Infectious Diseases

Question 1

Lab methods-

Answer 1

Wright stain = stool WBCS
Fluorescent antibody antigen stain for HSV1/2, VZV, RSV, adenovirus, flu A and B, paaflu
Direct obs/wet mount for fungal, dark-field for syphillis
PCR
Indrect = intradermal skin test for tb and coccioides
Ab testing for EBV, CMV, VZV, HIV, toxo, bartonella, henselae, myco pneumo
Nonspecifics like CRP and ESR

Question 2

High risk groups for fever

Answer 2

Infants under 28 days, older infants w/ high fevers > 39C/102.2 who appear ill, immuno def, sickle cell, hronic disease

Question 3

Eval of fever in infant <3 months

Answer 3

3-10% well appearing and 17% toxic have serious bacterial infec
Why? Transplac, passage through bc, postnatally. Viruses most common
Clin fx= nonspecific, fever, dim app, irritable, cough, rhino, v/d, apnea
Dx- clinical/lab fx- det low vs. high risk (abx recently? focal infection?) do cbc, blood culture, UA/UC, CXR if resp distres, and CSF. Low risk if wbc between 5-15K, bands <5Wbc on stool wright, normal csf.

Question 4

Fever hospitalization for:

Answer 4

all infants <=28 days
Infants 29-3 mo with toxic look, meningitis suspicison, PNA, pyelo, bone/soft tissue infection
Uncertain oupt f/u

Question 5

Abx for fever based on

Answer 5

Infants <28 need IV abx until cultures are negative
Infants 29-3 mo w/ low clin/lab criteri + outpt can get oupt parenteral
High risk older infants need hospitalized parenteral

Question 6

Abx in fever specifics

Answer 6

0-1 mo? GBS, E. coli, List- amp + gent or cefotax
1-3 mo? GBS, Strep pneumo, LM- amp + cef (+ vanco if worried abt bact meningitis)
3 mo- 3 y? Strep pneumo, H flu, neiss men- cef (+ vacno if bact mening)
3- adult? strep pneumo + NM- cef (+ vanco if bact mening)

Question 7

Fever eval, 3-36 mo

Answer 7

Risk bact 3-10%, likelhood bacterimia up w/ up fever/peripheral WBC
Strep pneumo most common
If kid toxic, do complete sepsis eval + iv abx + hospital
Nontoxic and < 2 years, do blood culture all kids or if wbc> 15k, stool culture if blood/mucus/wright stain, CXR if resp issue, empiric abx if WBC> 15k OR all kids. Reeval in24-48 hrs

Question 8

FUO

Answer 8

Fever > 8 days to 3 weeks, with no dx
Usually common illness w/ weird presentation, big ddx
25% resolve spont
Eval- comprehensive hx, ROS, PMH, SH, detailed p/e, CBC w/ diff, ESR, CRP, serum transam (hepatitis), UA/UC, blood cultures (endocarditis), Anti-strep O titer (rheum fever), ANA, RF, stool culture, TB, HIV, lots of imaging
MGMT- hospitalize for eval

Question 9

Bacterial meningitis

Answer 9

Most in first mo. of life, risk if young, immunodef, or anatomic defect (skull frac, vp shunt)
Fx- babies? nonspecific sx, minimal fever, maybe bulging font, older kids?fever, change consciousness, nuchal rigid, kernig/brudzinski(hip/neck), seizure, photophob, emesis, h/a
Dx- high IoS, all kids get LP- pleocytosis w/ neutros, WBC>5K!, low glucos, CSF:serum 3 mo- 3rd gen cephal, + vanco. give corticostreoids w/ or before first abx to down hearing loss
Supportive care- IVF, look at uo, serum sodium

Question 10

Bact meningitis complications

Answer 10

Gram negs have most complications, then S. pneumo, HIB, and Neisseria (5-50% mort dep on bacteria)
Hearing loss is most common, up to 25% pts
Global brain injury 5-10%
SIADH, seizures, hydroceph, brain abscess, cranial nerve palsy, learning disabled, focal neuro deficits

