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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
What do T-cells do?
"Army" - release cytokines signaling immune response - cytotoxins released to kill bad cells - keep system in check from killing everything
26
What do B-cells do?
"Memory" | Produce antibodies when a foreign antigen triggers the immune response
27
Disorders resulting from inherited defects of the immune system (both isolated and combined defects)= ?
Primary immunodeficiency (PID)
28
Impaired antibody (Ig) production= ?
Humoral immunodeficiency
29
Peds presentation of Primary Immunodeficiency
- recurrent, severe URI/LRTI including OM, sinusitis, PNA - meningitis more than once - poor growth - unexplained splenomegaly - delayed umbilical cord detachment
30
If considering primary immunodeficiency in a child, what do you meed to look for on CXR?
Thymus
31
What is Selective IgA Deficiency?
MC immunodeficiency -Deficiency of Serum IgA (w/ normal IgG and IgM) in a child >4 yo -Most individuals are asymptomatic
32
What is common variable immunodeficiency (CVID)?
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
33
Presenting clinical manifestations of common variable immunodeficiency (CVID)?
- pt's usually present around puberty - variable clinical manifestations - recurrent sinopulmonary and GI infections - at risk for autoimmune disease and some malignancies
34
Criteria for common variable immunodeficiency (CVID)?
- reduced serum IgA, G and M - Presence of B-cells - poor response to vaccines - absence of other immunodeficiency
35
What is the defining characteristic of severe combined immunodeficiency (SCID)?
severe deficiency of T-cell function and/or number = broad susceptibility to infection No Tx= death by 1 yr
36
What is the result of severe combined immunodeficiency (SCID)?
one or more severe infections in the first few months after birth (pNA, meningitis, bacteremia, opportunistic infections)
37
What chromosomal deletion is involved in Digeorge Syndrome?
22q11.2 deletion
38
What are the problems a/w Digeorge Syndrome (22Q11.2 syndrome)?
- Cardiac defects - Immune dysfunction (hypoplastic thymus gland) - cleft palate - hypocalcemia (parathyroid hypoplasia)
39
What is the chromosomal abnormality involved in Ataxia-Telangiectasia?
mutated 11q22-23
40
Presentation of homozygous Ataxia-Telangiectasia
- progressive cerebellar ataxia (first sign) - abnormal eye movements - oculocutaneous telangiectasias
41
Sx of children w/ Ataxia-Telangiectasia?
-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
What sign is a/w bacterial meningitis?
Opisthotontos posturing
43
What is key to treatment of bacterial meningitis?
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
In a child 0-29 days old, what is treatment for bacterial meningitis?
- ampicillin - +/-gentamicin - cefotaxime - vancomycin - acyclovir give all of these!
45
In a child 30->60 days old, what is treatment for bacterial meningitis?
- Ceftriaxone | - +/-Vancomycin
46
Bacterial arthritis usually affects?
the lower extremity, predominantly the hip and knee
47
What are the common bacterial causes of bacterial arthritis?
< 3 mo= Group B strep | > 3 mo= Group A strep
48
What are key sx of bacterial arthritis?
- monoarticular pain - fever - redness
49
Tx for bacterial arthritis
-Nafcillin, oxacillin, or vancomycin + -Cefotaxime
50
MC causes of myocarditis in kids
viral! | -enterovirus (coxsackie group B), adenovirus, parvovirus B19, Epstein-Barr virus, cytomegalovirus, HHV-6
51
What are sx of Hemolytic uremic syndrome?
- bloody diarrhea - no fever - white count >10,000 - abd tenderness
52
MC bacterial causes of rhinosinusitis & OM infections? (3)
- H. Influenza - Strep pneumoniae - Moraxella catarrhalis
53
What is a complication of acute otitis media?
acute mastoiditis
54
Common cause of acute bilateral lymphadenitis?
Group A Strep
55
Common cause of acute unilateral lymphadenitis?
- Staph aureus - Group A Strep - Anaerobic bacteria
56
Common cause of chronic bilateral lymphadenitis?
- Epstein-Barr virus | - Cytomegalovirus
57
Tx for lymphadenitis
Amoxicillin-clavulanate (Augmentin)
58
Fungal causes of periorbital cellulitis?
Mucorales and Aspergillus spp
59
Sx of orbital cellulitis?
