell transplant, and those receiving immunosuppressive therapy including prednisone at a dose of 2 mg/kg per day or more for 14 days)
  2. certain neonates, and
  3. pregnant women.
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7
Q

Time period for giving varicella-zoster immunoglobulin after exposure

A

within 10 days

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8
Q

For individuals that are nonimmune and exposed but otherwise do not meet criteria for immunoprophylaxis, to varicella IgG, _______ can be used if the individual is 12 months of age or older and if its not contraindicated

A

varicella vaccine

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9
Q

Post-exposure prophylaxis after 7 days of exposure to someone with chicken pox, in non-immunized patient

A

Acyclovir

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10
Q

Common bug causing Suppurative auricular perichondritis and treatment

A

pseudomonas (found in external ear canal)
ciprofloxacin

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11
Q

5-yr old girl ho just visited pakistan with 7 days of fevers, hepatosplenomegaly, no emesis, no jaundice. Whats at top of ddx? How do you confirm the dx?

A

Salmonella typhii
Blood cx

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12
Q

Clinical Criteria for Toxic Shock Syndrome

A
  • Fever > to 38.9°C (102°F)
    • Rash (typically diffuse erythroderma)
    • Desquamation (commonly palms/soles 1 to 2 weeks after the onset of symptoms)
    • Hypotension (systolic blood pressure less than fifth percentile for age for children younger than 16 years of age, ≤ 90 mm Hg for ≥ 16 years of age)
    • Multisystem involvement (in 3 or more organ symptoms):
  1. Gastrointestinal – vomiting or diarrhea at onset of illness
  2. Musculoskeletal – severe myalgias at onset of illness or creatine phosphokinase (CPK) greater than twice the upper limit of normal
  3. Mucocutaneous – vaginal, oropharyngeal, and/or conjunctival hyperemia
    Renal – blood urea nitrogen (BUN) or creatinine greater than twice the upper limit of normal, or urine with greater than 5 white blood cells/high power field without a urinary tract infection
  4. Hepatic – total bilirubin or aspartate aminotransferase/alanine aminotransferase greater than twice the upper limit of normal
    Hematologic – platelet count less than 100 x 103/μL (100 x 109/L)
  5. Central nervous system (CNS) – altered mental status without focal neurologic signs when afebrile and normotensive

• Negative results on the following tests or serology , if obtained:
Blood, throat, or cerebrospinal fluid cultures (blood culture may be positive for S aureus)
Rocky Mountain spotted fever, leptospirosis, or measles

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13
Q

If you have a weird post-surgical case and there’s staph aureus likely as source but patient is weird (AMS, rash, diarrhea, maybe rhabdo) think _____

A

TOXIC SHOCK SYNDROME

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14
Q

Gram stain of enterococci

A

gram positive cocci in pairs and chains

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15
Q

How to treat UTI caused by enterococci

A

ampicillin

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16
Q

Triad of congenital Rubella Syndrome

A
  1. sensorineural deafness,
  2. cataracts, and
  3. cardiac defects

…and hepatosplenomegally, meningoencephalitis, etc.

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17
Q

Contraindications to pertussis vaccination include:

A
  1. anaphylaxis after a previous dose of pertussis-containing vaccine
  2. encephalopathy within 7 days of receipt of pertussis vaccine without another identifiable cause.

Neuro: vaccine be deferred in patients with an evolving neurologic condition including seizure and Guillain-Barré

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18
Q

lancet-shaped diplococci on Gram stain with α-hemolysis on culture plate

A

strep pneumo

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19
Q

Populations at increased risk of invasive pneumococcal PNA

A

sickle cell
immunodeficiency
HIV
cochlear implant

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20
Q

For children with sickle cell, what vaccinations do they need?

A

PCV13 followed by PPSV23 8 weeks later

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21
Q

Timing of subacute lymphadenopathy

A

3-6wks

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22
Q

Ddx for subacute LAD

A

NTM/TB
Bartonella (cat scratch)
Viral: EBV, CMV, HIV

Mass: thyroglossal duct cyst, dermoid, brachiel cleft, lymphovascular malformation, hemangioma, ectopic thymus

Other diseases

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23
Q

Non-tender LAD with no systemic symptoms, with violaceous appearance in <5yo dx? Workup?
Tx?

A

NTM
PPD
Complete surgical excision

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24
Q

If you suspect RSV, no matter how sick the patient, likely just do….?

A

supportive care!

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25
Q

Parotitis (jaw line disappears), orchitis, aseptic meningitis, what’s the dx?

A

Mumps

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26
Q

Mode of transmission for Mumps

A

droplet

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27
Q

When are people contagious with mumps?

A

1-2 days before onset of parotitis to several days after

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28
Q

Precaution for meningitis

A

droplet

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29
Q

What PE makes you think bacterial pneumonia?

A

crackles

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30
Q

If you suspect bronchiolitis in winter in a hospitalized pt, what drug should you empirically start, especially for <2 yo?

A

oseltamivir

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31
Q

What causes seasonal variability in influenza subtypes?

A

antigenic drift: variation by mutations in H (hemagglutinin) and N (neiraminidase) genes

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32
Q

Indication to start antibiotics in diarrhea from campy jejuni

A

High fever, bloody diarrhea, worsening sx, sx lasting >7d, compromised immune system

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33
Q

When can kids return to daycare when they have enterocolitis (salmonella as an example)

A

no more than 2 stools above usual daily and contained in diaper

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34
Q

When do you have to treat salmonella diarrhea with abx, and which abx should you give?

