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Royal College > Infectious Disease CPS > Flashcards

Infectious Disease CPS Flashcards

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1
Q

Which children are exempt from the CPS guideline around AOM treatment

A

< 6 months
Craniofacial abnormalities
Immunocompromising conditions
Tympanostomy tubes
Recurrent AOM

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2
Q

Most common bacterial causes of AOM (4)

A

Strep pneumo
H influenzae
M catarrhalis
GAS

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3
Q

Criteria needed to diagnose an AOM

A

Middle ear effusion**
Acute onset of symptoms
Inflammation of the middle ear
Bulging TM is most significant for bacterial AOM

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4
Q

Complications of bacterial AOM

A

Mastoiditis most common
Acute facial nerve palse
Labyrinthitis
Venous sinus thrombosis
Meningitis

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5
Q

Which children can have watchful waiting for their AOM

A

Mild or moderately bulging TMs
Mildly ill
Alert
Responding to antipyretics
Fever < 39
Mild otalgia

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6
Q

Drug of choice for AOM and dosing

A

Amoxicillin
75 to 90 mg/kg/day BID
45 to 60 mg/kg/day TID

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7
Q

When should you treat AOM with something other than amox? And what to use

A

AOM with purulent conjunctivitis suggests H flu or moraxella - give amox clav or cefuroxime
Treated with amox in past 30 days - give amox clav
Allergy to amox - give cefprozil, cefuroxime, 3rd gen cefalosporin, or macrolides if severe allergy

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8
Q

Duration of therapy for AOM

A

2 years or older = 5 days
< 3, recurrent AOM, perforated TM, failure of initial therapy = 10 days

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9
Q

Diseases to consider when a returned traveller has
JAUNDICE (5)

A

Hepatitis A, B, E
Viral hemorrhagic fever
Typhoid fever
Leptospirosis
Malaria

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10
Q

Diseases to consider when a returned traveller has
LYMPH NODE ENLARGEMENT (8)

A

EBV
CMV
HIV
Rickettsiae
Brucellosis
Mycobacterium TB
Visceral leishmaniasis
Trypanosomiasis

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11
Q

Diseases to consider when a returned traveller has
DIARRHEA (8)

A

Rotavirus
E coli
Shigella
Salmonella
Campylobacter
Yersinia
Giardia
Amebiasis

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12
Q

Diseases to consider when a returned traveller has
1. Hepatomegaly (3)
2. Splenomegaly (4)

A
  1. Hepatitis A, B, E, malaria, amebiasis
  2. EBV, typhoid fever, malaria, visceral leishmaniasis
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13
Q

Diseases to consider when a returned traveller has
HEMORRHAGIC RASH (4)

A

Dengue
Meningococcus
Rocky mountain spotted fever
Viral hemorrhagic fever

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14
Q

Which disease are you more likely to get from mosquitoes that bite in the
1. Night
2. Day

A
  1. Malaria (Anopheles)
  2. Dengue
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15
Q

Non specific symptoms of malaria

A

Fever, chills, headache, N/V/D, lethargy, myalgia, abdo pain

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16
Q

Incubation period of
1. Typhoid
2. Dengue

A
  1. 7 to 14 days
  2. 2 to 14 days
17
Q

Presentation of typhoid (enteric) fever

A

Biphasic symptoms
Enterocolitis with diarrhea, then resolves
Fever, chills, rash, diaphoresis, headache, myalgias, confusion, psychosis, apathy

18
Q

Symptoms of Dengue fever

A

High fever, chills, headache, myalgias, red reticulate rash over thorax/face/flexion areas
May see lymphocytosis, neutropenia, and elevated aminotransferases

19
Q

3 symptoms of hemorrhagic dengue or shock syndrome

A

Hyponatremia
Hypoproteinemia
Circulatory collapse

20
Q

3 suppurative complications of GAS

A

Peritonsillar abscess
Retropharngeal abscess
Sepsis

21
Q

2 non suppurative complications of GAS

A

Post-strep glomerulonephritis
Acute rheumatic fever

22
Q

Which complications of GAS does antibiotic treatment prevent?

A

Prevents suppurative complications and acute rhematic fever
Does NOT prevent post strep GN

23
Q

JONES major criteria for Acute Rheumatic Fever

A

Joints: Polyarthritis
Carditis (clinical or subclinical)
Nodes: subcutaneous nodules
E: erythema marginatum
S: syndenham chorea

Need 2 major or 1 major and 2 minor to meet criteria

24
Q

What rash is seen in acute rheumatic fever?

A

Erythema marginatum

25
Q

Minor criteria of ARF

A

Fever > 38.5
ESR or CRP elevated
Prolonged PR interval

26
Q

Symptoms of GAS pharyngitis (FACTS)

A

Fever > 38
Anterior cervical lymphadenopathy (tender)
Absence of cough and rhinorrhea
Inflamed or purulent tonsils
Moderate to severe sore throat

27
Q

What age is strep throat most common in? Which age is it rare to see?

A

5-11 most common
Rare in children <3

28
Q

CENTOR decision rule for GAS

A

For children 3-14 years
One point for each of: exudate or swollen tonsils, tender or swollen anterior cervical lymph nodes, fever, no cough
Score 3 or more = do a throat swab

29
Q

What time frame do you need to treat strep throat to avoid complications

A

Within 9 days of symptom onset

30
Q

Optimal treatment for strep throat

A

Penicillin or amoxicillin for 10 days
Can use macrolides if truly allergic but resistance up to 20%

31
Q

Does GAS or viral pharyngitis respond faster?

A

GAS - should see rapid improvement in <24 hours
Viral takes 2-3 days

Royal College (8 decks)

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