Infectious diseases Flashcards
(94 cards)
1
Q
high-risk conditions that increase risk of bacteremia
A
sickle cell, asplenia, malignancy, chemo, HIV, renal disease, prolonged steroid use, central lines/ indwelling catheters, VP shunts
2
Q
Risk factors for UTI
A
febrile, white girls < 2 years old, and uncircumcised boys before toilet training. Previous UTI
3
Q
Toxicologic causes of fever
A
serotonin syndrome, neuroleptic malignant syndrome, ASA, anticholinergics, sympathomimetics
4
Q
Low risk criteria for fever in 1-2 month old infants
A
full term (> 37 weeks) no prolonged NICU stay no chronic medical problems no recent Abx in last 3 days well-appearing no focus on exam, WBC 5-15, Band/neut ratio < 0.2; Urine < 10 WBC/hpf, CXR no infiltrate (if done for resp symptoms)
5
Q
Antibiotic choices for sepsis in < 1 month old
A
ampicillin and gentamycin (cefotaxime if meningitis)
6
Q
Antibiotic choices for fever in 30-90 days
A
cefotaxime, vancomycin +/- ampicillin
7
Q
Cervical lymphadenopathy - acute bilateral causes
A
resp viruses, enterovirus, adenovirus, EMV, CMV
8
Q
Cervical lymphadenopathy - acute unilateral causes
A
S. aureus, S. pyogenes
9
Q
Cervical LN - chronic unilateral causes
A
atypical mycobacteria, TB, bartonella Henselae
10
Q
Risk factors for toxic shock syndrome
A
recent tampon use (prolonged/ high absorbency), recent surgery, and recent infection (involving skin or soft tissue or other site). Burns, steroids, malignancy, DM2, immunocompromised, IVDU
11
Q
Treatment of Toxic shock syndrome
A
Cloxacillin + clindamycin
IVIG for GAS TSS
12
Q
Classic triad of RMSF?
A
Fever, rash and headache
13
Q
Treatment of RMSF?
A
doxycycline
14
Q
When to do a CT scan before LP in meningitis?
A
focal neuro deficit, papilledema, history focal neuro disease, immunocompromised, signs cerebral herniation
15
Q
3 types of neonatal HSV
A
- Skin, eye, mouth
- CNS
- Disseminated
16
Q
Organisms that cause sinusitis
A
Same as AOM: pneumococcus, H. influenza, Moraxella, GAS
17
Q
Complications of sinusitis
A
orbital cellulitis, facial cellulitis or abscess, intracranial abscess, meningitis, orbital subperiosteal abscess, cavernous sinus thrombosis, OM frontal bone with subperiosteal abscess (Pott’s puffy tumor), sinus mucocele
18
Q
Clinical criteria for the diagnosis of sinusitis?
A
- Persistent > 10 days
- Worsening course
- Purulent nasal drainage (3 days) and fever
19
Q
Complications of mastoiditis?
A
intracranial spread (abscess), bacteremia, facial nerve damage, labyrinthitis, osteomyelitis
20
Q
Pathophysiology of tetanus?
A
bacteria enters wound and produces tetanus toxin that travels to the brainstem and spinal cord –> disrupts synaptic transmission by preventing release of neurotransmitters
o loss of inhibition (ie, disinhibition) of anterior horn cells and autonomic neurons results in increased muscle tone, painful spasms, and widespread autonomic instability
o may lead to life-threatening respiratory failure and autonomic dysregulation in severe cases
21
Q
Incubation period of tetanus?
A
3-21 days
22
Q
4 forms of tetanus?
A
o Generalized tetanus
o Local tetanus: tonic and spastic muscle contraction in one body extremity
o Cephalic tetanus: cranial nerve involvement (facial nerve)
o Neonatal tetanus: refusal to feed and difficulty opening mouth, facial muscle spasm, tonic contraction
23
Q
Treatment of botulism?
A
Supportive, intubation if needed
o For infants: baby botulism immunoglobulin (BabyBIG), no antibiotics
o For children: botulinum antitoxin, and pencillin or flagyl
24
Q
Treatment of tetanus?
A
Tetanus immunoglobulin (TIG) with some infiltrated into the wound and the rest IM; flagyl or penicillin 10-14 days
o Intubate + large doses of sedatives to reduce spasms/ laryngospasm
o Large doses of benzos
25
Etiology of pneumonia?
- Viral causes are most common
| - Bacterial: pneumococcus, S. aureus, GAS
26
Indications for hospital admission for pneumonia?
