Infectious Diseases Flashcards
First manifestation of neonatal tetanus
a. difficulty in feeding
b. fever
c. risus sardonicus
A p.951 manifests within 3-12 days of birth as progressive difficulty in feeding (sucking and swallowing)
In Pertussis, leukocytosis with lymphocytosis is seen during what stage?
a. incubation
b. catarrhal stage
c. paroxysmal stage
d. convalescent stage
B
p. 908
A 6-yo-girl exposed to her brother with varicella. What will you give that will alter the VZV infection? A. Vaccine B. IV immunoglobulin C. D. Acyclovir
A
NTP19 245 Varicella-Zoster Virus Infections
Postexposure Prophylaxis
Vaccine given to healthy children within 3-5 days after exposure (as soon as possible is preferred) is effective in preventing or modifying varicella, especially in a household setting where exposure is very likely to result in infection. Varicella vaccine is now recommended for postexposure use and for outbreak control. Oral acyclovir administered late in the incubation period may modify subsequent varicella in the healthy child; however, its use in this manner is not recommended until it can be further evaluated.
What congenital infection will note with cerebral calcifications? A. Rubella
B. Varicella
C. Toxoplasmosis
D. CMV
C. NTP19 Ch282 Toxoplasmosis
Congenital Toxoplasmosis
Congenital toxoplasmosis usually occurs when a woman acquires primary infection while pregnant. Most often, maternal infection is asymptomatic or without specific symptoms or signs. As with other adults with acute toxoplasmosis, lymphadenopathy is the most common symptom.
In monozygotic twins the clinical pattern of involvement is most often similar, whereas in dizygotic twins the manifestations often differ, including cases of congenital infection in only 1 twin. The major histocompatibility complex class II gene DQ3 appears to be more frequent among HIV-infected persons seropositive for T. gondiiwho develop toxoplasmic encephalitis, and in children with congenital toxoplasmosis who develop hydrocephalus. These findings suggest that the presence of HLA-DQ3 is a risk factor for severity of toxoplasmosis. Other allelic variants of genes, including Col2A, ABC4r, P2X7r, Nalp1, TLR9, and ERAAP are also associated with susceptibility.
Congenital infection may present as a mild or severe neonatal disease or with sequelae or relapse of a previously undiagnosed and untreated infection later in infancy or even later in life. There is a wide variety of manifestations of congenital infection, ranging from hydrops fetalis and perinatal death to small size for gestational age, prematurity, peripheral retinal scars, persistent jaundice, mild thrombocytopenia, cerebrospinal fluid (CSF) pleocytosis, and the characteristic triad of chorioretinitis, hydrocephalus, and cerebral calcifications. More than 50% of congenitally infected infants are considered normal in the perinatal period, but almost all such children develop ocular involvement later in life if they are not treated during infancy. Neurologic signs such as convulsions, setting-sun sign with downward gaze, and hydrocephalus with increased head circumference may be associated with or without substantial cerebral damage or with relatively mild inflammation obstructing the aqueduct of Sylvius. If affected infants are treated promptly, signs and symptoms may resolve and development may be normal.
The spectrum and frequency of neonatal manifestations of 210 newborns with congenital Toxoplasma infection identified by a serologic screening program of pregnant women are presented in Table 282-1. In this study, 10% had severe congenital toxoplasmosis with CNS involvement, eye lesions, and general systemic manifestations; 34% had mild involvement with normal clinical examination results other than retinal scars or isolated intracranial calcifications; and 55% had no detectable manifestations. These numbers represent an underestimation of the incidence of severe congenital infection for several reasons: the most severe cases, including most of those individuals who died, were not referred; therapeutic abortion was often performed when acute acquired infection of the mother was diagnosed early during pregnancy; in utero spiramycin therapy may have diminished the severity of infection; and only 13 infants had brain CT and 23% did not have a CSF examination. Routine newborn examinations often yield normal findings for congenitally infected infants, but more careful evaluations may reveal significant abnormalities. In 1 study of 28 infants identified by a universal state- mandated serologic screening program for T. gondii–specific IgM, 26 had normal findings on routine newborn examination and 14 had significant abnormalities detected with more careful evaluation. The abnormalities included retinal scars (7 infants), active chorioretinitis (3 infants), and CNS abnormalities (8 infants). In Fiocruz, Belo Horizonte, Brazil, infection is common, occurring in 1/600 live births. Half of these infected infants have active chorioretinitis at birth.
