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1. Disciplines 2 > Peds ID > Flashcards

Peds ID Flashcards

1
Q

Virus is alive, but weakened; virulence reduced

A

Live-attenuated

MMR, Flumist, Varicella

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2
Q

Killed-virus; capsid proteins remain and are antigenic

A

Inactivated

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3
Q

Small virus particles, no viral DNA

A

Viral particles

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4
Q

viral proteins only

A

subunit vaccine

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5
Q

inactivated toxin stimulates antibody production

A

toxoid

tetanus vaccine

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6
Q

Egg or chicken allergy is a contraindication for?

A

Influenza and yellow fever vaccines

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7
Q

Healthy patients who live in the same household as an immunocompromised patient can safely receive what kind of vaccine?

A

inactivated

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8
Q

Are the following contraindication to vaccines?

  • mild acute illness regardless of fever
  • low-grade fever
  • recent exposure to infectious disease
  • current abx therapy
  • breastfeeding
  • prematurity
A

NOOOO

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9
Q

MMR and Varicella are what type of vaccines?

A

Live

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10
Q

Contraindication for Hep B vaccine

A

life threatening allergy to baker’s yeast

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11
Q

Contraindications ro Rotavirus vaccine

A
  • weakened immune system
  • recent blood transfusion or immuniglobulin
  • major GI illnesses
  • Hx of intussusception
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12
Q

Contraindications for Tdap vaccine

A
  • seizure or encephalopathy after first dose

- life threatening allergy to latex

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13
Q

Contrindications for Hib vaccine

A

<6 weeks

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14
Q

Contraindications for MMR

A
  • life threatening allergy to neomycin, gelatin
  • pregnancy
  • weakened immune system

egg allergy is NOT a contraindication

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15
Q

Contraindications for Varicella vaccine

A
  • life threatening allergy to neomycin, gelatin
  • pregnancy
  • weakened immune system
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16
Q

Influenza vaccine is indicated for?

A 
everyone age 6 mo and up
Particularly important if:
-pregnant
-weakened immune system
-asthma
-health care providers
-household contacts of very young or very old
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17
Q

Normal side effects of vaccines

A
  • fussiness (< 3 hrs, consolable)
  • low grade fever (<101.5)
  • pain at injection site
  • redness at injection site
  • swelling at injection site
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18
Q

Abnormal reactions of vaccines

A

-inconsolable crying (>3 hrs)
-high fever (>104-105)
-seizure
-neurological abnormalities
-anaphylactic reaction
=facial/oral swelling, dyspnea
=ALWAYS a subsequent contraindication

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19
Q

What is an immunodeficiency?

A

Abnormal immune response

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20
Q

What are warning signs of immunodeficiency?

A

Too many illnesses too soon!

-4 or more ear infection
2 or more sinus infections in 1 yr
-2 or more months of abx w/ little effect
-2 or more PNAs in 1 yr
-failure to thrive
-recurrent abscesses
-persistant thrush
-need for IV abx to clear infections
-fam hx
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21
Q

If a kid has too many illnesses that are unexplained, what do you do?

A

start working up for immunodeficiency

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22
Q

How do newborn levels of IgG, IgM, and IgA compare to older children?

A

IgG is high, inherited from mom

IgM and IgA are very very low

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23
Q

A system of plasma proteins that interacts w/ pathogens to mark them for destruction by phagocytes (scouts/spotters)

A

complement

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24
Q

white blood cells that contributes to immune defenses by ingesting microbes and other cells infected w/ foreign particles (snipers)

A

phagocytes

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25
Q

What do T-cells do?

A

“Army”

  • release cytokines signaling immune response
  • cytotoxins released to kill bad cells
  • keep system in check from killing everything
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26
Q

What do B-cells do?

A

“Memory”

Produce antibodies when a foreign antigen triggers the immune response

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27
Q

Disorders resulting from inherited defects of the immune system (both isolated and combined defects)= ?

A

Primary immunodeficiency (PID)

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28
Q

Impaired antibody (Ig) production= ?

A

Humoral immunodeficiency

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29
Q

Peds presentation of Primary Immunodeficiency

A
  • recurrent, severe URI/LRTI including OM, sinusitis, PNA
  • meningitis more than once
  • poor growth
  • unexplained splenomegaly
  • delayed umbilical cord detachment
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30
Q

If considering primary immunodeficiency in a child, what do you meed to look for on CXR?

A

Thymus

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31
Q

What is Selective IgA Deficiency?

A

MC immunodeficiency
-Deficiency of Serum IgA (w/ normal IgG and IgM) in a child >4 yo

-Most individuals are asymptomatic

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32
Q

What is common variable immunodeficiency (CVID)?