Question 11

Aseptic Meningits

Answer 11

Inflamm w/ CSF lymphocytic pleo, if viral- normal CSF glucose, min elevated CSF protein
Clin fx- mild w/ fever, h/a, emesis or severe
Aseptic TB nonspecific lethargy, 2nd week => cranial nerve deficits, altered LOC, paraplegia, eventual death
Dx- viral mening CSF culture, or PCR for EBV, CMV, HSV, enterovirus, + surface enterovirus in throat/rectum suggestive, can do RPR, India ink for crypto, serum ab for coccidio myco, Lyme disease/cysticerosis

Question 12

TB meningitis

Answer 12

Lymphocytic pleocytosis, low glucose, super high protein, basilar enhancement
Postive acid fast csf stain, or + PCR
50% neg chest XR, tuberculin skin test

Question 13

Simple URI

Answer 13

Etio = rhino, paraflu, coronavirus, respiratory syncytial virus
Clin fx- low grade fever, rhino, cough, sore throat, 7-10 days
Color of nasal discharge does NOT predict sinusitis
Persistent sx or fever prompt for bacterial superinfection
Dx on fx
Mgmt - YDRATION, exclude more serious things, otc, NO ABX

Question 14

Sinusitis

Answer 14

Ethmoid/max sinuses in 3-4 mo gestation, sphenoid sinus 3-5 yo, frontal 7-10
Acute, sub acute, chronic
Dx on clin fx, imaging NOT USEFUl

Question 15

Acute sinusitis

Answer 15

Acute persistent = nasal d/c and cough 10-30 days, h/a bad breath, facial pain, low fever
Etio = s.pneumo, h flu, m. catarrhalis
Mgmt- amoxicillin, amox-clavulanate (augmentin), 2nd gen cephalo 10-14 days
Acte severe- high fever, purulent 2-5 days, same etio, same mgmt

Question 16

Subacute sinustis

Answer 16

Same features, but 30-90 days
etio = same- s.p neumo, h flu, m cat
Mgmt = same

Question 17

Chronic sinusitis

Answer 17

> 90 days!
Etio = maybe underlying CF, allergy, immunodef, s. aureus, anaerobes
Mgmt = trial broad spec abx, ct scan sinuses, iv abx

Question 18

Pharyngitis

Answer 18

Etio = coxsackie, EBV, CMV + same as URI
Bacterial = strep pyogenes (GABHS = strep throat), aracnobact hemoyticum, and diphteria
Clin fx= viral + strep overlap, hard to tell
dx- strep test (antigen test = rapid), 5% has pharynx GABHS
MGMT- viral = supportive, hidration. GABHS = oral penicillin VK (single IM does benza), if allergic oral erythromycin/macrolides
EBV pharyngitis- maybe steroids
Diphteria = oral erythromycin/parenteral penicillin

Question 19

EBV pharyngitis

Answer 19

enlarged posterior cervical LN, malaise, hepatosplenomeg

Question 20

Coxsackie pharyng

Answer 20

Painful vesicles/ulcers on post pharynx and herpangina (soft palate), or hand-foot =-mouth

Question 21

Strep throat

Answer 21

GABHS in 5-15 y/o winter/spring, 
Lack of other URI
exudate on tonsil, petachiae on soft palate, strawberry tongue, enlarged tender anterior lymph nodes
Fever
Scarlatiniform rash

Question 22

Diptheria

Answer 22

RARE, gray adherent tonsillar membrane

toxin-med cardiac/neuro compx

Question 23

Acute OM

Answer 23

Acute infec of middle ear
OME = w/ effusion, w/out sx of infection
Etio = s.pneumo, non type h flu, m. cat, URI AOM share bacteria
Clin fx- usually after/during URI, fever, ear pain, less hearing, sx less reliable in lil kids, if tymp membrane perfs, pus/fluid form ear
Dx = identify fluid within middle ear space! neumatic otoscope- fin abnormal mvt of eardrum! Or erythema/loss of tymp membrane landmarks, less reliable. can do tympanocyntesis/perf tymp membrane w/ pus within external aud canal
MGMT- abx for AOM, but controversial b/c will resolve on own. If use, do Amoxicillin- but if in day care or infected in past 1-2 months, then MRSA more likely, so do high dose amox, augmentin or cephalo. Macrolides in penicillin allergy
NO abx for AME

