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Flashcards in BRS #1 Deck (319):
1

causes of congenital microcephaly

TORCH
toxo
other- syphilis
rubella
CMV
herpes simplex

also in utero drugs and toxins and chromosomal abnormalities

2

causes of acquired microcephaly- born with normal head circumference

perinatal asphyxia
intraventricular hemorrhage
craniosynostosis
late prenatal and perinatal infections

3

iron deficiency anemia peaks between _____ and ____ months

9 and 15

4

a common cause of iron deficiency anemia

introduction of cow's milk before 9 months of age

5

most patients with elevated lead levels have sxs (T/F)

F

6

contraindications to circumcision

hypospadias, prematurity, bleeding diathesis

7

most common organism in nursing or bottle caries

strep mutans

8

oral vitamin D supplementation is recommended in patients exposed to minimal sunlight during _______

first year of life

9

infant walkers are helpful for developing gross motor (T/F)

F- these walkers have a risk of injury

10

ADHD is more common in ______ (girls/boys)
genetics play a large role (T/F)

boys
T

11

tx for ADHD

first line: stimulants
second line: clonidine, TCAs

12

ADHD and _________ may be genetically related

tourette's

13

childhood hearing loss is _____% genetic and ______% others

80% genetic- autosomal recessive
20% others

14

good prognostic factors for hearing loss

-inherited deafness > acquired deafness
-older age of onset (acquire language structure before deafness)
-earlier interventions/diagnosis

15

what to check for hearing loss

H&P
genetics eval if needed
Cr (Alport syndrome)
viral serologies (TORCH)

16

leading causes of blindness in children

-trachoma infection in developing nations- MCC blindness worldwide
-retinopathy of prematurity
-congenital cataracts

17

haptic perception

feeling someone's face to form a mental image of them (used by blind people)

18

define colic

crying that lasts > 3 hours/day and occurs > 3 days/week

19

colic occurs in __% of newborns

10%

20

time period of colic

begins 2-4 weeks
resolves by 3-4 months

21

nocturnal enuresis is more common in ____ (boys/girls)

boys

22

strong familial tendency for nocturnal primary enuresis is supported by a gene on chromosome ____

13

23

enuresis patient has large volumes of dilute urine... may be an issue with ____

vasopressin (diurnal variation)

24

labs to get for enuresis

UA/UCx, others as appropriate

25

tx for enuresis

behavioral training (alarm systems, rewards, etc)
DDAVP
imipramine (TCA)

26

day night reversal/random sleeping is normal during _______

first few weeks of life

27

sleeping through the night: sleeping more than ______ after midnight for a 4 week period

5 hours
50% of infants sleep through the night by 3 months

28

nightmares occur during _____ and night terrors occur during ______

nightmares: REM
night terrors: stage 4 non-REM

29

typical age range for temper tantrums

age 1-3

30

breath holding spells are involuntary, harmless, and always stop by themselves (T/F)

T

31

cyanotic vs. pallid spells

cyanotic: cries until cyanotic --> apneic and unconscious
pallid: unexpected event --> hypervasovagal --> pale and limp

32

management of breath holding spells

it's ok... it's not harmful
+/- giving iron
if spells are precipitated by exercise or excitement, get an EKG to r/o arrhythmia

33

toilet training ages

bowel: 29 months (16-48 months)
bladder: 32 months (18-60 months)

34

discipline techniques by age

before 6 months: no discipline
6-18 months: distraction and redirection
18 months- 3 years: time out, ignoring, disapproval
preschool: logical consequences
>5 years: negotiation and restriction of privileges

35

unusual to see hand preference before age _____

18 months

36

appropriately uses household objects in imitation
what age is the child?

15-18 months

37

cerebral palsy leads to loss of milestones (T/F)

F
it is non progressive

38

language development

13 months- uses 3 words that the parents understand, play peek-a-boo and patty-cake
15 months- understand > 20-30 words but only use 12-15 words
18 months- can point to 3-5 body parts, uses 20-30 words, beginning to put together 2-word phrases
24 months- multiple telegraphic two-word sentences
30 months- adjectives and adverbs, ask questions, sentences longer than two words

39

age range for symbolic play

24-30 months

40

cause and effect starts around _____

9 months

41

object permanence age

9 months

42

mama and dada age

9-12 months
usually have 1-3 additional words by 12 months

43

separation anxiety age

6-18 months

44

immature pincer (can hold small object between thumb and index finger) age

9 months

45

transfer objects and sit alone age

6 months
-babbling

46

parachute reaction age

8 months

47

average duration of growth spurt

2-3 years

48

growth is mainly controlled by this hormone

growth hormone

49

growth spurt occurs _______ earlier in females than in males

18-24 months

50

average duration of puberty

3-4 years

51

adrenarche

onset of adrenal androgen steroidogenesis
occurs 2 years before maturation of HPG axis

