General Flashcards
1
Q
Older kids sepsis Abx
A
Ceftriaxone/ Vanco or clox.
2
Q
Orbital cellulitis abx
A
Clindamycim for staph and anaerobes,
Cefuroxime for h. Flu
3
Q
Scarlet fever bug
A
GABHS produces 1 of 3 exotoxins A,B,C. A is most common. Can therefore have scarlet fever x3
4
Q
How often are blood cultures positive in meingitis?
How many WBC can a normal neonate have? vs normal child?
How many WBC does it take to make the CSF turbid
A
- 80-90%
- up to 30, older is 5
- 200-400
can have increased lymphocytes in early bacterial meningitis and vice versa
5
Q
Other causes of elevated PMN in CSF
A
TB - followed by lymphocytes fungal - followed by monocytes Amebae SLE Tumour or leukmia
6
Q
What are the enteroviruses?
A
coxsackie
echovirus
oliovirus
enterovirus
7
Q
Treatment of meningitis
A
ceftriaxone
cefotaxime
if can’t use - meropenem instead
+/- vancomycin to cover resistant strep pneumo
treat family with rifampin
8
Q
treatment of Campylobacter
A
supportive care
erythromycin or azithromycin- treat if have dysenteric disease, fever, or
toxic or immunocompromised.
can decrease duration and decrease shedding
9
Q
Parvovirus B19 mortality
A
Fetal hydrops - bone marrow suppression - anemia and CHF
once rash appears, no longer infectious
for aplastic anemia - infectious for one week since presentation
10
Q
causes of GBS
A
postinfectious polyneuropathy
- Campylobacter
- Helicobacter pylori
- respiratory tract (especially Mycoplasma pneumoniae)
- vaccines - rabies, influenza, and poliomyelitis (oral) , conjugated meningococcal vaccine, particularly serogroup C
- EBV
11
Q
Can you receive live vaccines while on steroids
A
If >2mg/kg/day or 20 mg/kg/d of pred for >14 days, no live vaccines until one month post Rx
If receive less than that, can give
if less than 14 days, can give when done Rx
12
Q
eosinophilia causes - MC and infectious
A
Allergies, asthma, eczema
Infectious causes: Ascaris because travels to other part of body ( if stay in gut/sequestered), toxocariasis, trichimosis, hookwarm, strongyloides
13
Q
Anal warts transmission
A
Perinatal
sexual abuse
transmission - from fingers
RX- 65 % DISAPPEAR IN 2 YRS, cryoi, anti wart med, Sx
14
Q
herpes whitlow treatment
A
HSV 1 in mouth, treat with acyclovir for 10 days
15
Q
Hep A Vaccine - when do we give it
A
Not in less than 1 yrs but ok if above. if family member has it.if high risk, also get Ig.
only good 2 weeks post exposure
16
Q
pleurodynia def - brochman syndrome
A
myositis caused by coxsackie
17
Q
Familial Mediterranean fever symptoms
A
periodic fever, irregular fever episodes, painful pleuritis, peritonitis,
18
Q
Rabies prophylaxis
A
Bats - even if in room, treat
quarantine animal and monitor - 10 d observation
if high risk - can treat and wait for results
Rx- rabies Ig in bite and Vaccine
19
Q
PANDA
A
Pediatric Autoimmune Neuropsychiatric Disorders Associated with Streptococcus pyogenes: OCD/Tic/Tourette anxiety emotional deterioration in hand writing enuresis
20
Q
HIV pathophysiology
A
CD4 depletion kills host cells Syncytium formation Normal host response CD4 cell dysregulation
21
Q
Chronic lymphadenitis causes
A
Non TB mycopla - drains
cat scratch - MOST COMMON
22
Q
What are RF for HIV vertical transmission?
