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Flashcards in Peds Infectious Dz 1 Deck (30)
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1

Otitis media:
-presentation
-peak incidence
-risk factors
-MC bugs
-Tx
-Complications

Presentation: pulling at ears, pain, fever, sinus congestion, etc.

Peak incidence: 6-36mo.

Risk factors:
-caretaker smoking, bottle propping, daycare

MC bugs: Strep Pneumonia, H. Flu, M. Cat

Tx: Amoxicillin 1st line, can do azithromycin in place of augmentin b/c it tastes good and wont gie the kiddo bad diarrhea.

Complications:
-mastoiditis, venous sinus thrombosis, brain abscess

2

Otitis Externa
-risk factors
-MC bugs
-sx
-PE findings
-tx

Risk factors:
-swimming, humid environments, qtips, immunocompromised

MC bug:
-staph aureus*
-PSEUDOMONAS*
-Proteus

Sx:
-otalgia
-pain at tragus
-pruritis
-discharge
-hearing loss
-inflamed regional LN

PE findings:
-edematous and erythematous ear canal
-yellow, brown, or white/grey debris
- no middle ear fluid, mobile TM.

Tx:
-clean ear canal
-protect ear from water
-Ofloxacin if TM perforation
-Cortisporin, Cipro HC, tobradex if TM INTACT!

3

Pharyngitis/Tonsillitis
-MC cause & complications

MC cause:
-viruses***
-Streptococcus pyogenes (GABHS) = complications are rheumatic heart dz, glomerulonephritis, and scarlet fever.

4

Viral pharyngitis:
-sx
-tx

sx: rhinorrhea, cough, fatigue, anorexia, abd pain

Tx: manage sx

5

GABHS Sore throat
-signs & sx
-dx
-tx

Signs and Sx:
-beefy red tonsils w/ exudate*
-strawberry tongue*
-petechiae*
-tender anterior cervical LN*
-HA, Abd pain
-high fever!*
-severe sore throat*
-absence of URI

Dx;
-throat culture** (gold standard)
-rapid strep
Tx:
-PCN VK 1st choice
-amoxicillin
-if pcn allergic give azithromycin or 3rd gen cephalosporin, ENT use clindamycin.

6

EBV
-sx
-whats found on peripheral blood smear?
-Dx
Tx

Sx:
-beefy red tonsils and exudate
-diffuse lymphadenopathy
-fatigue/malaise
-splenomegaly
-afebrile

Peripheral blood smear: atypical lymphocytosis

Dx:
-Monspot test (Heterophile aby testing)
-IgG and IgM testing if monospot negative.

Tx: education, no contact sports for 6-8wks

7

Herpangina
-MC cause
-sx
-Tx
-how is this different from from herpes simplex?

MC cause is enterovirus

Sx:
-high fever
-small ulcers on tonsillar pillars, soft palate, and uvula

Tx: acyclovir

Diff from herpes simplex because its not caused by herpes simplex virus and herpes likes to attack vermillion border of the mouth..

8

WHen you see ulcers and vesicles you should automatically think what?

VIRAL CAUSE!!!!!!!!!!!!!

9

Hand, foot, andd mouth dz
-cause
-signs & sx
-Tx

Cause: coxsackie virus

Signs an Sx: vesicles or red papules found on the tongue, oral mucosa, hands, and feet
*nodules are hard and non-blanching.

Fever, malaise

Tx: no tx, sometimes lozenges to help with swallowing.

10

Serious causes of sore throat

-peritonsillar abscess
-retropharyngeal abscess
-epiglottitis

11

Aphthous Stomatitis
-aka
-duration of dz
-management

aka: canker sore
-duration: 1-2wks
-management: topical preparations: numbing agent; orajel.

12

Gingiovstomatitis:
-cause
-sx
-duration of dz
-tx

cause: herpes simplex

sx:
-ulcers can develop on buccal mucosa, anterior pillars, inner lips,, tongue, and gingiva
-fever
-tender cervical lymphadenopathy

Duration: 7-10days

Tx:
-topical preparations (BUT NO STEROIDS)
-Acyclovir

13

Oral Candidiasis
-aka
-affects who
-sx
-PE findings
-Tx

Aka: thrush

affects infants and older children in debilitated state, also those taking abx or steroids.

Sx: mouth soreness, refusal of feedings

PE: white-curd like plaques predominantely on buccal mucosa

Tx: nystatin oral suspension

14

Sinusitis
-cause
-which type is unusual to occur before what age?
-sx
-tx

Cause: possibility when standard viral URI sx persist beyond 10-14 days.

Frontal sinusitis unusual before age 10 years.

Sx:
-facial pain, maxillary teeth pain, malodorous breath, congestion
-more likely if persistent and worsening sx

Tx: amoxicillin or augmentin

15

Croup
-MC cause
-MC at what age
-sx
-XRay findings
-Tx

MC cause: parainfluenza virus*, May also be caused by RSV, influenza, and adenovirus

MC at ages 6mo to 3 years

Sx:
-barking cough and stridor
-occurs at night, like 2-3AM, winter months
-URI sx

Xray: steeple sign


Tx:
-take out onto porch
-nebulized racemic epi
-dexamethasone IM if stridor
-observe for 3 hrs, if okay D/C.
*if see them in clinic and hear their croupy cough but they arent that sick you send them home with steroids.