< 3-6 months old, immunocompromised, no response to PO abx after 1-2 days, dehydration, suspected staph pneumonia (empyema, pneumatocele), O2 need, unstable vitals
27
What is Light's criteria for exudative pleural effusion?
pleural fluid:serum protein ratio > 0.5
pleural fluid:serum lactate dehydrogenase (LDH) ratio > 0.6
pleural LDH concentration > 2/3 the normal upper limit for serum
28
Transudative pleural effusion causes (list 4)
CHF, Cirrhosis, Nephrotic syndrome, Malnutrition causing low protein state, IBD, Peritoneal dialysis, Sarcoidosis, SLE, Pulmonary embolism
29
Stages of pertussis?
- First stage = catarrhal phase: 1-2 weeks; similar to URTI; mild cough, conjunctivitis, coryza
- Second stage = paroxysmal stage = 2-4 weeks; prolonged spasm of coughing and characteristic whoop cough from inflow of air; posttussive emesis common; may become cyanotic, anxious
- Third stage (convalescent): intensity of cough wanes
30
Complications of pertussis?
complete airway obstruction from mucous plug leading to respiratory arrest, bacterial pneumonia, apnea, seizure, encephalitis, intracranial hemorrhage, rectal prolapse, rupture diaphragm
31
Infectious DDx of Kawasaki?
viral (adenovirus, EBV, CMV), scarlet fever, Staph scalded skin, TSS, ricketsiall disease (RMSF), leptospirosis.
32
Treatment of pertussis?
Azithromycin x 5 days
Chemoprophylaxis for household contacts (azithromycin or erythromycin), booster if not fully immunized
33
Which organisms cause endocarditis
S. aureus, S. viridans, HACEK organisms (haemophilus, actinobaccilus, cardiobacterium hominis, Eikenella, Kingella)
34
5 bacterial causes of gastroenteritis?
Salmonella, Shigella, Yersinia, Campylobacter, E. coli
35
Organisms that cause HUS?
E. Coli O157:H7 (and Shigella, pneumococcus, and campylobacter)
36
Treatment of HUS?
NO antibiotics, supportive care, IV fluids, platelets if life-threatening bleeding, nephrology and ICU – may need dialysis.
37
Complications of C. Diff?
toxic megacolon, perforation, peritonitis
38
Treatment of C. Diff?
Mild - stop offending abx
Mod/ mild but not-resolving = flagyl PO
Severe = vancomycin PO
Severe, complicated = flagyl IV + vanco PO
39
Predisposing factors for bacteremia with salmonella NON-typhi
< 4 yo, elderly, sickle cell, asplenia, HIV, immunosuppressed/ immunocompromised
40
Causes of ellulitis after animal bite
pasteurella multocida, staph, GAS, capnocytophaga canimorsus (sickle cell)
41
Causes of cellulitis after stepping on nail with running shoe?
Staph aureus, Pseudomonas, GAS
42
Risk factors for community-acquired MRSA
o close skin-to-skin contact
o openings in the skin such as cuts or abrasions
o contaminated items and surfaces
o crowded living conditions
o poor hygiene. Clusters or increased rates have been reported in Aboriginal populations, athletes, daycare attendees, military recruits, intravenous drug users, men who have sex with men, and prisoners, but many infected children have no risk factors.
43
Most common bacterial cause of septic arthritis
S. aureus
Other organisms: GBS, S.pneumo, GAS, Kingella, salmonella
44
Synovial fluid description in septic arthritis
synovial fluid WBC > 50,000-100,000 cell/mm3 with neutrophil predominance
45
Kocher criteria for septic arthritis?
non weight bearing, ESR > 40, fever, WBC > 12,000 (all four met =99%; 2/4 = 40%)
46
Treatment of nec fasc?
ABC, IV access, bolus fluids and consider vasopressor/inotropes, IV antibiotics (penicillin/ cloxacillin + clindamycin =/- vancomycin ), urgent plastic surgery consult for debridement; severe GAS consider IVIG
47
Neurologic complications of varicella?
1. Acute cerebellar ataxia (after primary varicella)
2. Encephalitis (diffuse cerebritis)
3. Reye syndrome - associated with ASA administration
4. Aseptic meningitis
5. Peripheral motor neuropathy (herpes zoster)
6. Transverse myelitis
7. Guillain-Barre syndrome (herpes zoster)
8. Bacterial meningitis (according to flieshers)
9. Stroke like symptoms (secondary to infection of cerebral arteries)
10. *seizures (secondary to encephalitis)
11. *coma (secondary to encephalitis or reye’s)
48
Ophtho complications of varicella?
