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326 Cards in this Set
- Front
- Back
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What are the toxic effects of diptheria?
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Myocarditis with possible heart failure
Renal effects (proteinuria, renal failure, cylinduria, microscopic hematuria. polyneuritis (Guillian Barre like symptoms) |
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What presents as profuse, mucoid, grayish nasal discharge in infant and younger children?
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nasal diptheria (mildest form)
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What organism is most commonly a problem in bone marrow transplant units where it causes IV catherter-related infections and is resistant to most drugs?
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Corynebacterium jeikeium
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What organism causes a pharyngitis similar to s. pyogenes - complete with desquamative scarlitiniform rash?
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Corynebacterium haemolyticum NOW CALLED Arcanobacterium haemolyticum
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How do you treat pharyngitis caused by Acanobacterium haemolyticum?
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Penicillin or if allergic, Erythromycin or Tetracyclene.
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What organism is a large gram + rod (bacillus) that causes three variants of disease? (cutaneous, gastrointestinal and pulmonic)
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Bacillus Anthracis
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What is contracted by handling contaminated hides/wools?
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Anthrax (Bacillus Anthracis)
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What presents as deceivingly healthy infants with bacteremia and unilateral facial, genital or inguinal areas of skin infection in infants?
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Group B Strep Cellulitis-adenitis Syndrome.
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What is a gram negative rod with a single flagellum?
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Pseudomonal aeruginosa
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How is the rash associated with strep described and how does it progress?
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The rash has a sandpaper quality and usually begins on the neck and upper chest and spreads distally leaving the mouth area pale with "circumoral pallor"?
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What is the prominent erythematous rash that occurs in the flexor skin creases of the antecubital fossa with strep?
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Pastia Lines
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How long does the scarlet fever rash last and how does it resolve?
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The rash lasts about a week then fades with desquamation of the trunk, hands and feet.
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What presents as a rapidly fatal illness that can start with flu-like symptoms, purpura and DIC (with Howell Jolly Bodies)?
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Post-splenectomy pneumococcal sepsis.
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What is the gold standard, the pathognomonic sign and the sensitivity/specificity of rapid tests in regards to strep?
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Gold standard is throat culture.
Pastia lines are pathognomonic for scarlet fever. Rapid strep screens are 90% or higher sensitivity, and 100% specific. |
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What is the most common form of skin infection caused by strep pyogenes?
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Impetigo (Superficial pyoderma)
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What strain of strep causes impetigo and is highly associated with post-strep glomerulonephritis?
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M49
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What is an acute strep infection of the deeper layers of skin and underlying connective tissues?
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Erysipelas
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How do erysipelas and impetigo differ?
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Impetigo: nontender, honey crusted, age 2-5
Erysipelas: tender, solid erythema, rare in kids |
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What presents as red-crusted papules and pustules often at the site of a prior insect bite?
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Impetigo
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What usually presents as flaccid, coalescent pustules with bullae on previously normal skin?
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Bullous impetigo
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What heritages increase the risk for invasive pneumococcal disease?
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Native Americans
Alaskan Natives African Americans |
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In children, "occult bacteremia without a focus" accounts for what percentage of all pneumococcal invasive disease?
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60%
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What is the prime age for occult bacteremia without a focus?
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3-36 months of age
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When are the two peak ages for meningococcal meningitis?
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Children < 2 and
Adolescents 15-19 |
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What are the three types of infections caused by enterococcus in children/infants?
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1) UTI
2) Polymicrobial abdominal infections 3) Bacteremia/sepsis |
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What type of E coli causes persistent diarrhea in children in developing countries and in travelers?
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Enteroaggregative
(EaggEC) |
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What should be done if a neonate has citrobacter growing?
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Get a CT/MRI of head to look for brain abscess.
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What antibiotic should NEVER be used for pseudomonas infection?
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Ceftriaxone
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What is case fatality rate from meningitis caused by the following organisms?
Listeria S. pneumonia N. meningitidis Group B Strep H. flu |
Strep pneumonia 21%
Listeria monocytogenes 15% Group B strep 7% H. flu 6% N meningitidis 3% |
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What are common sources of infection with listeria?
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livestock or poultry
goat cheese meats deli meats hot dogs smoked salmon tofu vegetables that are soiled. |
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What gram negative cocobacillus causes fever, headache, rash, arthralgias and sometimes abdominal pain and diarrhea?
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Rickettsia rickettsii
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What states are most common for Rocky Mountain Spotted Fever?
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Carolinas (N & S)
Georgia Virginia Missouri Oklahoma Texas |
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What lab abnormalities are helpful clues in diagnosis RMSF?
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Hyponatremia and Thrombocytopenia
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What organism causes Q fever?
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Coxiella burnetti
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What is the treatment of choice for ALL Rickettsia infections?
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Doxycyclin (regardless of patient's age)
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When is chloramphenicals use in Rickettsial infections?
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NONE - NO LONGER USED
Essentially no longer available in the US |
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What makes a person susceptible to Q fever?
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Slaughterhouse workers and those around animals giving birth.
Cattle Cats Croaked Conception Always think Coxiella (Q fever) |
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What small, gram negative obligately intracellular organism is prevalent in Texas, Oklahoma, Missouri and Arkansas?
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Ehrlichia chaffeensis and causes HME (Human Monocytic Ehrlichiosis)
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What are the two types of Ehrlichiosis?
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HME (Human monocytic ehrlichiosis) &
HGE (Human granulocytic ehrlichiosis) |
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What is ehrliciosis treated with?
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Doxycycline/Tetracycline
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How does Ehrilchiosis present clinically?
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Fever
Headache Leukopenia Thrombocytopenia Sometimes Rash (Pancytopenia & tick bite) |
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What organism is
GRAM-VARIABLE? |
Gardnerella vaginalis
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How is Gardnerella vaginalis treated?
