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Pediatrics > BRS #1 > Flashcards

BRS #1 Flashcards

1
Q

causes of congenital microcephaly

A 
TORCH
toxo
other- syphilis
rubella
CMV
herpes simplex

also in utero drugs and toxins and chromosomal abnormalities

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2
Q

causes of acquired microcephaly- born with normal head circumference

A

perinatal asphyxia
intraventricular hemorrhage
craniosynostosis
late prenatal and perinatal infections

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3
Q

iron deficiency anemia peaks between _____ and ____ months

A

9 and 15

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4
Q

a common cause of iron deficiency anemia

A

introduction of cow’s milk before 9 months of age

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5
Q

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

A

F

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6
Q

contraindications to circumcision

A

hypospadias, prematurity, bleeding diathesis

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7
Q

most common organism in nursing or bottle caries

A

strep mutans

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8
Q

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

A

first year of life

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9
Q

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

A

F- these walkers have a risk of injury

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10
Q

ADHD is more common in ______ (girls/boys)

genetics play a large role (T/F)

A

boys

T

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11
Q

tx for ADHD

A

first line: stimulants

second line: clonidine, TCAs

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12
Q

ADHD and _________ may be genetically related

A

tourette’s

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13
Q

childhood hearing loss is _____% genetic and ______% others

A

80% genetic- autosomal recessive

20% others

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14
Q

good prognostic factors for hearing loss

A
  • inherited deafness > acquired deafness
  • older age of onset (acquire language structure before deafness)
  • earlier interventions/diagnosis
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15
Q

what to check for hearing loss

A

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

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16
Q

leading causes of blindness in children

A
  • trachoma infection in developing nations- MCC blindness worldwide
  • retinopathy of prematurity
  • congenital cataracts
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17
Q

haptic perception

A

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

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18
Q

define colic

A

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

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19
Q

colic occurs in __% of newborns

A

10%

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20
Q

time period of colic

A

begins 2-4 weeks

resolves by 3-4 months

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21
Q

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

A

boys

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22
Q

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

A

13

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23
Q

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

A

vasopressin (diurnal variation)

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24
Q

labs to get for enuresis

A

UA/UCx, others as appropriate

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25
Q

tx for enuresis

A

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

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26
Q

day night reversal/random sleeping is normal during _______

A

first few weeks of life

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27
Q

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

A

5 hours

50% of infants sleep through the night by 3 months

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28
Q

nightmares occur during _____ and night terrors occur during ______

A

nightmares: REM

night terrors: stage 4 non-REM

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29
Q

typical age range for temper tantrums

A

age 1-3

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30
Q

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

A

T

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31
Q

cyanotic vs. pallid spells

A

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

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32
Q

management of breath holding spells

A

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

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33
Q

toilet training ages

A

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

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34
Q

discipline techniques by age

A

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

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35
Q

unusual to see hand preference before age _____

A

18 months

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36
Q

appropriately uses household objects in imitation

what age is the child?

A

15-18 months

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37
Q

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

A

F

it is non progressive

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38
Q

language development

A

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

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39
Q

age range for symbolic play

A

24-30 months

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40
Q

cause and effect starts around _____

A

9 months

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41
Q

object permanence age

A

9 months

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42
Q

mama and dada age

A

9-12 months

usually have 1-3 additional words by 12 months

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43
Q

separation anxiety age

A

6-18 months

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44
Q

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

A

9 months

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45
Q

transfer objects and sit alone age

A

6 months

-babbling

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46
Q

parachute reaction age

A

8 months

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47
Q

average duration of growth spurt

A

2-3 years

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48
Q

growth is mainly controlled by this hormone

A

growth hormone

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49
Q

growth spurt occurs _______ earlier in females than in males

A

18-24 months

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50
Q

average duration of puberty

A

3-4 years

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51
Q

adrenarche

A

onset of adrenal androgen steroidogenesis

occurs 2 years before maturation of HPG axis

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52
Q

puberty begins ______ later in males than in females

A

6-12 months

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53
Q

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

A

testicular enlargement

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54
Q

facial and axillary hair growth starts _____ after pubic hair growth

A

2 years

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55
Q

puberty begins with _________ at age 9.5 in females

A

thelarche (development of breast buds)

