Infectious Disease Flashcards
1
Q
Treatment Options for Group A Strep Pharyngitis
A
- 10-day course of oral penicillin V.
- 10-day course of once-a-day amoxicillin
- a single dose of intramuscular benzathine penicillin G.
- 10-day course of an oral cephalosporin
- 10-day course of clindamycin
- Oral macrolide (though has 20% resistance))
2
Q
Incubation period for pharyngitis & peak age
A
2-5 days
Peak age 7 & 8yo
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
4
Q
Top causes of bronchiolitis in young children <12yo
A
- RSV
- human metapneumovirus
Difference: human metapneumovirus can happen year round; otitis media is common in hMPV
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
6
Q
Patients who should get immunoprophylaxis for varicella
A
- 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)
- certain neonates, and
- pregnant women.
7
Q
Time period for giving varicella-zoster immunoglobulin after exposure
A
within 10 days
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
9
Q
Post-exposure prophylaxis after 7 days of exposure to someone with chicken pox, in non-immunized patient
A
Acyclovir
10
Q
Common bug causing Suppurative auricular perichondritis and treatment
A
pseudomonas (found in external ear canal)
ciprofloxacin
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
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):
- Gastrointestinal – vomiting or diarrhea at onset of illness
- Musculoskeletal – severe myalgias at onset of illness or creatine phosphokinase (CPK) greater than twice the upper limit of normal
- 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 - 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) - 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
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
14
Q
Gram stain of enterococci
A
gram positive cocci in pairs and chains
15
Q
How to treat UTI caused by enterococci
A
ampicillin
16
Q
Triad of congenital Rubella Syndrome
A
- sensorineural deafness,
- cataracts, and
- cardiac defects
…and hepatosplenomegally, meningoencephalitis, etc.
17
Q
Contraindications to pertussis vaccination include:
A
- anaphylaxis after a previous dose of pertussis-containing vaccine
- 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
18
Q
lancet-shaped diplococci on Gram stain with α-hemolysis on culture plate
A
strep pneumo
19
Q
Populations at increased risk of invasive pneumococcal PNA
A
sickle cell
immunodeficiency
HIV
cochlear implant
20
Q
For children with sickle cell, what vaccinations do they need?
A
PCV13 followed by PPSV23 8 weeks later
21
Q
Timing of subacute lymphadenopathy
A
3-6wks
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
23
Q
Non-tender LAD with no systemic symptoms, with violaceous appearance in <5yo dx? Workup?
Tx?
A
NTM
PPD
Complete surgical excision
24
Q
If you suspect RSV, no matter how sick the patient, likely just do….?
A
supportive care!
25
Parotitis (jaw line disappears), orchitis, aseptic meningitis, what's the dx?
Mumps
26
Mode of transmission for Mumps
droplet
27
When are people contagious with mumps?
1-2 days before onset of parotitis to several days after
28
Precaution for meningitis
droplet
29
What PE makes you think bacterial pneumonia?
crackles
30
If you suspect bronchiolitis in winter in a hospitalized pt, what drug should you empirically start, especially for <2 yo?
oseltamivir
31
What causes seasonal variability in influenza subtypes?
antigenic drift: variation by mutations in H (hemagglutinin) and N (neiraminidase) genes
32
Indication to start antibiotics in diarrhea from campy jejuni
High fever, bloody diarrhea, worsening sx, sx lasting >7d, compromised immune system
33
When can kids return to daycare when they have enterocolitis (salmonella as an example)
no more than 2 stools above usual daily and contained in diaper
34
When do you have to treat salmonella diarrhea with abx, and which abx should you give?
for Patients with risk of invasive disease:
<3 mo
HIV/ immunosuppressed
Malignancy/hemoglobinopahies
chronic gut issues
Abx: if ill, start with CTX, then azithro
35
When can a mother with chicken pox transmit the disease?
5 days before through 2 days after delivery
36
What's the time window to give neonates varicella IgG?
within 96 hours (most effective) to 10 days post exposure
37
If varicella IgG is not available, what are the next things to give?
