Infectious Flashcards
(154 cards)
1
Q
Scarlet fever rash:
1. when it starts
2. from where it develop- the sequela of the rash
3. other menefistations
4. pathogen
A
- when it starts- 24-48 hrs **
2. from where it develop- **Groin and axilla and spread to trunk and extremity»_space; 3-4 days after the rush disaprre and the skin start to desquimation from face to bottom. , skin has Sand-like apperance - other menefistations- straberry tounge, exudate, red tonsilst, red uvula, post. platal patechial
- pathogen- GAS
2
Q
Which types of GAS can cause RF?
A
M types, 1,3,5,6,18,29
3
Q
Which ages of kids are at hish risk for RF?
A
5-15 yrs
4
Q
Jones criteria - how we diagnose acute RF?
A
2 major or 1 minor or 1major + 2 minor
in all must be evidance of recent GAS infection
Recent infection- positive throat culture or RAPD / ALSO or Anti- DNAse B / antihyloronidase
5
Q
What are the major critera of Jones?
A
J- Joint = migratory arthritis
O = Pancarditis
N = Nodules (subcutenous, mainly on joints)
E = Erythema marginatum
S = Syndheam chorea (could also present as cry/ lugher
6
Q
What are the minor criteria of acute RF?
A
- Fever
- Arthralgia - only of no major Joint criteria
- CRP / ESR
- prolong PR- only if no major pancarditis criteria
7
Q
Which Ab can be tested to proove GAS infection
A
Anti-DNAse B
Anti-strptolysin O
8
Q
In which 3 situations we can diagnose acute RF without filling criterias?
A
- Syndheam Chorea is the only major criteria
- indolent Carditis in a pt coming monthes after disease
- reccurent RF in High risk populations
9
Q
Tx for Acute RF with Syndenham chorea?
A
Penecillin + phenobarbital
10
Q
How to prevent reccurent RF?
A
PPX penecillin G IM
until age 21 or until 40 if theres a valvular damage
w/o carditis- 5y or until 21 (the longest)
with carditis w/o residual disease- 10y or until 21
wth residual disease- 10y or 40 , consider for life
11
Q
Tx for Acute RF?
A
- penecillin / amoxicillin PO 10 days or IM peneciilin one time
-
migratory polyarthritis or/with carditis- aspirin PO for several weeks
3.** caditis, cardiomegaly, heart failure-** Steroids
macrolide if theres an allergy to penecilin (azitromycin, clncamycin, erythromycin)
severe carditis- treat like HF
12
Q
Which vaccinces are dead ones?
חיסון מומת
A
- Influenza IM
- HAV
- Polio IM
- Rabies
13
Q
Which immunization contain recombinant products?
A
- HBV
- HPV
14
Q
Which immunizations contain toxoids?
A
- diphteria
- tetanus
15
Q
What is tha major advantage of conjuctudate vaccine vs polysaccharide one
חיסון מצומד לעומת פוליסכרידי
A
מוצמד = מוריד שיעור נשאות, מייצר נוגדנים עם אבידי גבוה יותר.
pnuemoccoc, Hib , hemingoccoc
16
Q
When we will give HPV vaccine
A
11-12 yrs
2 doses
if immunocomprimesied / > 15yrs - 3 doses
17
Q
Palivizumab is immunization against?
and what are the indications to give
A
RSV- in the start of brionchioles season
will be given to high risk pt:
1. neonate < 29wks until 1 yr old
2. Heart or lung condtions (congenital / nuromascular)- until 1 yrs old
3. BPD - until 1-2 yrs old
18
Q
which Abx can be use ppx for meningoccoc exposure?
and when we will give ppx
A
1.Rifampin- 2Xday for 2d
2.Ceftriazone- one dose
3.Ciprofloxacin- one dose (age > 1 month)
7 days before onset for household, pre-school exposure, close contact, flight next to in flight > 8 hrs
19
Q
PPx for tetanus after possible exposure?
A
- clean with soap and water
- vaccination (DTap, Tdap, Td) for - less then 3 doses or > 10 yrs since last shot
- Abs (TIG) for infected wound- with dirt, feces, soil, saliva in non-immunizations and HIV pt
TIG only given when immunization status is : uncertain or < 3 doses only in wound that is not clear and minor
20
Q
PPx for rabies after possible exposure?