16

Epiglottitis:
-MC cause
-sx
-dx
-tx

MC cause: H flu type B

SX:
-sudden
-fever
-dysphagia
-drooling*
-hot potato voice*
-inspiratory retractions
-stridor

Dx: Stat Xray: thumb print sign
laryngoscopy: red cherry spot

Tx:
-prepare to intubate
-call peds anesthesia folks
-emperic abx (Ceftriaxone)
-culture to cater abx

17

Mumps
-sx
-tx

sx:
-parotid* gland swelling
-aspetic meningitis
-transient pancreatitis
-orchitis* or oophoritis
-epididymitis*

Tx: supportive

18

Kawasaki Dz:
-aka
-what is this?
-cause
-common in who?
-sx
-Typical labs
-dx

aka: mucocutaneous lymph node syndrome

What: vasculitis of unknown etiology affecting medium sized arteries

Common in pediatric population

Sx: must include 4 of following sx + -fever* greater than 5 days:
-rash on palms
-unilateral cervical lymphadenopathy
-nonpurulent conjunctivitis*
-swollen hands and feet*
-mucous membrane involvement.


Typical Labs:
-hypoalbuminemia
-thrombocytosis
-elevated ESR

19

Kawasaki Dz:
-complications
-tx

Complications:
-cardiac: coronary vasculitis, aneurysm formation leading to arrhythmias, infarction, CHF, even death.

Tx:
-high dose aspirin and 2 days of IV immunoglobulin
-every 3 mo after dx they are monitored with EKG, echo, and CXR.

20

Measles
-aka
-sx
-cause
-what
-tx

aka: rubeola

sx:
-high fever*
-dry cough
-rhinitis
-conjunctivitis
-koplik spots (appear 1-2days prior to rash)*
-Rash* = dark red raised*, begins at hairline and spreads to trunk, arms, legs, hands and feet, leaves the same way it came.
rash is morbiliform = measle like rash?

Cause: virus

What: infection of epidermis

Tx: supportive

21

Rubella
-aka
-prevention
- what?
-MC
-sx
-Dx

aka: German Measles or congenital rubella syndrome

prevention: MMR vaccine to prevent spread to avoid congenital rubella syndrome

What: infection of the dermis

MC complication: arthritis and arthralgia

Sx:
-rash begins on face and progresses caudally, does not coalesce & fainter in color than measles.
-rash preceeded by low grade fever*, malaise, and URI
-lymphadenopathy of post auricular, suboccipital, and posterior cervical LN

Dx: serum IgM

Tx: supportive

22

Roseola
-aka
-MC cause
-MC age of infection
-transmission
-sx
-MC cause of what in infants?
-tx

aka: 6th dz

MC cause: HHV-6

MC age: 6-36mo

Transmission: virus acquired from close contact with saliva from parents or siblings

sx:
-abrupt onset of high fever lasting 3-7days
-rash on torso only!
-resolution of fever followed by development of erythematous maculopapular rash that spontaneously resolves

MC cause of infantile sz d/t high fever.

Tx: supportive

23

5ths Dz:
-aka
-Caused by?
-sx
tx

aka: slapped cheek, erythema infectiosum

Caused by parvovirus B-19

Sx: illness mild and includes:
-fever
-URI sx
-mild malaise
-rash is flat, lacey, pruritic, located on cheeks, trunk, and extremities

Tx: supportive

24

Varicella
-aka
-sx
-lesion description
-complications
-contagious
-Tx

aka: chickenpox

sx:
-pruritic vesicular rash beginning on face, neck, or upper trunk and spreads outward
-fever
-malaise


Lesion description: dew drop on rose petal, all are in different stages.

Complications: encephalitis and shingles later in life.

Contagious: 1-2days, until lesions

Tx:
-supportive
-acyclovir in immunocompromised
-immune globulin for those at risk for severe dz

25

Pityriasis Rosea
-cause
-1st sign of dz
-sx
-duration of dz
-tx

Cause: unclear

-1st sign if herald patch

Sx:
-herald patch at first then smaller satellite lesions that appear on central trunk. (look like inverted christmas trees; ovals that follow the dermatomes)
-itches

-lesions resolve in 6-10wks

tx: supportive, goes away on own.

26

Bronchiolitis
-MC cause
-complications
-sx
-tx
-prevention?

MC cause: RSV

Complications: respiratory failure

Sx:
-fever, URI sx, tachypnea, wheezing

Tx: supportive care
-Ribavirin for severely ill or immunocompromised.

Prevention: Palivizumab (Synagis) an IM monoclonal Ab that provides passive prophylaxis against RSV.

27

Bronchitis:
-sx
-WBC & CXR findings
-MC cause

Sx: URI sx w/ cough and malaise, coarse bronchial sounds
-mucopurulent sputum

WBC: normal
CXR clear

MC cause: viral

28

Pneumonia
-MC cause
-sx of bacterial and viral
tx

MC cause: most are viral but unable to predict which are viral so we treat with abx, causes of pneumonia vary with age.

Viral sx:
-rhinorrhea, cough, low grade fever, pharyngitis, tachypnea

Bacterial Sx:
-more abrupt
-high fever, cough, chest pain, shaking chills, tachypnea

Tx:
-abx
-bronchodilators if wheeze
-fluids
-O2
-if asthma and on steroids

29

Pertussis
-aka
- cause
-duration of dz
-contagious?
-sx
-tx
-dx
-tx

aka: whooping cough, 100 day cough, BADDDDDDDD!!!!

Cause: bordetella pertussis

Duration of dz: 4-12weeks

-highly communicable

sx:
-URI sx and slight fever
-after 2 weeks cough becomes paroxysmal with classic whoop.
-cough may cause vomiting

dx:
-nasal swab for culture
-nasal swab for PCR (more sensitive)

Tx:
-azithromycin 5-7 days

30

Bronchiectasis
-what is this?
-MC on who?

What: abnormal dilation and distortion of abnormal bronchial tree, resulting in chronic obstructive lung dz. impaired mucus clearance

MC in CF pts