IVIG
acyclovir
38
Management of varicella post exposure for healthy people within 5 days of exposure
If >12 mo, give the vaccine
39
What is the definition of significant exposure of varicella-zoster
1. Same household
2. Playmate (face to face >5 min or 1h
3. Hospital (same room - varicella; intimate contact - zoster)
4. New born infant
40
Breastfeeding when mother has chickenpox
Can express and give to infant, no direct breastfeeding
41
Signs/Symptoms of congenital varicella (when mother develops infection within 20 weeks of gestation)
CNS (microcephaly, cortical atrophy, seizures)
Eyes (chorioretinitis)
Skin (scarred skin lesions along dermatome)
Skeleton (limb hypoplasia)
42
What is the latin word for hookworm (2 kinds)
Necator Americanus
Ancylostoma duodenale
43
Treatment for hookworm and pinworm
Albendazole (most common)
Mebendazole
Pyantel pamoate
- must treat all household
44
Latin term for pinworm and what do they do
Enterobius vermicularis
Anal pruritus -- dx with tape
45
What is Taeniasis
tapeworm (beef and pork)
Nausea, vomiting, epigastric pain, and peripheral eosinophilia
46
Best way to screen neonates for HCV (timing and method)
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)
47
Definition of chronic HCV infection
>6 mo HCV RNA in blood
48
Eczema coxsackium etiology and what it looks like
enteroviral rash in infants and children with underlying ATOPIC DERMATITIS (includes >10% of BSA)
- vesicles, bullae, erosive lesions
- coxsackievirus A6
49
How long and in what way can enterovirus shed
Respiratory tract: 1-3 weeks
Fecal shedding: 2-8 weeks
50
When are women tested for GBS?
35-37 weeks
51
Late onset GBS timing, manifestation, and who is at risk
>7 days
Meningitis
Preterm (also at risk for early infection - perinatal exposure)
52
Long term effects of GBS
cerebral palsy
cortical blindness
learning disability
53
Early GBS infection manifestation
pneumonia
54
Rocky Mountain spotted fever rash
petechial/purpuric
several days after onset of febrile illness
55
Leading cause of bacteremia and meningitis among unvaccinated children <5 yo
H. flu
56
Meningococcemia is characterized by ___
rah: macular or maculopapular rash that progresses rapidly to petechiae or purpura
57
When to do Post-exposure chemoprophylaxis for meningitis in children and adults, and with what
within 24h
Rifampin- children
CTX or cipro - adults
58
When to get HSV surface DNA PCR perinatally
24h after birth
59
How do you test for botulism
stool study (botulinum toxin)
60
Gastritis, if you suspect h. pylori, what's the next step?
PPI
Can't treat h. pylori unless it is proven
61
Post exposure ppx for hep A
<12 mo
>12 mo
<12 mo: HAV Ig
>12 mo: hep A vaccine
62
When is the routine hep A vaccine supposed to be given
>12 mo age, 6 mo apart
63
Who should receive TB "prophylaxis" window treatment and when should you repeat testing
children <5 yo, continue until repeat
Repeat in 8-10 weeks after last exposure
64
Latent TB tx
INH 9 mo
Rifampin 4 mo
INH+R for 3 mo (weekly)
65
TB testing for children <2 yo
only PPD
66
Treatment for Lyme arthritis - late lyme (what if for under 8 yo, or allergic to penicillin)
28-day doxy
28-day amox
cefuroxime for penicillin allergic
67
What is Lyme disease caused by and what is the tick name
Borrelia burgdorferi
Ixodes Scapularis nymphs (deer and white-footed mice)
68
Timing of lyme
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
69
How do you test for Lyme disease
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
70
Synovial fluid WBC count for B Burgdorferi
2-50k
More than that think septic joint
71
How do you work up coccidiodomycosis
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
72
Treatment of coccidiodomycosis
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
73
Diarrhea 1-3 weeks + malnutrition and foul smelling stool, cramping, emesis think ____
giardia
74
Giardia risk factors
daycare, foreign travel, exposure to animals, MSM
75
Indication for tx of giardia and what are they
Indication: FTT, malabsorption syndrome, extraintestinal disease, immunocompromised host
>3 yo: Tinidazole single dose
1-3 yo nitazoxanide 3 days
Metronidazole 5-7 d
76
EBV serology profile and how to interpret
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
77
Treatment for cellulitis
amoxicillin - no MRSA coverage
** cephalexin/cefadroxil/cefuroxime - no MRSA coverage
** clindamycin **
doxycycline - not good for <8 yo, no B-hemolytic strep coverage
78
Risk factors for MRSA
family is a healthcare worker
other members of the family with skin abscesses
crowded living conditions
79
Name the infection:
Arthralgia and lacy rash
slapped cheek
pruritic exanthem
papular-purpuric gloves-and-socks syndrome
Parvovirus B19
80
Pregnant woman with parvovirus B19 in the 1st half of pregnancy, what will happen to the fetus
Generalized edema
Hydrops fetalis
81
Congenital CMV
central nervous system calcifications
chorioretinitis
hearing loss
82
Hearing loss is a consequence of which two congenital infections?