Question 24

Otitis externa

Answer 24

Infection of external auditory canal
Pathog- things that mess up barrier- trauma, cerumen removal, maceration of swin from swimming, moisture
Etio- pseudomonas, staph auerus, candida albicans, or AOM w/ perfed ear drum
Clin fx- pain, itching, draining from ear. Systemic sx absent, hx consistent w/ AOM helps decide if perf
Dx- erythema/edema of EAC, white/purulent material within canal, tenderness on palpation/mvmt of tragus, visualize tymp memb to exclude perf, maybe culture
Mgmt- restore EAC to natural acidic environemtn. Acetic acid in ear if milkd, more severe do topical abx + corticosteroic. Perfed AOM w/ OE- oral/topical abx

Question 25

Cervical Lymphadenitis

Answer 25

Enlarged, inflamed, tender LN Etio- local bact infection (s. aureus most common, s. pyogen too, mycobact (tb/avium), b/ henselae (cat scratch). Reactive lymphatd in responsive to infections in larynx/teeth/head/neck soft tissue Virus EBV, CMV, HIV also Kawasaki = UNILATERAL cervical lymphad, t. gondii can look like mono Structural lesions in neck (brach cc or cyst hygroma) 2ndary infec Fx- mobile, tender, warm LN, single or multiple, maybe systemic Dx- tests like tb skin, CBC w/ diff, ab titers for b. hensela/gondii if unresponsive, ab titers for EBV/CMB/HIV if diffuse/persistent. Imaging for cervical anatomy/abscess MGMT= empiric abx to staph/streph (cephalo 1 gen, or anti-staph penicillin 7-10 days, IV if toxic)

Question 26

Parotitis

Answer 26

Inflamm of parotid salivary glands Etio- mumps/other viruses = bilateral involvedment (CMB, EBV, HIV) Bact parotitis = s. auerues, s. pyog, m tb, unilateral!! uncommon unless down salivary flow/stones Clin fx- swelling above angle of jaw, oropharynx with pus from Stensen's duct (parotid duct) Dx= culture drainage, viral w/ serology, mumps in urine Mgmt = virus w/ supportive, acute bacterial = abx to staph/strep, maybe i&d Compx- mumps => meningoenceph, orchitis/epididmytis/pancreatitis Acute sup parotitis => abscess + osteomyelitis of jaw

Question 27

Impetigo

Answer 27

Superficial skin infection, upper dermis Staph aureus most common, GABHS also Fx- honey-colored crust/bullous lesions, commonly on face, esp nares, easy spread Visual dx, no culture, give topical mupirocin or oral abx (dicloxacillin, cephalexin, clinda) Compx bacteremia, post strep glomneph, and staph scalded skin

Question 28

Erysipelas

Answer 28

Dermal lymphatics, usually GABHS Clin fx = tender erythematous skin + distinct border, face and scalp Visual dx, give systemic GABHS theraphy Compx = bacteremia, post strep glomneph, nec fasc

Question 29

Cellulitis

Answer 29

Skin infection within dermis GABHS, s. aureus, break in skin barrier Cin fx- warm, red, tender, indistinct border Dx visual inspection, rarely postive blood culture, if agressive, biopsy/culture leading edge Mgmt = oral/IV abx w/ cephalo first gen or anti-staph penicillins

Question 30

Buccal cellulitis

Answer 30

NOw uncommon, unilateral bluish cheek if non-immunized, HIB- positive blood cultures H. flu directed ABX- 2nd/3rd gen chepahlo like cefuroximine/cefotaxime High rate of concomitant bacteremia/meningits, do an LP

Question 31

Perianal cellulitis

Answer 31

Well demarcated red around anus, also constipation GABHS, visual inspection/rectal swab Oral abx- cephalexin/dicloxacillin