A
high maternal viral load, seroconversion during pregnancy, low maternal CD4, intrapartum events resulting in inc exposure of fetus to maternal blood, preterm delivery, prolonged ROM, SVD
23
Q
Prevention of Mother to Child HIV Transmission
A
Screening in pregnancy
Antiretrovirals for Mom in pregnancy: if not getting HART then zidovudine during pregnancy and IV zidovudine intrapartum
C-section before ROM (if everything is not perfect)
AZT (zidovudine) for baby x6 weeks – started ASAP within 6 hrs
No breast feeding
24
Q
When do you test a newborn whose mom was HIV +
A
within first 48 hours (you know that there was transmission), 2 wks, 2 months, 4-6 months
25
When can you truly rule out HIV in neonate exposed
with 2 negative HIV PCR results at or after 1 month and 4 months of age ( most still test at 18 mo)
26
MC presentation of HIV
Infants - asymptomatic, LN, HSM
Older infants - FTT, candida after 1 yr, HSM, interstitial pneumonitis
Toddlers and older - LN, recurrent infections, parotitis, encephalopathy, dev regression
27
Common opportunistic infections in pt with HIV
1. encapsulated org
2. MAC
3. Oral candida
4. Viruses
28
Congenital syphilis
stillbirth, hydrops, preterm birth, IUGR, HSM, haemolytic anemia, jaundice and maculopapular rash
First 4-8 weeks : o HSM, snuffles, microcephaly, lymphadenopathy, mucocutaneous lesions (peeling hands and feet), osteochondritis, pseudoparalysis (from pain of limbs), edema, rash, haemolytic anemia, thrombocytopenia, chorioretinitis, glaucoma , nephrotic syndrome
29
Late presentation of congenital syphilis
Late manifestations: Hutchinson triad-interstitial keratitis, eighth cranial nerve deafness and Hutchinson teeth (peg-shapted lateral incisors)
Anterior bowing of shins, frontal bossing, saddle nose Clutton joints (symmetric painless swelling of knees), rhagades (linear scars around mouth and nose), mulberry molars (round aggregates of enamel on molars)
30
Abx for pneumonia
0-1 mo: amp+ gent or cefotax
1-3 mo: cefuroxime or amp. Erythro for pertussis
Rest: cefuroxime or amp, niacin
Aspiration-clindamycim
Pseudomonas: cefotax
31
IE dx criteria
Two major criteria, one major and three minor, or five minor criteria suggest definite endocarditis
32
What are the Duke major criteria
(1) positive blood cultures (two separate cultures for a usual pathogen, two or more for less typical pathogens) and
(2) evidence of endocarditis on echocardiography (or new valve regurgitation)
33
What are the Duke minor criteria
FIVE PM
- Fever > 38
- Immune complex phenomena (glomerulonephritis, arthritis, rheumatoid factor, Osler nodes, Roth spots),
- Vascular phenomenon (Janeway, emboli)
- Echocardiographic signs not meeting major criteria.
- Predisposition
- Microbi- a single + BCx or serologic evidence of infection
34
How do you differentiate orbital from preorbital cellulitis
1. proptosis
2. ophthalmoplegia
3. vision change - blurry
4. Chemosis
35
how do you diagnose AOM
1. signs of middle ear effusion - immobile TM or TM rupture, +-opacification of TM, +-loss of landmarks, +- air fluid level
2. signs of middle ear inflammation:bulging TM and erythema
3. Acute onset of symptoms - otalgia, or irritability
36
When do you adopt watch and wait for AOM
if greater then 6 mo with no significant med issues, mild symptoms and signs for 48-72 hours and parents who can recognize if not doing well.
37
How is maternal genital HSV classified
1. Newly acquired - first episode PRIMARY (60%!!! chance of transmission) or NON primary.
38
What are the types of HSV infections in neonates
1. disseminated - MC liver and lungs
2. localized CNS
3. SEM - skin, eyes, mucous Mb
39
Most common causes of transient neutropenia
Viral infection - influenza, adenovirus, coxsackie, RSV, hep A and B, measles, EBV, CMV
From redistribution of neutrophils, sequestration in reticuloendothelial tissue, increased use in damaged tissue, marrow suppression
40
Management to contact TB
ask about symptoms
if less than 5, mantoux neg and N CXR = Rx INH 9 mo
41
INH - How to take it and SE
Empty stomach absorbed better.
