[ Peds ] Id

Front 1

what is most effective therapy for MRSA? MSSA?

Back 1

vancomycin; nafcillin

Front 2

what is the most common cause of food poisoning in US?

Back 2

staph aureus; presents in <4-6 hours, usually in meat/cream-filled baked goods

Front 3

encapsulated bacteria

Back 3

strep pneumo

neisseria meningitidis

h. influenzae

Front 4

infections with encapsulated bacteria are more common in...

Back 4

asplenic patients, very young/old patients, patients with hypogammagolbulinemia

Front 5

most common causes of hemolytic uremic syndrome

Back 5

ecoli 0157:h7
pneumococcus pneumonia

Front 6

describe scarlet fever

Back 6

rash + strep pharyngitis

rash begins 24-48 hours into illness, sandpaper, begins neck/upper chest then spreads

prominent in flexor skin creases = pastia lines

Front 7

what is a risk factor for nec fasc due to GAS?

Back 7

recent/concurrent varicella infection

Front 8

blood culture in TSS in staph vs strep

Back 8

staph = neg

strep = more likely positive

Front 9

what drug to use for GAS if pcn and cef allergic?

Back 9

erythromycin

azithromycin

Front 10

treatment of impetigo

Back 10

usually keflex (cover staph and strep)

+ clinda if MRSA

Front 11

why is ampicillin used in babies with fever?

Back 11

covers:

strep agalactiae (gbs)

listeria

enterococci

Front 12

treatment of GBS infection

Back 12

pcn g + aminoglycoside (streptomycin, gentamicin)

Front 13

treatment ofr enterococcus

Back 13

amigoycoside + vanc, pcn, ampicillin (if septic)

Front 14

what food products have arisk of carrying listeria?

Back 14

goat cheese, meats, deli meats, hot dogs, soft cheeses, smoked salmon, tofu, vegetables soiled with manure

Front 15

neonate with + prelim culture with diphtheroids

Back 15

think listeria - gram positive rod that can mimic the appearance of diphtheroids

Front 16

treatment of diphtheria

Back 16

erythromycin

diphtheria antitoxin

Front 17

cutaneous anthrax presentation

Back 17

painless papule that vesiculates => ulcer -> black escharge with non-pitting induration and swelling

still painless!

Front 18

treatment of anthrax

Back 18

cipro or doxycycline

pincnillin g only if susceptible

Front 19

treatment of cdiff relapse

Back 19

treat 1st occurrence and 1st recurrence with metronidazole

2nd or greater recurrence with vancomycin with tapered regimen

Front 20

treatment of tetanus

Back 20

tetanus ig

metronidazole; pcn also acceptble

Front 21

marla has staple injury, unknown immunizations or known <3 imm. plan?

Back 21

tdap

(or dtap if <7y)

Front 22

marla has staple injury with >3 prior tetanus immunizations, last <10 years ago. plan?

Back 22

nothing

Front 23

marla has staple injury with >3 prior tetanus immunizations, last >10 years ago. plan?

Back 23

booster tdap

Front 24

marla steps on dirty nail, unknown immunizations or known <3.

Back 24

tdap (dtap if <7)

+ TIG

Front 25

marla steps on dirty nail with cow feces on it. has >3 tetanus imm, most recent <5y ago.

Back 25

no vaccine

Front 26

marla steps on dirty nail. has >3 tetanus imm, most recent >5y ago. plan?

Back 26

tdap (dtap if <7)

Front 27

wound is dirty and child has <3 tetanus vaccines or unknown

Back 27

TIG + vaccine

Front 28

wound is clean and immunizations UTD

Back 28

no treatment

Front 29

would is dirty and immunizations UTD

Back 29

UTD is <5y

no treatment

Front 30

drug of choice for neisseria meningitis

Back 30

penicillin g

prophylaxis:

rifampin

ceftriaxone

cipro (if >18yo)

Front 31

who should you prophylaxis for meningitis exposure?

Back 31

household, day care, close intimate contacts

passengers seated next to index case > 8 hours

healthcare worker if contact with oral secretions

Front 32

how to differentiate neonatal conjunctivitis?