Question 32

Nec fasc

Answer 32

``` Potntially fatal, deep cellulitis Pain/sstemic sx OOP to findings INfection beyond fascia to muscle Crepitus/hemorraghic bullae, polymicrobial IV abx = surgical debridement ```

Question 33

SSSS

Answer 33

S. aureus w/ exfoliative toxin Fever, tender skin, bullae, sheets of skin slough off Nikolsky sign w/ extension of bullae w/ pressure Good wound care + IV abx

Question 34

Scarlet fever

Answer 34

Toxin-med bacterial illness w/ skin rash GABHS strains making erythrogenic toxin Winter/spring/respiratory droplets/nasal secretions Clin fx- during any GABHS infection (impetigo, cellulitis, stre), first fever, chill, malaise, exudative phar) Exanthem- starts on trunk, moves periph, red skin + tiny skin colored papules, SANDPAPER, blanches, pastia's lines in skin creases, desquam dry skin Dx- positive throat culture/strep test MGMT- STOP rheumatic fever w/ appropro abx, oral penicillin VK, iv benzathin pen, erythrom/macrolids Compx= post strep glomneph and post strep arthritis (abx no prevent), rheum fever and PANDAS (ped autoimmune neuropsych disorder)- OCD/tic!

Question 35

TSS

Answer 35

Toxin mediated, shock, desquam, multiorgan dysfn Staph aureus, GABHS-assoc increasing Dx criteria- 5 outta 6 probable, 6/6 confirmed- fever > 11, hypotn, diffuse macular erythroderma, desquam 14 days lata, multisystem gi vom/d/ab pain, CK level/myalgias, hyperemic mucous memb, pyuria/elevated BUM, TCP, CNS, negative cultures! (excpet maybe positive blood culture of staph)

Question 36

Rotavirus

Answer 36

Most common infectious GE, winter, fecal oral INcub 1-3 days, asx or v/d/dehydration, diarrhea 4-7 days, maybe URI Dx- Elisa in stool, no WBC Tx- supportive mgmt, fluid, refeed quick, maybe lactose intol transiently

Question 37

Norwalk

Answer 37

RNA virus, feal oral, GE in all age groups, close pops Clin fx- vomiting more prom, 48-72 hours only Dx- clin fx, mgmt = supportive

Question 38

ETEC

Answer 38

Major traveller's diarrhea, noninvasive, watery Dx- no stool WBC, clin dx, confirm culture Abx- quinolone/sulfa shorten sx, hydration

Question 39

EPEC

Answer 39

Noninvasive watery diarrhea in preschoolers Stool culture dx, no stool wbc Oral sulfa/quinolon + hydration

Question 40

EHEC

Answer 40

0157:h7 => HUS via endotoxin release Stool WBC, culture dx If HUS, dont give abx (may increase endotoxin release)

Question 41

Shigella

Answer 41

Bloody diarrhea, maybe seizures b/c of neurotoxin Stool WBC present, culture dx 3rd gen cephalo/fluroroquino

Question 42

Salmonella

Answer 42

Bloody or nonbloody, fecale oral, poultry, milk, eggs, lizards/turtles Sickle cell patients especially et bacteremia/osteo Stool wbc either way, cuture dx No tx if uncomp GE if immunocompetend and older than 3 mo b/c then carry for longer Tx for invasive w/ third gen cephalo

Question 43

Campylobacter jejuni

Answer 43

Most common bacterial bloody diarrhea Self lim by contam food WBC in stool if bloody, stool cultrue dx Oral erythro indicated but often sx resolve w/out tx

Question 44

Yersinia enterocolitica

Answer 44

Mesenteric adenitis mimickin acute appendicits Stool culture/mesenteric node culture w/ organism Abx can benefit, 3rd gen cephalo

Question 45

C. diff

Answer 45

Normal gut flora overgrows post abx Dx w/ toxin in stool, maybe pseudomembranes on endo Oral/IV metro, Oral Vanc if resistant

Question 46

V cholerae

Answer 46

Developing countries, massive water loss/diarrhea Can culture from stool, or erologic diagnosis from CDC, but cinical REPLACE fluids, could use abx to shorten course but unsual

Question 47

Eval or diarrhea

Answer 47

Detailed h/p look for fever, rash, ab pain, vom, blood, abx, day care, travel, pets, foods, restaurant Check hydration in kiddosLab = CBC, lytes, FOBT, WBC, ova/parasite, culture, ELISA (rota, giardia, c dif) MGMT w/ fluids, maybe abx

