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85 Cards in this Set
- Front
- Back
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What temp is considered a fever?
100.0 102.4 100.4 101. 2 |
100.4 or 38.0
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What is the most common cause of febrile illnesses in children?
viral bacterial |
viral
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Which organisms are likely to cause infxn in infants less than three months of age?
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pathogens acquired during birth such as E.Coli, Klebsiella, enterococcus, strep group B, and Listeria
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What is the most common cause of serious infection in older children and adolescents?
S. Pneum S. Aureaus N. Meningitidis H. Influenza |
N. Meningitidis
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What is the most common cause of bone and joint infections?
S. Pneumo S. Aureaus H. Flu |
S. Aureus
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What is the most common organism found in blood cultures from kids with occult bacteremia?
S. Pneumo H. Influenza S. Aureus N. Mengitidis |
S. Pneumo >90% of the time
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What bacterial organism is most commonly assoc. with AOM?
S. Pneumo H. Influenza S. Aureus N. Mengitidis |
S. Pneumo and RSV
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What is the most common bacterial cause of phayngitis?
S. Pneumo H. Influenza S. Aureus N. Mengitidis S. Pyogenes |
S. Pyogenes (GABHS)
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A 6 y.o. child is brought to the ER by mom with c/o 4 days of pharyngitis complaints, now the child has a fever of 103.5, is having difficulty swallowing, has changes in speech and upon inspection has a deviated uvula, what is the most likely diagnosis?
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peritonsillar abscess
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Why is it important to treat GABHS?
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prevent rheumatic fever
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What is the diagnostic test of choice for GABHS?
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throat culture
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A pt. comes in w/ c/o 2 days of URI and has now developed a barky cough, fever and inspiratory stridor, what is it?
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croup
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what is the tx of croup?
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supportive, cool humidified air helps with the stridor, racemic epi decreased obstruction, and steroid therapy decreases duration and severity of symptoms.
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__ aka laryngotracheobronchitis is an acute respiratory illness resulting from inflammation and narrowing of the subglottic region of the larynx.
-stridor -rsv -croup -epiglottis |
croup
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what is the DOC for HSV encephalitis?
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acyclovir
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how are members of the herpesvirus family similar?
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all have a latent phase
all are intracellular, the latent phase allows for reactivation at some point |
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name four viruses which cause cold symptoms?
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rhinovirus
parainfluenza coronavirus adenovirus |
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name four virus families which cause central nervous system infection.
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togavirus
herpesvirus flavavirus coronavirus |
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a lab slip returns which says "coag negative staph" what does this mean and what is the likelihood that this organism is sensitive to methicillin and cephalosporins?
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staph epidemidis-can also be d/t UTI's or instrumentation
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During a laparotomy for a ruptured appendix with peritonitis, a culture is taken, what will it show?
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stool organisms, ecoli, anarobes
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name 2 characteristics of anaerobic infections?
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pilonidal cysts-smells horrible
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name 5 disease conditions which result largely from toxin production.
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botulism
tetanus c diff colitis TSS scarlet fever diptheria scalded skin syndrome |
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two days after a bld culture is drawn, the lab reports gram positive cocci. This pt. is a 10 month old with fever and no other identifiable clinical infxn. The child is not afebrile and looks good. What organism possibilities could be growing in this bld culture?
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staph epidermidis
staph aureus |
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an LP on a very ill 8 mth old in which the fluid is cloudy, gram stain shows many WBCs and gram positive cocci. What organism is likely causing the meningitis? What organism would be likely if the gram stain showed gram negative cocci?
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+ pneumococcus
- n. meningiditus |
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A new PA student orders a stool gram stain, what is the likely results?
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laughter, don't do it. If you want something order a stool smear to look for leukocytes.
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if staph epidermidis grows from a bld culture, how can one determine whether this is a contaminant or a staph epidermidis bacteremia?
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look at your pt! if they are fine, was contaminant, if sick then treat
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how does a bacteriostatic antibiotic behave in a bactericidal fashion?
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levels of the abx available at the point of infxn. with inc. drug levels will act as cidal and not static.
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how does a bacteriocidal abx act as a bacteriostatic fashion?
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low drug levels-will inhibit but not kill bacteria
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t/f
both pcn's and cephalosporins cross the blood brain barrier so either are good for meningitis. |
false; pcn crosses but cephalosporins to not
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defining an elevated temperature is difficult and variable because the 'normal' core temp is not a fixed value, and the methods of measuring temperature have varying degrees of accuracy.
-true -false |
true
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ibuprofen has a superior antipyretic effect compared to acetaminophen.
true false |
false; equally effective
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temperatures above 40 C result in febrile seizures in most patients.
true false |
false; risk for seizures is not the max temp but the time it takes to get up to max temp
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teething is known to cause fever.
true false |
false; may be a small rise but will not be out of normal range
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febrile children at risk for occult UTI's include those with a temp above 39 C. what is the commonly used age ceiling for bays and girls?
