Infectious Disease High Yield

Question 1

0-1 month Bacterial Meningitis

Answer 1

GBS, E. coli, Listeria

Ampicillin + Gentamicin or Cefotaxime

Question 2

1-3 months Bacterial Meningitis

Answer 2

GBS, Strep pneumoniae, Listeria

Ampicillin + Cefotaxime (or + Vancomycin if suspect bacterial
meningitis)

Question 3

3 months-3 years

Answer 3

Strep pneumoniae, HIB, Neisseria meningitidis

Cefotaxime (or + Vancomycin if suspect bacterial meningitis)

Question 4

3 years to adult

Answer 4

Strep pneumoniae, Neisseria meningitidis

Ceftoxamine (or + Vancomycin if suspect bacterial meningitis)

Question 5

Listeria

Answer 5

o Neonates are prone, especially those w/ T Cell defects
o Gram+Rod
o Can be maternally acquired from unpasteurized dairy, soft cheeses
Mom may just have flu-like illness
Has predilection for causing amnionitis
Brown, murky fluid
Can result abortion, stillbirth, neonatal sepsis
o Neonatal distress: Respiratory distress, temperature instability, poor feeding, lethargy/irritability
o Severeform
Gramulomatosis Infantiseptica
Pathognomic for Listeriosis
Granuloma formation and tissue destruction
o Skin (popular or ulcerative necrosis), liver, adrenals, lymphatics, lung, & brain

Question 6

Neisseria Meningitidis

Answer 6

o Children ≤2 y/o at greatest risk
o Will have petechial rash prominent on ankles, wrist, axilla,
flanks
o Complication
  Waterhouse-Friderichsen
  Fulminant Meningococcemia
  Vasomotor collapse
o Severe HoTN
  Large purpura and petechiae on flanks from
Adrenal hemorrhage

Question 7

Complications of Meningitis

Answer 7

Hearing loss (most common, 25%) (prevent with corticosteroids)
Global Brain Injury (5-10%)
SIADH, seizures, hydrocephalus, brain abscess, CN palsy
Can have developmental regression
o Ex. Forgetting how to copy shapes

Question 8

Aseptic Meningitis

Answer 8

Definition
Inflammation of the meniges w/ CSF lymphocytic pleocytosis
And if caused by a virus
o Normal Glc, normal to minimally ↑ protein
Causes
Viral most common
o If involves the brain also, then meningoencephalitis
o Enteroviruses
Most common in US Summer & Fall
o Mumps,HerpesViruses
o Viruses that cause encephalitis
Arboviruses (St. Louis, Western equine, Eastern equine, West Nile), influenza, Herpes viruses
Bacterial (some can cause aseptic presentation)
o TB(Children<5y/o)
o Borrelia burgorferi(Lyme)
o Treponema pallidum (Syphilis)
Fungal
o Coccidioides immitis, Cryptococcus neoformans, Histoplasmosis capsulatum
Parasitic
o Taenia solum (cysticerosis)
o Toxoplasma gondii (immunocompromised pt.)

Question 9

Simple URI (Common Cold)

Answer 9

Rhinovirus, parainfluenza, coronavirus, RSV S/Sx
Low grade fever, rhinorrhea, cough, sore throat
o Resolves in 7-10d
Color of nasal discharge alone doesn’t predict the presence of concurrent sinusitis
o Purulent nasal discharge may occur early in course of URI
Persistent Sx (>10d) or fever, suspect bacterial superinfection (sinusitis,
otitis media)

Question 10

Sinusitis

Answer 10

Clinical Diagnosis
Persistent Sx, ≥10d w/out improvement
Or Severe Sx (Fever ≥102°F, purulent nasal discharge, face pain ≥3d)
Or Worsening Sx ≥5d after initial improvement of Viral URI
Pus drainage from the meatus Formation
Ethmoid & Maxillary: present at birth
Sphenoid: Develop between 3 to 5 y/o
Frontal: 7 to 10 y/o
Complications
Cerebral Abscess
o Visualized by CT or MRI
Tx
Antibiotics
o OralAmoxicillin-ClavulanicAcid(Augmentin)
Covers the most common (S. pneumoniae &
nontypeable Haemophilus influenzae)

