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Peds > Infectious Dz and Allergies/Immunology > Flashcards

Infectious Dz and Allergies/Immunology Flashcards

1
Q

Things that can affect your dx with infectious disease

A 
Season
Age
General health
Fever
Previous sx
Exposure
Travel
Daycare
Immunization therapy
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2
Q

Work up for infectious dz- general

A 
CBC
-Left shift in CBC means high neutrophils can include bands
-Right shift is high lymphoctes
Gram stain
Cultures
LP
Rapid screening test
PCR (DNA, RNA)
Imaging
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3
Q

DDx- viral- ID

A

Petechiae
Neutropenia
Lymphocytosis

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4
Q

DDx- bacterial- ID

A 
Petechiae
Purpura
Leukocytosis- left shift
Neutropenia
Increased ESR/CRP
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5
Q

What does secondary prophylaxis include?

A

Meningococcus
Tetanus
-Dirty wound, give if they have not had shot within 5 yrs
-Clean wound, give if they have not had the shot within 10 yrs
Rabies
-Immunoglobulin, inject into wound as much as you can, then give IM injection
-Day 1, 3, 7, 14 for vaccine schedule
-Try to find the animal
-Document if they decline

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6
Q

Fever without source: 1-3 mos

A 
Viral
Bacteremia
-GBS
-E. coli
-Listeria monocytogenes
UTI
-E. coli
Pneumonia
-S. pneumoniae
-S. aureus
Meningitis
-S. pneumoniae
-HSV
-Enterovirus
-N. meningitidis
Bacterial diarrhea
-E. coli
-Salmonella
-Shigella
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7
Q

Fever without source: 3 mos- 3 yrs

A 
Viral
Occult bacteremia
- Greater than or equal to 102.2
-WBC > 15K
-Left shift
-Increased ESR/CRP
UTI
-UA, URC, BLDC
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8
Q

What to do with < 3 mos with fever?

A

Usually do an LP

Neonate: run your basic tests: BCx, CBC, CXR, urine

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9
Q

You don’t usually see strep in _____

A

< 2 yo

Will see URI, OM

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10
Q

Fevers of unknown origin

A 
Infections
Inflammatory dz
-15%
Malignancy
-10%
Fictitious
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11
Q

Fever and rash in peds

A 
Macular/maculopapular
-Usually measles or rubella
Diffuse erythroderma
Urticarial
Vesicular, bullous, pustular
Petichial-purpuric
Erythema nodosum
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12
Q

Characteristics of measles

A

Papular lesions of trunk, neck, face
Red watery eyes
Grey-white spots in the mouth

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13
Q

Characteristics of rubella

A 
Typically lasts around 3 days
Body aches
Anorexia
HA
Pharyngitis
Conjunctivitis
Low-grade fever
Highly contagious, but resolves on its own
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14
Q

Characteristics of roseola infantum

A

HSV 6 and 7
Abrupt fever, rose-colored maculopapular rash lasting 3-5 days
Cough

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15
Q

5ths dz- characteristics

A 
"Slapped cheek"
Caused by parvovirus B19
Usually occurs during springtime
Diagnose with PCr
Reoccurs with bathing, rubbing
Mild anemia, lymphopenia
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16
Q

Tx for herpes zoster

A

Antivirals and pain meds

Give hydrocodone at hospital but not for the 4 wks that you’ll treat it

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17
Q

Varicella zoster

A

Do not give ASA or acyclovir
Could develop post-secondary staph and strep infections with scratching and dirty fingernails
Give the vaccine at 12-15 mos and 4-6 yrs
-85% effective in preventing dz
-95% effective in reducing severity

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18
Q

Impetigo characteristics

A

Bolus impetigo has clear fluid-filled cysts
Crusting, yellow, honey-crusted
See on Gram stain: purple (Gram pos) cocci in clusters
Give 2% mupirocin

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19
Q

Cellulitis

A

Demarcate with a pen, tell them to come back in 24 hrs to the ER
Look for LAD, check above and below
Is there any fluctuation in the wound? Do you want to I and D?
Shot of Rocephin, then diclocycillin or Keflex

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20
Q

Erysipelas

A

Just dermal area, not full thickness
Line of demarcation is very clear
Causative agent is group A strep
If IC or DM, try to convince hospitalist to admit

