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General Peds Boards > Infectious Disease > Flashcards

Infectious Disease Flashcards

1
Q

Newborn with Sensorineural deafness, cardiac defects (PDA, PPS), cataracts, dermal erythropoiesis

A

Congenital rubella infection

  • Other clinical signs: IUGR, pneumonia, encephalitis, HSM, jaundice, anemia, thrombocytopenia, blueberry muffin rash
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2
Q

Hepatitis B serologies

A
  • Hepatitis B surface antigen and antibody to hepatitis B core antigen = CHRONIC infection
  • IgM hepatitis B core antibody = ACUTE infection
  • Hepatitis B e antigen is suggestive of high viral replication and increased virus transmission
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3
Q

Enterovirus meningitis

A
  • MC in summer/early fall
  • Transmission is fecal/oral
  • CSF viral PCR is best way to detect it
  • CSF: relatively low white count (can be neutrophil predominant early on), mildly elevated protein, normal glucose
  • Other symptoms: GI/respiratory symptoms, nonspecific viral exanthem, hand/foot/mouth rash
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4
Q

Pertussis treatment

A

5 day course of azithromycin for treatment and post-exposure prophylaxis

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5
Q

Pertussis clinical presentation

A
  • In < 3 month old can be severe - perioral cyanosis w/ coughing, gagging, apnea
  • Catarrhal stage (5-7 days): mild upper respiratory symptoms
  • Paroxysmal stage (7-10 days): whooping cough, post-tussive emesis, often afebrile
  • Full duration is usually 6-10 weeks
  • Complications: rib fractures, pneumonia, sleep issues, apnea, bradycardia, hypoxemia, hemorrhage, SIDS
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6
Q

Bordetella pertussis micro

A
  • Gram negative coccobacillus
  • Droplet spread
  • Incubation is 7-10 days
  • Diagnose with PCR
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7
Q

Immigrant child with eosinophilia

A

Test for Strongyloides stercoralis

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8
Q

Adenovirus signs and symptoms

A
  • Pharyngitis, conjunctivitis, fever, preauricular lymphadenopathy
  • Outbreaks associated with swimming pools
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9
Q

Coccidioidomycosis signs/symptoms and geography

A
  • Soil from SW US (California, Arizona, New Mexico, Texas), Mexico, Central/South America
  • Pulmonary: cough, fever, headache, effusions, lymphadenopathy
  • Disseminated: skin lesions, bone lesions/pain, CNS meningitis
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10
Q

Coccidioidomycosis micro

A
  • Fungus with septate hyphae

- Airborne –> inhale spores

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11
Q

Coccidioidomycosis diagonsis and treatment

A
  • Serologic testing in urine, serum, plasma, or BAL
  • Positive IGM at 1-3 weeks after infection
  • Positive IgG –> complement fixation tests are HIGHLY SPECIFIC
  • Tx with amphotericin B, fluconazole, or ketoconazole
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12
Q

Bloody diarrhea from unpasteurized milk, undercooked poultry, or contaminated water

A

Campylobacter jejuni

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13
Q

Campylobacter sign/symptoms

A
  • # 1 cause bacterial foodborne GI in kids
  • gram-negative, spiral, motile, non–spore-forming bacilli
  • Bloody diarrhea, fever, crampy abdominal pain
  • Complications: sepsis/meningitis in neonates,
  • Guillain-Barré syndrome, reactive arthritis, Reiter syndrome, myopericarditis, and erythema nodosum
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14
Q

Campylobacter treatment

A

3 days azithromycin to decrease duration and spread but often is just a self limited illness

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15
Q

Neisseria meningitidis micro and treatment

A

Gram negative encapsulated diplococcus that colonizes in nasopharynx

  • Transmission via droplets - higher rates of carriage in people in crowded living conditions
  • Rocephin or penicillins
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16
Q

Neisseria meningitidis signs/symptoms

A
  • Rapid septic shock
  • Purpuric rash, meningitis
  • Endotoxin can cause cardiovascular collapse, DIC, respiratory failure
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17
Q

Enterobius vermicularis transmission, symptoms, treatment

A
  • Pinworms (roundworm)
  • Transmission fecal-oral route with contaminated toys, bedding, clothing, or toilet seats
  • MC in children age 5-10
  • Symptoms: perianal pruritis, restless sleep, vulvitis with dysuria
  • Tx: albendazole (treat everyone in the house) and sanitize everything
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18
Q

Hepatitis C virus maternal to fetal transmission course

A
  • Only 5% of infants born to moms with hep C get the virus (low transmission rate) –> need to get an antibody test at 18 months of age (or 6 months after breastfeeding)
  • Chronic disease with slowly progressive liver fibrosis in childhood
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19
Q

Listeria infection in neonate

A
  • Risks: maternal GI illness prior to delivery, preterm
  • Micro: Gram positive rods
  • Symptoms: diffuse erythematous papular rash (granulomatosis infantisepticum), sepsis, meningitis
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20
Q

Measles post exposure prophylaxis

A

Immune globulin for infants < 6 months of age if within 6 days of exposure

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21
Q

Painless penile ulcers with indurated border

A
  • Primary syphilis
  • Definitive diagnosis: dark field microscopy
  • Presumptive diagnosis: RPR or VRDL
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22
Q

