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Step 2 Pediatrics > Pediatric Infectious Diseases > Flashcards

Pediatric Infectious Diseases Flashcards

1
Q

The occurrence of acute otitis media (AOM) peaks during ____ age.

A

between 6 -12 months of age.

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2
Q

Approx. ___ % of children will develop one or more episodes of acute otitis media by __ age.

A

before the age of 4 years.

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3
Q

____ and ____ are protective against acute otitis media.

A

Breastfeeding, and Xylitol.

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4
Q

Supportive care with pain and fever control with close follow-up is the best initial t/t in ____ cases of acute otitis media.

A

mild cases in children > 6 years of age.

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5
Q

What is/are the antibiotic (s) of choice in the t/t of moderate-severe cases of acute otitis media>

A
  1. Amoxycillin high-dose @ 80-90 mg/kg/day) x 10 days.
  2. Amoxy-Clavulanic acid (if h/o recent Amoxycillin use, or resistant or recurrent episodes of AOM).
  3. Cephalosporin: if penicillin allergic
  4. Azithromycin: if penicillin allergic.
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6
Q

Bronchiolitis is an acute inflammatory infection of ___ caliber airways.

A

small airways of the LRT.

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7
Q

Bronchiolitis primarily affects children of ___ ages, esp. in ___ season.

A

infants and children < 2 years of age;

in the fall or winter season.

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8
Q

___ is the most common pathogen responsible for bronchiolitis.

A

RSV

MN: I M Respiratory Pathogen RSV.
-Influenza, Infants/children < 2 yrs.
-Metapneumovirus
-Rhinovirus
-Parainfluenza
-RSV (most common)

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9
Q

CXR findings in severe cases of bronchiolitis include ____.

A

-hyperinflated lungs with flattened diaphragm, interstitial infiltrates, and/or atelectasis.

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10
Q

True/False?

Bronchiolitis is a clinical diagnosis and routine/mild cases do not require any laboratory or radiologic workup.

A

True.

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11
Q

Bronchodilators are indicated in the treatment of ___ cases of bronchiolitis.

A

patients with
-asthma
-strong family h/o asthma

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12
Q

When is the use of corticosteroids indicated in the m/m of bronchiolitis?

A

Not indicated

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13
Q

Antiviral agent Ribavirin is indicated in ____ cases of bronchiolitis.

A

high-risk infants such as those with
-underlying heart/lung disease.
-immune disorder.

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14
Q

RSV prophylaxis with ______ indicated in infants of ___ age.

A

with injectable monoclonal antibody (Palivizumab) in fall/winter in *high-risk infants ≤ 2 yrs. of age.

*high-risk criteria such as
-prematurity
-infants with chronic lung disease
-congenital heart disease.

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15
Q

True/False?
Young infants with bronchiolitis may p/w apnea.

A

true.

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16
Q

_____ is an acute viral inflammatory disease of the larynx esp. within the sub-glottic space p/w prodromal URI f/by low-grade fever, mild dyspnea, inspiratory stridor, and characteristic barking cough.

A

Croup aka laryngo-tracheo-bronchitis.

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17
Q

_____ is the most common cause of croup.

A

Parainfluenza virus (type 1).

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18
Q

Other than parainfluenza virus (type 1), what other viruses can cause croup?

A

-Parainfluenza virus type 2
-Parainfluenza virus type 3
-RSV
-Influenza virus
-Adenovirus

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19
Q

Subglottic narrowing of the upper airway leads to the characteristic ___ sign on CXR-AP view.

A

Steeple-sign (see attached image)

Image Source: https://radiopaedia.org

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20
Q

Croup mostly affects children in ____ age groups.

A

3 months to 3 years.

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21
Q

____ s/s are indicative of severe croup, and require hospitalization and t/t with nebulized racemic epinephrine and possible intubation to manage impending/existing airway compromise.

A

-respiratory distress at rest
-inspiratory stridor
-accessory neck muscle use.

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22
Q

Mild cases of croup may be managed as outpatients with _____.

A

cool-mist therapy and fluids.

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23
Q

Moderate cases of croup are managed with _____.

A

supplemental O2, oral/IM steroids, and nebulized *racemic epinephrine.