Question 48

HIV info 1

Answer 48

10000 kids in US, 1 mil AIDS world, 10x with HIV Perinatal transmission = 95% pediatric HIV- in utero, intrapartum or postpartum, Transmission rate up if high maternal viral load, advance maternal disease, primary maternal HIV infec, concomitant maternal genital infec (or chorio), preemie, PROM Down transmission if undetect viral load, c-sec, or adherence to ART/infant PEP Also sex/blood product/IV/tattoos Clin fx- asx, early sx = FTT, TC, recurrent infection (OM, PNA, sinusitis), lymphadeno, parotitis, recurrent thrush, loss of developmental milestones, severe zoster

Question 49

HIV Dx/MGMT

Answer 49

All babies w/ HIV mommas have transplacental maternal abs up to 24 mo, HIV specific DNA PCR @ birth + monthly till 4 mo, negative at 4 mo = uninfected MGMT = Give zidovudine 6 weeks as PEP, bactrim for PCP prophylaxis till PCR negative, no BF, urine CMV to check for coinfec (5%) HIV kiddos w/ ARVs (NRTIs, NNRTIs, protease), combo therapy key, prophylaxis opp infections, immunizations/well-child care critical. Give all vaccines, unless supa compromised (no MMR). flu, pneumococc, TB skin test Regular monitor T cell levels, do optho exam for CMV retinitis if CMV ab +

Question 50

Complications of HIV

Answer 50

PCP- most common opp infec in kiddos, CD$ cell numb coreelation, fever, hypox, interstitial pulm infiltrate, mmt prophylaxis against PCP w/ TMP/SMX MAC- fever, WL, night sweat, ab pain, bone marrow suppress, up LFT, if CD4< 50 Fungal- candidal thrush/esoph, crypto meningPNA, histo, cooccidio, asperigillosis, Viral cmw, hsv, vzv Parasite- toxo, cryptospor, isospora belli Lymphoma from EBV

Question 51

Infectious Mono

Answer 51

EBV = major cause, via saliva, infects B lymphocyte Also toxo, CMV, HIV similar Fx- young kids asx, older = fever up to 2 weeks, malaise/fatigue, pharyngitis (like GABHS), post cerv lymphadeno or diffuse, HSM, spleen big 80%, macular/scarlatin rash, sx resolve wks/months Dx- cbc w/ atypical lympho, neutropen, tcp, elevated transam Monospot = first line test, heterophile antibody, less sensitive in kids under 4 y b/c no relialbe antibody. CMV = majority of monospot neg mono EBV titires to dx younger than 4, do antibodies to VCA, EA, EBNA, or elevated IgM-VCA level + no EBNA abs = acute, or PCR Tx = supportive, compx = neurogenic, upper airway obs, AMOXICILLIN RASH (if given, maculopap), splenic rupture (no sports), malignancy (burkitt's lymphoma + nasophar carcinoma, lymphoprolif disease)

Question 52

Measles

Answer 52

Rubeola/ 10-day, Paramyxovirus Highly infectious 8-12 day incub, clinical prodrome, transient rash on muc membranes, then characteristic rash CCCk- conjunctivits, cough, coryza, Koplik spots (prodrome) Exanthem = neck/ears, spreads down chest/UE in 24 hours, red maculopap, covers LE by 2nd day, lasts 4-7 days, fever > 101 Compx- bacterial PNA =>death, OM, laryngotrach, encephalomyelitis (brain and SC), subacute sclerosing panencephalitis, Dx- clin + serologic, mgmt = supportive care, vitamin A, Immunoglob post exposure

Question 53

Rubella

Answer 53

German measles, 3 day measles, togavirus Highly infectious, milkd, asx, prodrome = mild URI/low grade fever Painful lymphadeno, suboccipital, post auricular, cervical nodes Exanthem = nonpruritic, maculopap, confluent- face to trunk/extremities, 3-4 days, milkdish fever Compx- meningoenceph, polyarteritis in teen girls, and Congen Rubella Syndrome (primary mat infec in first tri, fetal anomalies, blueberry baby, congen cataracts, PDA, hearing loss, MR, HTN, t1dm, autoimmune thryoid)

Question 54

Aspergillosis

Answer 54