A

for Patients with risk of invasive disease:
<3 mo
HIV/ immunosuppressed
Malignancy/hemoglobinopahies
chronic gut issues

Abx: if ill, start with CTX, then azithro

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35
Q

When can a mother with chicken pox transmit the disease?

A

5 days before through 2 days after delivery

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36
Q

What’s the time window to give neonates varicella IgG?

A

within 96 hours (most effective) to 10 days post exposure

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37
Q

If varicella IgG is not available, what are the next things to give?

A

IVIG
acyclovir

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38
Q

Management of varicella post exposure for healthy people within 5 days of exposure

A

If >12 mo, give the vaccine

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39
Q

What is the definition of significant exposure of varicella-zoster

A
  1. Same household
  2. Playmate (face to face >5 min or 1h
  3. Hospital (same room - varicella; intimate contact - zoster)
  4. New born infant
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40
Q

Breastfeeding when mother has chickenpox

A

Can express and give to infant, no direct breastfeeding

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41
Q

Signs/Symptoms of congenital varicella (when mother develops infection within 20 weeks of gestation)

A

CNS (microcephaly, cortical atrophy, seizures)
Eyes (chorioretinitis)
Skin (scarred skin lesions along dermatome)
Skeleton (limb hypoplasia)

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42
Q

What is the latin word for hookworm (2 kinds)

A

Necator Americanus
Ancylostoma duodenale

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43
Q

Treatment for hookworm and pinworm

A

Albendazole (most common)
Mebendazole
Pyantel pamoate

  • must treat all household
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44
Q

Latin term for pinworm and what do they do

A

Enterobius vermicularis

Anal pruritus – dx with tape

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45
Q

What is Taeniasis

A

tapeworm (beef and pork)
Nausea, vomiting, epigastric pain, and peripheral eosinophilia

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46
Q

Best way to screen neonates for HCV (timing and method)

A

Anti-HCV antibody at 18 mo

Reasoning: risk of perinatal transmission is low (5-8%), asymptomatic infection can persist for years, no antiviral agents are available for HCV-infected children younger than 2 yo

If <18mo, may have MATERNAL anti-HCV antibodies

RNA PCR can detect viremia that clear spontaneously (20% resolve by early childhood)

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47
Q

Definition of chronic HCV infection

A

> 6 mo HCV RNA in blood

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48
Q

Eczema coxsackium etiology and what it looks like

A

enteroviral rash in infants and children with underlying ATOPIC DERMATITIS (includes >10% of BSA)

  • vesicles, bullae, erosive lesions
  • coxsackievirus A6
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49
Q

How long and in what way can enterovirus shed

A

Respiratory tract: 1-3 weeks
Fecal shedding: 2-8 weeks

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50
Q

When are women tested for GBS?

A

35-37 weeks

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51
Q

Late onset GBS timing, manifestation, and who is at risk

A

> 7 days
Meningitis
Preterm (also at risk for early infection - perinatal exposure)

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52
Q

Long term effects of GBS

A

cerebral palsy
cortical blindness
learning disability

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53
Q

Early GBS infection manifestation

A

pneumonia

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54
Q

Rocky Mountain spotted fever rash

A

petechial/purpuric
several days after onset of febrile illness

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55
Q

Leading cause of bacteremia and meningitis among unvaccinated children <5 yo

A

H. flu

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56
Q

Meningococcemia is characterized by ___

A

rah: macular or maculopapular rash that progresses rapidly to petechiae or purpura

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57
Q

When to do Post-exposure chemoprophylaxis for meningitis in children and adults, and with what

A

within 24h
Rifampin- children
CTX or cipro - adults

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58
Q

When to get HSV surface DNA PCR perinatally

A

24h after birth

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59
Q

How do you test for botulism

A

stool study (botulinum toxin)

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60
Q

Gastritis, if you suspect h. pylori, what’s the next step?

A

PPI

Can’t treat h. pylori unless it is proven

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61
Q

Post exposure ppx for hep A
<12 mo
>12 mo

A

<12 mo: HAV Ig
>12 mo: hep A vaccine

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62
Q

When is the routine hep A vaccine supposed to be given

A

> 12 mo age, 6 mo apart

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63
Q

Who should receive TB “prophylaxis” window treatment and when should you repeat testing

A

children <5 yo, continue until repeat

Repeat in 8-10 weeks after last exposure

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64
Q

Latent TB tx

A

INH 9 mo
Rifampin 4 mo
INH+R for 3 mo (weekly)

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65
Q

TB testing for children <2 yo

A

only PPD

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66
Q

Treatment for Lyme arthritis - late lyme (what if for under 8 yo, or allergic to penicillin)

A

28-day doxy
28-day amox

cefuroxime for penicillin allergic

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67
Q

What is Lyme disease caused by and what is the tick name

A

Borrelia burgdorferi
Ixodes Scapularis nymphs (deer and white-footed mice)

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68
Q

Timing of lyme

A

early localized (3-30 days) 7-14d treatment, no seroconversion

Early disseminated (weeks to mo), 14d PO doxy or IV CTX (Carditis needs 21d ceftriaxone, meningitis 14d)

