ID

Question 1

VZV

Answer 1

Begins on face. Poss fever, malaise

Question 2

Rubeola

Answer 2

Measles.
Paramyxovirus
3Cs: cough, coryza, conjunctivitis. +Koplik spots
Measles IgM Abs

Question 3

Fifth disease

Answer 3

Erythema infectiosum.
Parvo B19
Starts with fever and URI the progresses to slapped cheek rash

Question 4

Roseola

Answer 4

HHV 6,7.

Fever, URI. Then diffuse rash

Question 5

Mumps

Answer 5

Paramyxo
Fever then parotitis and/or orchitis
May cause male infertility

Question 6

Scarlet fever

Answer 6

Diffuse erythematous eruption concurrent with pharyngitis.
3-6 days
Pentad: fever, pharyngitis, sandpaper rash in trunk and exremities, strawberry tongue, cervical LAD
Tx w/ penicillin, azithro, or ceph

Question 7

Croup

Answer 7

Severe inflamm upper airway-chokes off. Medical emergency.
Parainflu 1, 2
Seal-like barking cough with URI-like sxs
May have signs hypoxia, more difficult to breathe when lying down
Give racemic epi to decrease swelling to prevent asphyxiation

Question 8

Steeple sign (CXR)

Answer 8

Croup

Question 9

Epiglottitis

Answer 9

Truest medical emergency in paeds
Extremely irritable, refusal to eat, refuses to lean back, muffled speaking, looks extremely ill, drooling.

Look for vaccine delay w/ “hot potato” voice, fever, drooling in tripod position, refusal to lie flat.

PE: hot cherry-red epiglottitis
CXR-thumbprint sign

Tx-intubate immediately-do not even waste time with full exam. Ceftriaxone 7-10 days. Rifampicin for close contacts

Question 10

Whooping cough-stages

Answer 10

Catarrhal stage: severe congestion, rhinorrhea. 14 days
Paroxysmal stage: severe coughing episodes with extreme gasp for air followed by vomiting. 14-30 days
Convalescent stage: Decreased frequency of coughing. 14 days

Question 11

Signs whooping cough (PE, CXR)

Answer 11

Burst vessels in eyes

Butterfly appearance on CXR

Question 12

Tx-whooping cough

Answer 12

Macrolide only in catarrhal stage and to contacts

Question 13

How long does bronchitis last

Answer 13

7-10 days

Question 14

Pharyngitis

Answer 14

Inflamm pharynx and adjacent structures

Cervical adenopathy, petechiae, fever >104, other URI sxs

Question 15

Diphtheria

Answer 15

membranous inflamm pharynx due to bacterial invasion.
Do not scrape membrane
Tx is antitoxin–Abx don’t work

Question 16

Legg-Calve-Pethes disease

Answer 16

Avascular necrosis femoral head.
Presents with painful limp, usu ages 2-8
XR shows joint effusions and widening

Question 17

Slipped capital femoral epiphysis

Answer 17

Painful limp, externally rotated leg
Adolescence
XR: widening joint space.
Tx: internal fixation with pinning

Question 18

Causes meningitis in newborn

Answer 18

Listeria
Strep agalactiae (Group B strep)
E. coli and other coliforms

Question 19

Signs and sxs meningococcal disease

Answer 19

Non-blanching rash, purpura (>2mm)
Ill looking child
CRT >3s
Neck stiffness

Question 20

Herpes simplex encephalitis-signs and sxs

Answer 20

Focal neuro signs
Focal seizures
Decreased level consciousness

Question 21

Signs and sxs UTI (children older than 3 mo)

Answer 21

Vomiting
Poor feeding
Lethargy
Irritability
Abdo pain or tenderness
Urinary frequency or dysuria
Offensive urine or hematuria

Question 22

Signs/sxs septic arthritis

Answer 22

Swelling of limb/joint
Not using an extremity
Non-weight bearing

Question 23

Signs and sxs Kawasaki disease

Answer 23

Fever >5days and at least four of following:

• B/L conjunctival injection
• Change in upper resp tract mucous membranes (e.g. injected pharynx, dry cracked lips, strawberry tongue)
• Change in peripheral extremities (e.g. edema, erythema, desquamation)
• Polymorphous rash
• Cervical LAD

Question 24

Pharyngitis

Answer 24

Inflamed pharynx and soft palate, enlarged or tender local LNs
Usu caused by resp virus, e.g. adeno, entero, rhino.
Older kids-group A beta hemolytic strep (S. pyogenes)–rapid strep test and Abx (prevent RhF)

Question 25

Tonsillitis

Answer 25

Form of phayngitis with intense inflamm tonsils oft with purulent exudate S pyogenes: can cause recurrent tonsillitis in some children. More commonly gives consitutional disturbances eg HA, apathy, abdo pain, white tonsillar exudate, cervical LAD EBV has softer exudates Penicillins will cause rash if due to infectious mononucleosis ("glandular fever" to you Brits)

Question 26

Viral causes of maculopapular rash

Answer 26

HHV6 or 7 (Roseola),

Question 27

Bacterial causes maculopapular rash

Answer 27

Scarlet fever (S. pyog) Erythema marginatum--RhF Typhoid (S. typhi), classically rose spots Lyme disease--erythema migrans

Question 28

Non-bacterial, non-viral causes maculopapular rash

Answer 28

kawasaki | Juvenile idiopathic arthritis

Question 29

Viral causes vesicular/bullous/pustular rash

Answer 29

Chickenpox Hand, foot, and mouth disease (Coxsackie) HSV

Question 30

bacterial causes vesicular/bullous/pustular rash

Answer 30

``` Impetigo Boils/folliculitis Staphylococcal bullous impetigo Staphylococcal scaled skin TEN ```

Question 31

Non-viral, non-bacterial causes vesicular/bullous/pustular rash

Answer 31

Erythema multiforme, SJS

Question 32

Causes petechial/purpuric rash

Answer 32

``` Meningococcal and other bacterial sepsis Infective endocarditis HSP Thrombocytopenia Vasculitis Malaria ```

Question 33

HSV1

Answer 33

Gingiostomatitis is most comm manifestation in kids. Painful vesicles on mouth, hard palate, lips, and tongue. 2 weeks. Acyclovir if bad. Herpetic whitlows-pustules on broken skin on fingers

Question 34

EBV

Answer 34

Cause of infectious mononucleosis. Not monocytes, but look like them--atypical reactive T lymphos. Monospot test.