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21
Q

Forunier’s gangrene

A

Caused by staph, strep, clostridium
Very quick progression
Need immediate surgical consult
IV clinda, surgeon may add aminoglycoside, may also use Rocephin

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22
Q

Folliculitis

A

Affects follicles of hair cells
Pseudomonas, staph are causes
Chlorhexidine 1% or clinda cream

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23
Q

Ringworm

A 
Use KOH prep to diagnose
Will see budding, septate or aseptate hyphae
Treat with miconazole, clotrimazole
Takes time to heal
Use a thin layer, and keep it dry
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24
Q

Herpetic whitlow

A

Pruritis and pustules

Valacyclovir

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25
Q

Herpes gladitorium

A

Worry about eyesight
Do a slit lamp exam and document when it doesn’t affect the eye
Otherwise, you need to call an ophthalmologist

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26
Q

HPV vaccine

A

Give between ages 9-26
Quadrivalent covers 6, 11, 16, 18
3 doses
98-100% effective

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27
Q

Molluscum contagiosum

A

Cause is pox virus
Fleshy, skin-colored lesion with dimple
Self-limiting over several mos

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28
Q

What can be seen on a blood smear with mono?

A

Atypical lymphocytes

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29
Q

Cat scratch or bite

A

Could affect epitrochlear LN
Boggy
Caused by Pasturella multocida
Give Augmentin

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30
Q

M. Kansaii

A

Usually a post-surgical infection
Can also involve soft tissue
Found in TX, LA, FL, KS, IL
Treat with rifampin, methambutol

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31
Q

Encephalitis types

A 
California
St. Louis
Equine
West Nile
-Occurs in summer in North America
-Sore throat, fever, aching, lethargy, HA, behavior changes, neuro deficits
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32
Q

Encephalitis work up

A 
Get a CSF test
-Viral: nl glucose, slightly elevated protein
-Bacterial: low glucose, high protein
LP
BCx
CBC
MRI
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33
Q

Mechanism of encephalitis

A

Infection
Immune-mediated response
Herpes is MCC of sporadic encephalitis in children

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34
Q

Colds

A

Antihistamines and decongestants are not recommended for children under 6 yrs
If no better in 10-14 days consider bacterial

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35
Q

Sinusitis

A

Get a water’s view CT
-Will show areas of exudate, inflammation, or possible Netty pot use
Causes are M. catarrhalis, H. flu, S. pneumoniae
With children, look for a FB
Look for fever, tenderness mucopurulent d/c in nare
Treat with Augmentin

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36
Q

Otitis media

A

If it’s happened too many times, refer to ENT for possible myringotomy

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37
Q

Difficult cases of otitis externa

A

If canal is really tight, use an earwick

Put liquid lidocaine on there before inserting it

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38
Q

Croup

A

Steeple sign on X-ray
Usually in fall and winter mos
Give dexamethasone
Consider racemic epi to reduce subglottic edema

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39
Q

Epiglottitis

A

See thumb print sign on X-ray
Hib, staph, strep are causes
Treat with tube, abx

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40
Q

Pertussis

A 
B. pertussis
Spread by cough
Stages
-Catarrhal
-Paroxysms
-Convalescent
Peak incidence < 4 mos
Typically seen in 1-10 yos
Contagious for first few weeks
Runny nose, low-grade fever
WBC 20K
Lymphocytosis of 75-80%
Give azithromycin, clarithromycin
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41
Q

Bronchiolitis

A

Affects small bronchioles
Late fall to early spring
Runny nose, low-grade fever, cough
Leading cause of hospitalization in infants
ELISA to diagnose
Primarily caused by RSV
Hyperresonance on percussion with diffuse wheezes or crackles

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42
Q

PNA

A

Bacterial PNA is typically lobular
Not getting better, do another test, like a CT
Increased interstitial marking like tree branches indicates a viral infection
Treat with Z pack for CAP
Induce a sputum culture with a neb

43
Q

Types of pneumonia

A 
Atypical
Bronchial
SARS
-Coronavirus
PNA in the IC
-Gram neg enteric bacteria
-Virus
-Fungi
-Mycobacteria
44
Q