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Metronidazole
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How do mycobacteria look on microscopic examination?
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RED on green background because they are acid-fast
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What types of mycobacteria cause lymphadenitis in immunocompetent children?
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M. scrofulaceum
M. avium-intracellulare |
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How are mycobacteria inflammed lymph nodes treated?
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EXCISE THEM - Do not drain them because you will form a fistulous tract.
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Are mycobacteria inflammed nodes painful or painless?
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Painless
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What is diagnosed by Fite stains of skin and nerve?
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Leprosy (m. leprae)
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What causes "fish tank" skin ulcerations in people who work around fish tanks?
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m. marinum
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How do you treat m. marinum?
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Rifampin and Ethambutol
-OR- Rifampin and Clarithromycin |
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What can mimic the appearance of contaminant diptheroids on bood or CSF (culture/gram stain) in a neonate?
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Listeria
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What serotype of meningococcus accounts for 30% of meningitis from meningococcal disease?
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Serotype B
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What children should recieve MPSV4 vaccine?
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Kids over two who are splenectomized
or have functional asplenia (sickle cell) and those with complement or properidin deficiencies. |
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What causes eye drainage in 7-14 days after birth?
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Chlamydia trachomatous
(Need to do blood cx and LP) |
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What causes eye drainage within the first 2-7 days of delivery?
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Neisseria Gonorrhea
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What seasons have the highest rates of meningococcal menigitis?
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Winter and early Spring - most adults have natural immunity.
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What is the classic presentation of diptheria (tonsillopharyngeal)?
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Gray-white pharyngeal membrane
Hoarseness Sore throat Low grade fever <101 Bull neck appearance |
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What is the classic appearance of diptheria and what is the incubation period?
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Bull neck appearance.
Incubation period is 2-4 days |
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What is a gram negative diplococcus that causes respiratory infections and is the third most common cause of otits media and sinusitis in children?
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Moraxella Catarrhalis
(#1 is strep pneumo and #2 is H. flu) |
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What unusual infection presents with hoarseness, stridor and respiratory compromise?
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Laryngotracheobronchial diptheria.
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What specific injuries/circumstances should make one think of pseudomonas aeruginosa?
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1- nail or puncture wound through a tennis shoe
2- osteomyelitis (IV drug users) 3- endocarditis (IV drug users) 4- bacteremia in burn patients 5- chronic otitis externa (especially in diabetics) |
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What is the most common cause of pneumonia
in children older than one month of age? |
Viruses
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When is vancomycin used in MRSA treatment?
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In all cases of bacteremia and in serious infections with MRSA.
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What is the usefulness of bacterial antigens in diagnosing Group B Strep?
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Do NOT use antigen in urine
Blood culture is gold standard. Bacterial antigens can be useful in CSF when patient is on antibiotics. |
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What is the treatment duration for Group B Strep infections?
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Pneumonia - 10 days
Sepsis - 10 days Meningitis - 14 days Septic Arthritis - 14-21 days Osteomyelitis - 3-4 weeks. |
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How frequently does toothbrushing lead to transient bacteremia?
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40% of the time
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What is the treatment for listeria meningitis?
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Ampicillin and Gentamycin
for 2-3 weeks (Amp alone is only inhibitory) |
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What class of organisms usually cause furuncles and carbuncles?
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Staphylococcus
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What is the duration of perussis in children vs adolescents?
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6-10 weeks in children
-VS- >10 weeks in adolescents |
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How is diagnosis of pertussis made?
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Culture - NOT PCR or DFA
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What lab findings are suggestive of pertussis?
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Increased WBC with absolute lymphocytosis in clinical setting of paroxysmal cough in infants and chldren but NOT IN ADOLESCENTS.
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What type of E. coli causes watery diarrhea in infants and "travelers diarrhea" and how is it treated?
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Enterotoxigenic (ETEC) and it is treated with Bactrim
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What type of E coli causes diarrhea and fever?
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Enteroinvasive (EIEC)
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What type of E coli is responsible for hemolytic uremic syndrome?
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Enterohemmorhagic (EHEC) also known as Shiga-toxin producing E coli.
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Which form of Bacillus cereus is associated with fried rice left at room temperature?
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The emetic form
Incubation is 1-6 hours |
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Who should receive prophylaxis for meningococcemia?
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Household, daycare, close intimate contacts and passengers seated directly next to an index case during airline flights lasting more than eight hours.
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What is the indication for medical personel who care for patient with meningococcemia in regard to prophylaxis?
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Only medical professionals who have intimate contact with the case such as with mouth to mouth resuscitation or intubation.
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What presents as a URI with a gray-white pharyngeal membrane, hoarseness, sore throat and LOW fever < 101?
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diptheria caused by corynebacterium diptheriae
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What is the drug of choice for s. pyogenes infection?
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Penicillin
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Strep pharyngitis (usually s. pyogenes) is more likely with each of these three findings; what are they?
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1. Temp >100 F
2. Tender cervical lymphadenopathy 3. Exudative tonsils If none the chance of strep is <3%, if 1 finding, 20% and if 3 findings, 50% |
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What is the only type of Salmonella that is encapsulated and nonmotile
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Salmonella serotype Typhi.
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What is the incubation period for gastroenteritis caused by nontyphoidal salmonella?
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6-72 hours
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How is Shigella spread?
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Person to person transmission
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Shigella vs salmonella: Which requires less organisms to cause infection?
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Shigella
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What are control measures for Shigella in a daycare attendee or household?
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Symptomatic individuals should be cultured for Shigella as well. Anyone found to have Shigella cannot return until the diarrha has stopped and stool speciments test negative.