52

puberty begins ______ later in males than in females

6-12 months

53

________ at age 11-12 is the first sign of puberty in males

testicular enlargement

54

facial and axillary hair growth starts _____ after pubic hair growth

2 years

55

puberty begins with _________ at age 9.5 in females

thelarche (development of breast buds)

56

menarche generally occurs at age _____, 2-3 years after thelarche

12.5

57

3 stages of adolescence

early (10-13)
middle (14-17)
late (18-21)

58

FSH in males and females

males: induces spermatogenesis
females: stimulates ovarian follicle development, stimulates ovarian granulosa cells t to produce estrogen

59

LH in males and females

males: induces testicular Leydig cells to produce testosterone
females: stimulates ovarian theca cells to produce androgens, corpus luteum to produce progesterone, midcycle surge results in ovulation

60

testosterone in males and females

males: linear growth and muscle mass, hair growth, increases libido, depends voice, external genitalia development
females: linear growth, pubic and axillary hair

61

estradiol in males and females

males: increases rate or epiphyseal fusion
females: breast development, triggers mid-cycle LH surge, labial/vaginal/uterine development, growth of proliferative endometrium, linear growth

62

progesterone

no male function
females: converts endometrium to a secretory endometrium

63

adrenal androgens in males and females

males: pubic hair, linear growth
females: pubic hair, linear growth

64

tanner stages for testes and pubic hair

1: preadolescent, no hair, prepubertal testes
2: testes larger, sparse long downy hair
3: testes further enlarged, penis length enlarged, darker coarser and curlier hair
4: darkening of scrotal skin, penis enlarges, coarse and curly pubic hair extending over symphysis pubis
5: adult size testes and penis, adult type pubic hair spreads to medial surface of thighs

65

tanner stages of breast development

1: preadolescent
2: elevation of breast and nipple as small projections (breast bud)
3: enlargement of breast, no separation of areola and breast, areola enlarges
4: areola and nipple project to form secondary mound above level of breast
5: only nipple projects, areola recess to contour of breast

66

tanner stages for female pubic hair

1: nothing
2: sparse, long, downy hair along labia
3: darker, coarser, curlier hair
4: coarse and curly adult-type hair covering symphysis pubis
5: adult type hair spread to medial thighs

67

STDs to test for in adolescent who is sexually active

gonorrhea
chlamydia
syphilis
trichomonas
HPV

68

3 most common causes of death in teens

unintentional injuries, homicide, suicide

69

MC drug of abuse in teens
MC illicit drug of abuse in teens

alcohol
marijuana

70

binge drinking: _____ or more drinks at one time

5

71

____of teens are sexually active by the end of high school
____of teens do not use any contraception

50% for both questions

72

3 MC STDs in the US

HSV, HPV, chlamydia

73

3 causes of vaginitis

trichomonas, bacterial vaginosis, candidal vulvovaginitis

74

malodorous, profuse, yellow green discharge
strawberry cervix
vulvar inflammation and itching
dyspareunia

trichomonas vaginalis

75

how to dx trichomonas vaginalis

wet mount
culture
vaginal pH > 4.5

76

tx for trichomonas vaginalis

oral flagyl (metronidazole)

77

grey white thin vaginal discharge
pungent fishy odor --> whiff test
little vaginal or vulvar inflammation
clue cells

bacterial vaginosis

78

how to dx BV

whiff test with KOH
clue cells on wet mount
vaginal pH > 4.5

79

tx for BV

oral metronidazole or topical intravaginal therapy with 2% clindamycin or 0.75% metronidaole gel
*unlike with trich, partners don't need to be treated

80

severe itching
white cur like vaginal discharge
vulvar and vaginal inflammation

candidal vulvovaginitis

81

how to dx candidal vulvovaginitis

wet mount of KOH shows fungal hyphae
normal vaginal pH < 4.5
positive yeast culture

82

how to tx candidal vulvovaginitis

oral fluconazole or topical intravaginal anti yeast therapies
*partners don't need to be treated

83

causes of cervicitis

gonorrhea, chlamydia, HSV, syphilis

84

dx and tx chlamydia

dx with PCR
tx with oral doxycycline, erythromycin, or azithromycin
*partners need to be treated

85

tx for gonorrhea

IM ceftriaxone OR
single dose oral therapy with ofloxacin, cefixime, or ciprofloxacin
*partners need to be treated

86

tx for PID
inpatient:
outpatient:

inpatient: IV cefoxitin + oral doxycycline OR IV clindamycin + IV gentamicin
outpatient: 14 days ofloxacin and clindamycin OR single dose IM ceftriaxone and 14 days doxycycline

this may all be outdated

87

causes of genital ulcers

HSV 1 and 2, syphilis, H ducreyi (chancroid)