Late lyme (months): 28d or PO tx usually

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69
Q

How do you test for Lyme disease

A

2-tier testing:
1. Enzyme linked-immunosorbent assay (ELISA) or immunofluorescent assay (IFA)
Positive: 2 of 3 IgM bands, 5 of 10 IgG bands

followed by:
2. Western Blot

Increases specificity

PCR in joint aspirations

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70
Q

Synovial fluid WBC count for B Burgdorferi

A

2-50k

More than that think septic joint

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71
Q

How do you work up coccidiodomycosis

A

serum anticoccidiodal antibody
- IgM (2-3 wk of illness, wanes by 5 mo)
- Complement fixation (CF) titer >1:32 = disseminated disease

CSF anticoccidiodal CF also possible

Urine Ag testing can cross react with Blastomyces and histoplasma
Histopatch able if serology negative

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72
Q

Treatment of coccidiodomycosis

A

Critically ill: ampho

Severe pulm disease: fluconazole for 3 mo- 1 year (consolidation of >half of 1 lung, >10% wt loss, severe chest pain, duration >2mo)

CNS: may need lifelong fluconazole

Can actually self resolve

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73
Q

Diarrhea 1-3 weeks + malnutrition and foul smelling stool, cramping, emesis think ____

A

giardia

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74
Q

Giardia risk factors

A

daycare, foreign travel, exposure to animals, MSM

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75
Q

Indication for tx of giardia and what are they

A

Indication: FTT, malabsorption syndrome, extraintestinal disease, immunocompromised host

> 3 yo: Tinidazole single dose
1-3 yo nitazoxanide 3 days
Metronidazole 5-7 d

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76
Q

EBV serology profile and how to interpret

A

If prior infection:
IgG +, IgM -, early Ag - (can be +/- at any time, but always neg if never prior infection), nuclear Ag + (EBNA)

If current infection:
IgG + (rises quickly and stays for life), IgM +, EBNA neg (usually only positive in prior infection)

Heterophile Ab spot test: detects IgM produced by EBV-infected B cells, not specific to EBV – positive 80-90% of affected children in first 2 weeks of illness, not sensitive in <4yo

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77
Q

Treatment for cellulitis

A

amoxicillin - no MRSA coverage
** cephalexin/cefadroxil/cefuroxime - no MRSA coverage

** clindamycin **
doxycycline - not good for <8 yo, no B-hemolytic strep coverage

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78
Q

Risk factors for MRSA

A

family is a healthcare worker
other members of the family with skin abscesses
crowded living conditions

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79
Q

Name the infection:
Arthralgia and lacy rash
slapped cheek
pruritic exanthem
papular-purpuric gloves-and-socks syndrome

A

Parvovirus B19

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80
Q

Pregnant woman with parvovirus B19 in the 1st half of pregnancy, what will happen to the fetus

A

Generalized edema
Hydrops fetalis

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81
Q

Congenital CMV

A

central nervous system calcifications
chorioretinitis
hearing loss

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82
Q

Hearing loss is a consequence of which two congenital infections?

A

CMV
Rubella

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83
Q

Toxo and CMV congenital infection sequelae

A

chorioretinitis
CNS calcifications

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84
Q

When do you HAVE to remove CVLs in bacteremia?

A
  1. exit site, tunnel, or pocket of infection is found
  2. patient is critically ill
  3. infection by certain organism (candida, atypical mycobacteria, S. aureus)
  4. Bacteremia fails to clear in 48-72 h
  5. Underlying valvular heart disease
  6. Known endocarditis
  7. Development of metastatic infection
  8. Finding septic thrombophlebitis
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85
Q

When do you add gentamicin and rifampin in bacteremia?

A

Someone with prosthetic valve endocarditis

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86
Q

Can you do antibiotic lock therapy in children with bacteremia?

A

no, not enough data
Only adults

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87
Q

Within what window of time can hepatitis A immunoglobulin be given as prophylaxis?

A

2 weeks

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88
Q

When does respiratory papillomatosis present

A

2-5 yo

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89
Q

How do you get respiratory papillomatosis

A

vertical transmission from mother
HPV 6, 11

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90
Q

Aspergillus on smear

A

septate hyphae
dichotomously branched

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91
Q

Itchy painful rash, patient recently immigrated, face, thorax, extremities. Diagnosis?

A

chicken pox

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92
Q

In an infant/patient with good immune system, do you have to do varicella prophylaxis?

A

NO, but can give vaccine within 5 days if they need it

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93
Q

When do you NOT give varicella ppx?

A

> 10 days post exposure for immunocompromised ppl (pregnant, newborns) (ideally within 3-5 days)
Healthy individual that have had all their vaccines/ not eligible for vaccine

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5
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94
Q

Early congenital syphillis sequelae (4)

A

rash
snuffles
hepatosplenomegaly
thrombocytopenia
osteochondritis
pseudoparalysis

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95
Q

Late congenital syphilis symptoms, and when is it diagnosed?

A

> 2 yo
Developmental delay
Anterior bowing of shins
Hutchinson teeth

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96
Q

Diffuse maculopapular rash in palms, soles, condyloma lata, fever, malaise, LAD. Which stage of syphilis is this and when does it happen

A

secondary, weeks to months after inoculation

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97
Q

Dementia, aortic aneurysm, granulomas or gummas. Which stage of syphilis is this and when does it happen?

A

Tertiary-stage
decades after inoculation.

