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BRS7 Flashcards

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1
Q

ziehl neelsen stain is for

A

acid fast TB

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2
Q

silver stain is for

A

fungal elements

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3
Q

Wright stain is for

A

stool white blood cells

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4
Q

definition of fever in a child

A

38 or 100.4 or greater. must be a rectal temp

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5
Q

which groups are high risk for infection

A

young infants (less than one month), older infants with very high fevers (greater than 39) and infants and children who are immunodeficient, sickle cell disease or chronic illness

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6
Q

most common infecitous agent in child less than 3 months

A

virus

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7
Q

bacterial pathogens in 0-1 month old

A

group B strep, E coli and Listeria

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8
Q

antibiotics to treat bacterial infections in 0-1 month old

A

ampicillin and gentamicin or cefatoxine

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9
Q

bacterial infections in 1-3 months

A

group B, strep pneumonia, listeria

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10
Q

antibiotics to treat bacterial infections in 1-3 months

A

ampicillin plus cefotaxime. (use vanco if you suspect viral meningitis)

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11
Q

bacterial infections to treat 3 months-3 yrs

A

Strep pneumonia, H flu, Neisseria M

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12
Q

antibiotics to treat bacterial infections in 3 months- 3 yrs

A

cefotaxime (add vanco if you suspect viral meningitis)

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13
Q

which patients with fever get admitted

A

1) babies less than 28 days
2) infants between 29 days and 3 months who are either toxic appearing, suspected meningitis, pneumonia, pyelonephritis, bone or soft tissue infections unresponsive to PO abx,
3) unclear about follow-up bc of social situation

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14
Q

most common organism in children 3-36 months

A

strep pneumonia. H flu used to be but less bc of vaccination

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15
Q

definition of fever of unknown origin

A

fever lasting more than 8 days to 3 weeks when all prior testing and history have not produced a diagnosis. 1/4 resolve spontaneously

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16
Q

tests for fever of unknown origin

A

make sure to look at mucous membranes, skin, hepatosplenomegaly, joints and bones. check CBC, ESR, serum transaminases, and UA with culture, blood cultures, anti strep O titer, ANA, anti RF, stool for O and P and cdiff, TB skin test and HIV test.

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17
Q

meningitis definition

A

inflammation of the meninges. can be bacterial or aseptic

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18
Q

when do you see most bacterial meningitis

A

first month of life

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19
Q

3 risk factors for bacterial meningitis

A

1)young age 2)immunodeficiency (asplenia, terminal complement deficiency) 3)anatomic defects

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20
Q

clinical features of bacterial meningitis

A

most often non specific. may or MAY NOT be febrile. often have poor feeding, irritability, lethargy, and resp distress. older children present with fever and meningeal signs.

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21
Q

signs of meningeal irritation

A

change in consciousness, nuchal rigidity, seizures, photophobia, emesis, headache.

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22
Q

lumbar puncture for bacterial meningitis

A

high white count in CSF (mostly neutrophils, often greater than 5000), low glucose in CSF (.4), increased protein, positive gram stain and culture.