Question 11

Pharyngitis

Answer 11

Viral
o Coxsackievirus, EBV, CMV
  Bacterial
o Strep pyogenes (GA β hemolytic Strep [GABHS] aka “Strep
Throat”)
o Arcanobacterium hemolyticum, Corynebacterium diphtheria
(diphtheria)
  S/Sx
  Viral and GABHS overlap
  Viral
o Simple URI Sx
o Can have tonsillar exudates 
o EBV Pharyngitis
  Enlarged posterior cervical lymph nodes, malaise, & hepatosplenomegaly
o Coxsackievirus Pharyngitis
  Painful vesicles/ulcers on P. Pharynx
  Soft palate (herpangina) (not herpes)
  Blisters on palms/soles (hand-foot-mouth disease)

Question 12

GABHS pharyngitis

Answer 12

o Typically school age (5-15 y/o), winter & spring o Lack of other URI Sx (rhinorrhea, cough)
o S/Sx
Sore throat
Exudates on the tonsils, Petechiae on soft palate,
Strawberry Tongue, enlarged tender A. Cervical LN
Fever
Scarlatiniform rash (also in Scarlet fever)
Sandpaper rash
o Dx
Rapid Strep
o Tx
Amoxicillin
Erythromycin for penicillin allergic
o Complications
PSGN (ABx don’t prevent) and Rheumatic Fever (ABx prevent)
Peritonsillar Abscess
Asymmetric tonsilar bulge
o Displaces uvula to side

Question 13

Acute Otitis Media

Answer 13

Otitis media w/ effusion (OME): fluid w/ middle ear without Sx of infection Can have a retracted TM
If >3m then conduct audiometry testing to assess hearing loss If normal hearing then give ABx or can observe
o Causes
Bacterial
S. pneumoniae (most common), non-typeable H. influenzae, Moraxella catarrhalis
Viruses o S/Sx of AOM
AOM usually develops after simple URI
Fever, ear pain, ↓ hearing, pulling at ear
If TM perforates, may have drainage from ear
o Dx
Dx of AOM: fluid in middle ear (bulging TM, absent motility, otorrhea) & Sx of
Infection (erythema of TM)
Pneumatic Otoscopy identifies abnormal movement of TM
o From fluid
o Most reliable way of detecting middle ear fluid o BulgingTM
o Complications
Cerebral Abscess
Visualized by CT or MRI S/Sx
o Persistent fever, neurologic deficits,headache,seizures
o ↑ ICP
From accompanying edema from abscess
Mastoiditis
Erythematous, swollen, tender, skin overlying mastoid
Conductive hearing loss
Can spread to the meninges
o Tx
Don’t have to treat if ≥2 y/o and nonsevere
Treat if worsen w/in 48-72h ABx if used
Amoxicillin (80 mg/kg/day BID) initially o Higher dose than for Strep throat
If attended daycare w/in previous 2 months, then increased likelihood of penicillin resistant S. pneumoniae
o High dose amoxicillin, amoxicillin-clavulanic acid, or a cephalosporin
Macrolide (Erythromycin) if penicillin allergic No ABx for OME
Tube placement only if >3 infections in 6m or >4 infections in one year

Question 14

Otitis Externa (OE)

Answer 14

o Infection of the external auditory canal (EAC)
o Predisposition
Cerumen removal, trauma, maceration of skin from swimming, excess moisture
o Causes
Pseudomonas aeruginosa, S. aureus, or C. albicans
2° to perforated TM from AOE
o S/Sx
Pain, itching, and drainage
o Dx
Erythema/edema of EAC
Sometimes purulent white discharge
o Tx
Restore EAC to natural acidic state
Mild (minimal pain/discharge): acetic acid
Severe: Topical ABx/Corticosteroids
Perforated AOM w/ OE: Both oral & topical ABx