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56
Q

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

A

12.5

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57
Q

3 stages of adolescence

A

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

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58
Q

FSH in males and females

A

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

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59
Q

LH in males and females

A

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

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60
Q

testosterone in males and females

A

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

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61
Q

estradiol in males and females

A

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

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62
Q

progesterone

A

no male function

females: converts endometrium to a secretory endometrium

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63
Q

adrenal androgens in males and females

A

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

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64
Q

tanner stages for testes and pubic hair

A

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

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65
Q

tanner stages of breast development

A

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

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66
Q

tanner stages for female pubic hair

A

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

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67
Q

STDs to test for in adolescent who is sexually active

A 
gonorrhea
chlamydia
syphilis
trichomonas 
HPV
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68
Q

3 most common causes of death in teens

A

unintentional injuries, homicide, suicide

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69
Q

MC drug of abuse in teens

MC illicit drug of abuse in teens

A

alcohol

marijuana

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70
Q

binge drinking: _____ or more drinks at one time

A

5

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71
Q

____of teens are sexually active by the end of high school

____of teens do not use any contraception

A

50% for both questions

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72
Q

3 MC STDs in the US

A

HSV, HPV, chlamydia

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73
Q

3 causes of vaginitis

A

trichomonas, bacterial vaginosis, candidal vulvovaginitis

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74
Q

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

A

trichomonas vaginalis

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75
Q

how to dx trichomonas vaginalis

A

wet mount
culture
vaginal pH > 4.5

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76
Q

tx for trichomonas vaginalis

A

oral flagyl (metronidazole)

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77
Q

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

A

bacterial vaginosis

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78
Q

how to dx BV

A

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

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79
Q

tx for BV

A

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

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80
Q

severe itching
white cur like vaginal discharge
vulvar and vaginal inflammation

A

candidal vulvovaginitis

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81
Q

how to dx candidal vulvovaginitis

A

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

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82
Q

how to tx candidal vulvovaginitis

A

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

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83
Q

causes of cervicitis

A

gonorrhea, chlamydia, HSV, syphilis

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84
Q

dx and tx chlamydia

A

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

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85
Q

tx for gonorrhea

A

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

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86
Q

tx for PID
inpatient:
outpatient:

A

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

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87
Q

causes of genital ulcers

A

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

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88
Q

MC STD

A

genital warts

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89
Q

strains of HPV that cause cervical cancer

A

16 and 18

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90
Q

Tzanck smear for diagnosing ____

A

HSV 1 and 2

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91
Q

tx for HSV caused genital ulcers

A

acyclovir

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92
Q

tx for primary syphilis ulcer

A

IM penicillin or oral doxycycline if allergic to penicillin

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93
Q

tx for chancroid

A

oral azithromycin, erythromycin, or IM ceftriaxone

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94
Q

3 phases of the menstrual cycle

A

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

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95
Q

primary vs. secondary dysmenorrhea

A

primary- pain not associated with nay pelvic abnormality

secondary- pain due to pelvic abnormality (endometriosis, PID, bicornuate uterus, etc)

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96
Q

primary amenorrhea

A

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

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97
Q

secondary amenorrhea

A

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

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98
Q

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

A

high FSH and LH- ovarian failure –> check for Turners

low FSH and LH- hypothalamic or pituitary suppression or failure –> check visual fields and neuroimaging

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99
Q

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

A

dysfunctional uterine bleeding (DUB)

