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Pediatric: HEENT, PULM, ID > Pediatric- ID > Flashcards

Pediatric- ID Flashcards

1
Q

What is an infection of the herpes virus that has 3 different stages of infections

A

Varicella- Zoster Virus

chicken pox

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2
Q

What is the primary infection of varicella-zoster

A

chicken pox

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3
Q

what is the latent infeciton of varicella-zoster

A

persists in dorsal root ganglia

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4
Q

what is the reactivated infection of varicella-zoster

A

Shingles

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5
Q

what are the peak ages for a chickenpox infection child before vaccine

A

5- 10 years old

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6
Q

what are the peak ages for a chickenpox infection child after vaccine

A

10 - 14 years old

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7
Q

What season is chicken pox usually arise

A

winter-spring

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8
Q

How is varicella- zoster virus spread?
how many days from exposure to first symptom?
what are the first symptoms

A

respiratory droplets and direct contact with infected person

incubation period is 10-21 days then present with fever, malasie then the rash

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9
Q

When is a person with Varicella-zoster virus contagious?

A

Highly contagious the first 2 days before the onset of the rash and are contagious until all the lesions have crusted over

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10
Q

Key terms for this diagnosis- started with a fever, malasie then a rash on trunk that spread to face then arms. The rash will go through cycles and looks like a fluid filled vesicle on a erythematous base. Rash is markedly itchy

A

varicella-zoster or chicken pox
“teardrop on rose peatle”
fluid filled vesicles that ulcerate and crust over and heal

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11
Q

If a patient is hospitalized for varicella-zoster virus what is the treatment

A

negtaive pressure isolation room

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12
Q

If varicella-zoster rash is not typical and unsure of diagnosis what test can you confirm the diagnosis with?

A

PCR of vesicular fluid if atypical/ complicated presentation

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13
Q

Treatment for varicella-zoster

A

NO asprin give IB or tyneol
cool baths
careful hygiene to prevent secondary infection
High risk for complications: Acyclovir

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14
Q

What two infections often are commonly associated with Reye syndrome?

A
  • use of aspirin in a child
    1. varicella-zoster
    2. Influenza A & B
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15
Q

How effective is the varicella vaccine?

A

85% overall

97% against mod-severe disease

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16
Q

What is the most common complication of varicella-zoster

A 
* secondary infection of Strep or staph 
Encephalilits 
pneumonia - adults
if pregnant = congenital defects or severe neonatal infection 
Shingles
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17
Q

what are all the complications of varicella-zoster

A 
secondary infection of Strep or staph 
Encephalilits 
pneumonia - adults
if pregnant = congenital defects or severe neonatal infection 
Shingles
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18
Q

What is the treatment for a neonate with varicella-zoster

A

varicella-zoster Immunoglobumin ASAP !

VZIG

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19
Q

Key terms for this diagnosis- vomiting, confusion, seizures, coma, rapidly progressing encepahlopathy with hepatic dysfuction

A

Reye syndrome

aspirin use in children

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20
Q

key terms for this diagnosis- pre-eruption acute neuritis with fever, malaise and a rash in groups

A

shingles - zoster

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21
Q

What are the complications of Zoster

A

shingles:
1. post-herpetic neuralgia
2. bacterial infections
3. ocular involvement
4. Ramsey hunt syndrome - major complication
5. aseptic mengitis

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22
Q

key terms for this diagnosis- one sided face numbness, ear pain on the same side and a rash in the ear canal and auricle. Taste, hearing (ringing), lacrimation can also appear

A

Ramsey hunt syndrome - Herpes zoster oticus
a major disease after chicken pox infection
it is a polycranial neuropathy

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23
Q

what nerves are affected with Ramsey hunt syndrome

A

cranial nerves: V, IX, X

5, 9 ,10

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24
Q

Rubeola is also known as what

A

Measles

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25
Q

What virus causes Rubeola

A

Paramyovirus

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26
Q

key terms for this diagnosis- highly contagious infection with high fevers, rash, cough, coryza (stuffy nose), conjunctivitis, and small white dots in the mouth

A

Rubeola Measles

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27
Q

Koplik spots are what?

show up in what disease ?