Painful penile ulcers

A

HSV, chancroid, non-STD infections (EBV)

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23
Q

Common infections from developing worlds

A

TB, HIV, typhoid fever, invasive H. flu

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24
Q

Most common STD in the US

A

Chlamydia

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25
Q

Complication from using erythromycin in newborns

A

Pyloric stenosis (if used for less than 6 week old)

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26
Q

Newborn in first 2 months, afebrile, staccato cough, tachypnea, w or w/o eye discharge

A

Chlamydia trachomatis

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27
Q

Diagnosis of Chlamydia

A
  • Intracytoplasmic inclusion bodies in scrapings

- PCR is definitive diagnosis

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28
Q

Treatment of chlamydia conjunctivitis

A

Oral erythromycin

NOT TOPICAL

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29
Q

Chlamydia pneumonia symptoms

A
  • Low grade fever with infiltrates in an adolescent
  • Dx with immunofluorescent antiboides
  • Tx: azithromycin for 5 days or erythromycin for 14 days
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30
Q

Epidemiology of Rocky Mountain Spotted Fever

A
  • Rickettsia rickettsii is the bacteria
  • Peak in spring/summer
  • Incubation is 3-12 days
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31
Q

Purpuric macular rash that becomes petechial, starts on the wrists and ankles/palms and soles and spreads centrally 2-4 days after fever

A

Rocky Mountain Spotted Fever

  • Also commonly have headaches and myalgias
  • Labs: hyponatremia, can have pancytopenias
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32
Q

Diagnosis and treatment of RMSF

A
  • Serologic testing at presentation and 2-4 weeks later - dx is based on 4 fold increase in titers
  • TREAT prior to serologic testing results
  • Tx: doxycycline
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33
Q

Differences between ehrlichiosis and RMSF

A
  • Clinical symptoms very similar (headache, fever, myalgias)

- Ehrlichiosis is more likely to present with leukopenia and elevated LFTs

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34
Q

Infections from H. flu type B

A
  • Neonatal sepsis, childhood meningitis, periorbial cellulitis, pyogenic arthritis, epiglottitis
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35
Q

Gram negative cocci in pairs

A

H. flu and N. meningitidis

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36
Q

Treatment of H. flu

A
  • Ceftriaxone or cefotaxime

- OKAY to use IV steroids for this meningitis on initial presenation

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37
Q

Non-typeable H. flu infections

A

Otitis media and pneumonia

- Tx for otitis media plus conjunctivitis is oral augmentin (because this is like H. flu)

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38
Q

Infections in asplenia patients

A

Encapsulated organisms

- H. flu, Strep pneumo, N. meningitidis

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39
Q

Chemoprophylaxis following Hib exposure

A

Rifampin prophylaxis for:

  • All household contacts if anyone in the house is not fully immunized (< 4 years old) or if they’re immunocompromised
  • ALL workers/attendees of daycare if there are more than 2 cases in a 60 day period
  • Hib vaccine for all unimmunized or incompletely immunized (and then continue regular vaccine schedule)
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40
Q

Foods that salmonella comes from

A
  • Chicken
  • Eggs
  • Red meat
  • Unpasteurized milk and ice cream
  • Contaminated unwashed raw fruits/vegetables
  • Contaminated medical instruments
  • Pets (turtles, snakes, hedgehogs)
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41
Q

Salmonella symptoms

A
  • 1-2 days after ingestion
  • Watery, loose stools
  • Vomiting, abdominal cramps, fever
  • Dx: stool culture/PCR
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42
Q

Indications for treatment of salmonella

A
  • Younger than 3 months (to prevent invasive disease)
  • Risk of invasive disease: hemoglobinopathies, malignancies, severe colitis, immunocompromised

Tx: ceftriaxone, azithromycin, quinolones

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43
Q

Generalized constitutional symptoms (HA, abdominal pain, malaise, high fever) with HSM, red/rose spots, fever pulse dissociation

A

Typhoid fever (Salmonella typhii)

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44
Q

Watery diarrhea with high fever that then becomes bloody diarrhea after fever stops

A

Shigella

  • Also commonly have bandemia (left shift)
  • Can also have seizures
  • Commonly associated with daycare
  • Tx: supportive unless severe (rocephin)
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45
Q

Pseudomonas infections

A
  • Osteomyelitis/osteochondritis as a result of puncture wounds (nail through shoe)
  • Otitis externa
  • Infections from ventilators
  • Sepsis (especially neutropenic kids)
  • Pneumonia (especially in CF)
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46
Q

Treatment of pseudomonas

A
  • Pip/tazo
  • Gentamicin
  • Carbapenems
  • Ceftazidime/cefepime
  • Ciprofloxain/levofloxacin
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47
Q

Brucellosis exposures

A
  • Unpasteurized milk/cheese
  • Exposure to cattle, sheep, goats (ZOONOTIC DISEASE!)
  • Think about in fever of unknown origin
  • Very nonspecific symptoms (malaise, fatigue, leukopenia, fever)
  • Tx: Doxycycline or bactrim
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48
Q

Bloody mucous diarrhea after recent antibiotic

A
  • C. diff –> can be heme positive and not grossly bloody
  • Antibiotic: clindamycin or ampicillin
  • Pseudomembranous colitis
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49
Q