CMV
Rubella
83
Toxo and CMV congenital infection sequelae
chorioretinitis
CNS calcifications
84
When do you HAVE to remove CVLs in bacteremia?
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
85
When do you add gentamicin and rifampin in bacteremia?
Someone with prosthetic valve endocarditis
86
Can you do antibiotic lock therapy in children with bacteremia?
no, not enough data
Only adults
87
Within what window of time can hepatitis A immunoglobulin be given as prophylaxis?
2 weeks
88
When does respiratory papillomatosis present
2-5 yo
89
How do you get respiratory papillomatosis
vertical transmission from mother
HPV 6, 11
90
Aspergillus on smear
septate hyphae
dichotomously branched
91
Itchy painful rash, patient recently immigrated, face, thorax, extremities. Diagnosis?
chicken pox
92
In an infant/patient with good immune system, do you have to do varicella prophylaxis?
NO, but can give vaccine within 5 days if they need it
93
When do you NOT give varicella ppx?
>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
94
Early congenital syphillis sequelae (4)
rash
snuffles
hepatosplenomegaly
thrombocytopenia
osteochondritis
pseudoparalysis
95
Late congenital syphilis symptoms, and when is it diagnosed?
>2 yo
Developmental delay
Anterior bowing of shins
Hutchinson teeth
96
Diffuse maculopapular rash in palms, soles, condyloma lata, fever, malaise, LAD. Which stage of syphilis is this and when does it happen
secondary, weeks to months after inoculation
97
Dementia, aortic aneurysm, granulomas or gummas. Which stage of syphilis is this and when does it happen?
Tertiary-stage
decades after inoculation.
98
Cat scratch pathogen and abx of choice
Pasteurella multocida
Amox-clav, or doxy
Duration: 10-14 days, 3 weeks for tenosynovitis, 4 weeks for septic arthritis, 6 weeks for osteo
99
Cataracts, microcephaly, sensorineural deafness, peripheral pulmonic stenosis, hepatosplenomegally, thrombocytopenia, cerebral calcifications, radiolucent bone lesions. What is the TORCH infection?
Rubella
*radiolucent bone lesions* = rubella
100
Triad of hydrocephalus, chorioretinits, cerebral calcifications
Congenital Toxoplasmosis
101
Infant with respiratory distress, (respiratory ONLY symptoms), negative RSV, what other virus would it be?
Human metapneumovirus
102
Sx of adenovirus infection in infants
pneumonia, pertussis-like syndrome, croup, bronchiolitis
103
Influenza in infants, sx
sepsis-like, non-specific, croup, bronchiolitis, pna
104
Hint for human bocavirus infection
it has to be a COPATHOGEN with other community respiratory viruses
105
Thermoregulatory centers of the brain, and which side does what?
Anterior hypothalamus: controls heat dissipation (associated with hyperthermia)
Posterior hypothalamus: controls heat conservation (associated with hypothermia)
106
Agenesis of corpus callosum and hyperthermia/hypothermia, syndrome
[Reverse] Shapiro syndrome
107
Trichomonas vs. gardnerella
Gardnerella is fishy, gray
Trichomonas yellow, frothy malodorous
Trichomonas cervical exam may resemble strawberry from inflammation (rare)
108
How do you diagnose pertussis?
NAAT PCR nasopharyngeal
109
Treatment for postexposure prophylaxis for pertussis
5-day azithromycin
or
bactrim if older than 2 mo and can't tolerate azithro/has macrolide resistant strain
110
Precaution for pertussis
droplet for at least 5 days after initiation of azithro
111
When are pregnant mothers supposed to get TdaP?
27-36 wk GA
111
When are pregnant mothers supposed to get TdaP?
