Infectious Diseases Flashcards
1
Q
CSF with lymphocytic predominance and significantly low glucose suggests?
A
TB meningitis
Listeria meningitis in neonates, elderly, pregnant
2
Q
How does Toxoplasmosis present in immunocompetent children?
A
Disseminated LAD
Chorioretinitis
Fever
CNS involvement unusual outside of neonatal period
3
Q
Severe myalgia with poor perfusion, rapid progression over 12-24 hours is concerning for what?
A
Meningococcemia
4
Q
Nonspecific signs of congenital infection
A
Jaundice, hepatosplenomegaly (reticuloendothelial activation)
Blueberry muffin rash (extramedullary hematopoiesis; also rubella)
Symmetric growth restriction (suggestive of 1st trimester transmission)
5
Q
Congenital syphilis symptoms
A
Desquamating maculopapular rash (palms/soles)
Rhinorrhea
Skeletal long bone anomalies
6
Q
What would you see on bone x-ray of congenital syphilis?
A
Bilateral and symmetric metaphyseal erosions and periosteal inflammation of long bones
Pathologic fractures
7
Q
What are sequelae of untreated congenital syphillis?
A
Saddle nose
Perioral fissures
Hutchinson teeth (bite out of bottom of front upper teeth)
Saber shins (twirled fibula)
8
Q
Congenital CMV symptoms
A
Periventricular calcifications
Microcephaly
Sensorineural hearing loss
9
Q
Congenital toxoplasmosis symptoms
A
Chorioretinitis
Hydrocephalus
Diffuse intracranial calcifications
10
Q
How is toxoplasmosis transmitted?
A
Exposure to cat feces (litter or unwashed fruits/vegetables)
Undercooked meat from infected animals
11
Q
Congenital rubella
A
Cataracts (white pupillary reflex (leukocoria)
Sensorineural hearing loss
Heart defects (PDA)
12
Q
Congenital Zika
A
Microcephaly
Intracerebral calcifications (not periventricular)
13
Q
What should not be given for bloody diarrhea in well-appearing low-fever children?
A
Empiric antibiotics - increased risk of HUS if pathogen is high-risk STEC (E coli O157:H7)
14
Q
Mucus and blood in stool raise concern for viral or bacterial gastroenteritis?
A
Bacterial
15
Q
Nontender, violaceous cervical lymphadenitis
Chronic
A
Mycobacterium avium
16
Q
What is the empiric antibiotic therapy for acute, unilateral cervical lymphadenitis?
A
Clindamycin - good activity against MRSA and S pyogenes
17
Q
Small white spots of buccal mucosa, paired with centrifugal spread of maculopapular rash
A
Koplik spots - Measles (rubeola)
Rash will coalesce into dark-brown color
18
Q
Where do Herpangina (Coxsackievirus A) and HSV 1 oral lesions differ?
A
Coxsackievirus A: posterior oropharynx, gray vesicles/ulcers
HSV1: anterior oral mucosa/lips, clusters of vesicles/ulcers, erythematous and edematous gingiva
19
Q
What is age and seasonality of Coxsackievirus A?
A
3-10 yo
Late summer/early fall
20
Q
How do Herpangina and hand-foot-and-mouth disease differ?
A
Herpangina is not associated with rash
Both caused by Coxsackievirus A
21
Q
What does pinworm (Enterobius vermicularis) cause? Treatment?
A
Perianal pruritus, especially at night
Nematode eggs ingested and develop into adult worms in SI
Treat with pyrantel pamoate or albendazole for everyone around
22
Q
What treatment for Candida infection of perianal area?
A
Clotrimazole
23
Q
What does Strongyloides cause? Treatment?
A
Urticaria, respiratory problems, abdominal pain
Treat with ivermectin
24
Q
How does onchocerciasis present? Treatment?
A
River blindness: ocular lesions, dermatitis
Treat with ivermectin
25
Treatment for scabies
Permethrin
26
How does schistosomiasis present? Treatment?
Urticarial rash on lower legs/feet --> diarrhea, weight loss, RUQ pain
Hematuria with eosinophilia
Associated with swimming in fresh water
Treat with praziquantel
27
What bacteria are often seen with AOM with perforation?
Group A Strep
Typically resistant to Bactrim
28
What antibiotic is S pneumo typically resistant to?
Macrolides
29
Pediatric septic arthritis - which bacteria likely responsible, by age?
Age <3 months: S. aureus, Group B strep, Gram-- bacilli
Age >=3 months: S. aureus, Group A strep
30
What virus causes erythema infectiosum?
Parvovirus B19 - fifth disease
May also cause arthralgia, arthritis, and myocarditis
31
Congenital parvovirus can cause what?