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100
Q

polymenorrhea

A

regular intervals of < 21 days

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101
Q

menorrhagia

A

prolonged or excessive uterine bleeding that occurs at regular intervals

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102
Q

metrorrhagia

A

uterine bleeding that occurs at irregular intervals

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103
Q

menometrorrhagia

A

prolonged or excessive bleeding that occurs at irregular intervals

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104
Q

oligomenorrhea

A

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

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105
Q

DUB can result from ______ cycles

A

anovulatory

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106
Q

______ should be used for all DUB associated with anemia

A 
hormonal therapy (ex. OCPs)
iron
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107
Q

if hormonal therapies fail for DUB, can do this

A

D&C

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108
Q

how to tx gynecomastia in teenage boy who is otherwise normal

A

reassurance

resolves in 12-15 months

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109
Q

absent cremasteric reflex on side of testicular pain

A

torsion of the spermatic cord

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110
Q

how to tx testicular torsion

A

surgical detorsion and fixation within 6 hours

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111
Q

how to dx testicular torsion

A

physical exam

decreased uptake on radionuclide scan or decreased pulsations on doppler ultrasound

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112
Q

blue dot sign assoc with ______

A

torsion of testicular appendage

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113
Q

radionuclide scan and doppler are ____ in torsion of testicular appendage

A

normal or increased

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114
Q

how to tx torsion of testicular appendage

A

reassurance, rest, analgesia

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115
Q

radionuclide scan and doppler are ____ in epididymitis

A

increased

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116
Q

cryptorchidism

A

undescended testes

risk of testicular cancer

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117
Q

hydroceles

A

collections of fluid in tunica vaginalis

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118
Q

dx and tx of hydroceles

A

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

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119
Q

dilation and tortuosity of veins in the pampiniform plexus

A

varicoceles

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120
Q

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

A

left

bag of worms

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121
Q

how to tx varicoceles

A

reassurance

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122
Q

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

A

testicular enlargement

breast enlargement

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123
Q

menarche occurs _______ after thelarche

A

2-3 years

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124
Q

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

A

syphilis chancre

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125
Q

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

A

chancroid

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126
Q

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

A

HSV

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127
Q

ziehl-neelsen stain

A

acid fast bacilli

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128
Q

silver stain

A

fungal elements

129
Q

wright stain

A

stool WBCs

130
Q

fever in children

A

> 100.4 (38) by rectal measurement

131
Q

high fever in children

A

> 102.2 (39)

132
Q

evaluation of fever in infants < 3 months

what tests do you send?

A 
CBC
bcx
UA/ucx
CXR
CSF
133
Q

fever in infants < 3 months

when to hospitalize?

A

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
Q

abx management of infants < 28 days with infection

A

IV abx in hospital until cultures clear

135
Q

abx management of infants 29 days-3 months with infection

A

if high risk, then hospitalize and give IV abx

if low risk, then outpatient and give IM abx

136
Q

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

A 
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
Q

most likely organism causing fever in children 3-36 months

A

strep pneumo

HIB is on the decline since the vaccine

138
Q

how to manage kids 3-36 months with fever

A

-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
Q

suspected sepsis or meningitis in 0-1 month

pathogens and empiric abx

A

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

140
Q

suspected sepsis or meningitis in 1-3 months

pathogens and empiric abx

A

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

141
Q

suspected sepsis or meningitis in 3 months-3 years

pathogens and empiric abx

A

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

142
Q

suspected sepsis or meningitis in 3 years-adult

pathogens and empiric abx

A

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

143
Q

FUO duration

A

at least 8 days-3 weeks

144
Q

3 most common general causes of FUO

A

infectious disorders
rheumatologic disorders
malignancy

145
Q

fever, peritonitis, pleuritis, and monoarthritis

A

familial mediterranean fever

146
Q

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

A

period fever syndrome

147
Q

for FUO, when to hospitalize

A

generally recommended for children with fever > 2 weeks

148
Q

highest incidence of bacterial meningitis is during _____

A

first month of life

149
Q

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

A

T

150
Q

LP findings in bacterial meningitis

A

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

151
Q

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

A

HIB

152
Q

most common complication of bacterial meningitis in a child

A

hearing loss (up to 25%)

