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Pediatric Infectious Disease Flashcards

1
Q

After an initial catarrhal phase, pertussis progresses to a paroxysmal phase, which is characterized by a “[…]”, often with posttussive emesis.

A

After an initial catarrhal phase, pertussis progresses to a paroxysmal phase, which is characterized by a “whooping cough”, often with posttussive emesis
typically lasts between 2 - 6 weeks before gradual resolve of symptoms in the convalescent phase.

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2
Q

Can acute rheumatic fever be prevented with treatment of Streptococcal pharyngitis (e.g. oral penicillin)?

A

Yes

versus PSGN, which can occur with or without treatment

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3
Q

Cat-scratch disease is caused by the bacteria […].

A

Cat-scratch disease is caused by the bacteria Bartonella henselae.

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4
Q

Cat-scratch disease often manifests as a localized papule followed by regional tender […] that develops in the subsequent 1 - 2 weeks .

A

Cat-scratch disease often manifests as a localized papule followed by regional tender lymphadenopathy that develops in the subsequent 1 - 2 weeks.

affected lymph nodes are enlarged, tender, and have overlying erythema

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5
Q

Children with meningitis secondary to Haemophilus influenzae type b should receive […] to reduce the risk of sensorineural hearing loss.

A

Children with meningitis secondary to Haemophilus influenzae type b should receive dexamethasone to reduce the risk of sensorineural hearing loss.

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6
Q

Congenital CMV is associated with […] calcifications.

A

Congenital CMV is associated with periventricular calcifications.

versus toxoplasmosis, which is associated with diffuse intracerebral calcifications

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7
Q

Congenital […] is associated with periventricular calcifications.

A

Congenital CMV is associated with periventricular calcifications.

versus toxoplasmosis, which is associated with diffuse intracerebral calcifications

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8
Q

Congenital toxoplasmosis classically presents with […] intracerebral calcifications, hydrocephalus, and ventriculomegaly.

A

Congenital toxoplasmosis classically presents with diffuse intracerebral calcifications, hydrocephalus, and ventriculomegaly.

versus congenital CMV, which is associated with periventricular calcifications; diagnosis is confirmed by the presence of infant IgM or IgA

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9
Q

Congenital […] classically presents with diffuse intracerebral calcifications, hydrocephalus, and ventriculomegaly.

A

Congenital toxoplasmosis classically presents with diffuse intracerebral calcifications, hydrocephalus, and ventriculomegaly.

versus congenital CMV, which is associated with periventricular calcifications; diagnosis is confirmed by the presence of infant IgM or IgA

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10
Q

Diagnosis of malaria is confirmed by visualization of parasites on […].

A

Diagnosis of malaria is confirmed by visualization of parasites on thick and thin blood smears.

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11
Q

Empiric antibiotic therapy for acute, unilateral lymphadenitis is typically with […].

A

Empiric antibiotic therapy for acute, unilateral lymphadenitis is typically with clindamycin.

has activity against MRSA and Streptococcus pyogenes

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12
Q

Enterobius vermicularis (pinworm) infection is diagnosed using the […].

A

Enterobius vermicularis (pinworm) infection is diagnosed using the “tape test”.

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13
Q

Hemoglobinopathies, such a sickle cell trait and thalassemia, may confer resistance against […].

A

Hemoglobinopathies, such a sickle cell trait and thalassemia, may confer resistance against malaria.

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14
Q

Hydrophobia and aerophobia are pathognomonic features of encephalitic […].

A

Hydrophobia and aerophobia are pathognomonic features of encephalitic rabies.

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15
Q

Infectious mononucleosis often presents with fever, exudative pharyngitis, and lymphadenopathy, especially of the […] nodes.

A

Infectious mononucleosis often presents with fever, exudative pharyngitis, and lymphadenopathy, especially of the posterior cervical nodes.

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16
Q

Malaria should be suspected in ill patients who have traveled to endemic regions, especially those with […] fevers.

A

Malaria should be suspected in ill patients who have traveled to endemic regions, especially those with cyclic fevers.

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17
Q

Manifestations of scarlet fever include fever, sore throat, circumoral […], “sandpaper” rash, and strawberry tongue.