27-36 wk GA
112
Emesis right away after ingestion of food - milk/egg/meat, causative pathogen?
S. Aureus (very fast!) 2-4 hours
113
Bloody diarrhea 2-5 DAYS after eating food
campy
114
Gastroenteritis, bacteremia, meningitis, 24h after eating milk-based product or deli meats
Listeria
115
Diarrhea lasting 2 weeks, appendicitis-like pain, 4-6 days after eating pork chitterlings/unpasteurized dairy
Yersinia
also can be invasive (bacteremia, NEC, sepsis) in patients with excessive iron storage
116
Diarrheal illness that can have erythema nodosum, reactive arthritis, and proliferative GN
Yersinia enterocolitica
117
Diarrheal illness that can have erythema nodosum, reactive arthritis, and proliferative GN
Yersinia enterocolitica
118
How do you treat Yersenia
In immunocompromised: 3rd gen cephalosporin IV
Other options: bactrim, fluoroquinolones, aminoglycosides, doxy
If healthy patient, supportive
119
Watery mucoid stools/dysentery, abdominal pain, tenesmus, 1-3 days after eating.
Shigella
120
Watery mucoid stools/dysentery, abdominal pain, tenesmus, 1-3 days after eating.
Shigella
121
Fevers for many days, hepatosplenomegally +/0 arthritis, farm contact, disease?
Brucella melitensis
122
Gland-involvement, fever +/- pulmonary disease, +/- eschar. How do you get it and what is the pathogen?
Francisella Tularensis
Tick bite
Direct contact with infected animal
Inhalation of contaminated aerosols
Ingestion of contaminated food
123
When do you treat h. pylori in kids
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
When does mother to child transmission of HIV usually occur?
labor and delivery
125
When should women get intrapartum prophylaxis for HIV and with what agent?
if viral load is >1000 copies and with zidovudine
126
Should all infants born to HIV-infected mothers receive antiretroviral prophylaxis after birth? If so when and for how long?
YES, within 6-12 hours, for 4 weeks
127
Stages of measles
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
Precautions for measles
airborne
4 days before and 4 days after rash
129
Who should get postexposure ppx of measles and when, and with what
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
What vaccines can't pregnant women get?
MMR
Live influenza
Varicella
Oral polio (live)
BCG
Smallpox (vaccinia)
Travel: yellow fever, typhoid, japanese encephalitis
131
Child went to park and played in water, develops watery diarrhea, emesis, cramps 12-48h later. siblings/friends has the same. Pathogen?
Norovirus
132
Onset of diarrhea from cryptosporidiosis
3-14 days incubation
133
Sore throat, exudative (adherent and thick) pharyngitis, child not fully vaccinated, concern for which pathogen?
Corynebacterium diphtheriae
group A strep usually thiner
134
What does malaria (Plasmodium falciparum) look like under microscopy
ring forms
banana-shaped extra cellular things
135
Babesiosis on smear
tetrad forms / Maltese cross
extracellular rings
136
Incubation period of malaria
7 days
137
How do you diagnose malaria?
Giemsa stain
Repeat every 12-24 hours over 3 day period
138
Treatment of malaria
IV quinidine + tetracycline, clindamycin or doxy
139
Treatment of severe malaria (how do you diagnose and with what agent)
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
Severe head and neck infection and IJ thomcophlebitis, causative pathogen?
fusobacterium
141
After HSCT, what should you do with Hib vaccination?
Revaccinate Hib with 3-dose series starting 6 months after transplant and completion of immunosuppressive therapy
142
When is Hib usually given under normal circumstances
2, 4, 6 mo
OR
2, 4 mo
with booster at 12-15 mo
143
When should you give oseltamivir?
Any child <5 yo (especially <2yo), no matter illness severity
144
Common cause of septic arthritis in <4yo that is difficult to isolate by culture, associated with respiratory sx
Kingella Kingae (gram-neg)
Treat with augmentin, or 1st, 2nd, or 3rd gen cephalosporin
145
Immunosuppressed child with cough, chest xray bilateral haziness, hypoxic, what's the pathogen?