*Racemic epinephrine: l- plus d- rotatory forms of epinephrine; more potent; relieves airway obstruction and symptoms through vasoconstrictive effects on the tracheal mucosa.

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24
Q

Age groups affected in Croup vs Epiglottitis vs Tracheitis?

A

Croup: 3 mo- 3 years
Epiglottitis: 3-7 yrs
Tracehitis: 3 mo- 2 years.

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25
Q

Onset of s/s in Croup vs Epiglottitis vs Tracheitis?

A

Croup: prodrome of 1-7 days

Epiglottitis: rapid onset 4-12 hrs.

Tracehitis: prodrome 3 days f/by rapid decompensation (10 hrs.)

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26
Q

Fever severity in Croup vs Epiglottitis vs Tracheitis?

A

Croup: low grade/absent fever
Epiglottitis: high-grade fever
Tracehitis: high-grade fever

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27
Q

Think epiglottitis in a _____ patient.

A

unvaccinated child.

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28
Q

Common pathogens involved in causing epiglottitis include ___.

A

-Strep. species
-H. influenzae type B (rare now)
-Untypeable H. influenzae
-viral agents

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29
Q

____ sign on a CXR lateral view is characteristic of Epiglottitis.

A

Thumbprint sign (swollen epiglottis obliterating the valleculae).

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30
Q

____ is the best initial management in patients with Epiglottitis.

A

-Securing the airway with tracheostomy or endotracheal intubation.

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31
Q

___ agents are the most common cause of bacterial meningitis in neonates.

A

MN: Small Little Engels!

S: Strep group B (GBS)
E: E. coli
L: Listeria

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32
Q

___ agents are the most common cause of bacterial meningitis in infants and children.

A

-Strep. Pneumoniae
-N. meningitidis
-H. influenzae

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33
Q

___ agents are the most common cause of bacterial meningitis in adolescents.

A

-N. meningitidis
-Strep. Pneumoniae

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34
Q

What are some risk factors for the development of bacterial meningitis?

A

-sino-facial infections
-trauma
-immunodeficiency
-sepsis

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35
Q

Viral meningitis is most commonly caused by ___ viral pathogens.

A

enteroviruses.

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36
Q

What is the age distribution for viral meningitis in children?

A

children of all ages.

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37
Q

CSF findings in bacterial vs viral meningitis?

A

see attached image

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38
Q

____ is the treatment regimen for t/t of meningitis in neonates.

A

Ampicillin + Cefotaxime/gentamicin

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39
Q

____ is the treatment regimen for t/t of meningitis in older children.

A

Ceftriaxone + Vancomycin.

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40
Q

____ antibiotic is contraindicated in neonates d/t the risk of biliary sludging leading to kernicterus.

A

Ceftriaxone.

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41
Q

True/False?
The age of the baby is an important clue toward the etiology of neonatal conjunctivitis.

A

True.

*bacterial infections can occur anytime.

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42
Q

____ is/are the most common cause (s) of neonatal conjunctivitis that develops within the first 24 hrs after birth.

A

Chemical causes like silver nitrate drops, or from prophylactic erythromycin or gentamicin drops.

Source: https://www.ncbi.nlm.nih.gov/books/NBK441840/

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43
Q

Neonatal conjunctivitis with onset within the first 24 to 48 hrs of life is most likely d/t ____ cause.

A

Bacterial causes such as
-N. gonorrhoeae (most common),
-S. aureus.

Source: https://www.ncbi.nlm.nih.gov/books/NBK441840/

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44
Q

Neonatal conjunctivitis with onset within 5 to 14 days, 6 to 14 days, and 5 to 18 days are most likely to d/t ____, ___, and ____ agents respectively.

A

Chlamydia trachomatis, HSV, and P aeruginosa, respectively.

Source: https://www.ncbi.nlm.nih.gov/books/NBK441840/

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45
Q

___, ____, and ___ are the most common causes of neonatal infectious conjunctivitis.

A

-Chlamydia trachomatis
-HSV (mainly HSV 2)
-N. gonorrhoeae (< 1% of cases in US)

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46
Q

_____ is recommended as first-line prophylaxis against N. gonorrhoeae conjunctivitis in neonates.

A

erythromycin ointment.

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47
Q

____ ophthalmic ointment is more effective than erythromycin ointment in prophylaxis against penicillinase-productive N. gonorrhoeae.