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23
Q

meningitis picture with focal neurological findings

A

CT scan with contrast- to evaluate for brain abcess

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24
Q

what drug to give to reduce hearing loss in H influenza meningitis

A

corticosteroids. given with the first dose of abx

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25
high protein CSF?
acute bacterial meningitis, TB or brain abscess
26
normal glucose on CSF
this is viral meningitis
27
if you see predominantely lymphocytes on CSF
this is either fungal or TB
28
how do you diagnose HSV encelphalitis from CSF
RBCs in the CSF
29
which types of meningitis give worst complications
gram negative organisms, then strep pneumonia, HIB and finally Neiserria
30
most common complication in meningitis
hearing loss, then global brain injury, then other things like siADH, seizures, hydrocephalus, brain abscess, cranial nerve palsy, learning issues and focal neurologic deficits.
31
CSF for aseptic meningitis
pleocytosis, normal CSF glucose, and normal to low high CSF protein.
32
most causes of aseptic meningitis
viral
33
which viruses can be detected by PCR on CSF fluid
Epstein Barr (EBV), CMV, HSV, and enteroviruses
34
very high protein, very low glucose and high white count with lymphs mostly on CSF
this is TB
35
brain imaging classic finding in TB meningitis
basilar enhancement.
36
when are enteroviruses most common
summer and fall. most common cause of viral mengitis in US
37
viruses commonly causing encephalitis
arboviruses, influenza, and HSV
38
TB meningitis in a child less than 5
produces an aseptic meningitis.
39
3 bacteria that cause aseptic meningitis
1) TB, 2)borelia burgdorfi (lyme) and 3) syphillis
40
3 fungal causes of aseptic meningitis
coccidiodes immitis cryptococus neoformans histoplasmosis capsulatum
41
parasitic causes of aseptic meningitis
taenia solium | toxoplasma gondii- immunocompromised patients
42
4 drugs used to treat TB meningitis
isoniazid, rifampin, pyrazinamide, and streptomycin
43
common cold causes
rhinovirus, parainfluenza virus, coronavirus, and RSV
44
when to re-assess the common cold
after 10 days, check for superimposed bacterial infection. like sinusitis or AOM
45
sinuses present at birth
Ethmoid and maxillary
46
sinuses appear between 3-5
sphenoid
47
sinuses appear between 7-10 yrs
frontal
48
should you use imaging for initial diagnosis and management of uncomplicated sinusitis
NO
49
most common bugs for sinusitis
S pneumonia, H influenza and M catarrhalis
50
viral causes of pharyngitis
URI viruses plus coxsackie virus, EBV and CMV
51
bacterial causes of pharyngitis
Strep pyogenes (group A strep), arcanobacterium hemolyticum and corynebaterium diptheriae
52
can you see tonsilar exudates with viral pharyngitis
YES
53
presentation EBV pharyngitis
enlarged cervical lymph nodes, malaise and hepatosplenomegaly
54
strep throat symptoms
lack of other URI symptoms like runny nose, often has exudates on the tonsils, petechiae on soft palate, strawberry tongue, enlarged anterior cervical nodes. can have fever, scarlatiniform rash
55
gray adherent tonsillar membrane?
diptheria. can have cardiac and neuro side effects
56
gold standard strep test
culture (not rapid strep which is antigen testing)
57
treatment of strep throat
oral penicillin, single dose IM penicillin or in allergic patients, erythromycin or macrolides
58
treatment of diptheria
oral erythromycin or parenteral penicillin with anti-toxin
59
acute otitis media infection definition
acute infection of the middle ear space
60
otitis media with effusion
fluid within the middle ear space without symptosm of infection
61
bacterial pathogens of AOM
Strep pneumonia H flu (non typeable) Moraxella catarrhalis can also be caused by viruses
62
symptoms of AOM
develops often after an URI | fever, ear pain and decreased hearing
63
can you use erythema and loss of tympanic membrane landmarks to diagnose fluid in middle ear space
NO. use pneumatic otoscopy to show abnormal movement of the tympanic membrane and fluid in the middle ear
64
abx (if used) for AOM
amixicillin. if got abx recently in the past, possible S pneunaie that is resistant is possible. then use higher dose or cephalosporin.
65
treatment of AOM in pen allergic patient
macrolides
66
otitis externa definition
infection of the external auditory canal
67
pathogens in otitis externa
pseudomonas, staph aureus, candida albicans
68
symptoms of otitis externa
pain, itching and drainage from the ear. will see erythema and edema of the external auditory canal
69
treatment for otitis externa
restore to the acidic environment. use acetic acid solution to relieve the discomfort and restore environment. more severe cases need abx.
70
cervical lymphadenitis
enlarged, inflamed, tender lymph node or nodes in cervical area
71
most common bacterial agent for lymphadenitis