PJP
146
How do you treat urethritis/cervicitis from gonorrhoeae +/- chlamydia
Ceftriaxone 250 mg IM
AND
Azithro 1g once or doxy 100 mg bid for 7 days
147
sctoral/inguinal pain and abdominal discomfort +/- fevers. Diagnosis?
epididymitis
148
Who should receive post exposure prophylaxis for mumps?
infants <12 mo (does not count towards 2-dose series)
unvaccinated people over 12mo
149
Abdominal pain, fever, elevated liver enzymes, travel history, gram negative bacteremia. What is the pathogen and mode of transmission? How do you treat it?
Salmonella typhii
human to human
Ceftriaxone --> Fluoroquinolone
150
Cause of meningitis from mosquito bite in US and how to test for it
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
Management of acute necrotizing fasciitis
surgical debridement in OR
Do NOT get further imaging, no time
152
What nutritional deficiency can predispose you to infections and what type of infections?
severe protein-energy malnutrition (Kwashiorkor)
Pseudomonas
153
Rash associated with pseudomonas
ecthyma gangrenosum - painless
154
For healthy patients, do you have to treat toxo?
NO
Just need to start prophylaxis if becomes immunocompromised because it will become latent
155
How do you test for congenital toxo gondii?
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
Treatment of toxo
1. Congenital
2. To healthy children with chorioretinitis
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
Fever followed by blanching maculopapular rash that began after fever abruptly abated from neck and trunk to face and extremities. What's the pathogen?
HHV-6 "sixth disease" (Roseola)
158
What's the youngest age to use DEET and how concentrated should it be
2mo
30%
159
Alternative to amoxicillin for otitis media
cefdinir
160
If a breastfeeding mother has shingles, can she keep breastfeeding?
Yes, only if the lesions can be covered and do not come into contact with infant
161
Is CMV, Hep B, or Hep C a contraindication to breastfeeding? What about herpes?
No
Herpes only if lesions are on the nipple or breast
162
Treatment of congenital CMV
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
"blueberry muffin" lesions refer to infection from ___
CMV, congenital (extramedullary hematopoiesis)
164
How do you diagnose congenital CMV
PCR from either urine, saliva, resp tract, blood or CSF
NOT serology
165
Treatment for tympanostomy tube otorrhea
TOPICAL ofloxacin (better than oral)
166
If an otherwise healthy infant (<28d old) grew CoNS on blood cultures, what should you do next
Nothing, don't add abx, don't change plans, do not repeat blood cultures
167
Above many hours is considered prolonged rupture of membranes?
18h
168
When is the greatest risk of vertical transmission of HSV
0-21d of life
169
After 0-28 days of life when amp and gent is the empiric therapy of choice, what's 30-60 DOL?
cefotaxime
NOT ceftriaxone (high risk of displacing bilirubin from albumin)
170
When do you give prophylaxis abx for splenectomy or functional asplenia?
Until 5 yo OR until 1yr post splenectomy
171
Can you give live vaccines to patients with splenectomy?
YES
172
BEFORE splenectomy, what must you do and when
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
When do you give post exposure ppx for lyme
Usually if tick >36h on person and if engorged
174
How long to stay out of the water if you have...
Cryptospori
Norovirus
Shigella
Crypto: 2 week after resolution of sx
Shigella/Noro: 1 week after resolution of sx
175
Daycare exclusion viral
Measles
Mumps
Varicella
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)
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3 mechanisms of strep pyo infection
suppuration
toxin production
immune-mediated disease
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Antibodies to assess for rheumatic fever
ASO (antistreptolysin O)
Anti-DNAase B
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Criteria for toxic shock syndrome
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
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When do you treat mothers empirically for GBS
+ 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
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Pneumococcal normal vaccine series
PCV13:
4 dose
2, 4, 6 mo and 12-15 mo
PPSV23:
>5 yo OR >2yo in those immunocompromised
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When should Hib post-exposure ppx be given, and what is the agent to give
<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
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Extra GI manifestation of campy
septic arthritis
Reactive arthritis
Erythema nodosum
guillain-barre
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When should you look for bacteremia if you find salmonella?