A

Combination of poor vaccine response and a decrease in blood levels of IgG in conjunction w/ a severe decrease in levels of either IgM or IgA

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33
Q

Presenting clinical manifestations of common variable immunodeficiency (CVID)?

A
  • pt’s usually present around puberty
  • variable clinical manifestations
  • recurrent sinopulmonary and GI infections
  • at risk for autoimmune disease and some malignancies
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34
Q

Criteria for common variable immunodeficiency (CVID)?

A
  • reduced serum IgA, G and M
  • Presence of B-cells
  • poor response to vaccines
  • absence of other immunodeficiency
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35
Q

What is the defining characteristic of severe combined immunodeficiency (SCID)?

A

severe deficiency of T-cell function and/or number

= broad susceptibility to infection

No Tx= death by 1 yr

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36
Q

What is the result of severe combined immunodeficiency (SCID)?

A

one or more severe infections in the first few months after birth (pNA, meningitis, bacteremia, opportunistic infections)

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37
Q

What chromosomal deletion is involved in Digeorge Syndrome?

A

22q11.2 deletion

38
Q

What are the problems a/w Digeorge Syndrome (22Q11.2 syndrome)?

A
  • Cardiac defects
  • Immune dysfunction (hypoplastic thymus gland)
  • cleft palate
  • hypocalcemia (parathyroid hypoplasia)
39
Q

What is the chromosomal abnormality involved in Ataxia-Telangiectasia?

A

mutated 11q22-23

40
Q

Presentation of homozygous Ataxia-Telangiectasia

A
  • progressive cerebellar ataxia (first sign)
  • abnormal eye movements
  • oculocutaneous telangiectasias
41
Q

Sx of children w/ Ataxia-Telangiectasia?

A

-walk at nl age but don’t develop fluidity of gait
-difficulty coordinating eye and head movements
-Telangiectasias of the conjunctive
feeding/swallowing problems
-malignancy

42
Q

What sign is a/w bacterial meningitis?

A

Opisthotontos posturing

43
Q

What is key to treatment of bacterial meningitis?

A

CSF is a site of impaired humoral immunity
-Tx require adequate concentration of abx in the CSF

Goal is abx administration w/in 1 hr

44
Q

In a child 0-29 days old, what is treatment for bacterial meningitis?

A
  • ampicillin
  • +/-gentamicin
  • cefotaxime
  • vancomycin
  • acyclovir

give all of these!

45
Q

In a child 30->60 days old, what is treatment for bacterial meningitis?

A
  • Ceftriaxone

- +/-Vancomycin

46
Q

Bacterial arthritis usually affects?

A

the lower extremity, predominantly the hip and knee

47
Q

What are the common bacterial causes of bacterial arthritis?

A

< 3 mo= Group B strep

> 3 mo= Group A strep

48
Q

What are key sx of bacterial arthritis?

A
  • monoarticular pain
  • fever
  • redness
49
Q

Tx for bacterial arthritis

A

-Nafcillin, oxacillin, or vancomycin
+
-Cefotaxime

50
Q

MC causes of myocarditis in kids

A

viral!

-enterovirus (coxsackie group B), adenovirus, parvovirus B19, Epstein-Barr virus, cytomegalovirus, HHV-6

51
Q

What are sx of Hemolytic uremic syndrome?

A
  • bloody diarrhea
  • no fever
  • white count >10,000
  • abd tenderness
52
Q

MC bacterial causes of rhinosinusitis & OM infections? (3)

A
  • H. Influenza
  • Strep pneumoniae
  • Moraxella catarrhalis
53
Q

What is a complication of acute otitis media?

A

acute mastoiditis

54
Q

Common cause of acute bilateral lymphadenitis?

A

Group A Strep

55
Q

Common cause of acute unilateral lymphadenitis?

A
  • Staph aureus
  • Group A Strep
  • Anaerobic bacteria
56
Q

Common cause of chronic bilateral lymphadenitis?

A
  • Epstein-Barr virus

- Cytomegalovirus

57
Q

Tx for lymphadenitis

A

Amoxicillin-clavulanate (Augmentin)

58
Q

Fungal causes of periorbital cellulitis?

A

Mucorales and Aspergillus spp

59
Q

Sx of orbital cellulitis?

A
  • unilateral ocular pain, eyelid swelling, erythema
  • +/-fever, proptosis, toxic appearing
  • chemosis (conjunctival swelling)
60
Q

Tx for cellulitis and abscess?

A

drainage

  • PO Clindamycin, or Bactrim + Keflex
  • asmit for IVABx if febrile, ill apearing

DO NOT START W/ VANCOMYCIN

61
Q

Sx of necrotizing fascitits?

A
  • erythema
  • edema
  • severe pain (pain out of proportion)
  • fever (102-105)
  • crepitus
  • tachy
62
Q

Tx for necrotizing fascitits?