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What is a gram-negative, lactose fermenting, motile rod that is a common cause of UTI and also meningitis in neonates.
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E coli
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What are the ONLY indications for treating salmonella diarrhea?
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If a child is < 3 months or age or is immunocompromized.
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Where is salmonella serotype typhi found in the environment and in the carrier adults?
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It is found in contaminated food, milk or water and in carriers which seed in gallstones (Typhoid Mary?
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How is typhoid treated?
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3rd generation cephalosporins, ampicillin, TMP/SMX, quinilones and chloramphenical depending on sensitivities.
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What is characterized by raisiing of the eyebrows, narrowing of the palpebral fissures, downward/outward moving of the angles of the mouth and pressing of upper lip to the teeth?
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risus sardonicus
facies associated with tetanus |
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How does the toxin with clostridium botulinum work?
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It blocks presynaptic acetylcholine release..
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What is the median onset for LATE onset Group B strep infection? What is the range?
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Mean is 27 days.
Range is 7 days to 3 months |
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What is a gram negative diplococcus that is an occasional, ordinary inhabitant of the upper respiratory tract?
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Neisseria Meningitidis
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If a child han antibiotic associated collitis caused by c. diff, when do symptoms occur?
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Symptoms can occur up to 3 weeks after the antibiotics are stopped.
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What percentage of healthy peoplle have c diff in their stools?
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5%
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What organism is responsible for the MOST POTENT TOXIN KNOWS?
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Clostridium botulinum.
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What organisms do vanc resistant VRE originate from and what strains are identified.
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E. faecalis and E faecium
VanA, VanB, VanC, VanD, VanE |
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What are the most common organisms involved in acute sinusitis?
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1- Strep pneumoniae
2- Haemophilus influenza 3- Moraxella catarrhalis |
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Why is Bactrim no longer recommended to treat sinusitis?
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Because of strep pneumo resistance to Bactrim.
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What should empiric therapy in a child with cystic fibrosis be when having a respiratory exacerbation?
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piperacillin/tazobactam and
gentamycin. |
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What are carrier rates for Neisseria Meningitidis? What about in an epidemic?
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Normally 2-3%
Epidemic 100% |
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What is the characteristic facial expression that occurs when a child jaw is completely immobile and has a tonic expression with upgoing eyebrows, narrowing eyes, down and out angles of mouth, pressing of upperlip/teeth.
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risus sardonicus
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What is the treatment of endocarditis caused by viridans strep or S. bovis that is highly susceptible to penicillin? (MIC < or = 0.1)
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4 weeks of IV PCN or ceftriaxone
May add gent for 5 days for synergy. |
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What infections are caused by Group C streptococci?
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Bacteremia
Pneumonia Epiglotttitis UTIs Pharyngitis and other systemic infections |
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What is the most common cause of osteomyelitis in an otherwise normal child?
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Staph aureus
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If a child has staph aureus bacteremia, what sequellae should you check for?
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Endocarditis
Osteomyelitis |
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What condition involving staph is more likely in children with cyanotic congenital heart disease?
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Staphylococcal brain abscess
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What presents with red skin (erythroderma), hypotension, fever, diarrhea and hypocalcemia?
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Toxic Shock Syndrome
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What are the diagnostic criteria for toxic shock syndrome?
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1- Temp > 38.9 (102.2)
2- systolic bp <90 or <5% for age 3- Rash with subsequent desquamation (especially palms and soles) 4- Involvement of >3 organ systems: GI, muscula, mucous membranes, renal, liver, blood and CNS 5 Negative serology for RMSF, leptospirosis and measels. |
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How oftten will patients with meningococcemia have a rash?
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> 60%
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What presents as leukopenia, rose spots on the trunk about a week after fever starts (they look like 2-3 mm angiomas)?
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typhoid fever
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How do you diagnose typhoid?
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3 sets of blood cultures
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What is the most SENSITIVE test for diagnosis of salmonella typhi?
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bone marrow culture is the most sensitive test for diagnosis of salmonella typhi
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What is the most common serotype of shigella in the US? and what is the second?
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Shigella sonnei followed by shigella flexneri.
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What causes eye drainage in the first 48 hours of delivery?
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A chemical reastion to the antibiotic eye prophylaxis
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What are complications of gonococcal opthalmia?
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iridocyclitis and corneal ulcerations?
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What organism is a gram negative rod that causes two types of gastroenteritis - one with emesis and one with diarrhea?
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Bacillus cereus
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What is the incubation period and type of toxin for the emetic type of Bacillus cereus?
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1-6 hour incubation
has a preformed heat stable toxin |
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What is the incubation period and type of toxin for the diarrheal type of bacillus cereus?
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Incubation is 8-16 hours and is due to enterotoxin production in vivo in the GI tract.
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What organism should be suspected if you see ecthyma gangrenosum (round indurated, black lesion with central ulceration) with bacteremia
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Pseudomonal aeruginosa
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cellulitis due to s pyogenes can/cannot be responsible for post-strep glomerulonephritis and rheumatic fever?
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Can cause post-strep GN
Cannot cause rheumatic fever |
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What are complication of gonnococcal opthalmia?
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iridocyclitis and corneal ulcerations
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What is the incubation period and type of toxin for the emetic type of bacillus cereus?
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1-6 hour incubation
has a preformed heat stable toxin |
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What is the incubation period and type of toxin for the diarrheal type of bacillus cereus?
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Incubation is 8-16 hours and is due to enterotoxin production in vivo in the GI tract
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What organism should be suspected if you see ecthyma gangrenosum (round, indurated, black lesion with central ulceration) with bacteremia?
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Pseudomonas Aeruginosa
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What do non-typable H flu strains cause in children?
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conjunctivitis
otitis media sinusitis bronchitis neonatal bacteremia neonatal meningitis |
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How can Group A cellulitis proceed and be rapidly life threatening?