D. NTP19 Ch247 Cytomegalovirus
Congenital Infection
Symptomatic congenital CMV infection was originally termed cytomegalic inclusion disease. Only 5% of all congenitally infected infants have severe cytomegalic inclusion disease, another 5% have mild involvement, and 90% are born with subclinical, but still chronic, CMV infection. The characteristic signs and symptoms of clinically manifested infections include intrauterine growth restriction, prematurity, hepatosplenomegaly and jaundice, blueberry muffin–like rash, thrombocytopenia and purpura, and microcephaly and intracranial calcifications. Other neurologic problems include chorioretinitis, sensorineural hearing loss, and mild increases in cerebrospinal fluid protein. Symptomatic newborns are usually easy to identify. Congenital infections that are symptomatic and most severe and those resulting in sequelae are more likely to be caused by primary rather than reactivated infections in pregnant women. Re-infection with a different strain of CMV can lead to symptomatic congenital infection. Asymptomatic congenital CMV infection is likely a leading cause of sensorineural hearing loss, which occurs in approximately 7-10% of all infants with congenital CMV infection, whether symptomatic at birth or not.
Unimmunized 10yo. What will you give? A. DTap B. 3 doses of Tdap C. 3 doses of Td D. 1 dose of Tdap then 2 doses of Td
B
See Recommended immunization schedule for persons aged 0 through 18–2013
Mother on a 3 drug TB regimen. Child was accidentally being given/ ingested one of the drugs then the child developed seizures? A. isoniazid B. rifampicin C. pyrazinamide D. ethambutol
A
Isoniazid
The asymptomatic 4 year old brother has negative TST and chest x ray. What will you do? (Lahat kami nalito dito, kasi parang kulang yung case description, like na-expose ba siya or not, so we assumed na exposed sya sa kapatid niya na diagnosed with PTB.)
a. 3H.
b. Observe.
c. Observe and repeat TST after 3 months.
d. Treat with 3H then repeat TST after 3 months.
C ?
The asymptomatic 10 year old brother has negative TST and chest x ray. What will you do? (Ito rin, parang kulang).
a. 3H.
b. Observe.
c. Observe and repeat TST after 3 months.
d. Treat with 3H then repeat TST after 3 months.
C?
Patient initially with streptococcal sore throat, treated with antibiotics. However, after several days (forgot exact scenario), developed dysphagia, neck stiffness and pain, and on examination, there was note of swelling on the left pharyngeal wall. What is the diagnosis?
a. Pharyngeal abscess
b. Retropharyngeal abscess
c. Parapharyngeal abscess
d. Peritonsillar abscess
c. Parapharyngeal abscess
a. Pharyngeal abscess
b. Retropharyngeal abscess – PE reveals bulging posterior pharyngeal wall
c. Parapharyngeal abscess - PE reveals prominent bulging of the lateral pharyngeal wall with medial displacement of the tonsil
d. Peritonsillar abscess – an asymmetric tonsillar bulge is diagnostic
Which of the following extra-pulmonary Tuberculosis conditions are treated similarly as pulmonary TB (6 months)?
a. TB meningitis
b. GI and hepatobiliary TB
c. TB arthritis
d. TB pericarditis
b. GI and hepatobiliary TB
PPS: TB meningitis and TB of bone and joints – 9-12months treatment; TB pericarditis and TB meningitis –additional use of adjunctive therapy
Which of the following causes a IM-like illness?
a. CMV
b. Measles
c. Rubella
d. Herpes
a. CMV
CMV may cause a mononucleosis-like syndrome characterized by fatigue, malaise, myalgia, headache, fever, hepatosplenomegaly, elevated liver enzyme values, and atypical lymphocytosis.
Patient with right knee swelling, with lymphadenopathies (cervical, retroauricular and occipital), fever:
a. Infectious Mononucleosis
b. Measles
c. Rubella
c. rubella
NTP 19:
In postnatal infection with rubella, following an incubation period of 14-21 days, a prodrome consisting of low-grade fever, sore throat, red eyes with or without eye pain, headache, malaise, anorexia, and lymphadenopathy begins. Suboccipital, postauricular, and anterior cervical lymph nodes are most prominent.
- Arthritis following rubella occurs more commonly among adults, especially women. It begins within 1 wk of onset of the exanthem and classically involves the small joints of the hands. It also is self-limited and resolves within weeks without sequelae.
A 1 year old infant with cough and colds of 5 days’ duration developed moderate fever with increased frequency of cough 1 day prior to consult. A few hours prior to consult the patient was noted to have increased respiratory rate. On Physical Exam, the patient was noted to have T 38.5C, CR 100, RR 50.
What is the recommended home therapy?
a. Amoxicillin
b. Penicillin
c. Ampicillin
d. Cefuroxime
a. Amoxicillin
* PPS
What is included in Anicteric Leptospirosis? (I forgot the other choices) A. B. renal failure C. D.