Severe fetal anemia; hydrops fetalis
32
What virus causes roseola?
Herpes virus 6
33
What is the D-test?
Tests for inducible resistance to clindamycin by exposure to macrolides (erythromycin)
34
Name the 3 stages of pertussis
Catarrhal: Mild cough and clear rhinorrhea
Paroxysmal: Whooping cough with posttussive emesis
Convalescent: Resolution over weeks/months
Fever is uncommon
35
What is the most common cause of death in pertussis?
Pneumonia due to secondary bacterial infection
36
Treatment for Bordetella pertussis
Macrolides - can always prevent carriage/transfer; can reduce severity if given in first 14 days
37
Children with Dengue fever are at greater risk for what?
Dengue hemorrhagic fever - epistaxis, mucosal bleeding, platelets <100,000
May progress to dengue shock syndrome
38
Symptoms of Dengue
Fever, severe headache, retro-orbital pain, fatigue, severe myalgias or arthralgias
Leukeopenia, thrombocytopenia, mild elevation of hepatic transaminases
39
Leptospira spirochetes are acquired from where?
Animal contact or water/soil contaminated by urine of animals
More common after heavy rainfall or flooding
Incubation up to 1 month
Self-limited in 90% of cases
40
What are the phases of leptospira?
Septicemic:
Fever, chills, headache, transient rash
Severe myalgias of calves and lumbar area
Conjunctivitis without purulent discharge
Symptoms last up to 1 week, improve 1-4 days, then proceed
Immune-mediated: Vasculitis
Aseptic meningitis
Weil syndrome - jaundice, nonoliguric renal failure, hemorrhage due to thrombocytopenia
Pulmonary hemorrhage with hemoptysis
41
Neonatal treatment for CMV
Valganciclovir - treat for 6 months if started in 1st month of life
Only if symptomatic (SGA, microcephaly, jaundice, hepatosplenomegaly, petechiae)
42
What are common causes of aseptic meningitis with lymphocytic predominance?
Enterovirus (with maculopapular rash)
Lyme disease (disseminated)
Acute HIV (2-4 weeks after transmission), along with fever, generalized LAD, and maculopapular rash
43
What are most common causes of acute bacterial rhinosinusitis?
Nontypeable H flu
S pneumo
Moraxella catarrhalis
44
When should Augmentin be used for acute bacterial rhinosinusitis?
If symptoms are severe or worsening. Mild disease may be observed
45
Diagnostic criteria (1 of 3) of acute bacterial rhinosinusitis
Persistent symptoms >=10 days without improvement
Severe onset (fever >39 + drainage) >=3 days
Worsening symptoms following initial improvement
46
Fungal URI would be suspected based on what symptoms?
Epistaxis
Turbinate destruction
Palatal eschars
Maxillary cyanosis
47
Epiglottitis symptoms and cause
Distress (tripod position, sniffing position, stridor)
Dysphagia, dysphonia
Drooling
High fever
H flu type b
Streptococcal species
48
Cellulitis of the submandibular space (Ludwig angina)
Tender bilateral induration of the submandibular area
Elevation of the floor of the oropharynx
Fever
Drooling
Muffled voice
Stridor
Dysphagia
49
What is chemosis?
Swelling of the tissue that lines the eyelid and surface of eye
50
Treatment for Bartonella henselae
Azithromycin
51
Congenital Chlamydia
Conjunctivitis
Pneumonia
52
What does Rubella have that measles doesn’t
Arthralgias are possible in adolescents and adults
53
Congenital Listeria
Disseminated abscesses
Fever
Skin lesions
54
Acute rheumatic fever carditis shows what on EKG?
Prolonged PR interval
Diffuse ST elevations
Friction rub
55
What kind of murmur can acute rheumatic fever cause?
Blowing, systolic mitral regurgitation murmur
56
Diagnostic criteria for acute rheumatic fever
Joints (migratory arthritis)
Carditis
Nodules (subcutaneous)
Erythema marginatum
Sydenham chorea
Minor: Fever, arthralgia, ESR/CRP, prolonged PR interval
Carditis or chorea alone are sufficient
57
What is most common pathogen for pericarditis and myocarditis?
Coxsackie (which can also cause posterior pharyngitis)
Adenovirus
58
Viral myocarditis treatment
Supportive (e.g. diuretics, inotropes)
IVIG
Admit to ICU for risk of shock, fatal arrhythmias
59
Trypanosoma cruzi
Chagas disease:
Perimyocarditis myocardiopathy
Achalasia
60
Which infections cause subglottic narrowing?
Bacterial tracheitis
Croup
Stridor, fever common to both
61
What bacteria has sulfur granules?