88

MC STD

genital warts

89

strains of HPV that cause cervical cancer

16 and 18

90

Tzanck smear for diagnosing ____

HSV 1 and 2

91

tx for HSV caused genital ulcers

acyclovir

92

tx for primary syphilis ulcer

IM penicillin or oral doxycycline if allergic to penicillin

93

tx for chancroid

oral azithromycin, erythromycin, or IM ceftriaxone

94

3 phases of the menstrual cycle

follicular (proliferative) phase
-begins with pulsatile release of GnRH --> release of FSH and LH
ovulation phase
-LH surge secondary to peaking estradiol levels
luteal (secretory) phase
-corpus luteum makes progesterone --> secretory endometrium --> as corpus luteum involutes, progesterone and estradiol decrease, leading to endometrial sloughing and GnRH release

95

primary vs. secondary dysmenorrhea

primary- pain not associated with nay pelvic abnormality
secondary- pain due to pelvic abnormality (endometriosis, PID, bicornuate uterus, etc)

96

primary amenorrhea

no menstrual bleeding by age 16 if normal secondary sexual characteristics
no menstrual bleeding by age 14 if no normal secondary sexual characteristics

97

secondary amenorrhea

no menses for 3 cycles or 6 months after having had regular cycles

98

in amenorrhea, what does FSH and LH being high or low indicate

high FSH and LH- ovarian failure --> check for Turners
low FSH and LH- hypothalamic or pituitary suppression or failure --> check visual fields and neuroimaging

99

frequent, irregular menstrual periods, often associated with prolonged painless bleeding

dysfunctional uterine bleeding (DUB)

100

polymenorrhea

regular intervals of < 21 days

101

menorrhagia

prolonged or excessive uterine bleeding that occurs at regular intervals

102

metrorrhagia

uterine bleeding that occurs at irregular intervals

103

menometrorrhagia

prolonged or excessive bleeding that occurs at irregular intervals

104

oligomenorrhea

bleeding that occurs at regular intervals but no more often than every 35 days

105

DUB can result from ______ cycles

anovulatory

106

______ should be used for all DUB associated with anemia

hormonal therapy (ex. OCPs)
iron

107

if hormonal therapies fail for DUB, can do this

D&C

108

how to tx gynecomastia in teenage boy who is otherwise normal

reassurance
resolves in 12-15 months

109

absent cremasteric reflex on side of testicular pain

torsion of the spermatic cord

110

how to tx testicular torsion

surgical detorsion and fixation within 6 hours

111

how to dx testicular torsion

physical exam
decreased uptake on radionuclide scan or decreased pulsations on doppler ultrasound

112

blue dot sign assoc with ______

torsion of testicular appendage

113

radionuclide scan and doppler are ____ in torsion of testicular appendage

normal or increased

114

how to tx torsion of testicular appendage

reassurance, rest, analgesia

115

radionuclide scan and doppler are ____ in epididymitis

increased

116

cryptorchidism

undescended testes
risk of testicular cancer

117

hydroceles

collections of fluid in tunica vaginalis

118

dx and tx of hydroceles

dx: H&P, transillumination of scrotum reveals cystic mass
tx: reassurance

119

dilation and tortuosity of veins in the pampiniform plexus

varicoceles

120

varicoceles are most common on the _____ (left/right) and feel like _______

left
bag of worms

121

how to tx varicoceles

reassurance

122

puberty in boys begins with _______ and in girls begins with _________

testicular enlargement
breast enlargement

123

menarche occurs _______ after thelarche

2-3 years

124

STD- single painless ulcer with well-demarcated border and non purulent base, painless inguinal adenopathy

syphilis chancre

125

STD- painful ulcers that have irregular borders and a purulent base, painful inguinal adenopathy

chancroid

126

STD- multiple painful shallow ulcers, but base is not purulent

HSV

127

ziehl-neelsen stain

acid fast bacilli

128

silver stain

fungal elements

129

wright stain

stool WBCs

130

fever in children

> 100.4 (38) by rectal measurement

131

high fever in children

> 102.2 (39)

132

evaluation of fever in infants < 3 months
what tests do you send?

CBC
bcx
UA/ucx
CXR
CSF

133

fever in infants < 3 months
when to hospitalize?

if < 28 days, hospitalize no matter what
if between 28 days and 3 months, hospitalize if:
-toxic appearance
-suspected meningitis
-pna, pyelonephritis, bone and soft tissue infection unresponsive to oral abx
-patients in unstable social circumstances

134

abx management of infants < 28 days with infection

IV abx in hospital until cultures clear

135

abx management of infants 29 days-3 months with infection

if high risk, then hospitalize and give IV abx
if low risk, then outpatient and give IM abx

136

low risk criteria for children < 3 months with infection/fever

well appearing
previously healthy
no recent abx
no site of focal infection
WBC between 5000 and 15000
absolute band count < 1500
normal UA (< 5 WBCs
normal CSF

