Use LEFT and RIGHT arrow keys to navigate between flashcards;
Use UP and DOWN arrow keys to flip the card;
H to show hint;
A reads text to speech;
108 Cards in this Set
- Front
- Back
Abx of choice for serious Staph infection
|
Vancomycin
|
|
Most common cause of osteomyelitis (not in sickle cell patients)?
|
Staph. aureus
|
|
If a child has a serious Staph bacteremia, what should you be suspicious for?
|
Endocarditis
Osteomyelitis |
|
-may be caused by either Staph or Strep pyogenes (post-op with chickenpox)
-staph : blood cxs negative -strep : blood cxs positive -presents with red skin, hypotension, fever, diarrhea, and hypocalcemia (don't treat unless symptomatic) |
Toxic shock syndrome |
|
-exfoliating dermatitis mediated by exfoliating toxin-NIKOLSKY sign
|
Staph Scalded Skin Syndrome (SSSS)
|
|
Most common cause of food poisoning in US?
|
Staph aureus, due to preformed enterotoxin
|
|
Coag negative Staph
|
S. epidermidis and S. saprophyticus
- S. epidermidis is almost always methicillin-resistant; most common cause of both catheter-related bacteremia and post-op bacteremia when anything foreign left in body (heart valves, VP shunts), also common "contaminant" -treat with vanc! |
|
If you don't have a functioning spleen, what 3 bacteria are you at risk for?
|
1. Strep pneumoniae
2. Neisseria meningitidis 3. H. influenzae |
|
Most common cause of AOM?
|
S. pneumoniae
|
|
Most common cause of bacterial pneumonia in children > 1 month?
|
S. pneumoniae
|
|
Most common cause of bacterial meningitis in infants >2-3 months?
|
S. pneumoniae
|
|
Empiric treatment for presumed S. pneumoniae meningitis?
|
Vancomycin + Cefotaxime or Ceftriaxone
|
|
Group A Strep presentation in children vs infants
|
Children: Temp>100F, Tender cervical LAD, exudative tonsils
Infants: Thick, purulent nasal discharge (streptococcosis), low-grade fever, decreased feeding |
|
Risk of rheumatic fever is alleviated as long as you start abx within ___?
|
9 days
|
|
Sandpaper-like rash that appears 24-48 hours in the illness, begins on the neck and upper chest, also prominent in flexor creases of antecubital fossa and produces "Pastia lines", lasts 1 week then DESQUAMATES especially in groin/axilla, SPARES the circumoral area (aka circumoral pallor)
|
Scarlet Fever
|
|
"Honey-crusted" skin lesions most commonly around the mouth, nose, and extremities
|
Impetigo, Strep pyogenes (aka Group A Strep), Treatment to cover for both strep and staph with Keflex (Cephalexin)
|
|
-caused by Strep pyogenes (aka Group A Strep)-skin infection of the more superficial, upper dermis layers
-well-demarcated, raised, and can cause lymphangitis |
Erysipelas |
|
-can be caused by Strep or Staph-skin infection the lower dermis and subq fat
-if Strep, can become necrotizing fasciitis, is a/w more severe pain and swelling, skin becomes bluish and dusky, then frank gangrene (RECENT VARICELLA INFECTION IS A RISK FACTOR) |
Cellulitis
|
|
Can cellulitis due to Strep pyogenes be responsible for rheumatic fever??
|
NO! However it can cause post-streptococcal glomerulonephritis
|
|
Treatment of Strep pyogenes (Group A strep)
|
-PCN
-if PCN allergic --> use cephalosporin -if PCN and ceph allergic --> use erythromycin or azithromycin |
|
Strep agalactiae (Group B Strep) - early vs late onset
|
Early onset: within first 3 days, usually due to pneumonia/septicemia
Late onset: after 3 days and up to 90 days, usually more focal, most concerning is meningitis |
|
Strep agalactiae (Group B Strep) - initial treatment
|
PCN G + aminoglycoside (gentamicin)
|
|
GBS screening
|
-occurs at 35-37 weeks gestation
-prophylaxis must occur at least 4 hours prior to delivery! |
|
Intrapartum GBS prophylaxis
Should PCN be given in these cases: -PROM > 18 hours? -Prior PCN tx during this pregnancy for + screen? -previous infant with invasive GBS? -intrapartum temp >100.4? -prior + GBS in previous pregnancy with recent - screen? -unknown + complicated or premature? -unknown + uncomplicated and term? -c/section with AROM and + GBS? |
-PROM > 18 hours? YES
-Prior PCN tx during this pregnancy for + screen? YES -previous infant with invasive GBS? YES -intrapartum temp >100.4? YES -prior + GBS in previous pregnancy with recent - screen? NO -unknown + complicated or premature? YES -unknown + uncomplicated and term? NO -c/section with AROM and + GBS? NO |
|
Most common organisms for endocarditis?
