Midterm Flashcards
How would you work up someone with a primary immunodeficiency?
CBC w/ differential
Swab/sputum culture
Respiratory Panel
Blood, urine, CSF cultures
Your pt is a 4yo presenting with fever, lethargy, won’t eat, barely drinking for the past 2 days. No cough. Negative PMH. What do you suspect and how do you work it up?
Secondary Immune issue
CBC w/ differential
CMP (electrolytes)
Primary immunodeficiencies can be characterized by their defect:
(4 types)
Cellular immunity (T-cells)
Humoral immunity (B cells)
Phagocytes
Complement
Many primary immunodeficiencies are inherited these 2 ways
X linked
Autosomal recessive
Consider Primary immunodeficiency in children with SPUR:
Severe, Prolonged, Unusual, Recurrent infections
SCID(Severe combined immunodeficiency) and Wiskott-Aldrich(Aldrich syndrome) and DiGeorge are all caused by___ defects
T-cell
_____ is characterized by eczema and thrombocytopenia
Wiskott-Aldrich syndrome
_____ defects usually aren’t seen until after 6 mo due to remaining maternal immunoglobulins.
B-cell
Aggamaglobulinemia, CVID, Hyper IgM syndrome are all caused by:
B cell deficiency
T/F: immunizations are essential for kids with B cell deficiencies
False. Can’t make memory cells anyways
Most common cause of stridor in infants
Laryngomalacia
Most common cause of drug-induced cutaneous reactions (as in SJS or TEN)
Amoxicillin, Ampicillin, and Bactrim
____ is when neutrophils fail to adhere to vascular endothelium
Leukocyte adhesion defect
____ is when there is a defect in intracellular killing. Lack of superoxidase after phagocytosis.
Chronic Granulomatous Disease
Chronic granulomatous disease is inherited this way
x-linked recessive
How do you test the complement pathway function?
CH50
What type of immune mediated pathway is involved in hemolytic anemia
Type II
Serum sickness, Henoch-Schonlein purpura, and post-strep. Glomerulonephritis are all cause by type ____ reactions
Type III
Infants with eczema have lesions on _______ surfaces
Facial
Older children and with eczema have lichenification on ____ surfaces
Flexural
Asthma tests include
Lung fxn, peak flow, CXR, ABGs, eosinophil count
Causes of cough in the first months of life = CRADLE
CF RTI Aspiration Dyskinetic cilia Lung malformation Edema
In the Asthma Action Plan:
Green = ______% of the peak expiratory flow rate
Yellow = ______
Red = ____
Green = 80-100% Yellow = 50-80% Red = below 50%
This classification of asthma requires no daily medications
Mild intermittent
This classification of asthma has sx > 2days/week or >2 nights/mo
Mild persistent
This classification of asthma requires daily low-dose inhaled ICS and a LABA
Moderate persistent
This classification of asthma is characterized by continual daytime sx and frequent sx at night
Severe persistent
This lab is most important for determining status asthmaticus
ABGs (hypoxia)
The most common organism to cause Otits media
S. pneumoniae
The most common organism to cause Sinusitis
S. pneumoniae
The most common organism to cause Croup
Parainfluenza virus
The most common organism to cause whooping cough
Bordetella pertussis
The most common organism to cause bronchitis
Parainfluenza virus
The most common organism to cause bronchiolitis
RSV
The most common organism to cause Pharyngitis
Adenovirus
______ include apnea, color change, decreased muscle tone, emesis, choking, and gagging
ALTE (Apparent life threatening Events in Infancy)
The _____ sign on x-ray is characteristic of croup
Steeple sign
____ is the most common cause of bacterial tracheitis (croup)
Staph aureus
This respiratory condition is considered an emergency d/t sudden onset of inspiratory stridor. Lateral neck x-rays show a “thumb sign”
Epiglottitis
H influenza type B is the most common bacterial cause of
Epiglottitis
___ is the leading cause of hospitalization in infants
Bronchiolitis
Bronchiolitis is characterized by cough, coryza, rhinorrhea. And is caused by ____
RSV
Bronchiolitis is diagnosed via
Viral swab
___ is the most common type of pneumonia in children
Viral
In bacterial pneumonia, ____ is the most common organism
Strep pneumoniae
___ is the drug of choice for treating bacterial pneumonia
Amox
Drug of choice for pertussis:
Erythromycin
____ is the term for elevation of part or all of the diaphragm and can be either congenital or acquired
Eventration
Horner syndrome is associated with this pupil characteristic
Anisocoria
____ is inflammation of the lid margins associated with conjunctivitis
Blepharitis
Treatment for blepharitis includes__ and ___ which are applied____
Local steroid & abx ointment
Applied at night
What organism is typically responsible for Hordeolum or chalazion?