Diagnosis of C. diff

A
  • C. diff toxin using enzyme immunoassay

- C. diff isolation from stool does not necessarily mean causation

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50
Q

Treatment of C. diff

A
  • Metronidazole or oral vancomycin

- Cleaning (soap and water), alcohol doesn’t kill the spores

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51
Q

Strep pneumoniae infections

A
  • Respiratory tract infections, otitis media
  • Bacteremia and meningitis (in unimmunized kids)
  • Risk of colonization with antibiotic resistant strains in kids less than 2, attending daycare, and recent antibiotic administration
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52
Q

Treatment of strep pneumoniae

A
  • Penicillins and cephalosporins

- Meningitis: vancomycin and cefotaxime/ceftriaxone

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53
Q

Strep pyogenes transmission

A
  • Group A beta-hemolytic strep

- Inhalation of organisms in large droplets or by direct contactw ith respiratory secretions

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54
Q

Strep pyogenes (GAS) infections

A
  • Pharyngitis, cellulitis, necrotizing fasciitis, toxic shock
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55
Q

Rash that blanches easily and spares the face, palms, and soles - may mention pastia lines (red lines in skin folds of neck/axilla/groin/elbows)

A 
Scarlet fever (GAS)
- Can also describe sunburn like sandpapery rash as well as perioral pallor
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56
Q

Treatment for GAS pharyngitis

A
  • Dx with swab/culture
  • ASO antibodies tell you about recent infection
  • Tx: penicillin (can do amoxicillin) - erythromycin, clindamycin, first generation cephalosporin if allergic
  • Prevents rheumatic fever, not PSGN
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57
Q

Arcanobacterium haemolyticum

A
  • Catalase negative, acid fast, hemolytic, anaerobic, gram positive, bacillus
  • Causes acute pharngitis but no palatal petechiae or strawberry tongue
  • Commonly has a scarlatiniform rash (begins on extremities and then spreads to trunk)
  • Can also cause pneumonia, sinusitis, sepsis, peritonsillar abscess, orbital cellulitis
  • More common in teenagers
  • Tx: erythromycin, azithromycin, clindamycin
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58
Q

Erysipelas

A

Strep cellulitis - commonly have red streaks associated with lymphangitis

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59
Q

Causes of toxic shock syndrome

A

Strep, staph, EBV, coxsackievirus, adenovirus

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60
Q

Acute and long term complications of bacterial meningitis in children

A
  • Acute: seizures, empyema, cerebral edema, septic arthritis, vasculitis, cerebral hemorrhage/infarction, pericarditis
  • Long-term: developmental delay, intellectual disability, hearing impairment, epilepsy, spasticity, and hemiparesis.
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61
Q

Coag negative staph infections

A
  • Bacteremia from CVLs or indwelling IVs - Staph epi

- If no foreign body, it’s often a contaminant

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62
Q

MSSA treatment

A
  • Oxacillin/nafcillin

- If more invasive (bacteremia, endocarditis, meningitis), may need genatmicin or rifampin

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63
Q

Hospital acquired MRSA biggest risk factor

A
  • Nasal carriage

- Tx with vanc

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64
Q

Community acquired MRSA infection and treatment

A
  • Often cause skin/soft tissue infections
  • If abscess < 5 cm need only I&D, no abx
  • Abx: bactrim or clinda
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65
Q

Infant < 6 months old with poor sucking, descending generalized weakness/hypotonia, loss of facial expression, loss of head control, weak cry, constipation

A

Infantile botulism

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66
Q

Botulism mechanism of action

A
  • Food form (from poorly canned foods) - toxin is ingested
  • Infantile form - spores are ingested and they germinate after ingestion (toxin is produced and absorbed in GI tract)
  • Toxin blocks the release of acetylcholine into the synapse
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67
Q

Treatment of botulism

A
  • Aminoglycosides can potentiate the paralytic effects of the toxin so DON’T GIVE ANTIBIOTICS
  • Treatment is supportive care and maybe antitoxin for infantile botulism
  • For wound botulism, use penicillin or metronidazole after antitoxin is given
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68
Q

Three stages of syphilis

A
  • Primary: painless indurated ulcers (chancres) about 3 weeks after exposure
  • Secondary: mucocutaneous rash/lesions (polymorphic maculopapular and INVOLVES PALMS/SOLES), lymphadenopathy, condylomata lata - usually 1-2 months later
  • Tertiary: 15-30 years after initial infection –> gumma formation, cardiovascular involvement, neurosyphilis
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69
Q

Diagnosis of syphilis

A
  • Nontreponemal tests (RPR and VDRL) may be positive with other viruses so are just a screening
  • You should treat if this is positive while awaiting a confirmatory test
  • Treponemal test is used for confirmation (FTA-ABS), 100% specific for syphilis but can be positive for life so aren’t indicative of response to therapy –> This can be positive in lyme disease too so use the nontreponemal test to distinguish
  • Definitive diagnosis is spirochetes in microscopic darkfield exam or DFA
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70
Q

Treatment of syphilis

A

IV Penicillin G
- Giving this to a pregnant woman with syphilis also treats the newborn (penicillin crosses the placenta) –> if mom has an allergy she has to undergo desensitization for treatment

