ID COPY Flashcards

Question

Impetigo bugs and rx

Answer 1

S aureus GAS Cloxacillin, cephalexin, topical mupircoin

Answer 2

S. aureus GAS IV: Cloxa and ancef PO: cloa and keflex

Answer 3

GAS, S aureus Cloxa or ancef plus clinda think post varicella

Answer 4

50-90% Strep pneumoniae HIB Neiseeria Salmonella

Answer 5

Prevnar 13 and 23-v polysacchirde vaccine 4CMenB Influenza annual S. typhi vaccine pre travel

Answer 6

Unilateral swollen Cx nodes and ipsilateral conjuctivitis NO FEVER

Answer 7

Atypical mycobacterium

Answer 8

Bartonella henselae Azithromycin for nodes Doxcycline + rifampin for neuroretinitis

Answer 9

Ertherma migrains Systemic sx: fever, myalgia, neck stiffness

Answer 10

Multiple EM Meninigitis FACIAL NERVE PALSY

Answer 11

Pauciarticular arthritis, peripheral neuropathy, CNS manifestations

Answer 12

PO: Doxycycline, amoxicillin, cefuroxime IV: ceftriaxone, pencillin G

Answer 13

Physical: screens on windows and doors, fine mesh netting for cribs, long loose clothing, hat, closed shoes Repellents: DEET 12 years 30%, Icaridin for children 6M-12Y Insepct skin daily for ticks Shower within 2 hours of removal

Answer 14

Single dose doxy for children \> 8 years of age in exposed endemic regions

Answer 15

Peak: late summer and fall Asymptomatic 80%, fever 20%, CNS

Answer 16

Aseptic meningitis, encephalitis, acute flaccid paralysis

Answer 17

Cerebellar ataxia, encephalitis, reye syndrome, stroke, Zoster

Answer 18

HSV Otitis media Lyme disease Varicella zoster virus Cholesteatoma Facial nerve schwannoma Vestibular schwannoma

Answer 19

Facial nerve palsy Varicella zoster Worse prognosis Antivirals and corticosteriods

Answer 20

1. Malaria 2. Typhoid fever 3. Meinigococcemia 4. Viral hemorrhagic fever

Answer 21

TB Brucellosis Leishmaniasis Typhoid fever

Answer 22

Chest Xray

Answer 23

Mycobacterium tuberculosis infection Non-tuberculosis mycobacteria BCG Incorrect technique

Answer 24

Incorrect technique Active TB disease Immunodeficiency states Corticosteriods Young age Malnutrition Viral infections (measles, varicella, influenza) Live attenuated vaccines (measles)

Answer 25

Infants and post-pubertal adolescents Recently infected (past 2 years) Immunodeficiency states (Primary ID, HIV, Malignancy, organ transplant, immunosuppressive medications, malnutrition)

Answer 26

TST INterferon gamma release assays Chest Xray Gastric aspirates (three consecutive AM aspirates) Bronchoalveolar lavage Microbiology (acid fast staining, DNA, PCR)

Answer 27

Isoniazid for 9 months

Answer 28

4 drugs (INH, RIF, PYR, ETH)

Answer 29

Hepatotoxicty, peripheral neuropathy,

Answer 30

Hepatotoxicity, hypersensitivity reactions, memory impairment, drug interaction, body fluids turn orange

Answer 31

Hepatotoxicity, increased uric acid levels

Answer 32

Optic neuropathy

Answer 33

Antiretroviral therapy: Triple ART starting in 2nd tri IV ziovudine during labor and to newborn for 6 weeks BF is contraindicated C/s if VL \>1000

Answer 34

2 separate negative PCR tests at \>1 and \>2 months of age

Answer 35

Positive PCR x 2 to 18 months Reactive serology \>18 months

Answer 36

Increased risk of pneumococcal disease Vaccine responses not as good as healthy children Management of acute illness same

Answer 37

Clinical status Immunologic status Virologic status Antiretroviral therapy and adherence

Answer 38

Live virus: MMR in absence of severe immune compromise VZV conisder in asymptomatic cihldren BCG and oral polio CI

Answer 39

Vaccine within 2 weeks of exposure in those \> 12 months

Answer 40

Local wound care: allow bleeding, clean with soap and water Prevention: 1. Tetanus 2. Prophylactic ABx only for moder or severe, deep puncture, face/hand/gentalia/ foot 3. HIV PEP only if HIV infected PLUS exchange of blood

Answer 41

HBIG and HB vaccine within 12 hours of birth HB vaccine at 1 and 6 months

Answer 42

Stat HBsAG on Mom If results are available within 12 hours, if positive, give HBIG and HB vaccine, if not, nothing If not available, seriously consider both

Answer 43

5% Risk factors: HIV co-infection, higher HCV viral load, elevated ALT, cirrhosis

Answer 44

No evidence to support C/s Avoid invasive procedures

Answer 45

No evidence of transmission in breast milk

Answer 46

HCV serology at 12-18 months

Answer 47

HIV, HTLV, Variable: TB, HSV with lesions on breast

Answer 48

1. Prior to the patient or patient environment contact 2. Before aseptic procedure 3. After body fluid exposure 4. After patient/pateint environment contact

Answer 49

1. Use clinical judgement 2. Treat infection, not contamination 3. Assessment of antibiotic allergies 4. Know your local antibiogram 5. Selecting an antibiotic (narrow, optimize dosing and duration) 6. Promote vaccinations to reduce likelihood for disease

Answer 50

24 hours after treatment start

Answer 51

24 hours after treatment start

Answer 52

5 full days after treatment start

Answer 53

Resolution of diarrhea and stool negative x 2

Answer 54

Resolution of diarrhea and stool negative x 2

Answer 55

resoltuion of Sx and stool negative x 3

Answer 56

until 1 week after onset of illness or jaundice

Answer 57

after treatment given

Answer 58

PO vanco + IV flagyl

Answer 59

Alcohol doesn't kill spores Must wash with soap and water

Answer 60

6-59 months Chronic health conditions (NM, Cardiac or pulmonary, malignancy, IC

Answer 61

Cephalosporins, clavulin, septra

Answer 62

Toxic, unable to take PO, immunocompromised host Amp/Gent

Answer 63

First febrile UTI

Answer 64

US evidence of hydronephrosis, renal scarring or other findings suggestive of a high grade VUR Recurrence of febrile UTI

Answer 65

Quadrivalent inactiated vaccine (QIV)

Answer 66

1. Anaphylaxis 2. Immunodeficiency (certain vaccines) 3. Pregnancy (live) 4. GBS

Answer 67

PCV13 (Prevnar) PPSV23 (Pneumovax) \>8 weeks post prevnar, 2+ MCV4 4CMenB

Answer 68

Universally given starting at 6 weeks no later than 15 weeks (Older kids get inssussception)

Answer 69

Immunocompromised History of intussussception

Answer 70

-Chronic pulmonary and cardiac disease -SNHL requiring cochlear implants -Chronic kidney, liver, metabolic -Immunosuppresion -neurologic swallowing disorders -Hgbopathies -Chronic CSF leak -Malignancy, past HSCT

Answer 71

Non-pencillinase producing gram + cocci and gram + anaerobic DOC: Syphilis, GBS, GAS pharyngitis

Answer 72

Beta lactam ring Interefere with peptidoglycan cross-linking that is required to produce stable bacterial cell walls DO NOT cross the blood brain barrier

Answer 73

Eg: methicillin, oxacillin, dicloxacillin Side chains attached to pencillin lactam ring inhibit staph Excellent activity against Staph aureus

