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laughing your way peds > ID > Flashcards

ID Flashcards

1
Q

What is the treatment options for resistant TB

A

2 months of RIP (rifampin, INH, Pyrazinamide)

Then Pass on to 4 months of INH and rifampin

Or
Just start with 6-9 months of INH AND rifampin

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2
Q

What are manifestations of extra pulmonary TB

A

Meningitis
Adenitis
Pleuritis
Disseminated (miliary dz)

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3
Q

What is the treatment for TB meningitis

A

2 months of RIP AND streptomycin

Then RI for another 10 months

PLUS - steroids

Can stop streptomycin after isolating the strain and confirming sensitivity to INH

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4
Q

Buzzword for XRAY findings in PCP pna

A

Ground glass appearance

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5
Q

Antibiotic choice for tx of neutropenia fever

A

Zosyn + an aminoglycoside

Or

Ceftazidime

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6
Q

Organism causing diarrhea in pt that has been in swimming pool or municipal water

A

Cryptosporidium

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7
Q

Organism causing diarrhea in pt that has been near farm livestock or petting zoos

A

Cryptosporidium, e. Coli

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8
Q

Organism causing diarrhea in pt that is immunocompromised

A

Cryptosporidium

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9
Q

Organism causing diarrhea in pt that has consumed apple juice, cider or undercooked ground beef

A

E. Coli

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10
Q

Organism causing diarrhea from pt eating chitterlings or pork

A

Yersinia

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11
Q

Organism causing diarrhea in pt that has eaten improperly cooked poultry, untreated water or dairy farms

A

Campylobacter

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12
Q

Organism causing diarrhea in pt that has eaten unpasteurized milk

A

Campylobacter, e. Coli

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13
Q

What are first generation cephalosporins effective towards

A

Gram positive cocci

Not good for methicillin resistant organisms, listeria or enterococcus. They do not penetrate CSF.

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14
Q

What organisms do second generation cephalosporin cover

A

Beta lactamase producing gram negatives

Enterobacteriaceae, H. Flu, Moraxella Catarrhalis

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15
Q

What do 4th gen cephalosporins cover

A

Pseudomonas

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16
Q

When is rifampin used as prophylaxis

A

For meningococcal or Hib exposure

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17
Q

What organisms spread through airborne

A

Aspergillosis, TB, measles, varicella, disseminated zoster

*special handling units are needed to prevent spread as these remain airborne for prolonged periods of time

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18
Q

Bacteria that causes infections in asplenic pts (sickle cell)

A

Strep pneumonia, neissereia, h. Flu (encapsulated organisms)

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19
Q

Bacteria that cause infections in immunocompromised pts

A

Gram negative bacilli (pseudomonas, e. Coli, klebsiella) and staph

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20
Q

Dermatological manifestation for pseudomonas

A

Ecthyma gangrenosum; large pustules on an indurated, inflamed base

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21
Q

Dermatological manifestation for salmonella thyphi

A

Rose spots

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22
Q

Buzz words for chlamydia pna

A

Afebrile, staccato cough

Intracyroplasmic inclusion bodies

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23
Q

Tx for chlamydia trachomatis

A

1g of azithro or 7 days of doxy

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24
Q

How does Rocky Mountain spotted fever present

A

Petechial rash in wrist, ankle, palms and soles that then spreads centrally. Pt will also have a headache and may have fever and myalgia.

If no rash will present with hyponatremia and depression of one or all 3 cell lines in CBC

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25
Q

How do you test for RMSF during the acute phase

A

Direct immuniflurescense of skin biopsy

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26
Q

How do you distinguish ehrlichiosis from RMSF

A

Both have hyponatremia and theombocytopenia but ehrlichiosis will also have leukopenia and elevated liver enzymes

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27
Q

Who should receive chemoprophylaxis following h. Flu type b exposure

A

Everyone in household if -

Someone younger than 12 months who has not received the primary series of Jin vaccine

Someone younger than 4 incompletely immunized

If immunocompromised child present

If there are 2 or more cases occurring within 60 days and unimmunized or incompletely immunized children attend a childcare or preschool then prophylaxis is indicated for all attendees at the school

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28
Q

How does treatment impact pertussis based on the stage of when it is started

A

If during catarrhal stage will shorten this stage

If during paroxysmal stage will decrease the period of communicability but does not shorten the coughing stage

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29
Q

Turtles, snakes and hedgehogs - petting and then diarrhea. What organism?

A

Salmonella

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30
Q

How can shigella present

A

Fever with diarrhea. Bloody diarrhea after fever subsides.