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71
Q

When to treat a newborn born to a syphilis positive mom

A
  • NO: if mom treated with penicillin > 1 month before delivery
  • YES: if treated within last month, if treated with erythromycin (doesn’t cross placenta), if baby’s titers are higher than moms
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72
Q

Newborn with copious nasal secretions (snuffles), bullous lesions, osteochondritis, pseudoparalysis of the joints, poor feeding, hepatosplenomegaly

A

Congenital syphilis

Other sx: lymphadenopathy, mucocutanesou lesions, pneumonia, edema, thrombocytopenia, HSM, hemolytic anemia, jaundice, maculopapular rash

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73
Q

Hutchinson triad of untreated congenital syphilis

A
  • Intestitial keratitis
  • Eighth cranial nerve deafness
  • Hutchinson teeth (peg shaped notched central incisors)
  • Frontal bossing
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74
Q

Corynebacterium diphtheria infections

A
  • Gram positive, nonspore forming, nonmotile, pleomorphic bacillus –> spread through respiratory tract droplets and contact with discharges
  • Membraous nasopharyngitis (bloody nasal discharge with low grade fever), extensive neck swelling with cervical lymphadenitis, myocarditis, peripheral neuropathies
  • Tx: equine antioxin
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75
Q

Risk factors for enterococci infections and treatment

A
  • Recent antibiotic use, indwelling catheters (can cause bacteremia), recent surgery (part of normal gut flora)
  • Tx: ampicillin and vancomycin (except VRE)
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76
Q

Kingella kingae infection

A
  • Gram negative coccobacilli (HARD TO GROW FROM CULTURE)
  • Frequently colonizes young children (toddlers)
  • Can cause osteomyelitis, bacteremia, suppurative arthritis
  • Often have respiratory or GI symptoms with the fever
  • Tx: cephalosporins
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77
Q

Listeria monocytogenes infections

A
  • Facultative anaerobic, nonspore forming, gram positive bacillus (multiple intracellularly)
  • Common in pregnant women, immunocompromised, and neonates –> FOODBORNE
  • Pregnant women often have influenza like illness
  • Tx: ampicillin and gentamicin
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78
Q

Neisseria meningitidis symptoms

A
  • Non-specific symptoms with myalgias, joint pain, petechial/purpuric rash, can have meningeal irritation
  • Complications can occur rapidly: meningitis, limb ischemia, coagulopathy, pulmonary edema
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79
Q

Neisseria meningitidis micro and transmission

A
  • Droplets and in close contact (dorms, military, etc) and terminal complement deficiency or asplenia
  • Aerobic, nonmotile gram negative diplocci
  • Grows best in chocolate or blood agar
  • Dx with PCR or culture
80
Q

Neisseria meningitidis treatment

A

Cefotaxime or cetriaxone

81
Q

Neisseria meningitidis prophylaxis

A

All close contacts with invasive meningococcal disease regardless of immunization status
- Household contacts, child care/preschool contacts 7 days before illness, direct exposure to secretions 7 days before illness, anyone who slept in same area up to 7 days before illness, anyone with prolonged contact in close proximity during 7 days before illness, health care workers not wearing a mask

  • Tx: rifampin (can turn secretions orange)
82
Q

MCC of bacterial gastroenteritis inteh developed world

A

Campylobacter –> most in children younger than 4, common in daycares

83
Q

Sources of campylobacter

A
  • Ingestion of contaminated food (undercooked poultry, untreated water, unpasteurized milk)
  • Fecal material from infected animals/people
84
Q

Symptoms of campylobacter infection and treatment

A

Fever, abdominal pain, cramping, bloody diarrhea (dysentery)

  • Sx can mimic appendicitis or intussusception
  • Tx is hydration and azithromycin can shorten duration of illness
85
Q

Yersinia infection sources and symptoms

A
  • Swine –> unpasteurized milk or raw meat (pork) in a child younger than 5
  • Sx bloody diarrhea with pseudoappendicitis (RLQ pain and elevated WBC)
  • Can have bacteremia - tx with rocephin if immunocompromised
86
Q

Treatment/complications of yersinia

A
  • Supportive unless:
  • Bacteremia (common in kids less than 1 or predisposing conditions including excessive iron storage or immunocompromised)
  • Tx with bactrim, cefotaxime, aminoglycosides
87
Q

Bartonella infections and treatment

A

Cat scratch disease

  • Lymph nodes can become swollena nd tender
  • Dx with serologic testing and enzyme immmunoassay or IFA test
  • Tx is supportive unless HSM, large painful adenopathy, or immunocompromised
  • IF treatment is needed use azithromycin, erythromcin, bactrim, or rifampin
  • DON’T USE INCISION AND DRAINAGE OR SURGICAL EXCISION –> can lead to fistula formation or other complications
88
Q

What do you do with a positive PPD or quantiferon

A

Get a CXR

  • If xray is negative they have latent TB
  • If xray is abnormal (perihilar adenopathy or cavitary lesions) then treat for pulmonary TB
89
Q