Back 32

<48 hour after delivery: chemical reaction to prophylaxis

2-7 days: gonorrheae

7-14 days: chlamydia

Front 33

treatment of gonococcal ophthalmia

Back 33

ceftriaxone 50mg/kg im or iv; r/o SBO

Front 34

ecthyma gangernosum

Back 34

round, indurated black lesion with central ulceration

seen with pseudomonal bactermia, especially in neutropenic patients

Front 35

treatment for pseudomonas

Back 35

broad spectrum PCN's (pip-tax, cephalosporins)

Front 36

associations with pseudomonas

Back 36

CF

nail-puncture wounds

osteomyelitis and endocarditis in IV drug abusers

bacteremia in burn patients

hot tub rash

Front 37

where can you find salmonella?

Back 37

frozen foods, milk, eggs

baby chicks, iguanas, turtles

Front 38

what is typhoid fever?

Back 38

caused by salmonella serotype typhi

leukopenia, rose spots on trunk

Front 39

what lab finding do you seen in shigella?

Back 39

elevated WBC's with bandemia

Front 40

infant with fever, new onset seizure, large bloody stool

Back 40

shigella

Front 41

which infectious diarrhea to treat?

Back 41

shigella

no salmonella or ehec 0157:h7

Front 42

hemolytic uremic syndrome

Back 42

kidney failure

thrombocytopenia with purpura

hemolytic anemia

Front 43

where do you find ehec 0157:h7?

Back 43

undercooked beef, unpasteurized milk, apple juice

Front 44

a day care center has 2 cases of h. influenzae meningitis. do the other children need medicine?

Back 44

give prophylaxis.

rifampin 20mg/kg daily x 4 days to household contacts and day care attendees

Front 45

how is plague diagnosed? treated?

Back 45

yersinia pestis - aspirate LN, serology

tx: streptomycin

usu desert southwest, transmitted by coughing, by fleas or direct contact (when skinning animals)

Front 46

pseudo-appendicitis syndrome

Back 46

yersinia enterocolitica

Front 47

legionella pneumophila

Back 47

multisystem disease: diarrhea, headache, delirium, confusion, pneumonia

presents like mycoplasma; CXR looks worse

tx: azithromycin, quinolones

Front 48

where do you find brucella?

Back 48

unpasteurized milk or cheese, inhalation, handling carcasses

Front 49

presentation of brucellosis

Back 49

culture-negative endocarditis, lungs, GI tracht, orchitis, thyroiditis, adrenal insufficiency, SIADH, osteoarticular disease, sacroilitis, granulomatous hepatitis

FUO

Front 50

treatment of brucellosis

Back 50

doxycycline + aminoglycoside or rifampin

Front 51

tularemia

Back 51

arkansas, missour, oklahoma; ticks and blood-sucking flies, rabbit fever

fever, chills, myalgias, arthralgias, ulcer at site of inoculation

Front 52

what antibiotics may be useful in cat-scratch disease?

Back 52

azithromycin, rifampin (but treatment usu supportive)

Front 53

most common cause of guillain barre syndrome

Back 53

campylobacter

Front 54

what do you suspect in neonate with citrobacter growing in the csf?

Back 54

brain abscess

Front 55

what causes rocky mountain spotted fever? locations?

Back 55

rickettsia rickettsii

most common: carolinas, georgia, virgina, missour, oklahoma, texas

Front 56

RMSF rash

Back 56

maculopapular -> petechiael

distal extremities

Front 57

q fever

Back 57

zoonosis, transmitted to humans via inhalation

slaughterhouse workers, people exposed to infected animal during birthing

Front 58

treatment for rickettsia infetions

Back 58

doxycycline (even if <8yo)

Front 59

ehrlichiosis

Back 59

small, gram-negative, intracellular

"spotless rocky mountain fever"

viral picture (Fever, HA, leukopenia), tick bite

tx: doxycycline-tetracycline

Front 60

lemierre disease

Back 60

caused by fusobacterium (anaerobe)

more common in adolescents, young adults

internal jugular vein thrombophlebitis or thrombosis with signs of septic lung emboli

Front 61

acid fast

Back 61

red on a green background

all mycobacteria

Front 62

differentiating lymphadenopathy caused by mycobacterium

Back 62

TB: bilateral cervical

atypical mycobacterium: unilateral lymph nodes

Front 63

CXR findings in TB

Back 63

hilar lymphadenopathy

+/- upper lobe infiltrate

Front 64

what will serum sodium likely be in patient with TB meningitis?