Staph aureus
Adenovirus is the most common cause of viral ________
Conjunctivitis
A tender pre-auricular lymph node can be a sign of _____
Viral conjunctivitis
This ophthalmic condition could lead to permanent eye damage unless treated immediately with erythromycin
Ophthalmia Neonatorum
____ is inflammation of the cornea, and can be caused by HSV
Keratitis
____ is characterized by cobblestone papillae on tarsal conjunctiva
Allergic conjunctivitis
____ is a decrease in the child’s vision that can happen even when there is no problem with the structure of the eye
Amblyopia
Strabismus may be associated with cranial nerve # ____ involvement
CN 3 palsy
Patients with ____ will have pain upon traction of the pinna or tragus
Otitis Externa
____ is the most common organism causing swimmer’s ear
Pseudomonas
Topical _____ is used to treat otitis externa
Cipro HC
Your 14 mo old pt presents with a beefy red bulging TM. You suspect
Acute Otitis Media (AOM)
The most common cause of conductive hearing loss in children
Otitis media
Most common pathogen in AOM
Strep pneumoniae
____ is considered 1st line therapy for AOM
Amoxicillin
____ is a complication of AOM that causes white plaques on TM
Tympanosclerosis
Mastoiditis is a rare complication of ____
AOM
___ is the most common cause of viral rhinitis
Rhinovirus
Viral rhinitis may progress to ___ after 10-14 days
Sinusitis
Sinusitis in peds is usually bacterial, and is usually caused by
Strep pneumoniae
_____ is the most common complication of sinusitis
Orbital Cellulitis
The 2 bacterial pathogens that play the largest role in acute otitis media are:
H. influenza
Strep pneumoniae
Pt presents with mouth ulcers, fever, and cervical adenopathy. You suspect:
HSV
Treatment for thrush includes
Nystatin Oral
Up to 70% of pharyngitis cases are (viral/bacterial/fungal)
Viral
You are treating your patient with pharyngitis with Penicillin + Amoxicillin and they develop a rash. You order a CBC to see what’s going on. You get the labs back on your patient and it shows an increase of atypical lymphocytosis. What do you suspect?
Mono
Epstein Barr Virus
Herpangina, which is caused by ____, presents with ulcers w/ halo on anterior pillars, soft palate, and uvula.
Coxsackie virus
Your patient presents with an acute onset of beefy red throat, tonsillar exudates, and tender cervical lymph nodes. You suspect
Bacterial pharyngitis
Strep throat
____ presents with a sandpaper rash over the groin and torso
Scarlet fever
____ is the gold standard for diagnosing bacterial pharyngitis
Throat culture
Or rapid antigen test
Peritonsillar abscesses are also known as
Quinsy
_____ is considered a surgical emergency. Hospitalization with IV PCN or clindamycin is indicated in these patients who present with dysphoria, drooling, dyspnea, and neck hyperextension.
Retropharyngeal abscess
____ occurs in preschool children, is caused by beta-hemolytic strep, and presents with red, tender swollen lymph nodes and a high fever
Acute Cervical Adenitis
___ and ___ are severe complications of strep and staph infections
Rheumatic Fever
Acute Glomerulonephritis
Acute glomerulonephritis presents with ____ colored urine d/t gross hematuria
Tea or cola colored
What is the key to diagnosis for endocarditis?
Blood cultures
You must have 2 major and 1 minor of the ____ criteria to diagnose Endocarditis
Duke
The most commonly identified bacterial infection in kids under 3 is:
UTI
___ is a fever lasting > 14 days without an identified etiology
FUO (Fever of unknown origin)
Your 2 ½ mo old patient presents with a fever, but otherwise looks generally well. How do you manage this patient’s treatment?