- unilateral ocular pain, eyelid swelling, erythema - +/-fever, proptosis, toxic appearing - chemosis (conjunctival swelling)
60
Tx for cellulitis and abscess?
drainage - PO Clindamycin, or Bactrim + Keflex - asmit for IVABx if febrile, ill apearing DO NOT START W/ VANCOMYCIN
61
Sx of necrotizing fascitits?
- erythema - edema - severe pain (pain out of proportion) - fever (102-105) - crepitus - tachy
62
Tx for necrotizing fascitits?
- CT of affected area w/ IV contrast - Immediate surgical consult - Empiric abx (carbapenem + vancomycin + clindamycin)
63
Common cause of masitits? Tx?
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
MC bacteria in cat/dog bites? | Human bites?
Cat/dog= Pasteurella species Human= Eikenella
65
What is abx prophylaxis for bites?
Unasyn IV then Augmentin
66
What is the MC cause of croup?
Parainfluenza virus type 1
67
MC cause of epiglottitis?
Haemophilus influenza type b
68
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?
Bacterial tracheitis
69
MC cause of bronchiolitis?
Viral infection | -respiratory syncytial virus= MC
70
Tx of Bronchiolitis RSV?
nasal suctioning, high flow O2 trial of albuterol if others fail NO ABX
71
Tx of early onselt PNA in neonatal? Late onset?
Early= Amp + Gent Late= Vanco + Gent
72
MC cause of PNA in neonatal? | 6 mo-5yr?
neonatal= GBS 6mo- 5yr= strep pneumoniae
73
What are the stages of pertussis and when are babies more contagious?
Incubation 7-10 d Catarrhal 1-2 weeks Paroxysmal 2-4 weeks Covalescent 3-4 weeks Most infectious= Catarrhal
74
Presentation of Pertussis in Infants (particularly younger than 4 mo)
- may look deceptively well (like common URI) | - gagging, gasping, eye bulging, vomiting, cyanosis (cough may not be paroxysmal)
75
What leads to clinical suspicion of Pertussis in infants <4 mo
**Leukocytosis w/ lymphocytosis** - cough not improving - rhinorrhea - apnea, seizures, vomiting - PNA
76
What leads to clinical suspicion of Pertussis in infants > 4 mo and children?
cough illness a/w rhinorrhea in which the nasal discharge remains watery
77
Tx of pertussis?
Azithromycin | postexposure prophylaxis for all household and close contacts of case, even if fully immunized
78
Hallmark of Rocky Mountain Spotted fever?
blanching erythematous rash w/ macules (1-4 mm in size) that become petechial over time - fever - HA - Rash
79
What is important about tx for RMSF?
dx can rarely be confirmed or disproved early on so must not delay empiric tx -Doxycycline
80
Do the following produce nitrate? - E. coli, Klebsiella, and Proteus? - Pseudomonas, enterococci, S. Saprophyticus?
- E. coli, Klebsiella, and Proteus= Yes | - Pseudomonas, enterococci, S. Saprophyticus= No
81
Sx of Parvovirus B19
"Slapped cheek syndrome" - slapped cheeks rash - followed by a lacy rash over the trunk
82
Sx of HHV-6 Roseola?
- 3-5 days for fever | - blanching macularpapular rash starting on the neck and trunk and spreading to the face and extremities
83
Where does characteristic varciella rash start- go to?
Head -> trunk -> extremities
84
Sx of Measles
- fever, malaise, anorexia - conjunctivitis, coryza, cough - exanthem
85
Sx of Rubella (German Measles)
- rash, fever, lymphadenopathy | - discrete maculopapular exanthem that begins on face and spreads caudally
86
Molluscum contagiosum may appear anywhere on the body except?
palms and soles
87
In a pt who is febrile and has recently traveled, what should be suspected?
Malaria
88
What 4 pathogens cause mastoiditis?
S. pneumo S. pyogenes S. aureus Pseudomonas
89
What are extracranial complications of mastoiditis?
``` Superiosteal abscess Facial nerve palsy Hearing loss Labyrinthitis Osteomyelitis Bezold abscess ```
90
What imaging can you use to dx mastoiditis?
CT w/ contrast
91
What 3 pathogens most commonly cause a peritonsilar abscess?
S. pyogenes Strep anginosus S. aureus

1. Disciplines 2 (11 decks)

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