| SE= elevated LFT, periph neuropathy so take Vit B pyroxidine
42
Which TB med gives optic neuritis
Ethambutol
43
Mantoux / MMR - How do you give these when both are required
either give it at same time or 4 weeks apart
44
recurrent N. Meningitis
Think complement def
45
Cystinosis
AR, Lysosomal, cystine accumulation - get fancony syndrome - Kidney crap
CRF, ocular abnormalities, DM, Hypothyroidism
46
Sinusitis Rx
amoxicillin 10-14, saline washes can recommend but not studied
Amoxiclav if less than 2 yrs, recent Abx, daycare
47
Mono signs/symptoms
Fever, pharyngitis, LN, splenomegaly, elevated mononuclear cells and more than 10% atypical lymphocytes, hemolytic anemia, BM suppression
48
varicella and skin infections - what bug are you worried about
GAS***
| Nec fas - penicillin and clinda for exotoxin
49
clinical presentation of Parvo B 19
fifth disease -
| if pregnanct mom and exposed - do Ig and serial US to monitor for hydrops
50
GBS investigations
1. stools for campylo
2. CSF for increased protein
3. MRI to tule out others
4. EMG
5. Serial spyrometry
51
Pinwarm treatment
mebendazole x 1
| hygiene, treat household
52
congenital CMV
```
IUGR
microcephaly
hepatomegaly
eye stuff
SN hearing loss
rash
low plt
```
53
giardia RX
flagyl
54
When do you use Doxycycline
skin and soft tissue infection in kids > 7yrs
55
Aspergillus treatment
voriconazole
56
Most common bugs for line infection
Coag neg staph - CoNS- Vancomycin
57
Side effects of septra
```
neutropenia
anemia
low plts
transient inc in creat
hyPERKalemia
```
58
CP of mycoplasma pneumoniae
1. gradual onset of headache,
2. malaise,
3. fever, and
4. sore throat, followed by progression of lower respiratory symptoms, including hoarseness and cough. 5. Rash in 1/3
Coryza is unusual
59
Azithromycin - bacteriostatic or bactericidal?
static
60
Clindamycin - bacteriostatic or bactericidal?
static
61
what bites wounds require prophylactic antibiotics?
```
moderate to severe tissue damage - crush
deep puncture
hand/feet/face
genitals
in immunocompromised or asplenic
```
62
what antibiotic would you use for bites?
amoxiclav
if allergic - septra and clindamycin
63
what are clinical features of Blastomyces Dermatitidis?
```
Fungal infection - makes abscesses
cause a pyogranulomatous response =necrosis+fibrosis
1. pneumonia - acute /chronic
2.Skin - ulcers
3. GU - prostitis/endometritis
4. CNS - abscess
5. Bone - osteo
Rx = Itraconazole for mild, Ampho B for severe
```
64
what are phases of Pertussis?
catarrhal 1-2 wks
paroxysmal 2-6 wks
convalescent >2wks
65
how do you treat pertussis?
0-5 mo - AZITHROMYCIN for 5 days, 10mg/kg
> 5 mo - AZITHROMYCIN 10mg/kg on D1, 5/kg until 5d
adult - 500mg d1, 250 mg for rest - 5 days
Clarithromycin for 7 d
Erythromycin for 14 d
66
what are the CP and treatemnt of Brucellosis
GN - livestock, unpasteurized milk
fever
arthritis
HSM
RX: 8yr - Septra + rifampin for 6 weeks
67
what organism is going to cause symptoms within 24 hours of an animal bite?
Pasteurella multocida
treat with Amoxiclav
68
what is the most common side effect of clindamycin?
diarrhea in 20%
| higher risk of C. diff
69
what are extrpulmonary features of Mycoplasma
```
pharyngitis,
rash = Erythema multiorme
Stevens-Johnson syndrome,
hemolytic anemia,
arthritis,
CNS disease = encephalitis, aseptic meningitis, cerebellar ataxia, transverse myelitis, and peripheral neuropathy
```
70
how does TSS present?
multisystem disease with fever,
hypotension,
diffuse rash, and
multiple organ involvement (eg, nausea, vomiting, renal involvement, hepatitis, central nervous system dysfunction, severe myalgias).
71
What are features of Chlamydia trachomatis pneumonia
```
tachypnea,
nasal congestion,
otitis media,
rales on auscultation of the lungs,
a staccato cough that can be paroxysmal
palpable liver and spleen due to hyperinflation of the lungs.
