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MS3 > Peds 9 > Flashcards

Peds 9 Flashcards

1
Q

What are the names of the 2 main Sulfonamide drugs

A

Trimethoprim
Sulfamethoxazole

Aka Bactrim

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2
Q

MOA of sulfa drugs

A

Block folate synthesis

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3
Q

Uses of sulfa drugs

A
  • UTI
  • Acute prostatitis
  • Gram neg GI and UTI bacteria
  • MRSA
  • Nocardia
  • Pneumocystis jirovecii pneuomonia
  • Toxoplasma gondii
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4
Q

Adverse reactions of sulfa TMP/SMX

A
  • Pancytopenia (due to inhibition of DNA synthesis)
  • Megaloblastic anemia
  • Teratogen (NTD)
  • Allergic drug rx
  • Hemolytic anemia is G6PD deficiency
  • SJS
  • Type 4 RTA
  • Interstitial nephritis
  • Photosensitivity
  • Kernicterus
  • Drug induced lupus
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5
Q

Names of Fluoroquinolone drugs

A

Ciprofloxacin, Levofloxacin, Moxifloxacin

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6
Q

MOA of Fluoroquinolones

A

Inhibits bacterial topoisomerase, such as DNA gyrase (relieves supercoiling)

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7
Q

Uses of Fluoroquinolones (broad)

A

Mostly gram negative but some gram positive

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8
Q

What type of gram neg infections are fluoroquinolones used for

A
  • UTI (complicated - uncomplicated treated by TMP/SMX)
  • Even UTI treated by Pseudomonas
  • Pyelonephritis
  • Acute prostatitis
  • Gram negative gastroenteritis
  • Gram neg osteomyelitis
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9
Q

What type of gram positive infections are fluoroquinolones used for

A
  • Bacillus anthracis
  • Community acquired pneumonia
  • Atypical pneumonia (Mycoplasma and Legionella)
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10
Q

Adverse effects of Fluoroquinolones

A
  • Prolonged QT
  • GI (N/V/D)
  • Tendon and cartilage damage to elderly and hose on chronic steroids
  • Teratogen (damage to growing cartilage)
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11
Q

MOA of Metronidazole

A

Forms toxic free radical metabolites that disrupt bacterial DNA

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12
Q

In broad terms, what does Metronidazole treat

A

Anaerobic infections below the diaphragm

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13
Q

Clinical uses of Metronidazole

A
  • Entamoeba histolytica
  • Giardia
  • Trichomonas (vaginitis and cervicitis)
  • Gardnerella vaginalis
  • H. Pylori (can substitute for Amoxicillin if allergic)
  • C. Diff
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14
Q

Define Toxic epidermal necrolysis

A

Same as SJS but involving >30% of body (whereas SJS <10%)

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15
Q

Common drug causes of SJS

A
  • Seizure medications (Ethosuximide, Carbamazepine, Lamotrigine, Phenytoin, Phenobarbitol)
  • Sulfa medication
  • Penicillin
  • Allopurinol
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16
Q

Tx of SJS

A 
o	Supportive care
♣	IV fluids
♣	Watch airway
♣	Skin for superinfection
♣	Ophthalmologic referral in EVERY patient
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17
Q

What is Brudzinski sign

A

A physical finding consistent with meningitis; while the pt is supine, the neck is passively flexed resulting in involuntary knee and hip flexion

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18
Q

What is Kernig sign

A

A physical finding consistent with meningitis; while the pt is supine, the legs are flexed at the kip and knee at 90 degree angle resulting in pain with leg extension

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19
Q

Empiric tx of meningitis in neonate

A

Think about GBS, E. Coli, and Listeria

Ampicillin + Ceftriaxone

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20
Q

What bacteria is even more likely to cause meningitis in a sickle cell patient

A

Strep pneumo

Sickle cell = functional asplenia = susceptible to encapsulated organisms

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21
Q

Define dysentery

A

• Intestinal infection resulting in severe bloody diarrhea with mucus

22
Q

Define enteritis

A

• Inflammation of the small intestine, usually resulting in diarrhea; may be because of infection, immune response, or other causes

23
Q

Most common causes of bacterial diarrhea

A

Salmonella, Shigella, Campylobacter

24
Q

Tx of hemolytic uremic syndrome

A

Mostly supportive = fluid and electrolytes

Early dialysis may be needed

25
Q

Tx of Salmonella dysentery

A

Fluid and electrolyte correction

Abx do not shorten GI course and may increase risk of HUS

26
Q

Tx of Shigella dysentery

A

Is self-limited by often treated with abx because they can shorten the course and decrease shedding

