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EOR- PEDS > Infectious dz > Flashcards

Infectious dz Flashcards

1
Q

presents similar to TB – cough, chest pain, fever, weight loss, upper lobe infiltrates & cavities

A

Mycobacterium avium complex

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2
Q

Mycobacterium Avium Complex transmission

A

Transmission: present in soil & water (NOT person to person)

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3
Q

Sx of Mycobacterium Avium Complex

A

Symptoms seen in patient w/ underlying pulmonary disease (Bronchiectasis, COPD) &/ immunocompromised patients (HIV with CD4 count less than or equal to 50cells/uL)

Symptoms rarely occur in immunocompetent patients without underlying lung disease, inc. risk in bronchiectasis

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4
Q

Tx of Mycobacterium avium complex

A

MAC is treated with clarithromycin + ethambutol + Rifampin/Rifamycin/Rifabutin fort at least 12 months

Life threatening disease? Add a parenteral aminoglycoside to above regimen

Second line: Ethambutol + Rifamycin (or Rifabutin) + Aminoglycoside

Surgical excision of infected lymph nodes = curative in 90% of patients w/ lymphadenitis

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5
Q

Mycobacterium Marinum is found where

A

Atypical Mycobacterium – found in fresh & salt water ** MARINUM = AQUARIUM = WATER **

Transmission: Inoculation of a break in skin barrier (laceration, abrasion, etc.) with exposure to contaminated water

Occupational hazard of aquarium handlers, marine workers, fisherman & seafood handlers

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6
Q

Sx of mycobacterium marinum

A

Localized cutaneous disease: erythematous bluish papule or nodule at the site of trauma that can ulcerate (w/ history of exposure to non-chlorinated water 2-3w earlier)

Subsequent lesions may occur along the path of lymphatic drainage over a period of months

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7
Q

Chronic disease caused by Mycobacterium leprae & lepromatosis that primarily affects superficial tissues (especially skin & peripheral nerves)

Endemic in subtropical areas – requires long exposure (few months to 20-50 years incubation period)

A

Leprosy; Hansens dz

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8
Q

Sx of Leprosy

A

Lepromatous: nodular, plaque, or popular skin lesions (lepromas) with poorly defined borders • Hypopigmented lesions can be seen in cooler areas of the body – face (leonine), ears, wrists, elbows, knees & buttocks; loss of eyebrows & eyelashes ; Slowly evolving SYMMETRIC nerve involvement (sensation preserved), paresthesia in affected peripheral nerves

* MC seen in immunocompromised patients

Tuberculoid: limited disease – sharply demarcated hypopigmented macular lesions numb to the touch (loss of sensation) w/ sudden onset of ASYMMETRIC nerve involvement

MC in immunocompetent patients (immune system rxn in the nerves causes the loss of sensation) ; Mononeuritis multiplex: nerve damage – posterior tibial nerve, median & ulnar involvement (clawing), common peroneal nerve (foot drop), vibratory & proprioception preserved

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9
Q

Tx of leprosy

A

Lepromatous: Dapsone, Rifampin, Clofazimine x2-3 years

Tuberculoid: Dapsone + Rifampin 6-12 months → then Dapsone x2 years

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10
Q

Epstein Barr etiology/transmission

A

Epstein-Barr virus (part of Human herpesvirus family) infects B cells, incubation period 30-50 days

saliva (kissing disease), especially ages 15-25

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11
Q

Sx of Epstein Barr

A

Fever, lymphadenopathy (especially posterior cervical), can be generalized

Tonsillar pharyngitis – may be exudative; may have petechiae on the hard palate

Associated with headache, fatigue, malaise, splenomegaly (inc. risk of splenic rupture), hepatomegaly

Maculopapular rash seen in ~5%, especially if given Ampicillin

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12
Q

Dx of epstein barr

A

Heterophile antibody (Monospot) – test of choice (+ within 4 weeks) • Rapid Viral Capsid Antigen test, increased LFTs • Peripheral Smear: lymphocytosis >50% with >10% atypical lymphocytes

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13
Q

Tx of Mono

A

Mainstay of treatment: supportive – rest, analgesics, antipyretics – symptoms may last for months

Corticosteroids used ONLY if airway obstx d/t lymphadenopathy, hemolytic anemia, or severe thrombocytopenia – Strep & EBV can coexist

Avoid trauma & contact sports x3-4 weeks if splenomegaly is present to prevent splenic rupture

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14
Q

Why avoid contact sports if a pt has mono aka epstein barr

A

Avoid trauma & contact sports x3-4 weeks if splenomegaly is present to prevent splenic rupture

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15
Q

Infectious mono aka EBV is what herpes family?