Molds! invasive - severely IC pts, like transplant pts, high-dose systemic amphotericin B and resect aspergilloma, bnb Allergic bronchopulm aspg = wheezing, eosinophilia, pulm infiltrates, most often w/ CF, elevated igE, need corticos and maybe antifungal

Question 55

Candidiasis

Answer 55

Live on ze skin, and Gi tract, overgrowth post abx, mild superficial infection Clin fx- oral thrush, diaper dermatitis, vulvovaginal candiaisis, give topical antifungal INvasive candidal in IC patients, fungemia, meningitis, osteo, endopthalmitis- give systemic antifungal

Question 56

Coccidiomycosis

Answer 56

C.immitis in soil in SW US/Mexico Clin fx- inhaled into lungs, usually asx/mild pneumo, AA/FIlipino, pregnant women, neonates, IC ppl, dissem disease, severe PNA/mening/osteo MGMT - mild pulm disease, immunocompt pts, no tx! dissem disease w/ antifungal

Question 57

Cryptococcal infection

Answer 57

Cryptococcus neoformans = yeast in soil Clin fx- crypto inhale into lungs, most infec asx, CNS in immunocomp, crypto mening = AIDS defining illness Dissem infection in bones/joints/skin/in IC hosts, rare in kids MGMT - dissem = systemic antifung

Question 58

Amebiasis

Answer 58

Etio = e histolytica, acquired ingestion of cyts in contam food/water, sx in 1-4 weeks as trophozoite emerges from cyst Epi- highest incidence in developing nations Clin fx- asx, or can be mild colitis to severe dysentery, young kids/pregos/IC patients more severe sx- cramping ab pain, tenesmus, diarrhea w/ blood/mucus, WL, fever, tender hep meg, chest pain, right shoulder pain, resp distress, jaundice Ab compx = intestine perf, hemorrhage, stricture, ameboma! Extraintestinal amebiasis as abscee in liver (or brain/lung/organs) Dx- ID of trophozoites/cysts in stool, colon/biolpsy or serum ab assay, u/s CT scan identify abscess MGMT = based on site! Mtro = mainstay! DONT aspirate

Question 59

Giardiasis

Answer 59

G. lamblia, fecal oral, drink-contaminated mountain water, day care center, person-to-person, or via animals Clin fx- asx to explosive diarrhea, 1-2 weeks after cyst ingestion, 2-6 week persist, Localize in small bowel, diarrhea volume, watery, foul smelling, fart, WL, low-grade FEVA Dx- cysts, tropho in stool/stool ELIZA, give metro/fura

Question 60

Malaria

Answer 60

Obligate intracellular plasmodium (falciparum worst) Most impt cause morbid/mort, endemic, transmission mosquito Clin fx- vague flu, h/a, malaise, anorexia, fever, cyclical fevers 48-72 hrs, correlate RBC rupture, parasitemia, chills, vomiting, h/a, ab pain Hemolytic anemia, splenomeg, jaundice, hypogly, crebral, renal, shock, resp fail Dx- thick/think giemsa-stained PBS, think smear = id which tpe MGMT - chorlorquinines/mefloquine/doxy dep on type Prevention- chemoprophylaxis, control mosquito

Question 61

Toxo

Answer 61

t.gondii, cat feces contact, ingestion undercooked meat/fruit/veggies, contam cysts, transplacental passage, exposure to blood, org tx Asx, sx like mono, malaise, fever, sore throat, myalgias, lymphadeno, HSM, rash, Reactivate if immunosuppressed- more severe- enceph, focal brain, pneumonitis, dissem, HIV w/ focal seizure Ocular toxo => most common kind of chorioretinitis Congen toxo = triad hyroceph, intracranial cacl, chorio Dx- serologist, PCr/amnio, CSF MGMT- mostly no specific therapy, but if congen/prego/ic, give sulfadiazine/pyrimethamine PREVENT- avoid the cats!

Question 62

GEneral worm concepts

Answer 62

Risk = immigrants, travelers, homelss Asx, ab sx- pain, arex, n, rectal prolapse Dx w/ three separate stool exams, or tape test

Question 63

Cysticercosis

Answer 63

Mexico, central america, 20-50% epilepsy caused in endemic, fecal oral from taenia solium eggs ingested No sx until encysts in muscle/subq/brain Subq nodules palpated Neurocysticerosis- fourth ventricle most common, or parench, mening, spine, eyes- seziures, hydroceph stroke Dx- ova/stool tes, serology, head ct MGMT- antiparasitic if adult tape worm. Neurocyst w/ calcified lesions = old/nonviable, just give anticonvulsant

