condition seen in using erythromycin as treatment of pertussis in infants less than 1 month
infantile hypertrophic pyloric stenosis
bacteria associated with miller fisher syndrome
campylobacter jejuni
characteristic skin lesion of pseudomonas
echthyma gangrenosusm
acute angulation of the chin and larynx cause by weakness of the hyoid muscle due to Polio
rope sign
called the first disease
measles (rubeola)
called second disease
scarlet fever
it is called the third disease
rubella
fourth disease is called
filatov-dukes disease (atypical scarlet)
6th disease is called
roseola infantum / exanthem subitum
incubation period of hepatitis A
15-50 days
bacteria with appendicitis like symptom diarrhea
yersinia enterocolitica
triad of EBV
fatigue, generalized lymphadenopathy, pharyngitis
the atypical lymphocytes characteristic of mononucleosis
cd8 t lymphocytes
x linked lypmhoproliferative syndrome of Duncans syndrome is associated with what disease
EBV infection
this type of lymphadenopathy is suggestive of infectious mononucleosis
epitrochlear lymphadenopathy
this happens to patients with ebv treated with ampicillin
ampicillin rash
rash on the cheek with multiple papules seen in ebv is seen in what syndrome
gianotti-crosti syndrome
diagnosis of ebv is done through __
specific antibody or heliotrope Ab
what is the most feared complication of EBV
splenic rupture or subcapsular hemorrhage
exanthem subitum or 6th disease is caused by
HHV-6
fever for 3 days then fever lyses and a pink morbilliform rash appears in the trunks the face and extremities; the rash lasts for 1-3 days and on PE; there are ulcers in the palatoglossal junction; what is the diagnosis and what do you call the ulcers
roseola (infantum subitum); nagayama spots
virus that causes kaposi sarcoma
HHV8
children aged___ can not receive influenza vaccine
Less than 6 months
how many doses in influenza vaccine
2 doses 1 month apart for 6-36 month
what is the first sign of infection in infants with rsv
rhinorrhea
Infectious diarrhea without bloody stool and wbc is caused by
rotavirus
what coagulation factor is depressed in dengue
factor 12 hageman factor
what are the criteria for dengue hemorrhagic fever
fever for 2-7 days, biphasic; major or minor hemorrhagic manifestations (thrombocytopenia less than or equal to 100); increase capillary permeability ( inc HCT by = 20%); pleural eff/hyoalb/ ascitis
what is the pathologic hallmark of rabies
negri bodies
clinical for of rabies where there is throat pain, malaise, paresthesia and pruritus in the bite site then cns manifestation and phobic spasms
furious or encephalitic
form of rabies that is characterized by fever and ascending motor weakness affecting both limbs and cranial nerves
paralytic or dumb rabies
cardinal signs of rabies
hydrophobia and aerophobia
rabies vaccine alters the course of the disease. T or F
false. neithere vaccine or IG can alter the course of the disease once sx appeared
vaccine in rabies and Ig are contraindicated once Sx develop. T or F
TRUE
pre exposure immunization for rabies
3 IM injections at day 0, 7, 21 or 28; if the patient had pre exposure prophy before you give 2 dose of vaccine no Ig on days 0 and 3
patients with this disease is resistant to malaria
sickle cell
erythrocyte without duffy antigen is resistant to what malaria sp.
p. vivax
___ are resistant to p falciparum
Hg F (fetal Hgb); ovalocytes
paroxysmal fever occur with rupture of schizonts that occurs every__ hr in p. vivax and ovale
42 hrs
paroxysmal fever occur with rupture of schizonts that occurs every__ hr in p. mlariae
72 hrs
nephrotic syndrome is associated with what malaria sp.