27
Q

Are seizures more common with epidural or subdural hematomas

A

Subdural

28
Q

What bug is common cause of UTI in sexually active females

A

Staph saprophyticus

29
Q

Which staph is coag positive vs. coag negative

A
  • Staph aureus = coag positive

- Staph epi and sapro = coag negative

30
Q

What are the 3 main symptoms of scarlet fever

A

1) Redness and swelling of tongue
2) Pharyngitis
3) Rash that spares the face

31
Q

What are the symptoms of Rheumatic fever

A

♣ J – joints – poly arthritis
♣ O – in the shape of a heart – valvular damage, myocarditis, and pericarditis
♣ N – subcutaneous nodules – usually on extensor surfaces
♣ E – erythema marginatum – rash with thick red borders
♣ S – Sydenhams’ chorea – rapid involuntary movements, especially of hands and face

32
Q

Describe pathogenesis of rheumatic fever

A

Type II HSR - antibodies against M protein will have molecular mimicry with myocin in the heart

33
Q

What diseases may precede RF vs. PSGN

A
  • RF only after pharyngitis

- PSGN after pharyngitis or superficial infection (e.g. impetigo)

34
Q

How does early tx of strep pharyngitis affect risk of RF vs. PSGN

A

Early tx of strep will prevent RF but not PGSN

So RF is better off in both cases - only occurs after a single disease and can be prevented if that disease is treated

35
Q

Common diseases of strep pneumo

A 
MOPS:
M = meningitis
O = otitis media
P = pneumonia
S = sinusitis
36
Q

Common diseases of Enterococcus

A

do U Heart Trees:

  • U = UTI
  • Heart = endocarditis
  • Trees = biliary tree infections
37
Q

Tx of Enterococcus

A

Linezolid, Daptomycin, Tigecycline

38
Q

Describe Type 1 RTA

A

♣ Distal renal tubular acidosis -> defect in collecting tubule (decreased secretion of H+)
♣ Alpha-intercalated cells are unable to secrete H+ -> acidosis
♣ Hypokalemia
♣ Urine pH will be > 5.5 (because no H+ in urine)

39
Q

Describe Type 2 RTA

A

♣ Proximal renal tubular acidosis -> defect in proximal tubule
♣ Impaired HCO3- reabsorption -> Increased HCO3- excretion -> acidosis
♣ Hypokalemia and hypophosphatemia
♣ Urine pH < 5.5 (urine is acidified by a-intercalated cells in collecting tubule)

40
Q

Describe Type 4 RTA

A

♣ Hyperkalemic renal tubular acidosis
♣ Due to hypoaldosteronism -> decreased K+ secretion -> hyperkalemia
♣ Hyperkalemia prevents collecting tubules from generating NH4+ -> impaired ammonium excretion
♣ Urine pH < 5.5 (decreased aldosterone = decreased Na+ reabsorption = increased Na+ in lumen = positively charged lumen)

41
Q

Diagnose: bone pain that worsens at night, resolves with NSAIDs, imaging reveals bone mass with radiolucent core

A

Osteoid osteoma

42
Q

When should immunizations be given to premature babies - at chronological age, or at gestational age

A

Chronologic age

43
Q

What will you see on lateral XR in epiglottis

A

“thumb sign” = swollen epiglottis

44
Q

What will you see on lateral XR in retropharyngeal abscess

A

Widened prevertebral space

45
Q

What bone tumors occur at the epiphysis

A

Giant cell (soap bubble appearance)

46
Q

What bone tumors occur at the metaphysis

A

Osteochondroma, osteosarcoma

47
Q

What bone tumors occur at the diaphysis

A

Ewing sarcoma, Osteoid osteoma, Myeloma

48
Q

What will you see on XR in Osteosarcoma

A

♣ Imaging reveals a mass with sunburst appearance and lifting of periosteum (Codman triangle)
• THINK: osteoSarComa (S = sunburst and C = Codman)

49
Q

What will you see on XR in Ewing sarcoma

A

♣ X-ray reveals “onion-skin” appearance – tumor grows within medullary center of bone, pushing outwards and causing periosteum (outer layer) to lay down new layers of bone
THINK: eWING = Chicken WINGS and onion rings

50
Q

Describe Wiskott-Aldrich Syndrome

A

o X-linked recessive immunodeficiency due to mutation in WASp gene
o Leukocytes and platelets unable to reorganize actin skeleton defective antigen presentation
o WATER - Wiskott Aldrich, microThrombocytopenia, Eczema (especially truncal), Recurrent infections
o Treatment – stem cell transplant

MS3 (88 decks)

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