Increased bands on WBC

Seizures

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31
Q

Tx for pseudomonas

A

Piperacillin/tazobactam, gent

Imipenem/meropenem, ceftazidime

Cipro/levofloxacine

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32
Q

Fever and malaise in a pt with exposure to cattle, sheep or goats

A

Brucellosis

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33
Q

Tx for brucellosis

A

Tetracycline or bactrim

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34
Q

I&D only is appropriate for abscesses of which size

A

Smaller than 5cm

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35
Q

What’s the mechanism of action for adult botulism

A

Preformed toxin from poorly canned goods is ingested

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36
Q

Mechanism of action for infantile botulism

A

Spores are ingested and they germinate. The toxin is then produced and absorbed. Toxin blocks release of acetylcholine.

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37
Q

How do you diagnose infantile botulism

A

Toxin or organism in feces

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38
Q

Primary stage of syphilis

A

Chancre (painless)

3 wks after exposure and resolves in a few weeks

39
Q

Secondary stage of syphilis

A

1-2 months after first stage

Rash( palms and soles), mucocutaneous lesions, lymphadenopathy

Resolves spontaneously 3-12 wks

40
Q

Tertiary syphilis

A

15-30 yrs after initial infection

Gumma formation, cardiovascular, neurosyphilis

41
Q

Screening tests for syphilis

A

Rpr and vdrl

42
Q

Diagnostic tests for syphilis

A

FTA-ABS

Spirochete on microscopic dark field examination or direct fluorecent antibody

43
Q

When do you need to tread a newborn for syphilis

A
  • if mom was tx within a month of the pregnancy (not if tx bf)
  • if mom tx with erythromycin as it doesn’t cross the placenta
  • if baby titers are higher than mom’s
44
Q

Presentation of congenital syphilis

A

Snuffles, bullous lesions, osteochondritis, pseudoparalysis, poor feeding.

Lymphadenopathy, mucocutaneous lesions, pna, edema, thrombocytopenia, heoatosplenomegaly, hemolytic anemia, jaundice

45
Q

How does untreated congenital syphilis present

A

Develop symptoms after 2 yrs of age

Hutchinson triad -
Interstitial keratitis
8th cranial nerve deafness
Hutchinson teeth (peg shaped central incisor)

46
Q

Common infections associated with kingella kingae

A

Suppurative arthritis, osteo, bacteremia

47
Q

Serogroups that cause meningitis

A

C, Y, W-135

48
Q

Who should receive meningococcal chemophrophylaxis

A
  • household contacts
  • childcare contacts 7 days prior to onset of illness
  • secretions shared 7 days prior to onset
  • mouth to mouth or endotracheal intubation 7 days prior to onset
  • slept in same dwelling 7 days prior to onset
  • passages directly next to pt on flights longer than 8 hours
49
Q

Which bacteria causes abdominal pain that mimics appendicitis or intussuception

A

Campylobacter

Yersinia enterocolitica also mimics appi

50
Q

Yersinia pestis causes what

A

Bubonic plague

Swollen painful lymph nodes

51
Q

When is treatment for cat scratch disease indicated?

A

Hepatosplenomegaly, large painful adenopathy, immunocompromised pts

52
Q

If an infant is infected with rubella during the first trimester how would they commonly present and what’s the percentage likelihood

A

Cataracts and PDA

50%

53
Q

When is measles most contagious

A

4 days before to 4 days after the rash appears

54
Q

What are the stages of measles (rubeloa)

A
  • incubation 8-12 days
  • pristine first 2 days
  • koplik spots
  • rash around day 5
  • rash is worse after a week and resolves around day 10
55
Q

Post exposure management of measles

A
  • within 6 days of exposure immune globulin should be given
  • measles vaccines to those not completely immunized. If given within 3 days of exposure might help prevent onset of disease
56
Q

Complications of mumps

A 
M- eningitis
U- nderwear (orchitis) - not infertility 
M- uscle aches 
P- ancreatitis
S - welling if parotid gland
57
Q

What virus causes hydrops fetalis and aplastic crisis in sickle cell patients

A

Parvovirus b19

58
Q

When do you test during HIV exposure

A

At time of exposure, 6wks, 12 wks and 6 months.

If someone is going to seroconvert will do so in first 6 months

59
Q

When is the mmr vaccine contraindicated in pts with HIV

A

When the cd4 count is less than 15 percent of normal for age

60
Q

When is a newborn given VZIG for varicella exposure

A

If mother developed chicken pox 5 days before or 2 days after

61
Q

Pt with conjunctivitis, pharyngitis, and otitis media during the summer. What organism.

A

Adenovirus

62
Q

Pt with diarrhea who was in cruise ship. Organism.

