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161 Cards in this Set
- Front
- Back
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What is an occult fever?
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a fever with no other localized findings on hx and PE
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What is the MCC of an occult fever?
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UTI
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What bugs affects thos less than 3 months?
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-E.coli
-Klebsiella -enterococcus -Grp B step -listeria |
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What bug affect those 3-36 months?
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encapsulated bacteria
-strep peumoniae -Neisseria -Hib |
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What bug tends to affect older children most often?
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GABHS
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In older kids, bacteremia is infrequent and most often caused by what?
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Neisseria
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What are some signs of a serious illness in a child?
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-irritablity
-pooor eye contact -failure to recognize parents -porr interaction |
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What cqan be seen on PE for a very ill child?
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-fever
-hypothermia -tachypnea -irregular respirations -apnea -tach or bradycardia -hypotension -cyanosis -poor perfusion -petechial or purpuric rash |
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What is the most common disase dx in children?
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AOM
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MCC of AOM is what?
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strep pnemo
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Name 5 risk factors for development of AOM
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-6-18 months old
-bottle fed, pacifier use -born in fall -Native American -lower socioeconamic class |
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Tympanocentesis should only be used in what pts?
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immunocompromised pts with AOM
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What is DOC for AOM?
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-amoxicillin
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What is the MCC of bacterial pharyngitis?
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GABHS
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Pharyngitis in 2-5 y/o is most often the result of what?
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infection with respiratory viruses
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What is the viral syndrome of viral pharyngitis?
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-fever
-rhinorrhea -cough -mild pharyngitis -fatigue -anorexia -ab pain |
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GABHS pharyngitis is manifested by what symptoms?
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-acute fever
-headache -sore throat -ab pain -NO cough or rhinorrhea |
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HSV-1 pharyngitis is characterized by what?
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anterior protion of the mouth and lips are red
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What is a finding of pharyngitis caused by EBV?
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large tonsils (posterior adenopathy)
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What often precedes a peritonsuillar abscess?
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pharyngitis
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A peritonsillar abscess is rarely _______/
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bilateral
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What is seen on PE for a peritonsillar abscess?
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-high fever
-difficulty swallowing -change in speech -uvula is displaced |
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What bugs usually cause a peritonsillar abscess?
Tx? |
-GABHS
-S. aureus -aerobic and anerobic baceria -tx with IV abx and sx drainage |
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Tell me about findings in a child with retropharyngeal abscesses.
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-appear ill with high fever, difficulty swallowing, dyspnea
-swelling of posterior larynx -lateral neck films reveal swelling |
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Acute epiglotitis is rare b/c of what?
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Hib vaccine
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What is the PE findings in acute epiglotitis?
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-swollen, cherry red epiglottis with laryngoscopy
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What is the tx for acute epiglottis?
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-intubation and observation in an ICU and IV abx until swelling resolves
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What does PFAPA stand for?
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-periodic fever, aphthous stomatitis, pharyngitis, cervical adenitis
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What are some PE finding in PFAPA?
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-periodic high fever occuring q 3-4 weeks
-tonsils are moderately enlarged, erythemic, w/o exudate -cervical adenopathy -unknown etiology |
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What is the MCC viral agent associated with the cold?
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rhinovirus
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What are some airborne infections that cause URIs?
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-rubeola
-varicella -TB |
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What are some droplet transmission infections that cause URIs?
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-adenovirus
-coronavirus -influenza |
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What are some contact transmission infections that cause URIs?
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-RSV
-parainfluenza -enterovirus -rhinovirus |
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What is bronchiolitis?
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obstructive pulmonary disease of infants and young children
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MCC of bronchiolitis?
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RSV
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RSV is most common in what children?
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those younger than 1 with a peak incidence at 2-6 months
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What are 2 other causes of bronchiolitis other than RSV?
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-parainfluenza virus
-adenovirus |
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In bronchiolitis, viral proliferation causes what?
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edema, necrosis of epithelium lining of the airway, sloughing of ciliated cells, and formation of mucous plugs
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What is RSV season?
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Nov-April
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What are some risk factors for the development of RSV?
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-premies
-congenital heart disease -CF -immunodeficient |
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Chilren with RSV present how?
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-lethargy
-irritable -apnea -low grade fever -tachypnea -tachycardia -dehydration -dry or cyanotic mucous membranes |
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What is the medical tx for RSV or Bronchiolitis?
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-admit ill looking children
-O2 and bronchiodilators -Ribivarin -steriod DO NOT help |
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Croup mainly affects who?