|
Viridans streptococci > mutans or bovis
|
|
Gram-positive diplococcus (looks similar to Strep) that causes bacteremia, sepsis, NEC Treatment? |
Enterococcus faecalis -treat with vancomycin, linezolid, or ampicillin (resistant to cephalosporins) |
|
Gram-positive diphtheroid (rod), can be seen in an infant and mother will have history of nodules on the placenta, or mild maternal fever with virus-like symptoms Treatment? |
Listeria monocytogenes -treat with ampicillin |
|
Gram-positive rod, causes low fever, sore throat, eventually a gray-white pseudomembrane forms on the tonsils and pharynx, swelling can be so bad it requires intubation, can lead to motor/sensory problems or myocarditis Treatment? |
Corynebacterium diphtheriae treat with erythromycin |
|
Gram-positive anaerobic rod, history of a puncture wound, causes uncontrollable muscle spasms, arched back or "lock jaw" treatment? |
Clostridium tetani debridement of infected tissue + tetanus Ig + metronidazole |
|
1. Wound is dirty + <3 tetanus or unknown 2. Wound is dirty + >3 tetanus and last within 5 years 3. Wound is clean + <3 tetanus or unknown 4. Wound is clean + >3 tetanus and within 10 years |
1. TIG + vaccine (Tdap or DTaP) 2. nothing 3. vaccine 4. nothing |
|
Gram-positive anaerobic rod, in a child <6 months old with PROGRESSIVE descending weakness, progressive ptosis and poor suck, urinary retention Treatment? |
Clostridium botulinum (toxin inhibits presynaptic release of acetylcholine) Supportive care |
|
sore throat, deviated uvula, difficulty opening mouth (trismus), drooling, "hot potato voice" Treatment? |
Peritonsillar abscess 2/2 Strep pyogenes (GAS) Treat with IV abs to cover for anaerobes - clinda and ampicillin-sulbactam (Unasyn), after I&D switch to augmentin |
|
fever, LAD, painful swallowing, drooling, hyperextension of the neck |
Retropharyngeal abscess |
|
Gram-negative coccobacillus, causes headache, lethargy, thrombocytopenia, petechiae, rash that starts at the wrists/palms/soles and spreads to the trunk in hours Associated with hyponatremia Treatment? |
Rocky Mounted Spotted Fever Doxycycline |
|
Appears similar to RMSF but has associated liver dysfunction? |
Ehrlichia |
|
brain abscess |
Citrobacter |
|
small, non-tender papules or shallow ulcers that resolve, then a TENDER UNILATERAL INGUINAL lymph node appears that can rupture, relieve pain and possibly drain for months treatment? |
Lymphogranuloma venereum (LGV) caused by Chlamydia Treat with Doxycycline |
|
obligate intracellular anaerobe,"intracytoplasmic inclusions" |
Chlamydia |
|
gradual onset of a nonproductive cough, low-grade fever, and malaise Laboratory findings often include a positive Coombs test and an elevated reticulocyte count secondary to hemolytic anemia and elevated (> 1:128) cold agglutinin titers. Diagnose with IgM. |
Mycoplasma pneumoniae |
|
unimmunized or asplenic kid with epiglottitis/bactermia/PNA/meningitis/otitis and Gram-negative "pleomorphic organisms" Treatment? |
Hemophilus influenzae Treat with Ceftriaxone |
|
3 stages of infection (catarrhal, paroxysmal, convalescent), inspiratory whoop with paroxysmal cough, 6-10 week duration Labs show elevated WBC count >20k Treatment? And what does treatment effect? |
Bordetella pertusis Treat with erythromycin (Use azithromycin if <1 month due to risk of hypertrophic pyloric stenosis) and all contacts given vaccine. *treatment only shortness the early stage of pertussis (catarrhal), it does NOT decrease the whooping or paroxysmal stage! |
|
history of nail puncture wounds or "hot tub rash", causes osteomyelitis, PNA in CF kids, otitis externa... Treatment? |
Pseudomonas aeruginosa Treat with anti-pseudomonal drugs: ceftazidime, cefepime, ticarcillin, piperacillin, gentamycin, tobramycin |
|
