Pediatric Infectious Disease

Front 1

Toxic Shock Syndrome

Back 1

Temperature greater than 102 (39). Desquamating rash (palms and soles). Greater than three organ systems. Strep P Cx positive. Penicillin + clinda. Staph Cx neg. Oxycillin + clinda. (if pcn + clinda on exam, look for TSS)

Front 2

MRSA

Back 2

ClinDamycin (D test). Hospitalized - IV vanc. Endocarditis add refampin or gent.

Front 3

Strep pneumo

Back 3

Intermediate resistant. Cephotax or Cephtrix. Highly resistant or meningitis add Vanc.

Front 4

Grouip A Strep (strep pyogenes)

Back 4

Pharyngitis. If any URI symptoms, do not check for strep. Tx prevents scarlet fever, not PSGN. Toddlers (strep fever). Low grade fever; adb pain; purulent nasal discharge.

Front 5

Scarlet Fever

Back 5

Pharyngitis with rash (rash d/t exotoxins). Sandpaper rash prominent in flexor creases = pastia lines (pathopneumonic for Group A Strep).

Front 6

Erysipelis

Back 6

Group A Strep. Tender skin; rash with a well demarcated line that moves quickly (if patient is marked w a line for a rash, it's step).

Front 7

Neonatal Group B Strep (strep agalactiae)

Back 7

Early up to 6 days (after that, 1 hour). Mom with complications (may say not able to test Mom). Septocemia and pneumonia. Late (7 days to 3 months) Bacteromia w/o focus; meningitis; osteomyelitis (prox humerus). Late-late: (greater than 3 months) premature or IV lines (previous or current) bacteremia w/o focus.

Front 8

How do you diagnose and treat Group B Strep?

Back 8

Blood cx is gold standard. Antigen detection. Use only if already on antibiiotics. Serum or CSF (do not use urine antigen). Treatment: Amp and Gent initially, then pcn: pneumonia/sepsis 10 days; mening 14 days; amd osteo 3-4 wks.

Front 9

Enterococcus

Back 9

Newborn UTI or sepsis. Amp + Aminoglycoside. Check sensitivities (VRE). Linezolid.

Front 10

Lysteria

Back 10

Goats, goat cheese, or undercooked hot dogs. California or Mexico. Diphtheroid organisms. Amp + Gent.

Front 11

6 yo born in Russia w sore throat; temp 100; gray-white pharyngeal membrane. What is diagnosis and treatment?

Back 11

Corynebacterium diptheriae. Treatment (erythro or pcn AND Antitoxin).

Front 12

Bacillus anthracis

Back 12

Patient handling hides or wool. Painless papule to ulcer to black eschar. Bioterror: Outbreak in patients all at the same place. Does not require isolation. Pneuomonia (wide mediastinum).

Front 13

Bacillus cereus

Back 13

Emetic (1-6 hours); diarrheal (8-16). Top to bottom, brews inside=enterotoxin.

Front 14

Tetanus immunization: who gets what?

Back 14

Dirty wound and < 3 immunizations or history unknown = TIG+Vaccine (no TIG if > 3 IMM). Clean and > 10 years or dirty and > 5 years: less than 7 years: DTaP. 11 or older: Tdap (only 1 in lifetime), then Td.

Front 15

Neisseria meningitidis

Back 15

Fever; hypotension; diffuse purpuric lesions and petichaie. Treatment: Ceftriaxone. Prophylaxis: household contacts, daycare, significant others = Refampin unless pregnant, then Ceftriaxone

Front 16

Neisseria gonorrhea (GC)

Back 16

GC = Girls Cx, males gram stain (gram - diplococci). Treatment: Ceftriaxone.

Front 17

Gonococchial opthalmia

Back 17

2-7 days after delivery. Bloody, green or sansuinginous eye discharge. Evaluation: gram stain discharge and do a septic workup. Treatment: Ceftriaxone 125 mgs x 1. Less than 2 days usually chemical reaction. 7-14 days: Chlamydia.

Front 18

Pseudomonas

Back 18

Nail through a tennis shoe. IV drug users. Endocarditis/osteomyelitis. Diabetics. Chronic otitis externa. ALL patient. Ecthymia gangrenosum. Round indurated black lesion (pseudomonal bacteremia).

Front 19

Burkholderia

Back 19

Common in CF; bad prognostic sign; treat with Meropenum.

Front 20

Salmonella non-typhi

Back 20

Reptiles; eggs; peanut butter; raw chicken. Causes diarrhea; do not treat. SAL runs like a reptile and leave him alone.

Front 21

Shigella

Back 21

1-4 yo: daycare outbreaks often July-October. Person to person spread with as few as 10 organisms. Symptoms: rectal prolapse; bandemia and seizures. Treatment: 3rd gen cephalosporin or Azothromycin.

Front 22

E-coli

Back 22

ETEC, traveler's diarrhea. Treat with Bactrim. EHEC: (O157H57) Induces HUS. Triad of renal failure; thrombocytopenia w/ purpura; hemolytic anemia. Grows on sorbitol enhanced agar. DO NOT TREAT W ANTIBIOTICS.

Front 23

Legionella Pneumophilia

Back 23

Diarrhea, pneumonia, CNS (headache, delirium & confusion). Treatment: Azithromycin.

Front 24

Bartonella Henselae

Back 24

Cat scratch disease. Kids and adolescents: regional adenopathy, primarily in the axilla. DO NOT ASPIRATE. Serology is diagnostic. Treatment: none or Azithromycin.