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boys in first 3 years of life in late fall or early winter
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What is the MCC of croup?
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parainfluenza
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What are some PE findings in croup?
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-rhinorrhea
-hoarseness -barky cough -restlessness and agitation (hypoxia) -fever -tachypnea -tachycardia |
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What is the tx for croup?
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-supportive
-cool, humidified air -nebulized racemic epi -steroid decrease severity, duration and hospitilzation length |
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What kids have greatest attack rates of influenza?
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school aged children
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Influenza A is found where?
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in lots of animals
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Influenza B is found where?
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humans
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What is Antigenic shift?
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abrupt change with influenza A. Disappears and comes back different
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What is antigenic drift?
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-occurs in both flu A and B and is what causes seasonal epidemics
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What is seen in hx of flu in older children and adults?
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-fever
-HA -myalgia -sore throat -nonproductive cough |
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What symptoms are seen in chilren with the flu?
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GI symptoms
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What drugs can be used to tx flu A?
B? |
-Amantadien or Rimantadine
-Zanamivir or Oseltamivir |
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What are the prodromal sx of viral pneumonia?
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-rhinorrhea
-cough -low grade fever -pharyngitis |
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What is seen in the hx bacterial pneumonia?
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-more abrupt onset than viral
-fever -cough -CP -shaking chills -initially non-productive cough -neck pain and stiffness |
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What is seen on PE for viral pneumonia?
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-irritable, nasal flaring, subcostal intercostal refractions, cyanotic membranes
-fever less than 102.2 -tachypnea -tachycardia -rales -wheezes -mild hepatosplenomegaly |
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What is seen on PE for bacterial pneumonia?
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-ill looking or anxiousness
-high fever, tachycardia, tachypnea, hypotension -nasal flaring and cyanosis -fever, HA, and cough -rash on occasion -tactile fremitus -dullness to percussion -bronchophony -egophony -bronchial breath sounds -rales |
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In babies less than 2-3 months, what bugs cause pneumonia?
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-S. agalactiae
-gram negatives -Listeria -s. aureus |
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What is reactive adenopathy?
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-diffuse mild inflammation of lymph nodes that occurs in response to systemic or local infection
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In reactive adenopathy, how do nodes feel?
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-rubbery, mobile with a diamter less than 2cm
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What is lymphadenopathy?
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infection of the nodes itself
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What are the MCCs of lymphadenopathy?
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GABHS or S. aureus
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What is found on PE for lymphademopathy?
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-poorly mobile, soft tissue edema, erythema greater than 2cm
-tonsillar and anterior cervical nodes are mainly involved |
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Tell me about the findings of atypical mycobaceria lymphadenopathy in those less than 4.
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-submandibular, perauricular, anterior cervical, inguinal, or epitrochlear nodes
-bilateral adenitis isn't present -no fever or other sx -mildly tender, little warmth or inflammation -after several weeks, nodes become fixed and discolorded |
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Moratility in bacterial meningitis is highest with what bug in children?
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S. pneumoniae
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What types of bugs infect infants and older infants and cause meningitis?
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-enteric pathogens in infants and encapsulated bacteria in older infants and children
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What is seen in the hx of of an infant and young child with bacterial meningitis?
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-irritable
-anorexia -vomiting -inconsolable crying -lethargy -seizures -focal neurological signs |
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What is seen in the hx of an older child with bacterial meningitis?
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-HA
-back pain -stiff neck -photophobia -confusion -disorientation |
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What is often seen on PE for bacterial meningitis?
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-fever, buth hypothermia in younger kids
-increased ICP, bradycardia and HTN -Kernig and Brudzinki signs |
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In reactive adenopathy, how do nodes feel?
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-rubbery, mobile with a diamter less than 2cm
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What is lymphadenopathy?
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infection of the nodes itself
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What are the MCCs of lymphadenopathy?
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GABHS or S. aureus
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What is found on PE for lymphademopathy?
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-poorly mobile, soft tissue edema, erythema greater than 2cm
-tonsillar and anterior cervical nodes are mainly involved |
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Tell me about the findings of atypical mycobaceria lymphadenopathy in those less than 4.
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-submandibular, perauricular, anterior cervical, inguinal, or epitrochlear nodes
-bilateral adenitis isn't present -no fever or other sx -mildly tender, little warmth or inflammation -after several weeks, nodes become fixed and discolorded |
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Moratility in bacterial meningitis is highest with what bug in children?
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S. pneumoniae
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What types of bugs infect infants and older infants and cause meningitis?