A
- wash with water and soap
- RIG (rabies Ab’s)- SC to the bite area
- 4 doses Rabies killed vaccine- at presentation to the ER»_space; 3d»_space; 7d»_space; 14d
21
Q
when to treat for rabies from a home animal bite?
A
10days quarentine of the animal»_space; if the animal develops signs of rabies then start Tx.
22
Q
What is the most commo cause of Severe bacterial infeciton in babies < 3 months?
A
UTI
23
Q
Workout for toxic look baby (0-3 month) ?
A
- hospitalization
- empiric Tx
- full workout- labs, culture, urine, LP
- specific test (depends on presentation)- CXR, articulate puncture, stool culture
24
Q
with fever
Empiric Abx for newborns until 2 moths of age
A
Ampicillin + Gentamycin
if sepsis or menengitis:
switch Gentamycin to Ceftriaxone (3rd generation)
25
Empiric Abx for 2-3 month of age with fever
Ceftriaxone
if pneumoccoc meningitis is suspect- add vanco
26
When we will empirically cover HSV?
1. skin finding consist with HSV
2. toxic baby with clinical suspect
3. neurolohic symptoms - siezures, encephalitis, pleocytosis and mononuclears on CSF
**Tx if Acyclovir IV 60mg/kg day devided to 3 doses**
27
FUO definition
fever (38) > 8 days w/o source
28
How much time its take to drug fever to pass after medication is stopped?
around 72 hrs
29
which disease cause it?
how it spread?
**Parvo B-19**
slapped cheek
spread by droplet. start in face and then downwards
## Footnote
Fifth disease
30
which pathogen that present in adults in arthralgia and arthritis can cause in fetus **Hydrops fetalis**
Parvo-B19
31
Presentation of rubella?
Rash- from the face downwards (like measles but rubella disapper from head after 3 days not like measles)
Lymphadenopathy- Post. cervical, post, auricular, suboccipital
32
What is the congenital syndrome seen in rubella inf.
1. deafness (sensrinural)
2. bluberry muffin rash
3. jaundice
4. congenital cataract
5. microencephaly
6. Patent ductus arteriosus
33
What is the 6th disease?
which condition is higly a/w?
HHV6 (Roseola)
fever for 3-4 days >> then the fever fade an a rash show (diffuse rash w/o the face)
**higly a/w febrile seziures**
## Footnote
infected CD4 cells.
34
What are the 4 c's of Measles?
Cough
Coryza (runny nose)
Conjuctuvitis
Koplik spots- bluish spots on buccal mucosa
35
What is the most common cause of death due to measles?
| חצבת
pnuemonia (by virus imself or secondary to bacterial inf.)
36
SSPE (Subacute sclerosing panencephalitis) is a rare complication of which infection?
when it usally occure?
progressive demyelinating inflammation of the brain
measles
| occur around 10 yrs after the disease
37
What is the chrecteristic of Measels rash
Start behind ears >> spread to face and neck >> sperad to entire body and merge + palms and soles
38
What are the complications of measles?
* Acute otitis media- most common
* pneumonia
* encephalitis
* black measels- detach of skin
* SSPE- late
39
Tx for Measels?
* Isoprinosine (anti-viral)- remission in 30-40%
* Carbamazepine (early myoclonus)
* **vitamin A**
40
Post exposure PPx for measles?
vaccine in 3 days or IVIG in 6 days
41
Hand and mouth disease?
Dx?
Coxsackievirus A16, Echovirus
Dx
virus culture- 50-75% sensetivity
PCR- more sensetive in less time
42
Which complication can be seen in Coxsackievirus infection??
Aspetic meningitis- mainly type A
Myocarditis- mainly B type
Dilatead Cardiomyopathy- mainly B type
devil's grip (Bornholm disease)- unilateral pleuritic pain in lower chest >>> mainly B type
## Footnote
type A more common to see- **the type causeing hand and mouth disease**
43
When we will give Acyclovir for VZV infection?
immunosupression + unvacinated > 1 yr **only if given 24 hrs from onset of rash**
44
Complications of VZV?
1. secondary bacterial skin infection - 5% of kids
2. Reye syndrome- do not use Aspirin
3. newborns- from mother
45
how can newborn get VZV infection and what is the Tx?