Kids <3mo
sickle cell
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Which pathogen can cause both diarrhea and seizures/hallucinations
Shigella
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PNA in school aged children, usually causes laryngitis and loss of voice
chlamydophila pneumonia
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Pertussis usual age and blood work
<2mo (prior to immunization)
Lymphocytosis
Can cause pneumothorax/pneumomediastinum due to cough
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DTaP schedule (normal)
2, 4, 6, 12mo, 4-6 yo
5-dose series
Then TdaP at 11-12 yo
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"Adhering" pseudomembrane in pharynx, what's the pathogen
corynebacter
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Tx of corynebacter
Equine diphtheria antitoxin + penicillin/erythromycin for 14 days
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PEP for corynebacter
vaccine (regardless of immune status) +/- pen G or erythromycin for close contacts
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Staccato cough in neonate
chlamydia trachomatis
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Purulent discharge of eyes within 2-5 days of birth, pathogen?
Gonnorhoeae
Chlamydia is within 2 weeks - 30d
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Types of tertiary syphilis
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
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What causes false positives for RPR?
Rickettsia
SLE
Other treponemal infections
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Complication of syphilis therapy
Jarisch-Herxheimer reaction (immune reconstitution)
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Tx for syphilis
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
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How to assess for Active TB in children <5 yo
How about <24mo
3 morning gastric aspirates
<24mo must get LP
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Meningitis routine vaccination schedule
ACWY: 11-12yo AND 16 yo
With risk factors: >2mo
Men B: 2-dose series 16-23 yo
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When does the rash from Borrelia burgdorferi show up?
1-2 weeks after tick bite
200
When does early disseminated Lyme disease show up
1-4 mo
201
What stage of disease is monoarticular/oligoarticular in for Lyme?
6-12 mo after tick bite
202
What is STARI
Southern tick associated rash illness
Mimics Lyme but no burgdorferi
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GN bacilli that infects endothelial cells of blood vessels causing small vessel vasculitis, incubation 2-5 days
Rickettsia rickettsii
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Tick that transmits Rickettsia rickettsii and where is it endemic
black American dog ticks
Arkansas, Missouri, North Carolina, Oklahoma, Tennessee
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Tick that causes ehrlichia and where is it endemic
Amblyomma americanum
Southeast and southcentral US
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Tick that causes anaplasmosis and where is it endemic
Ixodes scapularis
NE and north central US
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Typical rash for ricketsii
wrist/ankles to trunk and face
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Erlichia and Anaplasma rash
involves trunk, spares palms and hands
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How to test and Common lab findings in Rickettsii, erlichia, anaplasma
IgG/IgM, then repeat 3-4 weeks later
hypoNa
hypoalbuminemia
thrombocytopenia
anemia
Erlichia and Anaplasma more likely to have leukopenia; on smear has morulae
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Signs and Treatment of cat scratch disease (bartonella)
LAD (biopsy shows granuloma), fever
7-12 days followed by erythematous papule at inoculation site
azithro + rifampin
Bactrim
Cipro
Gentamicin
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Tx of Psittacosis
tetracyclines or macrolides
212
Neonate with "white nodules" on organs
micro abscesses from listeria
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Fever, limping child with hepatosplenomegally who went to a farm abroad
Brucellosis
214
Tx of brucellosis
<8 bactrim + rifampin
>8 doxy plus streptomycin or genramicin or rifampin
Duration: 42-45 days
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Spirochete transmission through urine or contaminated soil/water
Leptospirosis
216
Phases of lepto
4 weeks after exposure: flu-like sx with transaminases with jaundice
Severe illness "Weil disease" (azotemia, vasculitis, meningitis, shock, icteric liver failure)
217
Intracellular GN orgamism transmitted by breathing in aerosolized droplets of coming in contact with infected animal feces
Coxiella burnetti
218
Person working ith newborn animals and carcasses, with pneumonia, granumaltous hepatitis, or endocarditis. Pathogen and how to treat
coxiella
Doxy for 14 days
219
Person working with newborn animals and carcassess with pneumonia, flu-like sx, granulomatous hepatitis. Pathogen and tx
coxiella
doxy for 14 d
220
How is the plague transmitted, and treated
Yersinia PESTIS
fleas of rodents, droplets from respiratory sites
Tx: cephalosporins, tetracyclines, fluoroquinolones
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Wool sorter's disease. Hemorrhagic mediastinitis, resp symptoms, black eschar, can have bloody stool
bacillus anthracis
tx: fluoroquinolones or doxy
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Rare but fatal long term complication of measles
subacute sclerosing panencephalitis (SSPE) 10 years after --> mental deterioration and seizures
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Treatment for measles
Vitamin A!