137

most likely organism causing fever in children 3-36 months

strep pneumo
HIB is on the decline since the vaccine

138

how to manage kids 3-36 months with fever

-if toxic --> complete eval, admit, abx
-if nontoxic and temp < 102.2 (39) --> monitor at home
-if nontoxic and temp > 102.2 (39) --> do the tests below
ucx for males < 6 months and females < 2 years
bcx
CXR if respiratory distress, rales, tachypnea
stool cx if blood or mucus in stool
empiric abx (for all children or for those WBC > 15,000)
re-eval in 24-48 hours

139

suspected sepsis or meningitis in 0-1 month
pathogens and empiric abx

group B strep
E Coli
Listeria
-ampicillin + gentamicin or cefotaxime (+ acyclovir if concerned for HSV infection)

140

suspected sepsis or meningitis in 1-3 months
pathogens and empiric abx

group B strep
strep pneumo
listeria
-ampicillin + cefotaxime (+ vanco if bacterial meningitis suspected)

141

suspected sepsis or meningitis in 3 months-3 years
pathogens and empiric abx

strep pneumo
HiB
N meningitidis
-cefotaxime (+ vanco if bacterial meningitis suspected)

142

suspected sepsis or meningitis in 3 years-adult
pathogens and empiric abx

streppneumo
N meningitidis
-cefotaxime (+ vanco if bacterial meningitis suspected)

143

FUO duration

at least 8 days-3 weeks

144

3 most common general causes of FUO

infectious disorders
rheumatologic disorders
malignancy

145

fever, peritonitis, pleuritis, and monoarthritis

familial mediterranean fever

146

period fever, pathos stomatitis, pharyngitis, cervical adenitis (PFAPA)

period fever syndrome

147

for FUO, when to hospitalize

generally recommended for children with fever > 2 weeks

148

highest incidence of bacterial meningitis is during _____

first month of life

149

fever may be absent or minimal in very young infants with bacterial meningitis (T/F)

T

150

LP findings in bacterial meningitis

lots of WBCs (100-50,000) predominantly neutrophils (PMNs)
hypoglycorrhachia (low CSF glucose)
increased protein
positive gram stain and culture

151

steroids can be given with first dose of abx with _____ meningitis

HIB

152

most common complication of bacterial meningitis in a child

hearing loss (up to 25%)

153

LP findings in viral meningitis

10-1000 WBC (mostly lymphs)
RBCs if HSV encephalitis
normal to high protein
normal glucose

154

LP findings in TB meningitis

10-500 WBCs (mostly lymphs)
very high protein!
low to very low glucose
**note, imaging will show basilar enhancement

155

LP findings in fungal meningitis

25-500 WBCs (mostly lymphs)
normal to high protein
low glucose

156

LP findings with parameningeal focus (brain abscess)

10-200 WBCs (can be polys or lymphs)
high protein
normal glucose

157

MCC of viral meningitis in the US (common in summer and fall)

enterovirus

158

how to tx aseptic meningitis

most viral meningitis is self-limited, exception: tx HSV encephalitis
tx with TB meningitis with isoniazid, rifampin, pyrazinamide, and streptomycin, +/- steroids

159

when do various sinuses develop?

ethmoid and maxillary present at birth
sphenoid: 3-5 years
frontal: 7-10 years

160

acute, subacute, and chronic sinusitis

acute: up to 30 days
subacute: 30-90 days
chronic: > 90 days

161

top 3 organisms implicated in sinusitis

strep pneumo
H flu
Moraxella catarrhalis

162

tx for acute and subacute sinusitis

amox, amoxicillin-clavulanate or second gen cephalosporin for 10-14 days

163

tx for chronic sinusitis

trial of broad spectrum oral abx
ct IMAGING
IV abx may be beneficial

164

common viral and bacterial causes of pharyngitis

coxsackievirus, EBV, CMV
strep pyogenes (group A beta hemolytic strep aka. GABHS or "strep throat")

165

pharyngitis with enlarged posterior cervical lymph nodes, malaise, hepatosplenomegaly

EBV pharyngitis

166

pharyngitis with painful vesicles or ulcer on posterior pharynx and soft palate (herpangina), +/- blisters on palms and soles

coxsackievirus pharyngitis
+/- hand foot and mouth disease

167

signs that it's GAHBS pharyngitis > viral cause

lack of other URI sxs (no rhinorrhea or cough)
exudates on tonsils
petechiae o n soft palate
strawberry tongue
enlarged tender anterior cervical LNs
fever
scarlatiniform rash

168

what kind of pharyngitis has "gray, adherent tonsillar membrane"

diphtheria

169

tx GAHBS pharyngitis

oral penicillin VK
single dose of IM benzathine penicillin
if penicillin allergic --> oral erythromycin or macrolides

170

tx EBV pharyngitis

may consider steroids if it's really severe

171

tx diphtheria pharyngitis

oral erythromycin or parenteral penicillin and a specific antitoxin
respiratory isolation!