Outpatient
only admit if looks ill
The maculopapular rash that accompanies Rubella is (confluent/non-conlfuent)
NOT confluent
A child with roseola infantum needs to be monitored for ________
Febrile seizures (30%)
Koplicks Spots are found in this childhood illness
Measles
Erythema Infectiosum, caused by the Parvo B19 virus, begins with this derm finding:
Red “slapped” cheeks
5th disease can cause ___ in pregnant women
Hydrops fetalis
_____ is the most common cause of diarrhea in the winter months
Rotavirus
Your patient presents with diarrhea along with systemic symptoms. You suspect: _____ and treat with:_____
Bacteremia
Abx + rehydration
Your patient experiences focal pain, warmth, and swelling of their femur. This condition, called ______, is usually caused by staph a.
Osteomyelitis
Septic arthritis is most commonly caused by____
Staph aureus
The most common virus causing meningitis is ____
Enterovirus
Your 6mo old patient presents w/ a blackened dry umbilical stump. This is weird. What do you suspect?
Leukocyte Adhesion Defect
LAD
Rapid onset of bacterial meningitis is usually due to:_____
Strep pneumo and
N. meningitits
Infection with Neisseria meningitidis results in these lesions ______
Non-blanching Petechiae
Or purpuric rash
___ are the principal cause of infectious encephalitis. It can be diagnosed using ___ on the CSF.
Viruses (arboviruses)
PCR
A ____ is
Macule
A ____ is >0.5 cm and contains clear fluid
Bulla
___and ____ are >0.5 cm and palpable
Nodules and plaques
A patch is __ 0.5 cm and flat
> (greater than)
A vesicle is
Filled with clear fluid
A ____ is filled with purulent fluid and can vary in size
Pustule
A wheal is an ________ primary lesion
Edematous
____ are secondary lesions composed of compact keratin flakes
Scales
____consist of dried serum, blood, or pus
Crusts
Potassium hydroxide examination is used for _____ diagnosis
Fungi and dermatophytes
Tzanck tests are used to test for ______
Herpes virus/ zoster
Use wood light examination to test for ____
Tinea versicolor
___ is a disorder of the stratum corneum resulting in fish-like scales
Ichthyosis
A collodion baby has a severe form of this skin condition:
Ichthyosis
___presents with skin fragility, blistering, frequent skin infections, & mouth erosions.
Epidermolysis Bullosa
___ is a pruritic vesicular rash of the hands and feet that you should NOT treat with emollients.
Dyshidrotic eczema
Excessive moisture and skin maceration leads to inflammation and __
Intertrigo
Cradle cap and dandruff are both greasy yellow scales caused by
Seborrheic Dermatitis
Giant birthmarks that can have hairs and need to be monitored for color changes. May require removal.
Congenital Melanocytic Nevi
You should worry about _____ when your patient has more than 6 café au lait spots greater than 0.5 cm.
Neurofibromatosis
Port wine stains, nevus simplex, and sturge weber syndrome are all _______ birthmarks
Vascular
_____ may be palpable with a bluish hue at the skin surface. Cherry or strawberry-like
Hemangioma
Guttate psoriasis can follow a ______ infection
Strep
This lesion follows a Christmas tree pattern
Pityriasis Rosea
____ has a “honey colored crust” with a red base
Impetigo
Bullous impetigo is treated with _______
Systemic ABX
Penicillin G is used to treat _____, which is a rapidly spreading warm macular erythema
Erysipelas
If your patient presents with streaking cellulitis, it is probably caused by ____
Strep
Erythema chronicum migrans is a lesion found in ______ disease
Lyme disease
DO NOT use –azole meds in the treatment of ______
Candida
____ present as pearly papules up to 1 cm in size
Molluscum Contagiosum
Permethrin and Lindane are used to treat this diffuse popular rash that presents with intense pruritus
Scabies
Erythema Nodosum is characterized by tender nodules over_____
Shins & legs
HSV is the most common cause of this rash in peds
Erythema multiforme
Erythema multiforme covers ______ % of the body
SJS rash covers _____ % of the body
10-30%
___ covers >30% of the body and is more often caused by a drug rxn
TEN (toxic epidermal necrolysis)
(EM/ SJS/ TEN) usually does not involve mouth ulcerations
EM
How do you differentiate TEN from staph scalded skin?
