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Pediatrics > Infectious 2 > Flashcards

Infectious 2 Flashcards

0
Q

Linked to gastroenteritis in enclosed populations (daycare, schools, cruises) – clinical features? Duration? Diagnosis? Management?

A

Norwalk virus

  1. Vomiting most prominent
  2. 2-3 day duration (shorter than other viral causes)

Diagnosis based clinical features

Supportive

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1
Q

Most common infectious agent causing gastroenteritis? Peak incidents? Incubation? Clinical Features? Diagnosis? Management? Complication?

A

Rotavirus; winter; Picogordo

  1. 1-3 Day incubation
  2. Vomiting, diarrhea, dehydration for 4-7 days
  3. Sometimes URI symptoms

ELISA test

  1. Supportive therapy and early feedings to prevent gut atrophy
  2. Transient lactose intolerance
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2
Q

Bacterial diarrhea with absent stool WBCs? Present stool WBCs? Either present or absent stool WBCs?

A

Toxigenic E. coli, pathogenic E. coli, campylobacter, Yersinia

Hemorrhagic E. coli, Shigella

Salmonella

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3
Q

Bacterial diarrhea

  1. Major cause of travelers diarrhea? Tx?
  2. Commonly Causes hemolytic uremic syndrome? Tx?
  3. Bloody diarrhea and seizures? Tx?
  4. Most common cause of bloody diarrhea in US? Tx?
  5. Can cause mesenteric adenitis? Tx?
  6. With water loss? Tx?
A
  1. toxigenic E. coli – quinolones, sulfonamides
  2. Enterohemorrhagic E. coli
  3. Shigella – ceftriaxone, fluoroquinolone
  4. Campylobacter – Erythromycin
  5. Yersinia – ceftriaxone
  6. Cholera – just fluid replacement
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4
Q

Classic electrolyte finding in diarrhea (chlorine)?

A

Non-anion gap hyperchloremic metabolic acidosis

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5
Q

HIV transmission in children? Factors that increase transmission? Factors that decrease transmission?

A
  1. Perinatal transmission (95%)
  2. Breast-feeding
  3. High maternal viral load
  4. Advanced maternal disease
  5. maternal genital infections (Chorioamnionitis)
  6. Premature birth
  7. Prolonged rupture of membranes
  8. Undetectable viral load
  9. C-section
  10. Compliance with therapy
  11. Infant postexposure prophylaxis
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6
Q

Clinical features of neonatal HIV infection? Diagnose by? Test that should be avoided?

A

Most infants are asymptomatic first year of life

  1. Failure to thrive
  2. Recurrent infections, thrush
  3. Lymphadenopathy, parotitis
  4. Loss of developmental milestones
  5. Thrombocytopenia
  6. Severe varicella infection

HIV DNA PCR monthly until four months page

ELISA - Maternal antibody present in children until two years of age

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7
Q

Management of infant born to mother with HIV?

A
  1. Zidovudine for six weeks – postexposure prophylaxis
  2. Bactrim for PCP until four months of negative HIV PCR
  3. No breast-feeding
  4. Urine CMV culture
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8
Q

Management for children positive for HIV?

A
  1. HAART therapy
  2. Prophylaxis based on CD4 count and age
  3. Immunizations (except varicella)
  4. Annual eye exams for CMV retinitis in children who are CMV antibody positive
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9
Q

Infectious mononucleosis – causes? Clinical features? Lab findings? Diagnosis based on age? Management?

A

EBV, CMV, HIV, toxoplasmosis

  1. Fever, malaise, fatigue
  2. Pharyngitis – exudative
  3. Posterior cervical adenopathy
  4. Hepatosplenomegaly
  5. Macular rash

Labs shows atypical lymphocytes, neutropenia, thrombocytopenia, elevated transaminases

  1. Monospot to test for heterophile antibody (only in children over four)
  2. EBV antibody titers in children under four
  3. PCR

Supportive. Corticosteroids sometimes for severe pharyngitis

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10
Q

Complications of infectious mononucleosis in short term? During tx? Long term?

A
  1. Splenic rupture
  2. Neurologic – cranial nerve palsies, encephalitis
  3. Severe pharyngitis – upper airway obstruction

Amoxicillin-associated rash – diffuse juridic maculopapular rash one week after starting abx

Malignancy – nasopharyngeal carcinoma, Burkitt’s lymphoma

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11
Q

Measles – cause? Clinical features? Diagnosis? Management?

A

Paramyxovirus rubeola

  1. Three C’s (cough, conjunctivitis, Coroza)
  2. Enanthem – Koplik spots on buccal mucosa
  3. Exanthem – rash beginning in the head and spreading within 24 hours
  4. Fever

Serologic testing

Vitamin A, supportive care

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12
Q

Complications of measles?

A
  1. Bacterial pneumonia – most common cause of mortality
  2. Otitis media
  3. Laryngotracheitis
  4. Encephalomyelitis
  5. Subacute sclerosing panencephalitis
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13
Q

Rubella – virus family? Incubation? Clinical features? Diagnosis? Management? Complications?