Question 15

Cervical Lymphadenitis

Answer 15

o Enlarged, inflamed tender lymph nodes o Causes
Localized Bacterial Infection
S. aureus, most common
o Fever &Tender
S. pyogenes, common
Mycobacterium: TB and MAC (atypical mycobacteriums)
Francisella tularensis
o Ulcerative lesion at inoculation site
o Regional extremely tender lymphadenopathy
B. henselae (cat scratch disease)
o May have Hx of cat exposure
o Papules develop at scratch site
o Nontender local lymphadenopathy: Cervical, inguinal, axial
o Nonspecific Sx: low-grade fever, malaise, fatigue
o Gram–bacilli on Warthin-Starry Stain
o Tx
Typically self limited, but can give Azithromycin

Question 16

Non-bacterial Cervical Lymphadenitis

Answer 16

Viral
Reactive lymphadenitis: EBV (tender generalized lymphadenopathy),
CMV, HIV
o Kawaskai
Unilateral cervical lymphadenitis
o T. gondii
Mono like illness w/ cervical lymphaenopathy
o Bilateral, symmetric, tender or nontender cervical adenopathy

Question 17

Parotitis

Answer 17

o Inflammation of the parotid salivary glands
o Causes
Mumps and other Viruses (CMV, EBV, HIV) Bilateral
Before vaccination, mumps was #1 cause Bacterial parotitis (acute suppurative parotitis)
Unilateral
S. pyogenes & TB
o S/Sx
Fever
Neck Swelling centered above the angle of the jaw & fever
Pus in oropharynx
Can be expressed from Stensen’s Duct
o Complications
Mumps: meningoencephalitis (also complication of bacterial), orchitis (most common complications, esp. for post puberty), & epididymitis, pancreatitis

Question 18

Staphylococcal Scaled Skin Syndrome(SSSS)

Answer 18

S. aureus exfoliative toxin
Scarlatiniform erythema
More erythematous in skin flexures and periorally
Fever, tender skin, bullae
Intact bullae are sterile (unlike impetigo bullae)
Nikolsky Sign
Extension of bullae when pressure applied
Skin Sloughs off
Extensive fluid and electrolyte loss
Tx
Clean and moisten skin w/ isotonic or burrow solution
IV Oxacillin or Naficillin (penicillinase resistant)

Question 19

Scarlet Fever

Answer 19

GABHS that produce erythogenic toxin S/Sx
Exanthem may develop during any GABHS infection o Begins on trunk
Moves peripherally
o Skin is erythematous w/ skin colored papules (scarlatiniform
appearance)
Sandpaper Rash texture
o Pastia’s Lines
Petechiae w/in skin crease
o Desquamation of dry skin as infection resolves
William Martin MD MBA 2016 TTUHSC SOM OC USN
2.23.2015
Fever
White exudates on inflamed tonsils, pharyngitis
Strawberry tongue w/ circumoral pallor
Dx
+ Culture/Throat Swab
Tx
Goal is to prevent Rheumatic Fever
Oral Penicillin VK, IM Benzathine Penicillin, or for penicillin allergic
erythromycin or Macrolide

Question 20

Complications of Strep Pharyngitis

Answer 20

PSGN (ABx doesn’t prevent), rheumatic fever (ABx prevent), Post Strep Arthritis (ABx doesn’t prevent)
Pediatric autoimmune neuropsychiatric disorder associated w/ streptococcal infection (PANDAS)
o Acute OCD or Tic DO after Strep Infection
o ABx prevents

Question 21

Toxic Shock Syndrome

Answer 21

Toxin Mediated
Fever, shock, desquamating skin rash, multiorgan dysfunction Causes
S. aureus #1, GABHS also
Tampons
Dx: 5 of 6 probable, 6 of 6 confirmed
Fever > 101
HoTN (SBP <90)
Diffuse macular erythroderma (looks like sunburn)
Desquamation (10-14d after illness)
Multisystem Involvement
o GI, Myalgias (↑CPK), Hyperemia of mucous membranes (pharyngitis, vaginits), pyuria, thrombocytopenia, CNS (∆MS)
- cultures other than S. aureus (CSF, blood, pharynx) Tx
Reverse shock, ABx, IVIG