A

silver nitrate

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48
Q

The onset of bilateral PURULENT conjunctivitis and MARKED eyelid edema within 1 week of birth is highly indicative of infection d/t ____ pathogen.

A

N. gonorrhoeae

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49
Q

Chamydial (trachomatis) neonatal ocular infection is characterized by ____ s/s.

A

-onset 1-2 weeks after birth
-milder than N. gonorrhoeae
-eyelid swelling with
-SCANT WATERY discharge.

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50
Q

Onser of clinical s/s in HSV ocular infection in neonates is about ____ (duration) after birth.

A

within 2 weeks.

51
Q

HSV conjunctivitis is characterized by ____ s/s.

A

-conjunctival injection,
-watery/sero-sanguinous eye discharge, and
-vesicular eruptions around the eyes.

52
Q

On gram staining of the conjunctival fluid, the presence of multinucleated giant cells indicates infection with ____ pathogen; and basophilic intracytoplasmic inclusions in epithelial cells indicate infection with ____ pathogen.

A

multinucleated giant cells -> HSV;

basophilic intracytoplasmic inclusions in epithelial cells -> chlamydia.

53
Q

Ocular discharge in bacterial conjunctivitis is usually _____ type, whereas in viral conjunctivitis is usually _____; gonorrhea has profuse purulent discharge, Pseudomonas has ___ colored discharge, and chlamydia can be ___ type.

A

bacterial conjunctivitis: purulent,
viral: watery;

Pseudomonas: greenish discharge.

chlamydia: watery f/by purulent and bloody discharge.

54
Q

Unilateral conjunctivitis most often is seen with ____ pathogens.

A

S. aureus, P. aeruginosa, HSV, and adenovirus.

55
Q

Bilateral conjunctivitis is seen with infection caused by _____ organisms.

A

-N. gonorrhea, or
-by use of ocular prophylaxis.
-Chlamydia unilateral -> bilateral.

56
Q

Chlamydia usually develops in one eye but affects the other in ____ days/weeks.

A

after 2 to 7 days.

57
Q

Neonatal conjunctivitis is frequently diagnosed in neonates born to mothers infected with ___.

A

HIV.

58
Q

Newborns with suspected ____ conjunctivitis should have samples drawn from both the conjunctivae and the oropharynx, and both conjunctival discharge and epithelial cells must be sampled if possible.

A

C. trachomatis ocular infection

59
Q

____ conjunctivitis in a neonate is a medical emergency; must be treated asap with _____.

A

Gonococcal conjunctivitis.

IV/IM Ceftriaxone 25-50mg/kg x 1 dose;
Alternative: Cefotaxime single dose of 100 mg/kg.

60
Q

Any delay in the institution of treatment in neonatal gonococcal conjunctivitis can lead to ___ complications.

A

corneal perforation and blindness.

61
Q

What is the recommended treatment for chlamydial conjunctivitis?

A

Oral
Erythromycin x 14 days,
or
Azithromycin 20 mg/kg/day x 3 days.

62
Q

A second course of oral Erythromycin or Azithromycin is usually required in newborns with chlamydial conjunctivitis d/t _____.

A

d/t recurrence after antibiotic therapy in about 1 out of 5 cases.

63
Q

____ may develop as an adverse effect in infants less than six weeks old who are treated with erythromycin.

A

Pyloric stenosis.

64
Q

For infants born to mothers with chlamydia exposure, there is no recommended prophylaxis; hence, it is important to educate the family to monitor for ___, and ___.

A

ocular infection, and pneumonia.

65
Q

When is the recommended t/t for herpetic conjunctivitis in a neonate?

A

IV Acyclovir x 14-21 days
+
topical vidaribine or trifluridine five times a day x 10 days.

66
Q

What is the golden principle of m/m of neonatal conjunctivitis?

A

Empirical treatment must be started soon after sending the culture and tapered once the final results are back.

67
Q

____ is a highly infectious form of bronchitis leading to severe life-threatening disease in infants < 6 months of age, caused by _____ pathogen.

A

Pertussis;

c/by GN bacillus B pertussis.

68
Q

_____ demographic groups in whom pertussis causes a milder self-limiting respiratory illness act as primary reservoirs for B. pertussis.

A

adolescents, young adults, and adults.