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98
Q

Cat scratch pathogen and abx of choice

A

Pasteurella multocida
Amox-clav, or doxy
Duration: 10-14 days, 3 weeks for tenosynovitis, 4 weeks for septic arthritis, 6 weeks for osteo

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99
Q

Cataracts, microcephaly, sensorineural deafness, peripheral pulmonic stenosis, hepatosplenomegally, thrombocytopenia, cerebral calcifications, radiolucent bone lesions. What is the TORCH infection?

A

Rubella

radiolucent bone lesions = rubella

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100
Q

Triad of hydrocephalus, chorioretinits, cerebral calcifications

A

Congenital Toxoplasmosis

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101
Q

Infant with respiratory distress, (respiratory ONLY symptoms), negative RSV, what other virus would it be?

A

Human metapneumovirus

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102
Q

Sx of adenovirus infection in infants

A

pneumonia, pertussis-like syndrome, croup, bronchiolitis

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103
Q

Influenza in infants, sx

A

sepsis-like, non-specific, croup, bronchiolitis, pna

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104
Q

Hint for human bocavirus infection

A

it has to be a COPATHOGEN with other community respiratory viruses

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105
Q

Thermoregulatory centers of the brain, and which side does what?

A

Anterior hypothalamus: controls heat dissipation (associated with hyperthermia)

Posterior hypothalamus: controls heat conservation (associated with hypothermia)

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106
Q

Agenesis of corpus callosum and hyperthermia/hypothermia, syndrome

A

[Reverse] Shapiro syndrome

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107
Q

Trichomonas vs. gardnerella

A

Gardnerella is fishy, gray

Trichomonas yellow, frothy malodorous

Trichomonas cervical exam may resemble strawberry from inflammation (rare)

108
Q

How do you diagnose pertussis?

A

NAAT PCR nasopharyngeal

109
Q

Treatment for postexposure prophylaxis for pertussis

A

5-day azithromycin
or
bactrim if older than 2 mo and can’t tolerate azithro/has macrolide resistant strain

110
Q

Precaution for pertussis

A

droplet for at least 5 days after initiation of azithro

111
Q

When are pregnant mothers supposed to get TdaP?

A

27-36 wk GA

111
Q

When are pregnant mothers supposed to get TdaP?

A

27-36 wk GA

112
Q

Emesis right away after ingestion of food - milk/egg/meat, causative pathogen?

A

S. Aureus (very fast!) 2-4 hours

113
Q

Bloody diarrhea 2-5 DAYS after eating food

A

campy

114
Q

Gastroenteritis, bacteremia, meningitis, 24h after eating milk-based product or deli meats

A

Listeria

115
Q

Diarrhea lasting 2 weeks, appendicitis-like pain, 4-6 days after eating pork chitterlings/unpasteurized dairy

A

Yersinia

also can be invasive (bacteremia, NEC, sepsis) in patients with excessive iron storage

116
Q

Diarrheal illness that can have erythema nodosum, reactive arthritis, and proliferative GN

A

Yersinia enterocolitica

117
Q

Diarrheal illness that can have erythema nodosum, reactive arthritis, and proliferative GN

A

Yersinia enterocolitica

118
Q

How do you treat Yersenia

A

In immunocompromised: 3rd gen cephalosporin IV

Other options: bactrim, fluoroquinolones, aminoglycosides, doxy

If healthy patient, supportive

119
Q

Watery mucoid stools/dysentery, abdominal pain, tenesmus, 1-3 days after eating.

A

Shigella

120
Q

Watery mucoid stools/dysentery, abdominal pain, tenesmus, 1-3 days after eating.

A

Shigella

121
Q

Fevers for many days, hepatosplenomegally +/0 arthritis, farm contact, disease?

A

Brucella melitensis

122
Q

Gland-involvement, fever +/- pulmonary disease, +/- eschar. How do you get it and what is the pathogen?

A

Francisella Tularensis

Tick bite
Direct contact with infected animal
Inhalation of contaminated aerosols
Ingestion of contaminated food

123
Q

When do you treat h. pylori in kids

A

When gastric/duodenal ULCER is present
(so you NEED endoscopy, cant do stool ag test or urea breath testing)

chronic gastritis or pain is not an indication

124
Q

When does mother to child transmission of HIV usually occur?

A

labor and delivery

125
Q

When should women get intrapartum prophylaxis for HIV and with what agent?

A

if viral load is >1000 copies and with zidovudine

126
Q

Should all infants born to HIV-infected mothers receive antiretroviral prophylaxis after birth? If so when and for how long?

A

YES, within 6-12 hours, for 4 weeks

127
Q

Stages of measles

A

2-4 days of fever and at least 1 of 3 Cs (cough, coryza, conjunctivitis)

Then koplik spots (small bluish-white plaques on buccal mucosa

then 2-4 days after fever, erythematous maculopapular rash on face and head then trunk and extremities

Then should recover

128
Q

Precautions for measles

A

airborne

4 days before and 4 days after rash

129
Q

Who should get postexposure ppx of measles and when, and with what

A

Within 72 hours of exposure (up to 6 days)
<6 mo: IM Measels Ig
6-11 mo: MMR vaccine if given 72h post exposure must be revaccinated at 12- 15 mo and receive 3rd at 4-6 yo

must be given to any close contact who have not been fully vaccinated

130
Q

What vaccines can’t pregnant women get?