p. malariae
contraindication to coartem medication in malaria
children with prolonged QT
katayama fever is caused by
acute schistomiasis
cicatrial penetration of of schistosomiasis in the skin
swimmers itch or schisto dermatitis
shisto that causes hematuria
hematobium
shisto that can migrate to the brain
japonicum
shisto that causes transverse myelitis
hematobium; mansoni
laboratory test for shisto
microscopy of miday 10ml urine; katokatz of stool
tx of shisto
praziquantel 40mg for hematobium, mansoni, intercalatum; prazi 60 mg for japonicum and mengkongi; oxaminiquine for mansoni
taenia that causes neurocysticercosis
taenia solium
tx for taenia
albendazole
tx for ascariasis
albendazole
tx for trichuris
mebendazole
whipworm causes
trichuriasis
what is the diagnosis of pin worm or enterobius
cellophane tape in the morning
produces deep blue punctate rash
toxoplasmosis
dx of malaria
giemsa stain; thin smear allows for positive identification of malaria sp
poor prognostic indicator of severe malaria
respiratory distress
patients with measles are infective from
3 days before rash until 4-6 after onset of rah
pathognomonic for rubeola ( measles)
warthin-finkeldey giant cell
virus shedding begins in what phase of measles
prodromal phase
viral replication subside on the onset of __
rash
pathognomonic SIGN of measles
koplik spot
this appears 1-4 days prior to appearance of rash in measles
koplik spot
lab findings in measles
decrease in total wbc count with lympho decreased more than neutrophils; normal esr and crp
measles igm is detectable in blood when
1-2 days after the onset of rash ( 72 hrs)
morbidity and mortality is greatest in measles in what age group
less than 5 and more than 20
most common cause of death in measles
pneumonia ( giant cell pneumonia)
most common bacterial pathogen in pneumonia of measles
PIA; pneumoniae, influenzae, aureus
most common complication of measles
otitis media
csf findings in measles encephalitis
lymphocytosis and elevated protein
what protein is missing in measles virus in sspe patients
M protein
manifestation of sspe begins at what age
7-13 yrs after primary infection
in stage 1 of sspe – there is temper tantrums; in the second phase what is the hallmark
massive myoclonus
diagnostic criteria of sspe
1 of the ff: measles antibody in csf, eeg with suppression burst, brain tissue biopsy of sspe
vit A treatment in measles
- 6m-2 yrs with complication (50,00iu for 6m-1yr and 100,000iu in more than 1yr OD)
you should avoid immunization of measles in what condition
severe hypersensitivity to neomycin and gelatin
vaccine is effective in modification of measles if pre exposure prophylaxis is given when
within 72 hr of exposure
measles Ig may be given up to __ days after exposure to prevent or modify infection (0.25 in immunocompetent and 0.5 immunocompromised)
6 days
virus shedding for rubella starts when
10 days after infection
highest infectivity for rubella is seen when
5 days before rash and 6 days after rash
in congenital rubella infection, what trimester results in severe defects
1st 8 wks of pregnancy
rash begins in the hairline then trunk extremities then palms
measles (rubeola)
rash begins in face that spreads centrifugally (trunk to extremities)
rubella [THINK Centri-petal = center seeking, centri-fugal = center fleeing]
rose colored lesion seen in rubella
forschheimer spots
the sspe counter equivalent in rubella
PRP progressive rubella panencephalitis
single most common finding in infants with CRS (congenital rubella syndrome)
deafness
most serious eye finding in CRS (congenital rubella syndrome) and what is the most common ocular abnormality
- cataract; * salt and pepper retinopathy
most common heart defect in CRS
PDA
most devastating result of polio
paralysis
paralysis in polio appears when
3-8 days after initial symptom
occurs in the 2nd phase of polio with severe muscle pain asymmetric flaccid paralysis with paresis commonly involving 1 leg
spinal paralytic polio
polio after IM injection
provocation paralysis
rope sign, dysfunction of cranial nerves, palatal and pharyngeal weakness , ascending paralysis. what disease
bulbar polio
diagnosis of polio
2 stool exam 24-48 hrs apart
vaccine associated paralytic polio
polio after receiving oral polio 7-14 days before
hand and foot mouth disease is caused by
cocksakie A16