Answer 74

Similar to pencillin Additional activity against aerobic gram negative E. Coli, Listeria, Salmonella

Answer 75

Anti-pseudo pencillins Expanded gram negative spectrum Pseudo aeruginosa and proteus

Answer 76

No! Classic example of EBV + amoxicillin

Answer 77

Gram + organisms Some activity of E coli and klebsiella species

Answer 78

Increased spectrum of activity of gram negative organisms Treatment of nosocoimal pneumonia No antipseudonomal activity

Answer 79

Broad spectrum, excellent activity against gram negative bacteria General less activity gram positive organisms

Answer 80

1. Penicillin binding proteins: crossing linking between glycan chains (target for beta lactam antibiotics) 2. Beta lactamase: enzymes that hydrolyze the beta lactam ring of the antibiotic. SPACE: Serratia, Pseudonomas, Actineobactera, Caitrobacter, and Enterobacter

Answer 81

-Rapid infusion of vancomycin -Complain of diffuse burning, itching, dizzines -Caused by histamine release from degradulaiton of mast cells underlies reaction -Reaction

Answer 82

Catarrheal (1-2 weeks): low grade fever, URI Sx, mild cough, apnea in infants Paroxysmal (1-6 weeks): severe cough in paroxysms and inspiratory whoop Convalescent (2-3 weeks): resolution of sympoms, cough fits may persist

Answer 83

1. Spiking fevers 2. Anemia 3. Splenomegaly

Answer 84

thick and thin smears

Answer 85

Dengue fever -Fever, severe headache, retro-orbital pain, fatigue, severemyalgias Abrovirus, transmitted by mosquitos May develop dengue hemorrhagic dever

Answer 86

Period fever, aphthous stomatitis, pharyngitis and cervical adenitits Childhood 4 day fevers 2-8 weeks in between

Answer 87

Cough, coryza and conjunctivitis

Answer 88

Mid face hypoplasia Dayare attendance Aboriginal Low SES Second hand smoke No BF

Answer 89

Catarrhal: 1 week (incubation 3-21 days) coryza, conjunctiviotis, mild cough Only phase that can be treated Paroxysmal: 2-6 weeks: severe paroxxysms of coughing with inspiratory whoop. Apnea in small infants Convalescent: up to 1 year, gradual decrease in cough

Answer 90

Bordetella Azithromucin, clarithromycin, erthyromycin

Answer 91

Food borne unpasteruized milk Adults working with livestock Triad: Fever, arthralgia, HSM

Answer 92

Orbital: proptosis, impairment of eye movement, pain, visual acuity decreased, SICK

Answer 93

6-72 hours

Answer 94

Days with abdo pain

Answer 95

Gastroenteritis Typhoid fever

Answer 96

Staph aureus

Answer 97

CHINA C: Connectiv tissue diseases H: Helminithic infections I: Idiopathic HES N: Neoplasia A: Allergies

Answer 98

Viridans type strp Staph aureus

Answer 99

Osler nodes

Answer 100

Major: 1. Positive blood cultures 2. Evidence of endocarditits on echo Minor: 1 Predisposing conditions 2. Fever 3. Embolic vascular signs 4. Immune complex phenomena 5. Single blood culture Diagnosis: 2 major, 1 major and 3 minor, 5 minor

Answer 101

Salmonella-diarrhea resolves, 3 negative cultures Shigella and e coli- diahrrhea reolves and 2 negative cultures Campylobactera- diarrhea resolves

Answer 102

\>2 in 24 hours until resolves

Answer 103

Until completed treatment

Answer 104

Well enough to go

Answer 105

5 days of antibiotics

Answer 106

1 week after onset of illness or jaundice

Answer 107

Nonpurulent conjuctivitis Rash without fver Parvo B19 CMV HBV HIV

Answer 108

Acute, self-limited fever, jaundice, malaise Highly contagious, fecal-oral Exclude x 1 week PEP: HepA IG within 2 weeks and Hep A vaccine if\>12 M

Answer 109

Screening in pregnancy Antiretrovirals for Mom in pregnancy C section pre ROM AZT for baby x 6 weeks NO breastfeeding

Answer 110

Major: 1. Migratory polyarthritis 2. Carditis 3. Chorea 4. Subcutaneous nodules 5. Erthyema marginatum Minor: Fever, AV block, Inflam markers, Arthralgia

Answer 111

Anti-inflammatory meds for the joints x2 months Pen V 10 day course PPx: minimum 5-10 years or until age 21 (longest)

Answer 112

Ethmoidal-Birth maxillary- 4 Sphenoid 5 Frontal 7-8

Answer 113

Vaccine for susceptibles \< 72 hours VZIG within 96 hours if: IC, pregnant, newborn of mom's with varicella 5 before, 2 after delivery, Prem \<28 or \<1000g

Answer 114

PPX within 2 weeks Vaccine IG for IC, Infants, Liver Dz

Answer 115

Neonate/Unvaccination: HBIg and Vaccine

Answer 116

Polysaccharide capsule Protein A (binds IG) Catalase inactivated hydrogen perioxide

Answer 117

Staph aureus

Answer 118

Strep pneumo

Answer 119

Hordeolum-purulent infection of the sweat gland of the eye lid, red, tender swelling. S aureus Stye-External hordeolum, skin side of the eyelid Chalazion-internatl hordeolu, conjunctival side of the eyelid

Answer 120

1. Strep pneumonia 2. Nontype H influenzae 3. M. CATARRHALIS

Answer 121

1. CLose contact with confirmed or suspected cases of TB 2. Radiographic or clinical evidence of tubercular disease 3. Immunosuppressive therapy 4. CHldren with ID including HIV

Answer 122

CHildren \< 4 years Children with Hodgkin, lymphoma, DM, chorinc renal failure, malnutrition Children born in high prevalence regions of the world Children exposed to adulted HIV homeless, incarcerated, illict durg user

Answer 123

\>4 without risk factors

Answer 124

Cataracts Purpuric rash ("blueberry muffin") Seizures from CMV CNS lesions Hepatosplenomegaly IUGR Microcephaly Prolonged neonatal jaundice

Answer 125

CMV: periventricular calcifications Toxoplasmosis: calcifications scattered throughout cortex

Answer 126

Humoral: B-cell Cellular: T-cell

Answer 127

Child 18 months: HIV ELISA (enzyme linked immunosorbent assay to look for HIV IgG: 99% specificity and sensitivity); if positive, confirm diagnosis with Western Blot (direct visualization of antibodies against the virus)

Answer 128

GAS invasive soft-tissue infection: necrotizing fasciitis, myositis, cellulitis, toxic shock syndrome Treatment: Penicillin and clindamycin

Answer 129

Classic triad (in 1/3 of patients): 1. Eczema 2. Thrombocytopenia 3. Immunodeficiency Complications: 1. Immunodeficiency: - T and B cell function is reduced - recurrent pneumonia/otitis media/sepsis/meningitis/sinusitis - progressive - can have hepatomegaly 2. Risk of malignancy (10-20%) - leukemia/lymphoma Mode of inheritance: -X-linked

Answer 130

Present at birth with thrombocytopenia features: bruising, petechiae, bloody diarrhea Eczema by 1st month of life, recurrent infections by 3 months of life

Answer 131

IgA & IgE: elevated IgM: reduced IgG: normal, reduced or elevated

Answer 132

1. CBC + diff 2. Blood culture 3. Bag for urine --\> cath if positive

Answer 133

1. Urine with \> 10 wbc/hpf 2. Colony count of single organism \> 50,000/ml \*\*\*Remember that if child has been symptomatic

Answer 134

1. Arthritis 2. Erythema migrans: painless, annular, central clearing, minimum size 5 cm 3. Aseptic meningitis 4. Cranial nerve palsies 5. Heart block 6. Ocular involvement

Answer 135

1. Dysuria 2. Penile discharge Most common etiology: Chlamydia trachomatis (3x more common than Neisseria gonorrhoeae)

Answer 136

1. Empiric treatment for chlamydia and gonorrhea - Azithromycin 1 g PO x 1 for chlamydia - Ceftriaxone 250 mg IM x 1 for gonorrhea 2. Instruct patients to abstain from sexual intercourse x 1 wk after single-dose therapy and until all partners are treated to prevent reinfection 3. Test for other possible STIs (syphillis, HIV, hepatitis, etc.)