Treatment of latent TB

A
  • Isoniazid for 9 MONTHS

- If INH resistant then can give rifampin for 6-9 months

90
Q

Extrapulmonary TB symptoms

A

MAPD

  • Meningitis
  • Adenitis
  • Pleuritis
  • Disseminated (miliary disease)
91
Q

PCP symptoms and prophylaxis

A
  • Pneumonia with immunocompromised patient, ground glass appearance, general perihilar infiltrates that can evolve to intersitital infiltrates
  • Bactrim prophylaxis - needs to be started at diagnosis or 4 weeks of age for infant born to HIV positive mother
92
Q

Cryptosporidium symptoms and sources

A
  • Contamination of water/pools, petting zoos, child care centers (poor hygiene after diaper changes)
  • NON-BLOODY, watery diarrhea that lasts a long time
93
Q

Aminoglycoside toxicity

A
  • Ototoxicity from high trough levels

- Effectiveness depends on high peak levels

94
Q

Penicillins mechanism of action and uses

A

Bind to bacteria penicillin binding proteins and inhibit bacterial cell wall formation
- Strep throat, syphilis, meningococcal infections, otitis media, pneumonia, UTIs

95
Q

First generation cephalosporin uses

A

Gram positive bacteria and useful for skin infections like MSSA
- DOES NOT penetrate CNS well

96
Q

Second generation cephalosporin uses

A

Good for beta lactamase producing gram negatives (H. flu, moraxella, etc.) and some gram positives

97
Q

Third generation cephalosporin uses

A

Excellent CSF penetration so good choice for meningitis

  • Cefdinir for otitis media/sinusitis and GAS
  • Cefixime for UTIs or respiratory infections
98
Q

Fourth generation cephalosporin uses

A

Cefepime –> Gram positives and gram negatives including psuedomonas

99
Q

Clindamycin mechanism of action

A
  • BACTERIOSTATIC (not bactericidal)

- Effective against aerobic GPCs, anaerobic GPCs, anaerobic GN cocci, chlamydia, protozoa

100
Q

Macrolide side effects

A
  • Use azithromycin more than erythromycin (less GI side effects)
101
Q

Rifampin uses and contraindications

A
  • Used for prophylaxis from meningococcal or Hib exposure and for invasive/resistant Staph infections
  • NEVER for pregnant person, teratogenic
102
Q

Side effects of bactrim

A

SJS, rash, neutropenia, anemia, thrombocytopenia

103
Q

Vancomycin side effect

A

Red man syndrome –> rate dependent infusion reaction caused by histamine relase (not a true drug allergy)
- Slow infusion and give benadryl

104
Q

Transmission and risk factors of entamoeba histolytica

A
  • Transmitted via fecal oral route via contaminated food or water
  • Increased risk people are immigrants, institutionalized people, MSM
105
Q

Symptoms and diagnosis of entamoeba histolytica

A
  • Dysnetery: 1-2 weeks of crampy abdominal pain, diarrhea, fever, tenesmus –> watery, bloody, mucus stools
  • Complications: liver and brain abscess and lung disease
  • Dx: trophozoites/cysts in stool, stool culture, enzyme immunoassay
106
Q

Treatment of entamoeba histolytica

A

Symptomatic need metronidazole or tinidazole then a course of iodoquinol to clear cysts from intestines (only iodoquinol if asympotmatic)
- Need f/u stool studies and screening of household members

107
Q

Symptoms/treatment of malaria

A
  • Plasmodium species (ovale requires lifelong treatment)
  • Found in tropical areas of the world –> female mosquito
  • High fever with chills, rigor, sweats, headache – fevers every 2-3 days
  • Dx made by peripheral smear (thick and thin smears)
  • Tx with quinidine
108
Q

Toxoplasma symptoms/transmission in pregnancy

A
  • Lower chance of fetal infection early in pregnancy but if it happens the consequences are more severe
  • Lymphadenopathy may be the only symptom
  • Transmission from changing cat litter, contaminated water/food (unwashed garden vegetables), inadequately cooked meat, unpasteurized goat milk
109
Q

Congenital toxoplasmosis symptoms

A
  • Microcephaly, hydrocephaly, chorioretinitis, diffuse cerebral calcifications, jaundice, HSM
  • Later signs: deafness, impaired vision, seizures, learning/cognition issues
110
Q

EBV serologies

A
  • Heterophile antibody tests confirms diagnosis but not reliable in kids less than 4
  • MC serology test is antibody against IgG viral capsid antigen that appears early in infection and persist for life
  • Acute infection will have negative Epstein Barr nuclear antigen (appears several weeks to months after onset of infection) and positive IgM
111
Q

EBV complications

A
  • Can evolve to lymphoma in immunocompromised hosts
  • Rash in patients who have mono and get ampicillin
  • Splenomegaly (no contact sports for minimum of 4 weeks or until spleen is no longer enlarged)
112
Q

Newborn with thrombocytopenia, petechia/purpura (blueberry muffin rash), periventricular calcifications, HSM, jaundice, SGA, microcephaly, hypotonia, sensorineural hearing loss

A

Congenital CMV —> however it is usually clinically silent (think of this though in a baby with hearing loss or learning disability)

  • Urine culture or PCR for CMV is definitive in first 3 weeks of life
113
Q

Mono like illness but not EBV

A

Acquired CMV –> viral culture and PCR for testing

114
Q

Human Herpesviruses

A
  • HHV4 = EBV
  • HHV5 = CMV
  • HHV6 = Roseola
  • HHV8 = Kaposi sarcoma
115
Q