Question 22

Diarrhea

Answer 22

o Viral
Rota and Norwalk
Rotavirus
Most common infectious cause of gastroenteritis
o Winter Months
Incubation is 1-3d
Vomiting, watery osmotic diarrhea, dehydration
o Self limited for 4-7d
Supportive Tx
Norwalk Virus
Outbreak of gastroenteritis in all age groups
o Esp. closed populations (day care, cruise ships)
Same Sx as Rotavirus, just more prominent vomiting
o Shorter duration, 2-3d
o Evaluation
Recent ABx
C. difficile
Unusual pets (e.g. turtles)
Salmonella
ELISA
Rotavirus, Giardia lamblia, C. difficile If WBCs absent, culture is of limited use
o Non-anion gap Hyperchloremic Metabolic Acidosis Result of bicarb loss in stools
o Tx
Fluids

Question 23

HIV and AIDS

Answer 23

o S/Sx
Infants typically asymptomatic for the first few years
Early Sx of HIV infection
FTT, Thrombocytopenia, Recurrent Infections (otitis media, pneumonia, sinusitis) Generalized Lymphadenopathy, Parotitis, Recurrent Thrush, loss of developmental milestones, Severe VZV, diarrhea
Older children may present w/ weight loss (FTT), AIDS defining illnesses (e.g. oral lesions), lymphadenopathy
o Dx
Infants
All infants born to HIV infected mothers have maternal Ab that may last 18-24m
o HIV specific DNA PCR is the test <18m (bc maternal Ab will interfere)
HIV specific DNA PCR is performed at birth & monthly until 4m to detect those infected perinatally
Negative HIV specific DNA PCR @ 4m consistent w/ non infected
o Followed till 18-24m when lose maternal Ab Older Children
ELISA, confirm Western Blot
o Tx
Infants born to HIV mothers
Zidovuidine for 6w postexposure prophylaxis after birth o Also for mother starting @ second trimester
TMP/SMX for PCP prophylaxis at 6 weeks old until HIV DNA PCR - @4m
No breastfeeding
Urine CMV Culture to detect CMV/HIV co infection (5%)

Question 24

Infectious Mononucleosis

Answer 24

o EBV #1 cause
Toxoplasmosis, CMV, and HIV can cause a similar clinical syndrome o S/Sx
Young children may be asymptomatic Older children: typical S/Sx
Fever, up to 2w
Malaise & Fatigue
Pharyngitis (typically exudative, resembling GABHS)
Posterior cervical lymphadenopathy
Hepatosplenomegaly
Takes weeks to months to resolve
o Complications
Post infectious Bell’s Palsy
o Dx
CBC shows atypical lymphocytes
May also have neutropenia, thrombocytopenia, & ↑LFT Monospot (first line)
Measures heterophile Ab
Less sensitive for children <4 y/o
o InsteadhaveEBVAbTiters
Viral Capsid Antigen (VCA) & EB Nuclear Antigen (EBNA)
Acute infection: ↑ IgM-VCA and absent EBNA Ab
CMV causes the majority of monospot negative mononucleosis Tx: supportive, corticosteroids for severe pharyngitis
Complications
Neurological, CN palsy and encephalitis
Severe pharyngitis can cause obstruction
Amoxicillin-Associated Rash
o EBV infected pts. who are misdiagnosed w/ GABHS and prescribed amoxicillin develop a diffuse pruritic maculopapular rash 1 week after
Splenic rupture
Malignancy: Burkitt’s lymphoma and nasopharyngeal carcinoma

Question 25

Measles

Answer 25

o Highly infectious o S/Sx Appear 8 to 10d after incubation Classic prodrome followed by a transient enanthem (rash on mucous membranes) and exanthem (skin rash) Classic prodrome, The Three C's (Cough, Conjunctivitis, & Coryza) Other early Sx: Photophobia & fever Enanthem: Koplik spots (small gray papules on an erythematous base on the buccocal mucosa) Pathogonomic and present before the generalized exanthem Exanthem: erythematous maculopapular eruption, begins around neck & ears, spreads down the chest and upper extremities during 24h Covers the LE by 2nd day and becomes confluent by the third day Fever o Complications Bacterial Pneumonia Otitis media, laryngotracheitis, encephalomyelitis (inflammation of brain and spinal cord), subacute sclerosing panencephalitis o Tx Supportive, Vitamin A IVIG for immunocompromised postexposure prophylaxis