Answer 137

Increased gallbladder sludge and subsequent cholelithiasis

Answer 138

The retropharyngeal nodes that drain the mucosal surfaces of the upper airway and digestive tracts (between the pharynx and the cervical vertebrae, extending down into the mediastinum) become infected - once infected, the nodes progress through 3 stages: cellulitis, phlegmon, abscess - most patients have history of recent ear/throat/nose infection

Answer 139

1. Localized infection of oropharynx extending to the retropharyngeal lymph nodes 2. Penetrating trauma 3. Vertebral osteomyelitis 4. Dental infection

Answer 140

This disease is most common in children between the ages of 1 and 6 years. There are several small lymph nodes in the retropharynx that usually disappear by the age of 4 or 5.

Answer 141

Think upper airway obstruction! 1. Respiratory distress 2. Stridor 3. Drooling 4. Fever 5. Refusal to eat 6. Obstructive sleep apnea 7. Neck stiffness/torticollis

Answer 142

1. Acute epiglottis 2. Lymphoma 3. Meningitis (if neck stiffness present) 4. Foreign body aspiration 5. Vertebral osteomyelitis

Answer 143

Polymicrobial! Most commonly: 1. GAS 2. Staph aureus 3. Oral anaerobes

Answer 144

Intravenous antibiotics until clinical improvement, then switch to PO abx (ideal duration of treatment unknown) - 3rd generation cephalosporin + clindamycin - studies have shown that \> 50% of children can be successfully treated without surgical drainage Indications for surgical drainage: 1. Respiratory distress 2. Failure to improve with IV abx

Answer 145

1. Significant upper airway obstruction 2. Rupture leading to aspiration pneumonia 3. Extension into mediastinum 4. Thrombophlebitis of internal jugular vein

Answer 146

Infection from the oropharynx extending to cause septic thrombophlebitis of the internal jugular vein and embolic abscesses in the lungs - causative organism: fusobacterium necrophorum (oral anaerobe) - most commonly seen in pharyngitis where peritonsillar abscess forms (ie. with GAS) and this allows the oral anaerobes to flourish within the abscess and then spread to the IJV - infected clot forms within the IJV and can throw off emboli

Answer 147

Used for management of febrile infants 1-3 months of age: if ALL criteria are present, then the risk of having occult bacteremia is less likely. Well appearing infant No skeletal, soft tissue, skin or ear infections Full term birth No prior illness No prior hospitalizations Not hospitalized longer than mother after delivery No prior antibiotics No Hyperbilirubinemia No chronic or underlying illness Complete Blood Count normal White Blood Cell Count normal (5000 to 15,000/mm3) Band Neutrophils \< 1,500/mm3 Other Lab Findings If Diarrhea is present, Fecal Leukocytes \<5 WBC/hpf Urine White Blood Cells \<10 WBC/hpf

Answer 148

BOY LoVe The crIME - BCG - OPV - Yellow fever - Live vaccines - Varicella - Typhoid - Influenza (intranasal) - Measles/mumps - Epidemic typhus

Answer 149

Listeria monocytogenes

Answer 150

Infant born to mom with primary HSV infection: 50% Infant born to mom with recurrent HSV infection:1-3% (due to less viral shedding and presence of maternal neutralizing antibody)

Answer 151

1. HSV 2. Varicella 3. CMV

Answer 152

Clostridium botulinum: intestinal colonization occurs from ingestion of spores from honey, dust, soil - spores secrete neurotoxin that irreversibly prevents acetylcholine, thus see anticholinergic effects - clinical features: constipation, urinary retention, symmetric progressive weakness (paralysis), ptosis, diplopia, respiratory failure, poor feeding - in older children, they have to ingest the actual neurotoxin itself (may be present in foods) to cause disease; eating spores alone does not result in disease since the spores cannot germinate and produce neurotoxin in the gut of a child \> 1 yo - in infants

Answer 153

Aminoglycosides! Worsen neuromuscular blockade

Answer 154

EBV infection = infectious mononucleosis - clinical features: fever, exudative pharyngitis, fatigue, lymphadenopathy, hepatosplenomegaly, tonsillar hypertrophy - complications: 1. Splenic rupture 2. Encephalitis 3. Hemolytic anemia/thrombocytopenia 4. Airway obstruction 5. Malignant association: Burkitt lymphoma, Hodgkin disease, etc.

Answer 155

Monospot = looks for heterophile antibodies produced by the immune system to EBV -sensitive test in children \> 4 yo (present in \>90% if has infection)

Answer 156

Bartonella Henselae (gram negative bacillus) - clinical features: 1. Regional lymphadenopathy (predominant) Less common: 2. Parinaud oculoglandular syndrome: inoculation of eyelid conjunctiva --\> conjunctivitis and ipsilateral preauricular lymphadenopathy 3. Liver and spleen granulomas 4. Encephalitis Immunocompromised: 5. Bacillus angiomatosis: proliferation of blood vessels --\> tumor like masses in skin and organs

Answer 157

Serology - mild disease: supportive care; self-limited with resolution in 2-4 mo, no need for abx - severe or systemic disease: 5 d course of azithromycin to treat severe, painful lymphadenopathy but does not shorten duration of symptoms

Answer 158

3-5 d of high fever followed by macular papular rash which appears on TRUNK first, then spreads to extremities/neck/face as the fever resolves. - associated with febrile seizures - infectious etiology: Human herpes virus 6 - treatment: supportive care

Answer 159

1. CD4 count 200 or less in a patient with HIV OR 2. The presence of an opportunistic infection in a patient with HIV

Answer 160

1. HIV PCR at 14-21 d; if negative, repeat at 2 and 6 mo. 2. If still negative, HIV antibodies assay (ELISA) at 18 mo. - treatment: zidovudine is given to mother prenatally, during L&D. Then start zidovudine for infant x 6 wks or until HIV PCR is back.

