Peds infectious disease Flashcards
1
Q
What are the ways to measure temp in a child
A
Oral, rectal, ear, axillary, forehead
2
Q
What is defined as a fever
A
> 100.4F (38 C)
3
Q
What is a defined low grade fever
A
100.4-101F
4
Q
At what fever level can cause brain damage
A
> 108F
5
Q
What is fever of unknown origin
A
temperature > 38.3 C (101F) for >3 weeks
6
Q
Potential causes of FUO
A
Autoimmune disease, malignancy, IBD, drug fevers, thyroxicosis, familial dysautonomia, munchausen
7
Q
What is the mgmt of
A
require admission and ful septic workup, antibiotic coverage for 48 hours (amp + gent or cefotaxime)
8
Q
What is the mgmt of child aged 29 - 60 yo with fever
A
consider a full septic workup, cansider admit if CRP >6, WBC 15000, F/u in 24 hours
9
Q
What is mgmt of fever in child 2-6 mos
A
temp 102, CBC, blod culture, UA, ceftriaxone if WBC >20000 with f/u in 24 hours
10
Q
What are the categories of fever
A
fever of short duration, fever without localizing signs, FUO
11
Q
What is the mgmt of fever in child 6-24 mos
A
temp >103, catheterized UA, catheterized urine culture, consider ceftriaxone
12
Q
Mgmt of child with temp >41.1C
A
risk of seizure, eval for infection, lower the body temp (Tylenlol or ibuprofen, tepid bath)
13
Q
What is the mgmt of child with petechiae and fever
A
N. meningitidis MC, strep pneumo, RMSF, ehrlichiosis
14
Q
What placement of petechiae is indicative of more serious disease
A
below the nipple line
15
Q
What medicines should be considered in child with fever and petechiae
A
cephalosporin, vanc, potentially doxy
16
Q
What is the common presentation of fever in immunocomprimised children
A
fever and neutropenia (ANC 38.5C or 3 temp >38C taken 2 hours apart; no rectal temp!
17
Q
What are common pathogens of fever in immunocomprimised children
A
Coag-neg staph, staph aureus, E.coli, P. aeruginosa, K.pneumoniae
18
Q
Treatment of fever in immunocomprimised children
A
empiric treatment x 14d or until neutropenia resolves; sephalosporin, vanc, Amphotericin B, GCSF
19
Q
At what age do the Kernig and Brudzinski sign show on PE
A
> 12 mos
20
Q
SSx meningitis in infants
A
Bulging fontanelle, poor feeding, irritability, sleepiness
21
Q
SSx of increased ICP in children
A
6th nerve palsy, bradycardia with HTN, ptosis or anisocoria
22
Q
Generalized treatment of meningitis in kids
A
ABCs, fluid restriction, maintain IV volume, anticonvulsants for seizures
23
Q
How often are blood cultures positive in meningitis in children
A
90% of the time
24
Q
Causative agents of meningitis in neonate
A
GBS, E.coli, Listeria, Klebsiella or enterobacter
25
Antibiotic treatment of meningitis in neonates
Cefotaxime plus ampicillin +/- gent
26
Causative agents of meningitis in 2mos-5yrs
strep pneumo, Neisseria meningitidis, HIB
27
Antibiotic treatment of meningitis in 2mos-5years
Ceftriaxone or cefotaxime and vanc (for potentially resistant strep pneumo)
28
Causative agents of meningitis >6yrs
Neisseria meningitidis, strep pneumo
29
Antibiotic treatment of meningitis of >6years
Ceftriaxone or cefotaxime and vanc (for potentially resistant strep pneumo)
30
SSx of pneumonia in older children
rales, tachypnea, URI sx, fever, chest pain and shaking chills
31
SSx of pneumonia in younger children
fever, malaise, GI, restlessness, apprehension, chills, tachypnea, cough, grunting, NO RALES OR RONCHI
32
Causative agents of pneumonia in neonates
GBS, E.coli, Chlamydia, RSV
33
Treatment of pneumonia in neonates
Hospitalize, cefotaxime or ceftriaxone if bacterial
34
Causative agents of pneumonia in 6mos-5years
strep pneumo, staph aureus, group A stret, mycoplasma, RSV, HIB, M. Tuberculosis
35
Treatment of pneumonia in 6mos-5years
Amoxicillin +/- azithromycin if outpatient; Ampicillin or 3rd gen ceph +/- azithromycin if inpatient; Vanc if severe
36
Causative agents of pneumonia in >5 years
Mycoplasma pneumo, chlamydia pneumoniae, strep pneumo
37
Treatment of pneumonia in 5years
azithromycin +/- amoxicillin if outpatient; Ampicillin or 3rd gen ceph +/- azithromycin if inpatient; Vanc if severe
38
Cause of Roseloa
HHV-6 or HHV-7 in children 6mos - 2 yrs
39
Ssx of Roseloa
high fever 3-4 days, rash lasts 48 hours, cough, nasal congestion, OM, febrile seizures
40
Rare complication of roseloa
encephalitis
41
Presentation of Erythema Infectiosum
caused by parovirus, "slapped cheek" appearance, lacy reticulated rash on body, seen between 3-12 years, low fever, malaise, HA, chills, arthritis, pruritis
42