1. Herpes zoster ophthalmicus (HZO) - *reactivation!
1. hyperemic conjunctivitis
2. episcleritis
3. iritis
4. corneal involvement (keratitis) [results from a necrotic ganglionitis]
5. lid droop
2. other: acute retinal necrosis (ARN)
49
What is Ramsay Hunt syndrome?
major otologic complication of VZV reactivation, which typically includes the triad of ipsilateral facial paralysis, ear pain, and vesicles in the auditory canal and auricle
50
Which form of malaria has the highest mortality?
Plasmodium falciparum
51
Criteria of severe malaria?
shock, acidosis, hypoglycemia, end-organ involvement (CNS, renal), > 5% parasitemia, severe anemia/ thrombocytopenia
52
Testing for malaria?
o Thin and thick smears x 2 (12-24 hours later)
o CBC/diff (thrombocytopenia is common), cultures
o R/O hypoglycemia, renal/liver dysfunction, cerebral malaria
53
Clinical criteria of dengue fever?
fever, vomiting, joint pain, “break-bone” fever, maculopapular rash, positive tourniquet test (petechiae)
54
Most common cause of traveler's diarrhea?
Traveler’s diarrhea is usually bacterial (80%) of cases.
Most common cause is ETEC (enterotoxigenic E. Coli)
55
What does Dukoral protect against?
Dukoral, a killed whole-cell oral vaccine with the nontoxic B subunit of cholera toxin, also provides limited (<50 percent) protection against infection with enterotoxigenic Escherichia coli.
56
What animals carry rabies?
Bats and wild carnivores (raccoon, skunk, coyote, foxes)
57
When to treat for rabies?
contact with bats, wild carnivores, bat found in room with sleeping/ non-verbal child, potential unprovoked dog bite if unavailable for observation for 10 days *contact public health
58
When to perform primary closure of a bite?
- cosmetically needed, joint/tendon/bone involvement
| - NOT for cat wounds (except face), old wounds, immunocompromised
59
When to treat a bite wound with prophylactic antiobiotics? Which abx to give?
crush wound, puncture wound, face, hands, feet, genitalia, immunocompromised, obvious signs of infection, ALL human bites, cat bites. Dog bites if primary closure
Use amox-clav x 5 days
60
Which organisms are involved in bite wounds?
o Human: Eikenella corrodens
| o Dog/ cat: staph aureus and Pasteurella multocida
61
Complications of measles
pneumonitis, otitis media, meningoencephalitis, late: subacute sclerosing pancencephalitis
62
Lab diagnosis of measles (what to send for testing)?
o Measles IgM and IgG
o NP/throat swab for measles PCR
o Urine for measles PCR
63
Complications of mumps?
Parotitis, epididymitis, orchitis, mastitis, myocarditis, hepatitis, pancreatitis, arthritis
64
What is trachoma?
chronic chlamydia eye infection that can results in corneal neovascularization and blindness
65
What are signs of HIV infection?
recurrent fever, developmental delay, FTT, chronic/ recurrent diarrhea, parotitis, oral thrush, lymphadenopathy, HSM, acquired microcephaly, bacteremia
66
What are some features of congenital syphilis?
Condylomata lata, snuffles, bony changes (saddle nose, saber shins, osteochondritis, perichondritis), HSM, lymphadenopathy, meningitis, chorioretinitis, dental changes (Hutchinson teeth, Mulberry molars)
67
What are the treponemal and non-treponemal tests?
* Non-treponemal tests = non-specific, IgG (RPR for serum, VDRL for CSF). False positives and false negatives are common
* Treponemal tests = specific/ confirmatory (FTA-ABS, TP-PA, MHA-TP)
68
Which labs to send for a needlestick injury?
Labs at baseline, 6 weeks, 3 months, 6 months:
o HBsAG, HBsAb, HBcAb; HIV and HCV serology
69
What are the management principles of daycare bite wounds?
- Local wound care – clean well with soap and water
- Tetanus immunization
- Prophylactic abx if:
o Moderate or severe tissue damage
o Deep puncture wounds
o Affecting face, hand, foot, genitalia
- HIV prophylaxis only if one of the children is known HIV+, exchange of blood
- Hep B vaccine if unknown status
70
Which bacteria can cause PID?