A

Rubeola Measles

small whiteish papules on the buccal mucosa opposite of the molars

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28
Q

Rash for what diagnosis- Macular rash that started on the head and face and spread down in 24 hours
may be petechial or hemorrhagic. rarely on palms or soles

A

Rubeola Measles

can have Koplik spots in the mouth

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29
Q

What disease have to be reported to the health department ?

A

Rubeola - measles
Mumps
Rubella - German measles

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30
Q

What is the best testing for Rubeola - measles

A

PCR or

IgM serology

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31
Q

Treatment for Rubeola - measles

A

support
hydrate, Tylenol for fevers
2 days of high-dose vitamin A (can decrease morbidity and mortality)

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32
Q

What are complications of Rubeola - measles

A
  1. otitis media
  2. Leukopenia
  3. pneumonia
  4. Encephalomyelitis
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33
Q

What virus causes Mumps?

A

Paramyxovirus

34
Q

key terms for this diagnosis- painful tender swelling in the cheeks one side or both, mild fever, muscle aches, malaise and headaches

A

Mumps

parotitis

35
Q

How long with the parotitis last in Mumps

A

1-3 days then subsides over the next week

36
Q

What is the best testing for Mumps

A

PCR or

IgM serology

37
Q

Treatment for Mumps

A
  1. supportive

2. warm or cold packs to the swelling

38
Q

what are complications of Mumps?

A
  1. Orchitis- epididymitis in adult males
  2. oophoritis in girls is rare
  3. deafness
  4. aseptic meningitis
  5. Meniingitis
  6. Encephalitis
39
Q

What virus causes Rubella

A

Togavirus

40
Q

key terms for this diagnosis- post auricalr, post cervical, post occiptal lymphadenopathy with rash that started on face and spread to the body it is red maculopapular fine rash. Small red spots in mouth

A

Rubella - German measles

41
Q

What are Forschheimer spots

what are the seen in ?

A

small red spots/petechiae on soft palate of mouth

Rubella - German measles

42
Q

what is the best testing for Rubella - German measles

A

IgM serology

43
Q

Treatment for Rubella - German measles

A
  1. supportive
44
Q

Complications of Rubella - German measles

A
  1. Congenital rubella syndrome - SIGNIFICANT morbidity with eyes, heart and neurologic complications
45
Q

What is another name for Roseola Infantaum

A

Sixth disease or Exanthem subtium

46
Q

What virus causes Roseola Infantaum

A

Herpesvirus 6 - HHV-6

less common HHV-7

47
Q

key terms for this diagnosis- child is irritable but consolable and other wise alter and active with high fevers > 104 and lasts for 3-5 days then a rose colored rash appears on neck/chest and spreads to face and extremities

A

Roseola Infantaum

Sixth disease or Exanthem subtium

48
Q

Treatment for Sixth disease

A

Roseola Infantaum
Sixth disease or Exanthem subtium
1. supportive
no vaccine against

49
Q

Treatment for Roseola Infantaum

A

Sixth disease or Exanthem subtium
1/3 have febrile seizures
rare to have meningitis or encephalitis
maybe that’s why we dont have a vaccine

50
Q

What virus causes Erythema Infectiousum

A

Parovirus B19

51
Q

what is another name for Erythema Infectiousum

A

Fifth Disease

52
Q

Key terms for this diagnosis- common in spring time, fever, malaise, myalgia, headaches, sore throat, rash appears a week later in 3 statges starts on the face then goes to the trunk

A

Erythema Infectiousum- Fifth Disease

53
Q

What are the stages of Erythema Infectiousum rash?

A

Rash appears about a week after cold symptoms
1. first appears on the face “slapped check” circumoral pallor
2. Maculopapular truncal rash 1-4 days later
3. lacy reticulated truncal rash a week later can be itchy
can reocur with exercise, bathing, rubbing and stress

54
Q

What is the best testing for Erythema Infectiousum

A

fifth disease

PCR or serology if atypical

55
Q

Treatmetn for Erythema Infectiousum

A

supportive

56
Q

complications of Erythema Infectiousum

A

aplatic crisis with underlying RBC disorder like sickle cell or thalassemia. Complication will have temporary stop in the production of RBC in bone marrow
-virus has a high viral affinity for RBC that is why the rash lasts awhile

57
Q

What virus causes Hand-foot-mouth disease

A

Cocksackie virus

58
Q

what time of year is Hand-foot-mouth disease common in ?