```
72
how do you treat Chlamydia pneumonia
erythromycin (PREP 2014)
73
how do you Dx pertussi?
PCR ( and culture)
74
at the beginning of a viral illness, what might you see on BW
lymphopenia
| can see inc in neutrophils too
75
what do atypical lymphocytes refer to?
```
mature T lymphocytes with larger Nu
seen in:
EBV
CMV
Toxo
viral hepatitis
rubella
roseola
mumps
some drugs
```
76
what is the management after a ? rabies exposure?
1. if domestic anaimal - observe animal for 10 d. if no signs of rabies = all good
2. if wild animal and caught = euthenise and look at brain
3. if wild animal known to harbor rabies and not captured = prophylaxis
77
who should get tetanus IG?
if received
78
what is the rabbies prophylaxis treatment
1. clean wound with soap
2. clean with virucidal agent
3. rabies IG administered into the wound and rest IM
4. rabbies vaccine day 0, 3, 7, 14
79
what is the definition of fever of unknown origin
> 14 d without etiology despite investigations
80
when is a patient with measles contagious?
5 days before the rash (1-2 days before onset of symptoms)
| 4 days after the rash
81
what are the MC features of measles?
Cough
Coryza
Conjunctivitis - stimson lines
Koplik spots
82
what is the post exposure mgnt for measles
Ig within 6 days of exposure
| + Vaccine within 72 hrs
83
what is german measles?
rubella
84
when is rubella contagious?
2 days pre rash
| 1 week post rash
85
are babies who had congenital tubella contagious
yes
| They can shed the virus in their nasal secretions and urine for up to 12 months
86
what are clinical features of rubella
```
3 day rash
LN - retroauricular, post cervical, post occipital
conjunctivitis
sore throat
low grade T
```
87
what is the usual presentation of roseola
```
peak 6-9 mo
very high temps for 3-5 days
look unwell
can get febrile seizure
rash appears as they get better - can spare the face
Caused by HHV6/7
```
88
what does Parvo B19 cause?
1. Slapped cheek
2. fetal anemia or hydrops
3. Aplastic crisis
89
what is the typical rash of Parvo?
slapped cheek and circumoral pallor
erythematous maculopapular truncal rash which fades and followed by a lacy reticulated rash that can be pruritis and can recur with exercise, bathing or rubbing
90
when is a child with varicella contagious?
2 day pre rash
| 7 days post rash
91
which CN is involved in Ramsay Hunt
CN VII
92
what are the 2 MC secondary bacterial infections that can complicate Varicella?
GAS
| Staph aureus
93
what are common complications of varicella
```
INFECTION - GAS
cerebellar ataxia
encephalitis
pneumonia
Nephritis/NS
orchitis
pancreatitis
MSK
pericarditis/myocarditis
```
94
who should get treated with oral acyclovir for Varicella
non pregnant > 12 yrs
chronic cutaneous or pulm disease
ASA therapy
on steroid
95
when do we worry if a pregnant mom at end of pregnancy develops varicella
if she has Varicella (not shingles)
5 days pre delivery to
2 days post delivery
Gets a lot of virus but mom has not had time to make Ab
Baby needs VZIG
96
who can receive VZIG
1. newborn whose mom had varicella 5 days pre or 2 days post delivery
2. hospitalized prem > 28 wks whose mom lacks Hx or serology
2. Hospitalized prem
97
what is the efficacy of varicella vaccine
85% in preventing any disease
| 97% effective in preventing moderate to severe
98
What is the daycare exclusion rule for impetigo
return 24 hr after start of Rx
99
how do you treat impetigo?
2% mupirocin TID x 10d
or if extensive, or around eyes or bullous
Cephalexin for 7 d
100
what usually causes cellulitis?
GAS = strep pyogenes - more spread
| staph aureus - more localized
101
what is Erysipelas?
dermis infection
GAS
sharp margins with orange peel quality
may need IV
102
what is ecthyma?
GAS
dermis infection
painful ulcers
need PO abx
103
what is ecthyma gangrenosum?
systemic infection in immunocompromised pt
PSEUDOMONAS aeruginosa throws septic emboli to skin
deep ulcers
104
what causes Nec fasciitis
```
polymicrobial
Staph aureus
GAS
E.Coli
Klebsiella
C. perfringens
```
105
what is nec fasciitis
subcutaneous infection + superficial fascia
106
how does necrotizing fasciitis present?