69
Q

The first catarrhal stage of pertussis marked by mild URI symptoms lasts for about ____ duration.

A

1-2 weeks.

70
Q

The second paroxysmal stage of pertussis marked by ____ s/s lasts for about ____ duration.

A

marked by paroxysms of cough with an inspiratory whoop and post-tussive emesis;

lasts for 2-3 months.

71
Q

Lab results in patients with Pertussis include ____.

A

Elevated WBC with lymphocytosis (often ≥ 70%).

72
Q

Management of pertussis include ____ strategies.

A

-Hospitalization of infants < 6 months
-Azithromycin x 10 days
-supportive t/t

73
Q

Exposed newborns are at high risk of Pertussis irrespective of their immunization status because ____.

A

they may not be entirely protected by transplacental maternal Igs.

74
Q

_____ is recommended for prophylaxis of close contacts of newborns diagnosed with Pertussis.

A

Azithromycin x 5 days.

75
Q

An unvaccinated child presents with h/o high fever with URI symptoms (cough, coryza) and conjunctivitis followed quickly by an erythematous maculopapular rash that had spread in a head-to-toe direction. What is the most likely diagnosis?

A

Measles (ss enveloped RNA paramyxovirus, genus Morbillivirus);

CLUE: Prodrome of high fever (101°F or >) with 3C’s (cough, coryza, or conjunctivitis), Koplik’s spot f/by MP rash in head-to-toe direction.

76
Q

Koplik spots that manifest as ______ are diagnostic for measles; they may appear ____ days before the rash onset, and fade ____ days after the rash onset.

A

tiny red spots with bluish-white centers inside the mouth on the lining of the cheek;

appear in 2-3 days before the rash onset, and fade 1-2 days later.

77
Q

The incubation period for measles averages ____ days from exposure to prodrome, and ____ days from exposure to rash onset.

A

-exposure to prodrome: 10-12 days;
-exposure to rash onset:14 days (range 7-21).

78
Q

Measles is infectious from ____ to ____ days after the rash onset.

A

from 4 days before and 4 days after the rash onset.

79
Q

True/False?
Measles virus can remain infectious in the air for up to 2 hours after an infected person leaves an area.

A

True.

80
Q

Complications of measles (one or more) may develop in about ____ % of cases.

A

~30% of cases

81
Q

Complications of measles are more common in ____ demographic groups.

A

in children under 5 years old, and adults 20 years and older.

82
Q

Common complications of measles include ____ (list most), whereas less common complications include _____ (list most).

A

Common: diarrhea, otitis media, laryngotracheobronchitis, pneumonia.

Less common: acute encephalitis, seizures, death.

83
Q

_____ is a rare complication of measles with average onset _____ (?duration) after measles infection.

A

Subacute sclerosing panencephalitis (SSPE): degenerative CNS disease;

onset occurs an average of 7 years after measles infection.

84
Q

Measles in _____ patient type may be severe, with atypical rash and prolonged course.

A

immunocompromised person (esp. T-cell deficiencies).

85
Q

Measles during pregnancy may result in ____ complications.

A

-premature labor,
-spontaneous abortion, and
-low-birth-weight infants.

86
Q

Detection of ___ in serum, and ___ in a respiratory specimen are the most common methods for confirming measles infection.

A

-measles-specific IgM in serum, and
-measles RNA by RT-PCR

87
Q

____ is the only way to distinguish between wild-type measles virus infection and a rash caused by a recent measles vaccination.

A

Genotyping.

88
Q

List some acceptable presumptive evidence of immunity against measles.

A

At least one of the following four:

  1. written documentation of adequate vaccination:
    -≥ 1 dose (s) of a measles-containing vaccine administered on or after the 1st birthday for preschool-age children and adults not at high risk.

-Two doses of measles-containing vaccine for school-age children and adults at high risk, including college students, healthcare personnel, and international travelers.

  1. Lab evidence of immunity*
  2. Lab confirmation of measles.
  3. Birth before 1957.
89
Q

What are some characteristic symptoms of Rubella aka “German Measles” or “3-day measles” that help differentiate it from Measles?

A

PRODROME (DO NOT look ill)
-Asymptomatic, OR
-tender generalized (clue: post-auricular) lymphadenopathy with/without
-low-grade fever.