Actinomyces
Can cause lymphadenitis in neck with sulfur granules
62
What is a cystic hygroma
Lateral cystic mass in posterior triangle of neck, usually present at birth
63
Treatment for chronic otitis media with TM perforation?
Topical fluoroquinolone
Most commonly Pseudomonas, S aureus
Can occur after weakened TM from negative middle ear pressure (Eustachian tube dysfunction, cholesteatoma)
64
Empiric antibiotics for neonatal sepsis
Ampicillin and gentamicin
65
Treatment for Bordetella pertussis
Azithromycin
66
What weight requirement for newborn Hep B vaccine?
>=2000 g
67
What drug is prophylactic for RSV in those <2 yo and high-risk of complications?
Palivizumab
68
Which newborns are most at risk for necrotizing enterocolitis?
<32 week premature infants with NG tube and formula feed
Tense and erythematous abdominal distention
Thrombocytopenia and metabolic acidosis are associated with severe disease
69
What is indicated by air within bowel wall (pneumatosis intestinalis) on abdominal X-ray?
Necrotizing enterocolitis
70
When is drainage indicated in children with parapneumonic effusion?
Moderate-large size, respiratory distress
In adults, it is based on fluid analysis
71
How does Zika virus affect the ventricles?
Ventriculomegaly
72
What antibiotic for UTI in children?
Empiric 3rd-gen cephalosporin - cefixime
73
What is the limited use of ciprofloxacin in children?
Pseudomonas UTI
74
What are the different possible manifestations of mumps?
Parotitis
Meningitis
Orchitis
75
What is the most common cause of nonhereditary sensorineural hearing loss in children? What is treatment?
Congenital CMV infection
Antiviral treatment is indicated for symptomatic infants
Treatment not recommended for asymptomatic patients with isolated SNHL
76
How do serum sickness and serum sickness-like reaction differ?
SS - triggered by foreign proteins in antitoxin, antivenom, or mAb; more severe immune complex titer and deposition, complement activation
SSLR - triggered by beta-lactam or sulfa antibiotics (due to genetic deficiencies in eliminating metabolic by-products --> hapten-mediated cytotoxicity T-cell injury or direct cytotoxicity)
77
Serum sickness and serum sickness-like reaction signs/symptoms
Mildly pruritic urticarial rash >24h
Multiarticular arthralgia but usually no arthritis
Low-grade fever and generalized LAD
Typically 5-14 days after medication initiation
78
Serum sickness is what kind of hypersensitivity reaction?
Type III hypersensitivity (immune complex-mediated)
79
What is trismus?
Inability to open mouth fully due to inflammation of pterygoid muscles, seen in peritonsillar abscess
80
What bacteria should be covered for peritonsillar abscess?
Group A hemolytic Strep, respiratory anaerobes
81
Patients with sickle cell anemia should be given what kind of prophylaxis?
Prophylactic penicillin 2x/day until they reach 5 yo
82
Strawberry tongue is present in what infections?
Scarlet fever
Kawasaki disease
Toxic shock syndrome
83
What does anti-DNase B antibody indicate?
Post-streptococcal GN
Also low C3, elevated antistreptolysin-O, and positive streptozyme test
84
Reye syndrome pathophysiology
Aspirin for viral illness --> mitochondrial dysfunction --> impaired fatty acid metabolism and acute hepatic steatosis --> hepatomegaly
Ammonia accumulates --> cerebral edema --> encephalopathy
ICP - vomiting, lethargy --> seizure, coma, death
85
What are complications of Campylobacter gastroenteritis?
Guillain-Barre syndrome
Reactive arthritis
Don't need to provide antibiotics except severe or high-risk cases (>7d, high fever, bloody stools, patients who are pregnant or immunocompromised or elderly)
86
Toxoplasmosis is from what sources?
Cat feces or undercooked meat of infected animals or unwashed produce
87
Beefy red plaques with satellite lesions in groin area
Candida dermatitis
88
What infection may present similarly to appendicitis? What differs?
Campylobacter gastroenteritis - pseudoappendicitis/infectious ileocecitis
Campylobacter jejuni may initially infect jejunum before spreading to ileum and cecum --> RLQ pain
89
Cystic fibrosis - which bacteria most involved?
S aureus at younger ages, especially iso concurrent influenza
Pseudomonas in at older ages
90
What is Waterhouse-Friderichsen syndrome?
Fulminant meningococcemia causing adrenal hemorrhage:
Sudden vasomotor collapse
Skin rash - Large purpuric lesions on flanks
91
LAD in HIV typically affects which nodes?
Axillary, cervical, and occipital
92
Tuberculosis histology
Caseating granulomas
Multinucleated giant cells
93
Nontuberculous mycobacterial lymphadenitis - sign, treatment
Chronic, violaceous, nontender cervical node
Rifampin + azithromycin
94
Can splenomegaly be present in subacute infective endocarditis?
