Pediatric Infectious Disease Flashcards
After an initial catarrhal phase, pertussis progresses to a paroxysmal phase, which is characterized by a “[…]”, often with posttussive emesis.
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.
Can acute rheumatic fever be prevented with treatment of Streptococcal pharyngitis (e.g. oral penicillin)?
Yes
versus PSGN, which can occur with or without treatment
Cat-scratch disease is caused by the bacteria […].
Cat-scratch disease is caused by the bacteria Bartonella henselae.
Cat-scratch disease often manifests as a localized papule followed by regional tender […] that develops in the subsequent 1 - 2 weeks .
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
Children with meningitis secondary to Haemophilus influenzae type b should receive […] to reduce the risk of sensorineural hearing loss.
Children with meningitis secondary to Haemophilus influenzae type b should receive dexamethasone to reduce the risk of sensorineural hearing loss.
Congenital CMV is associated with […] calcifications.
Congenital CMV is associated with periventricular calcifications.
versus toxoplasmosis, which is associated with diffuse intracerebral calcifications
Congenital […] is associated with periventricular calcifications.
Congenital CMV is associated with periventricular calcifications.
versus toxoplasmosis, which is associated with diffuse intracerebral calcifications
Congenital toxoplasmosis classically presents with […] intracerebral calcifications, hydrocephalus, and ventriculomegaly.
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
Congenital […] classically presents with diffuse intracerebral calcifications, hydrocephalus, and ventriculomegaly.
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
Diagnosis of malaria is confirmed by visualization of parasites on […].
Diagnosis of malaria is confirmed by visualization of parasites on thick and thin blood smears.
Empiric antibiotic therapy for acute, unilateral lymphadenitis is typically with […].
Empiric antibiotic therapy for acute, unilateral lymphadenitis is typically with clindamycin.
has activity against MRSA and Streptococcus pyogenes
Enterobius vermicularis (pinworm) infection is diagnosed using the […].
Enterobius vermicularis (pinworm) infection is diagnosed using the “tape test”.
Hemoglobinopathies, such a sickle cell trait and thalassemia, may confer resistance against […].
Hemoglobinopathies, such a sickle cell trait and thalassemia, may confer resistance against malaria.
Hydrophobia and aerophobia are pathognomonic features of encephalitic […].
Hydrophobia and aerophobia are pathognomonic features of encephalitic rabies.
Infectious mononucleosis often presents with fever, exudative pharyngitis, and lymphadenopathy, especially of the […] nodes.
Infectious mononucleosis often presents with fever, exudative pharyngitis, and lymphadenopathy, especially of the posterior cervical nodes.
Malaria should be suspected in ill patients who have traveled to endemic regions, especially those with […] fevers.
Malaria should be suspected in ill patients who have traveled to endemic regions, especially those with cyclic fevers.
Manifestations of scarlet fever include fever, sore throat, circumoral […], “sandpaper” rash, and strawberry tongue.
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
Manifestations of scarlet fever include fever, sore throat, circumoral pallor, “[…]” rash, and strawberry tongue.
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
Manifestations of scarlet fever include fever, sore throat, circumoral pallor, “sandpaper” rash, and […] tongue.
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
Maternal toxoplasmosis is typically acquired through ingestion of cat feces or […].
Maternal toxoplasmosis is typically acquired through ingestion of cat feces or raw/undercooked meat.
Orbital cellulitis is a more […] infection than preseptal cellulitis (mild or severe).
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
Patients with infectious mononucleosis often develop a maculopapular rash after administration of […] or […].
Patients with infectious mononucleosis often develop a maculopapular rash after administration of ampicillin or amoxicillin.
this does not represent a true drug allergy
Patients with […] often develop a maculopapular rash after administration of ampicillin or amoxicillin.
Patients with infectious mononucleosis often develop a maculopapular rash after administration of ampicillin or amoxicillin.
this does not represent a true drug allergy
Pertussis typically begins with a […] phase, characterized by a mild cough and rhinitis for 1 - 2 weeks.
Pertussis typically begins with a catarrhal phase, characterized by a mild cough and rhinitis for 1 - 2 weeks.
