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Paediatrics > Infectious Disease > Flashcards

Infectious Disease Flashcards

1
Q

Sepsis in Neonates:

Bacteria + Abx

A

GBS, E. Coli
enteroccoci, listeria

ampcillin + gentamycin
if mengitis, amp + cefotaxime +/- acyclovir

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2
Q

sepsis in >3mo olds

A

S pneumo
N. meningitidis, S aureas, H influ, strep pyogenes

ceftriaxone + vancomycin
allergy: cipro + vanco

if hospital acquired / immune compromised:
MSSA, MRSA, VRE, viridans

meropenem + gent + vanco

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3
Q

sickle cell /w fever

A

ceftriaxone +/- vancomycin (if clinically septic)

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4
Q

meningitis in neonate

A

GBS, E Coli, listeria

amp + cefotaxime +/- acyclovir

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5
Q

meningitis in >1mo old

A

S pneumo, N meningitidis, H flu

ceftriaxone + vancomycin, + amp if <3mo and immunocompromised

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6
Q

pneumonia in neonate

A

GBS, listeria, myocplasma, chlamydia

amp + gent, +/- azithro if chlamydia

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7
Q

pneumonia in >1mo

A

S pneumo, H flu, S aureas, S pyogenes,

atypical: mycoplasma pneumoniae, chlamydia pneumoniae. Viruses, TB.

high dose ampicillin or amoxil (azithro if atypical features)

ceftriaxone + azithro if severe or RF for anaerobes, step down to amox-clav

add oseltamivir for flu (and use amox-clav instead of amox)

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8
Q

otitis media

A

amoxicillin = 1st line

cefuroxime-axetil if non-severe allergy, azithro if severe

amox-clav or if fails 1st line

if perforated: topical ciprodex

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9
Q

Strep phayngitis / scarlet fever tx

A

penicillin V x 10 d (amoxicillin alternative)

macrolide (azithro) if allergy

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10
Q

AOM bacteria

A

strep pneumo, non-type H flu, moraxella ctarrhalis = most common

20% viral

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11
Q

diagnostic criteria AOM

A

1) rapid onset otaliga /w fluid + inflammation
2) effusion: immobile TM or acute otorrhea
3) bulging membrane + discoloration

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12
Q

Management of AOM

A

no effusion or non-bulging - likely viral, reassess ear in 24-48hr

> 6 mo, healthy + mildly ill: can wait 24-48 before Abx

if severe sx, >48h illness, perforation, or <6mo = start abx now

10 day course 6mo-2yrs

5 day course if 2 yr +

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13
Q

AOM complications

A 
mastoiditis
bacteremia
meningitis
cerebral abscess
transient hearing loss, speech delay
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14
Q

meningitis presentation

A

infants:
fever, poor feeding, vomiting, lethargy, crying, sepsis, bulging fontanelle, petechae

additionally in kids:
headache, back/neck pain, photophobia, confusion, nuchal rigidity, focal neuro signs

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15
Q

CSF analysis in meningitis

A

WBC:
5-50,000 = bacterial
20-2000 = viral

protein
>0.6 = bacterial
>0.3 = viral

glucose
<2.8 = bacterial
<3.3 = viral

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16
Q

treatment for meningitis

A

empiric abx
maintain BP
manage ICP
monitor fluids + lytes (SIADH)

dexamethasone if Hib meningitis or pneumococcal in 6wk+ old – must give BEFORE antibiotics

prophylactic antibiotics for close contacts if Hib or N Meningitidis

17
Q

impetigo

A

staph aureus, strep pyogenes

topics: mupirocin, fucidin
oral: cephalixin

if resistant: vanco

18
Q

UTI - bacteria + treatment

A

e coli = 80%, klebsiella, enterococcus, P aerginosa

complicated: ill, <3mo, vomiting, immunocompromised = admit, IV amp + gentamycin
uncomplicated: amox-clav 7-10d

renal + bladder US in all kids after 1st UTI

voiding cystourethrogram if scarring, high grade reflux, obstruction, or recurrence

19
Q

presentation of UTI

A

young: fever, poor feeding, vomiting, urine colour, lethargy, vague
older: fever, LUTS, macroscopic hematuria, suprapubic/fklan pain, foul urine smell

20
Q

diagnosing UTI

A

suggestive urinalysis AND 50,000 CFU/ml on culture

21
Q

pharyngitis DDx

A

GAS - 5-11yo, fever, tonilar hypertrophy/exudates, absence of cough/rhinitis, sandpaper rash, palate petechaie, strawberry tongue

viral - variable URTI sx, arthralgia, diarrhea, etc

EBV - last long, tonsil hypertrophy, LN, hepatoplnomegally

adeno - /w conjunctivitis

22
Q

pharyngitis tx

A

viral - none
GAS - amoxicillin or pen V for 10 days

allergy - erythromycin

23
Q

strep pharyngitis complications

A

acute rheumatic fever (valves, chorea, subQ nodules, fever)

acute glomerulonephritis

abscess / cellulaitis, deep neck space infection, otitis media, sinusitis, mastoiditis

24
Q

durations of sinusitis

A

acute: 10-30d
subacute: 30-90d
chronic >90d
recurrent: 3x in 6mo or 4x in 12

25
Q

sinusitis presentation

A

nasal congestion, purulent discharge, periorbital edema, ear/throat pain, halitosis, fever, fatigue

also headache, facial pain, tooth ache, hyposmia in older kids

26
Q

w/u for sinusitis

A

no imaging routinely

CT only if worried re complications, persistent or recurrent, anticipated surgery

27
Q

treatment for sinusitis

A

high dose amoxicillin x 14d

28
Q

complications of sinusitis

A

periorbital + orbital cellulitis, osteomyelitis, subperiosteal orbital fissure syndrome, orbital apex syndrome

older; meningitis, brain abscess, cortical thrombophebitis, cavernous or sag sinus thrombosis

29
Q

orbital cellulitis red flags

A

decreased EOM, proptosis, decreased visual acuity, RAPD, optic disc swelling

30
Q

w/u + treatment for orbital cellulitis

A

CBC, diff
blood cultures
emergent orbital CT scan

tx: admit! ENT + optho +/- ID consults
IV cloxacillin + IV ceftriaxone, +/- clinda/metronidazole
+/- surgical drainage

31
Q

orbital cellulitis complications

A

cavernous sinus thrombosis, meningitis, vision loss

32
Q

periorbital cellulitis treatment

A

traumatic: IV cefazolin or PO cephalexin

non traumatic: IV ceftriaxone or PO amox-clav

consider admission if <5, unwell, no trauma preceding. Admit if <2, sickle cell, bacteremia.

33
Q

When do to full septic w/u for fever without a source

A
  • <1mo old no matter what

- sick/toxic

34
Q

full septic workup

A 
cbc + diff
blood culture
urine cultures, U/A, microscopy
LP culture + analysis
\+/- CXR, stool, NP viral swab +/- CRP
35
Q

FWS in 1-3mo old, well-appearing

A

CBC, blood cultures
CRP
U/A + culture
+/- CXR, stool

LP only if unwell or WBC high or low

can either discharge /w 24h follow up or admit, +/- abx

Paediatrics (23 decks)

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