A
  • CT of affected area w/ IV contrast
  • Immediate surgical consult
  • Empiric abx (carbapenem + vancomycin + clindamycin)
63
Q

Common cause of masitits? Tx?

A

Staph aureus

Tx:
Well appearing > 2 mo= Keflex, Clindamycin

Ill appearing > 2 mo= IV clindamycin, vancomycin, IV cefazolin, nafcillin

Do NOT I&D- SURGICAL CONSULT

64
Q

MC bacteria in cat/dog bites?

Human bites?

A

Cat/dog= Pasteurella species

Human= Eikenella

65
Q

What is abx prophylaxis for bites?

A

Unasyn IV then Augmentin

66
Q

What is the MC cause of croup?

A

Parainfluenza virus type 1

67
Q

MC cause of epiglottitis?

A

Haemophilus influenza type b

68
Q

A child presents w/ acute onset airway obstruction in the setting of viral URI with laryngotracheitis, febrile, toxic-appearing, and poor response to tx. What is suspected?

A

Bacterial tracheitis

69
Q

MC cause of bronchiolitis?

A

Viral infection

-respiratory syncytial virus= MC

70
Q

Tx of Bronchiolitis RSV?

A

nasal suctioning, high flow O2
trial of albuterol if others fail

NO ABX

71
Q

Tx of early onselt PNA in neonatal?

Late onset?

A

Early= Amp + Gent

Late= Vanco + Gent

72
Q

MC cause of PNA in neonatal?

6 mo-5yr?

A

neonatal= GBS

6mo- 5yr= strep pneumoniae

73
Q

What are the stages of pertussis and when are babies more contagious?

A

Incubation 7-10 d
Catarrhal 1-2 weeks
Paroxysmal 2-4 weeks
Covalescent 3-4 weeks

Most infectious= Catarrhal

74
Q

Presentation of Pertussis in Infants (particularly younger than 4 mo)

A
  • may look deceptively well (like common URI)

- gagging, gasping, eye bulging, vomiting, cyanosis (cough may not be paroxysmal)

75
Q

What leads to clinical suspicion of Pertussis in infants <4 mo

A

Leukocytosis w/ lymphocytosis

  • cough not improving
  • rhinorrhea
  • apnea, seizures, vomiting
  • PNA
76
Q

What leads to clinical suspicion of Pertussis in infants > 4 mo and children?

A

cough illness a/w rhinorrhea in which the nasal discharge remains watery

77
Q

Tx of pertussis?

A

Azithromycin

postexposure prophylaxis for all household and close contacts of case, even if fully immunized

78
Q

Hallmark of Rocky Mountain Spotted fever?

A

blanching erythematous rash w/ macules (1-4 mm in size) that become petechial over time

  • fever
  • HA
  • Rash
79
Q

What is important about tx for RMSF?

A

dx can rarely be confirmed or disproved early on so must not delay empiric tx

-Doxycycline

80
Q

Do the following produce nitrate?

  • E. coli, Klebsiella, and Proteus?
  • Pseudomonas, enterococci, S. Saprophyticus?
A
  • E. coli, Klebsiella, and Proteus= Yes

- Pseudomonas, enterococci, S. Saprophyticus= No

81
Q

Sx of Parvovirus B19

A

“Slapped cheek syndrome”

  • slapped cheeks rash
  • followed by a lacy rash over the trunk
82
Q

Sx of HHV-6 Roseola?

A
  • 3-5 days for fever

- blanching macularpapular rash starting on the neck and trunk and spreading to the face and extremities

83
Q

Where does characteristic varciella rash start- go to?

A

Head -> trunk -> extremities

84
Q

Sx of Measles

A
  • fever, malaise, anorexia
  • conjunctivitis, coryza, cough
  • exanthem
85
Q

Sx of Rubella (German Measles)

A
  • rash, fever, lymphadenopathy

- discrete maculopapular exanthem that begins on face and spreads caudally

86
Q

Molluscum contagiosum may appear anywhere on the body except?

A

palms and soles

87
Q

In a pt who is febrile and has recently traveled, what should be suspected?

A

Malaria

88
Q

What 4 pathogens cause mastoiditis?

A

S. pneumo
S. pyogenes
S. aureus
Pseudomonas

89
Q

What are extracranial complications of mastoiditis?

A 
Superiosteal abscess
Facial nerve palsy
Hearing loss
Labyrinthitis 
Osteomyelitis 
Bezold abscess
90
Q

What imaging can you use to dx mastoiditis?

A

CT w/ contrast

91
Q

What 3 pathogens most commonly cause a peritonsilar abscess?

A

S. pyogenes
Strep anginosus
S. aureus

1. Disciplines 2 (11 decks)

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