Infant/toddler with 3-5 days fever followed by generalized macular/papular rash

A

Roseola –> common to have febrile seizures with this too

116
Q

Rubella symptoms

A
  • Mild viral illness

- Maculopapular rash, low grade fever, subactue clinical picture (underimmunized)

117
Q

Confluent macular papular rash, Koplik spots, conjunctivitis, fever, cough, coryza

A

Rubeola (Measles)

118
Q

Measles symptoms timeline

A

Transmitted by airborne droplets with incubation period of 8-12 days

  • Prodrome first two days then Koplik spots
  • Rash comes around day 5 then worse after abouta week and begins to resolve around day 10
119
Q

Mesales post exposure management

A
  • If exposure within 6 days: immune globulin should be given to infants < 12 months, pregnant women, and immunocompromsied individuals
  • Giving vaccine to those not fully immunized within 3 days of exposure will prevent infection (so don’t need immunoglobulin)
  • Vaccination must wait 5 months after immunoglobulin was given and until the child is at least 12 months (for it to count as their normal vaccine)
120
Q

Mumps outbreak management

A
  • Kids fully immunized can stay in school
  • Kids due for booster need to get booster
  • Kids who never got vaccine need it before going back to school
  • Parents who refuse to immunize: kid has to wait 26 days after last person in class developed symptoms
  • If child had mums can go to school 9 days after onset of symptoms
121
Q

Parotitis (difficulty opening mouth, unilateral swelling), fever, headache, malaise, meningitis/encephalitis, orchitis, pancreatitis

A

Mumps

  • Epididymoorchitis is MC complication of mumps (impaired fertility in only 15% of cases)
  • Tx is supportive
122
Q

Differential of parotid swelling

A
  • Mumps: low grade temp, non toxic
  • Bacterial infection: high fever, toxic
  • Salivary gland stone: intermittent swelling
123
Q

Airborne transmission bugs

A

Aspergillosis, TB, measles, varicella, disseminated zoster

124
Q

Parvovirus B19 infections

A
  • Fifth disease: slapped cheek rash (often preceded by mild viral illness) –> lacey rash on extremities (can be pruritic) –> polyarthropathy (more in female adults)
  • Hydrops fetalis
  • Aplastic crisis in sickle cell
125
Q

Neonatal HSV symptoms

A
  • Sepsis, meningitis, seizures (temporal lobe), skin/eye/mouth lesions
  • Most caused by HSV type 2 (PCR diagnosis)
  • Delivery via C-section does not rule out transmission
  • Tx: acyclovir
126
Q

HIV symptoms

A

Chronic non-specific symptoms: weight loss, fever, night sweats

  • Recurrent thrush
  • LOW CD4 count
127
Q

Perinatal modes of transmission for HIV

A
  • Vertical through delivery (C/S decreases risk by 50%)

- Breastfeeding

128
Q

Diagnostic HIV test for infant < 18 months

A
  • HIV DNA PCR is gold standard because antibody IgG can cross placenta from mom
  • If > 18 months can use enzyme immunoassay to test for HIV antibody then need western blot analysis for confirmation
129
Q

When to test if exposed to HIV

A
  • Seroconversion happens within first 6 months

- Test at exposure, 6 weeks, 12 weeks, and 6 months

130
Q

Isolation for varicella infection

A

Airborne and contact for 5 days after onset of rash and until all lesions are crusted

131
Q

Post exposure prophylaxis for varicella infection

A

Immunocompromised person exposed to varicella infection needs immune globulin

132
Q

Most common complication of varicella infection

A
  • Staph aureus superinfection involving the skin

- Can also lead to pneumonia or osteomyelitis

133
Q

Treatment for varicella

A
  • Give immunoglobulin - considered a preventive measure more than a treatment (Needs to be given within 96 hours of exposure)
  • Acyclovir for patients at increased risk of complications (unvaccinated people older than 12, people with chronic lung disease, children receiving steroids, immunocompromised)
134
Q

Newborn exposure of chicken pox

A
  • If mom develops symptoms (chickenpox) between 5 days before delivery to 2 days after delivery then the infant is at risk and should get immunoglobulin
  • If mom has a zoster rash (in dermatome) - don’t need any therapy
135
Q

Enteroviral infection symptoms

A
  • Vague complaints but can include high fever, rash, and viral meningitis (especially in summer)
  • Kids often less than 5
  • May have conjunctivitis/pharyngitis
  • Dx with PCR, need contact precautions
136
Q

Complication of coxsackie B virus

A

Myocarditis

137
Q

Best way to prevent RSV spread

A

Good hand hygiene –> can live on environmental surfaces for several hours and for 30 minutes or more on hands

138
Q

Indications for pavilizumab

A
  • Infants with chronic lung disease, preemies, and congenital heart disease
  • Doesn’t decrease risk of getting RSV but decreases severity of the disease
139
Q

Quickest and most useful way to test for influenza

A

Rapid antigen test

140
Q

Treatment for influenza

A

Mostly supportive but can use antivirals (neuraminidase inhibitors - oseltamivir or zanamivir) if severe disease or at risk for complications

141
Q

Infection caused by parainfluenza

A

Croup (laryngotracheobronchitis)