Yes
95
Subacute infective endocarditis glomerulonephritis has what kind of urinalysis?
Moderate blood, 2+ protein, RBC casts
96
Infective endocarditis treatment
Acute: Empiric vancomycin
Subacute: Based on culture results
97
Does neonatal sepsis cause hypotonia or hypertonia?
Hypotonia
98
What are risk factors for AOM?
Age 6-18 months
Lack of breastfeeding
Daycare
Cigarette smoke
99
Which of toxoplasmosis vs CMV can cause either macrocephaly or microcephaly and not just microcephaly?
Toxoplasmosis
100
Infant botulism presents with what neuronal dysfunctions?
Symmetric descending paralysis - affects cranial nerves first, oculobulbar palsy
Autonomic dysfunction - fluctuating HR/BP, decreased salivation
Constipation, poor feeding, hypotonia
101
How does botulism toxin work?
Inhibits presynaptic ACh release into neuromuscular junction
102
Tinea corporis - treatment
Most commonly Trichophyton rubrum
First-line/localized - topical - clotrimazole, terbinafine
Second-line/systemic - oral - terbinafine, griseofulvin
103
What viruses classically cause parotitis?
Mumps - along with fever, myalgias, fatigue
EBV
HIV can cause it
104
Mumps causes what potential sequelae?
Orchitis in boys
Sensorineural hearing loss (transient but can lead to deafness
Aseptic meningitis
Pancreatitis
Severe symptoms are more common in older than younger
105
What is empiric treatment for cervical lymphadenitis?
Clindamycin - empiric coverage of Gram+, MRSA, and anaerobes
Augmentin - may be used if not concerned about MRSA
106
Cat scratch disease - treatment
Azithromycin
106
TB sample gathering in young children with insufficient sputum
Early morning gastric lavage to get swallowed tracheal secretions
107
What infection causes morbilliform rash?
Roseola - high fever followed by blanchable, macular or maculopapular rash
108
Staphylococcal pustulosis - what is it? Treatment?
Localized erythematous pustules, vesicles, bullae that rupture to form erosions and honey-colored crusts
Seen in neonates in diaper area or prior wound (e.g. circumcision site)
Treat with topical mupirocin
109
How does GBS pneumonia appear on x-ray?
Diffuse alveolar densities with pleural effusions
Treat with ampicillin and gentamicin, then narrow to penicillin G once GBS isolated from blood
110
111
Neonatal Listeria has which focal infection in early vs late onset sepsis?
Early: Respiratory distress
Late: Meningitis
112
What prophylaxis is required for secondary prevention of rheumatic heart disease?
Penicillin G benzathine q3-4 weeks, duration dependent, whichever is longer:
Uncomplicated: 5 years or until age 21
Carditis without valves: 10 years or until age 21
Carditis with valves: 10 years or until age 40
113
Hallmark of tetanus and other signs
Opisthotonus (diffuse hypertonicity)
Trismus
Stridor and respiratory failure
114
Does Shiga toxin E. coli produce high fever?
No
115
Which bloody bacterial gastroenteritis can cause seizures?
Shigella
Also watch for bacteremia, rectal prolapse
116
Which part of intestines does Shigella prefer?
Rectosigmoid colon; watch for rectal prolapse
117
118
Bullous impetigo
Staph aureus -> vesicles and bullae erupting to exudates and crust
Little to no surrounding erythema
Limited to children unless immunocompromised
119
Measles vs Rubella
Worse rash, worse constitutional symptoms
Koplik spots, photophobia, cough
Rubella has tender LAD
120
Croup (e.g. parainfluenza) - trratment
Mild (no inspiratory stridor at rest) - single dose dexamethasone)
Moderate/severe - glucocorticoids + nebulized racemic epinephrine, observe for few hours
Admit if recurrent epinephrine needed or supplemental O2 or poor oral intake
121
When is dexamethasone given with antibiotics for meningitis?
Hib - to prevent sensorineural hearing loss
In adults, Strep pneumo - decreases morbidity/mortality
122
Acute otitis media - what to use in case of penicillin allergy
Azithromycin or clindamycin
123
Varicella postexposure prophylaxis protocol
Immunocompetent: give vaccine if <=5 days since last exposure; otherwise, recommend vaccine for future infection
Immunocompromised, pregnant, newborn (5 days prior to 2 days after delivery): Varicella Ig within 10 days of exposure
124
Adenovirus vs RSV vs parainfluenza
Adenovirus would have conjunctivitis
RSV has LRI signs (bronchiolitis)
Parainfluenza has barking cough
125
Does Varicella affect palms/soles?
No