Answer 161

1. Nucleoside reverse transcriptase inhibitors (NRTI) 2. Non-nucleoside reverse transcriptase inhibitors (NNRTI) 3. Protease inhibitors 4. Fusion inhibitors - use combination of 3 or 4 agents from at least 2 classes

Answer 162

1. Pneumonia with staph aureus, strep pneumo, GAS 2. Otitis media 3. Myocarditis 4. Encephalitis 5. Guillain Barre syndrome

Answer 163

By the saliva of a female Anopheles mosquito - carries plasmodium protozoa (intracellular) - most severe disease is seen with plasmodium falciparum - clinical features: 1. High fever 2. Chills 3. Hemolysis (anemia, jaundice, splenomegaly) 4. Cerebral malaria: increased ICP, seizures, coma, death - diagnosis: thick and thin blood smears several samples per day x 3 days to identify parasite (thick is better to identify that parasite is there, thin is to identify species)

Answer 164

1. Clinical status of patient: non-severe vs. severe 2. Plasmodium species 3. Drug susceptibility of the infecting parasite

Answer 165

For patients with non-severe, uncomplicated malaria, can treat with PO antimalarial (chloroquine = main one, other choices include primiquine, atovaquone proguanil or quinine sulfate plus doxycycline/tetracycline/clindamycin or mefloquine) Patients with the following factors should receive IV antimalarials (IV quinidine plus doxycycline/tetracycline/clindamycin): 1. Severe hemolysis: severe anemia, bleeding, jaundice, hemoglobinuria 2. ARDS 3. DIC 4. Renal failure 5. Impaired consciousness 6. Parasitemia \> 6% -continue therapy until parasite level

Answer 166

- Latent hepatic stages: Plasmodium vivax and ovale - chronic asymptomatic parasitemia: Plasmodium malariae

Answer 167

5 days prior to onset of rash to 4 days after

Answer 168

Measles (paramyxovirus): 1. Cough 2. Conjunctivitis 3. Coryza - also see fever and Koplik spots - Morbilliform rash starting from head and spreading downwards (happens on day 5 of illness) - diagnose measles with IgG and IgM serology

Answer 169

1. Pneumonia 2. Croup 3. Otitis media 4. Subacute sclerosing panencephalitis - rare degenerative encephalitis characterized by dementia and intellectual deterioration with seizures occurring many years after initial infection (11 yr on average)

Answer 170

Supportive treatment - prophylactic treatment with IVIG within 6 days of exposure REGARDLESS of immunization status should occur for: 1. Pregnant women 2. Immunocompromised 3. Infants

Answer 171

1. Africa 2. Asia 3. South America

Answer 172

Hemoglobin S - sickle cell anemia patients

Answer 173

1. Exoerythrocytic phase: - inoculation of parasite into bloodstream by female Anopheles mosquito - enters hepatocytes and multiplies asexually - hepatocytes burst releasing thousands of parasites into blood stream 2. Erythrocytic phase: - parasites then enter the erythrocyte and multiplies asexually - erythrocyte bursts releasing parasites (this is what causes the high fevers) that then develop into male and female and then are sucked up by mosquito during a blood meal to be transmitted to the next victim. GROSS.

Answer 174

In Chloroquine sensitive areas: give chloroquine -in chloroquine-resistant areas, use atovaquone, mefloquine

Answer 175

Gram negative diplococci

Answer 176

Pen G x 5-7 d (remember that meningitis with N meningitidis is also treated with IV abx x 5-7 d only) -mortality rate: 10%, most within 1st 48 hrs due to fulminant septic shock/DIC secondary to endotoxins -postexposure chemoprophylaxis should occur for anyone who came into contact with oral secretions of an infected patient = use rifampin

Answer 177

Diffuse adrenal hemorrhage secondary to meningococcemia infection

Answer 178

1. Anatomical or functional asplenia 2. Children with primary antibody deficiency disorders 3. Children with complement, properdin or factor D deficiency 4. Travellers to areas endemic for meningococcus 5. Lab personnel with exposure to meningococcus 6. Military

Answer 179

Mumps = paramyxovirus, mainly causing parotitis (inflammation of salivary glands) 1. Meningoencephalitis 2. Orchitis 3. Arthritis 4. Myocarditis 5. Pancreatitis

Answer 180

Two types of infection: 1. Erythema infectiosum: -fever, headaches, myalgias, polyarticular arthritis followed by slapped check facial rash followed by lacy, reticular rash on trunk and extremities - period of infectivity occurs BEFORE the onset of rash (ie. once rash has developed, the child is no longer contagious). 2. Aplastic anemia: - those with RBC aplasia ARE infectious at presentation and should be isolated for at least 1 wk or until resolution of fever - seen especially in children with hemoglobinopathies - treatment: supportive care, possible RBC transfusion

Answer 181

ICPC: "I caught pertussis coughing" 1. Incubation stage x 7-10 d 2. Catarrhal stage: most infectious stage, mild upper resp prodrome x 1 wk (catarrhal means INFLAMMATION OF MUCOUS MEMBRANES) 3. Paroxysmal stage: severe cough with inspiratory whoop x 1-3 mo, post-tussive vomiting 4. Convalescent stage: gradual resolution of symptoms - infants

Answer 182

Pertussis PCR or culture - may see leukocytosis with lymphocytosis - treatment: azithromycin x 5 d - treatment after paroxysmal stage begins does NOT change severity or duration of disease but does decrease infectivity

Answer 183

Azithromycin x 5 d regardless of immunization status in order to prevent spread

Answer 184

Usually last 3-5 yrs only - this is why booster is needed in adolescence/adults

Answer 185

1. Secondary pneumonia 2. Apneas 3. Pulmonary hypertension 4. Acute otitis media 5. Physical sequelae from forceful coughing: scleral hemorrhage, petechiae, laceration to frenulum

Answer 186

Dogs, cats, skunks, raccoons, foxes, coyotes, bats (any exposure to bats, even being asleep in the same room since bites/scratches can be tiny and not noticed!) -first the single stranded RNA virus replicates in the tissue at the site of the bite/scratch and over weeks-months, moves along peripheral nerves until it reaches the spinal cord (concentrated in brain stem) and spreads rapidly to the brain

Answer 187

Weeks-months after bite: rapidly progressive encephalopathy with seizures, delirium, dysphagia, hydrophobia

Answer 188

Negri body (clump of viral nucleocapsides that create cytoplasmic inclusions)

Answer 189

1. Animal with unknown vaccination status that bit the patient should be quarantined and observed for signs of rabies - may need to be euthanized with brain intact in order to see virus-specific antigens on brain tissue 2. Can take skin biopsy specimens of the patient or isolate the virus from saliva

Answer 190

Day 0, 3, 7, 14, 28 (total of 5 doses)

Answer 191

Should be administered immediately after the animal bite and infiltrated directly into the wound if present. The remainder should be given IM.

Answer 192

1. Direct contact 2. Autoinoculation 3. Fomites - clinical manifestations: common warts (verruca vulgaris), periungual warts, plantar warts, anogenital warts (condylomata acuminata), squamous cell carcinoma - all caused by different subtypes of HPV

Answer 193

1. Inoculation during birth through infected birth canal 2. Sexual abuse 3. Incidental spread from cutaneous warts \*\*\*significant proportion of genital warts in children contain HPV types that are usually isolated from cutaneous warts

Answer 194

More than 65% disappear spontaneously within 2 years - treatment is most successful when performed regular q2-4 wks - Common warts: liquid nitrogen or daily application of salicylic acid - plantar/palmar warts: salicylic acid - condylomata acuminata (anogenital warts): podophyllin application x 4-6 hr on weekly basis OR imiquimod cream 3 times weekly

Answer 195

1. Atopic dermatitis 2. Allergic rhinitis 3. Asthma \*NOT parasites :)

Answer 196

\*\*\*Remember that eosinophilia requires tissue-invasive/blood invasive parasites so you will NOT see eosinophilia with parasitic infections that are well contained within tissues or are solely intraluminal in the GI tract (ie. with giardia or enterobius vermicularis aka pinworms) 1. Toxocariasis: visceral larval migrans = most common cause of severe eosinophlia in children - toxocara species (roundworms from dogs/cats/foxes) larvae migrating from blood into liver, heart, CNS, eyes 2. Trichinosis: trichinella spiralis (roundworm) transmitted through raw or undercooked pork or bear meat - start off in the GI tract, then invade muscles causing edema of eyelids, myalgia, fever, eosinophilia, can become encysted in the muscle 3. Hookworm 4. Ascariasis: Ascaris lumbricoides from eating food/drink contaminated with feces - eggs hatch in intestines, burrow through the gut and migrate to lungs. Then break into the alveoli, pass up the trachea where they are coughed up and swallowed to continue the life cycle of being pooped out and passed onto the next victim 5. Strongyloidiasis: roundworm infection