Nisseria gonorrhea, Chlamycdia trachomatis, HSV, Trichomonas vaginals; Mycoplasma genitalium, Bacteroides, E.coli. H.influenza. Gardnerella vaginalis, GBS (non-STI bugs)
71
Risk factors for the development of PID?
young age, multiple partners, non barrier contraception, cigarette smoking, recent douching, BV, previous gynecological surgery, HIV, 3 weeks post IUD
72
Complications of PID?
tuboovarian abscess, infertility, chronic pelvic pain, ectopic pregnancy, perihepatitis (Fitz-Hugh Curtis syndrome), dyspareunia
73
Minimum criteria for the diagnosis of PID?
sexually active patient with pelvic or lower abdominal pain, no cause other than PID identified and one of the following: adnexal tenderness, uterine tenderness, cervical motion tenderness
74
Definitive/ specific criteria for the diagnosis of PID?
endometrial biopsy showing endometritis, laparoscopy showing abnormalities consistent with PID, transvaginal US showing thickened, fluid filled tubes or tuboovarian complex
75
What are the Jones criteria for the diagnosis of Acute rheumatic fever?
Need 2 major, or 1 major and 2 minor
- Evidence of recent GAS infection (ASOT positive, rapid strep positive, culture positive) AND
- 5 major: carditis, polyarthritis (migratory and large joints), syndenham chorea, subcutaneous nodules, erythema marginatum (mnemonic: JONES)
- 4 minor: fever (>38.5), arthralgia, elevated CRP/ESR (>60), prolonged PR
76
Which organism is associated with nec fasc in varicella?
Group A strep
77
List 5 clinical features that help you distinguish neonatal mastitis from hormone-stimulated breast bud in a neonate.
- fever
- erythema
- warmth
- purulent discharge
- unwell
- may have fluctuance if asbcess present
78
What is the most probable cause of an infection arising from an animal bite that develops in
< 24 hours?
> 48 hours?
< 24 hours: Pasteurella multocida
> 48 hours: S.aureus, S.viridans
79
When to give tetanus prophylaxis/ Ig?
If received childhood immunization (>=3 doses) and clean wound: none
If dirty wound and last vaccine was > 5 years ago, Tdap only
If received < 3 doses of vaccine and clean: Tdap only, if dirty Tdap and Ig
80
Which bacteria causes Guillain-Barre syndrome?
Campylobacter jejuni
81
What is the treatment for tinea capitis/ kerion?
terbinafine for 4 weeks
82
Criteria for watchful waiting in AOM (4)?
1. The child is >6 months of age.
2. The child does not have immunodeficiency, chronic cardiac or pulmonary disease, anatomical abnormalities of the head or neck, or a history of complicated otitis media (otitis media accompanied by suppurative complications or chronic perforation), or Down syndrome
3. The illness is not severe - otalgia appears to be mild and fever < 39°C in the absence of antipyretics
4. Parents are capable of recognizing signs of worsening illness and can readily access medical care if the child does not improve
83
2 modifiable risk factors for AOM?
1. Daycare attendance
2. household crowding
3. exposure to cigarette smoke
4. not being breastfed
5. Bottle propping
84
2 non-modifiable risk factors for AOM?
1. young age
2. orofacial abnormalities (such as cleft palate)
3. premature birth
4. immunodeficiency
5. family history of otitis media
85
What is a felon? Treatment?
Deep infection of the distal pulp space of a fingertip. 'minicompartment syndrome'
Treatment = incision, blunt dissection, and drainage. A longitudinal incision over the area of maximal tension or fluctuance is the procedure of choice.
86
What is paronychia?
Pus collecting in a single thin-walled pocket under the cuticle
87
Alternative treatment for pertussis if allergic to macrolides (azithromycin)?
Septra
88
Suspected herpes encephalitis – 1 EEG finding, one MRI head finding
EEG – focal slowing or epileptiform discharges localized to the temporal lobes
MRI or CT– focal parenchymal involvement or edema of the temporal lobes
89
Treatment for gonorrhea/ chlamydia
ceftriaxone 250 mg IM + azithromycin 1g PO x1
90
child immigrated from Ethiopia with HSM. 4 infectious causes
```
EBV
HIV
Yellow fever
Leishmaniasis
Malaria
```
91
List 4 infections that may present with vaginal discharge in a sexually active adolescent
1. Trichomonas vaginalis
2. Chlamydia trachomatis
3. Neisseria gonorrhoeae
4. Bacterial vaginosis / Gardnerella vaginalis - not STI but inc risk with inc partners
92
How many days after measles vaccine could a fever and rash be expected to develop?
Faint rash and mild febrile illness may occur 7-10 days after immunization with the live attenuated vaccine
93
List 3 common protozoa that can cause diarrhea.
1. Giardia Lambia
2. Entamoeba histolytica
3. Cryptospiridia
94
List 3 tick borne illnesses
1. Lyme (erythema migrans)
2. Tularemia (ulcer)
3. Rocky Mountain Spotted Fever
4. Ehrlichiosis (macpap rash)
5. Babesiosis