153
Q

LP findings in viral meningitis

A

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

154
Q

LP findings in TB meningitis

A

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

155
Q

LP findings in fungal meningitis

A

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

156
Q

LP findings with parameningeal focus (brain abscess)

A

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

157
Q

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

A

enterovirus

158
Q

how to tx aseptic meningitis

A

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

159
Q

when do various sinuses develop?

A

ethmoid and maxillary present at birth

sphenoid: 3-5 years
frontal: 7-10 years

160
Q

acute, subacute, and chronic sinusitis

A

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

161
Q

top 3 organisms implicated in sinusitis

A

strep pneumo
H flu
Moraxella catarrhalis

162
Q

tx for acute and subacute sinusitis

A

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

163
Q

tx for chronic sinusitis

A

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

164
Q

common viral and bacterial causes of pharyngitis

A 
coxsackievirus, EBV, CMV
strep pyogenes (group A beta hemolytic strep aka. GABHS or "strep throat")
165
Q

pharyngitis with enlarged posterior cervical lymph nodes, malaise, hepatosplenomegaly

A

EBV pharyngitis

166
Q

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

A

coxsackievirus pharyngitis

+/- hand foot and mouth disease

167
Q

signs that it’s GAHBS pharyngitis > viral cause

A 
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
Q

what kind of pharyngitis has “gray, adherent tonsillar membrane”

A

diphtheria

169
Q

tx GAHBS pharyngitis

A

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

170
Q

tx EBV pharyngitis

A

may consider steroids if it’s really severe

171
Q

tx diphtheria pharyngitis

A

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

172
Q

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

A

otitis media with effusion (OME)

173
Q

bacterial causes of acute otitis media

A

strep pneumo
non typeable H flu
moraxella catarrhalis

174
Q

most reliable method of detecting middle ear fluid

A

pneumatic otoscopy

175
Q

tx for AOM (acute otitis media)

A

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

176
Q

common pathogens in otitis externa

A

pseudomonas
staph aureus
candida albicans

177
Q

tx for otitis externa

A

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
Q

common causes of cervical lymphadenitis

A

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
Q

initial management of cervical lymphadenitis

A

tx for the most common cause: staph

first ten cephalosporin or anti-staph penicillin for 7-10 days

180
Q

common causes of parotitis

A

mumps and CMV, EBV, HIV, influenza –> bilateral

bacteria such as staph aureus, strep progenies, and mycobacteria tuberculosis –> unilateral

181
Q

how to tx parotitis

viral and bacterial

A

viral- supportive care

bacterial- abx that cover staph aureus and strep pyogenes

182
Q

superficial skin infection involving the upper dermis, honey colored crust

A

impetigo

183
Q

causes and tx of impetigo

A

staph aureus, GABHS (strep pyogenes)

tx with topical mupirocin, oral abx such as dicloxacillin, cephalexin, or clindamycin

184
Q

skin infection involving the dermal lymphatics

tender erythematous skin with a distinct border- face and scalp are common places

A

erysipelas

185
Q

common cause of erysipelas

A

GABHS

186
Q

tx of erysipelas

A

abx against GABHS

187
Q

skin infection occurring within the dermis

infected skin border is indistinct

A

cellulitis

188
Q

common causes of cellulitis

A

staph aureus and GABHS

189
Q

tx for cellulitis

A

first gen cephalosporins or anti-staph penicillins

190
Q

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

A

buccal cellulitis

HIB

191
Q

how to manage buccal cellulitis

A

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

192
Q

most common cause of perianal cellulitis

A

GABHS

193
Q

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

A

polymicrobial
GABHS
anaerobic bacteria

194
Q

in staph scalded skin, you may see ______ sign

how to tx?