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In some cases it can be deep-seated and lead to necrotizing fasciitis which causes destruction down to subcutaneious tissue level after 4-6 days, frank gangrene.
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Why are more cases of meningococcemia identified in children?
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Most adults have developed natural immunity to meningococcus.
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What is the most common cause of both catheter-related bacteremia and bacteremia occurring post-op when anything foreign remains in the body?
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Staph-epidermidis
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What time frames are associated with hematuria after strep pyogenes skin infection, IgA nephropathy and s. pyogenes pharyngitis?
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skin infection - 21 days
IgA nephropathy <5 days Pharyngitis 10 days |
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How does s. typhi differ from other salmonella serotypes?
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Salmonella typhi is only in humans and transfers by direct contact with infected person or fomite.
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What is the most common reason for penicillin failure in treatment of strep?
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Non-adherence
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What is the resistance rate with oral erythromycin or azithromycin in treatment of strep?
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5-10%
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What presents as a painless papule that vesiculates and forms a painless ulcer, then a painless black eschar and often with a lot of non-pitting, painless induration and swelling.
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Cutaneious anthrax
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What is the drug of choice for treatment of infections due to E. Gallinarum and E. casseliflavus?
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Ampicillin (Vanc Resistant)
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When does non-typable H flu meningitis/bacteremia occur in 80% of the cases?
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1st day of life.
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What can group B strep cause in post-partum women?
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Endometritis and Bacteremia
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What time(s) of year are most common for strep pharyngitis and what age group?
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Winter and Spring
Children > 3 years old |
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Skin strep pyogenes may cause what sequelae?
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Acute post-streptococcal GN but NOT rheumatic fever.
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What are the major species of clostridium?
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c. difficile
c. botulinum c. perfringens c. septicum c. tetani |
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What percentage of children with systemic meningococcal disease will end up having a complemement deficiency?
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20%
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What are the five clinically significant serotypes of meningococcus?
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A, B, C, W-135 and Y
(B, C and Y cause 30% in US) A&W are in rootbeer, not the US |
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Treatment of impetigo should cover what organisms and what class of medications is first line?
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Strep pyogenes and Staph aureus. Txt with cephalosporins.
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What is the treatment of choice for group A streptococcus cellulitis?
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Surgical debridement along with IV penicillin and clindamycin.
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What organisms cause cellulitis and gas gangrene by means of alpha toxin?
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Clostridium septicum, perfringes, tetani and novyi.
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What type of E coli causes acute and chronic diarrhea in infants and how do you treat it?
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Enteropathogenic E. Coli (EPEC)
Bactrim and oral gentamycin |
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Why has the incidence of TB been rising since 1988?
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Rise of HIV
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How do children generally spread TB?
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Generally, they don't, they get it from adults.
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What percent of those with initial TB infection seroconvert and which stay disease free? What about HIV?
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90% remain disease free
5% convert in two years 5% convert after two years HIV -40% convert within months |
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What is the difference in clinical presentation in those who have primary TB and those who have latent TB?
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Primary TB =lower lob disease
Laten TB=upper lobe/apical |
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How do most children with TB infection present?
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Most have no symptoms at any time.
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What will show on CXR in an infant with TB?
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Hilar Lymphadenopathy
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What is a frequent complication of TB in children > 6 years?
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Asymptomatic Pleural Effusion
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What are the serologic properties of the pleural fluid/effusion with TB
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WBC 1,000 - 6,000
low glucose elevated protein elevated LDH acid fast bacilli |
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What is the most serious complication of TB in children?
|
meningitis
occurs 3/1000 untreated patients |
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What age group most commonly develop TB meningitis?
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6 months - 4 years
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What infectious sequelae can present as a brain tumor in children in developing areas of the world?
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Tuberculoma
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When are tuberculomas likely to occur?
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Paradoxically after they have begun treatment for TB
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What are the extrapulmonary manfestations of TB?
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Pericarditis
Meningitis Lymphadenopathy Tuberculoma can cause SIADH can cause communicating hydrocephalus. |
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What is the ONLY contraindication to doing a ppd?
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Necrotic skin reaction to previous skin test
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Who is considered moderate risk forTB an what is the cutoff on ppd?
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10 mm
-children <4 -healthcare workers -homeless -immigrants -diabetics -any group housing setting or jail -immunosuppresed but <15mg/day predisone. |
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Who is considered high risk for TB and what is the ppd cutoff?
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5mm
-cell mediated dysfunction/HIV CXR changes(fibrotic) -close contacts in index case -compromised host(transplant or steroids >15 mg/day steroids >1 mo |
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Who is classified as low-risk for TB and what is the ppd cutoff?
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15mm
> or = to 4 years old NO RISK FACTORS |
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What is the 4 drug regimen ffor TB consist of?
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STRIP OR RIPE (streptomycyn vs ethambutol)
INH Rifampin Pyrazinamide (PZA) Ethambutol (oral preferred) or streptomycin (injection) |
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What is the three drug regimen for treatment of TB?
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RIP
Rifampin Isoniazid Pyrazinamide |
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What is standard treatment of TB in the US?
|
4 drug therapy for 2 months (unless 3 drug criteria are met or sensitivity comes back that it responds to 3 drug), then after 2 mos, drop to INH and rifampin for an additional 4 months.
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What drug replaces rifampin in treatment of TB in HIV patients who are on protease inhibitors?
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Rifabutin
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What is the duration of treatment for active TB?
|
6 months
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What is the duration of treatment of latent TB?
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9 months
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What is the current optimum treatment regimen of latent TB?
|
INH x 9 months
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What is the treatment for extrapulmonary TB?
|
The same as pulmonary unless it is CNS disease in which case 4 drug treatment with streptomycin is preferrable.