From mother- if she was sick 5 days prior the delivery to 2 days post delivery
**must treat with VZIG**
46
which CN is involve in **Ramsay Hunt syndrome**
CN VII
(VZV shingles)
פאציאליס ושלפוחיות בתעלת האוזן
47
What is the Tx for VZV shingles in kids and what its main benefit
acyclovir
accelerate recovery and reduce risk for post herpetic neuralgia
48
which CN is involve in lesions of VZV in mouth and cornea
CN V
49
Tx for impetigo
Abx ointment- Mupirocin or fusidic acid
Abx PO (rapidly involving inf. / reccurent / facial lesions) - Ceflaxine (1st generation)
50
Tx for Cellulitis
Ceflaxine or cefalozine PO (1st generation)
51
Tx for S. aureus folliculitis
Anti-septic Soap
if cont. >> Abx ointment
52
Which inf. a/w abcess in the follicular head 1-2 cm
Furuncle
S.aureus
53
Tx for furuncles?
Abx PO
driange- if abcess
mupiricon- if carrier in nostrils
54
What we need to check in a case of reccurent furunculosis?
S.aureus carrier (child or close family)
אבחון עם משטף אף
55
Which pathogen is a/w SSSS what is the Tx?
S. aureus >> Epidermolytic toxins
**Tx**
* IV penecillin + Clindamycin
* Supportive
## Footnote
risk for declie and sepsis
56
what is Paronychia?
whats the pathogen and Tx?
זיהום של שולי הציפורן, כסיסה, הגיינה יודה , מציצתאצבע
Acute- s. aureus
Chronic- Candida
Tx:
אמבטיית חיטוי
משחה אנטיביוטית
ניקוז- במוגלה
זיהום חום- אנטיובטיקה דרך הפה
57
What is the disease in each of the photos
from left to right
1. impetigo- Abx ointment or Cephazolin PO
2. cellulitis- Cephazolin / Cheplaxine PO
3. folliculutus- anti-septal soap >> consider Abx ointment
## Footnote
S. aurues
58
Whays the main different between this two situations?
one is furuncle = abcess in follicule
other = Carbuncale = Abcess in few follicules and not single
## Footnote
S. aurues
59
What we see in each photo from left to right and clinical menefistation
1. **Erysipelas**- superfical dermis, acute onset with fever
2. **Ecthyma**- complication of impetigo by GAS, כיב עמוק מכוסה בגלד עבה
3. **Perianal dermatitis-** sharp borders around anus, could cause pruritus. Daycare age
4. **Blistering Dactylitis-** mainly schoolage kids.
## Footnote
GAS
60
What is the Tx for the following skin infections
1. Erysipelas
2. ecthyma
3. perianal dermatitis
4. Blistering dactylitis
1. **Erysipelas- **Penecillin / Cefelozin PO (if severe penecillin IV)
2. **ecthyma**- ריכוך והסרה + משחה אנטיובטית, קו 2 פניצלין דרך הפה
3. **perianal dermatitis**- penecillin PO
4. **Blistering dactylitis**- penecillin PO + drianege
61
Abx regimen for Necrotizing fascitis
Clindamycin + Cefotxime or Ceftriaxone
62
Which toxin is a/w TSS?
TSST-1 (s. aureus)
| suprantigen
## Footnote
mainly by MSSA
63
What are the major criteria of Toxic shock syndrome
1. fever > 38.3
2. Hypotension
3. rash- eventulay scalded
64
What is needed for Dgx of TSS?
3 major criteria + 3 minor criteria
| major- fever, hyptension, rash
## Footnote
minor- mucositis, GI, Liver > X2, kidney > X2, muscle, CNS, PLT < 100
65
what are the 3 stages of skin in TSS
1. rash
2. healing- עור מתקלף, תוך 7-10 ימים
3. הקרחה ואיבוד צפורנים- תוך חודשיים
66
Tx for TSS
1. Clindamycin + naf/ oxacillin / cefazolin
2. in severe- IVIG / setroids
3. if MRSA susp. - Vanco
67
Which HSV is a/q genital ulcers?