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-enteric pathogens in infants and encapsulated bacteria in older infants and children
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What is seen in the hx of of an infant and young child with bacterial meningitis?
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-irritable
-anorexia -vomiting -inconsolable crying -lethargy -seizures -focal neurological signs |
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What is seen in the hx of an older child with bacterial meningitis?
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-HA
-back pain -stiff neck -photophobia -confusion -disorientation |
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What is often seen on PE for bacterial meningitis?
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-fever, buth hypothermia in younger kids
-increased ICP, bradycardia and HTN -Kernig and Brudzinki signs |
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What is seen in the CSF of bacterial meningitis pts?
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-cloudy
-PMNs -protein elevation -low glucose -gram stain positive |
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What virus is the leading cause of severe encephalitis?
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HSV
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What are arboviruses that can cause encephalitis?
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-arboviruses are RNA viruses that cause either aseptic meningitis or encephalitis usually from a tick or mosquito virus
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What are different types of encephalitis caused by tick or mosquito bites?
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-St. Louis encephalitis
-Western Equine -Eastern Equine -California encephalitis -West Nile Virus |
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Neurological sequelae are most often found in what types of encephalitis?
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eastern equine and St. Louis
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Moratlity is high in what type of encephalitis?
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eastern equine
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What is found in the hx for encephalitis?
ps-they are nonspecific for encephalitis alone |
-fever
-irritablity -lethargy -anorexia -rhinorrhea -pharyngitis -cough -diarrhea -vomiting -rash |
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What can be seen on PE for encephalitis?
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-LOC
-CN abnormalities -hemiparesis -ataxia |
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What is seen in the CSF for encephalitis?
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-lymphocytic pleocytosis
-elevated protein -normal or mild decrease in glucose |
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Pyogenic or septic arthritis is the result of what?
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bacterial infection of the joint space
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What is reactive arthritis?
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an inflammatory response in the joint space that occrus at the result of infectin elsewhere
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Infectious arthritis is most common in those under what age?
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3
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WHat joints are most often affected in infectious arthritis?
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knees, hips, ankles
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What bugs tend to cause infectious arthritis?
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-GABHS
-N. miningitidis -gonorrhea -salmonella |
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Pyogenic arthris typically presents with what?
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acute pain in the affected joint
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What are some PE findings in infectious arthritis in children?
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-affected joint is swollen, warm and tender
-ROM is decreased |
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Why is hip difficult to find PE findings on?
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-no red, warm, or swelling, and pain may refer to the knee
-child may hold hip flexed, externally rotated, and abducted |
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What labs are elevated in infectious arthritis?
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ESR, WBC, and CRP
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What are some other tests you can do in infectious arthritis?
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-X-rays
-US for fluid -MRI |
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Osteomyelitis is usually caused by what?
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bateria
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Osteomyelitis:
-males_______ females -lower extremities_____upper |
males greater than females
lower extremities greater than upper |
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What is the most common bug to cause osteomyelitis?
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S. aureus
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What is often seen on hx for osteomyelitis?
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fever and malaise and refusal to bear weight on affected limb
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In osteomyelitis, palpation of the affected bone reveals what?
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tenderness
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MRubeola (measles) most often occur when?
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winter or spring
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What is seen in the hx of someone with rubeola?
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-high fever
-dry cough -coryza -conjunctivitis with clear discharge |
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What is pathognomonic for rubeola?
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Koplik spots
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In rubeola when does the rash appear?
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3-4 days after onset of prodromal sx
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Tell me about the evolution of the rash in rubeola?
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begins at hairline and psread to involve trunk, arms, legs and then hands and feet
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Rubella/German Measles season is when?
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winter or early spring
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What are the most common complications of Rubella?
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arthritis and arthralgia that mostly affects fingers, wrists, and knees
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What is seen in the hx or Rubella?
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-low grade fever
-malaise -lymphadenopathy -URI |
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What lymph nodes tend to be enlarged in Rubella?
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post auricular, suboccipital, posterior cervical
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In Rubella, the rash often begins how many days after symptoms start?
Their evolution? |
1-5 days
-begin on face and progress caudally and DO NO coalesce |
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What are the 2 other names for Roseola?
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-Exanthem Subitum
-6th disease |
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Roseola is uaully from what and remains latent where?
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-usually from infected saliva from parents/siblings and remains latent in mononuclear cells
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What is seen in the hx for Roseola?
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-few prodromal sx and an abrupt onset of fever that lasts 3-7 days
-some GI sx |
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What is seen on PE for Roseola?