Question 26

Rubella

Answer 26

o Unlike measles, typically mild or asymptomatic, incubation 14-21d o S/Sx Prodrome: Mild URI w/ low grade fever (<101oF) Painful lymphadenopathy Suboccipital, posterior auricular, and cervical nodes Exanthem follows the adenopathy Nonpruritic, maculopapular, and eventually confluent Begins on Face and spreads to trunk/extremities o Complications Meningoencephalitis Polyarthritis Teenage girls/young women Congenital Rubella Syndrome First trimester infection Thrombocytopenia, Hepatosplenomegaly, jaundice, purpura (blueberry muffin baby), MR XR o Longitudinal striations in metaphysis (osteochondritis or periostitis = congenital syphilis) Triad o Cataracts, PDA, Sensorineural Hearing Loss Pregnancy test priority if woman is infected of childbearing age

Question 27

Entamoeba Histolytica

Answer 27

o Ingested cyst in contaminated food or water Sx begin 1-4w later as trophozoite emerges from cyst and invades mucosa o S/Sx Ranges from asymptomatic to disseminated Extraintestinal amebiasis Most asymptomatic Symptomatic: mild Colitis to severe Dysentery Cramping abdominal pain, diarrhea w/ blood or mucus, tenesmus (feeling of constantly needing to pass stools, despite an empty colon) o Can mimic IBD in chronic forms Can last for weeks Abdominal complications o Intestinal perforation, hemorrhage, strictures, local inflammatory mass (ameboma) Extraintestinal amebiasis Abscess, most commonly in the liver, although can form in brain or lungs o Dx Trophozoites or cysts in stool Serum Ab Assay US/CT of for liver cyst o Tx Metronidazole plus a luminal amebicide (iodquinol or paromomycin)

Question 28

Giardiasis

Answer 28

o Giardia lamblia o Travelers to Russia and drinking/swimming in contaminated mountain water in the western US, daycare o S/Sx May persist for 2-6w (prolonged) Diarrhea Voluminous, watery, & foul smelling Bloating, flatulence, weight loss o Dx Cysts & trophozoites in stool Stool ELISA o Tx Metronidazole (same w/ Amebiasis)

Question 29

Malaria

Answer 29

o Plasmodium: falciparum, vivax, malariae, ovale o S/Sx Initial: flulike Sx, headache, anorexia, fever Cyclical fevers: correlate w/ RBC rupture Hemolytic anemia, splenomegaly, jaundice o Dx Thin and thick Giemsa peripheral smear o Tx Chloroquine, quinine, mefloquine, doxycycline o Prevention Chemoprophylaxis: chloroquine, mefloquine, doxycycline, atovaquone

Question 30

Toxoplasmosis

Answer 30

o T.gondii o Congenital Triad Diffuse Intracranial Calcifications, chorioretinitis, hydrocephalus jaundice, hepatomegaly, o Transmission: cat feces, ingestion of cyst contaminated, transplacental o S/Sx Mononucleosis-like illness Malaise, fever, sore throat, myalgias, lymphadenopathy