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Why is streptomycin generally preferred over ethambutol as the fourth drug in TB for younger children?
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Because it's hard to monitor for toxicity affecting visual acuity in this age group.
|
|
|
When can the 3-drug regimen be used in TB? (3 criteria)
|
ONLY IF:
1-New TB pt and <4% primary resistance to INH in area 2-No know exposure to pt with drug resistant infection 3-Not from a high-prevalence country |
|
|
What vitamin can be beneficial in TB regimens and why?
|
Vitamin B6 (pyridoxine) to help prevent peripheral neuropathy and mild CNS effects. Give to milk or meat deficient kids, HIV, and pregnant adolescents.
|
|
|
What organism is only WEAKLY ACID-FAST and is beaded, branching and filamentous?
|
Nocardia asteroides
|
|
|
What infection does Nocardia most often start as?
|
lung infection - can proceed to cavitary lesion, focal brain absesses and neutrophilic chronic meningitis
|
|
|
What class of medicines is first line for treatment of Nocardia?
|
sulfonamides
|
|
|
What is an anaerobic organism that usually presents as cervicofacial infection stemming from dental infection.
|
Actinomyces
|
|
|
What does actinomyces specifically cause in females?
|
PID when there is an IUD in place.
|
|
|
What is the drug of choice for Actinomyces?
|
Penicillin/Ampicillin.
Tetracycline if allergic. |
|
|
What genus of organism are obligate intracellular parasites?
|
Chlamydia
|
|
|
What should be suspected if someone develops a pneumonia associated with poultry, especially with splenomegaly?
|
Chlamydophila psittaci (Chlamydia psittaci)
|
|
|
What presents with myalgias, rigors, headache and a high fever to 105?
|
C. psittaci (psittacosis)
|
|
|
How is Chlamydia pneumonia spread?
|
Person-to-person spread
|
|
|
What type of eye infection does chlamydia trachomatis cause in an infant?
|
Trachoma - chronic external eye infection causing cataracts but NOT GLAUCOMA.
|
|
|
What does antibiotic eye ointment at birth prevent?
|
Gonnorheas, but NOT CHLAMYDIA
|
|
|
What is the treatment of choice for chlamydial organisms?
|
Macrolides.
|
|
|
Stapylococcus, Salmonella, Serratia and Aspergillus are more likely to be seen in what patient suabgroup?
|
Those with chronic granulomatous disease.
|
|
|
H. flu, Strep pneumoniae and meningococci are more likely to be seen in what patient subgroup?
|
Asplemic patients.
|
|
|
Aspergillus, Mucor and Pseudomonas infections are more likely in what patient subgroup?
|
Granulocytopenic (leukemia, chemo, post-transplant) than in patients with AIDS.
|
|
|
If cerebral calcifications circumvent the ventricles, what is usually the cause?
|
Congenital CMV
|
|
|
What infection is associated with eating rasperries from Guatemala? (or basil, lettuce, snow peas or contaminated water)
|
Cyclopora
malaise, myalgia, low-grade fever, fatigue |
|
|
What are complications of gonococcal opthalmia?
|
iridocyclitis and corneal ulcerations?
|
|
|
What organism is a gram negative rod that causes two types of gastroenteritis - one with emesis and one with diarrhea?
|
Bacillus cereus
|
|
|
What causes eye drainage in the first 48 hours of delivery?
|
A chemical reaction to the antibiotic eye prophylaxis.
|
|
|
How do you diagnose typhoid?
What's the MOST SENSITIVE TEST? |
3 sets of blood cultures,
bone marrow culture is the most sensitive test for diagnosis of S serotype typhi |
|
|
What is the most common serotype of shigella in the US, what is the second?
|
Shigella sonnei followed by shigella flexneri
|
|
|
What is the incubation period and type of toxin for the emetic type of bacillus cereus?
|
1-6 hour incubation
it has a preformed heat stable toxin |
|
|
What is the incubation period and type of toxin for the diarrheal type of Bacillus cereus?
|
Incubation is 8-16 hours and is due to enterotoxin production in vivo in the GI tract.
|
|
|
What organism should be suspected if you see ecthyma gangrenosum (round indurated black lesion with central ulceration) with bacteremia
|
Pseudomonas Aeruginosa
|
|
|
Cellulitis due to S. pyogenes can/cannot be responsible for post-strep glomerulonephritis and rheumatic fever.
|
Can cause post-strep GN
CANNOT cause Rheumatic Fever. |
|
|
What do non-typable H flu strains cause in children?
|
conjunctivitis
otitis media sinusitis bronchitis neonatal bacteremia and meningitis |
|
|
How can group A cellulitis proceed and be rapidly life threatening?
|
It can lead to necrotizing fasciitis which causes destruction down to subcutaneous tissue level. After 4-6 days, frank gangrene.
|
|
|
Why are more cases of meningococcemia identified in children?
|
Most adults have developed natural immunity to meningococcus.
|
|
|
What is the most common cause of both catheter-related bacteremia and bacteremia occurring post-op when anything foreign remains in body?
|
Staph epidermidis
|
|
|
What time frames are associated with hematuria after strep pyogenes skin infection, IgA nephropathy and s. pyogenes pharyngitis.
|
skin infection - 21 days
IgA nephropathy < 5 days Pharyngitis - 10 days |
|
|
How does s. typhi differ from other salmonella serotypes?
|
s typhy is only in humans and transfers by direct contact with infected person or fomite.
|
|
|
What is the most common reason for penicillin failure in treatment of strep?
|
Non-adherence
|
|
|
What is the resistance rate with oral erythromycin or azithromycin in treatmet of strep?
