Infectious Disease

Question 1

3 MCC of sepsis/meningitis in <28days old

Answer 1

GBS
Ecoli
Listeria

Question 2

Empiric abx for <28day old with fever

Answer 2

Amp + Gent or cefotaxime

Question 3

3 MCC of sepsis/meningitis for 1-3month old

Answer 3

GBS
S.pneumo
LIsteria

Question 4

Empiric abx for 1-3mo old with fever

Answer 4

Ampicillin + cefotaxime (+ vanc if meningitis)

Question 5

3 MCC of sepsis/meningitis for 3mo-3yo

Answer 5

S pneumo
Hib
Neisseria

Question 6

Empiric abx for 3mo-3yo with fever

Answer 6

Cefotaxime + vanc if meningitis

Question 7

2 MCC of sepsis/meningitis in >3yo

Answer 7

S pneumo

Neisseria

Question 8

Abx for >3yo with fever

Answer 8

Cefotaxime (+ vanc if meningitis)

Question 9

which 3 classes of patients with fever get admitted?

Answer 9

1- any baby <28days
2- 1-3mo who is toxic, meningitis, or severe infection.
3- outpatient follow up is unclear

Question 10

When to just observe a fever w/o workup in 3mo-3yo?

Answer 10

If fever <102.2 and non toxic

If toxic, workup for sepsis regardless of temp

If >102.2, workup regardless of appearance

Question 11

What should be given in addition to antibiotics if suspecting Hib meningitis?

Answer 11

Corticosteroids –> reduces hearing loss

Question 12

CSF profile for TB

Answer 12

Lymphocytosis
Very high protein
Low glucose

Question 13

CSF profile for fungus

Answer 13

Lymphocytosis
Normal/mildly high protein
low glucose

Question 14

Most common long term complication of meningitis

Answer 14

hearing loss

Question 15

hallmark PE finding of TB meningitis that distinguishes it from viral/fungal.

Answer 15

cranial nerve deficits

Question 16

Tx of viral meningitis

Answer 16

self limiting

Question 17

what 2 things should prompt you to think about bacterial superinfection in a viral uri?

Answer 17

sx >10 days

High grade fever

Question 18

most important aspect of managing viral URI?

Answer 18

HYDRATION!

Question 19

most common viral vs bacterial causes of pharyngitis

Answer 19

viral- URI bugs, coxsakie, EBV, CMV

bacterial- Strep pyogenes

Question 20

acute bacterial sinusitus tx

Answer 20

Amoxicillin, augmentin or cefdinir

Question 21

Tx for AOM. Exception?

Answer 21

Amoxicillin. Unless they recieved amox within the last month, then give augmentin or cephalosporin

Question 22

3 MCC of otitis externa

Answer 22

Pseudomonas
Staph aureus
Candida

Question 23

hallmark of tx for otitis externa

Answer 23

Restore acidic environment of ear canal! –> give acetic acid drops

Question 24

tx of severe otitis externa? OE + AOM?

Answer 24

Severe OE only –> topical abx

OE + AOM –> Oral + topical

Question 25

2 MCC of an enlarged tender lymph node

Answer 25

S aureus / s pogenes

Question 26

Initial management of tender lymph node

Answer 26

Treat the most common cause! Start empiric abx (cephalosporin or pcn)

Question 27

What should you supsect if lymphadenoapthy doesnt respond to empiric abx?

Answer 27

Bartonella or toxoplasmosis

Question 28

What should you order if you have diffuse, persistent and tender lymphadenopathy

Answer 28

EBV, CMV, HIV

Question 29

cause of unilateral vs bilateral parotid enlargement

Answer 29

unilateral - bacterial | bilateral - viral/mumps

Question 30

MCC for bacterial parotitis

Answer 30

Staph/strep

Question 31

MCC of impetigo

Answer 31

staph! then strep

Question 32

location of cellulitis vs erysepilas

Answer 32

``` cellulitus = dermis erysepilas = dermal lymphatics ```

Question 33

Buccal cellulits presentation and causitive agent

Answer 33

Bluish discolartion of the cheek in an unvaccinated kid. Caused by Hib

Question 34

Rash with hemorrhagic bullae and crepitus

Answer 34

Nec fash

Question 35

Nec fash tx

Answer 35

immediate abx and debriedment

Question 36

classic pattern of scarlet fever rash

Answer 36

strep infection (throat, cellulitis, impetigo) Rash that starts on TRUNK and spreads out

Question 37

which 2 strep complications will abx prevent?

Answer 37

PANDAS | RF

Question 38

PANDAS presentation

Answer 38

development of OCD or a tic after strep infection

Question 39

Post streptococcal arthritis vs RF

Answer 39

RF has multiple symptoms. Post strep arthritis is ONLY arthritis that lasts for several weeks then resolves (not prevented by abx)

Question 40

Fever, desquamating rash, multisystem organ failure

Answer 40

Toxic schock syndrome

Question 41

MCC of toxic shock syndrome

Answer 41

s. aureus

Question 42

2 ways to differentiate rotavirus from norwalk virus infection

Answer 42

Rota= diarrhea + vomiting 4-7 days Norwalk= vomiting>diarrhea, only 2-3 days

Question 43

classic electrolyte finding in acute diarrhea

Answer 43

Hyperchloremic non anion gap metabolic acidosis

Question 44

2 best ways to prevent vertical transmission of HIV

Answer 44

Have mom on HAART so she has an undetectable viral load. Csection is better than vaginal

Question 45

4 Classic symptoms of HIV in a child

Answer 45

FTT Recurrent infections Lymphadenopathy Thrombocytopenia

Question 46

When do babys develop symptoms of HIV

Answer 46

After first year of life

Question 47

Diagnostic test for inutero infection

Answer 47

anti-HIV ab present for first 2 years of lif

Question 48

Diagnostic test for perinatal infection

Answer 48

HIV DNA PCR every month until 4 months

Question 49

At which point do you know a child is NOT infected with HIV?

Answer 49

negative HIV PCR at 4 months

Question 50

3 steps in initial management of a baby born to HIV mother, regardless of if the child is infected or not

Answer 50

Zidovudine x 6weeks for ppx Bactrim ppx x4 months until PCR is neg NO BREAST FEEDING

Question 51

mycobacterium avium presentation

Answer 51

fever, weight loss, night sweats, abdominal pain/diarrhea, MARROW SUPPRESION, TRANSAMINITIS

Question 52

Diagnostic test for EBV in children less than 4 vs older than 4

Answer 52

``` <4yo = EBV ab titers >4yo= antiheterophile ab titers ```

Question 53

Most common EBV ab titer that will be positive in infection

Answer 53

IgM to viral capsid antigen

Question 54

Patient with pharyngitis and fever gets amoxicillin then develops diffuse maculopapular rash

Answer 54

Dx is actually EBV, not strep....this is a weird phenomenon that happens when EBV+ patients get amoxicillin.

Question 55

most common complication of measels

Answer 55

bacterial pneumonia

Question 56

what causes the blueberry muffin rash of congenital rubella?

Answer 56

Thrombocytopenia

Question 57

wheezing, eosinophilia in a patient with chronic lung disease (CF, asthma)

Answer 57

Allergic bronchopulmonary aspergilosis

Question 58

2 ways to dx giardiasis

Answer 58

Stool ova and parasite | stool ELISA test