Question 31

Pinworm

Answer 31

``` o Nocturnal anal pruritus or vulvovaginitis in prepubertal females o Dx Scotch Tape Test o Tx Mebendazole ```

Question 32

Congenital CMV

Answer 32

S/Sx IUGR (w/ microcephaly) Cataracts, chorioretinitis seizures, hepatosplenomegaly, jaundice, purpura Periventricular calcifications Sensorineural hearing loss o If mother was previously infected, IgG will protect fetus in event of reactivation o Can be shed in urine for years

Question 33

Bell's Palsy

Answer 33

o Postinfectious HSV #1 EBV, VZV, Lyme have also been implicated o Tx Eye drops to keep eye lubricated Can do Glucocorticoids

Question 34

Cat-Dog Bite

Answer 34

Pasteurella multocida (#1) & S. aureus P. multocida causes swelling within 24-48h w/ tenderness, erythema, and sanguinopurulent discharge Complications: tenosynovitis, osteomyelitis, septic arthritis Tx Covers both: Amoxicillin-Clavulanate (Augmentin) (Ampicillin alone doesn’t cover S. aureus) Don’t close, leave open to heal if possible

Question 35

Scabies

Answer 35

o Multiple excoriated & crusted (w/ blood) erythematous plaques Typically on extensor elbow, webs of fingers, axillary folds, near nipples o Burrows Thin grey, brown, or red lines o Commonlyfamilyinvolved o Tx Permethrin Cream Dry clean all linens/clothes

Question 36

Acute Osteomyelitis

Answer 36

o Occurs from hematogenous spread, indirect spread of infected soft tissue, direct inoculation from trauma o S/Sx Fever, erythema Tenderness (to palpation) & ↓ Motility (unable to stand on leg) o Causes Children: S. aureus (most common), Group A Strep After dog bite: Pasturella multocida Puncture wound through shoe (rubber): Pseudomonas Sickle Cell Anemia: Salmonella o Xray Deep tissue edema

Question 37

TB

Answer 37

o Fever, weight loss, and LRT S/Sx o PPD ≥5mm + if exposure history, abnormal CXR, or immunodeficiency o Prolonged contact w/ someone diagnosed w/ TB Number one risk factor for children No sign of disease o High risk, should start Isoniazid prophylaxis even if initial negative TB skin test If repeat TB skin test is negative in 8 to 12w can discontinue 3 to 8w after exposure is needed before developing hypersensitivity to TB CXR shows Pulmonary disease o 6months:Isoniazid+Rifampin o Plus Pyrazinamide and Ethambutol for the first 2 months.

Question 38

Tinea Capitis (ringworm of scalp)

Answer 38

o Dermatophyte Trichophyton tonsurans (most common) or Microsporum canis Trichophyton tonsurans: creates “black dot” pattern, spores w/in hair shaft Microsporum canis: spores surround hair shaft o S/Sx Multiple scaly circular patches of the scalp Where hair has broken off o Patchy hair loss o Breaks off at level of scalp Enlarged lymph nodes o Dx Woods Lamp Blue-green fluoresce: Microsporum canis No fluoresce: Trichophyton tonsurans Potassium hydroxide prep of culture Grows on Sabourad Medium o Tx Oral Griseofluvin

Question 39

Postviral Synovitis (Transient Synovitis)

Answer 39

o 1 to 2 weeks after an URI or Rubella Vaccine o S/Sx Tenderness of joint May refuse to weight bear/walk Fever is absent or low grade o Typically resolves spontaneously w/in one week

Question 40

Citrobacter koseri

Answer 40

o Neonatal meningitis 80% develop an abscess o Tx 3rd/4th generation cephalosporin and draining of abscess

Question 41

Septic Arthritis

Answer 41

``` o Infection of the joint space red, swollen, tender joint, w/ limited mobility o ↑ ESR o Dx Arthrocentesis for joint fluid WBC > 50,000 w/ >90% Nφ indicates bacterial ↓ Glc o Tx 1st IV Empirical ABx 2nd Surgical drainage/debridement ```

Question 42

Diaper Dermatitis

Answer 42

o From irritant contact dermatitis Urine, feces, moisture, heat o Erythematous scaly patches that spare skin creases o Tx Severe Low dose corticosteroids and/or Zinc oxide

Question 43

Candidiasis

Answer 43

o Well demarcated papules and plaques Affects the skin folds (unlike Diaper Dermatitis) o Can develop superimposed on diaper dermatitis o Tx Topical antifungal

Question 44

Molluscum Contagiosum Virus

Answer 44

o Spread by skin to skin o More common in people w/ HIV, atopic dermatitis, immunocompromised o Red to pink glossy papules w/ umbilicated centers Pruritic Causes further self annoculation (Koebnerization) o Results in linear aggregations of papules Often surrounded by molluscum dermatitis Mild eczematous eruption o Tx: None, will reduce on own