enterovirus that causes myocaridtis and pericarditis
cocksackie B
most common cause of meningitis in mumps immunized population
enterovirus
enterovirus that does not grow in culture
cocksackie A
cause of 5th disease or erythema infectiousum
parvovirus b19
this virus affects the erythroid cell line and has no effect on myeloid thus causes aplastic crisis
parvovirus B19
virus associated with hydrops fetalis
parvovirus b19
slapped cheek
5th disease - parvovirus b19
what is the most common manifestation of parvovirus b19 in immunocompromised
chronic anemia
syndrome of parvovirus b19 that is characterized as purpuric rash in hands and feet
papular purpuric sock and gloves syndrome
what is not used as a treatment of parvovirusb19 induced arthropathy
IVIG
where does latent hsv and VZV lays dormat
in the sensory ganglion neuron
leading cause of fatal encephalitis in children
hsv encephalitis
hallmark of hsv infection
skin vesicles and ulcers
6 mos - 5yrs, painful vesicles in the mouth , drooling, sudden onset. what is the diagnosis
herpetic gingivostomatitis
herpes from rugby playing
scrumpox
herpes from wrestling
herpes gladiatorum
hsv of the paronchia seen in patients who suck their thumb
whitlow
csf analysis of this disease shows moderate mononuclear, erythrocytes, protein increase and normal to low glucose
hsv encephalitis
hsv, recurrent aspetic meningitis called
mollaret meningitis
most common aseptic meningitis
HSV (other: coxsackie b)
fever is uncommon in this type of encephalitis
hsv enceph
the best test for hsv infection
viral detection by pcr or virus isolation
tx for hsv
acyclovir
tx of herpes labialis
oral valacyclovir
in hepes gladiatorum what meds can prevent recurrence
oral valacyclovir
hsv associated erythema multiforme is treated with antivirals T or F
false, it has no effect
chicken pox is infective during
1-2 days before vesicles and 3-7 days after when they are crusted
illness of varicella being __ days after exposure
14-16 days
incubation period of varicella
10-21 days
simultaneous presence of lesion in various stage is characteristic of what infection
varicella
distribution of rash in varicella is __
centripetal [THINK Centri-petal = center seeking, centri-fugal = center fleeing]
varicella that occurs in person vaccinated more than 42 days before rash
breakthrough disease caused by wild type of varicella
if the mother has varicella __ days prior to delivery she may pass the virus to the child but it is attenuated since there is Ab of the mother passed also.
more than 5 days
maternal varicela IgG can pass through the placenta at what aog
by 30 wks
neonate with cicatrical skin scarring with limb hypoplasia and neurologic manifestation
congenital varicella syndrome
leukopenia is low in the first __ of varicella infection
72 hrs
varicella vaccine is given when
total of 2 dose on 12-15 months and 4-6 year old; pag catch up na less than 12 – 2 dose 3 months apart and pag more than 12, 2 dose na 1 month apart
post exposure prophy for varicella can be given if exposure is
3- 5 days after exposure
new borns whose mother has varicella 5 days before delivery or 2 days after delivery should be given
1 vial of Varicella Ig
amphotericin is inactive in this sp of candida
c. lusitanea
fluconazole is inactive againts this strain of candida
c. krusei and some gabrata
what is the most common clinical syndromes associated with m. pneumoniae infection
tracheobronchitis and bronchopneumonia
lobar infiltrates with necrotizing pneumonia with normal wbc but elevated esr
m. pneumoniae infection
tx for m pneumoniae infection
claryth or azith
bacteria that is the most common infectious agent in SJS
m. pneumoniae
treatment for NGU (ureaoplasma and m. hominis)
1 dose azith and doxy for 7 dyas
the absence of ___ differentiates c trachomatis pneumonia from rsv
fever and wheezing
blood result of c trachomatis infection shows increased
peripheral eosinophilia
the most common cause of pyogenic skin and soft tissue infection
s. aureus
TSS caused by staph aureus is associated with
mensturation and focal staph infection
food poisoning caused by s. aureus is caused by ingestion of ___
preformed toxin
tx of life threatening s aureus infection
vanco plus genta or vanco plus rif
tx for non life threatening aureus infection
nafcillin or oxacillin; clindamycin
tx for mrsa