febrile patient with green, malodorous diarrhea (may be bloody) associated with food, so look for a history of a recent picnic (ex: cream, poultry, and eggs). or PET IGUANAS Treatment? |
Salmonella non-typhi does NOT require antibiotic treatment (unless immunocompromised then Ceftriaxone) * Treating can cause a carrier state and prolong shedding |
|
fever, diarrhea, abdominal pain, and “ROSE SPOTS” ( small, flat, rose-colored macules) with PERSISTENT FEVER after the diarrhea has resolved |
Salmonella typhi (aka Typhoid fever) Treat with Ceftriaxone |
|
fever, vomiting, "appear ill", watery diarrhea that progresses within HOURS and becomes bloody with TENESMUS, spread by person-to-person contact (highest in daycare centers!) complications include rectal prolapsed and seizures Labs show BANDEMIA Treatment? |
Shigella Treat sicker patients with ceftriaxone or azithromycin |
|
bloody diarrhea with kidney failure, thrombocytopenia with purpura, hemolytic anemia Treatment? |
EHEC (Enterohemorrhagic) O157:H7 E.coli NO ABX! Contraindicated |
|
non-bloody diarrhea with cramps, fever, vomiting, recently went on vacation Treatment? |
ETEC (Enterotoxigenic) E.coli "Traveler's diarrhea" Self-limited, loperamide is ok |
|
watery/mucoid/bloody diarrhea, TENESMUS, liver abscesses, takes WEEKS to develop, history of travel to SW US/Mexico |
Entamoeba histolytica (aka Amebiasis) Treat with metronidazole if colitis or liver abscesses present |
|
non-bloody diarrhea with fairly quick onset (about 10 hours), ingestion of raw turkey or raw beef |
Clostridium perfringens |
|
ingestion of raw pork or unpasteurized milk, fever and diarrhea, can cause PSEUDO-appendicitis, erythema nodosum, reactive arthritis |
Yersinia enterocolitica |
|
diarrhea with FAST onset (within 1-8 hours) - one is associated with eating rice |
Staph aureus and Bacillus cereus diarrhea (rice) |
|
intermittent watery diarrhea for weeks, history may include camping or child in daycare |
Giardia Diagnose by STRING test + ELISA Treat with metronidazole |
|
history of bird exposure, travel to NW US, causes cavitary pneumonia, meningitis, or disseminated (more often in T-cell deficient patients) |
Cryptococcus Treat meningitis or disseminated with amphotericin Treat pneumonia with fluconazole |
|
broad-based budding yeast, usually found near water, can present as pneumonia or flu-like illness, skin lesions |
Blastomycosis |
|
recent travel out SW US (Arizona, California, Texas), pneumonia with coin lesion or flu-like illness |
Coccidiodomycosis |
|
recent travel to Mississippi or Ohio River valleys, flu-like illness, interstitial pneumonia, palate ulcers, splenomegaly, mediastinal/hilar calcifications (can look like TB) |
Histoplasmosis |
|
asthmatic that worsens despite treatment with steroids, increased eosinophilia and lung infiltrates |
Allergic Bronchopulmonary Aspergillosis (ABPA) |
|
most children with this infection have no signs or symptoms, may have fever, night sweats, weight loss, immigrant or recent travel, CXR with hilar LAD, apical infiltrate, pleural effusion, and supraclavicular lymph node |
TB |
|
if PPD is >5mm, positive for? |
patients with TB X-ray findings history of close contact with documented case immunocompromised (or receiving >15mg/day prednisone for >1 month) |
|
if PPD is >10mm, positive for? |
recent immigrants prisoners health care workers diabetics children <4 years of age |
|
PPD + moms: 1. if mom is asymptomatic and has negative X-ray 2. if mom has active dz OR positive X-ray |
1. check PPD in baby every 3 months 2. infant gets FULL treatment |
|
For older kids: 1. if PPD neg and CXR neg 2. if PPD pos and CXR neg 3. if PPD pos and CXR pos 4. if TB meningitis |
1. INH prophylaxis for 12 weeks 2. INH prophylaxis for 9 months 3. triple or quad therapy 4. triple or quad therapy + steroids + streptomycin |
