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53 Cards in this Set

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_______ may be given to the pt who APPEARS WELL, but has no source for fever & has a WBC COUNT > 15,000
Ceftriaxone
If meningitis with S. pneumoniae is a possibility, then _____ should be added to the regimen
Vancomycin
What are the 3 bacteria that MCC Meningitis in patients < 3 months of age?
GBS

L. monocytogenes

E. coli
What are the 3 MCC of Meningitis in pts > 3 months old?
N. meningitides

S. pneumoniae

HiB
Patients with CSF shunt infections may have _______ infections
S. epidermidis
Pts with Sick Cell Disease & CSF leaks are prone to _______ infections
Pneumococcal
What is the Brudzinksi sign?
involuntary flexion of the knees & supine hips after flexion of the neck while supine
What is the Kernig Sign?
flexion of the hip 90 degrees with subsequent pain on extension of the leg
Data suggest that the administration of ________ given to kids > 6 wks w/ acute bacterial meningitis may reduce the incidence of hearing problems, decrease fever, & lower CSF protein & lactate levels
IV Dexamethasone
When does Aseptic Meningitis usually occur?
Summer & Fall
When is the only time when Aseptic Mengitis is treated?
HSV = acyclovir
What drug is given to family contacts of pts with HiB & N. meningitides Meningitis?
Rifampin
Pts with Sickle Cell disease are predisposed to these 2 pathogens that can cause Osteomyelitis
S. auerus

Salmonella
________ infections may be associated with puncture wounds of the foot thru a sneaker causing Osteomyelitis
P. aeruginosa
A 12-month old infant presents to the physician with the CC of refusing to bear weight on his left lower extremity. The mother states that the child had an ear infection 1 wk ago. The patient was prescribed Abx, but the mother states she did not fill the prescription
Osteomyelitis
What is done to confirm the diagnosis Osteomyelitis?
Periosteal Bone Cx

Radiographs turn + after 10-14 days, showing soft tissue swelling & periosteal elevation

If radiographs are negative, but there is still a suspicion, then an MRI should be performed as the next step
What are the best ways to determine response to therapy of Osteomyelitis treatment?
ESR & C-reactive protein
How long is treatment for Osteomyelitis?
4-6 wks
A 5-yr old presents with fever, knee pain, & a limp. On physical examination the knee is red, warm, & swollen. Full ROM of the knee is not possible on physical exam
Septic Arthritis
In newborns, what bacteria are important agents of septic arthritis?
S. aureus

GBS

Gram-negative bacilli
What is the cause of Whooping Cough = forceful inspiratory gasp (whoop) after a paroxysmal cough
B. pertussis
What are the 3 stages of Pertussis?
Catarrhal: lasts 1-2 wks & consists of rhinorhea, conjunctival injection, & cough

Paroxysmal: lasts 2-4 wks & consisting of coughing spasms, insiratory whoop, & facial petechiae

Convalescent: lasts 1-2 wks w/ decreased frequency of symptoms
What does a CBC show in Pertussis Whooping Cough?
Leukocytosis caused by absolute Lymphocytosis
What is the treatment for Pertussis infection?
Supportive Care

ERYTHROMYCIN shortens the period of communicability
-family members should recieve for 14 days
-does not affect duration of Paroxysmal stage
Lyme disease
1. bacteria
2. vector
1. B. burgdorferi
2. Ixodes scapularis = deer tick
What is the presentation of Lyme Disease?
Early localized disease = Erythema Migrans = red-raised border with central clearing

Early disseminated = Neurologic & Cardiac
-Neurologic = "aseptic meningitis", Bell palsy, neuropathy
-Cardiac = myocarditis, heart block

Late = Arthritis
What is the treatment for Early disease Lyme Disease?

What is Rx for Disseminated dx?
Doxycycline or Amoxicillin
-kids <8 yo should not receive Doxy

Ceftriaxone or Penicillin G
What is the MC complication of Measles infection?
Otitis Media

Pneumonia & Encephalitis are other major complications
A 15-month-old infant is brought to the physician b/c of a RASH. The mother states that the pt had a FEVER of 104 F for the last 3 DAYS without any source of infection. She explains that the ever has resolved, but now the child has pink, slightly raised lesions on the trunk, upper extremities, face, & neck
Roseola = HSV-6
Explain the rash in Roseola
Before the rash physical findings are minimal but may include mild URI signs such as rhinorrhea & conjunctival redness. Occipital Lymphadenopathy may be found