A

Summer - early fall

59
Q

key terms for this diagnosis- mild fever, mouth or throat pain will not eat, lesions in the mouth appear as a thin halo of erythema with an ulcer. A rash that is not itchy or painful on the hands, feet, butt, upper thighs and arms

A

Hand-foot-mouth disease

60
Q

best testing for Hand-foot-mouth disease

A

not needed unless atypical or complicated

61
Q

Treatment for Hand-foot-mouth disease

A

supportive

hydrate !!! the sores in their mouth are uncomfortable wont want to drink

62
Q

complications of Hand-foot-mouth disease

A
  1. dehydration

2. rarely encephalitis, meningitis, flaccid paralysis

63
Q

what temperature is considers a fever

what is a high fever

A

> 38 C 100.4F
High fever > 40 C 104.0 F
with serious infections neonates can be hpothermic

64
Q

What are some good points to educated mom on fevers

A

infants/children ususally have higher body core temp >99F

flucuated up to 3 degress of body temp through the day especially late afternoon with activity

65
Q

What is dangerous about fevers?

A

The dramatic change in temperature either high to low

or low to high can cause a febrile seizure

66
Q

What age group is at higher risk for serious bacterial infections with a fever present

A

less than 3 months

67
Q

What is the most common cause of a fever in <3 month old ?

A

UTI- E. coli

68
Q

What are common bacteria to cause infection in <1 month old

A

Group B strep
E. Coli
Listeria

69
Q

What are common bacteria to cause infection in 1-3 months old

A

Strep pneumonia
Hamophilous influenza
Nissera mengitidies

70
Q

What do you do if you have a <4 weeks old or ill-appearing <3month old with a rectal temp >38C

A 
Admit to hosptial to work up sepsis monitor for 36 hours 
NEED: 
1. Blood cultures
2. Urine 
3. CSF 
4. CBC
5. CXR 
6. Stool studies - fecal leukocytes or stool culture if diarrhea
71
Q

Treatment for Fever in <3 month old

A 
START ABX NOW 
1. ampicillin + cefotaxime 
may add 
acyclovir 
vancomycin
72
Q

If an infant is 29 days - 3 months well-appearing child with a fever
they can be followed as outpatient if what criteria are met?

A
  1. reliable follow up
  2. WBC 5,000- 15,000
  3. UA <10,000
    obtain blood cultures, urine cultures, CXR
    can give Ceftriaxone IM
    need to follow up in 24 hours
73
Q

what is the definition of Fever of unknown origin

A

temperature of >38 C lasting >14 days

without an obvious source despite testing and complete H&P

74
Q

Fever of unknown origin- is most commonly caused by what ?

A 
a common disease presenting as unusual
most common are infectious 
inflammatory disease
malignancy less often 
consider munchausen
75
Q

What is the work up for a fever of unknown origin?

A
  1. CBC with diff
  2. ESR
  3. LFT’s
  4. UA with culture
  5. Blood cultures
  6. CXR
  7. ANA
  8. RF
  9. Serum complement
76
Q

What is the most common cause of a seizure in 6months- 6 years

A

fever

occur in 4% of kids

77
Q

What are the characteristics of typical febrile seizure

A
  1. generalized - all over the body
  2. less than 15 min
  3. occurs once in 24 hours
78
Q

Treatment for typical febrile seizure

A

do not require work up or any treatment

may reoccur in 50 % of kids

79
Q

What are the characteristics of complex/atypical febrile seizure

A
  1. focal feature - one part of body
  2. > 15 min
  3. reocurs in 24 hours
  4. preexisitng neruo or development problem
80
Q

Treatment for atypical febrile seizure

A

require more specific evaluation
EEG
MRI as outpatient
consult pediatric neuro

81
Q

Treatment for a seizure lasting > 5 min

A
  1. IV benzo - diazepam or lorazepam

2. if prolonged give rx for rectal diazepam

82
Q

what is the prognosis of Febrile Seizures

A

very good
only 2% higher risk than general population to develop epilepsy
complex seizure has higher risk

Pediatric: HEENT, PULM, ID (4 decks)

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