NTP19 Ch 212 Leptospira
Anicteric Leptospirosis
The septicemic phase of anicteric leptospirosis has an abrupt onset with flulike signs of fever, shaking chills, lethargy, severe headache, malaise, nausea, vomiting, and severe debilitating myalgia most prominent in the lower extremities, lumbosacral spine, and abdomen. Bradycardia and hypotension can occur, but circulatory collapse is uncommon. Conjunctival suffusion with photophobia and orbital pain (in the absence of chemosis and purulent exudate), generalized lymphadenopathy, and hepatosplenomegaly may also be present. A transient (<24 hr) erythematous maculopapular, urticarial, petechial, purpuric, or desquamating rash occurs in 10% of cases. Rarer manifestations include pharyngitis, pneumonitis, arthritis, carditis, cholecystitis, and orchitis. The second or immune phasecan follow a brief asymptomatic interlude and is characterized by recurrence of fever and aseptic meningitis. CSF abnormalities include a modest elevation in pressure, pleocytosis with early polymorphonuclear leukocytosis followed by mononuclear predominance rarely exceeding 500 cells/mm 3 , normal or slightly elevated protein levels, and normal glucose values. Although 80% of infected children have abnormal CSF profiles, only 50% have meningeal manifestations. Encephalitis, cranial and peripheral neuropathies, papilledema, and paralysis are uncommon. A self-limited unilateral or bilateral uveitis can occur during this phase, rarely resulting in permanent visual impairment. Central nervous system symptoms usually resolve spontaneously within 1 wk, with almost no mortality.
Most common cause of bacterial peritonitis? A. E. coli B. Staph aureus C. Strep pneumonia D.
C. NTP19 Ch 321.1 Idiopathic Nephrotic Syndrome
Infection is a major complication of nephrotic syndrome. Children in relapse have increased susceptibility to bacterial infections because of urinary losses of immunoglobulins and properdin factor B, defective cell-mediated immunity, their immunosuppressive therapy, malnutrition, and edema or ascites acting as a potential culture medium. Spontaneous bacterial peritonitis is a common infection, although sepsis, pneumonia, cellulitis, and urinary tract infections may also be seen. Although Streptococcus pneumoniae is the most common organism causing peritonitis, gram-negative bacteria such as Escherichia coli may also be encountered. The patient’s caregivers should be counseled to seek medical attention if the child appears ill, has a fever, or complains of persistent abdominal pain. A high index of suspicion for bacterial peritonitis, prompt evaluation (including cultures of blood and peritoneal fluid), and early initiation of antibiotic therapy are critical.
All patients who are presumed or proven to have gonorrhea should be evaluated for concurrent? A. Chlamydia B. C. D.
A. NTP19 Ch 185 Neisseria gonorrhoea
All patients who are presumed or proven to have gonorrhea should be evaluated for concurrent syphilis, hepatitis B, HIV, and C. trachomatis infection. The incidence of Chlamydia co-infection is 15-25% among males and 35-50% among females. Patients beyond the neonatal period should be treated presumptively for C. trachomatis infection unless a negative chlamydial NAAT result is documented at the time treatment is initiated for gonorrhea. However, if chlamydial test results are not available or if a non-NAAT result is negative for Chlamydia, patients should be treated for both gonorrhea and Chlamydia infection ( Chapter 218.2). Sexual partners exposed in the preceding 60 days should be examined, culture specimens should be collected, and presumptive treatment should be started.
Patient complaining of itching and restless sleep with nocturnal perianal itch A. Enterobiasis
B.
C.
D.
A. NTP19 Ch 286 Enterobiasis
Pinworm infection is innocuous and rarely causes serious medical problems. The most common complaints include itching and restless sleep secondary to nocturnalperianal or perineal pruritus. The precise cause and incidence of pruritus are unknown but may be related to the intensity of infection, psychologic profile of the infected individual and his or her family, or allergic reactions to the parasite. Eosinophilia is not observed in most cases, because tissue invasion does not occur. Aberrant migration to ectopic sites occasionally may lead to appendicitis, chronic salpingitis, pelvic inflammatory disease, peritonitis, hepatitis, and ulcerative lesions in the large or small bowel.
Bloody diarrhea, tenesmus A. B. Salmonella typhosa C. Enterohemorrhagic E. coli D.
C. NTP19 Ch 192. Escherichia coli Enteroinvasive Escherichia Coli
Clinically, EIEC infections present either with watery diarrhea or a dysentery syndrome with blood, mucus, and leukocytes in the stools, as well as fever, systemic toxicity, crampy abdominal pain, tenesmus, and urgency. The illness resembles bacillary dysentery, because EIEC share virulence genes with Shigella spp. EIEC are mostly described in outbreaks; however, endemic disease occurs in developing countries where these bacteria can be isolated. In some areas of the developing world as many as 5% of sporadic diarrhea episodes and 20% of bloody diarrhea cases are caused by EIEC strains.
