Pediatric Infectious Disease Flashcards
What is the clinical manifestation of conjunctivitis
Bacterial
viral
or allergic
what is the presentation of bacterial conjunctivitis
erythema, cehmosis, itching, burning, mucopurulent exudate, matter in eyelashes
what is the presentation of viral conjunctivitis
erythema, chemosis, tearing (bilateral); HSV unilateral photophobia, fever, nose lesions
What is the presentation of allergic conjunctivitis
stringy mucoid exudate, swollen eyelids and conjunctiva, itching, tearing, headache, rhinitis
what is the treatment of bacterial conjunctivitis
erythromycin ointment or polymixin B/trimethorpim
warm soaks, no sharing towels or pillows/stress hygiene
What is the treatment of viral conjunctivitis
refer to ophthalmologist if HSV, otherwise cool compressess, supportive, hygiene
what is the treatment of allergic conjunctivitis
allergy referral if needed
What is the presentation of peri/orbital cellulitis
fever, swelling and erythema of surrounding tissues, deep red color of eyelid
proptosis, eye pain, decreased visition, limited extraocular motility think orbital cellulitis
what is the etiology of peri/orbital cellulitis
S. aureus
H. influenza
m. catarrhalis
What is the treatment of peri/orbital cellulitis
CBC with diff, EOMI, PERRLA
if even remotely thinking orbital cellulitis: CT scan
admission and IV antibiotics
if periorbital: augmentin (90mg/kg/day, BID)
What can cause otitis externa
retained moisure: penduomonas, s. aureus, eczema, weborrhea, psoriasis
What is the treatment of otitits externa
antimicrobial +/- steroid
cortisporin 2gtts in ear every 3-4 hours for 5-7 days
Floxin 5gtts in affected ear BID for 7 days
what is the etiology of otitis media
S.pneumonia, H. infleunza, M. catarrhalis
What are the causes of otitis media
Virual URI
Bacterial URI
allergic rhinitis
Eustachian tube dysfunction/anatomic
what are the symptoms of otitis media
ear pain
hearing loss
fever?
drainage?
What is the treatment of otitis media
pain management
watchful waiting?
antibacterial therapy: amox 90mg/kg/day, BID
What is the treatment of non-allergic rhinitis
nasal sprays
what is the treatment of viral rhinitis
nasal saline, steam?
What are the clinical findings with influenza
sudden onset high fever (102-106)
headache, chills, coryxa
vertigo, sore throat, body aches, cough
what is the treatment of influenza
supportive, treat high risk with anti-virals (immunocompromised, asthmatic, chronic illness, age 6mo - 6 years)
-tamiflu
What is the clinical manifestation of sinusitis
persistent nasal congestion, without improvemement after 10 days
severe and worsening symptoms
what is the etiology of sinusitis
98% is viral
10 days
fever
unremitting headache
gravity tests
What is the treatment of sinusitis
amoxicillin/amoxicillin-clavulanate 90mg/kg/day, usually BID
what are risk factors for thrush
common in first weeks of life, inhaled steroids, HIV infection, recent abx
What is the treatment of thrush
oral nystatin
(sterilize pacifiers, nipples, toys, etc)
what is the etiology of gingivostomatitis
herpes virus - 1
what is the clinical manifestation of gingivostomatitis
very sick, highly infectious
10+ ulcers of bucal mucoas, lips, tongue
may have fever, tender cervical nodes, inflammation
what is the treatment of gingivostomatitis
symtpomatic
if seen within 72 hours of onset: acyclovir, “magic mouthwash”
What is the etiology of bacterial pharyngitis
GAS
mycoplasma pneumonia
chlamydia pneumoia, groups C and G strep
what is the clinical manifestation of bacterial pharyngitis
tender anterior cervical nodes, palatial petechiae, beefy-red uvula, tonsillar exudate
what is the treatment of bacterial pharyngitis
amox 90mg/day BID/TID x 10 days
What is the centor criteria
used for bacterial pharyngitis
-adenopathy, tonsillar exudates, absence of cough, fever
What are complications of bacterial pharyngitis
rheumatic fever
glomerulonephritis
lemierre syndrome
tonsillar abscess
What is the etiology of peritonsillar cellulitis/tonsillitis
GAS
S.pneumo
h.flu
m.cat
what is the clinical manifestation of peritonsillar cellulitis/tonsillitis
high fever, unilateral, tonsil bulges medially, soft palate and uvula edematous, displaced toward involved side, possible trismus
what is the treatment of peritonsillar cellulitis/tonsillitis
usually start with IV or oral abx for 12-24 hours
EENT or ED referral for drainage if no improvement or worse
what is the cause of mononucleuosis
epstein-Barr virus (EBV)
what is the highest incidence population for mono
15yo - 25 yo
what is the complications of mono
splenic rupture, hepatitis
what is the treatment of mono
supportive: ibuprofen/acetaminophen for fevers
steroids (controversal)
soft diet, liquids
no contact sports or activites
rest
what is croup
acute inflammaotry disease of larynx
-viral (RSV, influenza, adenovirus, mycoplasma pneumonia)