A

Nikolsky

good wound care, IV abx against staph aureus

195
Q

scarlet fever is caused by a toxin produced by _______ infection

A

GABHS

can be impetigo, cellulitis, pharyngitis, etc

196
Q

exanthem of scarlet fever

A
  • 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
Q

how to tx scarlet fever

A

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

198
Q

complications of GABHS infections (4)

-which ones can you prevent with abx?

A
  • 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
Q

fever, shock, desquamating skin rash, multi organ dysfunction

A

toxic shock syndrome

200
Q

bacteria that cause TSS

A

staph aureus > GABHS

201
Q

how to tx TSS

A

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

202
Q

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

A
  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
Q

2 most common viral causes of diarrhea

A

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
Q

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)
A

salmonella

205
Q

electrolyte finding in diarrhea

A

non anion gap hyperchloremic metabolic acidosis

206
Q

when should you do a stool culture?

A

only if WBCs are present

207
Q
  • major cause of traveler’s diarrhea
  • no stool WBCs
  • abx may shorten duration of sxs
A

ETEC

208
Q
  • watery diarrhea often in preschoolers
  • no stool WBCs
  • tx with oral sulfonamides or quinolones
A

EPEC

209
Q
  • bloody diarrhea
  • can cause HUS if it’s strain 0157:H7
  • stool WBCs present
A

EHEC

210
Q

how to tx EHEC if it gives you HUS

A

don’t give abx as it may worsen endotoxin release

211
Q
  • bloody diarrhea, may have seizures
  • stool WBCs present
  • tx with 3rd gen cephalosporins or fluroquinolones
A

shigella sonnei

212
Q
  • 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
A

campylobacter jejuni

213
Q
  • mesenteric adenitis, can mimic acute appendicitis

- 3rd gen cephalosporins can be used

A

yersinia enterocolitica

214
Q
  • diarrhea after abx use
  • pseudomembranes
  • tx with flagyl (+PO vanco for resistant cases)
A

c diff

215
Q
  • watery diarrhea with massive water loss in foreign country

- tx with fluid replacement, abx generally not used

A

vibrio cholerae

216
Q

factors that decrease vertical HIV transmission

A
  • low maternal viral load
  • c section
  • adherence to therapy and postexposure ppx
217
Q

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
A

signs of HIV in babies

218
Q

how to monitor for HIV in babies born to infected moms

A

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
Q

what to give to babies at risk for HIV

A
  • zidovudine for 6 weeks
  • bactrim until negative at 4 months
  • no breastfeeding
  • urine CMV culture
220
Q

what to do for babies infected with HIV

A
  • 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
Q

ppx and tx for PCP

A

ppx: bactrim
tx: bactrim, pentamidine, atovaquone

222
Q

risk for MAC when CD4 < _______

A

50

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

223
Q

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

A

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

224
Q

dx EBV mononucleosis

A
  • 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
Q

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

A

CMV

226
Q

how to tx EBV infectious mononucleosis

A

supportive tx

if severe pharyngitis, then can give steroids

227
Q

complications of EBV infectious mono

A
  • neurologic complications: CN palsies, encephalitis
  • amox associated rash if mistaken for strep throat
  • splenic rupture
  • malignancy: nasopharyngeal carcinoma, Burkitt’s lymphoma
228
Q

virus of the paramyxoviridae family

A

measles (aka rubeola)

229
Q

incubation period of measles

A

8-12 days

230
Q

3 C’s of the classic prodrome of measles

A

cough, conjunctivitis, coryza

also photophobia and low grade fever may be present

231
Q

enanthem of measles

A

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

232
Q

describe the exanthem of measles

A

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
Q

do you see a fever with measles?

