Flashcards in Peds Infectious Dz 1 Deck (30)
Presentation: pulling at ears, pain, fever, sinus congestion, etc.
Peak incidence: 6-36mo.
-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.
-mastoiditis, venous sinus thrombosis, brain abscess
-swimming, humid environments, qtips, immunocompromised
-pain at tragus
-inflamed regional LN
-edematous and erythematous ear canal
-yellow, brown, or white/grey debris
- no middle ear fluid, mobile TM.
-clean ear canal
-protect ear from water
-Ofloxacin if TM perforation
-Cortisporin, Cipro HC, tobradex if TM INTACT!
-MC cause & complications
-Streptococcus pyogenes (GABHS) = complications are rheumatic heart dz, glomerulonephritis, and scarlet fever.
sx: rhinorrhea, cough, fatigue, anorexia, abd pain
Tx: manage sx
GABHS Sore throat
-signs & sx
Signs and Sx:
-beefy red tonsils w/ exudate*
-tender anterior cervical LN*
-HA, Abd pain
-severe sore throat*
-absence of URI
-throat culture** (gold standard)
-PCN VK 1st choice
-if pcn allergic give azithromycin or 3rd gen cephalosporin, ENT use clindamycin.
-whats found on peripheral blood smear?
-beefy red tonsils and exudate
Peripheral blood smear: atypical lymphocytosis
-Monspot test (Heterophile aby testing)
-IgG and IgM testing if monospot negative.
Tx: education, no contact sports for 6-8wks
-how is this different from from herpes simplex?
MC cause is enterovirus
-small ulcers on tonsillar pillars, soft palate, and uvula
Diff from herpes simplex because its not caused by herpes simplex virus and herpes likes to attack vermillion border of the mouth..
WHen you see ulcers and vesicles you should automatically think what?
Hand, foot, andd mouth dz
-signs & sx
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.
Tx: no tx, sometimes lozenges to help with swallowing.
Serious causes of sore throat
-duration of dz
aka: canker sore
-management: topical preparations: numbing agent; orajel.
-duration of dz
cause: herpes simplex
-ulcers can develop on buccal mucosa, anterior pillars, inner lips,, tongue, and gingiva
-tender cervical lymphadenopathy
-topical preparations (BUT NO STEROIDS)
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
-which type is unusual to occur before what age?
Cause: possibility when standard viral URI sx persist beyond 10-14 days.
Frontal sinusitis unusual before age 10 years.
-facial pain, maxillary teeth pain, malodorous breath, congestion
-more likely if persistent and worsening sx
Tx: amoxicillin or augmentin
-MC at what age
MC cause: parainfluenza virus*, May also be caused by RSV, influenza, and adenovirus
MC at ages 6mo to 3 years
-barking cough and stridor
-occurs at night, like 2-3AM, winter months
Xray: steeple sign
-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.
MC cause: H flu type B
-hot potato voice*
Dx: Stat Xray: thumb print sign
laryngoscopy: red cherry spot
-prepare to intubate
-call peds anesthesia folks
-emperic abx (Ceftriaxone)
-culture to cater abx
-parotid* gland swelling
-orchitis* or oophoritis
-what is this?
-common in who?
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
-swollen hands and feet*
-mucous membrane involvement.
-cardiac: coronary vasculitis, aneurysm formation leading to arrhythmias, infarction, CHF, even death.
-high dose aspirin and 2 days of IV immunoglobulin
-every 3 mo after dx they are monitored with EKG, echo, and CXR.
-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?
What: infection of epidermis
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
-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
-MC age of infection
-MC cause of what in infants?
aka: 6th dz
MC cause: HHV-6
MC age: 6-36mo
Transmission: virus acquired from close contact with saliva from parents or siblings
-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.
aka: slapped cheek, erythema infectiosum
Caused by parvovirus B-19
Sx: illness mild and includes:
-rash is flat, lacey, pruritic, located on cheeks, trunk, and extremities
-pruritic vesicular rash beginning on face, neck, or upper trunk and spreads outward
Lesion description: dew drop on rose petal, all are in different stages.
Complications: encephalitis and shingles later in life.
Contagious: 1-2days, until lesions
-acyclovir in immunocompromised
-immune globulin for those at risk for severe dz
-1st sign of dz
-duration of dz
-1st sign if herald patch
-herald patch at first then smaller satellite lesions that appear on central trunk. (look like inverted christmas trees; ovals that follow the dermatomes)
-lesions resolve in 6-10wks
tx: supportive, goes away on own.
MC cause: RSV
Complications: respiratory failure
-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.
-WBC & CXR findings
Sx: URI sx w/ cough and malaise, coarse bronchial sounds
MC cause: viral
-sx of bacterial and viral
MC cause: most are viral but unable to predict which are viral so we treat with abx, causes of pneumonia vary with age.
-rhinorrhea, cough, low grade fever, pharyngitis, tachypnea
-high fever, cough, chest pain, shaking chills, tachypnea
-bronchodilators if wheeze
-if asthma and on steroids
-duration of dz
aka: whooping cough, 100 day cough, BADDDDDDDD!!!!
Cause: bordetella pertussis
Duration of dz: 4-12weeks
-URI sx and slight fever
-after 2 weeks cough becomes paroxysmal with classic whoop.
-cough may cause vomiting
-nasal swab for culture
-nasal swab for PCR (more sensitive)
-azithromycin 5-7 days