Question 45

HSV

Answer 45

``` o Herpetic Whitlow Infection of distal finger Painful coalescing vesicles w/ erythematous base Tx Analgesics and observation o Acyclovir may shorten duration. ```

Question 46

Orbital Cellulitis

Answer 46

o S/Sx Proptosis, periobrital swelling, painful eye movements, & opthalmoplegia Fever o Associated w/ preexisting sinusitis o Tx Head CT to asses degree of orbital involvement Broad Spectrum ABx Both anaerobic and aerobic

Question 47

Bacterial Conjunctivitis

Answer 47

Acutely painful and red eye w/ copious purulent discharge | No fever or impairment of extraoccular movements

Question 48

Torch Infections

Answer 48

o Isolate neonate from pregnant women

Question 49

Meningitis due to TORCH Infections

Answer 49

``` o Toxoplasmosis, Other, Rubella, CMV, HSV o Jaundice, hepatosplenomegaly, rashes Can present w/ seizures o Head CT Intracranial calcifications ```

Question 50

Lyme Disease

Answer 50

``` o Erythema Migrans o Tx Doxycycline ≥8 y/o Because of tooth discoloration Amoxicillin <8 y/o ```

Question 51

DIC

Answer 51

o Can result from overwhelming sepsis o Mechanism: widespread thrombi in small vessels w/ resultant platelet & factor consumption resulting in mix bleeding/clotting picture

Question 52

VZV

Answer 52

o Vesicles, pustules, & crusts in various stages of evolution/healing. o Complications Pneumonia Uncommon, but most common cause of hospitalization following VZV infection o More common in immunocompromised (ex. ALL) Progressive dyspnea, fever, and dry coughs Tx: IV Acyclovir Superinfection w/ GAS Most common complication Tx: Acyclovir not indicated, Tx bacterial infection CNS Rare Cerebellar ataxia No Tx required o Tx If mom develops infection w/in 5 days prior to delivery or two days after delivery o VZIG for infant Full term infants > 10 days old do not need prophylaxis after sick contact, but do need to be isolated from that person for the course of their infection (e.g. mom) Don’t give the vaccine before 1 y/o Children >13 y/o Oral Acyclovir Younger w/out complication, no acyclovir IVIG (VZIG) for pregnant women exposed

Question 53

X-linked Agammaglobulinemia (Burton's Agammaglobulinemia)

Answer 53

``` o B-lymphocyte Tyrosine Kinase Defect o May have absent tonsils o Dx Male w/ FHx of recurrent resp bacterial infections, normal T-lymphocytes (CD3+), Absent B-lymphocyte (CD19+) o Live vaccines are contraindicated o Tx Regular infusions of IVIG ```

Question 54

Congenital Syphilis

Answer 54

o Treponemapallidum o Severe Still birth, neonatal death, over infection (e.g. hydrops fetalis) o Early manifestations w/in 5w (other source said <2y??????) Cutaneous lesions on palms/soles (Rash all over body) Hepatosplenomegaly, jaundice, anemia, snuffles (profuse rhinorrhea) Metaphyseal dystrophy and periostitis on radiographs o Late manifestations w/in first 3m (othersourcesaid>2y??????) Can be prevented w/ early Tx Frontal bossing, short maxilla, high palatal arch, hutchinson’s triad (blunted upper incisors, interstitial keratitis, CN 8 Deafness), saddle nose, perioral fissures o Scrapies from skin contain treponemes

Question 55

Congenital HSV

Answer 55

o Vesicularrash o Three patterns w/in 4w Localized to skin, eyes, mouth Localized to CNS Focal Seizures Fulminant, multiple organs o Highest risk of transmission 3rd trimester Half mothers unaware they’re infected

Question 56

GBS Infection

Answer 56

o First 7 days of life (usually first 24h) o Risk factors: Delivered at home o Sepsis, pneumonia, and/or meningitis Most common cause of neonatal meningitis o Fever, lethargy, irritability, respiratory distress o Blood culture: gram + cocci in chains