A

yes, usually T > 101 (38.3)

234
Q

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

A

bacterial pneumonia

235
Q

other complications of measles:

A

otitis media
laryngotracheitis
encephalomyelitis
subacute sclerosing panencephalitis- rare and late

236
Q

how to tx measles

A
  • supportive tx
  • vitamin A
  • IG ppx for high risk individuals who have been exposed
237
Q

togavirus

A

rubella/German measles

238
Q

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

A

asymptomatic

3-4 days

239
Q
  • 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
A

rubella

240
Q

meningoencephalitis and polyarteritis can be complications of _______

A

rubella

241
Q

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

A

first trimester

30-50%

242
Q
  • thrombocytopenia
  • HSM
  • jaundice
  • purpura (blueberry muffin baby)
  • congenital cataracts
  • PDA
  • sensorineural hearing loss
  • meningoencephalitis
  • MR, HTN, DM1, autoimmune thyroid disease
A

congenital rubella syndrome

243
Q
  • 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
A

immunocompromised

chronic lung dz such as CF

244
Q

coccidiomycosis occurs in this geographic area

A

SW US and Mexico

245
Q

how you contract entamoeba histolytica

A

ingestion of cyst in contaminated food or water

246
Q

symptoms and signs of entamoeba histolytica infection

A
  • 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
Q

how to dx amebiasis

A

stool cysts or trophozoites

248
Q

how to tx amebiasis

A

metronidazole

+/- iodoquinol (luminal amebicide)

249
Q

how you get giardia

A

drinking contaminated water for the most part

250
Q

sxs of giardia infection

A

voluminou watery and foul smelling diarrhea

bloating, flatulence, weight loss

251
Q

how to dx giardia

A

look at stool for cysts and trophozoites, stool ELISA

252
Q

how to tx giardia

A

metronidazole

253
Q

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

A

malaria

plasmodium falciparum

254
Q

transmission of malaria is via _______

A

anopheles mosquito

255
Q

sxs of malaria

A

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

256
Q

how to dx malaria

A

thin and thick giemsa stained peripheral blood smears

  • thick for screening
  • thin for species and stage identification
257
Q

medications for malaria

A

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

258
Q

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

A

cat feces

259
Q

most cases of toxoplasmosis are asymptomatic unless you’re immunocompromised… then you might present with ________

A

focal seizures

260
Q

ocular toxo is the most common cause of __________

A

infectious chorioretinitis

261
Q

triad of congenital toxo

A

hydrocephalus, intracranial calcifications, choreoretinitis

262
Q

when should you tx for toxo?

A

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

263
Q

general concept of dx for helminth infections

A

3 separate stop examinations

can use cellulose tape test for pinworms

264
Q

MCC epilepsy in places like Mexico and Central America

A

neurocysticercosis

265
Q

signs and sxs of cysticercosis

A

subcutaneous nodules
4th vetnricle
seizures, hydrocephalus, stroke

266
Q

how to dx cysticercosis

A

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

267
Q

how to tx cysticercosis

A

meds for ppl with the adult tapeworm

if old cysts on brain imaging, can give anti-epileptics

268
Q 
fever
petechial rash that begins on extremities and moves in a caudal and centripetal direction 
myalgias
HSM and jaundice 
CNS  sxs
hypotension
A

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

269
Q

RMSF is most common in _____ region of US

A

southeast

270
Q

dx RMSF

A

thrombocytopenia, elevated transaminases, hyponatremia

serologic tests

271
Q

how to tx RMSF

A

oral or IV doxycycline and supportive care

*note: ppx abx after tick bites are not indicated

272
Q

what is spotless RMSF

A

ehrlichiosis

  • occurs in SE US as well-same sxs but no rash
  • dx with serology or PCR
  • tx with doxycycline and supportive care
273
Q

what bacteria causes cat scratch disease

A

bartonella henselae

274
Q

regional LAD after cat or kitten scratch

  • papule at initial scratch followed by LAD 1-2 wks later
  • can see Parinaud oculoglandular syndrome
A