Question 35

Parvo B19

Answer 35

Infects erythroblasts, hence why dangerous (aplastic anemia) in those with hemolytic anemias or less reserve "Slapped cheeks", fever, malaise, myalgia Bad in utero--fetal hydrops and death due to anemia

Question 36

Hand, foot, and mouth disease

Answer 36

Coxsackie A16 most common cause Painful vesicular lesions on hands, feet, and mouth, and often on buttocks. Subsides within few days. Mild systemic features.

Question 37

Chickenpox

Answer 37

VZV Papules start on head and trunk and progress to peripheries Vaccine exists. If new lesions beyond ten days, suggests defective cellular (T cell) immunity

Question 38

Lyme disease

Answer 38

Borrelia burgdoferi via ticks Erythema migricans: red, painless, expanding ("target lesion") Fever, HA, myalgia, arthralgia, malaise LAD. Can cause myocarditis, heart block, meningoenceph, cranial and periph nerve neuropathies

Question 39

Impetigo

Answer 39

S. aureus>S. pyogenes More common if pre-existing skin disease, e.g. eczema Erythem macules to vesicles which rupture causing HONEY COLORED CRUSTING. Spreads via self-inoculation Tx: topical Abx e.g. mupirocin

Question 40

Peri-orbital cellulitis

Answer 40

Tenderness and edema of eyelid, erythema, and fever Infants: Hib Older child: dental abscess or paranasal sinus infection Orbital cellulitis if left untreated. Can cause visual problems, abscess formation, meningitis, cavernous sinus thrombosis Tx: CT to assess posterior spread, LP to exclude meningitis Immediate IV abx

Question 41

Scalded skin syndrome

Answer 41

S aureus: exfoliative toxin causes separation epidermis Fever; malaise; purulent crusting infection around eyes, nose, and mouth with subsequent spread Nikolsky positive Tx: IV Abx, analgesia, fluid maintenance

Question 42

Necrotizing fasciitis

Answer 42

Staph or S pyogenes Severe skin infection extending from dermis to fascia to muscle Systemically unwell, severe pain, necrotic center with damaged tissue Medical emergency IV Abx, surgical debridement, consider admission to intensive care. May require amputation

Question 43

Complications meningitis

Answer 43

``` hearing loss Local vasculitis Local cerebral infarction Subdural effusion Hydrocephalus Cerebral abscess ```

Question 44

Cushing triad (meningitis)

Answer 44

Bradycardia, hypertension, abnormal pattern breathing | Bad news bears

Question 45

Late signs meningitis

Answer 45

Papilledema, bulging fontanelle in infants, opisthotonus (hyperextension head and back)

Question 46

Tx meningococcal disease

Answer 46

IM benzylpenicillin immediately and urgent transfer to hospital Third generation ceph (e.g. ceftriaxone), dexamethasone

Question 47

Contraindications to LP

Answer 47

``` Cardiorespiratory instability Focal neuro signs Signs raised ICP: coma, high BP, low heart rate, papilledema Coagulopathy Thrombocytopenia Local infection at site LP ```

Question 48

CSF findings: bacterial meningitis

Answer 48

Turbid appearance Neutrophils Increased protein Decreased glucose

Question 49

CSF findings: viral meningitis

Answer 49

Clear appearance Increased lymphocytes Normal/increased protein Normal/decreased glucose

Question 50

CSF findings: TB meningitis

Answer 50

Turbid, clear, or viscous appearance Increased lymphos Very high protein Very low glucose

Question 51

Encephalitis - definition - Etiologies - Sxs - Tx

Answer 51

Inflamm of brain parenchyma 1. Direct invasion cerebrum by neurotoxic virus (e.g. HSV) 2. Delayed brain swelling from neuroimmunological response (e.g. post-infectious encephalopathy e.g. post-chickenpox) 3. Slow virus infection e.g. HIV or subacute sclerosing panenceph following measles Sxs may be indistinguishable from meningitis: fever, altered consciousness, often seizures Tx: high dose acyclovir IV

Question 52

Malaria

Answer 52

Plasmodium protozoa Think Falciparum if fatal or involves brain Other types: vivax/ovale (tertian), malariae Sxs: HA, cough, fatigue, malaise, shaking chills, arthralgia, myalgia, diarrhea, N&V, anorexia, lethargy, jaundice Thick and thin blood film: thick confirms dx, thin identifies species Quinine for falcip, chloroquine for others

Question 53

Dengue fever

Answer 53

Dengue virus, transmitted by Aedes aegypti mosquito "Break bone fever". Erythem rash, high fever, HA, arthritis, myalgia, vomiting, hemorrhagic signs, lethargy, hepatomegaly, abdo distention Can cause hemorrhagia--severe capillary leak syndrome Tx: fluid resusc, monitoring, blood transfusion if severe