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Pediatrics Clerkship > Pediatric Infectious Disease - AMBOSS and OME > Flashcards

Pediatric Infectious Disease - AMBOSS and OME Flashcards

1
Q

Signs and symptoms of trachoma conjunctavitis

A
  • Starts as follicular conjunctavitis, then progresses to mixed papillary and follicular
  • Corneal haziness with neovascularization, aka pannus, is a classic finding
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2
Q

Fever and sore throat with papulovesicular lesions on the posterior orophaynx

A

Classic presentation of herpangina. Often occurs with HFM disease

Oropharyngeal herpes-like infection caused by Coxsackie virus

Most common in kids age 3-10

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3
Q

Best diagnostic test for confirming a diagnosis of osteomyelitis

A

Bone marrow biopsy

In stable patients, this should precede the administration of antibiotics.

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4
Q

Most common etiology of osteomyelitis in children and treatment

A

S. aureus

Treat w/ vancomycin

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5
Q

Mumps

A
  • Caused by Mumps virus
  • Seen in pubertal males who present with bilateral parotid swelling
  • May cause orchitis in males, which may lead to sterility
  • Diagnosis is clinical, treatment is supportive
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6
Q

Erythema infectiosium

A
  • Parvo B19
  • Starts on cheeks, then rarely appears in other places
  • Fever and rash occur at the same time
  • Diagnosis is clinical, treatment is supportive
  • May provoke an aplastic crisis in patients with a hemoglobinopathy
  • If mom is pregnant, separate her from the infected child – otherwise her current pregnancy could end in hydrops
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7
Q

Measles

A
  • Caused by Paramyxovirus
  • Prodrome: The four C’s
    • Cough
    • Coryza
    • Conjunctavitis
    • Koplik spots
  • Fever and rash then occur simultaneously
  • Rash begins on face, then spreads down trunk and arms
    • Really fever begins when the rash starts to spread
  • Diagnosis is clinical, treatment is supportive plus vitamin A
  • Later in life, at risk for subacute sclerosing panencephalitis
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8
Q

Rubella

A
  • Caused by Rubella virus
  • Prodrome: Tender postauricular and suboccipital lymphadenopathy
  • Fever and rash then occur simultaneously
  • Rash begins on face, then spreads down trunk and arms
    • Really fever begins when the rash starts to spread
  • Diagnosis is clinical, treatment is supportive
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9
Q

Roseola

A
  • Caused by HHV-6
  • Prodrome: Very high, spiking fever, >104F
  • Rash occurs after fever breaks
  • Rash starts on the trunk, then expands outward
  • Diagnosis is clinical, treatment is supportive
  • Since there is a high spiking fever, there may be a febrile seizure. If you are going to use the temperature, use acetominophen. Aspirin causes Reye syndrome.
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10
Q

Varicella

A
  • Caused by VZV
  • Rash without fever
  • Diffuse rash with “vesicles on an erythematous base in different stages of healing”
  • Diagnosis is clinical, treatment is supportive
    • No Tzank smears. No PCRs. CLINICAL diagnosis.
  • Shingles later in life
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11
Q

Hand-foot-mouth disease

A
  • Caused by Coxsackie A
  • Looks exactly like varicella, but only appears on the hands, feet, and mouth
    • Can also involve oropharynx and buttocks, but not the trunk
  • Diagnosis is clinical, treatment is supportive
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12
Q

Consideration of ICP in meningitis

A

If you suspect ICP may be elevated, start antibiotics NOW, then do CT, then an LP

If you don’t think ICP is elevated, do LP, then start antibiotics

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13
Q

Why don’t we like to use ceftriaxone in very young patients?

A

It causes hyperbilirubinemia in kids, particularly babies. It displaces bilirubin from albumin.

Ceftriaxone is contraindicated in premature infants up to 41 wks (GA at delivery + wks after birth) of age.

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14
Q

Pediatric empiric meningitis regimen for kids < 30 days

A
  • Vancomycin
  • Cefatoxime
  • Ampicillin
  • +/- steroids
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15
Q

How old does a kid have to be before we are confident that ELISA is a reliable test for HIV again?

A

18 months

If < 18 months, we use a DNA PCR

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16
Q

Prophylaxis in kids with HIV/AIDS

A
  • 200
    • PCP coverage w/ TMP-SMX (elseif dapsone, elseif atovaquone)
  • 100
    • Toxo coverage w/ TMP-SMX (elseif atovaquone)
  • 50
    • MAC coverage w/ azithromycin
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17
Q

___ is always the most common cause of osteomyelitis

A

Staph aureus is always the most common cause of osteomyelitis

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18
Q

Osteomyelitis workflow

A
  • Start with X-ray. If positive for osteomyelitis, go to biopsy. If negative, do an MRI.
  • If MRI is positive, go to biopsy.
    • If toxic, give abx before biopsy
    • If not toxic, biopsy before abx
19
Q

Testing for pulmonary TB in kids

A
  • If < 5, PPD
  • If > 5, IFNg RA
20
Q

Treating active vs latent TB

A
  • Rifampin, isoniazid, pyrazinamide, ethambutol (RIPE) for active
  • Isoniazid + B6 for latent
21
Q

Lots of history and exam findings can suggest otitis media, but the diagnosis is made with. . .