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
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.
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.
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.
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).
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
Treatment of neonatal tetanus includes […] and tetanus immune globulin.
Treatment of neonatal tetanus includes antibiotics and tetanus immune globulin.
e.g. penicillin
What abnormal cell (seen on blood smear) is associated with infectious mononucleosis?
Atypical lymphocytes (reactive CD8+ T-cells)
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
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)
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
What eye pathology is associated with toxoplasmosis?
Chorioretinitis
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
What is the first-line treatment for Bordatella pertussis infection?
Macrolides
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
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
What is the likely diagnosis in a child with a pruritic rash with clusters of vesicles in different stages of healing?
Varicella zoster infection
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.
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
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
What is the likely diagnosis in an unvaccinated child that presents with fever and bilateral parotitis?
Mumps
most commonly occurs in school-age children
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)
What is the most common cause of laryngotracheitis (croup)?
Parainfluenza virus
What is the most common cause of neonatal sepsis?
Group B Streptococcus
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
What is the most common cause of sepsis in patients with sickle cell disease?
Streptococcus pneumoniae
What is the most common predisposing factor for acute bacterial sinusitis?
Viral URI
What is the most common source of rabies transmission in the United States?
Bats
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
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
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
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
What is the recommended post-exposure prophylaxis for a pregnant woman exposed to varicella zoster?
Administer varicella zoster immunoglobulin
What is the recommended post-exposure prophylaxis for an immunized child exposed to varicella zoster?
Observation
What is the recommended post-exposure prophylaxis for an incompletely immunized healthy child exposed to varicella zoster?
Administer VZV vaccine
all non-immune healthy patients > 1 year old with varicella exposure should receive postexposure prophylaxis
What is the recommended treatment for a patient with infectious mononucleosis that presents with difficulty swallowing and labored breathing?
[…]
IV corticosteroids
acute airway obstruction is a rare but potentially fatal complication of infectious mononucleosis
What is the recommended treatment for an neonate with suspected HSV infection?
Empiric acyclovir
What is the recommended treatment for children with group A Streptococcus pharyngitis?
oral penicillin or amoxicillin
What is the recommended treatment for congenital toxoplasmosis?
pyrimethamine, sulfadiazine, and folate
What is the recommended treatment for Enterobius vermicularis (pinworm) infection?
albendazole or pyrantel pamoate for patient & household contacts
What is the recommended treatment for herpangina?
Supportive (e.g. hydration, analgesics)
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
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
What microorganisms (2) are most commonly associated with non-bullous impetigo?
Staphylococcus aureus (more common) and Streptococcus pyogenes
What mumps complication occurs predominantly in post-pubertal males?
Orchitis
may result in impaired fertility
What neurologic complication is associated with mumps infection?
Aseptic meningitis
What organism is responsible for recurrent pulmonary infections in a young child with cystic fibrosis?
Staphylococcus aureus
What organism is responsible for recurrent pulmonary infections in an adult with cystic fibrosis?
Pseudomonas aeruginosa
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
What procedure is both diagnostic and therapeutic for septic arthritis?
Arthrocentesis
should be performed prior to empiric antibiotic therapy to minimize false negative results
What symptom is characteristic of rubella in adolescents/adults, but not in children?
arthralgias/arthritis
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
What X-ray finding is characteristic of laryngotracheitis (croup)?
“Steeple sign” (due to subglottic edema)
Which congenital infection is associated with cataracts, sensorineural hearing loss, and patent ductus arteriosus?
Rubella
Which congenital infection is associated with rhinorrhea, desquamating skin rash, and hepatomegaly?
Syphilis
also may have abnormal long-bone radiographs
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
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)
Which infectious skin disorder is a superficial bacterial skin infection characterized by honey-colored crusting?
Impetigo
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
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
Which type of meningitis presents with decreased glucose and increased PMNs in the CSF?
Bacterial meningitis
Which type of meningitis presents with normal glucose and increased lymphocytes in the CSF?
Viral meningitis
[…] 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.
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.
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.
[…] 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.
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
[…] 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
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
[…] 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
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
[…] 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
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
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