IVIG within 6 days, immunization of close contacts >6 mo, immunocompromised hosts
224
viruses in the paramyxoviridae family
measels and mumps
parainfluenza
RSV
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How is varicella transmitted?
airborne if there are open vesicles
226
Complications of chickenpox
bacterial superinfection
PNA
acute cerebellar ataxia
encephalitis
227
Congenital varicella sequelae
1st to 2nd trimester: limb hypoplasia, CNS damage, scarring of skin (in a dermatome), ophtho abnormalitis
228
What can you give for life threatening RSV
Ribavirin
229
Guideline for palivizumab
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
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Papular acrodermatitis is associated with
Hepatitis B and EBV
231
Neonate born to HbsAg mother needs ___
HBIG + Hep B vaccine (does not count towards dose series)
Repeat testing for infection at 9 and 12 mo
232
If you have mono and are given ampicillin, what happens?
morbilliform rash
233
HHV-6 rash
sixth disease
234
smallpox vs. chickenpox
smallpox = SAME stage of lesions
chickenpox = DIFFERENT stages of lesions
235
When are pregnant women the most at risk for hydrops fetalis
<20 wk GA
236
Polio affects which part of the spinal cord
motor neurons, anterior horn
flaccid paralysis
237
Child gets a clean wound, what questions do you ask and do you give Td or TIG?
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
Child gets dirty tetanus-prone wound, Td (or DTap if <7yo) or TIG?
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
Child gets bit by an animal (pet: dog/cat/ferret). Do you give rabies immunoglobulin? What if it's a bat/skunk/raccoon/fox?
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
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Dengue and Chikungunya are transmitted by what kind of mosquito?
Aedes aegypti
241
Workup of candidiasis in neonates must include (5)
US of head
US of abdomen
LP
echocardiogram
Eye exam
242
Treatment of invasive candidiasis in
1. Neonate
2. Pediatric patient
1. Neonate: ampho, 3 weeks
2. Pediatric: echinocandin (micafungin), can narrow to fluconazole if possible. Duration: 2 weeks from clearance
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Tx of candida meningoencephalitis
flucytosine
244
False positive galactomannan can be from?
zosyn
245
Where is Blasto endemic to
Missouri, St. Lawrence Rivers, Great Lakes
246
Pneumonia not getting better, wt loss, fever cough, erythema multiforme/nodosum, really non-specific, and Ohio/Mississippi. Dx?
Histo
247
Erythema nodosum/multiforma and pulm infection. Southwest US
Coccidiomycosis
248
Pneumonia lingeright with painless papules, that becomes violaceous, and verrucous with microabscess in the center, usually heals with scar. St. Lawrence and Great Lakes
Blasto
249
How to test for coccidiomycosis
Urine antigen test, immunodiffusion and complement fixation test
250
CXR with pulm infiltrate +/- cavitation, NO hilar/mediastinal lymphadenopathy. On BAL, "broad-based budding yeast"
Blasto
251
Tx for
1. Histo
2. Blasto
3. Cocci
Histo: itraconazole, ampho if disseminated
Blasto and Cocci: itra- or fluconazole. Itraconazole for bone, fluconazole for CSF penetration
252
Cryptococcus mode of transmission
pigeon dropping
253
Confusion, headache, vision changes, increased opening pressure, india ink stain shows "halo" organism
cryptococcus
254
How to treat cryptococcus
fluconazole and amphoterecin B
255
Perihilar opacity spreading to periphery with hypoxia "batwinging"
PJP
Test for B-D-glucan and LDH
256
Child living in poverty, has PICA, has a dog, has severe asthma and sudden unilateral vision changes with peripheral eosinophilia. Diagnosis?
toxocariasis (Toxocara canis)
Treat with albendazole, and steroids
257
Loffler pneumonia (cough, wheeze, dyspnea, shifting pulm infiltrates, hemoptysis), is caused by what pathogen
Ascaris lumbricoides
258
Tapeworm in latin tems is____
cysticercosis
259
Tapeworm in latin tems is____
cysticercosis
260
How do you test for amoeba
enzyme immunoassay stool specimen
261
Treatment of cryptosporidiosis in immunocompromised pt
nitazoxanide
262
Malaria is carried by what mosquito
Anopheles
263
Malaria prophylaxis
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)
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Where can you get anthrax from
cattle, sheep, goats
Spores can survive in soil or in hide