vanco + genta or ; vanco + rif
drug test that confirms effectivity of clinda for aureus infection
D-test
diagnosis of tss is based on __
clinical manifestation
major criteria of TSS caused by aureus in which all are required
REMEMBER: HAR-Tss – hypotension, acute fever, rash
scarliniform rash with desquamation of the hands and soles associated with shock, strawberry tongue
TSS aureus
most common cause of nosocomial bacteremia associated with vascular catheter
CONS particularly s. epidermidis
most common cause of shunt meningitis
CONS
most common cause of uti in sexually active females
saphrophyticus
DOC of CONS
vanco
the second most common cause of meningitis in children
strep pnemoniae
round pneumonia with 2 day hx of cough and spiking fever. there is also leukocytosis. what is the dlt
strep pneumonia, culture, cefotaxime ceftri clinca vanco
if erythromycin is resistant to streo pneumo and clinda is sensitive what should you do
do a D-test of clinda, if it is positive you can not use it anymore since resistance with clinda can be induced by the organism
the most common cause of osteomy and suppurative arthritis in children
s. aureus
penicillin prophylaxis is often administered for at least ___ after splenectomy
2 yrs after or upto 5 yrs of age
pneumococcal vaccination is given
- 3 doses 1 month apart for 2-6 mos then booster at 12 to 15 months * 2 doses 2 months apart for 7-11 mos with booster on 12-15 mos * if more than 1 year old 2 doses no booster
what strep pyogenic exotoxin is responsible for the rash of scarlet fever
toxin A,B,C
patient has upper respiratory tract infection and on after 24- 48 hrs punctate rash on the neck spreading to the trunk which blanches on pressure. the skin is rough and has goose pimple feel. no rash on the face after 3 days the rash desquamates cephalocuadally. there is strawberry tongue appearance
scarlet fever caused byGAS
swollen red tender superficial bleb on the skin that has slightly elevated border involving the deeper layer of the skin
erysepelas caused by GAS
the most common cause of prepubertal vaginits
GAS
criteria of strep tss
clinical criteria: hypotension plus 2 of CHARGS - coagulopathy- hepatic involvement - ards - generalized rash - renal impairment - soft tissue necrosis; definitive case: culture form sterile site
the most common cause of acute paryngitis
virus
most common cause of bacterial phayrngitis
GAS
DOC of GAS
penicillin
bacteria associated with PANDAS ( neurospsychiatric disease ) TiC,tourettes, chorea
GAS
if treatment is started within _ days of onset for GAS infection, rheumatic fever is prevented
9 days
major jones criteria
SPECC - subcutaneous nodules - polyarthritis - erythema marginatum - chorea - carditis
minor jones criteria
CAPE FP - crp elevated - arthralgia - phase reactants - esr - fever - prolonged pr interval
positive result in jones criteria
2 major or 1 major 2 minor
may occur as the only manifestation of acute rheumatic fever
chorea
the only manifestation of acute rheumatic fever months after having acute rheumatic fever
carditis
the joints affected in ARhF
larger joints (WEAK) - wrist - elbows - ankles - knees
True or False
TRUE
most serious manifestation of ArhF
carditis ( particularly Endocarditis) and chronic rheumatic heart disease
major consequence of rheumatic carditis
valvular stenosis
erythematous,serpinginous macular lesion with pale centers that are non puritic seen in trunk and extremities only. it is seen in ArhF
erythema marginatum
tx for ArhF
10 days of pen G or 1 dose of IM Benz PenG then start long term prophylaxis
in patients with carditis in ARhF what meds should you start aside from pen G
aspirin, prednisone
DOC for syndenhams chorea
Phenobarbital, if not effective you give haloperidol or chlorpromazine
antibiotic prophlaxis for ARhF should continue for how long
for 5 yrs or until 21 yrs old whichever is longer
what is the prophy antibiotic regimen for ARhF
600,00IU in
duration of treatment for RF with carditis
10 yrs or until 21 yrs which ever is longest
duration of treatment for RF with residual heart disease or valvular disease and carditits
10 yrs or until 40 yrs which ever is longer ( sometimes lifelong treatment is needed)
late onset GBS infection presents in __ days
more than 7 days
more common serotypes in late onset GBS
serotype III