cat scratch disease

275
Q

dx cat scratch dz

A

elevated IgM antibody to B henselae

276
Q

how to tx cat scratch dz

A

supportive unless pt has systemic dz or is immunocompromised

  • then give oral azithromycin, bacterium, or cipro
  • don’t do surgery
277
Q

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

A

T

278
Q

this age of children are most at risk for TB disease

A

infants < 12 months

279
Q

most common form of extra pulmonary TB disease in children

A 
cervical lymphadenitis (scrofula)
other extrapulm: meningitis, abd involvement, skin and joint, Pott's disease (vertebrae), disseminated or miliary disease
280
Q

PPD readings based on risk factors

A

> 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
Q

how to dx TB disease in children

A

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

282
Q

how to tx latent TB

A

isoniazid for 9 months

-give pyridoxine (vitamin B6) to prevent neuro sxs of tx

283
Q

how to tx TB disease

A

2 months INH, rifampin, pyrazinamide

4 months of INH and rifampin

284
Q

what to do for fever in baby < 28 days

A

total eval
IV abx
hospitalization

285
Q

what to do for fever in baby 7 months old

A

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
Q

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

A

T

287
Q

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

A

HIB

288
Q

which 2 post-strep complications can be prevented with abx

A

PANDAS and rheumatic fever

289
Q

bulky foul smelling stools, weight loss, day care attendance

A

giardia

290
Q

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

A

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

291
Q

MCC FUO

in what % of cases is a cause found

A

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

292
Q

E Tox is associated with which cells in the lesions

A

eosinophils

293
Q

what is D-penicillamine used for

A

increases copper clearance in Wilson’s disease

294
Q

_____ can help eliminate tyrosine in transient tyrosinemia of the newborn

A

vitamin C

295
Q

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

A

mccune-albright syndrome

296
Q

hypogonadotropic hypogonadism

anosmia (absent sense of smell)

A

kallman syndrome

297
Q

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

A

Prader-Willi syndrome

298
Q 
ovarian dysgenesis
short stature
webbing of the neck
left sided congenital heart disease 
hypothyroidism
A

Turner syndrome

299
Q

hypogonadism
retinitis pigmentosa
obesity
polysyndactyly

A

laurence-moon-biedl syndrome

300
Q

infants of diabetic mothers may have ______ cardiomyopathy

A

hypertrophic

301
Q

causes of dilated cardiomyopathy

A

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

302
Q

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

A

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

303
Q

unilateral parotitis is most likely caused by infection with _____

A

staph aureus
strep pyogenes
mycobacterium tuberculosis

304
Q

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

A

congenital rubella

305
Q

hydrocephalus, intracranial calcifications, chorioretinitis assoc with congenital ______

A

toxoplasmosis

306
Q

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

A

CMV infection

307
Q

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

A

6 months of age

308
Q

dancing eyes and dancing feet

A

neuroblastoma with acute cerebellar atrophy

309
Q

hemihypertrophy, aniridia, GU malformation, abdominal mass

A

Wilms tumor

310
Q

prognosis for neuroblastoma for children < 1 year

A

quite good

can spontaneously regress

311
Q

what endocrine abnormality to look for in Turner syndrome

A

hypothyroidism

312
Q

in pts with OI, screen for this

A

early conductive hearing loss

313
Q

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

A

< 9 years –> amoxicillin

> 9 years –> doxycycline

314
Q

GBS is often associated with a recent _____ infection

A

campylobacter

315
Q

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

A

menkes kinky hair disease

low serum copper level

316
Q

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

A

acrodermatitis enteropathica

zinc deficiency

317
Q

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?

A

digeorge

hypocalcemia

318
Q

interrupted aortic arch
recurrent fungal infections
small chin
short palpebral fissures

A

digeorge syndrome

319
Q

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

A

acrodermatitis enteropathica- zinc deficiency

Pediatrics (14 decks)

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