RASH: erythematous, MP rash (like measles) but TENDER.

90
Q

What are some complications of rubella?

A

-polyarthritis (in adolescents)
-encephalitis
-thrombocytopenia (rare; post-natal infection).

-CONGENITAL RUBELLA: Deafness, cataracts, PDA, Intellectual disabilities.

91
Q

_____ is aka fifth disease.

A

Erythema Infectiosum.

*caused by Parvovirus B19 *(ss, ne DNAv, Parvoviridae family).

*ne: non-enveloped.

92
Q

What features help in differentiating Erythema Infectiosum (Fifth disease) from Measles clinically, as both may p/w an erythematous MP rash?

A

Fifth Disease (see attached image):
-PRODROME: None
-FEVER: often absent/low grade
-RASH: pruritic, “Slapped-Cheek”, arms-to-trunk/legs, WORSENS with fever and sun exposure.

Measles: prodrome of high-fevers, cough, coryza or conjunctivitis, kopliks spots, f/by head-to-toe rash.

93
Q

____ is a complication of Fifth disease in children and adults; typically resolves in about ____ duration.

A

Arthropathy;

resolves in ~ 3 weeks.

94
Q

Fifth Disease is of concern in ____ demographic groups d/t the risk of serious complications such as _____ (list all).

A
  1. Pregnant women: r/o
    -miscarriage,
    -intrauterine death, and
    -hydrops fetalis.
  2. SCD or chronic hemolytic diseases (e.g. HS, severe iron deficiency anemia etc.) d/t the r/o
    -aplastic crisis d/t destruction of reticulocytes by the virus.
95
Q

True/False?

The patient with Fifth disease is not infectious when the rash appears.

A

True.

96
Q

Roseola Infantum aka _____ or

A
97
Q

______ a viral illness that most commonly affects kids between 6 mo-2 yrs., is usually marked by 3-5 days of high fever of up to 104°F (40°C), followed by a distinctive nonpruritic, pink papular rash that begins on the trunk and appears just as the fever breaks.

A

Roseola
aka Sixth Disease
aka Exanthema Subitum
aka Roseola Infantum.

98
Q

Roseola infantum is caused by infection with ____ virus (es).

A

HHV-6
HHV-7 (less commonly).

99
Q

Approx. ___ percent of children with roseola may experience an acute febrile seizure during the febrile phase of the illness.

A

~ 50%
*d/t ability of the virus to cross the BBB.

Data Source: https://www.ncbi.nlm.nih.gov/books/NBK448190/

100
Q

In 2/3rd of patients with Roseola, erythematous papules known as ____ spots are found on _______.

A

Nagayama spots;

found on the soft palate and uvula (hence, aka Uvulopalatoglossal spots).

101
Q

What are some potential complications a/w primary HHV-6 infection?

A

-Febrile seizure (in ~50%) d/t very high fever.

Other potential complications:
-myocarditis,
-rhabdomyolysis,
-thrombocytopenia,
-GBS and
-hepatitis.

102
Q

A child p/w a “teardrop” vesicular rash on an erythematous base that first appeared on the face f/by spread to the rest of the body 24 hours after a mild fever and malaise. On PE, the rash appears at different stages of healing and spares the palms and soles. What is the most likely diagnosis?

A

Varicella aka chicken pox.

*c/by VZV (DNA virus of herpesviridae family).

103
Q

Varicella rash is infectious from ___ to __ duration.

A

24 hrs before eruption up until after the lesions crust over.

104
Q

Varicella is more severe in which age group (s)?

A

adults.

105
Q

What is/are the source (s) of varicella infection?

A
  • aerosol exposure or direct blister contact with a person with active infection.
    -Direct blister contact with a patient with shingles (reactivation of varicella).
106
Q
A
107
Q

Breakthrough varicella is _____ (define/describe).

A

Varicella infection with wild-type VZV, occurring in a vaccinated person more than 42 days after varicella vaccination.

-usually mild with no/low fever, and
-fewer than 50, predominantly maculopapular skin lesions.
-shorter illness.

108
Q

____ is/are the most common complication (s) of varicella in children.

A

Bacterial infections of the skin and soft tissues (e.g. cellulitis, impetigo or erysipelas)

109
Q

_____ is the most common complication of varicella in adults.

A

Pneumonia

110
Q

Disseminated primary varicella that carries very high mortality is usually seen in ___ individuals.