HSV2
| mor in womens
68
Ulcers in 6m-5y kids in the ant. mouth with lymphadenopathy and fever
Primary herpatic gingivostomatitis
| self limiting, Acyclovir < 72h to shorten length of disease
69
What is Herpetic whitlow
herpes in finger of kids that sucking their fingers
## Footnote
Tx- PO acyclovir, reduce lengh and reccurent
70
Which medicatio is C/I in Herpes in the eye?
Steroids- can worse the infection
71
Whats the Dgx? Dentritic like lesion in eye exeminaiton?
Herpes in eye
## Footnote
יכול להגרום להצטלקות הקרנית עד לעיוורון
72
Which HSV is more a/w HSV encephalitis?
HSV-1
73
Tx for HSV enecephalitis, and what is the mortality rate w/o Tx?
IV acyclovir
w/o- 75% mortality
74
What are petrussis stages of ilness?
1. incubation - 7-10 days
2. caterral- 1-2 wks. coryza, fever low grade
3. proxismal- 2-4wks, whooping cough >> vomiting
75
what are the red flags in whooping cough?
long episode > 45 sec
cyanosis
sat% not recover
non reaction to stimuli after vomiting
76
most common complication of whooping cough?
pneumonia- bacteria itself or pneumoccoc, strep, HIB
77
Test of choice for petrussis?
Nasopharynx PCR
78
Tx for petrussis?
Macrolides (azytromycin 5 dys)
79
Which Abx can cause **Hyperthropic Pyloric stenosis** in nwb < 14 days
Macrolides (mainly arythromycin)
80
PPx for family and close contact with petrussis?
5 days azytromycin for households and close contact
81
Tx for gonohrrea?
Ceftriaxone
+
Doxy / Azytromycin- clamydia
## Footnote
in dissaminated disease- hospitalizaiton + ceftriaxone IM + doxy/ azytromycin
82
What are the lesions seen in the 3 stages of shypilis?
* stage 1- **Chancre** - non painfuk
* stage 2- flu like + maculopappular rash + **Condyloma lata**
* Stage 3- **Gummatous lesions**
83
Tx after rape:
1. Chepalosporin 3rd generation- genoccoc
2. Azytromycin / doxy - Clamydia
3. flagyl (metronidazole)- Thricomonas vaginalis and Bacterial vaginosis
4. consider HIV PPx
84
Brucelosis Triad?
Fever + Hepatosplenomagalia + arthritis (sacroiilitis)
| 2-4 wks after infection
85
Which zoonotic disease menifest in sacroiliitis + Thrombocytopenia and eleveted liver enzymes?
Brucellosis
86
Dgx of brucellosis?
Blood culture- takes time (4 wks)
**Rose bengel -** agglutinaiton test
87
Tx for brucellosis?
**below 8 yrs**
Resprim (SMX-TMP) 4-8 wks + Rifampin 6 wks
**above 8 yrs**
Doxycycline 6 wks + Rifampin 6 wks / Sterptomycin / gentamycin 2 wks
88
What consider to be a **complicated Brucellosis** and what will be the Tx?
**Meningitis, Endocarditis, Osteomylitis**
Tx:
Doxycyclin + Rifampin + gentamycin
89
Mediteranean spotted fever
pathogen
Dgx
Tx
R. conorii
3-5 days after fever- maculopappular rash of involve hand and feets (like measles)
Dgx- Serology IgM eleveted
Tx- Doxy X2 for 7 days. if pregnant- Chlorompenicole
## Footnote
Tx same like murine thypus
90
Q-fever
patoghen
Triad + high clue sings in childrens
Dgx
Tx
patoghen- Coxiella brunetti (lice from cattle)
Triad + high clue sings in childrens- **Triad- high fever, atypical pneumonia, hepatitis**
in kids- osteomylitis which not repsnd to empiric tx
Dgx- IgM positive for phase 2 (in chronic- IgG positive for phase 1)
Tx- doxycycline
91
Most common pathogens for lymphadenitis?
| painful + swollen LN
GAS
CMV
EBV
Satph
92
What are the indication for biopsy of lymphadenitis?
progressive growth within 2 weeks / no reduce in size in 4-6 weeks
Red flags- FUO, B symptoms, Supraclavicular LN, mediastinal mass
93
After how many days of no Tx response we will imaged a suspected LN?
after 1-2 days:
neck MRI/ US/ CT
94
What is the most common cause of regional chronic Lymphadenopathy
Cat scartch
95
What is the mosy common a-typical presentation in Cat scratch disease?