|
5-10%
|
|
|
What presents as a painless papule that vesiculates and forms a painless ulcer, then a painless black eschar and often with a lot of non-pitting, painless induration and swelling.
|
Cutaneous Anthrax
|
|
|
What is the drug of choice for treatment of infections due to E. gallinarium and E. casseliflavus?
|
Ampicillin
(Vanc Resistant) |
|
|
When does non-typable H flu meningitis/bacteremia occur in 80 % of cases?
|
1st day of life.
|
|
|
What can group B strep cause in post-partum women?
|
Endometritis and Bacteremia
|
|
|
What time(s) of year are most common for strep pharyngitis and what age group?
|
Winter and Spring
Children > 3 years of age |
|
|
Skin strep pyogenes may cause what sequelae?
|
Acute Post-streptococcal GN but NOT rheumatic fever.
|
|
|
What are the major species of clostridium?
|
C. difficile
C. botulinum C. perfringens C. septicum C. tetani |
|
|
What percentage of children with systemic meningococcal disease will end up having a complement deficiency?
|
20%
|
|
|
What are the clinically significant serotypes of meningococcus?
|
A, B, C, W135 and Y
|
|
|
What organism has pseudohyphae with KOH preparation?
|
Candida
|
|
|
What causes retinal lesions that present as white, cotton-like chorioretinitis?
|
Candida
|
|
|
What are the three deadly syndromes caused by candidemia?
|
1)septic peripheral thrombophlebitis
2)septic thrombosis of the great central veins (esp with central lines. 3)hepatosplenic candidiasis - think of this in recovering leukemia pts. CT scan shows focal involvement liver/spleenn. |
|
|
What type of pneumonia is associated with cavitary lesions and peripheral "cannon ball" skin lesions?
|
Cryptococcal pneumonia
|
|
|
Who is at risk for the most severe form of cryptococcal infection and what is it?
|
Cryptococcal Meningoencephalitis
T-cell deficient pts, AIDS, steroids, Hodgkins, ALL, Diabetes, Post-organ transplants |
|
|
What is the treatment of cryptococcal meningitis?
|
Amphotericin B
5-flucytosine (5-FC) |
|
|
What organism is found in Southwest US (California and Arizona) and Northern Mexico and causes self limited flu-like illness with pulmonary "coin lesions"
|
Coccidiodes Immitis
|
|
|
What organism is confined to the Mississippi and Ohio River Valleys and is prevalent in bat and bird droppings?
|
Histoplasma
|
|
|
What organism is confined to Arkansas and Wisconsin hunters and loggers?
|
Blastomyces
Think of this with beaver dams |
|
|
What are the two diseases Malassezia furfur causes in kids?
|
Tinea Versicolor
Septic like picture in NICU |
|
|
What organism requires "olive oil overlay" to grow in a lab?
|
Malassezia FurFur
|
|
|
What organism is associated with hay bales, straw in barns and rose gardeners?
|
Sporotrichosis
|
|
|
What starts as a black, necrotic spot on the nose or paranasal sinuses and extends intracranially?
|
Mucormycosis (very poor prognosis)
|
|
|
What can both Aspergillus and Mucor cause in the pulmonary system?
|
Necrotizing Cavitating Pneumonia
|
|
|
Do protozoa cause eosinophillia?
|
No
|
|
|
When does toxoplasmosis cause problems in pregnancy and when are the problems most serious?
|
Most likely to have congenital infection LATER
1st trim 25% 2nd trim 54% 3rd trim 65% BUT most serious complications are from early in pregnancy |
|
|
What congenital infection has:
-microcephaly -hydrocephalus -hepatosplenomegaly -maculopapular rash or thrombocytopenic purpura -retinochoroiditis -WIDESPREAD cerebral calcifications |
Congenital Toxoplasmosis
|
|
|
How long is the treatment regimen for an infant born with congenital toxoplasmosis?
|
12 months
|
|
|
What causes localized ocular involvement with retinal lesions that look like yellow-white cotton patches and has irregular scarring and pigmentation.
|
Toxo (ocular)
|
|
|
What organism causes Vincent angina?
|
Borrella vincentii
|
|
|
What organism causes relapsing fever?
|
Borrelia recurrentis
|
|
|
What is the treatment for late, more severely affected individual with Lyme Disease?
|
Ceftriaxone 75-100 mg/kg/day OR PCN G 300,000 u/kg divided Q4 for 21 days.
|
|
|
How do you differentiate between Isospora belli and cryptosporidium caused diarrhea?
|
Acid Fast Stain
Isospora - large and oval Cryptosporidium - small and round |
|
|
What organism is only weakly acid fast, often missed and appears as beaded, branching and filamentous?
|
Nocardia
|
|
|
What is an anaerobic organism that causes infection and are characteristic clusters of organisms which usually affect cervicofacial infection?
|
Actinomyces
"sulfur granules" are clustered organisms |
|
|
What type of organism is chlamydia?
|
Obligate Intracellular
|
|
|
What type of chlamydia causes pneumonia and are found in birds?
|
Chlamydia psittaci
|
|
|
What type of chlamydia causes pneumonia and is not associated with birds?
|
Chlamydia pneumoniae
|
|
|
What type of chlamydia affects the eye?
|
Chlamydia trachomatous
|
|
|
How is chlamydia psittaci spread?
|
person to person
|
|
|
What is usually the drug of choice in prophylaxing for procedures with high risk of infections? (hysterectomy, joint replacement, etc)
|
Cefazolin
|
|
|
What organisms are more likely to be seen with patients who have chronic granulomatous disease?
|
Staphylococcus
Salmonella Serratia Aspergillus |
|
|
What causes Weil Syndrome and what is Weil Syndrome?
|
Severe hepatitis with renal failure and hemorrhagic complications caused by Leptospirosis
|
|
|
What organism should be suspected after contact with dog or rat urine?