172

fluid within the middle ear space w/o sxs of infection

otitis media with effusion (OME)

173

bacterial causes of acute otitis media

strep pneumo
non typeable H flu
moraxella catarrhalis

174

most reliable method of detecting middle ear fluid

pneumatic otoscopy

175

tx for AOM (acute otitis media)

abx are controversial but if you give anything, give amoxicillin
-no abx for OME (otitis media with effusion)

176

common pathogens in otitis externa

pseudomonas
staph aureus
candida albicans

177

tx for otitis externa

if mild --> acetic acid to restore natural environment of the external auditory canal
if more severe --> topical abx +/- topical steroid
if caused by perforated AOM --> oral and topical abx

178

common causes of cervical lymphadenitis

staph aureus is most common
strep pyogenes
mycobacteria
bartonella henselae (cat scratch disease)
EBV, CMV, HIV
kawasaki disease- unilateral cervical lymphadenitis
Toxoplasma gondii- looks like mono with cervical LAD

179

initial management of cervical lymphadenitis

tx for the most common cause: staph
first ten cephalosporin or anti-staph penicillin for 7-10 days

180

common causes of parotitis

mumps and CMV, EBV, HIV, influenza --> bilateral
bacteria such as staph aureus, strep progenies, and mycobacteria tuberculosis --> unilateral

181

how to tx parotitis
viral and bacterial

viral- supportive care
bacterial- abx that cover staph aureus and strep pyogenes

182

superficial skin infection involving the upper dermis, honey colored crust

impetigo

183

causes and tx of impetigo

staph aureus, GABHS (strep pyogenes)
tx with topical mupirocin, oral abx such as dicloxacillin, cephalexin, or clindamycin

184

skin infection involving the dermal lymphatics
tender erythematous skin with a distinct border- face and scalp are common places

erysipelas

185

common cause of erysipelas

GABHS

186

tx of erysipelas

abx against GABHS

187

skin infection occurring within the dermis
infected skin border is indistinct

cellulitis

188

common causes of cellulitis

staph aureus and GABHS

189

tx for cellulitis

first gen cephalosporins or anti-staph penicillins

190

unilateral bluish discoloration on the cheek of a young unimmunized child... what is it and what is the causative agent?

buccal cellulitis
HIB

191

how to manage buccal cellulitis

IV abx against H influenza (2nd or 3rd gen cephalosporin like cefuroxime or cefotaxime)
LP to eval for meningitis

192

most common cause of perianal cellulitis

GABHS

193

cause of nec fasc is often _________ but may involve _____ and ______

polymicrobial
GABHS
anaerobic bacteria

194

in staph scalded skin, you may see ______ sign
how to tx?

Nikolsky
good wound care, IV abx against staph aureus

195

scarlet fever is caused by a toxin produced by _______ infection

GABHS
can be impetigo, cellulitis, pharyngitis, etc

196

exanthem of scarlet fever

-begins on trunk and moves peripherally
-skin is erythematous with tiny skin colored papules and has the texture of sandpaper
-rash blanches with pressure
-petechiae distributed in skin creases (pastia's lines)
-desquamation as it's resolving

197

how to tx scarlet fever

oral penicillin VK
IM benzathine penicillin
if PCN allergic --> erythromycin or macrocodes

198

complications of GABHS infections (4)
-which ones can you prevent with abx?

-post strep glomerulonephritis: HTN and coca colored urine, can NOT be prevented
-rheumatic fever- CAN be prevented
-post strep arthritis- can NOT be prevented
-PANDAS- OCD or tic disorder after strep infection... CAN be prevented

199

fever, shock, desquamating skin rash, multi organ dysfunction

toxic shock syndrome

200

bacteria that cause TSS

staph aureus > GABHS

201

how to tx TSS

-supportive measures
-anti-staph abx
-removal of nidus of infection if applicable
+/- IVIG

202

6 criteria of TSS
6/6 = confirmed
5/6 = probable

1. temp > 101 (38.5)
2. hypotension (SBP < 90 or < 5th percentile for age)
3. diffuse macular erythroderma (looks like sunburn)
4. desquamation 10-14 days after onset of illness
5. multisystem involving, including 3 or more:
-GI- N/V/D, abdominal pain
-myalgias or elevated CK
-hyperemia of mucous membranes
-pyuria in presence of negative urine cultures or elevated BUN and Cr to 2x normal
-thrombocytopenia
-CNS dysfunction
6. negative cultures of blood, CSF, and pharynx (except for positive blood cx for staph aureus)

203

2 most common viral causes of diarrhea

rotavirus- most common agent causing gastroenteritis, common in winter months, lasts 4-7 days, positive stool ELISA, supportive tx
norwalk virus- common in all age groups esp daycares, schools, cruises, lasts 48-72 hours, supportive tx

204

diarrhea assoc with lizards and turtles, eggs, poultry, milk
-can be bloody or non bloody
-can be WBCs or not
-only treat if invasive (3rd gen cephalosporin)

salmonella

205

electrolyte finding in diarrhea

non anion gap hyperchloremic metabolic acidosis

206

when should you do a stool culture?