-3 mths for boys, 12 mth for girls -6 mths for boys, 18 mth for girls -12 mths for boys, 48 mth for girls |
6 mths for boys, 18 mths for girls
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t/f
any kid under the age of 3 mths with a fever needs a cxr only. |
false; these kids need a septic workup
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a high fever may cause brain damage.
true false |
false; brain can tolerate significant temp elevation
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t/f
cat scratch disease is usually transmitted by flea-infested kittens. |
true; the flea is the reservoir for the cat to cat transmission
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t/f
cat scratch disease is more common in dry, desert-like areas, as compared to humid climates. |
false; cat fleas require humid environment
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t/f
adenopathy d/t cat scratch disease usually develops rapidly, within a few hours |
false; usually takes 7-14 days. Look for a 'bump' by the scratch
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t/f
when pt's have hepatosplenic cat scratch dx their liver fcn tests are always abn, and they always have concomitant lymphadenopathy. |
false; LFT's usually nml, not always LNopathy.
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t/f
azithromycin is the only antibiotic that has been shown to be effective in the tx of typical CSD lymphadenopathy in a dbl-blind, placebo controlled trial. |
true; but you don't necessarily have to tx bartonella, it is self limiting
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t/f
serology is the diagnostic test of choice for CSD. |
true; bartonella antibody test
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when is the peak age of OM?
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6-18 months
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what are some risk factors for OM?
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smoking
daycare previous OM cleft palate HS bottle |
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what are the 3 MC organisms that cause OM?
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s. pneumo
H. flu moraxella |
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what abx is the DOC against OM?
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amoxil 90-100mg/kg/day divided into 3 doses
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what are the 3 second line antibiotics recommended by the CDC if amoxil fails?
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Augmentin
cefuroxime ceftriaxone |
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for what reason should you treat chronic otitis media with effusion with either abx or Pe tubes?
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to prevent hearing loss
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what are some complications of OM?
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perforation
mastoiditis otitis externa brain abcsess meningitis hearing loss |
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what is the most common organism cultured in otitis externa?
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pseudomonas
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what are four factors that can predispose a pt. to develop otitis externa?
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dampness (swimmer's ear)
excema lack of cerumen trauma |
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what can be instilled in the ear to prevent OE in an OE prone child?
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ETOH
acetic acid 1/2 etoh, 1/2 vinegar |
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how long do you have to treat a strep infxn to prevent scarlet fever?
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9 days
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a 12 y.o. boy with 4 days of a sore throat, afebrile, has rhinorrhea, cough and one day of diarrhea assoc. with his sore throat. throat is mildly erythematous.
-culture, give 10 d. of abx for group a strep -culture, withhold abx unless culture is negative -advise him on sx treatment -give abx without testing for group A strep |
culture, withhold abx unless his culture comes back positive.
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A 14 y.o. boy, known prostitute comes in for c/o sore throat, rash and pronounced fatigue. Exam shows, exudative pharyngitis. Tests to consider include all except?
-throat swab for strep -hiv antibody -throat swab for gonorrhea -monospot for EBV |
hiv antibody-instead do B24 antigen or reverse transcriptionase test
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A 3 y.o. is very fussy, febrile, and has profuse rhinorrhea. On exam, shallow ulcers are noted on the soft palate and vesicles are noted on one palm and both soles of feet. this is ?
-group a strep -a. hemolyticum -coronavirus -coxsackievirus |
coxsackievirus aka: hand, foot and mouth disease.
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the diagnosis of AOM is a reliable explanation for a high fever, thus eliminating the need for other diagnostic considerations in a pt. with an otherwise benign examination.
true false |
true; unless under 3 mths of age-do a septic workup.
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a 3 y.o. boy with a bad h/a, nausea, photophobia and fever. Immunizations UTD, he is not toxic in appearance. Mild photophobia, alert and cooperative, mild nuchal rigidity. If this pt has meningitis does he have bacterial or viral? and why?
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viral d/t age, viruses are more common the older you get and the baby has had immunizations.
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An LP shows 3 RBC, 200 WBC, 70% segs, 10% lymphs, 20% monos, protein 45, glucose 50. Gram stain of the CSF shows many WBC's and no organisms. Is this CSF indicative of viral or bacterial meningitis.
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viral, with bacterial meningitis the segs would be >90%
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what are the 3 MC bugs that cause meningitis and what abx covers the with close to 100% certainty?
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H. Flu
meningiococcus pneumococcus tx with ceftriaxone |
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a CSF sample shows: WBC 1243, 94% neutrophils, 23 glucose, bld glucose 73, 62 protein. is this viral or bacterial?