142
Q

Rotavirus symptoms

A
  • 1-2 days of fever, watery stools, intermittent vomiting, dehydration
  • Dx with antigen testing of the stool
143
Q

Animals that carry rabies

A

Bat, raccoon, possum, skunk, fox, coyote, bobcat

144
Q

Treatment/prophylaxis of rabies and when to give it

A
  • If animal is suspected of being rabid or if exposed to a bat (they can transmit without biting the human)
  • Prophylaxis: 4 dose rabies vaccine and immunoglobulin infiltrating the wound (if prior vaccine just need 2 vaccine series)
145
Q

Ascaris lumbricoides worm life

A

Most prevalent human intestinal roundworm
- Adult worms live in lumen of small intestine and produce 200,000 eggs/day that are then excreted in the stool and then incubate in soil for 2-3 weeks –> infection from ingestion of eggs in contaminated soil

146
Q

Ascaris lumbricoides infection symptoms and treatment

A
  • Most are asymptomatic
  • Can have nonspecific GI symptoms or symptoms of abdominal pain/obstruction
  • Think of this with travel to a tropical region/endemic area
  • Tx with albendazole or ivermectin
147
Q

Trichinella spiralis infection source

A
  • Undercooked pork
148
Q

Necator americanus (hookworm) infection symptoms

A
  • Often asymptomatic
  • Chronic infection can lead to hypochromic microcytic anemia, growth delay, developmental delay
  • Stinging/burning sensation –> pruritus –> papulovesicular rash for 1-2 weeks (on area that you stepped on it)
  • Enters the body through the feet
149
Q

Tapeworm infection symptoms

A
  • Taeniasis and Cysticerosis are the worms

- Often asymptomatic but can have nausea, diarrhea, pain

150
Q

Toxocariasis infection symptoms

A
  • GI symptoms or respiratory symptoms (wheezing, hepatomegaly, abdominal pain), vision problems
  • Exposure to dogs/cats is risk factor or preschooler eating dirt
  • Can have eosinophilia on labs
  • Tx with albendazole or thiabendazole
151
Q

Enterobius vermicularius (pinworm) infection

A
  • Perianal or perivulvar itching
  • Transmission via fecal-oral route directly or via contaminated hands –> commonly have reinfection
  • Diagnosis with adult worms in perianal region 2-3 hours after child is asleep
  • Tx albendazole
152
Q

Treatment of candidiasis

A
  • Oral in immunocompetent host: nystatin
  • Oral in immunocompromised: fluconazole
  • Invasive disease in neonate: IV amphotericin
153
Q

Cryptococcus symptoms and exposure

A
  • Pulmonary disease, CNS disease/meningitis
  • Associated with AIDS
  • Exposure to bird droppings (pigeons)
  • Tx: amphotericin B with oral flucytosine or fluconazole
154
Q

Aspergillosis symptoms, diagnosis, treatment

A
  • Eosinophilis and infiltrates on CXR
  • Dx with positive serum galacomannan
  • Tx: voriconazole (ampho B in neonates)
155
Q

Histoplasmosis symptoms, geography, treatment

A
  • Common in Missouri/Mississippi river valleys –> exposure to bird droppings
  • Influenza like symptoms, respiratory symptoms, hepatosplenoemgaly
  • Tx: supportive if immunocompetent, ampho B or fluconazole for disseminated disease/immunocompromised
156
Q

Workup for neonate with candidemia (secondary sites)

A
  • Ultrasound of kidneys
  • Echo for endocarditis
  • LP for CSF
  • Eye exam
157
Q

Measles complications

A

Otitis media, bronchopneumonia, laryngotracheobronchitis, diarrhea, acute encephalitis, subacute sclerosing panencephalitis (years down the road)

158
Q

Infection that requires you to stay out of daycare/school until 24 hours after starting therpay

A

Strep pharyngitis

159
Q

Symptoms of trichomonas

A
  • Yellow/green/frothy smell vaginal discharge
  • Vulvovaginal pruritis
  • Strawberry cervix
  • Diagnosed on wet mount
  • Tx with metronidazole
160
Q

Symptoms of babesios

A
  • Fever and hemolytic anemia
  • Prodrome of malaise, anorexia, fatigue
  • Tick bite transmission (same tick that transmits Lyme disease)
  • Tx with clindamycin and quinine
  • Will mention someone from Martha’s vineyard in question stem
  • On smear: maltese cross
161
Q

Mucormycosis appearance

A

Right angle septations

162
Q

Flesh colored, translucent, dome shaped papules

A

Molluscum contagiosum - viral rash

163
Q

Exposure to hay or rose garden –> nodules on forearm

A

Sporotrix - treat with itraconazole

164
Q

Staph scalded skin syndrome

A
  • Toxin mediated disease by exfoliative toxins A and B
  • Nikolsky sign (toxin mediated cleavage of the epidermis)
  • Scarlitiniaform erruption and can have bullous lesions
165
Q

Prophylaxis for a dog bite in a child with penicillin allergy

A
  • Clindamycin (covers anaerobes and skin flora)

- Bactrim (covers pasturella)

166
Q

Prophylaxis for a dog bite in a child

A
  • Augmentin
167
Q

Fever, weight loss, lymphadenopathy with negative mono spot in sexually active teen