Other name for erythema infectiosum
Fifth's disease
43
Presentation of rash in Fifth's disease
appears on day 3-4, confluent on cheeks, reticulated, lacy pink, oval, papules and macules, lasts 2-40days
44
Complications of Roseola
arthritis (adults), aplastic crisis and severe anemia, hydrops
45
SSx of varicella
prodrome of fever, respiratory sx, malasie, HA, descending rash of successive CROPS of red macules, vesicles to crust to scab, pruritis
46
When do you give acyclovir in children with varicella
13yrs or older with respiratory issue
47
What do you give for postexposure varicella in immunocompromised patients
VZIG, IV acyclovir
48
What is the peak age if rubella
6-9 ages
49
Another name for rubella
German Measles
50
SSX of rubella
anorexia, malasie, conjunctivitis, HA, low-grade fever URI, lymphadenopathy
51
Exanthem of rubella
Starts on face and descends with pink maculs and papules
52
Enthanem of rubella
rose-colored spots on soft palate (Forschheimer spots)
53
Another name for rubeola
Measles
54
SSx of rubeola
coryza, hacking, bark-like cough, conjuctivitis, photophobia, malasie, periorbital edema, lymphadenopathy, Koplik's spots
55
Rash presentation in rubeola
descending rash begins behind ears, erythematous, maculopapular, becoming confluent, fading to yellow
56
When do you give measles vaccine
12mos to 4-6 years
57
treatment of measles
High dose vitamin A and support
58
Precipitating factors for HSV1 outbreak
sunlight, stress, illness or local trauma,
59
SSx of primary HSV1
mild or severe fever, sore throat and lymphadenopathy, grouped vesicles, may heal in 2-4 weeks
60
SSx of recurrent HSV 1
prodrome of tingling, itching, burning, small localized crop of blisters, heals in 1-2 weeks, absents systemic sx
61
Treatment of primary HSV 1
IV or oral acyclovir, acetaminophen, IV hydration
62
Treatment of recurrent HSV 1
acyclovir at start of sx, topical pencyclovir
63
When do you start prophylaxis of HSV 1
>6 recurrence per year
64
What are the peak age for mumps
5-14 years
65
What is mumps contagious
2 days prior to sxs to 5 days after
66
SSx of mumps parotitis
salivary gland tenderness and swelling, fever, facial lymphedema, orchitis, oophoritis, meningoencephalitis
67
How often does mumps affect the testicles in males
1/3 of psotpubertal males with 1/3 testicle atrophy
68
Pathogen causing infectious mononucleosis
EBV
69
SSx of mononucleosis
fever, fatigue, malasie, lymphadenopathy, exudative pharyngitis, HSM, atypical lymphocytosis
70
treatment of rash in mononucleosis
penicillins
71
Complications of Infectious mononucleosis
airway obstruction, neuro, hematologic, orchitis, myocarditis
72
Cause of hand-foot-and-mouth disease
coxsacie A16 virus or enterovirus 71, highly contagious
73
SSx of hand-foot-and-mouth
lowgrade fever, malaise, abd pain, respiratory sx, painful ulcerative oral lesions, less than 100 cutaneous lesions, palms and soles involved
74
Treatment of hand-foot-and-mouth
acetaminophen, benadryl, kaopectate, maalox mouthwash
75
Primary age of infection of adenovirus
76
SSx of adenovirus
pharyngitis, fever, rhinitis, cough, exudative tonsillitis, om, adenopathy, conjunctivitis, pneumonia, morbilliform rash that may be petechial
77
Complications of adenovirus
acute hemorrhagic conjunctivitis, croup, bronchilitis, hemorrhagic cysitis, mesenteric lymphadenitis
78
What is the most prognostic indicator in severity of meningitis
CSF glucose count
79
SSx of enterovirus
febrile, common cold, pharyngitis, herpangina, stomatitis, pneumonia, rash, neuro, GI, Eye, heart
80
Rash presentation in enterovirus
macular, maculopapular on trunk or palms and soles
81
neurologic presentation of enterovirus
aseptic meningitis, encephalitis, paralysis
82
GI presentation of enterovirus
vomiting, diarrhea, abd pain, hepatitis
83
eye presentation of enterovirus
acute hemorrhagic conjunctivitis
84
heart presentation of enterovirus
myocarditis, pericarditis
85
What are the viral exanthems reportable to health dept
measles/rubeola, rubella, mumps, varicella
86
Age presentaiton in scarlet fever
children 2-10 years old
87
SSx of scarlet fever
fever, strawberry tongue, pharyngitis, cervical lymphadenopathy
88
Rash presentation in scarlet fever
exotoxin mediated, appears 1-3 days prior to fever, diffuse erythema, sandpaper texture, confluent petechiae in skin folds, NO palms and soles, perioral sparing
89
when does the rash of scarlet fever desquamate
7-14 days
90
what is pastia sign