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-high fever, but mainly normal otherwise
-cervical lymphadenopathy or AOM -erythematous maculopapular rash that resolves spontaneously |
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Parvovirus B 19 is transmitted how?
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contact with respiratory secretions
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When are you most contagious in B19 infection?
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in prodromal period
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Why does B19 cause anemia in children?
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because the virus affects RBC precursors
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What is seen on the hx for B19 infection?
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low grade fever, URI sx, and malaise
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What is seen on PE for B19 infection?
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red flat rash on the cheeks and lacy, reticular, often pruritic rash on the trunk and extremities
-may get worse with warm temps |
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B19 may cause an _____ crisis
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aplastic
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Varicella produces what kind of rash?
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generalized pruitic vesicular rash
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When is varicella contagious?
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from 1-2 days before onset of the rash until lesions crust
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What is seen on hx for varicellia?
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fever and malaise
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Tell me about the rash in Varicella?
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begins on neck, face or uppper trunk and spreads outwards in 3-5 days
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In Varicella, what does a Tzanck smear reveal?
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multinulceated giant cells
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The rash of scarlet fever results from what?
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vascular effects of strep pyrogenic exotoxins A, B and C from GABHS
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GABHS can cause what things?
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-impetigo
-cellulitis -erysipelas -necrotizing fasciitis |
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What are the prodromal symptoms of scarlet fever?
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-fever
-pharyngitis -chills -ab pain -rash 1-2 days after sx |
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Tell me about the rash in scarlet fever
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-erythematous and blanching, with fine sandpaper like papules on palpation
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The rash in scarlet fever is prominent where?
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warm, moist areash and spares the mouth (Pastia lines)
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In scarlet fever fine desquamation starts on the face and spreads where?
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to the trunk and extremities
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Staph Aureus is an exfoliative toxin that causes what?
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-bullous impentigo
-staph scalded skin syndrome -scarlatiniform eruption -cellulitis -TSS |
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Rocky Mountain Spotted fever is caused by what?
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-tick bite
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What are the prodromal symptoms of RMSF?
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-HA
-fever -malaise -N/V -ab pain -diarrhea |
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Tell me about the rash in RMSF.
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-appears after 3rd day, begins peripherally on the wrists, ankles, and lower legs and speads centrally
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What lab can be run for RMSF?
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Rickettsial Group Specific Test
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What drug is used to tx RMSF?
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tetracyclines
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N. Meningitidis can cause what things?
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-chronic bacteremia
-acute bacteremia with sepsis -meningitis |
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What is the prodrome of n. meningitidis?
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fever, phryngitis, and HA
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What may be seen on PE for N. Meningitidis?
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-fever
-hypotension -poor perfusion -cyanosis -petechiae or purpuric skin lesions |
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What is DOC for N. Meningitidis?
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PCN
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90% of Peds get HIV how?
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perinatal transmission
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In the first 2-3 months in peds HIV they can develop what?
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PCP
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Tell me about testing infants exposed to HIV.
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-PCR for HIV viral DNA 48 hrs after birth and repeated at 1 and 3 months of age
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If a child is over 18, how do you test for HIV?
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-serologic tests are negative 3-4 weeks after acute infection
-do ELISA and confirm by Western blot |
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In adolescents with HIV viral RNA in plasma is negative for how long before test will be positive?
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1-3 weeks
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WHat increases and decreases in children with HIV?
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-increased CD8
-decreased CD4 and lymphocytes |
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Tell me about treating HIV in children.
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-two NRTIs plus either a protease inhibitor or an NNRTI
-babies born to HIV+ mothers should take AZT (can cause anemia) -breastfeeding is not recommended |
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TB is transmitted how?
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when an infected person releases infected droplets of mucus into the air
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TB likes to infect what areas of the body?
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-eyes
-ears -skin and bone -GU tract |
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What is seen on PE in TB?
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-wt loss, fever, lymphadenitis, hepatosplenomegaly, abnormal neuro exam
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What is the most common extra pumonary manifestation of TB?
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TB lymphadenitis (scrofula)
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What are some risk factors for the development of Lyme Disease?
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-live in overgrowth with tick-infested brush as well as occupational or recretional exposure
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What is the hallmark sign of Lyme Disease?
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erythema chonicum migrans
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What is seen on hx and PE for lyme disease?
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-fever
-HA -malaise -lymphadenopathy |
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What happens in the 2nd stage of Lyme Disease?
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Dissemination, arthralgia and cardiac abnormalities
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What happens in the 3rd stage of Lyme Disease?
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pauciarticular arthritis
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