A

MMR
Live influenza
Varicella
Oral polio (live)
BCG
Smallpox (vaccinia)
Travel: yellow fever, typhoid, japanese encephalitis

131
Q

Child went to park and played in water, develops watery diarrhea, emesis, cramps 12-48h later. siblings/friends has the same. Pathogen?

A

Norovirus

132
Q

Onset of diarrhea from cryptosporidiosis

A

3-14 days incubation

133
Q

Sore throat, exudative (adherent and thick) pharyngitis, child not fully vaccinated, concern for which pathogen?

A

Corynebacterium diphtheriae

group A strep usually thiner

134
Q

What does malaria (Plasmodium falciparum) look like under microscopy

A

ring forms
banana-shaped extra cellular things

135
Q

Babesiosis on smear

A

tetrad forms / Maltese cross
extracellular rings

136
Q

Incubation period of malaria

A

7 days

137
Q

How do you diagnose malaria?

A

Giemsa stain
Repeat every 12-24 hours over 3 day period

138
Q

Treatment of malaria

A

IV quinidine + tetracycline, clindamycin or doxy

139
Q

Treatment of severe malaria (how do you diagnose and with what agent)

A

Agent: IV artesunate

High parasite density (>5%)
Impaired consciousness
seizures
shock
ARDS/Pulm edema
Acidosis
AKI
Abnormal bleeding/ DIC
Jaundice + any other above or below
Severe anemia <7

Plasma exchange

140
Q

Severe head and neck infection and IJ thomcophlebitis, causative pathogen?

A

fusobacterium

141
Q

After HSCT, what should you do with Hib vaccination?

A

Revaccinate Hib with 3-dose series starting 6 months after transplant and completion of immunosuppressive therapy

142
Q

When is Hib usually given under normal circumstances

A

2, 4, 6 mo
OR
2, 4 mo

with booster at 12-15 mo

143
Q

When should you give oseltamivir?

A

Any child <5 yo (especially <2yo), no matter illness severity

144
Q

Common cause of septic arthritis in <4yo that is difficult to isolate by culture, associated with respiratory sx

A

Kingella Kingae (gram-neg)

Treat with augmentin, or 1st, 2nd, or 3rd gen cephalosporin

145
Q

Immunosuppressed child with cough, chest xray bilateral haziness, hypoxic, what’s the pathogen?

A

PJP

146
Q

How do you treat urethritis/cervicitis from gonorrhoeae +/- chlamydia

A

Ceftriaxone 250 mg IM
AND
Azithro 1g once or doxy 100 mg bid for 7 days

147
Q

sctoral/inguinal pain and abdominal discomfort +/- fevers. Diagnosis?

A

epididymitis

148
Q

Who should receive post exposure prophylaxis for mumps?

A

infants <12 mo (does not count towards 2-dose series)

unvaccinated people over 12mo

149
Q

Abdominal pain, fever, elevated liver enzymes, travel history, gram negative bacteremia. What is the pathogen and mode of transmission? How do you treat it?

A

Salmonella typhii
human to human

Ceftriaxone –> Fluoroquinolone

150
Q

Cause of meningitis from mosquito bite in US and how to test for it

A

West Nile Virus
Serology (IgG/IgM) – but serum IgM can be positive for 1 year, CSF IgM more sensitive to acute infection

Other ddx: enterovirus, HSV, other arbovirus

151
Q

Management of acute necrotizing fasciitis

A

surgical debridement in OR

Do NOT get further imaging, no time

152
Q

What nutritional deficiency can predispose you to infections and what type of infections?

A

severe protein-energy malnutrition (Kwashiorkor)
Pseudomonas

153
Q

Rash associated with pseudomonas

A

ecthyma gangrenosum - painless

154
Q

For healthy patients, do you have to treat toxo?

A

NO
Just need to start prophylaxis if becomes immunocompromised because it will become latent

155
Q

How do you test for congenital toxo gondii?

A

Mother’s serum
Ab and PCR testing of neonate serum, urine and CSF

Repeat several times

Need regular eye, hearing, neuro exams, head and abdominal imaging

156
Q

Treatment of toxo
1. Congenital
2. To healthy children with chorioretinitis

A
  1. Congenital: prednisone + pyrimethamine, sulfadiazine and folinic acid /leucovorin (12mo if sx, 3mo if no sx)
  2. Healthy children: above minus prednisone

Prednisone only in chorioretinitis or CSF infection

157
Q

Fever followed by blanching maculopapular rash that began after fever abruptly abated from neck and trunk to face and extremities. What’s the pathogen?

A

HHV-6 “sixth disease” (Roseola)

158
Q

What’s the youngest age to use DEET and how concentrated should it be

A

2mo
30%

159
Q

Alternative to amoxicillin for otitis media

A

cefdinir

160
Q

If a breastfeeding mother has shingles, can she keep breastfeeding?

A

Yes, only if the lesions can be covered and do not come into contact with infant

161
Q

Is CMV, Hep B, or Hep C a contraindication to breastfeeding? What about herpes?

A

No

Herpes only if lesions are on the nipple or breast

162
Q

Treatment of congenital CMV

A

oral valganciclovir 16 mg/kg for 6 months for symptomatic infants –> IV if baby has NEC or intestinal problems

Must start by 4 weeks of age

no treatment for asymptomatic infants!