Front 25

CiTrobacter

Back 25

Causes brain abscesses. Evaluate with a head CT.

Front 26

Hemophilis influenza (non-typeable)

Back 26

Causes many problems, including conjunctivits, OM, bronchitis, and newborn meningitis/bacteremia in first day (use Cephotaxime).

Front 27

H. Influenzae

Back 27

2-7 yo; dysphagia, drooling; cheery red esophagus. DO NOT examine w/ a tongue depressor, must maintain adequate airway.

Front 28

Occult bacteremia (H. Influenzae)

Back 28

ALWAYS TREAT even if only 1 positive blood cx. Treatment: 3rd generation cephalosporin. Chemoprophylaxis with Refampin (if prophylaxis is a choice w/ H. flu, choose it).

Front 29

Yercynia pestis

Back 29

Plague. Transmitted by fleas. Kid from the SW desert or bioterrorism attack. Bubonic lymphadenopathy that separates. Pulmonic. Very contagious by coughing. Hemorragic w/ fever. MUST BE IN AIRBORNE ISOLATION. Aspirate the lymph nodes. Treat w/streptomycin or Doxycycline.

Front 30

Which of the 3 diseases w/ severe lynphadenopathy should be aspirated?

Back 30

Yercenia. Suck out the pest, not the cat or the rabbit.

Front 31

Yercynia enterocolitica

Back 31

Diarrheal disease in infants, typical exposure to chitterlings. Bacteremia in patients with sickle cell disease. Psudoappendicitis.

Front 32

Francisella Tularensis (Tularemia)

Back 32

Arkansas or Missouri and a large lymph node. Primarily from rabbits eating or inhalation or self innoculation. Don't aspirate. Treatment: Streptomycin, Gentomycin, Tetracyclines.

Front 33

H. Flu Meningitis

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Most common sequelae 6 hrs to 2 days to prevent hearing loss. Give dexomethasone 0.6 mg/kg day. Divided Q6.

Front 34

Epiglottitus

Back 34

Cherry red epiglottus. Dysphagia and drooling. Do not examine with tongue depressor. Must maintain an adequate airway.

Front 35

H. Flu Bactermia

Back 35

Always treat even if only 1 positive cx. Treat w/3rd gen cephalosporin. Chemo prophylaxis (in propholaxis is a choice with H. flu, choose it). Refampin.

Front 36

Reckettsia Reckettesii (Rocky Mtn. Spotted Fever).

Back 36

Arthralgia, fever and rash. Tick exposure (often unknown). Rash is on distal palms and soles. Maculopapules. Hyponatremia. Diagnosis: specific immunifluorescent assay (NOT WHEAL FELIX}. Treatment: Doxy or Chloramphenicol. East Coast patient.

Front 37

Erlichia

Back 37

Tick borne, Missouri, OK, Arkansas (like Tularemia). Flu-like illness. Pancytopenia. Diagnosis: Serology, morula on smear.

Front 38

Micobacteria scrofulaceum or Avium intracellular

Back 38

Lymphadenitis in kids. Excise the nodes.

Front 39

Micobacterium marinum

Back 39

Fish tank bacillius. Skin ulceration. Lesions along lymphatic track.

Front 40

TB

Back 40

Children get it from adults. Most have no signs or symptoms. Infants and adolescents more likely to be symptomatic. Primary TB usually leads to latent TB. Most have no active disease with initial infection. Primary pulmonary disease. Adolescents, HIV, lower lobe. Late onset pulmonary diseases month to years after infection. Upper and apical lobes.

Front 41

TB meningitis

Back 41

6 mo - 4 yo, SIADH. Primarily in basal ganglia, enhances on MRI.

Front 42

Actinomyces

Back 42

SULFUR GRANULES. Causes PID if IUD present. Treatment: Penicillin or Tetracycline.

Front 43

Chlamydia psittaci

Back 43

Birds, pneuomonia and splenomegaly.

Front 44

Chlamydia trachomatis

Back 44

STACCATO COUGH. Pneumonia in first 4 mos of life. Newborns, eye ointments do not prevent. Treatment: Erythromycin.

Front 45

Leptospirosis

Back 45

Swimming w/ your dog. Hawaii. Conjunctival suffusion. Diagnosis: blood cx, after 1 week, urine. Treatment: PCN or Doxy.

Front 46

Invasive malassezia furfur

Back 46

Low birth weight, lipids, large liver and spleen, low platelets. Blood cx requires olive oil overlay. Treatment: Ampho B.

Front 47

Sporotorachum schenckii

Back 47

Pick and get stick. Berry pickers, florists tend to get it. Lesion ulcerates and progresses along nodes. Treat w/saturated solution of potassium iodide.

Front 48

Malaria

Back 48

Plasmodia falciparium. Blood smear w/banana gametocyte. Multiple parasites on one slide. Treatment: quinine + Doxy or Mefloquine. P Vivax and Malariae: Both tend to relapse.

Front 49

Babesia Microti

Back 49

Maltese cross in RBC. Febrile hemolytic anemia. Hemoglobinuria. Ixodes tick. Nantucket. Treatment: Clindomycin + quinine. IF severe, exchange transfusion, then antibiotics.

Front 50

Toxocariasis

Back 50

Children 1-4 yo. Visceral larva migrans. Migratory pneumonia. Eosinophillia. Elevated isohemoglutenens. Treatment: Mebendazole.