A

EBV = 4

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16
Q

Roseolavirus is what herpes family

A

6 or 6th disease

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17
Q

Measles aka

A

RubeOLA or 1st disease

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18
Q

Transmission of Rubeola (measles)

A

Transmission: respiratory droplets, airborne, ~6-21 day incubation period • 3-phase progression: Prodrome → Enanthem → Exanthem

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19
Q

3 C’s of Measles

A

Prodrome: URI syx + malaise, anorexia, fever + 3 C’s!!:

Cough, coryza, conjunctivitis

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20
Q

Rash seen with Rubeola

A

Enanthem: Koplik spots: small 1-3mm pale white/blue papules w/ an erythematous base on buccal mucosa opposite the 2nd molars (pathognomonic)

Exanthem: Rash: morbilliform (maculopapular), brick-red rash beginning @ hairline spreading cephalocaudally & centrifugally that darkens & coalesces, blanches

Rash lasts 7 days w/ (+) lymphadenopathy & pharyngitis

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21
Q

Tx of measles

A

Mainstay: supportive – PO hydration, Tylenol or Ibuprofen, isolate x1w

Vitamin A: ↓ morbidity & mortality

Measles immunoglobulin: for high risk children

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22
Q

Transmission of mumps

A

Transmission: respiratory droplets, saliva, & household fomites ~12 day incubation period • Increased in spring & most infectious 48h prior to onset of parotitis & infectious for 9 days after onset

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23
Q

Sx of Mumps

A

Prodrome: low-grade fever, myalgia, malaise, HA, earache → parotitis (bilaterally usually)

PE: parotid swelling & tenderness, erythema & edema of Stensen’s duct

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24
Q

Complications of mumps

A

Epididymo-orchitis (unilateral) = MC complication, esp in postpubertal males – may occur 5-10d after parotitis onset

Neurologic: aseptic meningitis (MC), encephalitis, deafness

Oophoritis, arthritis, infertility

MCC of pancreatitis in children

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25
Q

Tx of mumps

A

Supportive: antipyretics, analgesics, self-limited [syx last 7-10 days]

Hospitalized: patient placed on droplet precautions & CDC recommends isolation for at least 5 days after syx onset

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26
Q

Rubella aka german measles sx

A

Prodrome: low grade fever, cough, anorexia, & posterior cervical/posterior auricular lymphadenopathy

Exanthem: Rash: pink/red nonconfluent maculopapular rash that starts on face & spreads to trunk & extremities lasting 3 days [spreads more rapid than measles and much darker & confluent in measles]

Forchheimer spots: small red macules/petechiae on soft palate

Photosensitivity & joint pain

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27
Q

Dx of Rubella

A

Rubella-specific IgM antibody w/ enzyme immunoassay

Rubella-virus specific IgM antibodies present – can be + up to one year after infection

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28
Q

Tx of Rubella

A

Supportive: Tylenol/Ibuprofen, oral hydration

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29
Q

Neonate born w/ hepatosplenomegaly, jaundice, continuous machinery-like murmur, cataracts, sensorineural hearing loss & thrombocytopenia [Blueberry muffin rash]

A

Congenital rubella syndrome

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30
Q

Erythema Infectiosum – Fifth Disease MC bug + transmission

A

Parvovirus B-19: infects & destroys reticulocytes, leading to a decrease or transient alt in erythropoiesis (can lead to aplastic crisis [Sickle cell patients @ highest risk, & G6PD patients])

MC in children <10 y/o

Transmission: respiratory droplets, 4-14 day incubation period

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31
Q

Sx of fifth dz

A

Nonspecific viral symptoms (coryza, malaise, fever) followed by erythematous malar rash w/ “slapped-cheek” appearance & circumoral pallor for 2-4 days

Malar rash is followed by a lacy, reticular maculopapular rash on the extremities (especially upper) that usually spares palms & soles, resolving in 2-3 weeks – pruritic

32
Q

Tx of fifth disease

A

Symptomatic

Self-limited disease, use anti-inflammatories [Acetaminophen or NSAIDs] EXANTHEM: Hand-foot-and-mouth Di

33
Q

Hand foot mouth etiology

A

Coxsackievirus type A – this is an Enterovirus that is part of a Picornavirus family

Commonly in children under 5 & in Summer/early Fall

Transmission: primarily fecal-oral & oral-oral, most contagious in 1st week

34
Q

Sx of hand/foot/mouth

A

stomatitis & a vesicular rash on hands and feet

Mild fever, URI symptoms [sore throat, malaise, irritability], & decreased appetite starting 3-5 days after exposure