|
Leptospirosis
|
|
|
How do cultures usually change with leptospirosis infection?
|
Blood cultures positive initially (4-7) days
Urine cultures positive afterward PCR and Serology more useful |
|
|
How is Leptospirosis treated?
|
Penicillin or Doxycycline
|
|
|
What forms of tick can transport Lyme disease?
|
Ixodes Pacificus (California)
|
|
|
What type of tick carries both Lyme disease and Babesia?
|
Ixodes Scapularis
|
|
|
What infection in Arkansas and Missouri is much more common than lyme disease? (so lyme is rarely seen)
|
Ehrilichiosis
|
|
|
What is characterized by an initial lesion similar to a spider bite with either a clear or bulls eye center? Can have myalgias, headache, fever,lymphadenopathy and arthralgias.
|
Stage 1 Lyme Disease
|
|
|
What is characterized by recurrent erythema migrans, neurologic problems, heart problems, neuritis, cranial nerve palsy, foot drop, etc.
|
Stage 2 Lyme Disease
|
|
|
What is characterized by arthritis (usually large joints) chronic neurologic syndromes, and an often perplexing picture?
|
Stage 3 Lyme Disease
|
|
|
What percentage of patients with stage 3 Lyme Disease have positive serology?
|
10% - So 90% don't
Don't worry about test - just treat |
|
|
What is pathognomonic for Lyme Disease?
|
Erythema migrans
|
|
|
What is treatment for early Lyme Disease?
|
Oral doxycycline 100 mg BID or Amoxicillin for kids < 8 for 21 days.
|
|
|
What is the treatment in mild to moderate cases of listerosis?
|
Ampicillin (high dose)
|
|
|
What is treatment of choice for serious/resistant listerosis?
|
Ampicillin and Aminoglycoside
|
|
|
What is the treatment of choice for listerial meningitis?
|
Ampicillin (high dose) and Aminoglycoside
|
|
|
What is treatment of corynebacterium and what does it do?
|
Treatment is erythromycin but only makes patient less contagious - it is not therapuetic. Need to give DIPTHERIA ANTITOXIN with antibiotic
|
|
|
What do you do after patients have recovered from diptheria?
|
Immunize them with diphtheria toxoid
|
|
|
How do you treat pharyngitis caused by Arcanobacterium haemolyticum?
|
Penicillin, Erythromycin or Tetracycline
|
|
|
What is the treatment of choice for anthrax?
|
Penicillin G or a Quinolone
|
|
|
What is used for prophylaxis for exposures to anthrax?
|
Cipro for 30-60 days
|
|
|
What is the treatment of choice for c. diff?
|
Stop the antibiotics and give 7-14 days of metronidazole
|
|
|
If a child has c diff and is treated with metronidazole and gets better, then returns 2 weeks after resolution with a relapse, what do you treat her with?
|
Metronidazole
|
|
|
When do you use bacitracin, rifampin and cholestyramine in the treatment of c. diff?
|
As adjuvant therapy in complicated cases
|
|
|
What presents as either generalized, with widespread distribution of toxin or localized with toxin only near the portal of entry?
|
Tetanus
|
|
|
What is the incubation period for clostridium tetani?
|
5-12 days
|
|
|
What is usually seen with the majority of patients with clostridium septicum sepsis?
|
A GI malignancy (usually in adults)
|
|
|
How is tetanus neonatorum treated?
|
-Provide quiet, stimulus-free environment
-continuously administered neurologic blocking agents -mechanical ventilation -IV fluids and nutritional support -TETANUS ANTITOXIN -METRONIDAZOLE |
|
|
How is tetanus prophylaxed for a clean wound and immunizations are up to date with most recent tetanus < 10 years?
|
No treatment necessary
|
|
|
How is tetanus prophylaxed for a dirty wound and immunizations are up to date (most recent tetanus <5 years)?
|
No treatment necessary
|
|
|
How is tetanus prophylaxed for a dirty wound and either the child has less than 3 tetanus shots or the immunization history is unknown?
|
TIG (tetanus Immune Globulin) and immunize with DTap < 7 years, Td/Tdap or Tdap if 10-21 years
|
|
|
What should be checked in all patients with meningococcal bacteremia or meningitis have checked?
|
A CH50 and CH100 assay
|
|
|
What complement deficiencies are most likely to leave a child prone to meningococcemia?
|
deficiency of C5-C9
|
|
|
What illness presents with fever, hypotension, diffuse purpuric lesions and DIC?
|
Meningococcemia
|
|
|
What is a common complication of meningococcal meningitis?
|
Hearing loss
|
|
|
What is the treatment of choice for meningococcemia?
|
Penicillin G
if allergic then 3rd gen cephalosporin or chloramphenical |
|
|
What should be done if an infant presents with bloody green or serosanguinous discharge from the eyes within the first two weeks of age?
|
Culture for gram stain, C&S (look for gonnorhea and chlamydia)
|
|
|
How is opthalmia neonatorium treated?
|
Rocephin 50mg/kg IV x 1 but 2-3 days may be needed until cx comes back
|
|
|
What are the three clinical stages of pertussis?
|
Mild URI (catarrhal)
Cough with inspiratory whoop (paroxysmal) Symptoms resolve over weeks to months (convalescent) |
|
|
How are neonatal (> 1 month of age) patients treated for pertussis?
|
Azithromycin, Erythromycin, Clarithromycin
|
|
|
How do you treat pertussis if they are macrolide antibiotic allergic?
|
Bactrim
|
|
|
How is pertussis treated in infants < 1 month of age? why?
|
Azithromycin is recommended because of increased risk of increased pyloric stenosis with erythromycin (despite it not being approved < 6 mos of age)
|
|
|
How is pertussis exposure (contacts) treated?
|
Same as for treatment and is recommended for all household and daycare contacts, and booster doses of Tdap for those 11-18
|
|
|
What presents with diarrhea progressing to dysentery and can cause rectal prolapse, bandemia & seizures
|
Shigella
|
|
|
What has the classic triad of kidney failure, thrombocytopenia with purpura and hemolytic anemia?
|
Hemolytic Uremic Syndrome
|
|
|
What is the treatment of choice for Enteroemmorhagic E coli (EHEC)?
|
Supportive care.