confluent petechiae n skin folds; scarlet fever
91
treatment of scarlet fever
PCN, erythromycin, macrolides, or 1st gen ceph
92
Cause of Scalded skin syndrome
toxin mediated disease caused by staphylococcal toxins A and B, source of infection is URI, conjunctiva, ear
93
Main age group of Scalded skin syndrome
94
SSx of Scalded skin syndrome
irritability, low to absent fever, abrupt onset of eyrthema, painfuls skin,
95
Where are the most prominent places for Scalded skin syndrome to present
mainly periorally, periorbitally and on flexor surfaces
96
What is Nikolsky's sign
separation of the epidermis
97
treatment of Scalded skin syndrome
systemic antistaphylococcal drugs, topical mupirocin, silvadene, rash resloves in 2 weeks
98
What is the pathogen that causes meningococcemia
Neisseria meningitidis
99
what is the most common serotype of meningococcemia
B
100
What are the serotypes of meningococcemia
A, B, C, Y, W-135
101
What is the most common age to develop meningococcemia
under 5 years, highest attack rate is 1st year of life
102
SSx of meningococcemia
high fever, HA, nausea, marked toxicity, hypotension
103
Rash presentation of meningococcemia
bright pink, tender macules or papules over extremities and trunk - petechiae - purpura
104
what can fulminant meningococcemia progress to
DIC, massive skin, mucosal hemorrhages and shock
105
Treatment of meningococcemia
Aggressive treatment with vanc and ceftriaxone initially, PCN G, cefotaxime or certriaxone with cultures, fluids, heparin if DIC
106
Impetigo is what?
Bacterial infection of the superficial layers of the epidermis; caused by S. aureus or streptococcus pyogenes
107
Rash presentation of impetigo
erythematous papules that progresses to vesicles and bullae then breaks down leving honey-colored crust, lesions spread easily
108
Treatment of GAS impetigo
topical treatment with mupirocin, oral PCN
109
Treatment with s. aureus impetigo
topical treatment with mupirocin, clindamycin, 1st gen ceph (MSSA only)
110
Causative agent of erysipelas
GAS
111
What does erysipelas affect
superficial layers of skin and underlying connective tissue
112
Age of onset of erysipelas
young children
113
SSx of erysipelas
skin over affected area is swollen, red, hot, very tender, raised advancing edges and sharply demarcated borders; more superficial than cellulitis
114
Treatment of erysipelas
PCN, amoxicillin, 1st gen ceph
115
Causative agent of RMSF
Rickettsia Ricketsii
116
SSx of RMSF
high fever, periorbital HA, myalgia, toxic appearance, nausea, vomiting, photophobia, irriability, conjunctivitis, splenomegaly
117
Rash presentation of RMSF
PALMS AND SOLES, maculopapular, extremities and spreads inward, petechial,
118
Complications of RMSF
DIC, shock, purpura fuminans
119
Treatment of RMSF
doxy for all children x 10 days
120
What is Kawasaki's syndrome
Acute febrile illness/systemic vasculitis of unknown etiology, most often affects boys and children
121
What is the peak age of Kawasaki's syndrome
2 years
122
Complications of untreated Kawasaki's syndrome
coronary artery aneurisms leading to sudden death later
123
When is peal mortality of Kawasaki's syndrome
15-45 days after onset of fever
124
How long must the fever be present to quality for Kawasaki's
5 days
125
What are the other principle features of Kawasaki's besides fever
bilateral bulbar conjunctival injection w/o exudate, polymorphous exanthem, cervical lymphadenopathy, changes in lips and oral cavity, changes in extremities
126
What are the mouth presentations of Kawasaki's
erythema, lips cracking, strawberry tongue, diffuse injection of oral and pahryngeal mucosae
127
What are the extremity changes in Kawasaki's
Acute: erythema of palms and soles, edema of hands and feet; subacute: periungual peeling of fingers/toes in weeks 2-3
128
Treatment of Kawasaki's disease
IVIG w/in 10 days, ASA high dose, warning about Rye syndrome, flu vaccine, MMR and Varicell deferred for 11 mos after IVIG
129
Most common age of SJS presentation
2-10 years
130
Most common reason for SJS
adverse med reaction to NSAIDs, sulfonamides, anticonvulsants
131
Prodrome of SJS
fever, HA, sore throat, malasie, cough, vomiting, diarrhea
132
Mucosal involvement of SJS
at least two mucosal surfaces, target lesions
133
Eye presentation of SJS
redness, swelling, bullae, denuded erosions on conjunctivae, pain or photophobia, scarring
134
Treatment of SJS
fluids, xeroform dressings, D/c meds, prevent bacterial infections, ophthalmalogical eval, IVIG
