Peds ID Flashcards
what are the different vaccination types?
live-attenuated inactivated viral particles subunit vaccine toxoid
Contraindications for vaccines
immuno or pregnant: NO LIVE VACCINES, anaphylaxis hx to specific vaccine, egg or chicken for influenza or yellow Fv, mod-severe illness
what kind of vaccine should family of an immunocompromised pt receive?
inactivated vaccine
if accidentally given live–> avoid contact w/pt for 7days
May give live attenuated influenza vaccine if pt is candidate except if…
immunocompromised pt: less than 6mo’s old, stemp cell transplant in prior 2 mo’s, has graft vs. host dz, has SCID
what is the main warning sign of immunodeficiency?
too many illnesses too soon that are unexplained
what are the parts of the innate immune system?
Skin and physical barriers
Bloodbourne and phagocytes
what is the complement system?
plasma proteins that interacts with pathogens to mark them for destruction by phagocytes (Scouts/spotters)
Acquired immune system: what do CD4 cells do?
what if you lose them?
Recognize bad cells then release cytokines signaling the immune response
HIV
acquired immune system: what do CD8 cells do?
Perforins open bad cell walls
Cytotoxins released to kill the bad cell
acquired immune system: what do B cells do?
Produces antibodies when a foreign antigen triggers the immune response
what is humoral immunodeficiency characterized by?
impaired antibody (Ig) production
PID peds clinical presentation:
recurrent, severe URI/LRTI incl OM, pna
infx w/encapsulated bacteria (GBS, S. pneumo, Hib)
poor growth, unexplained splenomegaly
Dx of primary immunodeficiency
fam hx
r/o underlying chronic dz
labs for PID
CBC with differential Chem panel Immunoglobulin levels Urinalysis ESR and CRP if child is sick
imaging/diagnostics for PID
CXR look for thymus +/- CT
What is the MC immunodeficiency?
selective IGA deficiency
dx of selective IGA deficiency
Deficiency of Serum IgA (w normal IgG& IgM) in a child > 4 yo
presenting s/s for selective IGA deficiency
most asxs!!!
Recurrent sinopulmonary infx’s, autoimmune disorders, GI infx’s and other intestinal disorders, allergic disorders, anaphylactic transfusion reactions d/t Anti- IgA Abs
what is common variable immunodeficiency (CVID):?
combo of poor vaccine response and a decrease in blood levels of IgG in conjunction with a severe decrease in levels of either IgM or IgA,
when do peds pt’s usu. p/w CVID?
present around puberty: variable presentation, recurrent, at risk for autoimmune dz’s and malignancy
dx criteria for CVID
Reduced serum IgA, G & M
Poor response (or no response) to vaccines
what is severe combined immunodeficiency? (SCID)
severe deficiency of T-cell
broad susceptibility to infection.
what is the tx for SCID?
no tx
death by 1yr
characteristics of SCID?
multiple forms (MC = x-linked males only)
severe infx’s 1st few mo’s after birth
become ill from live vaccines: varicella, MMR, OPV, RV
characteristics of digeorge syndrome (22Q11.2 deletion syndrome)
cardiac defects, immune dysfx (hypoplastic thymus gland), cleft palate, hypocalcemia (parathyroid hypoplasia)
presentation for ataxia-telangiectasia?
progressive cerebellar ataxia, oculocutaneous telangiectasias, don’t develop fluidity of gait, malignancy
bacterial meningitis characterized by? caused by?
opisthotontos posturing, mortality ~100%, medical emergency
S. pneumo, N. meningitidis, H. influenza type b
tx for bacterial meningitis in 0-29d old
requires adequate concentration of abx in the CSF
Ampicillin \+/-Gentamicin Cefotaxime Vancomycin Acyclovir
w/in 1 hr
tx for bacterial meningitis in 30-60d old
Ceftriaxone
+/- Vancomycin
w/in 1 hr
characteristics of bacterial arthritis?
predominantly the hip and knee, more than one join, particularly in neonates
sxs: septicemia, cellulitis, fv w/out source of infx
who should you suspect bacterial arthritis in?
monoarticular pain, fever, redness
tx for bacterial arthritis?
antistaphylococcal agent (nafcillin, oxacillin, vancomycin)
cefotaxime (covers gonorrhea)
MC bacteria from bacterial arthritis in:
< 3 mo’s
3mo- 3yrs
< 3 mo’s –> group B streptococcus
3mo-3yrs –> Group A streptococcus
labs for osteomylitis?
CBC, ESR, CRP, blood cultures
MC causes of myocarditis?
enterovirus (coxsackie group B), adenovirus, parvovirus B19, EBV, cytomegalovirus, and HHV-6
what is the main characteristic to evaluate if a peds pt has diarrhea?
bloody vs. non-bloody
what are causes of bloody diarrhea?