Oral exanthem: erythematous macules that become painful oral vesicles surrounded by a thin halo of erythema that undergoes ulceration (esp on buccal mucosa & tongue) followed by exanthem

Exanthem: greyish-yellow vesicular, macular or maculopapular lesions on the distal extremities (often including palms & soles) – less commonly vesicles are seen on face & torso **Not painful or pruritic

35
Q

Sixth disease aka Roseola etiolgy

A

Respiratory droplets with a 10-day incubation period; 90% occur in children, < 2 years of age

36
Q

Sx of Roseola

A

Fever prodrome: high fever 3-5 days (may exceed 104) & lymphadenopathy – child appears well & alert during febrile phase, the fever resolves abruptly before the onset of the classic rash*

Rash: rose, pink, macular or maculopapular, blanchable rash beginning on the trunk & neck before spreading to the face; Macules 2-5mm & rash lasts hours up to 2 days

Only viral exanthem that starts on the trunk

37
Q

Tx of Roseola

A

Supportive – mainstay of treatment (self-limited) – rest, maintain fluid intake, antipyretics

Adequate handwashing important to prevent spread of infection

38
Q

child appears well & alert during febrile phase, the fever resolves abruptly before the onset of the classic rash

A

Roseola aka sixth dz

39
Q

Highly contagious infection secondary to __________, a gram-negative coccobacillus

A

Bordetella Pertussis

40
Q

What age group is MC for bordatella pertussis

A

Rarely seen d/t widespread vaccination – MC in children under 2 y/o

41
Q

3 phases of bordatella whooping cough

A

Catarrhal Phase: URI syx lasting 1-2 weeks – most contagious during this phase

Paroxysmal Phase: severe paroxysmal coughing fits with inspiratory whooping sound after cough fits – may have post coughing emesis, lasts 2-4 weeks

Convalescent Phase: resolution of the cough (cough may last for up to six weeks)

42
Q

Inflammation of the bronchioles – the smallest air passages of the lungs which usually occurs in children under 2

A

Acute bronchiolitis

43
Q

MCC of bronchiolitis

A

Respiratory Syncytial Virus (RSV) = MCC, Rhinovirus, Adenovirus, Influenza virus, parainfluenza virus, etc

At risk: Infants 2 months to 2 years most commonly affected, exposure to cigarette smoke, lack of breastfeeding, prematurity, & crowded conditions

44
Q

Tx of acute bronchiolitis

A

Supportive measures mainstay of treatment – humidified oxygen, IV fluids, nebulized saline, cool mist humidifier, antipyretics (Acetaminophen)

Mechanical ventilation may be indicated if severe

45
Q

Inflammation of the larynx & subglottic airway

A

Croup aka laryngotracheitis

46
Q

MCC of croup

A

MCC = parainfluenza virus type I, RSV, Adenovirus, & Rhinovirus

MC between 6 months-6 years; especially in fall & winter

47
Q

Sx of Croup

A

Upper airway involvement: harsh, “seal-like barking” cough – hallmark of the disease in infants & young children, inspiratory stridor, hoarseness (especially in older children & adults), dyspnea, low-grade fever – symptoms often worse @ night

URI symptoms (coryza) prior, during, or after acute presentation

48
Q

Dx of Croup

A

Clinical diagnosis - once epiglottitis & foreign body aspiration are excluded

Frontal cervical radiograph: Steeple sign (subglottic narrowing of the airway) – 50%, rarely done

49
Q

Tx of Croup

A

Supportive (air humidifier), antipyretics

Severe: IV fluids and nebulized racemic epinephrine, steroids

50
Q

Autosomal recessive exocrinopathy → abnormal mucus production → obstruction of glands & ducts

A

Cystic fibrosis

51
Q

Cystic fibrosis pathophys

A

Mutation in the cystic fibrosis transmembrane conductance receptor (CFTR) gene leads to abnormal chloride & water transport across exocrine glands throughout the body, leading to a thick, viscous secretion of the lungs, pancreas, sinuses, intestines, liver & genitourinary tract

MC in Caucasians & Northern Europeans

52
Q

Sx of cystic fibrosis

A

Infancy: meconium ileus, failure to thrive, diarrhea from malabsorption (may lead to rectal prolapse)

Pulmonary: CF is the MCC of Bronchiectasis in the US

GI: malabsorption (especially fat-soluble vitamins [A, D, E, K], steatorrhea, diarrhea, recurrent pancreatitis (may lead to pancreatic insufficiency), distal intestinal obstruction, biliary cirrhosis

53
Q

Dx of cystic fibrosis

A

Elevated sweat chloride: test of choice (most accurate) – NaCl 60mmol/L or greater on 2 occasions after Pilocarpine administration (Pilocarpine is a cholinergic drug that induces sweating)