**Parinaud oculoglandular syndrome**
unilateral conjuctivitis + peri-ocular lymphadenopathy
96
Dgx and Tx for cat scratch
Dgx- **clinical**. can use serological / PCR testing as well
Tx- self limiting. Azytromycin after 30d to accelerate recovery
97
Which infection cause a unilateral non painful non motile LN >> becoming **blue** >> rupture and **seen more in toddlers**
Non TB mycobacterium
**mainly MAC**
Dgx- mentuo / IGRA
Tx- driange (Abx only if TB)
98
Which pathogen is a/w **Ampiciliin rash**?
EBV
99
A pt present with fever, exudative pharyngitis and lymphadenopathy
after administred ampicillin and rash is formed (shown in the picture)
what is most likley the pathogen
EBC
80%- ampicillin rash
50%- splenomegalia
10-20%- hepatomegalia
100
Which disease can be fatal to boys with **Duncan disease**
EBV
101
How to different primary inf. vs latent inf. in EBV
**primary- **EBV Early antigen positive,VCA-IgM positive,EBNA negetive
**latent- **EBNA + VCA-IgG
102
Retroparyngeal abcess:
Age
etiologies
Dgx
pathogens
age < 5 yrs
Etiologis- after URI or trauma
Pathogens- MRSA, MSSA, PAS, anerobes
Dgx- CT. culture from abcess- definite
103
Peri-tonsillar abcess:
Age
etiologies
Dgx
pathogens
age < adulcensts
Etiologis- after pharyngitis / tonsillitis
Pathogens- GAS and anerobes
Dgx- Clinical presenation + US
104
Tx for Peri-tonsillar abcess and Retropharyngeal abcess?
PTA- Amoxicillin- calvenulate / clyndamycin for 14 days
RPA- Ampicillin sulbactan, clindamycin, vanco-if MRSa susp.
105
Complications for Rtero-PA and Peri-tonsillar abcess?
1. Airway obstruction
2. Mediastinitis
3. Aspiration pneumonia
4. Lamierre synd- Jugular throboplhbitis
106
Which pathogen is mostly a/w Lemierre syndrome?
Fusobacterium
sending septic embolis to lungs from jugular thrombophlbitis
## Footnote
Ceftriaxone IV + I/D if abcess as necessary
107
Whats the Dgx?
Retropharyngeal abcess
108
What is the gold standart for GAS pharyngitis infection
Culture from לוע
90-95% sensetivity
109
Tx for GAS pharyngitis
* first line- penecillin / amoxicillin-calvinulate for 10 days *or penecillin G IM one time *
* mild sensetivity to penecillin- cehalaxine
* anapylaxis with penecillin- azytromycin or clindamycin
110
Clinical presenation of P-FAPA?
age of presentation, times of episodes
* Periodic Fever
* Aphtous somatitis
* Pharyngitis
* Adenitis
sporadic syndrome age 2-5y, every 8-12 times per year for 4-6 days
111
Tx for PFAPA?
Signle dose of presnisone / bethenazole
in severe cases- tonsillectomy
**disease itself is self limited withing 4-8yrs w/o any bad prognosis **
112
Which types of worms cause the night echiness?
and what is the Tx?
**Anterobius vernmicularis** (Pinworm- interstitial nematode)
**Tx-**Albendazole
113
Tx for peri-natal infection of HBV
**HBIg + HBV vaccine**
until 12 hrs from delivery
95% succsess.
no C/I for breastfeeding
114
What are the stages of chronic infection in HBV
1. immune tolerant- no Tx. most kids
2. immune active- most Tx in here, high ALT and liver fibrosis
3. inactive phase- seroconversion- anti-HBe
4. re-activation- in immunosuppresion pt
115
Which blood measurement is a good marker in HBV for the sevirty of demage and acute liver failure?
PT
116
Which HBV Ab is indication for **seroconversion** and recovery with low risk for infection others?