S aureus. Strep pyogenes is also common. TB and atypical TB can be seen. B henselae (cat scratch) is also seen.
72
reactive lymphadenitis
response to infections in pharynx, mouth, teeth etc
73
viral infections and cervical lymphadenitis
EBV, CMV, HIV
74
unilateral cervical lymphadenitis with rash on palms and soles, conjunctivitis and strawbery tongue
kawasaki disease
75
toxoplasma gondii infection and neck mass
T gondii can cause a mono like illness with cervical lymphadenopathy
76
clinical features cervical lymphadenitis
mobile, tender, warm, enlarged nodes. can be fluctuant (compressible)
77
when to check antibody titers to viruses in cervical lymphadenopathy
when it is diffuse and persistent
78
parotitis infection definition
inflammation of the parotid salivary glands
79
etiology of bilateral parotid gland enlargement
mumps, CMV, EBV, HIV, influenza etc.
80
unilateral parotid gland enlargement etiology
bacterial. S aureus, S pyogenes, M tb. increased risk with decreased salivary flow from stone formation. rarer than viral in kids.
81
in parotitis where would you see drainage
if you see it, the mouth may show pus form Stensen's duct
82
how to diagnose MUMPS
viral serology or urine
83
complications of mumps
meningoencephaliis, orchitis, epididymitis, pancreatitis.
84
impetigo
superficial infection of upper dermis
85
most common bug for impetigo
S. aureus
86
impetigo features
honey colored crusted or bullous lesions. face, around nose.
87
erysipelas
skin infection of dermal lymphatics
88
most common bug causing erysipelas
GABHS
89
clinical features erysipelas
tender, erythematous skin with distinct border
90
cellulitis
skin infection within the dermis
91
most common cause of cellulitis
GABHS and Staph aureus
92
is there a distinct border of erythma with cellulitis
no. it is indiscrete
93
buccal cellulitis
this is cellulitis in a unilateral bluish discoloration on the cheek of a young unimmunized child from HIB
94
cause of perianal cellulitis
usualy GABHS
95
necrotizing fascitis symptoms
deep cellulitis presenting with pain and systemic symptoms out of proportion to physical findings.
96
staph scalded skin syndrome
S. aureus infection that produces an exfoliative toxin. fever, tender skin and bullae. Nikolsky sign is present.
97
scarlet fever rash
this starts on the trunk, moves peripherally, skin colored papules, sandpaper rash. rash blanches with pressure.
98
pastia's lines
petechiae localized within the skin creases in alinear distribution in Scarlet fever
99
organism of GABHS
Strep pyogenes group A
100
fever, shock, desquamating skin rash and multi organ failure
this is toxic shock syndrome
101
most common organism for TSS
S aureus
102
two most common viruses causing diarrhea
Rotavirus and Norwalk virus
103
when do you see rotavirus
winter months
104
do you see WBCs in stool for rotavirus
no
105
treatment of rotavirus
supportive
106
prominent symptoms of norwalk virus
vomiting (unlike diarrhea for rotavirus)
107
diarrhea with lizards or turtles as pets
think salmonella
108
electrolyte findings in diarrhea from infection
non anion gap hyper-chloermic metabolic acidosis. from bicarbonate loss in stool.
109
how to predict WBCs in stool without checking for them
presence of RBcs. they tend to go together
110
when does HIV transmission occur
in pregnancy, or post partum through breast feeding
111
early symptoms of HIV
FTT, thrombocytopenia, recurrent infections, lymphadenopathy, parotitis, recurrent hard to treat thrush, loss of milestones, severe varicella infection
112
infants born to HIV pos mom have antibodies for how long
can persist for 18-24 months
113
how to detect HIV at birth
HIV specific DNA PCR from birth to 4 months
114
medications given to baby born to HIV pos mom
zidovudine for 6 months porophylaxis as well as trimethoprim tmp smx for pneumocystis pneumonia and urine CMV testing.
115
should HIV patients recieve their vaccines
YES. crucial. not the live ones!
116
infectious agent in mono
EBV. others include toxoplasmosis, CMV and HIV
117
symptoms of mono in older kids
young kids are often asymptomatic. older kids have fever, malaise and fatigue, pharyngitis, posterior cervical lymphadenopathy, hepatosplenomegaly. some get rash.
118
CBC in mono
shows atypical lymphocytes
119
how does the monospot test work
first line test in diagnosing EBV infections. measures the presence of heterophile antibodies ability to agglutinate sheep red blood cells.
120
is monospot good for all ages
not good for kids less than 4
121
mono spot negative mononucleosis
this is mostly from CMV
122
how to diagnose mono in child less than 4 yrs
EBV anitbody titers. acute infection is rise in IgM and ebstein barr nuclear antigens are for more chronic- 2-3 months after infection
123
amoxicillin and EBV
can cause a rash. diffuse pruritic maculopapular rash1 week after starting antibiotic.

Pediatrics (3 decks)

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