Back 64

low due to SIADH

Front 65

what is a positive PPD?

Back 65

5mm - HIV+, abnormal CXR, close contacts, immunocompromised

15mm - no risk factors and >4 years

10mm - everyone else, including all <4y

Front 66

do you treat close contacts of patients with active TB?

Back 66

yes if PPD+, yes if PPD- and immunocompromised or <4y

Front 67

how to treat LTBI?

Back 67

inh x 9mo

rifampin x 6mo if inh-resistant or intolerant

Front 68

treatment for active TB

Back 68

rifampin

isoniazid

pyrazinamide (pza)

ethambutol

usually 2mo with 4 drug therapy, then INH + rifampin x 4 more mo

Front 69

SE of ethambutol

Back 69

decrease in visual activity, esp decreased color perception

Front 70

which children should receive pyridoxine with inh therapy?

Back 70

exclusively breastfed infants, children on milk or meat deficient diets, nutritional deficiencies, symptomatic HIV-infected children, pregnant adolescents

Front 71

draining lesion fo the face has sulfur granules noted on microscopy. etiology?

Back 71

actinomyces

tx: pcn, ampicillin

Front 72

pneumonia, splenomegaly, parrot exposure

Back 72

chlamydia psittaci (psittacosis)

Ddx: histoplasma (pna, splenomegaly, bird/bat droppings)

Front 73

what kind of infection is associated with septic shock with warm extremities?

Back 73

gram negative septic shoc; no compensatory peripheral vasoconstriction

Front 74

infections more likely in kids with chronic granulomatous disease

Back 74

staph, salmonella, serratia, burkholderia, aspergilolus

Front 75

weil disease

Back 75

severe hepatitis with renal failure and hemorrhagic complications; very high bilirubin

due to leptospiROSis

tx: pcn, doxycycline

Front 76

contact with dog or rat urine - disease?

Back 76

leptospiROSis

Front 77

cause/transmission of lyme disease

Back 77

borrelia burgdori; transmitted by ixodes scapularis tick

Front 78

stages of lyme disease

Back 78

early: erythema migrans, myalgias, arthralgias, fever, HA, LAD

stage ii: weeks-months; neurologic problems (meningitis, neuritis - bells palsy, foot broth), heart problems (myocarditis, rapidly alternating 1st 2nd or 3rd defree AV block)

stage iii: months to years: arthritis, chronic neuro syndromes

Front 79

treatment of lyme disease at different stages

Back 79

early and isolated bell's: doxycycline 100mg BID or amoxicillin x 21 days

nonresponders, cardiac, neuro: cefgtriaxone or PCN x 21 days

Front 80

therapy for candida albicans fungemia with central line?

Back 80

remove the line! also be wary of septic thrombosis in great central veins

ampho b, fluconazole, -fungin

Front 81

most common presentation of severe cryptococcus infection

Back 81

cryptococcal meningoencephalitis in t-cell deficient pateints (AIDS, steroids, hodgkin, ALL, post-transplant)

Front 82

what are risk factors for cocci? histoplasmosis? blastomyces?

Back 82

cocci: southwest US, northern mexico, dust

histo: mississippi and ohio river valleys, bat and bird droppings

blastomyces: arkansas and wisconsin hunters and loggers

Front 83

what disease entity is malsseizia furfur associated with in adolescents? infants?

Back 83

tinea versicolor

NICu babies with IV lipids; requires olive oil to grow, stop lipids, start fluconazole or ampho b

Front 84

ROSe gardener with cutnaneous and lymphagitic nodules

Back 84

sporotrichosis

tx: potassium iodide or itraconazole

Front 85

newborn with microcephaly, hydrocephalus, hepatosplenomegaly, maculopapulr rash or TTP, retinochoroiditis, cerebral calcifications

Back 85

toxoplasmosis

Front 86

at what stage of pregnancy is the mother more likely to transmit toxoplasmosis to her fetus? at what stage is the infection more likely to cause serious sequelae?