Rash is rose colored & begins on the trunk & spreads to the neck, face, & proximal extremities
A 5 yo kid has low-grade fever, pinpoint rash, postoccipital & retroauricular lymphadenopathy, & rose spots on the soft palate
Rubella
How does the RMSF rash present?
begins on the extremities & spreads to the entire body, including the palms & soles, & which turn into petechiae
What is the treatment of choice for RMSF?
Tetracycline or Doxycycline
-chloramphenicol for pts able to take tetracycline
What are the complications if RMSF is not treated?
-Death
-Vasulitis = gangrene of digits, ear lobes, nose, scrotum, or entire limbs
-Meningoencephalitis
a 5 year old child is brought to the emergency center b/c he has a temperature of 102 F & is developing a pruritic rash. Rash appears to be in various stages of papules, vesicles, & crusts. It began on his trunk & spread to his extremities
Varicella = chicken pox
What is the cause of Whooping Cough = forceful inspiratory gasp (whoop) after a paroxysmal cough
B. pertussis
What are the 3 stages of Pertussis?
Catarrhal: lasts 1-2 wks & consists of rhinorhea, conjunctival injection, & cough

Paroxysmal: lasts 2-4 wks & consisting of coughing spasms, insiratory whoop, & facial petechiae

Convalescent: lasts 1-2 wks w/ decreased frequency of symptoms
What does a CBC show in Pertussis Whooping Cough?
Leukocytosis caused by absolute Lymphocytosis
What is the treatment for Pertussis infection?
Supportive Care

ERYTHROMYCIN shortens the period of communicability
-family members should recieve for 14 days
-does not affect duration of Paroxysmal stage
Lyme disease
1. bacteria
2. vector
1. B. burgdorferi
2. Ixodes scapularis = deer tick
What is the presentation of Lyme Disease?
Early localized disease = Erythema Migrans = red-raised border with central clearing

Early disseminated = Neurologic & Cardiac
-Neurologic = "aseptic meningitis", Bell palsy, neuropathy
-Cardiac = myocarditis, heart block

Late = Arthritis
What is the treatment for Early disease Lyme Disease?

What is Rx for Disseminated dx?
Doxycycline or Amoxicillin
-kids <8 yo should not receive Doxy

Ceftriaxone or Penicillin G
What is the MC complication of Measles infection?
Otitis Media

Pneumonia & Encephalitis are other major complications
A 15-month-old infant is brought to the physician b/c of a RASH. The mother states that the pt had a FEVER of 104 F for the last 3 DAYS without any source of infection. She explains that the ever has resolved, but now the child has pink, slightly raised lesions on the trunk, upper extremities, face, & neck
Roseola = HSV-6
Explain the rash in Roseola
Before the rash physical findings are minimal but may include mild URI signs such as rhinorrhea & conjunctival redness. Occipital Lymphadenopathy may be found

Rash is rose colored & begins on the trunk & spreads to the neck, face, & proximal extremities
A 5 yo kid has low-grade fever, pinpoint rash, postoccipital & retroauricular lymphadenopathy, & rose spots on the soft palate
Rubella
How does the RMSF rash present?
begins on the extremities & spreads to the entire body, including the palms & soles, & which turn into petechiae
What is the treatment of choice for RMSF?
Tetracycline or Doxycycline
-chloramphenicol for pts able to take tetracycline
What are the complications if RMSF is not treated?
-Death
-Vasulitis = gangrene of digits, ear lobes, nose, scrotum, or entire limbs
-Meningoencephalitis
a 5 year old child is brought to the emergency center b/c he has a temperature of 102 F & is developing a pruritic rash. Rash appears to be in various stages of papules, vesicles, & crusts. It began on his trunk & spread to his extremities
Varicella = chicken pox
A mother brings her 4 yo child to the physician with hx of Anal itching. The pt attends day care, & you are told that the child's favorite activity is playing in the sandbox

Dx?
Diagnostic tests?
Rx?
Enterobiasis = Pinworms
Cellophane tape test
Albendazole, Mebendazole, Pyrantel pamoate
A patient is brought to the physicians office b/c the mother found a worm in the diaper
Ascariasis
A 5 yo presents w/ complaint of anorexia, ab pain, & diarrhea. The pt is noted to have a yellow-green pallor
Hookworm = Ancylostoma duodenale, Necator Americanus