A

Manifestations of scarlet fever include fever, sore throat, circumoral pallor, “sandpaper” rash, and strawberry tongue.

the “sandpaper” rash is typically prominent along skin folds and results in desquamation as the illness resolves

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18
Q

Manifestations of scarlet fever include fever, sore throat, circumoral pallor, “[…]” rash, and strawberry tongue.

A

Manifestations of scarlet fever include fever, sore throat, circumoral pallor, “sandpaper” rash, and strawberry tongue.

the “sandpaper” rash is typically prominent along skin folds and results in desquamation as the illness resolves

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19
Q

Manifestations of scarlet fever include fever, sore throat, circumoral pallor, “sandpaper” rash, and […] tongue.

A

Manifestations of scarlet fever include fever, sore throat, circumoral pallor, “sandpaper” rash, and strawberry tongue.

the “sandpaper” rash is typically prominent along skin folds and results in desquamation as the illness resolves

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20
Q

Maternal toxoplasmosis is typically acquired through ingestion of cat feces or […].

A

Maternal toxoplasmosis is typically acquired through ingestion of cat feces or raw/undercooked meat.

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21
Q

Orbital cellulitis is a more […] infection than preseptal cellulitis (mild or severe).

A

Orbital cellulitis is a more severe infection than preseptal cellulitis. (mild or severe)

periorbital (preseptal) cellulitis is caused by infection anterior to the orbital septum; orbital (postseptal) cellulitis is a posterior infection

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22
Q

Patients with infectious mononucleosis often develop a maculopapular rash after administration of […] or […].

A

Patients with infectious mononucleosis often develop a maculopapular rash after administration of ampicillin or amoxicillin.

this does not represent a true drug allergy

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23
Q

Patients with […] often develop a maculopapular rash after administration of ampicillin or amoxicillin.

A

Patients with infectious mononucleosis often develop a maculopapular rash after administration of ampicillin or amoxicillin.

this does not represent a true drug allergy

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24
Q

Pertussis typically begins with a […] phase, characterized by a mild cough and rhinitis for 1 - 2 weeks.

A

Pertussis typically begins with a catarrhal phase, characterized by a mild cough and rhinitis for 1 - 2 weeks.