the most common manifestation of early onset GBS is
sepsis
the most common manifestation of late onset GBS is
bacterimia and meningitis
late onset GBS infection is more severe than early onse. True or False
TRUE
syndromes common in childhood GBS disease beyond early infancy
bacteremia and endocarditis
doc of GBS
Penicillin
duration of treatment for GBS ventriculitis and oseteomyelitis
4 weeks
duration of treatment for bacteremia without focus in GBS
10 days
duration of treatment for GBS meningitis
2-3 weeks
periventricular leukomalacia and dev delay are complications of what disease causing meningitis
GBS
corynobacterium that is urease positive
C. ulcerans
most common site of diptheria
pharynx and tonsils; the second is nose and larynx
the universal early sx of diptheria
sore throat
bull neck appearance
diptheria
tissue affected by diptheretic toxin
heart and CNS
tx of diptheria
diphtheria antitoxin; erythromycin for carriage
when an asymptomatic carrier is identified prophylaxis for diptheria is given for how many days
10-14 days then give dt if no booster as been given within 1 yr
the only contraindication for tetanus and diptheria toxoid
hx of neurologic or severe hypersensitivity reaction to previous dose
Diptheroid toxin should be not be given frequently than every __
10 yrs
umbrella type formation in medium is characteristic of what bacteria
listeria
the only mode of transmission of listeria
maternal fetal transmission only
most common manifestation of late onset listeriosis ( >/= 5 days)
neonatal meningitis
manifestation of early onset listeria
neonatal sepsis
history of oral trauma/ dental procedure; painless slow growing mass with fistula; what is it called and is the etiologic agent
lumpy jaw; actinomycosis
the hallmark of actinomycosis
spread that fails to respect tissue or facial planes
the pathogenic strain of n. meningitidis
A,B,C, W-135 and Y
what age is the highest incidence of meninggococal disease
less than 1 yr old
what are the clinical hallmark of severe meningococcal sepsis
activating coagulation, bleeding, stimulating cytokine
the severity of meninggococcal disease is related to the level of exotoxin in the bloodstream; true or false
false, endotoxin related
diffuse adrenal hemorrhage without vasculitis seen in fulminant meningococcemia is called what syndrome
waterhouse-friderchisen syndrome
a meningococcemia that progresses from without sx to shock in several hours and purpura
fulminant meninggococcemia
diagnostics of meningo and treatment
culture of blood csf or synovial fluid; penicillin ampi ceftri
most common neurologic sequelae of meningo meningitis
deafness
prophylaxis for Neisseria carriage
rifam 15- 10mgkg for 2 days a cipro one dose
meninggo vaccine recommendation
one dose at 11-19 yrs old booster after 5 yrs; if high risk group 2 dose 2 months apart
most common sexually transmitted infection in sexually abused children
n gonorrhea
cause PID in post pubertal females
gonorrhea
dissemination of gonorrhea from fallopian tube through the peritoneum to the liver capsule causing perihepatitis is seen what syndrome
fitz hugh curtis syndrome
initial sx of disseminated gonorrhea
acute onset poly arthralgia with fever
tx of gonorrhea
ceftriaxone (even in pregnant and for neonates )IM single dose or cefixime single dose
doc of H influenza
amoxicillin
what are the most common cabteria of otitis media? otitis externa?
- PIM - s. pneumoniae, h. influ, moraxella * pseudomonas
prophylaxis for h influ exposure
rifampicin for 4 days
painful genital ulceration (chancroid) is caused by
h. ducreyi
buboes are formed by
h ducreyi
tx for chancroid
azith OD or Ceftri IM OD
severe coughing episodes with extreme gasps for air followed by vomiting
pertussis
neither natural disease nor vaccination provides complete or lifelong immunity against this bacteria. protection wanes 3- 5 yrs after vaccination
pertussis; DTaP protective until adolescence
Contraindications to DTaP
-immediate anaphylactic reaction, encephalopathy, CNS complication w/in 7 d –> give DT instead of DTaP (adverse reactioins attributed to pertussis component of vaccine)
__- marks the start of paroxysmal stage of pertussis
coughing
infants __ age does not manifest the classic stage of pertussis – sudden onset of reddening of face, choking, gagging and gasping (ALTE)
less than 3 months