A

Acute HIV

168
Q

Treatment of tularemia

A

Gentamicin (gentle rabbits)

169
Q

Types of tularemia

A
  • Ulceroglandular
  • Glandular
  • Oculoglandular
  • Respiratory

Associated with rabbites, hares, and rodents

  • Diagnose with serology (but can also do with culture)
170
Q

Bacteria associated with brain abscess and infant formula

A

Citrobacter and Enterobacter

- Gram negative meningitis (need imaging to rule out abscess)

171
Q

Erythematous papule that becomes pusule and erodes –> serpiginous border, painful in groin

A

Haemphilus ducreyi (chancroid)

172
Q

Empiric antimicrobial therapy for an asplenic patient with sepsis

A
  • Vanc and rocephin

- Risk for encapsulated organisms: S. pneumoniae, N. meningitidis, H. influenzae

173
Q

Empiric antimicrobial therapy for febrile neutropenic with beta lactam allergy

A

Cipro/vanc or aztrenoma/vanc

  • Normally would do cefepime, pip/tazo, or meropenem (need to cover pseudomonas)
174
Q

Most common infections in a burn patient

A
  • Staph aureus
  • Pseudomonas
  • Candida
  • HSV1
175
Q

Indications for line removal with a CLABSI

A
  • Infection with Staph aureus, fungi, or mycobacteria
  • Severe sepsis
  • Suppurative thrombophlebitis
  • Endocarditis
  • BSI continuing > 72 hours after initiating therapy
176
Q

At what age is a positive urine CMV indicative of a congenital CMV infection

A

Infant less than 3 weeks

177
Q

Diarrhea plus Haiti

A

Cholera

- If mild dehydration just need oral rehydration

178
Q

Taenia solium infection

A
  • Seizures with a single enhancing lesion in the soleus

- Neurocystercosis

179
Q

Chagas disease bug and symptoms

A
  • Trypanosoma cruzi
  • Often asymptomatic
  • Some can have swelling/inflammation at site of inoculation
  • Romana’s sign in the eye
180
Q

Antibiotic coverage for pott’s puffy tumor

A

Ceftriaxone, vancomycin, metronidazole

181
Q

How do you interpret PPD

A
  • If immunocompromised: > 5 is positive
  • If born in endemic area, working/living in high risk area like jail or healthcare, or less than age 4: > 10 is positive
  • If born in US and over age 4: > 15 is positive
182
Q

What CD4 count does PCP prophylaxis need to start in HIV patient

A

200 –> use bactrim

  • < 100 concern for toxo
  • < 50 concern for MAC (add on azithro)
183
Q

West Nile virus symptoms

A
  • Arbovirus
  • Often asymptomatic
  • Can have fever, headache, myalgias, encephalitis (less than 1% develop neuroinvasive disease)
184
Q

Hepatitis A prophylaxis during a known outbreak

A
  • Hep A vaccine if > 12 months and healthy

- Immunoglobulin for < 12 months, immunocompromised, or chronic liver disease

185
Q

Hepatitis B prophylaxis for baby born to HBsAg positive mom

A
  • Immunization and immunoglobulin within 12 hours of birth
186
Q

How long after IVIG infusion can patient receive MMR/varicella

A

11 months

187
Q

Bug and bacteria for lyme disease

A
  • Ixodes deer tick (have to feed at least 36 hours to transmit Lyme disease)
  • Borrelia burgdorferi
188
Q

Progression of lyme disease

A
  • First 2 weeks: Erythema chronicum migrans (bullseye rash) at site of tick bite (but only in 25% of cases), vague arthralgias, fatigue
  • Several months to years: CNS, cardiac, arthritic disease (pauciarticular), Bell’s Palsy
189
Q

Arthritis associated with lyme disease

A

Pauciarticular in large joints (especially the knee)

190
Q

Labwork for Lyme disease

A
  • Lyme enzyme immunosorbent assay (EIA) titer of fluorescent antibody (FA) test –> if positive or equivocal then do confirmatory Western blot test
  • Detectable levels of serum antibodies don’t build up until 4-6 weeks so false negatives can be common
  • False positives: SLE< dermatomyositis, other rickettsial diseases
191
Q

Lyme treatment

A
  • Doxycycline for > 8 years old
  • Amoxicillin for < 8 years
  • Treat for 14-21 days
192
Q

Child treated for lyme that then develops fevers, chills, hypotension, sepsis picture

A

Jarisch-Herxheimer reaction

- Caused by lysis of organism and release of endotoxin

193
Q

Monospot limitations

A
  • Not good in kids less than 4
  • If negative initially, can become positive 2-3 weeks into illness
  • Antibody titers can be detected for up to 9 months
194
Q

Fever, vesicular lesions in posterior pharynx

A

Coxsackie virus

- Lesions usually spare the tongue and gingival surfaces

195
Q

Skeletal changes associated with congenital syphilis

A
  • Pseudoparalysis (painful osteochondritis)

- Multiple sites of osteochondritis at the wrists, elbows, ankles, knees, metaphysis/diaphysis of the long bones

196
Q

Time to keep home from school if hepatitis A infection

A
  • Patient should stay home for 7 days if an acute infection

General Peds Boards (24 decks)

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