Back 86

more often acquired later in pregnancy, but more serious if acquired earlier

Front 87

what is CT scan in congenital toxo likely to show?

Back 87

widespread cerebral calcifications

Front 88

treatment of congenital toxo

Back 88

pyrimethamine

sulfadiazine

leucovorin (folinic acid)

Front 89

food associated with cyclospora infection

Back 89

raspberries from guatemala

Front 90

treatment of isospora diarrhea

Back 90

bactrim

(large and oval on stain_

Front 91

what does cryptosporidium cause? dx/tx?

Back 91

watery diarrhea; azithro

small and round on stain

Front 92

what type of malaria gives you banana gametocytes?

Back 92

plasmodium falciparum

Front 93

type of malaria more commonly associated with nephrotic syndrome

Back 93

plasmodium malariae

Front 94

which type of malaria has chloroquine resistance?

Back 94

plasmodium falciparum

Front 95

treatment of non-falciparum malaria

Back 95

chloroquine and primaquine

Front 96

treatment of falciparum malari

Back 96

chloroquine; if resistant

atovaquone/proguanil

quinane sulfate + pyrimethamine + sulfadoxine, doxy, or clinda

artesmine (artesunate)

Front 97

what do you have to screen for before starting primaquine?

Back 97

g6pd deficiency

Front 98

babesiosis

Back 98

febrile, hemolytic anemia, esp in asplenic patients; caused by babesia microti transmitted vi ixodes tick

maltese cRoss (intra-rbc tetrade) on smear

clindamycin + quinine or atovaquone azithro

Front 99

how do you diagnose an amebic liver abscess?

Back 99

serology

Front 100

treatment of giardia

Back 100

nitazoxanide (if cannot swallow pills)

metronidazole

tinidazole

Front 101

child from south america with heart block, CHF, unilateral firm edema of eyelids

Back 101

chagas disease caused by trypanosoma cruzi

(also can cause achalasia, megaesophagus, megacolon)

Front 102

cause, treatment of pinworms

Back 102

enterobius vermicularous

mebendazole, pyramentel pamoate, or albendazole

Front 103

largest intenstinal roundworm that infects humans

Back 103

ascaris lumbicoides

Front 104

only worm to replicate in humans

Back 104

strongyloides stercoralis

Front 105

what causes visceral larva migrans?

Back 105

toxocariasis canis; transmitted by ingesting soil contaminated with dog feces (ex: 1-4yo with history of pica or eating dirt)

causes fever, hsm, migratory pna, hypergam, eosinophilia

Front 106

treatment of HSV resistant to acyclovir

Back 106

foscarnet

Front 107

when is a varicella exposed child potentially contagious?

Back 107

from day 10 after exposure to the end of the incubation period (21 days)

Front 108

what antiinflammatory drugs should be avoided in chicken pox

Back 108

aspirin - reye syndrome

ibuprofen - strep pyogens infection

Front 109

who should get varizig if exposed?

Back 109

immunocompromised children

pregnant women

newborns whose mothers had varicella <5 days before or <48 hours after delivery

hospitalized preemie infants >28 wks without vzv immunity

hospitalized preemies <28 weeks

Front 110

treatment of vozster

Back 110

high dose acyclovir shortens course

famciclovir, valacyclovir decrease incidence of postherpetic neuralgia

Front 111

clinical findings of congenital CMV infection

Back 111

periventricular intracerebral calcifications

blueberry muffin babby (like congenital reubella)

microcephaly

chorioretinitis

sensorineural hearing loss

iugr, hsm, jaundice, thromboctyopenia, cerebral atrophy

Front 112

what infection does cmv produce in adolescents?

Back 112

mono-like

Front 113

which ebv ab tests are positive in acute infection?

Back 113

igm-vca

Front 114

fever for 3-6 days, cessation of fever and apperance of macular to maculopapular rash

Back 114

exanthem subitum / resola infantum / 6th disease

caused by hhv-6 and 8

Front 115

presentation of rubella in child

Back 115

adenopathy (postauricular, occipital, posterior cervical_, rash, low-grade fever

Front 116

findings in severe congenital rubella

Back 116

ttp - blueberry muffin lesions

radiolucencies in metaphyseal long bones

congenital heart disease

sensorineural deafness

cataracts with microphthalmia, congenital glaucoma

hsm, hepatitis, hemolytic anemia, bulging anterior fontanelle, csf pleocytosis, retinopathy, mr

Front 117

what virus can cause acute hemorrhagic cystitis?