only if WBCs are present

207

-major cause of traveler's diarrhea
-no stool WBCs
-abx may shorten duration of sxs

ETEC

208

-watery diarrhea often in preschoolers
-no stool WBCs
-tx with oral sulfonamides or quinolones

EPEC

209

-bloody diarrhea
-can cause HUS if it's strain 0157:H7
-stool WBCs present

EHEC

210

how to tx EHEC if it gives you HUS

don't give abx as it may worsen endotoxin release

211

-bloody diarrhea, may have seizures
-stool WBCs present
-tx with 3rd gen cephalosporins or fluroquinolones

shigella sonnei

212

-most common cause of bacterial bloody diarrhea in the US
-often in poultry
-stool WBCs are present if blood is present
-tx with oral erythromycin but sxs often resolve anyways

campylobacter jejuni

213

-mesenteric adenitis, can mimic acute appendicitis
-3rd gen cephalosporins can be used

yersinia enterocolitica

214

-diarrhea after abx use
-pseudomembranes
-tx with flagyl (+PO vanco for resistant cases)

c diff

215

-watery diarrhea with massive water loss in foreign country
-tx with fluid replacement, abx generally not used

vibrio cholerae

216

factors that decrease vertical HIV transmission

-low maternal viral load
-c section
-adherence to therapy and postexposure ppx

217

asymptomatic in first year but
-failure to thrive
-thrombocytopenia
-recurrent infections
-LAD
-parotitis
-recurrent difficult to treat thrush
-loss of developmental milestones
-severe varicella infection or zoster

signs of HIV in babies

218

how to monitor for HIV in babies born to infected moms

maternal antibodies persist unti 18-24 months
-do PCR monthly until 4 months --> if negative at 4 months, then infant has not been infected --> follow until they lose their maternal antibodies

219

what to give to babies at risk for HIV

-zidovudine for 6 weeks
-bactrim until negative at 4 months
-no breastfeeding
-urine CMV culture

220

what to do for babies infected with HIV

-start HAART
-ppx for opportunistic infections per age and CD4 count
-give all immunizations except the varicella (MMR is ok)
-monitor CD4 and viral load
-annual eye exam for CMV retinitis

221

ppx and tx for PCP

ppx: bactrim
tx: bactrim, pentamidine, atovaquone

222

risk for MAC when CD4 < _______

50
-fever, weight loss, night sweats, abdominal pain, bone marrow suppression, elevated LFTs

223

adolescent with fever, malaise, fatigue, pharyngitis, posterior cervical LAD, hepatosplenomegaly, macular or scarlatiniform rash, resolves in weeks to months

infectious mononucleosis caused by EBV (can also be todo, CMV, and HIV)

224

dx EBV mononucleosis

-labs: atypical lymphocytes (esp B lymphocyte), neutropenia, thrombocytopenia, elevated transaminases
-first line is mono spot looking for heterophile antibody
-this is less sensitive in kids < 4 years
-for kids less than 4 years, get EBV antibody titers
-acutely: positive IgM-VCA and negative Ab to EBNA
-2-3 months later: positive Ab to EBNA

225

most common cause of mono spot negative infectious mononucleosis in older children

CMV

226

how to tx EBV infectious mononucleosis

supportive tx
if severe pharyngitis, then can give steroids

227

complications of EBV infectious mono

-neurologic complications: CN palsies, encephalitis
-amox associated rash if mistaken for strep throat
-splenic rupture
-malignancy: nasopharyngeal carcinoma, Burkitt's lymphoma

228

virus of the paramyxoviridae family

measles (aka rubeola)

229

incubation period of measles

8-12 days

230

3 C's of the classic prodrome of measles

cough, conjunctivitis, coryza
also photophobia and low grade fever may be present

231

enanthem of measles

koplik spots- small gray papules on an erythematous based located on the buccal mucosa
***these are pathognomonic of measles

232

describe the exanthem of measles

maculopapular starts around neck and ears and spreads down to chest and upper extremities by day 1, LE by day 2, confluent by day 3, lasts 4-7 days

233

do you see a fever with measles?

yes, usually T > 101 (38.3)

234

_______ is the MC complication and MC cause of mortality with measles

bacterial pneumonia

235

other complications of measles:

otitis media
laryngotracheitis
encephalomyelitis
subacute sclerosing panencephalitis- rare and late

236

how to tx measles

-supportive tx
-vitamin A
-IG ppx for high risk individuals who have been exposed