Question 57

Rocky Mountain Spotted Fever

Answer 57

``` o American dog Tick,Mid alantic region o Rash begins on ankles and wrist and spreads centrally o Headache, fever, malaise DIC can follow or ∆MS in severe cases o Tx Doxycycline (even in young pt.) ```

Question 58

Roseola (Sixth Disease)

Answer 58

o HHV 6 o Children 6m to 3 y/o o High Fever (103 to 106°) o Rosy rash (maculopapular) after 3d of high fevers (Fever resolves) Starts on trunk and spreads to his arms/face Non-pruritic o Self-limited, no Tx

Question 59

Hand-foot-mouth disease

Answer 59

o Prodrome Fever & anorexia o Ulcers on tongue and oral mucosa o Vesicular rash on hands & feet

Question 60

Blueberry Muffin Rash

Answer 60

o TORCH infections, specifically CMV and Rubella | o Result of extramedullary hematopoesis

Question 61

Hepatitis C

Answer 61

o No contraindication to breastfeeding

Question 62

Hepatitis A

Answer 62

o 90% asymptomatic o Daycare outbreaks o Shed in stools for 2-3w before Jaundice and up to 1w after o Dx IgM HepA Peaks 4 to 6w, but doesn’t last past 6m o IgG HepA Persists a lifetime and doesn’t mean active infection o Tx IG prophylaxis for household and close contacts w/in 2w of exposure

Question 63

Asplenia

Answer 63

o Vulnerable to Encapsulated: Strep pneumoniae, HIB, Neisseria meningitidis Malaria, babesiosis

Question 64

Group A Strep

Answer 64

``` o Strep progenies o Pharyngitis Rapid Step Test + o Treat immediately w/penicillin - o Confirm w/culture ```

Question 65

Kawasaki Syndrome (KS)

Answer 65

o Medium Sized Artery Vasculitis o Most common in Asians < 5 y/o o Hydrops of Gallbladder Gallbladder becomes distended w/out stone or inflammation Abdominal pain Seen in: KS, GAS, Leptospirosis, Henoch-Schonlein Purpura o S/Sx Strawberry Tongue Erythema w/ prominence of papillae Seen in o Scarlet Fever, KS, Toxic Shock Syndrome High Grade Fever >4d, Unilateral enlarged cervical lymph nodes (>1.5cm) Exanthem (widespread polymorphic rash) Eventual desquamation Thrombocytosis (>500,00 often much higher) o Complication Coronary Artery Aneurysm Can lead to an MI o Dx Fever > 4d, Bilateral Bulbar Conjunctivitis (non-purulent), Lesions of the lips/oral cavity (strawberry tongue, cracked lips, pharyngeal erythema), peripheral extremity edema/erythema (swollen red hands/feet), rash, and cervical lymphadenopathy (unilateral cervical, > 1.5cm) o Tx IVIG and High Dose ASA

Question 66

Rheumatic Fever

Answer 66

o GAS Follows infection by 2 to 4w o MajorCriteria Migratory Polyarthritis, erythema marginatum, sub cutaneous nodules, chorea (hand movements, lip smacking, facial twitches), carditis (endo/myo/pericarditis) Erythema Marginatum: Erythematous, serpiginous (wavy margins), macular (flat, < 1cm,) lesions w/ pale centers that aren't pruritic (itchy) o MinorCriteria ↑ ESR/CRP, First Degree AV Block o ↑ ASO titers Anti-DNase B, antistreptolysin O, antihyaluronidase o Murmurs Mitral Regurgitation Pansystolic Mitral Stenosis Loud S1 w/ mid-diastolic rumble at the apex Can cause atrial fibrillation from LA enlargement o EKG ↑ PR interval o Tx Infection Penicillin Symptoms NSAID for the arthritis Steroids for the carditis Diuretics & Inotropic agents if CHF Prophylaxis against recurrence Daily oral Penicillin or monthly IM o RheumaticFeverw/outCarditis For 5y or until 21 (whichever is longer) o Rheumatic Fever w/ Carditis, but w/ no residual heart or valvular disease For 10y or until 21 (whichever is longer) o Rheumatic Fever w/ Carditis and valvular or heart disease For 10y or until 40 (whichever is longer)

Question 67

Parvovirus B19

Answer 67

o Fifth disease (aka Erythema infectiosum) o Slapped Cheek Rash Starts on face before spending to trunk and extremities Lace like Intense Red on face o In absence of rash presents as arthraligas (esp. in older females) o Mild systemic Sx Low grade fever (~99°) o Aplastic Anemia If underlying sickle cell anemia, hereditary spherocytosis o Infection during pregnancy can cause nonimmune hydrops fetalis