PNA workup

A 
CBC
-Bacterial vs viral
-Sputum gram stain and culture depending on child's age
-Rapid viral antigen detection
PCR
Blood cultures
CXR
45
Q

DDx of PNA

A 
CF
AIDS
Disorders of leukocytes
Disorders of cilia
-Kartagener syndrome- immotile cilia
GERD
FB
46
Q

Complications of PNA

A 
Abscess secondary to lung necrosis
Empyema
Effusion
Bronchiectasis d/t scarring
Penumatociles- thin blebs, air or fluid-filled, can sometimes pop
Bronchiolitis obliterans
-small airways are replaced scar tissue
Sawyer-James syndrome
-Severe necrotizing pneumonia
-Increased translucency of lung
-Adenovirus type 21
47
Q

Tx of PNA

A

Do culture and MIC
S. pneumoniae MIC < 2- Ampicillin/PCN/amoxicillin
S. pneumoniae MIC >4- Ceftriaxone/Levoquin/Linezolid
Mycoplasma- Zithromycin
MRSA- Clindamycin or Vanc IV
HSV- acyclovir

48
Q

Infective endocarditis

A 
Reasons for kids to get this- wound that hasn't healed well or very infected, dental work
Bacteria
-Viridians step
-S. aureus
-Hemolytic strep A, B, C, G, D
-Cause vegetation on valves, which become incompetent. Results in hemolyzing blood
Fungi
-Candida
49
Q

Workup for infective endocarditis

A 
ESR/CRP
CBC
BLDC
RF/ANA- may be positive
Echo- consider doing TEE instead of transthoracic- more sensitive
50
Q

Complications of infective endocarditis

A

Emboli
Abscess
Aneurysm

51
Q

Tx for infective endocarditis

A

Viridians strep- PCN G 4 wks
May consider Pen G plus aminoglycoside 2 wks
Surgery
Cure rate >90% in uncomplicated endocarditis d/t viridians

52
Q

Acute gastroenteritis

A

Diarrhea
Leading cause of morbidity and common in US
Person-to-person contact
Contaminated food/water
If you see both nausea and vomiting at the same time, consider food poisoning

53
Q

Acute gastroenteritis bacteria

A 
E. coli
Salmonella
Shigella
Vibrio cholera
B. cereus- refried rice
S. aureus- mayo
54
Q

Acute gastroenteritis virus

A

Rotavirus
Adenovirus 40 and 41
Norovirus

55
Q

Acute gastroenteritis parasites

A

E. histolytica

Giardia lamblia

56
Q

Labs for acute gastroenteritis

A 
BMP- worried about dehydration, look at electrolytes
Sodium may be low
CBC
Fecal culture
Ova and parasites
57
Q

Tx of acute gastroenteritis

A

Bacterial: 3rd gen cephalosporin S. typhi
Parasite: Metronidazole
Virus: supportive

58
Q

Hepatitis

A

Types A, B, C, D, E, G
A= poor hand washing
B+ D= chronic hep
-Could lead to fulminant hep, cirrhosis and CA
HBV and HCV
-IV drugs, maternal fetal, blood products/needle stick

59
Q

Tx of hepatitis

A

HBV
-Interferon Alpha-2B or lamivudine
HCV
-Interferon or in combination with ribavirin
Most cases of acute viral hep resolve in time
-HAV and HEV- acute
-HBV, HCV, HDV= chronic, possible cirrhosis and carcinoma

60
Q

UTI labs

A 
Ensure clean catch
UA
URC
Imaging if necessary
-Could have stone or chronic kidney or bladder infections due to vesicourethral reflux
Chlamydia culture if suspect
61
Q

UTI possible origin in teens

A

Staph saprophyticus, chlamydia and E. coli 12-72 hours after intercourse
Causes urethral syndrome and urethritis

62
Q

Vulvovaginitis

A

MC gyn in children

63
Q

Causes of vulvovaginitis

A 
Physiological leukorrhea- nl
Non-specific: nl
Bacterial
-3 criteria: homogenous d/c, pH >4.5, a little fishy odor
-Also see clue cells 
-Treat with metronidazole
Candidiasis
-Treat with metronidazole
Enterobiasis- pinworms
-Treat with mebendazole
Giardiasis
-Treat with metronidazole
Molluscum contagiosum
-Treat with curretage
Phthirius pubis: crabs
-Treat with permethrin
Scabies
-Treat with permethrin
Staph/strep
-Treat with dicloxacillin or 1st gen cephalosporin
FB
64
Q