Answer 197

Hookworm infection - causes microscopic blood loss

Answer 198

1. Aspergillosis in the form of ABPA 2. Coccidiodomycosis

Answer 199

1. Rifampin PO BID x 2 d (preferred in children) 2. Ceftriaxone IM x 1 3. Ciprofloxacin (for \> 18 yo) - pregnant women: rifampin and cipro is contraindicated - use ceftriaxone

Answer 200

Herpes whitlow = HSV infection of fingers or toes - most commonly seen in infants/toddlers who suck the thumb and who are experiencing symptomatic or subclinical oral HSV-1 infection - HSV-2 herpes whitlow develops in teenagers due to exposure to infectious genital secretions (ie. fingering) - have itching, pain, erythema - do NOT incise the lesion (even if it looks like it might contain pus) since this may prolong recovery and increases risk of secondary bacterial infection - rapid improvement/recovery within 18-20 d - no clinical trials assessing benefit of antiviral treatment for this - BUT can start high dose oral acyclovir (2 g/d div BID PO x 10 d)

Answer 201

- Hep A: 5% progress to chronic hepatitis (95% recover within 1-2 wks of illness, chronic disease is unusual) - Hep B: \>90% of perinatally infected infants, 25-50% of young children who acquire Hep B during 1-5 yo, 10% of older children and adults - Hep C: 75% of children - Hep D: only if there is concurrent Hep B infection - Hep E: does not cause chronic hepatitis

Answer 202

Acute febrile illness with abrupt onset of anorexia, nausea, malaise, vomiting and jaundice -typical duration is 7-14 d

Answer 203

Supportive care and monitoring of liver enzymes and liver function tests for acute liver failure

Answer 204

ontagious 2 wks before and 7 days after onset of jaundice/symptoms

Answer 205

\*\*\*Overall: infants 1 yo and healthy: Hep A vaccine -\> 1 yo and immunocompromised/chronic liver disease/chronic health problems: both Hep A vaccine and Hep A immunoglobulin \*\*\*Give post-exposure prophylaxis if

Answer 206

Order: HBsAg, HBsAb, HBcAg, HBcAb, HBeAg, HBeAb, HBV DNA, liver function tests, liver enzymes - after exposure to HBV, the following occurs: 1. HBsAg (hep B surface antigen) rises first and is the first detectable antigen to appear during infection - also gets cleared later on - this is what is inside the Hep A vaccine that then stimulates production of HBsAb - if your HBsAb AND HBcAb is positive, this means prior infection - if your HBsAb is positive but HBcAb is negative, this means prior immunization 2. HBV DNA PCR will then become positive 3. HBcAg (Hep B core antigen): found inside the virus, rises next. This is what stimulates formation of HBcAb - if your HBcAb is positive, this means that you have been previously infected with Hep B (this is how you distinguish between prior infection vs. immunization) 4. HBeAg (Hep B e antigen): sometimes signals high levels of viral replication; induces HBeAb; not all Hep B strains have HBeAg \*\*\*If the host had Hep B and cleared the infection: see both HBsAb and HBcAb and possibly HBeAb

Answer 207

- Acute hep B: supportive care - Chronic hep B: interferon alpha or lamivudine

Answer 208

Acute recurrent episodes of fever + 1 or more of the following lasting 1-4 d: 1. Sterile peritonitis 2. Arthritis/arthralgia 3. Pleuritis - can also have erysipelas-like rash, splenomegaly but less common - complication: may progress to development of renal amyloidosis - diagnosis: genetic testing for FMF gene to confirm - treatment: prevent attacks with prophylactic colchicine, also decreases progression to amyloidosis

Answer 209

Periodic Fever lasting 4 d and recurs every 2-8 wks LIKE CLOCKWORK! APHTHOUS STOMATITIS Pharyngitis Adenitis (cervical) -most common cause of recurrent fevers in children -other periodic fever syndromes have IRREGULAR intervals in between fevers whereas PFAPA has VERY regular intervals between fevers -treatment: steroids, cimetidine

Answer 210

Periodic fever syndrome with abdominal pain, cervical adenopathy, splenomegaly - fevers occur at irregular intervals - seen in Dutch families usually - see elevated IgD levels but is not diagnostic since other autoinflammatory disorders can cause this - treatment: steroids

Answer 211

1. PFAPA: most common 2. TRAPS (TNF-receptor associated periodic syndrome) 3. Hyper-IgD syndrome 4. Familial mediterranean fever syndrome

Answer 212

PFAPA: fever occurs at REGULAR intervals like clockwork Familial mediterranean fever: fevers are usually shorter in duration than in other periodic fever syndromes, only one treated with COLCHICINE (not steroids) TRAPS: autosomal dominant, EYE involvement (periorbital edema, conjunctivitis) Hyper IgD syndrome: elevated IgD levels, does NOT progress to amyloidosis

Answer 213

Infections: 1. Campylobacter 2. Mycoplasma pneumoniae Vaccines: 1. Rabies 2. Influenza 3. Oral polio 4. Conjugated meninococcal vaccine (serogroup C)

Answer 214

High risk children \> 2 yo: 1. Asplenia 2. Sickle cell disease 3. Antibody deficiencies 4. HIV infection 5. Chronic lung, heart, kidney disease 6. Diabetes mellitus

Answer 215

Sensorineural hearing loss (58%)

Answer 216

Coxiella burnetii: - airborne, from FARM ANIMALS, EXTREMELY infectious and resistant to chemical and physical treatments - associated with farm visits, lamb birthing season - causes fever, mild interstitial lymphocytic pneumonitis (lives in the lungs) & hepatomegaly due to lymphocytic lobular hepatitis - only 40-50% of people infected with C. burnetii develop symptoms - can see leukocytosis, thrombocytopenia, elevated liver enzymes - diagnose by serology (abs to C. burnetii antigens) - self-limited illness - treat with doxycycline in any age (benefits \>\> tooth discoloration in children

Answer 217

Gonorrheal conjunctivitis: leads to corneal perforation and blindness if left untreated -treatment: Ceftriaxone IM or IV x 1 dose, saline eye irrigation q10-30 minutes, until purulent discharge has cleared, must r/o sepsis Chlamydial conjunctivitis rarely involves the cornea; usually isolated to conjunctiva and is self-limited (BUT can progress to chlamydial pneumonia which is bad) -treatment: erythromycin PO x 2 wks (may prevent subsequent chlamydial pneumonia). CANNOT treat with topical therapy alone since this will NOT clear the chlamydia from their resp tract and thus not prevent pneumonia

Answer 218

Chemical: onset less than 2 days N. gonorrhea: onset 2-7 days C. trachomatis: onset 5-14 days

Answer 219

Conjunctivitis in the 1st month of life with concerns re: C. trachomatis and N gonorrhea perinatal acquisition -prophylaxis: erythromycin 0.5% ophthalmic ointment