Skin biopsy
Term for head lice
Pediculosis capitis
____ are painless, raised lesions which may have unknown duration
Warts
Tinea pedis is very uncommon in children. You should probably suspect ___ instead.
eczema
Griseofulvin is used to treat this fungal infection
Tinea capitis
Ichthyosis and epidermolysis bullosa are _____ disorders
Inherited
Acne is a ____ disorder
Sebum
Skin scrapings help test for ___
Scabies
Culture from an NP swab is essential for the diagnosis of this chronic cough
Pertussis
Septic arthritis is treated using____
Arthrocentesis
Treatment of status asthmaticus includes
Humidified O2 and a B2 ag.
Mono is diagnosed using this lab test
CBC
Viral encephalopathy is diagnosed using:
PCR on CSF
The most essential lab value for evaluating status asthmaticus is____
ABGs
Dacrocystitis, sinusitis, and AOM are all treated using
Amoxicillin 80-90 mg/kg
Strep throat is treated with
Pen G
Keratits and erythema multiforme are both caused by:
HSV
Your pt is a 4yo presenting with fever, lethargy, won’t eat, barely drinking for the past 2 days. No cough. Negative PMH. What do you suspect and how do you work it up?
Secondary Immune issue
CBC w/ differential
CMP (electrolytes)
Primary immunodeficiencies can be characterized by their defect:
(4 types)
Cellular immunity (T-cells)
Humoral immunity (B cells)
Phagocytes
Complement
Many primary immunodeficiencies are inherited these 2 ways
X linked
Autosomal recessive
Consider Primary immunodeficiency in children with SPUR:
Severe, Prolonged, Unusual, Recurrent infections
SCID and Wiskott-Aldrich and DiGeorge are all caused by___ defects
T-cell
_____ is characterized by eczema and thrombocytopenia
Wiskott-Aldrich syndrome
_____ defects usually aren’t seen until after 6 mo due to remaining maternal immunoglobulins.
B-cell
Aggamaglobulinemia, CVID, Hyper IgM syndrome are all caused by:
B cell deficiency
T/F: immunizations are essential for kids with B cell deficiencies
False. Can’t make memory cells anyways
Most common cause of stridor in infants
Laryngomalacia
Most common cause of drug-induced cutaneous reactions (as in SJS or TEN)
Amoxicillin, Ampicillin, and Bactrim
____ is when neutrophils fail to adhere to vascular endothelium
Leukocyte adhesion defect
____ is when there is a defect in intracellular killing. Lack of superoxidase after phagocytosis.
Chronic Granulomatous Disease
Chronic granulomatous disease is inherited this way
x-linked recessive
How do you test the complement pathway function?
CH50
What type of immune mediated pathway is involved in hemolytic anemia
Type II
Serum sickness, Henoch-Schonlein purpura, and post-strep. Glomerulonephritis are all cause by type ____ reactions
Type III
Infants with eczema have lesions on _______ surfaces
Facial
Older children and with eczema have lichenification on ____ surfaces
Flexural
Asthma tests include
Lung fxn, peak flow, CXR, ABGs, eosinophil count
Causes of cough in the first months of life = CRADLE
CF RTI Aspiration Dyskinetic cilia Lung malformation Edema
In the Asthma Action Plan:
Green = ______% of the peak expiratory flow rate
Yellow = ______
Red = ____
Green = 80-100% Yellow = 50-80% Red = below 50%
This classification of asthma requires no daily medications
Mild intermittent
This classification of asthma has sx > 2days/week or >2 nights/mo
Mild persistent
This classification of asthma requires daily low-dose inhaled ICS and a LABA
Moderate persistent
This classification of asthma is characterized by continual daytime sx and frequent sx at night
Severe persistent
This lab is most important for determining status asthmaticus
ABGs (hypoxia)
The most common organism to cause Otits media
S. pneumoniae
The most common organism to cause Sinusitis
S. pneumoniae
The most common organism to cause Croup
Parainfluenza virus
The most common organism to cause whooping cough
Bordetella pertussis
The most common organism to cause bronchitis
Parainfluenza virus
The most common organism to cause bronchiolitis
RSV
The most common organism to cause Pharyngitis
Adenovirus
______ include apnea, color change, decreased muscle tone, emesis, choking, and gagging
ALTE (Apparent life threatening Events in Infancy)