A

. . . pneumatic insufflation demonstrating rigidity of tympanic membrane

22
Q

A swimmer with otitis externa is likely to have ___

A serial ear picker with otitis externa is likely to have ___

A

A swimmer with otitis externa is likely to have Pseudomonas

A serial ear picker with otitis externa is likely to have Staph

23
Q

Great way to differentiate otitis externa and media in a single physical exam maneuver

A

Pull on the pinna

Otitis externa: It hurts like hell

Otitis media: It relieves the pain

24
Q

Treating otitis externa

A

Most mild cases are self-limited and require no treatment

If it looks really bad or if the person is toxic, then you can treat with eardrops of fluoroquinolones and steroids

25
Q

Mastoiditis

A
  • Infection of the mastoid bone
    • Syndrome looks like otitis media + mastoid swelling, sometimes with anteriorly rotated ear
  • Caused by the same bugs that cause otitis media
  • Hx of tympanoplasty is a risk factor
  • Diagnosis is clinical
  • Treat with surgical decompression and treatment with otitis media Abx (ampicillin-clavulonate)
26
Q

Workup and treatment of sinusitis

A

It is usually viral, which requires no workup or treatment.

If it is bacterial, it will not be subtle. It will be obvious. Bilateral purulent discharge and high fever. There are no diagnostic imaging tests, this is a clinical diagnosis. Treat with amoxicillin-clavulonate.

27
Q

Recurrent viral and/or bacterial sinusitis warrants. . .

A

. . . a CT scan to assess for anatomic defect or foreign body

28
Q

CENTOR score for pharyngitis

A
  • No Cough. +1
  • Exudates, +1
  • Nodes, +1
  • Temperature >38oC, +1
  • OR:
    • < 14, +1
    • > 44, -1
  • If < 1, it’s viral, do nothing
  • If 2-3, do rapid Strep. If it’s negative and you still feel like they have it, you can do a culture too.
  • If >=4, treat with amox-clav now, but get rapid strep anyway for documentation
29
Q

How to approach an insect in an ear

A

May occur in anyone who sleeps outside for any reason. Patient will report a sensation of crawling or buzzing.

DO NOT shine a light in the ear to inspect. The insect will burrow deeper in the ear towards the tympanic membrane.

Instead, use lidocaine to paralyze the insect, then retrieve it.

30
Q

Treating a simple nose bleed

A
  • Lean forward (NOT back – you will be aspirating blood and when you cough you will just dislodge the clot)
    • Let blood drip into sink or bucket
  • Apply pressue and/or ice
  • If anterior bleed, you can cauterize
  • If posterior, packing works but they should be on prophylactic antibiotics (to prevent toxic shock)
31
Q

When a patient with CF gets pneumonia, you should assume and cover for ___

A

When a patient with CF gets pneumonia, you should assume and cover for pseudomonas

32
Q

Effects of pertussis toxin

A
  • Mechanism: ADP-ribosylation of G protein and decreased downstream cAMP and MAPK signaling
  • Results:
    • Decreased neutrophil and macrophage recruitment
    • Skewing of Th1 response and resultant inappropriate lymphocytosis
  • Can also cross the BBB and lead to neurologic sequellae
33
Q

Gianotti-Crosti syndrome aka papular acrodermatitis of childhood

A
  • Erythematous papular eruption without associated symptoms
    • Symmetrically distributed on face, extensor surfaces of arms and legs, and buttocks. Trunk and back are spared.
    • Sometimes coalesce into plaques and become pruritic
  • Occurs age 1-6 following a URI
  • Assocaited viruses:
    • EBV
    • Varicella
    • Hepatitis B
  • Treamtent: Supportive. Self-resolving in up to 8 weeks.
  • Always screen for risk factors, signs, and symptoms of Hep B. If present, order serologies.
34
Q

Verrucae

A
  • aka warts!!! Caused by HPV
  • Benign, spread skin-to-skin. May develop at site of trauma
  • Four types:
    • Verruca vulgaris (the common wart)
    • Verruca plantaris (plantar warts)
    • Verruca plana (flat warts)
    • Condyloma accuminata (genital warts)
  • Treatment is with topical salicylate, liquid nitrogen cryotherapy, imiquimod cream, oral zinc sulfate. There are more still. May require multiple treatments.
35
Q

Unilateral thoracic exanthem aka Asymmetric Periflexural Exanthem of Childhood

A
  • Rash with varying morphologies
    • May appear as erythematous macules or papules with a surrounding halo, morbilliform, eczematous, or scarlatiniform, or reticular
    • Begins on one side of the trunk, spreads centripetally
    • Most often seen in winter and spring months
    • Preceded by low-grade fever, lymphadenopathy, respiratory and GI complaints
    • Pruritis is common
  • Occurs in children gae 1-5 years
  • Presumed viral, but origin is unknown (much like pityriasis rosacea)
  • Treatment: Topical or oral antihistamines and mild steroids for pruritis. Self-resolving in 6-8 weeks without treatment. May desquamate or leave post-inflammatory pigment changes.
36
Q

Management of mild vs severe staphylococcal scalded skin syndrome

A
  • Mild to moderate: Oral antistaphylococcal medication
  • Severe: Treated as though they have a second-degree burn. This means meticulous fluid management and IV oxacillin or clindamycin.
37
Q

For how long are children with chickenpox contagious?

A

From 24 hours before onset of rash until ALL lesions have crusted over.

38
Q

Most common cause of tinea capitis in the US

A

Trichophyton tonsurans

A relative of rubrum, but not rubrum itself.

39
Q

When is a VCUG indicated for workup of a UTI?

A
  • UTI in a male
  • Recurrence of UTI
  • Urosepsis
40
Q

Palivizumab usage

A

Used prophylactically to prevent RSV.

Given to premies and babies born with congenital heart disease in September to prevent infection during winter.

41
Q

If croup or bronchiolitis is the suspected diagnosis, then ___ is not indicated.

A

If croup or bronchiolitis is the suspected diagnosis, then CXR is not indicated.

42
Q

When do you stop treating osteomyelitis?

A

When ESR normalizes

43
Q

What form of adenopathy is EBV most strongly associated with?

A

Posterior cervical

Pediatrics Clerkship (23 decks)

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