what are the clinical findings of Croup
barking cough, stridor, low grade fever, cough, drooling
what is the treatment of Croup
dexamethasone 0.15-0.6 mg/kg PO max 10mg as one-time dose
nebulized racemic epinepherine
fluids, warm, moist air
What are the 4D’s of epiglottitis
Drooling - Dysphagia- Dysphonia - Distressed Respiratory efforts
what is the treatment of epiglottitis
Intubation, IV antibiotics
what is “hands, foot and mouth disease”
Coxackie virus
what is the treatment of coxsackie
supportive
what is the prodrome for rubeola (measles)
fever
malaise
and anorexia; followe by cough, coryza and conjunctivitis
What is the treatment of rubeola (measles)
supportive
control of spread (vaccinate)
what is the vaccination for rubeola (measles)
2 shot series (MMR)
12-15 months
before school (4-6 years old)
what is the presentation of mumps
low grade fever
malaise
headache
anorexia
myalgia
parotitis 48 hours later
what are the complications of mumps
meningitis
encephalitis
orchitits
what is the treatment of mumps
supportive, analgesic, bed rest for orchitis
isolate until parotitis is gone
vaccinate
What is the presentation of rubella (german measles)
acute onset maculopapular rash on face. spreads rapidly down body
may have fever, lymphadenopathy 1-5 days prior
what is the treatment of rubella (german measles)
supportive
what is the presentation of roseola infantum
presents in 3-5 days of high fever followed by maculopapular rash on trunk, spreading to extremities, neck and face as fever resolves
may have associated febrile seizures
how is rotavirus transmitted
fecal-oral route
peaks in winter months, 3-15 months of age
what is the presentation of rotavirus
vomiting followed by diarrhea that lasts about 4-8 days
what is the treatment of rotavirus
fluid replacement, anti-diarrheal meds are ineffective
how is rotavirus prevented
hygiene, vaccination
what is the presentation of viral gastroenteritis
like rotavirus, but not seasonal, duration may be longer
abdominal findings mostely benign; ~hyperactivity but no tenderness, no HSM
norwalk causes more vomitting than diarrhea
what is the treatment of viral gastroenteritis
supportive esp fluids
what is the presentation of Hep A
significant GI upset (anorexia, v/d)
jaundice
liver tenderness and enlargement
incubation period 15-40 days, jaundice 5-10 days after initial symptoms
what is the treatment of Hep A
supportive
what is the prevention of Hep A
immunization, immune globulin if given within 1-2 weeks of exposure
what is the presentation of pinworms
intense perianal itching overnight
what is the diagnostic test for pinworms
“scotch tape test” in the morning before defecation/washing
what is the treatment of pinworms
mebendazole 100mg once PO, repeat in 2 weeks
wash linens
Treat entire house
what is the presentation Kawasaki disease
high fever, conjunctivitis, mucositis, rash, extremity changes, lymphadenopathy, cardiovascular inflammation
what is the treatment of Kawasaki disease
IV IG and aspirin
echocardiogram: done early acute phase and again 6-8weeks later
what is the presentation of rabies
drooling, seizures, signs of CNS dysfunction
universally fatal once symptoms occur
what is the treatment of a suspected contact with rabies
one dose immune globulin, series of rabies vaccine over a 2 week period (Pediatric ID)
what is Varicella
highly contageous herpes family virus
chickenpox is the primary illness (globar rash vs dermatomal)
what is the presentation of varicella
prodrome: low grade fever, HA, bachache, URI; 1-2 days prior to onset of rash
Rash: begins on face, scalp or trunk, scabs from 5-20 days
what is the treatment of varicella
supportive, PCN for bacterial superinfection, VZ IG if immunocompromised
what is erythmea infectiosum
parvovirus B19
mild flu-like symptoms followed by rash 10 days later
“slapped-cheek”, lacey-like pattern
what is the treatment of erythema infectiosum
supportive
avoid pregnant females
what is molluscum
poxavirus (soil virus)
umbilicated, white or whitish-yellow papules in groups
what is the treatment of molluscum
imiquimod, cantharidin, curettage, oral cimetidine, liquid nitrogen
what is christmas tree with preceding herald patch
pityriasis rosea
what is a fungus on head, groin, body or feet
tinea (“ringworm”)
What is Henoch-Schonlein purpura (igA vasculitis)
inflammation and bleeding of small vessels in joints, intestine and kidneys
usually resulting form autoimmune response - preceding URI, allergic reaction, med, injury or cold weather response
what is the treatment of Henoch-Schonlein purpura
steroids (heme consult)
What is ITP
idiopathic thrombocytopenia purpura
usual preceding viral illness; immune system now attacks own plateelts
what is the treatment of ITP
usu. resolves spontaneously, may need steroids, rare splenecomy; heme consult