|
To check for how infectious a TB patient is? |
obtain sputum samples or gastric aspirates for AFB smear |
|
fever, sore throat (often exudative), LAD, malaise, URI sx, atypical lymphocytes (basophilic-staining with "foamy" cytoplasm), periorbital and eyelid edema |
EBV (mono) -although leukemia also has atypical lymphocytes |
|
high fever, rash appears a few days AFTER the fever subsides, may have seizures or encephalopathy, infants can have bulging fontanelles |
HHV-6 (aka Roseola) |
|
fever, seizures, and mentioning of the temporal lobe on CT |
herpes simplex virus encephalitis |
|
vesicular rash that appear in different stages, starts on the trunk then to the face/extremities |
Varicella zoster |
|
When to give VZV immunoglobulin to newborns? |
If mother developed symptoms with 5 days prior to delivery |
|
1. Primary mode of HIV transmission in kids? 2. HIV positive pregnant women should receive? 3. What lab to check at birth? 4. What to give at birth if mom did not get meds? 5. When to repeat lab? 6. If any are positive, then? 7. When to repeat anti-HIV antibodies? |
1. Vertical 2. Zidovudine or Nevirapine 3. DNA PCR 4. Zidovudine (AZT) within 72 hours and continue for 6 weeks 4. 2, 3, 6 months 6. If positive, repeat to confirm. 7. anti-HIV ABs can persist for 18 months (check at 12 or 18 months to see if they have cleared) |
|
high fever, small vesicles on an erythematous base, some ulcerated, in the posterior pharynx and soft palate, also with vesicles on the palms, soles, and buttocks. |
Coxsackievirus |
|
fever, irritability, dysphagia, and drooling associated with vesicular lesions in the posterior oropharynx, which generally spare the tongue and gingival surfaces |
Herpangina (caused by Coxsackie A) |
|
“slapped cheek” appearance associated with circumoral sparing and a lacy reticular rash on the trunk and/or upper extremities causes anemia and hydrops fettles (ascites, pleural effusions, etc) |
Parvovirus B19, fifth disease |
|
exudative pharyngitis, conjunctivitis, otitis, gastroenteritis, NO rash, often in summer |
Adenovirus |
|
cough, conjunctivitis, coryza, then Koplik spots (bluish-white macular lesions on oral mucous membranes), and last is the rash that starts at the head and progresses down |
Measles (aka Rubeola) |
|
When are patients contagious for Measles? |
four days prior to the onset of the rash until four days after the rash disappears |
|
if <3 days since measles exposure in an unimmunized child >6 mo or unknown |
give MMR also needs to be given again at 1 year of age |
|
if >3 days since measles exposure in an unimmunized child or unknown |
give measles immunoglobulin (MIG) |
|
mild fever, generalized malaise, headache, sore throat, cough, and/or coryza. generalized, fine, discrete, pinkish maculopapules starts on the face and spreads to trunk and extremities within 24 hours, disappears on the face when body rash starts, resolves in 3 days |
German measles (Rubella)
|
|
infant with cataracts, microphthalmia, deafness, PDA, blueberry muffin syndrome |
Congenital Rubella |
|
bilateral parotiditis with low-grade fever, also orchitis, pancreatitis or meningitis |
Mumps |
|
large flat "bullseye" or "target" lesion, also CAN have carditis, arthritis (usually at large joints like knees), neuritis (Bell's palsy or neuropathy) |
Borrelia burgdorferi (Lyme disease) Treatment is oral doxy if >8yo or amox if <8yo (unless has carditis, encephalitis/meningitis, or recurrent arthritis then treat with IV PCN or ceftriaxone) |
|
conjunctival suffusion, transient rash, abdominal pain, headache, or evidence of non-bacerial meningitis, transmitted through urine of animals |
Leptospirosis Treat with PCN |
|