163
Q

“blueberry muffin” lesions refer to infection from ___

A

CMV, congenital (extramedullary hematopoiesis)

164
Q

How do you diagnose congenital CMV

A

PCR from either urine, saliva, resp tract, blood or CSF

NOT serology

165
Q

Treatment for tympanostomy tube otorrhea

A

TOPICAL ofloxacin (better than oral)

166
Q

If an otherwise healthy infant (<28d old) grew CoNS on blood cultures, what should you do next

A

Nothing, don’t add abx, don’t change plans, do not repeat blood cultures

167
Q

Above many hours is considered prolonged rupture of membranes?

A

18h

168
Q

When is the greatest risk of vertical transmission of HSV

A

0-21d of life

169
Q

After 0-28 days of life when amp and gent is the empiric therapy of choice, what’s 30-60 DOL?

A

cefotaxime

NOT ceftriaxone (high risk of displacing bilirubin from albumin)

170
Q

When do you give prophylaxis abx for splenectomy or functional asplenia?

A

Until 5 yo OR until 1yr post splenectomy

171
Q

Can you give live vaccines to patients with splenectomy?

A

YES

172
Q

BEFORE splenectomy, what must you do and when

A

Give vaccines to encapsulated organisms (Hib, Meningitis ACWY and Pneumococcal) at least 2 weeks prior

Hib: catch up if not done yet. If >5 yo unimmunized, just give 1 dose

PCV13
(2-5yo): 1 more PCV13 (completely vaccinated); 2 more PCV 13 (incompletely vaccinated, 8 weeks apart)
>5 yo: 1 PCV13 if never received conjugate vaccine

PPSV23: 1st dose >24mo and 8 weeks from last completed PCV13. Repeat every 5 years

Men ACWY:
<2mo
should NOT be given within 4wks of PCV13 (decrease antibody response)

173
Q

When do you give post exposure ppx for lyme

A

Usually if tick >36h on person and if engorged

174
Q

How long to stay out of the water if you have…
Cryptospori
Norovirus
Shigella

A

Crypto: 2 week after resolution of sx
Shigella/Noro: 1 week after resolution of sx

175
Q

Daycare exclusion viral
Measles
Mumps
Varicella

A

Measles: 4 days after beginning of rash
Mumps: 5 days after onset of parotid gland
Varicella: until all lesions have dried and crusted (6 days after onset)

176
Q

3 mechanisms of strep pyo infection

A

suppuration
toxin production
immune-mediated disease

177
Q

Antibodies to assess for rheumatic fever

A

ASO (antistreptolysin O)
Anti-DNAase B

178
Q

Criteria for toxic shock syndrome

A

Fever
Diffuse macular erythroderma
Desquamation 1-2 weeks after onset of sx
Hypotension
Multisystem involve ment (3 or more): GI, MSK (CPK), Mucus membrane, renal, hepatic, heme, CNS

MUST have negative results for blood, throat, CSF cultures, rickettsia, leptospira, rubeola

179
Q

When do you treat mothers empirically for GBS

A

+ GBS screen at 35-37wk
Prior infant with GBS disease
GBS bacteriuria at any point during pregnancy
Unknown GBS status at onset of labor PLUS
<37wk GA
ROM >18h
Intrapartum fever
GBS NAAT +

Must be 4+ hours before delivery

180
Q

Pneumococcal normal vaccine series

A

PCV13:
4 dose
2, 4, 6 mo and 12-15 mo

PPSV23:
>5 yo OR >2yo in those immunocompromised

181
Q

When should Hib post-exposure ppx be given, and what is the agent to give

A

<4yo contact who are not fully vaccinated or anyone immunocompromised, everyone in the house should be given ppx

2+ cases of invasive Hib within 60 days at a child care facility with unimmunized/underimmunized children, then all should get it regardless of immune status

Rifampin

182
Q

Extra GI manifestation of campy

A

septic arthritis
Reactive arthritis
Erythema nodosum
guillain-barre

183
Q

When should you look for bacteremia if you find salmonella?

A

Kids <3mo
sickle cell

184
Q

Which pathogen can cause both diarrhea and seizures/hallucinations

A

Shigella

185
Q

PNA in school aged children, usually causes laryngitis and loss of voice

A

chlamydophila pneumonia

186
Q

Pertussis usual age and blood work

A

<2mo (prior to immunization)
Lymphocytosis
Can cause pneumothorax/pneumomediastinum due to cough

187
Q

DTaP schedule (normal)

A

2, 4, 6, 12mo, 4-6 yo
5-dose series

Then TdaP at 11-12 yo

188
Q

“Adhering” pseudomembrane in pharynx, what’s the pathogen

A

corynebacter

189
Q

Tx of corynebacter

A

Equine diphtheria antitoxin + penicillin/erythromycin for 14 days

190
Q

PEP for corynebacter

A

vaccine (regardless of immune status) +/- pen G or erythromycin for close contacts

191
Q

Staccato cough in neonate

A

chlamydia trachomatis

192
Q

Purulent discharge of eyes within 2-5 days of birth, pathogen?

A

Gonnorhoeae

Chlamydia is within 2 weeks - 30d

193
Q

Types of tertiary syphilis

A

neurosyphilis (2mo-30yr): cranial nerve, argyl robertson pupil, Tabes dorsalis (demyelination of spinal cord)

CV: 10-40 years, aneurysms

Late benign: gummas- skin and bone lesions

194
Q

What causes false positives for RPR?