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25
Scarlet fever is caused by infection with [...].
Scarlet fever is caused by infection with **group A Streptococcus (S. pyogenes)**. thus it is diagnosed and treated the same way as GAS infection
26
The major criteria for the diagnosis of [...] are the J♥NES criteria.
The major criteria for the diagnosis of **acute rheumatic fever** are the J♥NES criteria.
27
The major criteria for the diagnosis of acute rheumatic fever are the [...] criteria.
The major criteria for the diagnosis of acute rheumatic fever are the **J♥NES** criteria.
28
The most important risk factor for vertical transmission of HIV is high maternal [...].
The most important risk factor for vertical transmission of HIV is high maternal **viral load**.
29
The symptoms of laryngotracheitis (croup) often improve upon exposure to [...] air (temperature).
The symptoms of laryngotracheitis (croup) often improve upon exposure to **cold** air (temperature).
30
The treatment for measles virus is generally supportive, however [...] is recommended for hospitalized patients.
The treatment for measles virus is generally supportive, however vitamin A is recommended for hospitalized patients. reduces the morbidity and mortality of severe measles by promoting antibody-producing cells and regeneration of epithelial cells
31
Treatment of neonatal tetanus includes [...] and tetanus immune globulin.
Treatment of neonatal tetanus includes **antibiotics** and tetanus immune globulin. e.g. penicillin
32
What abnormal cell (seen on blood smear) is associated with infectious mononucleosis?
Atypical lymphocytes (reactive CD8+ T-cells)
33
What are the most common causative organisms (2) associated with acute bacterial rhinosinusitis?
Streptococcus pneumoniae and nontypeable Haemophilus influenzae each organism accounts for ~30% of cases; Moraxella catarrhalis is the third most common and accounts for ~10% of cases
34
What are the most common causes (2) of osteomyelitis in children with sickle cell disease?
Salmonella and Staphylococcus aureus thus empiric antibiotic treatment should cover both organisms (e.g. clindamycin + ceftriaxone)
35
What bacteria causes marked lymphocytosis via production of lymphocytosis-promoting factor?
Bordetella pertussis blocks circulating lymphocytes from leaving the blood to enter the lymph node
36
What eye pathology is associated with toxoplasmosis?
Chorioretinitis
37
What is recommended treatment for pregnant women and children \< 8 years old with early localized Lyme disease?
Oral amoxicillin oral doxycycline is contraindicated in these patients; IV ceftriaxone is reserved for Lyme meningitis, encephalopathy, and carditis/heart block
38
What is the first-line treatment for Bordatella pertussis infection?
Macrolides
39
What is the likely diagnosis in a child that presents with an inability to extend the neck with a widened prevertebral space on X-ray after having fever and sore throat for one week?
Retropharyngeal abscess
40
What is the likely diagnosis in a child that presents with fever, pharyngitis, and gray vesicles/ulcers on the posterior oropharynx?
Herpangina (secondary to coxsackie A virus infection) location on the posterior oropharynx helps differentiate herpangina from herpetic gingivostomatitis; herpangina is also more common in the summer/early fall
41
What is the likely diagnosis in a child with a pruritic rash with clusters of vesicles in different stages of healing?
Varicella zoster infection
42
What is the likely diagnosis in a neonate that presents with hypothermia, hypotonia, and leukopenia with bandemia?
Neonatal sepsis signs of neonatal sepsis are non-specific; it may manifest with hypothermia or hyperthermia, leukocytosis or leukopenia, etc.
43
What is the likely diagnosis in a young child that presents with fever and a petechial rash on the lower extremities with a positive Brudzinski sign?
Meningococcal meningitis
44
What is the likely diagnosis in an infant that presents with failure to thrive, lymphadenopathy, and leukocytosis with a history of Pneumocystis jirovecii infection?
HIV infection due to selective loss of CD4+ T lymphocytes, however absolute lymphocyte count is normal (versus SCID); diagnosis is confirmed with PCR reaction testing
45
What is the likely diagnosis in an unvaccinated child that presents with fever and bilateral parotitis?
Mumps most commonly occurs in school-age children
46
What is the mode of transmission of measles virus (rubeola)?
Airborne thus patients with suspected measles should be isolated and place on airborne precautions (e.g. negative pressure room, N95 face mask)
47
What is the most common cause of laryngotracheitis (croup)?
Parainfluenza virus
48
What is the most common cause of neonatal sepsis?
Group B Streptococcus
49
What is the most common cause of osteomyelitis in both infants and children?
Staphylococcus aureus in children, osteomyelitis most often occurs in the metaphyses of bones (highly vascular) and develops secondary to hematogenous spread