Answer 220

1. Primary: painless, single genital ulcer (chancre) appearing 3-6 wks after inoculation 2. Secondary: follows 6-8 wks later with fever, generalized lymphadenopathy (especially inguinal), disseminated maculopapular rash on body/palms/soles, condylomata lata, mucous membrane lesions 3. Tertiary syphilis: does not happen in children; involves cardiovascular, neurologic and msk systems 4. Latent syphilis = asymptomatic infection a. Early latent: acquisition within the preceding year b. late latent: acquisition within unknown duration

Answer 221

Early syphilis: single IM dose of benzathine pen G Late syphilis: IM doses of benzathine pen G x 3 at weekly intervals Neurosyphilis: IV aqueous crystalline pen G x 10-14 d

Answer 222

1. HSM 2. Snuffles (rhinitis) 3. Lymphadenopathy 4. Copper rash on palms/soles/perioral/perianal 5. Pneumonia 6. Osteochondritis

Answer 223

Usually appear after 2 years of age: 1. interstitial keratitis (corneal scarring) 2. 8th CN palsy (deafness) 3. Hutchinson teeth (bifid teeth) 4. Mulberry molars (multiple enamel spots on molars) 5. Saddle nose deformity 6. Frontal bossing 7. Clutton joints (symmetrical joint swelling, usually in knees)

Answer 224

1. Interstial keratitis 2. 8th cranial nerve palsy 3. Hutchinson teeth Indicative of congenital syphilis

Answer 225

1. Quantitative treponemal syphilis test (TP-PA) 2. Direct fluorescent antibody staining by scraping skin or mucous membrane (FTA-ABS) 3. Nontreponemal reaginic antibody assays: VDRL (venereal disease research lab) & RPR (rapid plasma reagin)

Answer 226

Pen G x 10-14 d with repeat of nontreponemal antibody titres at 3, 6, 12 months to document falling titres -neurosyphilis: serologic testing + CSF q6months x at least 3 years or until CSF findings are normal

Answer 227

1. S. aureus 2. GAS

Answer 228

1. non-TB mycobacteria 2. Bartonella henselae

Answer 229

1. Staph aureus 2. Coag neg staph

Answer 230

1. High fever 2. Severe diarrhea 3. Immunocompromised 4. Toxic - treatment: Azithro or erythro PO, IV gent, tobra or meropenem - resistant to penicillins, cephalosporins, vanco

Answer 231

if on steroids for \> 14 d, considered immunosuppressed and do NOT get live vaccines until off-steroids x 1 month

Answer 232

Clinical features: 1. Macular, coalescing rash on FACE, then moves downwards 2. Fever 3. Pharyngitis 4. Conjunctivitis 5. Lymphadenopathy 6. Transient arthropathy 7. Forckheiner spots: rose-colored spots on oropharynx -period of infectivity 6 days pre rash up to 6 days post rash -CNS complication: rubella panencephalitis

Answer 233

Caffey's - usually related to mandible - differential diagnosis: hypervitaminosis A (but no fever/irritiability, subacute onset)

Answer 234

1. Clarithro + amoxil OR flagyl + PPI

Answer 235

1. Pasteurella 2. Eichenella

Answer 236

Shed virus in urine/stools x 1 year

Answer 237

1. Infants meningitis

Answer 238

1. Absence of fever 2. Eosinophilia 3. Cough 4. Bilateral interstitial markings - treatment: erythromycin

Answer 239

Viral: 1. Hep B 2. EBV 3. Mumps Bacterial: 1. Mycoplasma 2. Bartonella henselae 3. GAS 4. Yersinia 5. TB Fungal: 1. Histoplasmosis 2. Blastomycosis 3. Coccidiocomycoses Other causes: 1. OCP 2. Sulfa drugs 3. SLE 4. IBD

Answer 240

1. MCV-C: conjugate vaccine serogroup C (most common in adolescents) - brand names: mejugate, meningitec, neissvac-C 2. MCV-4: conjugate quadrivalent serogroup: A/C/Y/W135 - brand names: menactra, menveo 3. 4CMenB: conjugate vaccine serogroup B (most common in preschool kids) All children: - MCV-C @ 12 mo - MCV-4 @ 12 yo (grade 7) Children at increased risk of meningococcal disease: (asplenia, immunocompromised = primary antibody disorder, complement deficiency, perperdin deficiency, factor D deficiency, travellers to high meningococcus areas, military, lab workers, cochlear implants ) - MCV-C @ 2, 4, 6, 12 mo - MCV-4 @ 2 yo and q5yr - 4CMenB starting at @ 2 mo (also for outbreaks, close contacts of person with serogroup B) Remember that conjugate \>\>\> polysaccharide vaccines in inducing an immune response

Answer 241

1. Peripheral neuropathy: prevent by giving pyridoxine (vit B6) 2. Elevated liver enzymes

Answer 242

Ethambutol

Answer 243

If the child received BCG vaccine more than 10 years ago, will not affect TST result

Answer 244

Either give both the same day OR do TST 4 wks after MMR

Answer 245

1. Azithromycin 2. Doxycycline

Answer 246

1. Ethmoid present by birth, pneumatises first! 2. Maxillary present at birth but pneumatises 2nd at 4 yo 2. Sphenoid: complete by 5 yo 3. Frontal: begins at 3-7 years of age, complete by age 12 years

Answer 247

1. Penetrating wounds from dirty object (nail, splinter, glass, etc.) 2. Animal bites 3. Burns/frostbite - clostridium tetani = produces tetanus toxin that blocks normal inhibition of antagonistic muscles on which voluntary coordinated movement depends = affected muscles sutain maximal contraction and cannot relax - does not affect sensory nerves so patients remain conscious and in severe pain \*\*Basically anything except a clean, minor wound

Answer 248

1. Most common presenting symptom: trismus (masseter muscle spasm or lockjaw) 2. Risus sardonicus: abnormal spasm of the facial muscles that looks like a creepy smile 3. Opisthotonos when abdo/lumbar/hip/thigh muscles are involved 4. Laryngeal and resp muscle spasm = airway obstruction/asphyxiation 5. Fever due to sustained muscle contraction (increased metabolic rate) 6. Autonomic effects: tachycardia, dysrhythmias - lasts up to 4 wks 7. Generalized tetanic spasms (seizures) leading to rhabdomyolysis and renal failure, intramuscular hematomas, spinal fractures - can be triggered by any sights/sounds/touch \*\*overall: see LOCKJAW, think tetanus!

Answer 249

Clinical findings - routine lab results are usually normal, neither EEG or EMG show characteristic pattern -neonatal tetanus: lack of maternal immunization

Answer 250

1. Tetanus immunoglobulin 500 U IM ASAP: if the tetanus toxin is already bound at the NMJ then there is nothing you can do about this but TIG neutralizes toxin that hasn't bound yet 2. Surgical wound debridement 3. Antibiotics: Pen G x 10-14 d 4. Muscle relaxants: diazepam or rocuronium (flaccid paralysis, requires I&V but at least gives muscles a break) 5. Supportive care

Answer 251

DTaP at 2, 4, 6, 18 months with booster at 4-6 yo and q10y after

Answer 252

A) If the patient has received LESS than 3 tetanus toxoid vaccines or imm status unknown: - always give tetanus vaccine (Td or TdaP) - if wound is clean/minor: no TIG - if wound is contaminated: YES TIG B) If the patient has received 3 or more tetanus toxoid vaccines: - don't have to give tetanus vaccine UNLESS \> 10 yrs since last dose for clean/minor wounds or \> 5 yr for contaminated wounds - don't have to give TIG ever \*\*\*\*So overall, clean/minor wounds NEVER need TIG; contaminated wounds only need TIG if patient has received 24 hrs since injury, unable to be debrided)