leukocytosis is seen in what stage of pertussis
cattarhal stage
not a manifestation of pertussis
eosinophilia
tx of pertussis
macrolide (azith is preferred) x 14 days – catarrhal stage; hospitalize infant
machine gun-like cough
pertussis
Stages of whooping cough
1) catarrhal stage: congestion & rhinorrhea; 2 wks 2) paroxysmal stage: coughing + gasping for air + vomiting + burst of eye blood vessels; 3o days 3) convalescent stage: decreased cough freq; 2 wks
-CXR: “butterfly pattern”(clouded mid lung fields)
pertussis
Whooping cough, Retinal hemorrhage, child stroke
pertussis
1 child preventable dz
pertussis
the most common clinical presentation of salmonellosis
acute enteritis
tx of salmonella AGE
ceftri, cefotox, ampi ceficime
incubation of typhoi
1-2 wks
rash in typhoid
rose spot in trunk on 7th day of illness
most common extra intestinal manifestation of bacillary dysentery (shigella)
neurologic
most common complication of shigellosis
dehydration
tx of shigellosis irrespective of age
ciprofloxacin
e coli that causes bloody diarrhea
invasive and shiga toxin
antibiotic should not be given to this type of e coli because it may increase the risk of HUS
STEC
most severe form of cholera
cholera gravis
DOC for severe cholera
doxycycline or tetracycline; alternative is erythromycine
syndrome associated with campylobacter
GBS
yersinia enterocolitica is associated with what vasculitis
kawasaki
ecthyma gangrenosum ( gangrenous skin lesion with eschar ) is caused by
pseudomonas
prominent symptom of infant botulism
loss of head control
antibiotic therapy is not part of the treatment of this disease
infant botulinism – toxin is intracellular
clinical hallmark of botulism
fatiguability with repetitive muscle activity
__source of botulism, not a safe food for children less than 1 yr
honey
localized tetanus involving bulbar musculature is called
cephalic tetanus
poor prognosis in tetanus is onset of trismus in less than 7 days and onset of tetanic spasm in __-
less than 3 days
flesh eating bacteria
gas
measles Ig is given until how many days post exposure
vaccine is given 72 hrs; Ig is given until 6 days
what complement is decreased in dengue
c3
rash of dengue
morbilliform rash that spares the palms and soles
criteria for dengue hemorrhagic fever
fever, major/minor bleeding, thrombocytopenia (= 100), increase permeability (hct >20%), effusion (ascitis/pleural eft), hypoalbuminemia
dengue shock criteria
criteria of hemorrhagic + hypotension, narrow pulse, poor perfusion, tachycardia
h/o vaccination delinquency; hot potato voice(muffled); fever; drooling in tripod position; refuses to lie flat
Epiglotitis
T/F Epiglotitis is a life-threatening emergency
T
T/F In Epiglotitis, do not inspect airway
T, bronchospasm may completely obstruct the airway
what agent causes epiglottitis
unimmunized-haemophilus influenza type B; immunized-streptococcus spp
acute onset high fever,Respiratory distress: drooling, dysphagia, inspiratory retractions, neck hyperextension, sniffing dog position, leaning forward
Epiglotitis
Xray is the initial diagnostic test for epiglotitis
F
how to treat epiglottitis
-intubation in OR(initial!) -tracheostomy(2ndary) -ceftriaxone for 7-10 days -rifampin to all close contacts!
Definitive diagnosis of epiglottitis
fiberoptic visualization of cherry red epiglottis
floppy epiglottis, disproportionately small soft larynx; noisy breathing, worse with lying on back (gravity); larygoscopy: collapse of laryngeal structures during inspiration; no treatment needed, resolves by 18 months
traceomalacia/laryngomalacia
MCC of stridor in children
traceomalacia/laryngomalacia
what does the steeple sign specify in resp tract imaging
croup (LTB), represents SUBGLOTTIC narrowing
what causes croup
parainfluenza virus 1 & 2 (mcc); RSV(2nd mcc)
barking cough!; coryza; INSPIRATORY stridor; worse dyspnea upon lying down + possible hypoxia (not in epiglottitis!, develops later)
croup (LTB)
how to dx croup (LTB)
1) clinical(initial) 2) XR: steeple sign!; not initial next step!
Treatment of Croup based on severity
1) mild: cool mist tx, fluids 2) moderate: supp O2, IM corticosteriods, nebulized racemic epinephrine 3) severe: nebulized racemic epinephrine-racemic (not intubation (for epiglottitis)!)
inflammation of the larynx w/in the sub-glottic space
croup (LTB)
Seal-like cough
Croup