A

Togavirus

Often asymptomatic with incubation period of 2 to 3 weeks

  1. Prodrome of URI and fever
  2. Painful suboccipital, posterior auricular lymphadenopathy
  3. Exanthem beginning on face and spreading to trunk
  4. Fever less than 38

Viral culture and serology

Supportive

  1. Meningioencephalitis
  2. Polyarteritis in females
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14
Q

Congenital Rubella?

A
  1. Blueberry muffin baby -Thrombocytopenia, jaundice
  2. Hepatosplenomegaly
  3. Congenital cataracts
  4. Sensorineural hearing loss
  5. Patent ductus arteriosus
  6. Mental retardation, hypertension, DM
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15
Q

Allergic bronchopulmonary aspergillosis – characterized by? Labs? Management?

A
  1. Wheezing
  2. Eosinophilia
  3. Pulmonary infiltrates

Elevated Aspergillus specific immunoglobulin E

Corticosteroids and antifungal

16
Q

Patients with a high-risk of giardiasis?

A
  1. Travelers to Russia
  2. Drink contaminated Mountain water in western United States
  3. Day care center outbreak
17
Q

Diagnosis malaria with?

A

Giemsa stain

18
Q

Most common cause of infectious chorioretinitis? Triad? Transmission?

A

Toxoplasmosis

Hydrocephalus, intracranial calcifications, chorioretinitis

Cat feces

19
Q
  1. Most common Helminth infection in the US? Treatment?
  2. Loffler syndrome? Treatment?
  3. Helminth infection that causes tenesmus, bloody diarrhea, rectal prolapse? Treatment?
  4. Helminth that can cause Fe deficiency anemia? Tx?
  5. Migrating, pruritic, erythematous tracks on skin? Tx?
  6. Ocular larva migrans? Tx?
A
  1. Enterobius – albendazole
  2. Ascaris lumbercoides - transient pneumonitis from migration through lungs causing fever, eosinophilia
  3. Trichuris trichuria - Albendazole
  4. Necantor americus and Ancylostoma duodenale - Albendazole
  5. Cutaneous larva migrans – ivermectin
  6. Toxocara canis – albendazole
20
Q

Cysticercosis - organism? Transmission? Clinical features? Diagnosis? Management?

A

Taenia solium. Fecal-oral.

  1. No symptoms until tapeworm is in muscle, subcutaneous tissue, brain
  2. Subcutaneous nodules – calcified on x-ray
  3. Neurocysticercosis – 4th ventricle involvement causing Seizures, hydrocephalus, stroke
  4. stool O&P
  5. Serology
  6. CT/MRI – solitary parenchymal cyst on multiple calcifications

Anti-parasitics or if only calcified lesions – anticonvulsants

21
Q

Rocky Mountain spotted fever – Gram stain shows? Clinical features? Laboratory findings? Diagnosis? Management?

A

Gram-negative intracellular coccobacillus

  1. Hypotension
  2. Petechial rash beginning on the wrist/ankles moving centrally
  3. Hepatosplenomegaly
  4. CNS – headache, seizures
  5. Fever and myalgia

Thrombocytopenia, elevated transaminases, hyponatremia

Serologic testing

Doxycycline

22
Q

Ehrlichiosis – Clinical features? Laboratory findings? Diagnosis? Management?

A

Same symptoms as Rocky Mountain spotted fever WITHOUT rash (Fever, headache, myalgias, lymphadenopathy)

Thrombocytopenia, elevated transaminases, hyponatremia

Serology and PCR

Doxycycline

23
Q

Bartonella – clinical features? Diagnosis? Management?

A
  1. Papule along the lines of scratch, followed by lymphadenopathy after two weeks
  2. Fever
  3. Parinaud oculoglandular syndrome (conjunctivitis and preauricular lymphadenitis)

Elevated serum IgM antibody to bartonella

Supportive care

24
Q

Tuberculosis disease (vs tuberculosis)? Transmission of TB in children under 12? Extrapulmonary TB?

A

Signs and symptoms of TB without positive findings chest radiograph

Not contagious because cough is minimal and lesions are small

  1. Scrofula (cervical lymphadenitis)
  2. meningitis
  3. ileitis
  4. joint
  5. Pott’s disease
  6. Miliary
25
Q

Radiographic features of TB?

A
  1. Hilar/mediastinal lymphadenopathy
  2. Ghon complex – parenchymal infiltrates with enlarged hilar lymph nodes
  3. Lobar involvement, pleural effusion
26
Q

Positive tuberculin skin test in children if?

A

> 5 mm in children with close contact with persons with TB, suggestive x-ray findings, immunocompromised

> 10 mm in children younger than four, chronic medical condition, area endemic for TB

> 15 mm in children older than four with no other risk factors

27
Q

Definite diagnosis of TB if?

A
  1. Positive culture from gastric aspirates
  2. Positive staining of fluid for acid-fast bacilli
  3. Caseating granulomas on biopsy

Pediatrics (38 decks)

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