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Peds ID Flashcards

1
Q

2 parts of immune system and their components

A
  1. innate
    - barriers
    - complement
    - macros and neutros
  2. adaptive
    - humoral
    - cell
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2
Q

how is immune system not fully developed in infants

A
  1. no specific adaptive immunity - no ABs
  2. T-cell indep responses weak prior to 24 months - no humoral system
  3. T-cell dep. is well dev. from birth
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3
Q

what are 2 maternal factors

A
  1. IgG in gestation

2. IgA in milk

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4
Q

def. transient hypogammaglobunemia

A

period when Moms Ig gone and haven’t got all of their own yetr

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5
Q

3 ways anatomy is diff.

A
  1. airways narrow
  2. eustachian tube angle
  3. may have malformation
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6
Q

how is fetal gut diff.

A

sterile

- reduces attachement of more pathogenic bacteria

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7
Q

what is key in fever

A

vast majority will resolve, but need to be ableto find those that are serious

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8
Q

def. fever w/o source

A

acute febrile illness in which the etiology is not known after throurough exams

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9
Q

def. serious bact. infection

A

sterlie site infection

- menigitis, bone and joint, sepsis, UTI

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10
Q

def. toxic appearance

A

clinical picture consistent with sepsis

- 15-20% chance of serious infection

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11
Q

mgmt to toxic child

A
  1. full workup-
    - CBC
    - urinanalysis
    - LP
    - CXR
  2. empiric ABs
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12
Q

3 life threatening bact.

A
  1. GBS
  2. E coli
  3. listeria
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13
Q

2 life threatening virus

A
  1. HSV

2. enteroviruses

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14
Q

what is ABs for no menigitis

A

ampi (for listeria) and gentamycin or cefotaxime

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15
Q

what is ABs for meningitis

A

ampi + cefotaxime

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16
Q

what to give for HSV

A

add acyclovir

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17
Q

what is cause and effect of GSB in

A

vertical

- dissemniated - pneumonia, septicemia

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18
Q

what is cause and effect of GSB in >7day

A

vertical or horizontal

- focal - meningitis, osteomylitis, sepsis

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19
Q

mgmt of neonatal GBS

A

ampi +/- gentamycin

  • IV fluids
  • ionotrops
  • ventilation
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20
Q

indication of post-partum AB prophylaxis

A 
mom is GBS +
if unknown
- previous infant with GBS
- GBS bacteruria in preg.
- delviery 18hrs
- intrapartum fever
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21
Q

what is maternal AB for prophylaxis

A

pen G every 4 hours until delviery

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22
Q

mgmt of infant at risk of GBS

A

if sick - full sepsis work up and treat

if well, but risk factors - do CBC - WBC >5 observe, WBC

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23
Q

when to consider HSV

A

should always keep in mind, even if mom had no lesions

24
Q

3 HSV presentation

A
  1. skin,eye, mouth
  2. encephalitis
  3. disseminated
25
diagnosis and mgmt of HSV
PCR or culture - LP is neccesary | treat - IV acyclovir
26
what is risk of serious infection in well appearing BB with no risk factors
3-6%
27
what is approach to well appearing neonate (0-28day) with fever
full workup and empiric treatment
28
2 times of bacterial infections in 29-90day old
1. perinatal (vertical) | 2. env.
29
3 perinatal infections in 29-90day
1. GBS 2. E coli 3. listeria
30
4 env. infections in 29-90
1. strep pnemoniae 2. neisseria meninigitis 3. staph. aureus 4. group A strep
31
7 criteria for low risk baby
1. previously healthy 2. non toxic 3. no focal infection 4. leukocytes 5-15 5. absoulte band count
32
what to do with high and low risk 29-90 day old
high - admit and treat | low - outpatient
33
approach to fever in 3-36 month old
maybe do tests, acetominophen | come back in 48 hours if fever persists
34
see AB therapy table
do it
35
meningitis bact. in 0-28 days
1. GBS 2. E coli 3. listeria
36
meningitis bact. in 29-90 days
same but some overlap with older
37
meningitis bact. in >90 days
1. strep pneumonia | 2. neise=seria
38
Sx and signs of meningitis in infants
can be very non-specific - bulgin fontanelle - dimished activity - petechiale rash
39
kernig and brud signs
kernigs - leg lift | bruds - head lift
40
ABs for meningitis at each age
neonate- ampi + cefotaxime 1-3month - ampi + cefotaxime +- vanco (for strep resistant) >3 month - ceftriaxone + vanco
41
what does botulism do
stops the release of Ach
42
3 botulism forms
1. food borne - preformed toxin 2. wound - contamination of wound with spores 3. infant - ingestion of spores - honey and construction
43
clinical picture of botulism
floppy child
44
diagnosis of bot.
mouse assay
45
Mgmt of botulism
1. supportive care - airway, nutrition, stool softener 2. human botulism Ig
46
def. of streptococcal toxic shock syndrome
hypotension + 2 of - renal impariment - DIC - hepatic abnormlaity - adult RSD - scarlet fever rash - soft tissue necrosis
47
patho of strep toxic shock
1. superantigen mediated release 2. activation of large number of T cells 3. cytokine storm
48
mgmt of strep toxic shock
1. support 2. ABs - pen. + clindamycin 3. IVIg 4. surg for nec. fascitis
49
5 strep syndromes
1. resp tract 2. skin and soft tissue 3. deep and systemic 4. toxin mediated 5. non-suppurative
50
incidence of CMV
- most common congential infection | - most common cause of aquired hearing loss
51
2 types of CMV
symptomatic at birth -10-15% | asymptomatic at birth
52
2 outcomes of CMV
brain and eye disease
53
CMV epidemiology
- less common in dev. countries and high SES | - transmission through saliva
54
CMV diagnosis and mgmt
diagnosis - detect in urine or saliva | treat - gancyclovir
55
HIV manifestation in infants
- opp. infections - recurrent bact infections - trush - failure to thrive - chronic diarrhea - dev. delay
56
3 ways to prevent HIV transmission to BB
1. ARV 2. elective C-section if VL>100 copies 3. exclusive formula feeding

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