50
What is the most common cause of sepsis in patients with sickle cell disease?
Streptococcus pneumoniae
51
What is the most common cause of viral meningitis?
Non-polio enteroviruses e.g. echovirus, coxsackieviruses
52
What is the most common predisposing factor for acute bacterial sinusitis?
Viral URI
53
What is the most common source of rabies transmission in the United States?
Bats
54
What is the next step in management for a child that develops a fever and mild rash one week after receiving the MMR vaccine?
Reassurance a small fraction of patients develop a self-limiting mild rash and fever 1 - 3 weeks after vaccination; respiratory isolation is not required
55
What is the next step in management for a child that presents with fever, pharyngitis with tonsillar exudates, and tender anterior cervical lymphadenopathy?
Rapid streptococcal antigen testing GAS pharyngitis in children should always be confirmed by rapid streptococcal antigen testing or throat culture prior to initiation of antibiotics (versus adults, who can be treated empirically if they meet all Cantor criteria) Centor criteria (fever \>38.5°C, swollen, tender anterior cervical lymph nodes, tonsillar exudate and absence of cough) are an algorithm to assess the probability of group A β haemolytic Streptococcus (GABHS) as the origin of sore throat, developed for adults.
56
What is the next step in management for a patient with a cat bite after thorough wound cleaning?
Amoxicillin + clavulanate prophylactic for possible Pasteurella multocida infection (amoxicillin), as well as oral anaerobes (clavulanate); wound closure should be avoided
57
What is the next step in management for an asymptomatic adolescent that presents with a soft, mobile, non-tender cervical lymph node measuring 1 cm in diameter?
Observation further work-up is indicated if lymphadenopathy persists, the node enlarges, or if symptoms develop
58
What is the next step in management for an infant with suspected bacterial meningitis based on history and physical exam?
lumbar puncture followed by IV antibiotics e.g. vancomycin and a third-generation cephalosporin; lumbar puncture can be performed safely in infants without CT imaging as the risk for herniation is low
59
What is the recommended empiric treatment for suspected bacterial meningitis in children?
vancomycin + a third-generation cephalosporin in neonates cefotaxime is preferred over ceftriaxone because ceftriaxone can displace bilirubin from albumin, increasing the risk of kernicterus
60
What is the recommended post-exposure prophylaxis for a pregnant woman exposed to varicella zoster?
Administer varicella zoster immunoglobulin
61
What is the recommended post-exposure prophylaxis for an immunized child exposed to varicella zoster?
Observation
62
What is the recommended post-exposure prophylaxis for an incompletely immunized healthy child exposed to varicella zoster?
Administer VZV vaccine ## Footnote all non-immune healthy patients \> 1 year old with varicella exposure should receive postexposure prophylaxis
63
What is the recommended treatment for a newborn of a mother with active hepatitis B?
hepatitis B immune globulin followed by HBV vaccine at birth
64
What is the recommended treatment for a patient with infectious mononucleosis that presents with difficulty swallowing and labored breathing? ## Footnote [...]
IV corticosteroids acute airway obstruction is a rare but potentially fatal complication of infectious mononucleosis
65
What is the recommended treatment for an neonate with suspected HSV infection?
Empiric acyclovir
66
What is the recommended treatment for children with group A Streptococcus pharyngitis?
oral penicillin or amoxicillin
67
What is the recommended treatment for congenital toxoplasmosis?
pyrimethamine, sulfadiazine, and folate
68
What is the recommended treatment for Enterobius vermicularis (pinworm) infection?
albendazole or pyrantel pamoate for patient & household contacts
69
What is the recommended treatment for herpangina?
Supportive (e.g. hydration, analgesics)
70
What is the recommended treatment for localized non-bullous impetigo?
Topical antibiotics (e.g. mupirocin) oral antibiotics (e.g. cephalexin, clindamycin) are indicated for widespread non-bullous impetigo or extensive bullous impetigo
71
What is the recommended treatment for vaccinated close contacts of patients with pertussis?
Prophylactic macrolides patients who are not fully immunized also require pertussis vaccination in addition to antibiotic treatment
72
What microorganisms (2) are most commonly associated with non-bullous impetigo?
Staphylococcus aureus (more common) and Streptococcus pyogenes
73
What mumps complication occurs predominantly in post-pubertal males?
Orchitis may result in impaired fertility
74
What neurologic complication is associated with mumps infection?
Aseptic meningitis
75
What organism is responsible for recurrent pulmonary infections in a young child with cystic fibrosis?