Answer 253

A) Latent TB = positive TST in context of known exposure to TB positive close contact but normal CXR and asymptomatic -treatment: isoniazid x 9 months to prevent reactivation B) Treatment of pulmonary TB (fully drug susceptible): 6 months total isoniazid (+/- pyradoxine) + rifampin with pyrazinamide in first 2 months -drug resistant or unknown susceptibility: add ethambutol to first 2 mo regimen C) TB with HIV coinfection -extend isoniazid + rifampin to 9 mo total D) TB meningitis -extend isoniazid +rifampin to 12 mo total -add corticosteroids (decrease mortality rates, decreases neurologic sequelae = prednisone 2 mg/kg/day x 4-6 wks, then taper

Answer 254

initial focus of TB infection in the lung with enlarged regional lymph nodes - most common site of TB infection: lungs (80%) - extrapulmonary sites: lymph node (67%), meninges, pleura, miliary (disseminated), skeletal (13%)

Answer 255

1. Latent: positive TST but asymptomatic and normal CXR 2. Active TB: TB infection with symptoms and radiologic findings

Answer 256

TB lymphadenopathy

Answer 257

Brainstem and meninges - more common in children 6 mo-4 yo - get CN palsies (3, 6, 7 since they're on brainstem)

Answer 258

1. Immunize infants with DTaP vaccine at 2, 4, 6, 15 mo with booster at 4 yo 2. Immunize adolescents with booster with single dose of Tdap

Answer 259

TB in the spinal vertebrae

Answer 260

Sputum culture -can do induced sputum with jet nebulizer and chest percussion followed by NP suctioning

Answer 261

Gastric aspirates for culture may be the only option for young children BUT it only yields organism in AM

Answer 262

Tuberculin sensitivity develops 3 wks-3 mo after infection

Answer 263

-0-4 mm: HIV infection with immune suppression AND high likelihood of having TB (ie. close contact of active case, abnormal xray or from population with high prevalence) - 5-9 mm: 1. HIV 2. Immunosuppressed (chemotherapy) 3. Children suspected of having TB 4. Close contact of active contagious case within 2 years 5. Abnormal CXR with fibronodular disease 6. End stage renal disease -\>10 mm: all other cases

Answer 264

Could still have TB! Negative TST or IGRA does NOT exclude active TB! -in all cases of suspected TB, you should do everything you can to get a culture diagnosis always always always

Answer 265

1. Liver enzymes (AST, ALT) 2. Bilirubin 3. HIV serology 4. Baseline ophtho assessment in younger children (due to risk of retrobulbar neuritis due to ethambutol)

Answer 266

1. Children who have milk/meat deficient diets 2. Adolescents who are breastfeeding or pregnant 3. Children with nutritional deficiencies 4. Symptomatic HIV infection 5. Breastfed infants

Answer 267

Isoniazid can cause hepatotoxicity and lead to death or need for transplant! -tell them to stop taking isoniazid ASAP and do liver work up

Answer 268

1. Air fluid level in retropharyngeal space 2. Increased width of retropharyngeal space

Answer 269

1. Meningitis 2. Lateral sinus thrombosis 3. TM perf 4. Intracranial abscess 5. Hearing loss 6. Cholesteatoma \*\*\*Chronic suppurative otitis media: purulent drainage from perforated tympanic membrane \> 6 wks

Answer 270

1. Failed antibiotics for recurrent AOM 2. Chronic otitis media 3. Tympanic membrane retraction with ossicular erosion or cholesteatoma formation

Answer 271

Between 3 mo - 3 yrs -peritonsillar abscess: adolescents most common

Answer 272

- Diagnosis: physical exam shows mastoid swelling and redness with protrusion of the ear forward - treatment: IV antibiotics (3rd generation cephalosporin ie. ceftriaxone) = if no improvement or if still febrile in 48 hrs, may need mastoidectomy

Answer 273

Peritonsillar abscess - will see unilateral tonsillar swelling with a deviated uvula - treatment: surgical drainage and antibiotic therapy x 10-14 days (usually IV penicillin or something with GAS coverage) - most severe complication: rupture of the abscess with resultant aspiration pneumonitis

Answer 274

TMP-SMX IV with or without steroids (for severe hypoxemia)

Answer 275

Strep viridans most common -can also see S. epidermidis, S. auresua, HACEK organisms (hemophilus, actinobacter, cardiobacterium, Eikenella, Kingella)

Answer 276

GI stuff! Crampy abdominal pain, vomiting, watery diarrhea - can cause bad disease in immunocompromised patients - treatment: supportive therapy for immunocompetent children, nitazoxanide for immunosuppressed with severe disease

Answer 277

Enterotoxigenic E coli

Answer 278

Previously healthy child, nephrotic syndrome = both strep pneumo - catheters/VP shunts: S. epidermidis, S. aureus - cirrhosis: E coli \*\*\*Treat with 3rd generation cephalosporin, add vanco if catheter related infection

Answer 279

Emergent surgical debridement with antibiotic therapy

Answer 280

Coag-negative staph

Answer 281

Chlamydia: Erythromycin PO x 14 d Gonorrhea: Ceftriaxone x 1 dose

Answer 282

Pasteurella infections cause pain and swelling within the FIRST DAY of the bite whereas other bacteria cause pain and swelling AFTER the 1st day (take more time to develop)

Answer 283

Need all 3 major criteria: 1. Acute fever 2. Hypotension 3. Erythroderma with convalescent desquamation rash -AND- 3/7 minor criteria 1. Mucous membrane inflammation (vaginal, oropharyngeal, strawberry tongue) 2. GI: Vomiting or diarrhea 3. Renal abnormalities (urea or cr \> 2x normal) 4. Liver abnormalities (bilirubin or liver enzymes \> 2x normal) 5. Muscle abnormalities (myalgia or CK \> 2x normal) 6. CNS abnormalities (altered LOC) 7. Thrombocytopenia -AND- Absence of another explanation and negative blood cultures (except occasionally for Staph aureus)

Answer 284

Mumps = do NOT see rash -usually have bilateral parotitis (2nd side can appear a day after the first side), can have displacement of the uvula, fever, orchitis

Answer 285

Increased ICP (from cerebral edema) and subsequent herniation - up to 40% mortality - see elevated liver enzymes and ammonia but NORMAL total bilirubin - two viruses involved: influenza and varicella in a patient on ASA therapy

Answer 286

Shigella infection! -in Shigella infection, increased risk of seizure and the seizure PRECEDES diarrhea which distinguishes shigella from other GI infections (like campylobacter)

Answer 287

Spirochete = spiral bacteria - typically occur in tropical countries - found in livestock, birds, dogs (major reservoir in USA), cats, rats: usually people get exposed via contaminated water or soil or contact with animals

Answer 288

\*\*\*Most infections are mild or subclinical!!!! Most patients clear the infection without any symptoms KEY: illness follows biphasic course = initial (septicemic = see leptospires in blood, CSF, other tissues) phase lasting 2-7 days, followed by brief period of well-being before onset of a second symptomatic leptospiric phase (this is where leptospires move into the tissues and you can't find them anymore in blood and csf) 1. Septicemic stage: flu like symptoms with myalgia, headache, abdo pain, vomiting, fever, conjunctival injection, photophobia - ----asymptomatic phase--- 2. Second stage: aseptic meningitis (pleiocytosis aka elevated WBC and elevated proteins, normal glucose), uveitis, rash, fever \*\*Can also get icteric leptospirosis (Weil Syndrome) where immune phase is characterized by jaundice, renal failure, thrombocytopenia, cardiovascular collapse = this is very rare! Diagnosis: serologies, microscopis agglutination test (serogroup specific assay), ELISA

Answer 289

Penicillin in children 9 yo x 7 days -early treatment may shorten duration/severity of infectio

Answer 290

Early soft tissue changes take 3 days to develop and bone changes take up to 12 days after onset of osteomyelitis

Answer 291

Classic triad: fever, headache, rash 1. Prodromal period with headache, malaise, pain and tenderness of calf muscles in children is very common 2. Abrupt onset of fever and chills 3. Maculopapular rash on the flexor surfaces of the wrists and ankles, then moves in a central direction, typically involves palms and soles - rash can then become hemorrhagic within 1-2 days - can cause CNS depression, seizures, etc. - transmitted by ticks from Dermacentor family (rickettsia rickettsii is the organism carried by the tick) - treatment: Doxycycline regardless of the child's age!