237

togavirus

rubella/German measles

238

unlike measles, rubella is often _______ and the exanthem only lasts ______

asymptomatic
3-4 days

239

-prodrome: URI, low grade fever
-painful LAD
-non pruritic, maculopapular rash that spreads from face to trunk to extremities and lasts 3-4 days
-mild fever < 101

rubella

240

meningoencephalitis and polyarteritis can be complications of _______

rubella

241

congenital rubella syndrome occurs when mother is infected during __________. _____% of infected fetuses have anomalies

first trimester
30-50%

242

-thrombocytopenia
-HSM
-jaundice
-purpura (blueberry muffin baby)
-congenital cataracts
-PDA
-sensorineural hearing loss
-meningoencephalitis
-MR, HTN, DM1, autoimmune thyroid disease

congenital rubella syndrome

243

-invasive aspergillosis occurs in ________ pts... tx with amphotericin B and surgery
-allergic bronchopulmonary aspergillosis occurs in pts with ________... tx with steroids and maybe anti fungal drugs

immunocompromised
chronic lung dz such as CF

244

coccidiomycosis occurs in this geographic area

SW US and Mexico

245

how you contract entamoeba histolytica

ingestion of cyst in contaminated food or water

246

symptoms and signs of entamoeba histolytica infection

-most pts are asymptomatic
-can get cramping abdominal pain, tenesmus, diarrhea that may contain blood or mucus
-may form abscess in liver and other organs

247

how to dx amebiasis

stool cysts or trophozoites

248

how to tx amebiasis

metronidazole
+/- iodoquinol (luminal amebicide)

249

how you get giardia

drinking contaminated water for the most part

250

sxs of giardia infection

voluminou watery and foul smelling diarrhea
bloating, flatulence, weight loss

251

how to dx giardia

look at stool for cysts and trophozoites, stool ELISA

252

how to tx giardia

metronidazole

253

______ is the most important parasitic cause of morbidity and mortality in the world
which species is responsible for most severe dz?

malaria
plasmodium falciparum

254

transmission of malaria is via _______

anopheles mosquito

255

sxs of malaria

flu-like prodrome
cyclical fevers 48-72 hours correlating with RBC rupture and subsequent parasitemia
can have hemolytic anemia, splenomegaly, jaundice, etc

256

how to dx malaria

thin and thick giemsa stained peripheral blood smears
-thick for screening
-thin for species and stage identification

257

medications for malaria

chloroquine, quinine, quinidine gluconate, mefloquine, doxycycline depending on resistance patterns and species
-can do pox with chloroquine, mefloquine, doxyclycline, or atovaquone

258

toxoplasmosis can be transmitted via contact with ______ but also with undercooked meats and contaminated fruits and veggies

cat feces

259

most cases of toxoplasmosis are asymptomatic unless you're immunocompromised... then you might present with ________

focal seizures

260

ocular toxo is the most common cause of __________

infectious chorioretinitis

261

triad of congenital toxo

hydrocephalus, intracranial calcifications, choreoretinitis

262

when should you tx for toxo?

congenital toxo
pregnant women with acute todo
immunocrompromised ppl with reactivated brain lesions
-tx with sulfadiazine and pyrimethamine

263

general concept of dx for helminth infections

3 separate stop examinations
can use cellulose tape test for pinworms

264

MCC epilepsy in places like Mexico and Central America

neurocysticercosis

265

signs and sxs of cysticercosis

subcutaneous nodules
4th vetnricle
seizures, hydrocephalus, stroke

266

how to dx cysticercosis

stool exam only sensitive 25% of time
serology
head CT or MRI

267

how to tx cysticercosis

meds for ppl with the adult tapeworm
if old cysts on brain imaging, can give anti-epileptics

268

fever
petechial rash that begins on extremities and moves in a caudal and centripetal direction
myalgias
HSM and jaundice
CNS sxs
hypotension

rocky mountain spotted fever caused by rickettsia rickettsii (transmitted via tick bite)

269

RMSF is most common in _____ region of US

southeast

270

dx RMSF

thrombocytopenia, elevated transaminases, hyponatremia
serologic tests

271

how to tx RMSF

oral or IV doxycycline and supportive care
*note: ppx abx after tick bites are not indicated

272

what is spotless RMSF

ehrlichiosis
-occurs in SE US as well-same sxs but no rash
-dx with serology or PCR
-tx with doxycycline and supportive care

273

what bacteria causes cat scratch disease

bartonella henselae

274

regional LAD after cat or kitten scratch
-papule at initial scratch followed by LAD 1-2 wks later
-can see Parinaud oculoglandular syndrome

cat scratch disease

275

dx cat scratch dz

elevated IgM antibody to B henselae

276

how to tx cat scratch dz

supportive unless pt has systemic dz or is immunocompromised
-then give oral azithromycin, bacterium, or cipro
-don't do surgery

277

children < 12 years of age with TB are generally not contagious (T/F)

T

278

this age of children are most at risk for TB disease

infants < 12 months

279

most common form of extra pulmonary TB disease in children

cervical lymphadenitis (scrofula)
other extrapulm: meningitis, abd involvement, skin and joint, Pott's disease (vertebrae), disseminated or miliary disease

280

PPD readings based on risk factors

> 5 mm: close contact with TB disease, clinical or radiographic findings of TB, immunocompromised
> 10 mm: younger than 4 years, chronic medical condition, live in TB endemic area
> 15 mm: older than 4 years, no other risk factors