A

Norovirus

Rapid onset and quick resolution

63
Q

What animals would you think of for rabies

A

Bat, raccoon, skunk, coyote, bobcat

64
Q

When do you treat with oral acyclovir or valacyclovir in healthy children with varicella

A

Unvaccinated older than 12 yrs

Chronic cutaneous or pulmonary disorder

Ppl receiving long term salicylate tx

Kids receiving short, intermittent, or aerosolized courses of corticosteroids

65
Q

When do you give varicella IG or IGIV for post exposure prophylaxis

A

Immunocompromised or pregnant without immunity.

Newborn that mom had chicken pox 5 days before or 2 days after

Hospitalized preterm >28 wks without maternal immunity or less than 28 wks regardless

66
Q

Whose at risk for infection with entamoeba histolytica

A

Immigrants or long term visitors of endemic areas

Institutionalized people

Men who have sex with men

67
Q

Presentation of amebic dysentery from entamoeba hystolytica

A

Belly pain, diarrhea (watery, bloody and mucous), tenesmus (painful but ineffectual urge to defecate)

68
Q

What’s the clinical course of entamoeba

A

Ashmptomatic to severe GI to abscesses in the liver and brain or lung disease

69
Q

Treatment for asymptomatic pts with entamoeba

A

Oidoquinol, paromyocin or diloxanide

70
Q

Treatment for symptomatic pts with entamoeba

A

Metronidazole or tinidazole

Plus…

Iodoquinol or paromycin

71
Q

Presentation of pts with giardia intestinalis

A

Acute watery diarrhea, foul smelling stool, fluctuance, anorexia, wt loss, anemia

72
Q

When is tx for toxo given and what is it

A

Pyrimethamine, sulfadiazine, foilinic acid (leucovorin)

All congenital infections

Or acquired with chorioretinitis, severe organ damage, immunocompromised

73
Q

What clues indicate ascaris lumbricoides infection

A

Obstruction or abdominal pain symptoms

AND

Travel or immigration from a tropical region

74
Q

How does toxocara canis present (toxocariasis, visceral larva migrans)

A

GI symptoms (HEPATOMEGALY, abdominal pain) AND

Respiratory symptoms (wheezing)

  • exposure to cats and dogs
  • preschooler eating dirt
  • eosinophilia
75
Q

How do you diagnose visceral larval migrans

A

ELISA

76
Q

Tx for visceral larval migrans

A

Abendazole or thiabendazole

77
Q

Where is coccidiodomycosis seen

A

CAT: California, Arizona, Texas

78
Q

How does coccidioidomycosis present

A

Influenza like symptoms with fever, night sweat, headache, chest pain and muscle aches

Tx amphoterecin b, fluconazole or ketoconazole

79
Q

Presentation for aspergillosis

A

Asthmatic with worsening symptoms despite tx

Increased eosinophils and infiltrates noted on Cxr

80
Q

How do you diagnose aspergillosis

A

Positive serum galactomannan

81
Q

Where do you see histoplasmosis

A

Ohio, Missouri, Mississippi River valleys

82
Q

Presentation of histoplasmosis

A

Flu like symptoms AND hepatosplenomegaly

From bird droppings like crypto
Flu like as coccidiomycosis

83
Q

How does cryptococcosis present

A

Pulmonary disease as well as meningitis (headache)

84
Q

Which organism is associated with rose spots

A

Salmonella which can cause thyphoid

85
Q

Which organism gives you a normal WBC but bandemia

A

Shigella

86
Q

Tx for campylobacter

A

Azithromycin and erythromycin which shorten duration of illness and excretion of organism

Most common cause of bacterial gastro in developed world

Bloody diarrhea!!!!! Fever and abdominal pain

87
Q

How does yersinia enterocolitica present

A

Bloody diarrhea! RLQ pain, high WBC

88
Q

What pts do you commonly see yersinia enterocolitica in

A

Sickle cell and thalassemia because it loves iron!

89
Q

When do you treat yersinia?

A

Less than 3 months are at increased risk for bacteremia and those who have sickle cell and thalassemia due to excessive iron stores

Tx Bactrim

90
Q

Tx for kingella kingae

A

Penicillin agents

Resistant to clinda and Bactrim

91
Q

What organisms cause osteoporosis

A 
Staph aureus (most common) 
Strep pneumonia, group a strep

Salmonella (in sickle cell)

Group B strep (neonates)

92
Q

When can a mother provide expressed breast milk but not breastfeed

A

Varicella 5d before or 2 days after

Untreated active TB until RD for a minimum of 2 wks

HSV lesions until they have resolved

93
Q

Contraindications to breast feeding

A

Brucellosis, HIV, HTLV 1 or 2

laughing your way peds (26 decks)

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