Anti-HBe
117
Pathogens of meningtitis in the following ages:
1. < 1 month
2. 1-3 month
3. > 3 month
and viruses
1. < 1 month - GBS, E-coli, Lysteria
2. 1-3 month- GBS. Pneumoccoc, Listeria
3. > 3 months- pneumoccoc, meningoccoc
Viruses- Enteroviruses
paraechovirus
118
most a/pathogen of death from meningitis?
pnuemoccoc
119
Ampiric Tx for meningeitis in the following ages:
1. < 1month
2. > 1 month
1. **< 1 month -** Cefotaxime + Ampi + gentamycin
2.** > 1 month-** Cefotaxime / Ceftriaxome + Vancomycin + Steroids
120
most common cause of SBI (sys. bcterial inf.) in baby < 3 months
UTI
121
Indication for hospitalization in kids with UTI
1. age < 2 month
2. severe disease
3. dehydration/ vomiting - things that challenge PO Tx
122
Tx for cystitis and Pyelonephritis
Cystitis- Cehalxine (cephoral) / Augmentin
Pyelonephritis- Cehalxine (cephoral) / Augmentin / Cefuroxime
123
main distinguish of pyelonephritis from cystitis?
pyelo- **Fever**
cystitis- צריבה דחיפות ותכיפות במתן שתן
124
most leading death infection in kidas < 5 yrs
pnuemonia
125
Tx for pneumonia in the following age groups:
1. age < 1 month
2. 1month - 5 yrs
3. age > 5 yrs
1. < 1 month = hospitalizaiton + Ampicilin + gentamycin
2. 1 month-5 yrs - **Amoxiciliin (5-10 days)** *2nd line- augmentin, cheplaosporin zinath or ceftriaxone IM*
3. age > 5 yrs- **Azytromycin 3-5 days** (macrolides) for atypical
## Footnote
לזכור טיפול בקהילה ב-2 המצבים הבאים:
1. מתחת לגיל 5- ניתן מוקסיפן ל-5-10 ימים
2. מעל גיל 5- ניתן אזניל (אזיתרומיצין) ל-3-5 מים
**Fleuroquinolones are C/I in kids < 18**
126
What is the definiton of reccurent pneumonia?
2 or more episodes in year or 3 or more episodes in life *with normal imgaing btwn episodes*
127
Otitis externa pathogens + Tx?
psuedomoans + S.arueus
Tx- Abx ointment (quinolones or polymyxin + steroids
| רגישות במגע באפרכסת, כאב בלעיסה, הפרשה מהאוזן. ללא חום ללא פגיעה בשמיעה
## Footnote
swimmers ears
128
3 most common pathogens of acute otitis media
1. Hib non typeable
2. Pneumoccoc
3. morexella catteralis
## Footnote
mainly co-infection with viruses (URTI)
129
mainly age group peak of Acute otitis media (AOM)
6-15 months
130
How to Dgx Otitis media?
* Autoscope- bulgeing and purelant effusion
* Tympanometry- acustic mesuremnt
* Acustic reflectometry- **screeinig for AOM** >> if pathologic >> Pneumatic otoscopy
* pneumatic otoscopy- evaluation of ear ventilation- very relable
131
What consider to be Reccurent AOM (acute otitis media)
> 3 episodes in 6 months or > 4 in 1 year.
considert **Tympanostemy tube replacment**
132
What are the complications of Otitis media?
* **Chronic supportive Otitis media** with > 6 wks of drainage *Tympanic membrane perforated*
* Mastoiditis
* Meningitis
* Cholesteatoma
* conductive hearing loss
* TM perforation
133
Tx for Otitis media
1st line- amoxicillin PO for 7 days
2nd line- augmentin (when resistant, 3 daysw/o improvment)
3rd ine- Cegtriaxone IM
*drainage- severe or unresposive cases*
134
in acute otiris media **when Abx is not initially started**
1. 6-23 month baby with unilateral AOM w/o severe symptoms
2. > 24 month old with unilateral or bi-lateral AOM w/o severe symptoms
| **watchful waiting for 48-72 hrs**
## Footnote
Severe symptoms - fever > 39 or Otalgia (ear pain)
135
Tx forDgx of mastoiditis and Tx
Dgx- clinical presenation- OM signs + אפרכסת זקורה + CT to asses involvment of mastoid
Tx- Ceftriazome IV + surgical driange if abcess present
136
Coomon pathogens in bacterial sinusitis?