281

how to dx TB disease in children

positive culture from gastric aspirate
positive AFB stianing
positive histology from bx specimen

282

how to tx latent TB

isoniazid for 9 months
-give pyridoxine (vitamin B6) to prevent neuro sxs of tx

283

how to tx TB disease

2 months INH, rifampin, pyrazinamide
4 months of INH and rifampin

284

what to do for fever in baby < 28 days

total eval
IV abx
hospitalization

285

what to do for fever in baby 7 months old

ucx, UA, CBC, blood cx
if WBC > 15,000 then IM ceftriaxone
no hospitalization unless toxic, dehydrated, or poor followup
*doesn't need CXR or LP in a nontoxic pt with no respiratory signs

286

early in viral meningitis, WBC may be PMN predominant with subsequent shift to lymphocyte predominant (T/F)

T

287

steroids can reduce incidence of hearing loss in meningitis caused by _____

HIB

288

which 2 post-strep complications can be prevented with abx

PANDAS and rheumatic fever

289

bulky foul smelling stools, weight loss, day care attendance

giardia

290

gray white malodorous vaginal discharge, fishy odor, little vaginal or vulvar inflammation
what is it, what do you see on microscopy, do you need to tx partners

BV
clue cells
no need to tx partners
no abx or antiyeast meds are indicated

291

MCC FUO
in what % of cases is a cause found

uncommon presentation of common thing
infectious > rheumatologic
75% of cases, a cause is found eventually

292

E Tox is associated with which cells in the lesions

eosinophils

293

what is D-penicillamine used for

increases copper clearance in Wilson's disease

294

_____ can help eliminate tyrosine in transient tyrosinemia of the newborn

vitamin C

295

peripheral precocious puberty
hyperthyroidism
coast of Maine spots
fibrous dysplasia of bones --> fxs

mccune-albright syndrome

296

hypogonadotropic hypogonadism
anosmia (absent sense of smell)

kallman syndrome

297

hypotonia, hypogonadism, small hands and feet, growth problems in first year of life 2/2 feeding problems, hyperphagia and obesity later in childhood

Prader-Willi syndrome

298

ovarian dysgenesis
short stature
webbing of the neck
left sided congenital heart disease
hypothyroidism

Turner syndrome

299

hypogonadism
retinitis pigmentosa
obesity
polysyndactyly

laurence-moon-biedl syndrome

300

infants of diabetic mothers may have ______ cardiomyopathy

hypertrophic

301

causes of dilated cardiomyopathy

virral myocarditis
carnitine deficiency
anomalous origin of the left coronary artery <-- can present with MI

302

how to tx 7 day old boy with b/l conjunctival discharge

oral erythromycin b/c it's most likely chlamydia infection

303

unilateral parotitis is most likely caused by infection with _____

staph aureus
strep pyogenes
mycobacterium tuberculosis

304

cataracts, congenital heart disease (often PDA), sensorineural hearing loss, thrombocytopenia and extramedullary hematopoiesis manifesting as blueberry muffin

congenital rubella

305

hydrocephalus, intracranial calcifications, chorioretinitis assoc with congenital ______

toxoplasmosis

306

microcephaly, HSM, cerebral calcifications but no cataracts or congenital heart disease
this is most likely congenital _______

CMV infection

307

can sit with support
vocalize with mixed vowel and consonant sounds
just learned to transfer objects from hand to hand

6 months of age

308

dancing eyes and dancing feet

neuroblastoma with acute cerebellar atrophy

309

hemihypertrophy, aniridia, GU malformation, abdominal mass

Wilms tumor

310

prognosis for neuroblastoma for children < 1 year

quite good
can spontaneously regress

311

what endocrine abnormality to look for in Turner syndrome

hypothyroidism

312

in pts with OI, screen for this

early conductive hearing loss

313

how to tx early localized Lyme disease
if < 9 years
if > 9 years

< 9 years --> amoxicillin
> 9 years --> doxycycline

314

GBS is often associated with a recent _____ infection

campylobacter

315

myoclonic seizures, progressive neuro degenerations, MR, pale kinky friable hair
what is it, what lab abnormality

menkes kinky hair disease
low serum copper level

316

symmetric dry vesiculobullous scaly rash, FTT, chronic diarrhea
what is it, what lab abnormality

acrodermatitis enteropathica
zinc deficiency

317

parathyroid hypoplasia
cellular mediated immunodeficiency --> recurrent fungal infections
cardiac findings- aortic arch abnormalities
defect in structures derived from 3rd and 4th pharyngeal pouches
what is it and what lab abnormality might you find?

digeorge
hypocalcemia

318

interrupted aortic arch
recurrent fungal infections
small chin
short palpebral fissures

digeorge syndrome

319

12 month old boy with vesicles and scales in the diaper area, FTT, chronic diarrhea

acrodermatitis enteropathica- zinc deficiency