Question 64

Enterobius vermicularis = pin worm

Answer 64

Most common in US, fecal oral, preschool Anal or vulvar pruritis, insomnia, arex, anuresis, nighttime teeth grind Mebendazole/albendazole, pyrantel, reat all close contacts

Question 65

Ascaris lumbricoides

Answer 65

largest/most common roundworm, fecal oral Loffler syndrome- transient pneumonitis as larvae go through lungs- fever/cough/wheezing/eosino, sbo Mebend/albend or pyrantel, screen friends

Question 66

Trichuris trichuria

Answer 66

Worldwide distribu, seen w/ ascaris Asx mainly, or ab pain/tenesumus/bloody diarrhea/rectal prolapse Mebendazole, albendazole, pyrantel pamoa

Question 67

Necator americanus/ancylostoma duodenale- hookworm

Answer 67

Rural/trop/human feces in soil, digs in through food, cough up, swallow, Rash/pruritis where penetrate, iron-def anemia/FTT, fatigu,e pallor Mebendaazole, albend, ppa, screen, iron

Question 68

Strongyloides stercoralis

Answer 68

Like hookworm life cycle- tropics, subtropics/SW US, Pruritic papules at penetration site, pneumonitis, GI sx, eosionphilia Ivermectin, thiabendazole, albendazole

Question 69

Cutaneous larva migrans

Answer 69

Intradermal migration of dog/cat hookworms from feces- soil Migrating serpiginous tracks on skin Self lim, give ivermectin/thiabe/alben if severe

Question 70

Toxocara canis- visceral larva migrans- VLM

Answer 70

1-4 y/o kids w/ Pica, eat eggs in soil/dog fur, larva released, migrate through tissues VLM- fever/eosino/leukocytosis/HSM, malaise, cough, myocarditis ocular larva migrans- retinal granulomas/endohtalmtis- albenda, mebenda, steroids

Question 71

Rickettsial

Answer 71

Lyme, RMSF- rickettsia rickettsi- gram neg intracell Southeastern US, summer/spring, school-age, less than 50% recall tick bite Fever, petechial rash on extremities (ankles/feet to caudal/centripital), myalgias, HSM, jaundice, CNS, h/a, hypotn TCP, hyponat, elevated transam, CSF aseptic Dx- serologic + clinical, MGMT = oral/IV doxy + supportive care, abx on clinical testing Prevent w/ tick avoid

Question 72

Ehrlichiosis-

Answer 72

Ehrlichia chaffeenis- tick Same regions as RMSF- spottless! Fever, h/a, myalgia, lymphadeno- same TCP, elevated liver, hyponat, dx w/ serology/pcr doxy + supportive care

Question 73

Cat Scratch

Answer 73

Bartonella- g negative regional lymphadeno, post scratch Papule along line of scratch,red, warm, tender 1/3 w/ fever, 1-% w/ pus, parinaud oculoglandular syndrome, enceph, osteo, hep, PNA, hepatic/splenic lesions Dx- demo elevated IgM MGMT = supportive care- abx if systemic/immuno def, oral zpack, bactrim, cipro. no surgery

Question 74

TB

Answer 74

Myocbacterium TB, recent contact w/ contagious pulm tb Latent = asx w/ postive skin test, or radiograph w/ granulomas TB disease- signs sx of TB w/out positive dx findings Epid- high risk immigrants, homelss, jail, immunodef, kids under 12 usually NOT contagious b/c cough too small LTBI- positive TB test do not progress to disease, infants under 1 greatest risk of getting...fever chills WL, cough, night sweat Extrapulm = cervical scrofula, meningitis, ileitis abdomen, skin/joit, skeletal potts, Xr- hilar/mediastinal lymphadeno, ghon complex, lobar/pleural effusion/cavitary upper lung Dx- with PPD- read 48-72 hours later, 2012 weeks after exposure. Induration measurement > 5 mm kids, >1 mm if under 4/chornic med condition or endemic, > 15 if over 4 w/ no risk factor def dx= culture from gastric aspirates, AFB tain, psotive histology MGMT- LTBI = INH for 9 mo, also give b6 TB disease give 1nh, rif, pyrazinamid,e 2 mo, then 4 mo inh + rifampin