A

Rickettsia
SLE
Other treponemal infections

195
Q

Complication of syphilis therapy

A

Jarisch-Herxheimer reaction (immune reconstitution)

196
Q

Tx for syphilis

A

1, 2, 3tiary disease: benzathine pen G x1 dose
Late latent: benz pen G weekly x3 doses
Neurosyphilis: Aqueous pen G x10-14 days
Congenital syphilis: Aqueous pen G x10 d

Allergy: tetracycline or doxy

197
Q

How to assess for Active TB in children <5 yo
How about <24mo

A

3 morning gastric aspirates

<24mo must get LP

198
Q

Meningitis routine vaccination schedule

A

ACWY: 11-12yo AND 16 yo
With risk factors: >2mo
Men B: 2-dose series 16-23 yo

199
Q

When does the rash from Borrelia burgdorferi show up?

A

1-2 weeks after tick bite

200
Q

When does early disseminated Lyme disease show up

A

1-4 mo

201
Q

What stage of disease is monoarticular/oligoarticular in for Lyme?

A

6-12 mo after tick bite

202
Q

What is STARI

A

Southern tick associated rash illness
Mimics Lyme but no burgdorferi

203
Q

GN bacilli that infects endothelial cells of blood vessels causing small vessel vasculitis, incubation 2-5 days

A

Rickettsia rickettsii

204
Q

Tick that transmits Rickettsia rickettsii and where is it endemic

A

black American dog ticks

Arkansas, Missouri, North Carolina, Oklahoma, Tennessee

205
Q

Tick that causes ehrlichia and where is it endemic

A

Amblyomma americanum
Southeast and southcentral US

206
Q

Tick that causes anaplasmosis and where is it endemic

A

Ixodes scapularis
NE and north central US

207
Q

Typical rash for ricketsii

A

wrist/ankles to trunk and face

208
Q

Erlichia and Anaplasma rash

A

involves trunk, spares palms and hands

209
Q

How to test and Common lab findings in Rickettsii, erlichia, anaplasma

A

IgG/IgM, then repeat 3-4 weeks later

hypoNa
hypoalbuminemia
thrombocytopenia
anemia

Erlichia and Anaplasma more likely to have leukopenia; on smear has morulae

210
Q

Signs and Treatment of cat scratch disease (bartonella)

A

LAD (biopsy shows granuloma), fever
7-12 days followed by erythematous papule at inoculation site

azithro + rifampin
Bactrim
Cipro
Gentamicin

211
Q

Tx of Psittacosis

A

tetracyclines or macrolides

212
Q

Neonate with “white nodules” on organs

A

micro abscesses from listeria

213
Q

Fever, limping child with hepatosplenomegally who went to a farm abroad

A

Brucellosis

214
Q

Tx of brucellosis

A

<8 bactrim + rifampin
>8 doxy plus streptomycin or genramicin or rifampin

Duration: 42-45 days

215
Q

Spirochete transmission through urine or contaminated soil/water

A

Leptospirosis

216
Q

Phases of lepto

A

4 weeks after exposure: flu-like sx with transaminases with jaundice

Severe illness “Weil disease” (azotemia, vasculitis, meningitis, shock, icteric liver failure)

217
Q

Intracellular GN orgamism transmitted by breathing in aerosolized droplets of coming in contact with infected animal feces

A

Coxiella burnetti

218
Q

Person working ith newborn animals and carcasses, with pneumonia, granumaltous hepatitis, or endocarditis. Pathogen and how to treat

A

coxiella
Doxy for 14 days

219
Q

Person working with newborn animals and carcassess with pneumonia, flu-like sx, granulomatous hepatitis. Pathogen and tx

A

coxiella
doxy for 14 d

220
Q

How is the plague transmitted, and treated

A

Yersinia PESTIS
fleas of rodents, droplets from respiratory sites

Tx: cephalosporins, tetracyclines, fluoroquinolones

221
Q

Wool sorter’s disease. Hemorrhagic mediastinitis, resp symptoms, black eschar, can have bloody stool

A

bacillus anthracis

tx: fluoroquinolones or doxy

222
Q

Rare but fatal long term complication of measles

A

subacute sclerosing panencephalitis (SSPE) 10 years after –> mental deterioration and seizures

223
Q

Treatment for measles

A

Vitamin A!

IVIG within 6 days, immunization of close contacts >6 mo, immunocompromised hosts

224
Q

viruses in the paramyxoviridae family

A

measels and mumps
parainfluenza
RSV

225
Q

How is varicella transmitted?

A

airborne if there are open vesicles

226
Q

Complications of chickenpox

A

bacterial superinfection
PNA
acute cerebellar ataxia
encephalitis

227
Q

Congenital varicella sequelae

A

1st to 2nd trimester: limb hypoplasia, CNS damage, scarring of skin (in a dermatome), ophtho abnormalitis

228
Q

What can you give for life threatening RSV

A

Ribavirin

229
Q

Guideline for palivizumab

A

5 monthly doses (protection for 6 months)

Who:
1. preterm born <29wk GA, less than 12mo at start of RSV season
2. or <32 wk GA with CLD (req >21% O2 for at least the first 28d after birth) (for 1st and 2nd year of life if ongoing need for supplemental O2)
3. Children with acyanotic, hemodynamically significant CHD - first year of life; or another dose after ECMO, or after cardiac transplant <24mo

230
Q

Papular acrodermatitis is associated with

A

Hepatitis B and EBV

231
Q

Neonate born to HbsAg mother needs ___

A

HBIG + Hep B vaccine (does not count towards dose series)

Repeat testing for infection at 9 and 12 mo

232
Q

If you have mono and are given ampicillin, what happens?