A

immunocompromised individuals.

111
Q

What are some complications of acquiring primary varicella infection during pregnancy?

A

-the fetus may present later with chickenpox, and/or
-potential to cause varicella congenital syndrome.

112
Q

___ and ___ tests can be used to confirm the diagnosis of varicella.

A
  1. PCR (highest yield) of the vasicular fluid (non-crusted), and non-skin samples such as BAL and CSF.
  2. DFA (antibody) testing has largely replaced the Tzanck test.
113
Q

True/False?
Treatment with Acyclovir is not recommended for children with Varicella who have normal immune function, as the agent has no effect on the complication rates.

A

True.

*acyclovir decreases symptoms in Varicella by one day if taken within 24 hours of the start of the rash.

114
Q

Oral antiviral (acyclovir or valacyclovir) is advised to be started within _____ timeline in adults (including pregnant women) with Varicella, infection tends to be more severe.

A

24 to 48 hours of rash onset

115
Q

Intravenous antivirals are indicated in the treatment of Varicella in _____ individuals.

A

immunocompromised patients (children and adults).

116
Q

What are some complications of Varicella Zoster (Shingles)?

A

-Encephalopathy
-Aseptic Meningitis
-Pneumonitis
-TTP
-GBS
-Cellulitis
-Arthritis

117
Q

Hand-Foot-and-Mouth Disease (HFMD) presents with a prodrome of ____ s/s followed by _____.

A

prodrome of fever, malaise, anorexia, oral and throat pain
f/by development of oral ulcers and a maculopapular vesicular on hands, feet, and sometimes buttocks.

118
Q

____ is the causative pathogen in Hand-Foot-and-Mouth Disease (HFMD).

A

Coxsackie A virus

119
Q

CSF)–IgM is the best diagnostic test for West Nile Virus (WNV) encephalitis, which commonly causes meningoencephalitis in children. Although this patient presents with features of meningitis, WNV manifests with seizures. WNV is also a vector-borne seasonal disease that is endemic to certain regions of the United States, making it an unlikely explanation for this patient’s clinical presentation. CSF-IgM will hence be an unsuitable confirmatory test.

A

CSF)–IgM is the best diagnostic test for West Nile Virus (WNV) encephalitis, which commonly causes meningoencephalitis in children. Although this patient presents with features of meningitis, WNV manifests with seizures. WNV is also a vector-borne seasonal disease that is endemic to certain regions of the United States, making it an unlikely explanation for this patient’s clinical presentation. CSF-IgM will hence be an unsuitable confirmatory test.

120
Q

Aseptic meningitis is an acute inflammation of the lining of the brain caused by nonbacterial sources, commonly a virus. It presents with symptoms of fever and pain and resistance on passive flexion of the neck suggestive of meningitis and can be confirmed by abnormal CSF findings (mildly elevated proteins, normal glucose, and lymphocytic predominance).
CSF-PCR is the investigation of choice to confirm the diagnosis of aseptic meningitis, as it detects viral etiologic agents (most commonly enterovirus) more efficiently and rapidly as compared to cell culture.

A
121
Q

Viruses are the predominant cause of aseptic meningitis, with enteroviruses accounting for 85% of all cases of aseptic meningitis in children. Enteroviruses associated with aseptic meningitis include polio viruses, coxsackie A viruses, coxsackie B viruses, echoviruses, and enterovirus 71.

Most children have a recent or simultaneous manifestations of upper respiratory infection such as rhinitis and pharyngitis.

A
122
Q

Clinical manifestations caused by aseptic meningitis are similar to those of the common cold, pharyngitis, otitis media, and influenza. But the presence of neck stiffness and aforementioned CSF analytical findings are suggestive of the diagnosis of aseptic meningitis.

septic meningitis is distinguished by the presence of neck stiffness, higher fever (>38.3°C [102°F]), and altered mental status, along with CSF analytical findings of higher WBC count (often >1000 cells/µL), elevated protein (>250 mg/dL), and decreased glucose (<40 mg/dL).

West Nile virus is also endemic in some parts of the United States, but presents with manifestations of encephalitis, including seizures.

A
123
Q
A

Step 2 Pediatrics (15 decks)

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