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bacterial as the % of neutrophils is >90%
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A CSF sample shows 5 WBC, 1% neutrophils, 65 glucose, 85 bld glucose, 21 protein, what is this?
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normal CSF
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A CSF sample shows 90 WBC, 60% neutrophils, 50 glucose, 87 bld glucose, 48 protein. what is this?
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viral meningitis
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which of the following viruses are most commonly associated with viral croup?
-adenovirus -HPV -varicella virus -parainfluenza virus -RSV |
parainfluenza virus
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t/f
An acutely ill child presents to the ER with the s/s of acute epiglottitis. The dx should be confirmed with direct visualization of the epiglottis? |
false; don't mess with the throat unless you have an ENT, surgeon or anesthesiologist present.
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which of the following is/are true?
-there is good evidence from RCT that mist therapy is effective for the tx of croup. -abx are indicated in the tx of croup -nebulized albuterol is effective in the tx of croup. -dexamethasone has been shown to be effective in the tx of croup. |
dexamethasone has been shown to be effective in the tx of croup.
there are no RCT racemic epi is better than albuterol no abx |
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which of the following is/are true?
-croup affects more girls than boys -croup shows no seasonal prevalence -most cases occur in teenagers -it is a common respiratory infection in children. |
it is a common respiratory infection in children
boys>girls fall/early winter |
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t/f
once a child with croup has been given corticosteroid tx and reacemic epi, they may safely be discharged home after 20-30 min. of monitoring. |
false; watch for at least a couple of hours
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t/f
the MC pathogen in acute hematogenous osteomyelitis is Group A Strep. |
false; group A staph aureus
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t/f
a sequestration is an area of loose necrotic bone that is a result of acute osteomyelitis. |
true
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t/f
The duration of abx therapy for acute hematogenous osteomyelitis is typically 7-10 days. |
false; at least 4 weeks.
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t/f
plain xrays will always show bony changes withing the first few days of the onset of acute osteomyelitis. |
false; it takes a week, if highly suspect get an MrI or bone scan.
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t/f
the MC bone involved in acute hematogenous osteomyelitis in children is the tibia. |
false: the femur is MC, 2nd is tibia
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t/f
Osteomyelitis has a propensity to involve the diaphysis of the long bones. |
false; metaphysis
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what is the DOC for staph aureus osteomyelitis?
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vanco
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A 5 y.o. with a slapped face appearance, that is UTD on immunizations, has a moderate fever relieved by tylenol. After the next several days a faint pink rash appears on the trunk and extensor surfaces of his upper extremities. what do you think it is?
-exanthem infectiosum (5ths dx) -exanthem subitum -hand/foot/mouth disease -varicella -measles |
exanthem infectiosum
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Sx's of congenital rubella include all of the following except:
-congenital heart disease -hydrocephalus -deafness -microphthalmia -zig-zag scarring |
not hydrocephalus
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your pt has varicella, her aunt is pregnant and not immune to chickenpox. When is the soonest the aunt can visit the pt?
-now -when the lesions crust over -when the lesions are all gone -2 mths after lesions heal -after delivery |
when the lesions crust over
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3 y.o. pt is seen for several days of fever and refusal to eat. Pe shows slightly dehydrated child with punched out, painful oral ulcers w/ assoc. small red macules on the palms and soles. What tx with you recommend?
-rest and fluids -rest, fluids, vanilla ice cream -rest, fluids, ice cream, acetomenaphin -rest, fluids, tylenol, acyclovir -rest, fluids, tylenol, cipro |
rest, fluids, tylenol, and vanilla ice cream
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which one of the following is not a finding in HIV wasting syndrome (failure to thrive)?
-<5th % on wt for ht on 2 measurements -chronic diarrhea -persistent wt. loss -temp of 38.5 intermittently for 2 mths -thrombocytopenia |
thrombocytopenia
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which one of the following is used as a screening test in HIV infxn diagnosis?
-enzyme immunoassay -PCR -western blot -immune fluorenscence assay -viral culture |
enzyme immunoassay- looking for antibodies
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which of the following vaccines is not routinely recommended in HIV infected asymptomatic children?
-IPV -MMR -Hib -Pneumoccal -Varicella |
varicella
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which of the following is a definite indication to start antiretroviral tx in HIV infected children?
-CD4 count >1500 in a asymptomatic 4 y.o. -Pneumocystis jerovicii pneumonia -recurrent otitis media but no other sxs -b/l anterior CLadenopathy |
pneumocystis jerovicii pneumonia is an AIDS defining condition
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which one of the following is/are not shown to be a transmission route for HIV infxn?
-vertical transmission -breast feeding -vectors -bld transfusion -heterosexual sex |
vectors
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which of the following enzymes have critical importance in the establishment of HIV infection?
-neuroaminidase -DNA polymerase -protein kinase -RNA polymerase -reverse transcriptase |
reverse transcriptase
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