like Otitis media
Hib non-typable
morexella
pneumoccoc
137
What is the definition of acute, subacute and chronic sinusitis
acute < 30 d
sub-acute 31-90d
Chronic > 90d
138
when the following sinuses are openied
* Ethmoidal
* maxillary
* spenoidal
* frontal
* Ethmoidal- from birth
* maxillary- 4 y
* spenoidal- 5y
* frontal- 7-8y
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Which 2 clinical presentation in adults with sinusitis are **rare** in childrens
כאבי ראש ורגישות בניקוש על פני הסינוסים
140
how to Dgx sinusitis and what is the defenite dgx way
**Dgx by following criteria**
1. גודש נזלת ושיעול > 10 ימים ללא שיפור
2. חום > 39 מעלות
3. נזלת מוגלתית מעל 3 ימים
4. סימנים מחמירים / נשנים לאחר שהיה כבר שיפור
| **Defintie Dgx- Sinus aspirate culture** לא פרקטית ולא נעשית בשגרה
## Footnote
אבחנה קלינית
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Tx for sinusitis
| And what is the risk factors for resistance
## Footnote
first line and secondline and Tx for frontal sinusitis
50-60% self limiting
**thus only Abx in severe cases**
1. Amoxicillin 5-7d
2. augmentin (if risk factors for resistent to amoxiciliin) 7-10d
3. Frontal sinusitis- Ceftriaxone IV until improvment >> PO
## Footnote
risk factors for resistant-
* Abx in last 3 months
* daycare
* age < 2y
* no reposne after 72hrs
* co-morbidity
* immunodepression
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What is Ondansetron?
when we will give and when its C/I and why
Anti-emesis medication for kids who vomiting
C/I- severe hydration >> can worsen diarrhea and prolong QT
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what areth the indication of Abx in Gastroenteritis?
think about background but mainly pathogens
* age < 3 month
* co-morbidity
* dysenthera- fever, blood and WBC in stool
* Shigella- Azytromycin / Ceftriaxone PO
* ETEC/ EPEC- Azytromycin (azenyl)
* Vibrio colerae- Azytromycin
* C.difficile- in severe cases Metronidazole IV /PO + vancomycin PO / stool transplant
## Footnote
* Compylobacter- only if dysentria - Azytromycin
* Non-thypi salmonella- only in specific pt (immunocompremise) >> Ceftriaxone
* EHEC O157:H7 - Tx with Abx can cause HUS
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**Osteomylitis**
age
bones
age < 5 yrs, more in boys
bones- lower leg >> Femur > tibia > humerus > fibula
145
Osteomylitis pathogens in newborns < 3 months
* S.aureus
* GBS
* E.coli
* Gram negetive
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Osteomylitis in childrens > 3 months
* S.aureus
* pneumoccoc
* Kingella kingi
* GAS (can present with VZV)
* Salmonella - sickle cell
* coagulase negetive staph - cath. associated
Sexually active- think about Genoccocus
## Footnote
othes zoonotic- Brucella, Q-fever
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Tx for osteomylitis
under age 3 month and above
under 3 month- Cefazolin + Gentamycin
above 3 month- Cefuroxime / Naficillin / Cefazolin
## Footnote
naf or oxacillin
148
Tx of brucelosis < 8 and > 8 yrs
age < 8 - resperim + Rifampin
age > 8 - doxy + Gentamycin / Rifampin
## Footnote
for Q fever- Rifampin/ Resperim/ Tetracyclins
149
Length of treatment in osteomylitis
3-4 weeks but can be up to 6 weeks
150
Septic arthritis,
most comoon joints + age
age < 3 , mainly boys
Most common joints- knee > hip > uncle
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Dgx of septic arthritis
US- most sensetive
X-ray- follow bone healing
Articulocentesis- if suspect to be infected and accsable.
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Empiric tx for septic arthritis.
which pathogens we want to cover
when we will need surgical drainage?
1. S. aureus
2. in little ones kingella 6-36 months
for both we can cover with cephazolin or vanco (if MRSA suspceted)
3. **Septic hip-** emergency and need surgical drainage
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in Septic Arthritis when we can cosider to change IV to PO therapy?
clinical improvment - no fever > 48 hrs, CRP decreasein 30-50%, negetive blood cultures
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Rash + migratory arthritis
Acute RF