UTI parenteral tx

A

Cephtriaxone or gentamycin

65
Q

UTI oral tx

A

Cephalosporin
Augmentin
Septra/Bactrim

66
Q

chlamydia

A 
70% of women are asymptomatic
Gram neg
May lead to PID
-Abd pain
-Adnexal tenderness
-Pain on cervical motion
-Fever
Tx
-Rocephin + doxy or Azithro
67
Q

Syphilis

A

Treponema pallidum
Great imitator
Primary-chancre
Secondary- fever, LAD, rash, condolomata lata lesion
Tertiary- organ damage, neurosyphilis, aorta
Diagnose with dark field microscopy

68
Q

Tx of syphilis

A

Primary- 2.4 mil U pen G benzathine q2-4h x 10 days
Secondary: 2.4 mil u pen G x 3 wks (3 doses)
Tertiary: 3-4 mil U pen G q4h x 10-14 days

69
Q

HSV

A 
Pre-herpatic pain
Vesicular
HSV culture
Rx
-Acyclovir/Famcivlovir/Valacyclovir
Post-herpatic pain lasts 3-4 wks
Meds reduce recurrence by 75%
70
Q

H. ducreyi

A

Bacterial
See chancre
Culture
Tx: Azithro 1 gm po

71
Q

Granuloma inguinale

A

Cause is Klebsiella
Requires bx for staining
Tx: Doxy

72
Q

Trichomoniasis

A 
Vulvular inflammation
70% asymptomatic
D/c- frothy bubbly
Strawberry cervix
Diagnose with KOH
Tx: metronidazole
73
Q

Candidiasis

A 
Thick d/c with itch
Candida albicans
Consider DM/BCP/ current or recent abx
KOH
Fluconazole or nystatin for tx
74
Q

Genital warts

A 
HPV aka condylomata acuminata
Firm grey to pink
Cervical neoplasia or dysplasia
HPV 16 and 18 (70% cancer)
Tx: Podofilox or cryo
75
Q

Type I allergy

A

Immediate
IgE
Anaphylaxis, angioedema, urticaria

76
Q

Type II allergy

A

Cytotoxic
IgM, IgG, complement, phagocytosis
Cytopenia, nephritis

77
Q

Type III allergy

A

Immune complex
IgM, IgG, complement, precipitins
Serum sickness, vasculitis

78
Q

Type IV allergy

A

Delayed
T-lymphocytes
Contact dermatitis

79
Q

Idiopathic allergy

A

Effector mechanism varies

Non-specific rash

80
Q

Dx of allergies

A 
Skin patch testing
RAST (radioallergosorbent test) panels
CXR
CT sinuses
Serum immunoglobulins
81
Q

Allergic rhinitis

A

Eosinophilic inflammation of nasal mucosa
PE will show a transverse nasal crease
Eosinophils will be present in nasal secretions and elevated on CBC
Non-allergic rhinitis is more likely vasomotor, infectious, or secondary to a FB

82
Q

Allergic rhinitis medications

A

Mild: antihistamines PRN
Moderate: routine administrations of LTRA (Leukotriene receptor antagonist)- Singulair (montelukast)
Severe: topical nasal steroid, immunotherapy, antihistamine, or LTRA

83
Q

Systemic anaphylaxis

A

Rapid onset allergic reaction d/t the widespread degranulation of mast cells after crosslinking of IgE on the mast cell surface
Often secondary to bee stings, food exposures, or drug administration
Severe manifestations: airway obstruction, hypotension

84
Q

Stings

A

Good to watch if you have FHx
Tx: Children younger than 16 with diffuse urticaria require epi
Children >16 are treated as adults and require subQ epi
Any child with a systemic rxn to a bee sting requires referral to an allergist
Any child with a life-threatening rxn to a bee sting requires venom immunotherapy which is 98% effective in preventing future rxns