Answer 292

Tennis shoe = pseudmonas since shoe is warm and moist Bare foot = staph aureus since it is bare skin

Answer 293

1. . Pleural effusion 2. Empyema 3. Pyopneumothorax

Answer 294

Usually I&D only is adequate but depending on age/clinical status, may need antibiotics

Answer 295

3-4 yo -before then, perinatal or diaper changed by someone with a finger wart is more likely

Answer 296

\*\*\*\*Likelihood of going onto chronic infection is inversely related to age - Perinatal infection is MOST likely to go on to chronic Hep B - horizontal transmission in childhood is in the middle - Adult infection is LEAST likely to go on to chronic Hep B infection

Answer 297

Healthy person: vaccinate with varicella vaccine Pregnant women and immunocompromised: - check VZV IgG serologies, - If negative, give VZV IgG since they cannot receive the vaccine

Answer 298

\> 5 mm IF: 1. exposed to a close contact with known or suspected TB 2. clinical symptoms of TB 3. immunocompromized (HIV) or on immunosuppressants \> 10 mm IF: 1. 15 mm IF: - any child \> 4 yo without any other RFs

Answer 299

(e.g., cefazolin, cephalexin, cefadroxil) • Good activity against gram-positive organisms (especially Methicillin-susceptible S. aureus and streptococci spp.) • Frequently used as prophylaxis for orthopedic, cardiovascular, head and neck, and many types of neurosurgical or general surgical procedures (i.e., herniorrhaphy) • May have activity against some E. coli and Klebsiella species, but lack efficacy against Haemophilus influenza • May be considered as alternatives to penicillins for the treatment of group A streptococcal pharyngitis and group B streptococcal prophylaxis during labor.

Answer 300

(e.g., cefuroxime, cefotetan, cefoxitin) • Increased spectrum of activity, including many gram-negative organisms • Increased activity against B. fragilis • Prophylaxis for intra-abdominal (e.g., cefotetan, cefoxitin) • Treatment for nosocomial pneumonia • No antipseudomonal activity

Answer 301

(e.g., ceftriaxone, cefotaxime, cefixime, cefdinir, ceftazidime) • Broad spectrum, excellent activity against gram-negative bacteria • Generally less activity against gram-positive organisms than earlier generations, such as methicillin-susceptible S. aureus. • Very high blood and CSF levels achievable in relation to minimal inhibitory concentration for bacterial strains • Wide therapeutic index with generally minimal toxicity (similar to previous generations) • Some offer single-daily dosing • Ceftazidime: the first cephalosporin with antipseudomonal coverage • More expensive

Answer 302

Penicillin-binding proteins (PBPs) β-Lactamase

Answer 303

Ninety percent of deaths are attributable to pneumonia, which most often develops as a secondary bacterial infection

Answer 304

Spiking fevers, anemia, and splenomegaly. Malaria is caused by species of Plasmodium (transmitted by the Anopheles mosquito), which infect red blood cells (RBCs); certain species (particularly P. vivax and P. ovale) can have a dormant liver stage. The classic malarial fever involves a periodicity (typically 48 to 72 hours) associated with the rupture of RBCs. Chills, headache, abdominal pain, and myalgias are also common symptoms.

Answer 305

Thick and thin blood smears.

Answer 306

All pregnant women and infants should be screened for possible infection with a nontreponemal test for Treponema pallidum. Such tests include the rapid plasma reagin card test (RPR) and the Venereal Disease Research Laboratory (VDRL) slide test. If blood from the mother or infant yields a positive nontreponemal serologic test, a specific treponemal test should be performed on the infant’s blood. Examples include the fluorescent treponemal antibody (FTA) absorption test and the microhemagglutination test for T. pallidum.

Answer 307

All HIV-exposed newborn infants should receive zidovudine (AZT) at a dose of 4 mg/kg orally every 12 hours for the first 6 weeks of life. Elective cesarean delivery is also recommended for women with high HIV loads.

Answer 308

AZT monotherapy during pregnancy (compared with combination antiretroviral therapy) High maternal viral load at or near delivery Rupture of membranes \> 4 hours before delivery Fetal instrumentation with scalp electrodes and forceps Vaginal delivery (especially with high maternal viral loads) Episiotomies and vaginal tears Prematurity and low birth weight (possible impaired fetal or placental membranes) Concurrent maternal HSV-2 infection (increased shedding of HIV in genital secretions) Breastfeeding Incidence of HIV during pregnancy and postpartum

Answer 309

Acute infection is best characterized by the presence of high titers of VCA IgM or IgG with or without high titers of EA and with no or low titers of EBNA

Answer 310

CBC and Creatinine ANC\<0.5:STOP LT Hearing and neurocognitive

Answer 311

Treat with pyrimethamine in combination with sulfadiazine (supplemented with leucovorin) for 1 yr.

Answer 312

Salmonella: 6-72 hrs Campylobacter: days with abd pain that mimics appendicitis or intussusception Ecoli is 2-3 days Yersinia enterolitica: 4-6 days Shigella: 2-4 days (spread person-person)

Answer 313

1. Screening in rpegnancy 2. ARV in MOm 3. Ziovudine intrapartum 4. C/s 5. Baby ziodovudine x 6 eeks 6. No BF

Answer 314

Acute flaccid paralysis, AIDS, Anthrax, botulism, brucella, campylobacter, genital chlamydia, cholera, CJD, cryptosporidiosis, cyclospora, diphtheria, giardia, GBS disases of the newborn, hantavirus pulmonary syndrome, Hepatitis A,B,C, HIV, Influenza, Invasive HIb, Invasive GAS, Invasive pneumococcal or meningococcal disease, Legionella, leprosy, malaria, measles, mumps, pertussis, polio, rabies, rubella, salmonella, Shigella, smallpox, syphilis, tetanus, TB, tularaemia, typhoid, E.coli 0157:H7, west nile infections

Answer 315

* Swelling of prevertebral tissue \< 7mm at C2 \< 5 mm at C3-4 \< 40% AP diam of vert body \< 14 mm at C6 Loss of cervical lordosis

Answer 316

DTaP -IPV Hib

Answer 317

Men-C-ACYW-CRM

Answer 318

Men-P-ACYW-135

Answer 319

Men-C-C-CRM

Answer 320

2,4,6, 12/18

Answer 321

10 year post last dose Approx 14-16

Answer 322

2 or 3 doses Complete before 8 months

Answer 323

2/4/12 for 3 dose 2/4/8/12-15M for 4 dose

Answer 324

12 years (Either mono or quad)

Answer 325

12-15 18M or no later than school entry

Answer 326

Either 0/1/6 OR three doses at 12

Answer 327

Girls 9-14 0/1/6

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