```
local swelling,
erythema,
tenderness
Fever
Constitutional signs are out of proportion to cutaneous signs, especially with involvement of fascia and muscle
```
107
how do you manage nec fasc
1. support
2. Sx
3.Clindamycin and penicillin as per review course
pip taz or
Ceftriaxone and Vanco
108
what causes hot tub folliculitis?
P. aeruginosa
109
CP of EBV
```
fever
lymphadenopathy
exudative pharyngitis
splenomegaly
hepatomagaly
petechia on soft palate
```
110
what are hematological complications of EBV
low Plt
hemolytic anemia
hemophagocytic syndrome
splenic reupture
111
EBV has been linked with some Ca, such as
nasopharyngeal CA
Burkitt lymphoma
Hodgkin
112
What patient with EBV should receive steroids
```
tonsillar inflammation and potential airway issues
massive splenomegally
myocarditis
hemolytic anemia
HLH
```
113
what is the organism that causes cat scratch
BArtonella Henselae
114
what are the MC affected LN in cat scratch
1. axillary
2. cervical
3. submand
115
How do you treat cat scratch?
most don't need treatment - resolves 2-4 month
| azithromycin for 5 days
116
what are possible complications of EBV
```
aseptic meningitis
seizures
transverse myelitis
encephalitis
GBS
coombs + hemolytic anemia
Ab mediated thrombocytopenia
HLH
```
117
what CSF findings would be consistent with encephalitis?
increased lymphocytes
normal glucose
slight elevation in protein
118
MC cause of croup
laryngotracheobronchitis
parainfluenza
RSV
119
most common age group for croup
6 mo to 3 years
120
what is spasmodic croup?
```
6mo to 3 yrs
sudden onset
usually at night
NO prodrome
unclear etiology
manage the same
```
121
What is the age group for epiglottitis?
3-4 yrs
122
what are features of epiglotittis
```
3-4 year old
H. influenza type b - much less now
GAS
Staph aureus
STRIDOR
drooling
sniffing position and tripod
XRAY - thickened and bulging epiglotittis = thumb sign
```
123
how do you manage epiglotittis
1. intubate
2. IV cetriaxone
3. If Hib - some family mb may need prophylaxis ( if less than 2 and not fully vaccinated, if unvaccinated, if immunocompromised) Rifampin 4 d
124
what causes infective endocaditis in all children
strep vididens - alpha hemolytic - usually subacute
125
if pt is known to have congenital heart disease and has never had Sx, what bug is the cause
strep viridens
126
what bugs cause endocarditis in pt who have had cardiac surgery, have valve replaces and endovascular materials?
Staph aureu - usually acute EI
| staph epidermidis
127
what cardiac lesions are most at risk of infective endocarditis
```
left sided lesion:
AS
TOF
PDA
VSD
```
128
what are clinical features of IE
```
FROM JANE:
Fever
Roth's spots
Osler's nodes
Murmur
Janeway lesions
Anemia
Nail hemorrhage (splinter hemorrhages)
Emboli
+
malaise
wgt loss
heart failure
splenomegaly
```
129
what is your initial Abx choice for IE
Vancomycin and gentamycin
| if confirm strep - do pen g or ceftriaxone for 4 weeks
130
what are the clinical features of bacterial tracheitis
```
Staph aureus most common
Moraxella catarrhalis, H. influenzae
usually post viral croup
brassy cough
high temp
toxic
not the posturing of epiglottitis
clinical Dx
```
131
how do you manage bacterial tracheitis
ceftriaxone + vanco
132
In what age group is strep most likely to cause pharyngitis?
School age
| less likely before 3
133
airborne
measles
TB
varicella
zoster
134
who should get post exposure varicella vaccine?
within 72 hrs
if susceptible
if older than 12 mo
no contraindications
135
how do you manage TSS
Empiric therapy with cloxacillin (or cefazolin) plus clindamycin for most cases
Penicillin + clindamycin ± IVIG for TSS due to group A strep