54
Q

PFT on cystic fibrosis

A

Obstructive pattern, usually irreversible

55
Q

CF tx

A

Antibiotics are often needed – Macrolides; Cephalosporins (Cefuroxime, Cefixime), Augmentin, Fluoroquinolones &/ inhaled aminoglycosides

Airway clearance treatment: inhaled bronchodilators, decongestants, mucolytics, inhaled recombinant human deoxyribonuclease (breaks down large amounts of DNA in the respiratory mucous that clogs up the airways)

Supportive: pancreatic enzyme replacement, supplementation of fat soluble vitamins, vaccinatinos – Pneumococcal, influenza • Lung & pancreatic transplant in selected cases

56
Q

patient, young, growth retardation, long history of recurrent pneumonia/chroic diarrhea, foul smelling stools

A

Cystic fibrosis

57
Q

Atelectasis & pulmonary perfusion without ventilation d/t insufficiency of surfactant production by an immature lung

A

Hyaline membrane dz = IRDS (neonatal/infant resp distress syndrome)

58
Q

MC single cause of death in the first month of life

A

Hyaline membrane dz; Disease of preterm infants caused by a lack of pulmonary surfactant production

59
Q

CXR findings of hyaline membrane disease

A

CXR: diffuse bilateral reticular atelectasis (causes ground-glass appearance) opacities + air bronchograms, poor lung expansion, domed diaphragms

60
Q

Tx of hyaline membrane dz

A

Exogenous surfactant via endotracheal tube to open the alveoli + mechanical ventilation (CPAP)

2-3 day clinical course with or without treatment 90% survival rate w/ treatment & normal return of lung function within 1 month

61
Q

udden onset of one time chills & rigors (violent shivering), fever, productive cough w/ blood-tinged (rusty) sputum – (common in patients with a splenectomy)

A

Strep pneumo pneumonia

62
Q

extremes of age (under 6, elderly), immunocompromised (DM, HIV, chemotherapy), underlying pulmonary disease (asthma, COPD, bronchiectasis, CF), alcoholics

What type of pneumonia?

A

H. Flu

63
Q

superimposed infection after a viral infection – hospital-acquired pneumonia, seen with salmon colored sputum

What type of pneumonia?

A

Staphylococcus Aureus

64
Q

purple-colored (currant jelly) sputum (chronic alcoholism, sick patients, patients with chronic illnesses (Diabetes)

What type of pneumonia?

A

Klebsiella

65
Q

cavitary lesions are hallmark* (nonspecific) or lobar consolidations

What type of pneumonia?

A

Klebsiella

66
Q

MCC of atypical walking pneumonia – outbreaks in late summer & early fall • Risk factors: young & healthy (school-age children, college students, military recruits)

What type of pneumonia?

A

Mycoplasma pneumonia

67
Q

CXR findings of mycoplasma pneumonia

A

atypical pattern – reticulonodular pattern most common, diffuse, patchy or interstitial infiltrates

68
Q

Tx of mycoplasma pneumonia

A

Macrolides (Azithromycin) or Doxycycline

Lacks a cell wall so naturally resistant to beta-lactams

69
Q

outbreaks related to contaminated water sources (air conditions, portable water, vents), no person-person Risk factors: immunosuppressed, smokers, elderly, chronic lung disease

GI symptoms prominent – diarrhea (watery & non-bloody), N/V

What type of pneumonia is this?

A

Legionella

70
Q

Tx of legionella pneumonia

A

Macrolides (Azithromycin) or respiratory Fluoroquinolones (Levofloxacin, Moxifloxacin, & Gemifloxacin)

71
Q

CURB65 criteria

A

CURB65 (ADMIT IF AT LEAST 2)

Confusion, Uremia (30+), RR 30+, BP low (under 90/60), age 65+

72
Q

Congenital CMV sx

A

Blueberry muffin rash (thrombocytopenia, petechiae, purpura)

Chorioretinitis

Periventricular calcifications

Sensorineural hearing loss

Hepatosplenomegaly

IUGR

73
Q

Congenital CMV tx

A

IV ganciclovir or oral valganciclovir

74
Q

Chlamydia Trachomatis sx

A

Purulent conjunctivitis

Staccato cough (Machine gun like)

Tachypnea

Interstitial or patchy infiltrates

75
Q

Tx of Newborn Chlamydia Pneumonia

A

Macrolide abx

76
Q

MCC of neonatal sepsis (gram positive cocci)

A

Streptococcus agalactiae (Group B Strep/GBS)

EOR- PEDS (9 decks)

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