Back 117

adenovirus (11, 21)

Front 118

antivirals for influenza

Back 118

influenza A: amantadine and rimantadine

A & B: neuraminidase inhibitors - oseltamivir and zanamivir (contraindicated in children with CLD/asthma, inhaled powder)

Front 119

what causes hand foot and mouth disease?

Back 119

coxsacievirus a16, a5, and a10

enterovirus 71

Front 120

what viruses can cause acute hemorrhagic conjunctivitis?

Back 120

enterovirus 70

coxsackievirus a24

Front 121

what causes asymmetric, flaccid proximal-> distal paralysis without reflexes?

Back 121

polioviruses

Front 122

clinical case definition of polio

Back 122

age<6y

fever at onset of disease

descending paralysis with maximum extent at 4 days

residual neurologic deficit >60 days after onset

Front 123

how to diagnose rabies?

Back 123

negri bodies (Acidophilic inclusion bodies) in cytoplasm of neurons

Front 124

what does parvovirus b19 cause?

Back 124

erythema infectiosum (fifth disease), arthralgias/arhtritis, aplastic anemia

Front 125

waht is the risk for a pregnant womam infected with parvo b19?

Back 125

~5-10% will have fetal loss with intrauterine hydrops

Front 126

adolescent in desert sotuwhest p/w hemorrhagic pnemumonia, thrombocytopenia, increased hematocrit

Back 126

hantavirus

Front 127

side effects of zadovudine?

Back 127

bone marrow suppression, myopathy

Front 128

side effects of the D's - ddi, ddc, d4t

Back 128

ddi (didanosine), ddc (zalcitabine), d4t (stavudine)

pancreatitis and peripheral neuropathy

Front 129

side effect of abacavir

Back 129

potentially fatal hypsensitivity reaction

Front 130

what anti-hiv med is teratogenic?

Back 130

efavirenz

Front 131

what anti-hiv med causes kidney stones?

Back 131

indinavir

Front 132

what anti-hiv meds to avoid in pregnant women?

Back 132

efavirenz - teratogenic

d4t/ddi = fatal lactic acidosis

Front 133

regimen for postexposure prophylaxis to hiv

Back 133

zdv, 3tc, +/- lopinavir/ritonavir

Front 134

ture or false? zdv/d4t combined or ddc or zdv alone is acceptable for a child with symptomatic hiv

Back 134

false; zdv/d4t are atagonistic, never use single drug, also don't use ddc (outdated)

Front 135

what causes focal-space occupying, ring-enhancing cns lesions in hiv patients?

Back 135

toxoplasma gondii

Front 136

how to diagnose cryptococcal meningitis?

Back 136

cryptococcal antigen test or india ink in csf and blood

Front 137

what are the criteria to diagnose endocarditis?

Back 137

2 major, 1 maj + 3 minor, or 5 minor

major: positive blood culture, abnormal echo

minor: predisposing condition, fever, vascular phenomena, immunologic phenomena (acute GN, osler nodes, roth spites, RF

Front 138

what organism most commonly causes endocarditis in children? what about in patients with normal valves? what about <1 year after prosthetic valve placed?

Back 138

strep viridans

staph aureus

staph epi

Front 139

which antibiotics bind to the 30s subunit? 50s subunit?

Back 139

30s - aminoglycosides (irreversibly), tetracyclines (reversibly)

50s - oxazolidinones (linezolid), macrolines (reversible)

Front 140

which antibioitcs are bacteriostatic?

Back 140

erythromycin, tetracycline, clindamycin

Front 141

side effects of amphotericin b

Back 141

hypokalemia, hypomagnesemia, renal tubular acidosis

Front 142

antibiotics to avoid in pregnant women

Back 142

tetracycline and quinolones

tetracycline also when breastfeeding

Front 143

most cases of RMSF are found in...

Back 143

Arkansas, Missouri, North Carolina, Oklahoma, and Tennessee.