Staphylococcus aureus
76
What organism is responsible for recurrent pulmonary infections in an adult with cystic fibrosis?
Pseudomonas aeruginosa
77
What pathogens (2) are the most common cause of acute, unilateral lymphadenitis in children?
Staphylococcus aureus and Streptococcus pyogenes affected nodes are typically enlarged, tender, warm, and erythematous
78
What procedure is both diagnostic and therapeutic for septic arthritis?
Arthrocentesis should be performed prior to empiric antibiotic therapy to minimize false negative results
79
What symptom is characteristic of rubella in adolescents/adults, but not in children?
arthralgias/arthritis
80
What test is used to screen for infectious mononucleosis?
Monospot test 25% false-negative rate during 1st week of illness; may also be negative in patients with infectious mononucleosis secondary to CMV
81
What X-ray finding is characteristic of laryngotracheitis (croup)?
"Steeple sign" (due to subglottic edema)
82
Which congenital infection is associated with cataracts, sensorineural hearing loss, and patent ductus arteriosus?
Rubella
83
Which congenital infection is associated with limb hypoplasia, cataracts, and skin scars?
Varicella zoster
84
Which congenital infection is associated with rhinorrhea, desquamating skin rash, and hepatomegaly?
Syphilis also may have abnormal long-bone radiographs
85
Which congenital infection is associated with seizure and temporal lobe hemmorhage without evidence of intracranial calcifications?
Herpes simplex virus the characteristic vesicles of HSV are present in the skin-eye-mouth disease subtype, but may be absent in CNS and disseminated disease
86
Which diagnosis, preseptal or orbital cellulitis, is likely to present as eyelid erythema/edema with normal vision and intact extraocular eye movements?
Preseptal cellulitis typically managed with oral antibiotics with activity against gram-positive organisms (versus orbital cellulitis, which requires IV antibiotics)
87
Which infectious skin disorder is a superficial bacterial skin infection characterized by honey-colored crusting?
Impetigo
88
Which microorganism is associated with rapid-onset food poisoning with predominant vomiting after eating dairy products?
Staphylococcus aureus rapid onset (1 - 6 hours) due to preformed enterotoxin
89
Which type of meningitis presents with decreased glucose and increased lymphocytes in the CSF?
Fungal/TB meningitis tuberculous meningitis is also characterized by very high protein level in the CSF
90
Which type of meningitis presents with decreased glucose and increased PMNs in the CSF?
Bacterial meningitis
91
Which type of meningitis presents with normal glucose and increased lymphocytes in the CSF?
Viral meningitis
92
[...] are bluish-white lesions on the buccal mucosa and are pathognomonic for measles.
**Koplik spots** are bluish-white lesions on the buccal mucosa and are pathognomonic for measles.
93
Koplik spots are bluish-white lesions on the buccal mucosa and are pathognomonic for [...].
Koplik spots are bluish-white lesions on the buccal mucosa and are pathognomonic for measles.
94
Enterobius vermicularis (pinworm) infection typically presents in school-age children with [...], especially at night.
Enterobius vermicularis (pinworm) infection typically presents in school-age children with **perianal pruritus**, especially at night.
95
[...] infection typically presents in school-age children with perianal pruritus, especially at night.
**Enterobius vermicularis (pinworm)** infection typically presents in school-age children with perianal pruritus, especially at night.
96
Laryngotracheitis (croup) typically presents with a hoarse, "[...]" cough and inspiratory stridor.
Laryngotracheitis (croup) typically presents with a hoarse, **"seal bark"** cough and inspiratory stridor. often preceded by non-specific symptoms (e.g. rhinorrhea, fever); management included corticosteroids and/or nebulized racemic epinephrine
97
[...] typically presents with a hoarse, "seal bark" cough and inspiratory stridor.
**Laryngotracheitis (croup)** typically presents with a hoarse, "seal bark" cough and inspiratory stridor. often preceded by non-specific symptoms (e.g. rhinorrhea, fever); management included corticosteroids and/or nebulized racemic epinephrine
98
Measles virus (rubeola) is characterized by a prodrome of cough, coryza, and conjunctivitis, followed by a maculopapular rash that spreads in a [...] pattern.
Measles virus (rubeola) is characterized by a prodrome of cough, coryza, and conjunctivitis, followed by a maculopapular rash that spreads in a **cephalocaudal** pattern. the best prevention is with the MMR vaccine, which is typically given at age 1 and 4
99
[...] is characterized by a prodrome of cough, coryza, and conjunctivitis, followed by a maculopapular rash that spreads in a cephalocaudal pattern.