yellow-green, bubbly, frothy, vaginal discharge with pH >4.5, strawberry cervix, intensely pruritic |
Trichomonas vaginalis Treat with metronidazole |
|
watery diarrhea lasting a long time (more than 7 days!) |
Cryptosporidium (protozoan) Treatment is supportive |
|
cycles of cold, harsh chills, then high fever with diaphoresis (all within 6 hour periods), HSM, hemolytic anemia, diagnose with blood smear |
Malaria |
|
which types of malaria relapse? |
Plasmodium vivax and ovale |
|
Chagas disease, mild illness initially undiagnosed in a child, slowly damages the heart over many years, eventually die of CHF or heart blocks, also thromboembolic events, transmitted by Reduviid bug |
Trypanosoma cruzi |
|
child with itchy butt, diagnose with tape test |
Enterobius vermicularis (pinworms) Treat with albendazole x 1 dose (may repeat two weeks later) |
|
travel to tropical climate or immigrant, abdominal pain, pancreatitis, INTESTINAL OBSTRUCTION, also RESPIRATORY symptoms and SHIFTING INFILTRATES on serial CXRs associated with eosinophilia |
Ascaris lumbricoides Diagnose by examining stool for worms or barrel-shaped eggs Treat with albendazole or pyrantel pamoate |
|
flukes/flatworms, chronic intermittent abodminal pain, possible blood in stool and HSM |
Schistosomiasis Treat with praziquantel |
|
tapeworm from pork, GI discomfort, can also cause NEUROCYSTICERCOSIS and seizures |
Taenia solium Treat with albendazole or praziquantel |
|
tapeworm that causes visceral larva migrans exposure to dogs, cats, dirt GI and respiratory symptoms: abdominal pain, HSM, wheezing labs with high leukocytosis and eosinophilia |
Toxocara canis Often self-limited, can treat with albendazole |
|
hookworm that infects the skin and migrates for weeks, leaves itchy red serpiginous tracks |
Cutaneous larva migrans Treat with albendazole or ivermectin |
|
whip worm that causes diarrhea and rectal prolapse |
Trichuris |
|
acute sinusitis is caused by what bugs? |
Haemophilus, Moraxella, Strep pneumo |
|
chronic sinusitis (>4 weeks) is caused by what bugs? |
<90 days: usually HMS bugs, tx with Amox >90 days: think STAPH AUREUS, tx with Cefazolin |
|
For uncomplicated OM in children > 6 mo, what is the longest you can choose to withhold abs? |
3 days |
|
How many episodes of AOM in one year warrants tubes? |
5 or more |
|
painless otorrhea due to destructive lesions at the base of the skull, can lead to hearing loss, otorrhea will have debris containing skin and epithelial cells |
cholesteatoma needs ENT! requires excision |
|
chronic otorrhea bugs? |
pseudomonas and staph |
|
cervical or submandibular LAD in neonate/infant |
think Staph or Strep pyogenes |
|
preauricular LAD |
think adenovirus or mono |
|
pleomorphic gram-negative organisms
fever, LAD, ULCERS, h/o deer or rabbit exposure Treatment? |
Tularemia Treat with gentamicin or streptomycin+tetracycline |
|
>3 weeks of chronic, draining & tender LAD, possible history of cat exposure Treatment? |
Bartonella henselae (cat scratch disease) Supportive care |
|
freely mobile painless node without any other symptoms, PPD is slightly indurated but not large enough for TB Treatment? |
Atypical mycobacteria treatment is surgical excision |
|
gram-negative organism fever, chronic cervical LAD, myalgias, HSM, exposure to farm or unpasteurized milk |
Brucellosis Treat with trimethoprim or if old enough, tetracycline |
|
"intracytoplasmic inclusions" starts as small nontender papule then a tender unilateral inguinal lymph node, pain relieved if ruptured, can drain for months treatment? |
Lymphogranuloma venereum serovar (caused by Chlamydia trachomatis) treat with doxy |
|
painless cervical or supraclavicular LAD in a teenager, with fever, night sweats, weight loss, negative PPD |
Hodgkins lymphoma Diagnose by Reed Sternberg cells by biopsy |