85
Q

Anaphylaxis therapy

A

Epi is primary
Antihistamines are secondary
For severe event steroids may prevent late-phase rxn

86
Q

Angioedema

A

Hereditary angioedema: autosomal dominant d/o characterized by the absence or abnormal function of the C1 esterase inhibitor which results in increased vascular permeability
Angioedema related to allergic rxn: self-limiting, episodic, commonly triggered by minor trauma
Give benadryl, dexamethasone

87
Q

Asthma causes

A 
Allergens
-Pollen, mites, animal dander, mold
Irritants
-Tobacco smoke
Viral infections
-RSV
-URI
Exercise
88
Q

Allergy meds

A 
Antihistamines
-1st gen: sedation problems
-2nd gen: preferred where sedation a problem
LTRA
-Similar efficacy to antihistamines
Mast cell stabilizers
Topical corticosteroids
-Most effective, block more aspects of allergic inflammatory response
89
Q

Allergic conjunctivitis

A

If bacterial, will have matted eyes, exudative drainage, whereas allergic has clear fluid
Acute or chronic, seasonal and perennial
Itching and excessive tearing
Tx is with saline eye drops and antihistamines

90
Q

Causes of a cough in a child <1

A 
CF
Resp tract infection
Aspiration
Dyskinetic cilia
Lung/airway malformation
Edema
91
Q

Long-term controlled meds for asthma

A 
ICS
LTRAs
-Zafrilukast > 5 yrs BID
-Montelukast QD
--6 mos-5 yrs 4 mg
--6-14 yrs 5 mg
--15 yrs and above 10 mg
92
Q

LABA

A 
Relax airway smooth muscle
No anti-inflammatory
BID
>5 yrs
Maintenance
Prevention of exercise-induced asthma
93
Q

Omalizumab (Xolair)

A

Anti-IgE AB
Mod to severe asthma
12 yrs and older
SubQ q2-4 wks

94
Q

SABA

A

Bronchodilator
Acts in 5-10 mins
4-6 hr duration
Prophylaxis

95
Q

Ipratropium

A

Relieves bronchoconstriction
Decreases mucus hypersecretion
Reduces cough
Not for long-term use

96
Q

Corticosteroids

A

Acute exacerbation
3-10 days
1-2 mg/kg/day then 1 mg/kg/day days 2-5

97
Q

General tx principles in asthma

A

Step up-step down therapy
All children should have short acting MDI
ICS preferred for all children-persistent asthma
Rules of two;
-Sx 2 or more days/week
-Sx 2 or more nights/mo

98
Q

Primary immunodeficiency

A

Refers to a group of more than 300 rare, chronic disorders in which the immune system fails toa ct appropriately
Red flags:
-Severe infections requiring hospitalizations at an early age
-Persistent or recurrent illnesses
-Infections secondary to obscure or uncommon organisms

99
Q

Things to check with immunodeficiency

A

CBC to look for neutropenia or lymphopenia (SCID), esosinophils (allergic dz) or anemia (chronic dz)
Serum immunoglobulin levels should be obtained: IgG, IgA, IgM, IgE, IgD

100
Q

DiGeorge syndrome

A

Partial immune defects with low T-cell numbers and functions that tend to improve with age
Known as velocardiofacial syndrome or catch 22 syndrome because of the Cardiac anomalies, Abnormal facial features, Thymic hypoplasia, Cleft palate and Hypocalcemia stemming from deletions in chromosome 22q11.2

101
Q

Wiskott-Aldrich syndrome

A

X-linked disorder that results from defects in both cell-mediated and humoral immunity. There is a predisposition of lymphoproliferative disorders
Children presents with the triad of thrombocytopenia (low platelets), eczema and recurrent infections

102
Q

Chediak-Higashi syndrome

A

Abnormality of secondary granule that results in defective neutrophil and NK cell function
Usually presents with partial oculocutaneous albinism
Most cases progress to a lymphoproliferative syndrome with generalized fever, jaundice, hepatomegaly and pancytopenia

103
Q

Stem cell therapy

A

This is the only cure available for primary immunodeficiency
Stem cells are found in bone marrow, cord blood and peripheral blood
The main risk associated with stem cell therapy is GVHD

Peds (11 decks)

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