A

morbilliform rash

233
Q

HHV-6 rash

A

sixth disease

234
Q

smallpox vs. chickenpox

A

smallpox = SAME stage of lesions
chickenpox = DIFFERENT stages of lesions

235
Q

When are pregnant women the most at risk for hydrops fetalis

A

<20 wk GA

236
Q

Polio affects which part of the spinal cord

A

motor neurons, anterior horn
flaccid paralysis

237
Q

Child gets a clean wound, what questions do you ask and do you give Td or TIG?

A

Never need tetanus Ig in clean wounds

  1. Have they had 3 or more tetanus shots? (2, 4, 6, 12mo and 11yo). Yes –> don’t give Td (or DTap if <7yo)
  2. Has it been more than 10 years since the last tetanus shot? Yes –> give Td

If yes to 1 and no to 2, no need to give Td.

238
Q

Child gets dirty tetanus-prone wound, Td (or DTap if <7yo) or TIG?

A
  1. Have they had 3 or more tetanus shots?
    If no, give both vaccine and Tetanus Ig

If yes,
2. Has it been more than 5 years since last tetanus shot?
If yes, give only Td or DTap (no need for TIG)

239
Q

Child gets bit by an animal (pet: dog/cat/ferret). Do you give rabies immunoglobulin? What if it’s a bat/skunk/raccoon/fox?

A

Pet: if healthy, observe for 10 days and give pt ppx only if signs of rabies in animal develop. If unknown, suspect of rabid, give vaccine and rabies Ig

Wild animal: always give vaccine and rabies Ig

240
Q

Dengue and Chikungunya are transmitted by what kind of mosquito?

A

Aedes aegypti

241
Q

Workup of candidiasis in neonates must include (5)

A

US of head
US of abdomen
LP
echocardiogram
Eye exam

242
Q

Treatment of invasive candidiasis in
1. Neonate
2. Pediatric patient

A
  1. Neonate: ampho, 3 weeks
  2. Pediatric: echinocandin (micafungin), can narrow to fluconazole if possible. Duration: 2 weeks from clearance
243
Q

Tx of candida meningoencephalitis

A

flucytosine

244
Q

False positive galactomannan can be from?

A

zosyn

245
Q

Where is Blasto endemic to

A

Missouri, St. Lawrence Rivers, Great Lakes

246
Q

Pneumonia not getting better, wt loss, fever cough, erythema multiforme/nodosum, really non-specific, and Ohio/Mississippi. Dx?

A

Histo

247
Q

Erythema nodosum/multiforma and pulm infection. Southwest US

A

Coccidiomycosis

248
Q

Pneumonia lingeright with painless papules, that becomes violaceous, and verrucous with microabscess in the center, usually heals with scar. St. Lawrence and Great Lakes

A

Blasto

249
Q

How to test for coccidiomycosis

A

Urine antigen test, immunodiffusion and complement fixation test

250
Q

CXR with pulm infiltrate +/- cavitation, NO hilar/mediastinal lymphadenopathy. On BAL, “broad-based budding yeast”

A

Blasto

251
Q

Tx for
1. Histo
2. Blasto
3. Cocci

A

Histo: itraconazole, ampho if disseminated
Blasto and Cocci: itra- or fluconazole. Itraconazole for bone, fluconazole for CSF penetration

252
Q

Cryptococcus mode of transmission

A

pigeon dropping

253
Q

Confusion, headache, vision changes, increased opening pressure, india ink stain shows “halo” organism

A

cryptococcus

254
Q

How to treat cryptococcus

A

fluconazole and amphoterecin B

255
Q

Perihilar opacity spreading to periphery with hypoxia “batwinging”

A

PJP

Test for B-D-glucan and LDH

256
Q

Child living in poverty, has PICA, has a dog, has severe asthma and sudden unilateral vision changes with peripheral eosinophilia. Diagnosis?

A

toxocariasis (Toxocara canis)

Treat with albendazole, and steroids

257
Q

Loffler pneumonia (cough, wheeze, dyspnea, shifting pulm infiltrates, hemoptysis), is caused by what pathogen

A

Ascaris lumbricoides

258
Q

Tapeworm in latin tems is____

A

cysticercosis

259
Q

Tapeworm in latin tems is____

A

cysticercosis

260
Q

How do you test for amoeba

A

enzyme immunoassay stool specimen

261
Q

Treatment of cryptosporidiosis in immunocompromised pt

A

nitazoxanide

262
Q

Malaria is carried by what mosquito

A

Anopheles

263
Q

Malaria prophylaxis

A

Mefloquine (though resistant in SE Asia), don’t give for any psych issues, seizures, cardiac conduction issues. Good for pregnant woman.

Chloroquine if in central America West of Panama Canal, Haiti, DR, most of Middle East. Can exacerbate psoriasis.

Give doxycycline (not good for <8yo, or preg), atovaquone-proguanil (renal) or primaquine (P. vivax, not for G6PD or preg) (can be given in all regions)

264
Q

Where can you get anthrax from

A

cattle, sheep, goats
Spores can survive in soil or in hide

Pediatrics (26 decks)

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