E. coli O157:H7, salmonella, shigella, campylorbacter, C. diff
rhinosinusitis infx’s causes:
Haemophilus influenzae (nontypeable), S. pneumoniae, and Moraxella catarrhalis
characteristics and tx for rhinosinusitis infx’s?
most viral (7-10d)
14-21d of
augmentin 45-90mg x 10d
OM causes:
h. influenzae, s. pneumo, moraxella catarrhalis
peds anatomy
Tx for OM:
children 2 yrs and older w/mild sxs –> obs
Amoxicillin 80-90mg x10d
PCN allergy: 3rd gen cephalosporin, macrolide, or clindamycin
what is a complication of acute OM?
acute mastoiditis
causes of mastoiditis?
s. pneumo, s. pyogenes, s. aureus, pseudomonas aeruginosa
what are some complications of acute mastoiditis?
extracranial: subperiosteal abscess, facial n. palsy, hearing loss, labyrinthitis, osteomyelitis, bezoid abscess
dx of mastoiditis?
clinical but can do imaging CT w/IV contrast
tx for mastoiditis
antimicrobial therapy and drainage
requires consultation with an otolaryngologist
MC causes of acute b/l lymphadenitis? acute unilateral lymphadenitis?
B/L: Group A streptococcus
unilateral: s. aureus, Group A. strep, anaerobic bacteria
MC causes of chronic B/L lymphadenitis?
EBV, cytomegalovirus
Tx for lymphadenitis?
Amox-clavulanate
MC pathogens of peritonsilar abscess
strep pyogenes (group A), strep anginosus, s. aureus
s/s for retropharyngeal abscess?
appear ill w/moderate Fv
dysphagia, odynophagia, torticollis, “hot potato,” stridor, trismus
how do peds pt’s develop retropharyngeal abscess?
retropharyngeal space contains two chains of lymph nodes that are prominent in the young child, but atrophy before puberty
tx for retropharyngeal abscess
secure airway
CT IV contrast
empiric abx: group A. strep, s. aureus, respiratory anaerobes
Unasyn or clindamycin +/- vanco
what is peri-orbital cellulitis?
Preseptal cellulitis/periorbital cellulitis is an infection of the anterior portion of the eyelid
causes of periorbital cellulitis?
s. aureus, strep pna, Hib
fungal causes: mucorales and aspergillus
orbital cellulitis characteristics:
Unilateral ocular pain, eyelid swelling, and erythema.
+/- Fv, Proptosis, toxic appearance
Chemosis
tx for periorbital cellulitis
is empiric and based upon knowledge of the common infecting organisms
Ceftriaxone IM THEN Augmentin OR clinda if MRSA susp.
tx for orbital cellulitis
empiric/immediate
Ceftriaxone, Unasyn, Vancomycin, Clindamycin
Antifungal IV
CT w/IV contrast
consult: optho-plastics
tx for abscess
DRAINAGE!!!
PO Clinda or bactrim + Keflex
if Fv –> Vanco
s/s of necrotizing fasciitis
deep infx, erythematous, swollen, warm, tender, pain out of porportion, crepitus, tachycardia
tx/managment for nec fasciitis
septic w/u,
CT w/IV contrast, immediate surgical consult
abx –> carbapenem + vanco + clinda
impetigo pathogens
S. aureus and Beta-hemolytic streptococci usu. mixed
tx for impetigo
keflex, bactrim
clindamycin
topical bactroban
mastitis tx/management
well appearing > 2mo –> keflex, clinda
ill appearing >2mo –> IV clinda, vanco if PCN allergy OR IV cefazolin, nafcillin
Surgical consult do NOT drain!!!
neonatal mastitis tx
empiric abx –> IV vanco, nafcillin, and CTX
surgical consult
MC pathogen from cat and dog bites? human bite?
cat/dog: pasteurella spp.
human –> elkenella
tx for bites
augmentin primary
dox/bactrim/cipro + flagyl or clindaymcin for anaerobic
what abx should you give prophylactically for lac repair d/t animal bite
unasyn IV then augmentin
etiology for croup
viral: parainfluenza virus type 1
etiology of epiglottitis
hib
bacterial tracheitis?
invasive exudative bacterial infection of the soft tissues of the trachea usu. polymicrobial
pathogens causing bacterial tracheitis
typical seasonal epidemics of parainfluenza, respiratory syncytial virus (RSV), and seasonal influenza
s/s for bacterial tracheitis
w/ laryngotracheitis who are febrile, toxic-appearing, and have a poor response to treatment w/ racemic epi or glucocorticoids
MC cause of bronchiolitis?
viral: RSV is MC
bronchiolitis RSV tx
no abx
nasal suctioning, high flow O2
trial of albuterol if all else fails
neonatal pneumonia tx
early onset: amp + gent
late onset: vanco + gent usu. nosocomial
6mo-5yo tx for community acquired pna
strep pneumo–> amoxicillin
> 5y/o community aquired pna tx?
mycoplasma pna, chlamydia pna –> azithromycin
pertussis complications
failure to thrive, apnea, pneumonia, respiratory failure, seizures, and death
d/t bordetella pertussis
what phase of pertussis are pt’s most contagious?
catarrhal
