Infectious Disease (Alice) (12%) Flashcards by Seth Northway

firm inflamed swelling in the right submandibular area unresponsive to IV abx

atypical myobacterial dz

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FNA findings of myobacterial dz

acid-fast bacilli on ziehl-neelsen staining

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atypical myobacterial infections in children are most frequently located where

superior anterior cervical or submandibular nodes

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95% of myobacterial infxns in kids present with

unilateral, subacute, painless, firm, progressive LAD

mc do NOT involve constitutional sx

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mc age for pediatric myobacterium infxns

1-5 yo

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3 pediatric myobacterial infxns to know

MAC
kanasaii
marinum

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sx of MAC (4)

fever
diarrhea
wt loss
anemia

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mode of transmission for MAC

soil
water

not person to person

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MAC is mc symptomatic in what pt pop

HIV w. CD4 < 50

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dx for MAC

AFB
culture

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tx for MAC

clarithromycin
PLUS
ethambutol
x at least 12 mos
+/- rifampin

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prophylactic tx for MAC for HIV pt

azithromycin OR clindamycin if CD4 < 50

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which myobacterium infxn presents w. TB like sx

kanasii

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tx for myobacterium kanasasii

rifampin
PLUS
ethambutol

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where is myobacterium marinum found

fresh and saltwater

think aquarium/marine animals

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tx for myobacterium marinum (4)

tetracyclines
fluoroquinolones
macrolides
sulfonamides

x 4-6 weeks

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sore throat
fever
malaise
diffuse tonsillar exudate

EBV

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splenomegaly
painful LAD
hepatomegaly

EBV

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classic EBV triad

fever
LAD
pharyngitis

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what lab trend does EBV make you think of

lymphocytic leukocytosis

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what is this showing

atypical lymphotyctes w. enlarged nuclei and prominent nucleoli -> EBV

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what is this rash associated w.

maculopapular rash w. ampicillin -> EBV

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HSV viruses and associated symptoms/conditions

HSV1: oral lesions
HSV2: genital lesions
HHV3: varicella zoster - chicken pox/shingles
HHV4: EBV
HHV5: CMV
HHV6: roseolovirus (6th disease)
HHV7: similar to HHV6 - not classified
HHV8: rhadinovirus - kaposi’s sarcoma (KSHV)

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what is this showing

HHV 3 - varicella zoster

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what is this showing

HHV 3 - chickenpox

what is this showing

HHV4 - EBV

what is this showing

HHV5 - CMV

what is this showing

HHV 6/7 - roseola (6th dz)

what is this showing

HHV8 - kaposi sarcoma

what virus causes the influenza

orthomyxovirus

4 contraindications to influenza vaccine

- < 6 mo old - severe egg allergy - previous rxn - guillain barre w.in 6 weeks of previous vaccination OR w.in past 6 weeks

contraindication for flumist flu vaccine

asthma

gs dx for influenza (2)

RT-PCR OR viral culture

CXR findings in primary influenza

bilateral diffuse infiltrates

are false positives or false negatives more common w. rapid influenza diagnostic tests (RIDT)

false negatives

which antivirals treat influenza A and B

oseltamivir zanamivir *best w.in 48 hr of sx onset*

5 indications for antiviral tx w. influenza

hospitalized outpt w. severe/progressive sx > 65 yo pregnant/2 weeks postpartum lots of comorbidities

what virus causes measles

paramyxovirus

3 phases of measles

prodrome: 3 c's enathem: koplik spots exanthem: morbilliform, maculopapular, blanching rash

what are the 3 c's of measles

cough coryza conjunctivitis PLUS fever

what is this showing

irregularly-shaped bright red spots in the mouth w. bluish white central dot -> koplik spots

how does the measles rash spread

cephalocaudally

clinical dx of measles requires (2)

fever x >/= 3 days PLUS at least one of the 3 c's or koplik spots

gs dx for measles

IgM abs viral PCR

management of measles (2)

isolation x 1 week after rash onset symptomatic

4 complications of measles

otitis media PNA diarrhea encephalitis

5 yo w. acute onset of painful swollen parotid glands - temp 100.8

mumps

what does this make you think

mumps

what virus causes mumps

paramyxovirus

how is mumps transmitted

respiratory droplets

3 different presentations of mumps

parotitis orchitis aseptic meningitis

incubation period of mumps

12-14 days

hallmark symptom of mumps

bilateral parotitis

mcc of pancreatitis in children

mumps

dx of mumps is usually made by

hx of exposure PLUS parotitis

2 diagnostic tests for mumps

saliva/blood test real-time nested PCR

lab finding suggestive of mumps

elevated amylase (from parotitis)

2 CSF findings of mumps

lymphocytosis decreased glucose

18 mo old w. increasing intermittent cough x 3 weeks that lasts 10 min at a time and causes gasping inhalations

whooping cough (pertussis)

what bacteria causes pertussis

bordetella pertussis

think pertussis if you see (2)

cough > 2 weeks < 2 yo

3 stages of pertussis

catarrhal: cold-like paroxysmal: inspiratory whooping cough convalescent: residual cough

the convalescent stage of pertussis can last up to

100 days

dx for pertussis

nasopharyngeal swab culture

tx for pertussis

macrolide supportive SABAs/LABAs

enterobiasis vermicularis is aka

pinworm (variation of roundworm)

mc symptom of pinworm

perianal itching esp at night (when eggs are laid) gross. stop it.

transmission of pinworm (3)

direct contact food surfaces

t/f: pinworm eggs can live for 2-3 weeks on an inanimate object

dx for pinworm

scotch tape test -> eggs under microscopy

tx for pinworm

albendazole mebendazole

teardrop vesicles on an erythematous base/dewdrops on a rose petal

varicella - chickenpox

what is this showing

dewdrops on a rose petal -> chicken pox

what is this showing

dewdrops on a rose petal -> chicken pox

describe the spread of chicken pox

cephalocaudal

acute chickenpox becomes dormant in the

dorsal root ganglion

what is this showing

maculopapular rash along one dermatome -> **shingles**

dx for shingles

tzanck smear -> multinucleated giant cells

what is this showing

multinucleated giant cells -> zoster

dendritic lesions on slit lamp

zoster ophthalmicus -> CN V shingles

ramsay hunt syndrome is aka _ and involves CN _

zoster oticus CN VII

3 sx of ramsay hunt syndrome

otalgia lesions on ear/auditory canal/TM facial palsy

management of shingles

acyclovir PLUS valacyclovir PLUS famciclovir w.in 72 hr to prevent post perpetic neuralgia

definition of postherpetic neuralgia

pain > 3 mo paresthesias decreased sensation

tx for postherpetic neuralgia (4)

gabapentin TCA topical lido capsaicin

zoster vaccine is recommended for

adults > 60 yo