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PEDS- Clinical Disciplines Exam 2 > Peds ID > Flashcards

Peds ID Flashcards

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1
Q

what are the different vaccination types?

A 
live-attenuated 
inactivated
viral particles
subunit vaccine
toxoid
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2
Q

Contraindications for vaccines

A

immuno or pregnant: NO LIVE VACCINES, anaphylaxis hx to specific vaccine, egg or chicken for influenza or yellow Fv, mod-severe illness

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3
Q

what kind of vaccine should family of an immunocompromised pt receive?

A

inactivated vaccine

if accidentally given live–> avoid contact w/pt for 7days

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4
Q

May give live attenuated influenza vaccine if pt is candidate except if…

A

immunocompromised pt: less than 6mo’s old, stemp cell transplant in prior 2 mo’s, has graft vs. host dz, has SCID

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5
Q

what is the main warning sign of immunodeficiency?

A

too many illnesses too soon that are unexplained

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6
Q

what are the parts of the innate immune system?

A

Skin and physical barriers

Bloodbourne and phagocytes

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7
Q

what is the complement system?

A

plasma proteins that interacts with pathogens to mark them for destruction by phagocytes (Scouts/spotters)

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8
Q

Acquired immune system: what do CD4 cells do?

what if you lose them?

A

Recognize bad cells then release cytokines signaling the immune response

HIV

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9
Q

acquired immune system: what do CD8 cells do?

A

Perforins open bad cell walls

Cytotoxins released to kill the bad cell

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10
Q

acquired immune system: what do B cells do?

A

Produces antibodies when a foreign antigen triggers the immune response

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11
Q

what is humoral immunodeficiency characterized by?

A

impaired antibody (Ig) production

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12
Q

PID peds clinical presentation:

A

recurrent, severe URI/LRTI incl OM, pna

infx w/encapsulated bacteria (GBS, S. pneumo, Hib)

poor growth, unexplained splenomegaly

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13
Q

Dx of primary immunodeficiency

A

fam hx

r/o underlying chronic dz

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14
Q

labs for PID

A 
CBC with differential
Chem panel
Immunoglobulin levels
Urinalysis
ESR and CRP if child is sick
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15
Q

imaging/diagnostics for PID

A

CXR look for thymus +/- CT

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16
Q

What is the MC immunodeficiency?

A

selective IGA deficiency

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17
Q

dx of selective IGA deficiency

A

Deficiency of Serum IgA (w normal IgG& IgM) in a child > 4 yo

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18
Q

presenting s/s for selective IGA deficiency

A

most asxs!!!

Recurrent sinopulmonary infx’s, autoimmune disorders, GI infx’s and other intestinal disorders, allergic disorders, anaphylactic transfusion reactions d/t Anti- IgA Abs

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19
Q

what is common variable immunodeficiency (CVID):?

A

combo of poor vaccine response and a decrease in blood levels of IgG in conjunction with a severe decrease in levels of either IgM or IgA,

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20
Q

when do peds pt’s usu. p/w CVID?

A

present around puberty: variable presentation, recurrent, at risk for autoimmune dz’s and malignancy

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21
Q

dx criteria for CVID

A

Reduced serum IgA, G & M

Poor response (or no response) to vaccines

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22
Q

what is severe combined immunodeficiency? (SCID)

A

severe deficiency of T-cell

broad susceptibility to infection.

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23
Q

what is the tx for SCID?

A

no tx

death by 1yr

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24
Q

characteristics of SCID?

A

multiple forms (MC = x-linked males only)