NO ANTIBIOTICS as they increase the risk of HUS. |
|
|
What presents with bloody diarrhea, hemorrhagic colitis, thrombocytopenia, hemolytic anemia & kidney failure?
|
Enterohemorrhagic Ecoli
|
|
|
What are the eleven criteria for Systemic Lupus Erythematosus and how many are needed to make a diagnosis?
|
4 of the following
-malar rash -discoid rash -oral ulcers -photosensitivity -arthritis -serositis -hematologic manifestations -CNS manifestations -Nephritis -Immune manifestations -Elevated ANA |
|
|
What immune manifestations (labs) are in the criteria for diagnosing SLE?
|
+ anti-double-stranded DNA
+ anti-Smith-antibody false + for syphyllis (VDRL) increased antiphospholipid antibodies |
|
|
What is the strongest risk factor for atopy
(allergy, asthma, food allergy, eczema, atopic derm) developing in a child? |
A history of atopy in a first-degree relative or parent.
|
|
|
What presents as a petechial rash, meningitis, septic arthritis, seizures, buccal cellulitis with complications of subdural empyema, brain infarcts, cerebritis, ventriculitis, abscess, hydrocephalus and death.
|
H. flu meningitis
|
|
|
How frequently are there long term sequelae from those who survive H flu meningitis and what are the sequelae?
|
15-30 of survivors have:
-sensorineural hearing loss -language disorders -mental retardation and/or developmental disorders |
|
|
What is the treatment of H. flu meningitis?
|
Ceftriaxone or Cefotaxime
AND Dexamethasone 0.6mg/kg/day divided Q6 hrs x 2 days to prevent hearing loss and neurologic sequelae. |
|
|
What presents as abrupt onset of high fever, dysphagia, drooling and "cherry red" epiglottis?
|
H. flu epiglotittis
|
|
|
What presents similar to epiglotittis but is more common now that we have Hib vaccine? What causes it?
|
Bacterial tracheitis due to staph aureus.
|
|
|
What infections did H. flu cause prior to Hib vaccine?
|
meningitis
septic arthritis osteomyelitis buccal cellulitis periorbital cellulitis occult bacteremia pneumonia |
|
|
How does H. flu occult bacteremia present and what does it evolve into?
|
It results in 30-50% developing meningitis or other deep focal infection.
|
|
|
Prior to Hib, how did pneumonia present?
|
With pleural effusions and 90% had positive blood cultures.
|
|
|
What is treatment of invasive H flu? What is treatment of noninvasive H flu?
|
Invasive - 3rd generation cephalosporin
Noninvasive - Amoxicillin |
|
|
Who gets prophylaxis and what is used for contacts of patients with invasive H. flu?
|
Rifampin 20 mg/kg (max 600 mg) Qday x 4 days to household contacts and daycare attendees.
|
|
|
How is plague treated?
|
Streptomycin with 2nd line choices of tetracycline or quinolones
|
|
|
What organism is a small gram-negative cocobacillus that contaminates food, milk, water, and pork (especially "chitterlings")
|
Yersinia Enterocolitica
|
|
|
What presents in older children and adolescents with "pseudoappendicitis syndrome"
|
Yersinia Pseudotuberculosis
OR Yersinia Enterocolitica |
|
|
What are adults likely to present with if they have Yersinia infection?
|
reactive arthritis
|
|
|
What type of bacteremia occurs in very young and in those with iron overloads (especially in children who are transfusion-dependent with sickle cell disease, aplastic anemia)
|
Yersinia infection
|
|
|
What can cause diarrhea, CNS symptoms, headache, delerium, confusion, pneumonia that looks like mycoplasma pneumonia?
|
Legionella pneumophilia
|
|
|
What types of pneumonia look much worse on CXR than clinical presentation?
|
Legionella pneumophilia
Mycoplasma pneumoniae |
|
|
Klebsiella can cause pneumonia, bacteremia, meningitis and UTIs, but is universally resistant to what?
|
Ampicillin
|
|
|
What causes culture-negative endocarditis, lung infections, GI tract infections, orchitis, abortion, SIADH, thyroiditis, adrenal insufficiency, osteoarticular disease, sacroillitis, and granulomatous hepatitis?
|
Brucella - often transmitted by handling carcasses of animals or unpasturized milk or cheese.
|
|
|
What should you look for if the patient has been to the desert southwest and becomes ill?
|
Plague
|
|
|
What should you look for if the patient has been to Arkansas, Missouri or Oklahoma and becomes ill?
|
Tularemia
|
|
|
What presents with a sudden onset of fever, chills, myalgias and arthralgias followed by "ulceroglandular form" ulcer at site of innoculation?
|
Franisella Tularensis
(tularemia) |
|
|
What do you treat tularemia with?
|
Gentamycin
Tetracycline Streptomycin |
|
|
What is characterized by > 3 weeks of chronic, tender, regional cervical/axillary lyphadenopathy, a primary skin lesion (small, nondescript, pink papule) which persists for months then resolves?
|
Bartonella henselae
|
|
|
What causes bacillary angiomatosis in immunocompromised patients?
|
Bartonella henselae
|
|
|
What is the most common cause of head injury in infants < 1 year?
|
Shaken baby or other child abuse.
|