**Measles virus (rubeola)** is characterized by a prodrome of cough, coryza, and conjunctivitis, followed by a maculopapular rash that spreads in a cephalocaudal pattern. the best prevention is with the MMR vaccine, which is typically given at age 1 and 4
100
Rubella (German measles) is characterized by a prodrome of mild fever and posterior auricular lymphadenopathy followed by a maculopapular rash that spreads in a [...] pattern.
Rubella (German measles) is characterized by a prodrome of mild fever and posterior auricular lymphadenopathy followed by a maculopapular rash that spreads in a **cephalocaudal** pattern. generally milder than measles virus
101
[...] is characterized by a prodrome of mild fever and posterior auricular lymphadenopathy followed by a maculopapular rash that spreads in a cephalocaudal pattern.
**Rubella (German measles)** is characterized by a prodrome of mild fever and posterior auricular lymphadenopathy followed by a maculopapular rash that spreads in a cephalocaudal pattern. generally milder than measles virus
102
Waterhouse-Friderichsen syndrome is characterized by sudden vasomotor collapse due to bilateral [...] hemorrhage.
Waterhouse-Friderichsen syndrome is characterized by sudden vasomotor collapse due to bilateral **adrenal** hemorrhage. classically in a patient with meningococcemia
103
[...] syndrome is characterized by sudden vasomotor collapse due to bilateral adrenal hemorrhage.
**Waterhouse-Friderichsen** syndrome is characterized by sudden vasomotor collapse due to bilateral adrenal hemorrhage. classically in a patient with meningococcemia
104
Acute rheumatic fever is caused by [...] due to resemblance of bacterial M protein with proteins in human tissue.
Acute rheumatic fever is caused by **molecular mimicry** due to resemblance of bacterial M protein with proteins in human tissue.
105
Infectious mononucleosis most commonly occurs due to an [...] infection.
Infectious mononucleosis most commonly occurs due to an **EBV** infection. less commonly occurs secondary to CMV infection
106
The monospot test is used for diagnosis of infectious mononucleosis and detects IgM [...] antibodies that cross-react with horse or sheep RBCs.
The monospot test is used for diagnosis of infectious mononucleosis and detects IgM **heterophile** antibodies that cross-react with horse or sheep RBCs. usually turns positive within 1 week after EBV infection; may be negative with infectious mononucleosis due to CMV
107
Otitis Extrena usua suspects:
* P. aeruginosa (Gram -) * S. aureus (Gram +) * S. pneumoniae (Gram +)
108
Otitis Media usual suspects and resistance mechanisms:
* S. pneumoniae (Gram +, PBP ) * H. influenzae (Gram -, beta lactamase) * M. catarrhalis (Gram -, beta lactamase)
109
Otitis Media atypicals:
* M. pneumoniae * Legionella * C. pneumoniae
110
Otitis Media treatment:
1. amoxicillin for G+ and G- - high dose can overcome PBP resistance 2. Augmentin (G+, G-, anaerobes) 3. ceftriaxone
111
Sinusitis usual suspects:
\*S. pneumoniae * H. influenzae * M. catarrhalis
112
Sinusitis atypicals:
* M.pneumoniae * Legionella * C.pneumoniae
113
Sinusitis, chronic:
•consider S. aureus as well
114
Sinusitis treatment:
1. amoxicillin for G+ and G- - high dose can overcome PBP resistance 2. Augmentin (G+, G-, anaerobes) 3. ceftriaxone
115
Bacterial Pharyngitis/Nasopharyngitis:
* anterior cervical lymphadenopathy * if peritonsillar, retropharyngeal or lateral pharyngeal abscesses, think F. necrophorum
116
Viral Pharyngitis/Nasopharyngitis:
•anterior +/- posterior cervical lymphadenopathy
117
Laryngeotracheobronchitis "Croup":
•Parainfluenza
118
Epiglottitis:
* H. influenzae (Gram -) * S. pyogenes (Gram +) * S. aureus (Gram +)
119
Bronchiolitis:
Bronchiolitis is a common lung infection in young children and infants. It causes inflammation and congestion in the small airways (bronchioles) of the lung. Bronchiolitis is almost always caused by a virus. Typically, the peak time for bronchiolitis is during the winter months. * RSV * metapneumovirus * Parainfluenze
120
Pneumonia usual suspects:
* S. pneumoniae (Gram +) * H. influenzae (Gram -) * M. catarrhalis (Gram -)
121
Pneumonia atypicals:
* M. pneumoniae (Gram -) * Legionella (Gram -) * C. pneumoniae (Gram -)
122
Pneumonia treatment:
levofloxacin treats them all! •Usual suspects: 1. amoxicillin 2. Augmentin (amoxicillin/clavulanic acid) 3. ceftriaxone •Atypicals: 1. macrolides 2. flouroquinilones
123
Other causes of pneumonia:
Pneumonia is an infection that inflames your lungs' air sacs (alveoli). The air sacs may fill up with fluid or pus, causing symptoms such as a cough, fever, chills and trouble breathing. * TB * cocci * M.avium * aspergillus * miliary (Miliary pattern consists with the presence of multiple small (usually 1 to 3 mm in diameter) nodules in the lung with sharp margins. Aims: A heterogeneous group of conditions comprising more than 80 entities may display miliary pattern.) -TB, cocci, histo, blasto

Pediatrics (20 decks)

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