severe infx’s 1st few mo’s after birth

become ill from live vaccines: varicella, MMR, OPV, RV

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25
characteristics of digeorge syndrome (22Q11.2 deletion syndrome)
cardiac defects, immune dysfx (hypoplastic thymus gland), cleft palate, hypocalcemia (parathyroid hypoplasia)
26
presentation for ataxia-telangiectasia?
progressive cerebellar ataxia, oculocutaneous telangiectasias, don't develop fluidity of gait, malignancy
27
bacterial meningitis characterized by? caused by?
opisthotontos posturing, mortality ~100%, medical emergency S. pneumo, N. meningitidis, H. influenza type b
28
tx for bacterial meningitis in 0-29d old
requires adequate concentration of abx in the CSF ``` Ampicillin +/-Gentamicin Cefotaxime Vancomycin Acyclovir ``` w/in 1 hr
29
tx for bacterial meningitis in 30-60d old
Ceftriaxone +/- Vancomycin w/in 1 hr
30
characteristics of bacterial arthritis?
predominantly the hip and knee, more than one join, particularly in neonates sxs: septicemia, cellulitis, fv w/out source of infx
31
who should you suspect bacterial arthritis in?
monoarticular pain, fever, redness
32
tx for bacterial arthritis?
antistaphylococcal agent (nafcillin, oxacillin, vancomycin) cefotaxime (covers gonorrhea)
33
MC bacteria from bacterial arthritis in: < 3 mo's 3mo- 3yrs
< 3 mo's --> group B streptococcus 3mo-3yrs --> Group A streptococcus
34
labs for osteomylitis?
CBC, ESR, CRP, blood cultures
35
MC causes of myocarditis?
enterovirus (coxsackie group B), adenovirus, parvovirus B19, EBV, cytomegalovirus, and HHV-6
36
what is the main characteristic to evaluate if a peds pt has diarrhea?
bloody vs. non-bloody
37
what are causes of bloody diarrhea?
E. coli O157:H7, salmonella, shigella, campylorbacter, C. diff
38
rhinosinusitis infx's causes:
Haemophilus influenzae (nontypeable), S. pneumoniae, and Moraxella catarrhalis
39
characteristics and tx for rhinosinusitis infx's?
most viral (7-10d) 14-21d of augmentin 45-90mg x 10d
40
OM causes:
h. influenzae, s. pneumo, moraxella catarrhalis peds anatomy
41
Tx for OM:
children 2 yrs and older w/mild sxs --> obs Amoxicillin 80-90mg x10d PCN allergy: 3rd gen cephalosporin, macrolide, or clindamycin
42
what is a complication of acute OM?
acute mastoiditis
43
causes of mastoiditis?
s. pneumo, s. pyogenes, s. aureus, pseudomonas aeruginosa
44
what are some complications of acute mastoiditis?
extracranial: subperiosteal abscess, facial n. palsy, hearing loss, labyrinthitis, osteomyelitis, bezoid abscess
45
dx of mastoiditis?
clinical but can do imaging CT w/IV contrast
46
tx for mastoiditis
antimicrobial therapy and drainage requires consultation with an otolaryngologist
47
MC causes of acute b/l lymphadenitis? acute unilateral lymphadenitis?
B/L: Group A streptococcus unilateral: s. aureus, Group A. strep, anaerobic bacteria
48
MC causes of chronic B/L lymphadenitis?
EBV, cytomegalovirus
49
Tx for lymphadenitis?
Amox-clavulanate
50
MC pathogens of peritonsilar abscess
strep pyogenes (group A), strep anginosus, s. aureus
51
s/s for retropharyngeal abscess?
appear ill w/moderate Fv dysphagia, odynophagia, torticollis, "hot potato," stridor, trismus
52
how do peds pt's develop retropharyngeal abscess?
retropharyngeal space contains two chains of lymph nodes that are prominent in the young child, but atrophy before puberty
53
tx for retropharyngeal abscess
secure airway CT IV contrast empiric abx: group A. strep, s. aureus, respiratory anaerobes Unasyn or clindamycin +/- vanco
54
what is peri-orbital cellulitis?
Preseptal cellulitis/periorbital cellulitis is an infection of the anterior portion of the eyelid
55
causes of periorbital cellulitis?
s. aureus, strep pna, Hib fungal causes: mucorales and aspergillus
56
orbital cellulitis characteristics:
Unilateral ocular pain, eyelid swelling, and erythema.  +/- Fv, Proptosis, toxic appearance Chemosis
57
tx for periorbital cellulitis
is empiric and based upon knowledge of the common infecting organisms Ceftriaxone IM THEN Augmentin OR clinda if MRSA susp.
58
tx for orbital cellulitis
empiric/immediate Ceftriaxone, Unasyn, Vancomycin, Clindamycin Antifungal IV CT w/IV contrast consult: optho-plastics
59
tx for abscess
DRAINAGE!!! PO Clinda or bactrim + Keflex if Fv --> Vanco
60
s/s of necrotizing fasciitis
deep infx, erythematous, swollen, warm, tender, pain out of porportion, crepitus, tachycardia
61
tx/managment for nec fasciitis
septic w/u, CT w/IV contrast, immediate surgical consult abx --> carbapenem + vanco + clinda
62
impetigo pathogens
S. aureus and Beta-hemolytic streptococci usu. mixed
63
tx for impetigo
keflex, bactrim clindamycin topical bactroban
64
mastitis tx/management
well appearing > 2mo --> keflex, clinda ill appearing >2mo --> IV clinda, vanco if PCN allergy OR IV cefazolin, nafcillin Surgical consult do NOT drain!!!
65
neonatal mastitis tx
empiric abx --> IV vanco, nafcillin, and CTX surgical consult
66
MC pathogen from cat and dog bites? human bite?
cat/dog: pasteurella spp. human --> elkenella
67
tx for bites
augmentin primary dox/bactrim/cipro + flagyl or clindaymcin for anaerobic
68
what abx should you give prophylactically for lac repair d/t animal bite
unasyn IV then augmentin
69
etiology for croup
viral: parainfluenza virus type 1
70
etiology of epiglottitis
hib
71
bacterial tracheitis?
invasive exudative bacterial infection of the soft tissues of the trachea usu. polymicrobial
72
pathogens causing bacterial tracheitis
typical seasonal epidemics of parainfluenza, respiratory syncytial virus (RSV), and seasonal influenza
73
s/s for bacterial tracheitis
w/ laryngotracheitis who are febrile, toxic-appearing, and have a poor response to treatment w/ racemic epi or glucocorticoids
74
MC cause of bronchiolitis?
viral: RSV is MC
75
bronchiolitis RSV tx
no abx nasal suctioning, high flow O2 trial of albuterol if all else fails
76
neonatal pneumonia tx
early onset: amp + gent late onset: vanco + gent usu. nosocomial
77
6mo-5yo tx for community acquired pna
strep pneumo--> amoxicillin
78
>5y/o community aquired pna tx?
mycoplasma pna, chlamydia pna --> azithromycin
79
pertussis complications
failure to thrive, apnea, pneumonia, respiratory failure, seizures, and death d/t bordetella pertussis
80
what phase of pertussis are pt's most contagious?
catarrhal

PEDS- Clinical Disciplines Exam 2 (5 decks)

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