Clinical practice guidelines recommend the use of oral high dose antibiotic as first line treatment for acute otitis media and/or sinusitis
a. amoxicillin
b. co-amoxiclav
c. clarithromycin
d. cefuroxime axetil
a. amoxicillin
4/F presented with high grade fever and developed generalized seizures, later presented with abdominal cramps, blood-streaked mucoid stools. PE showed T38.5C, HR 100, fecalysis done showed pus cells, E. histolytica cysts few. Management of the case involves the ff. except:
a. Oral rehydration therapy
b. Antibiotic therapy with metronidazole
c. Supplementation with vitamin A
d. Zinc therapy x 14 days
c. Supplementation with vitamin A
Wound resulting from the direct inoculation of Pseudomonas…
a. impetigo
b. erysipelas
c. Ecthyma gangrenosum
c. Ecthyma gangrenosum
Nelson’s 18th: This is the characteristic skin lesion of Pseudomonas, whether by direct inoculation or secondary to septicemia.
A 10 year old boy was noted to have diarrhea and was treated with antibiotics for 10 days. He had onset of bloody stools, fever. He was later admitted and treated with Ciprofloxacin, with no improvement of the bloody stools.
a. Campylobacter jejuni
b. Clostridium difficile
c. ETEC
d. Shigella
d. Shigella – TMP-SMX recommended treatment
* Nelson’s 18th: See table 337-1 Food-borne illnesses
Which of the following TB conditions are rare in young children?
a. TB meningitis
b. TB of the bones
c. Renal TB
d. GI TB
c. Renal TB - occurs very late after primary infection
* PPS TB guidelines
Which of the following will not need antibiotic prophylaxis for pertussis?
a. Fully immunized but immunocompromized child in the household
b. Sickle Cell Anemia patient
c. Adult household contacts with on other child in the house beside the index case
No answer given
What is the best test for E.vermicularis?
a. Fecal smear
b. Rectal swab
c. Cellulose tape swab
d. Stool exam
c. Cellulose tape swab
* Nelson’s 18th: Definitive diagnosis is established by identification of parasite eggs or worms. Microscopic examination of adhesive cellophane tape pressed against the perianal area demonstrates eggs.
Which causes cerebral malaria?
a. P. ovale
b. P. falciparum
c. P. vivax
d. P. malariae
b. P. falciparum
Nelson’s 18th: Cerebral malaria is a serious complication of P. falciparum infection that is most common among children and non-immune adults
True about tetanus diagnosis:
a. It is diagnosed clinically
b. CT scan
c. CBC, Blood CS
d. Wound culture
a. It is diagnosed clinically
* Nelson’s: Diagnosis may be established clinically. Routine laboratory studies are usually normal.
Neonatal tetanus manifests commonly as:
a. seizures
b. opisthotonus
c. Poor feeding
c. Poor feeding
* Nelson’s 18th: The infantile form usually manifests within 3-12 days of birth as progressive difficulty in feeding, associated hunger, and crying.
True about IGRA in TB diagnostics
a. More specific, differentiates between BCG effect and actual TB infection
b. distinguished between LTBI and active disease
*PPS TB guidelines: IGRA detects not only active TB but latent TB as well.. could potentially serve as “rule out” tests (high sensitivity).
What is the antibiotic of choice for pertussis in 1 month old child and below?
a. Erythromycin
b. Clarithromycin
c. Azithromycin
c. Azithromycin
Nelson’s 18th: see table 194-2 recommended antibiotic treatment for pertussis
What is the most common cause of death (50-60%) in respiratory diphtheria?
a. Asphyxia secondary to pseudomembranes
b. Cardiomyopathy
b. Cardiomyopathy
* Nelson’s 18th: Toxic cardiomyopathy occurs in 10-25% of patients with respiratory diphtheria and is responsible for 50-60% of deaths.
Which of the ff is not part of congenital rubella syndrome?
a. CAVSD
b. muscle atrophy
c. microcephaly
d. chorioretinitis
no answer given
Which is not true about cholera
a. Diarrhea is voluminous watery, without abdominal cramps or pain, and with fever
b. Person to person transmission has been noted
c. Ciprofloxacin can be used to eradicate the disease
c. Ciprofloxacin can be used to eradicate the disease
* Nelson’s 18th: TMP-SMX is recommended antibiotic for confirmed cases.
The most common Group A Streptococcus infection is acute pharyngotonsillitis. Which is NOT TRUE?
a. Classic presentation is seen in the less than 3 years old
b. Purulent otitis media and sinusitis
c. Non-purulent presentations include Acute Rheumatic Fever and Acute glomerulonephritis
d. Treatment with intramuscular benzathine penicillin G is effective
a. Classic presentation is seen in the less than 3 years old
* Nelson’s 18th: The incidence of pharyngeal infections is highest in children 3-15 years of age.
