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98 Cards in this Set

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Infant born to HIV mother; while awaiting HIV test results what treat with?
prophylactic TMP-SMX to prevent PCP
what to do if HIV child exposed to measles?
give measles IG regardless of immune hx
All children w/ HIV will eventually have what?
wt loss and FTT due to poor calroic intake and poor appetite, int absorption + increased energy use due to chronic inf
Give vit C to HIV child?
not necessary
Meningitis vaccine (MCV4) to whom?
All kids 11-12 in day care; or adolescent entering high school;
or adolescent entering college!!
specific absolute CI/ to MMR, varicella?
Pregnancy or severe immunodeficiency
absolute c/i's to DTaP vaccine?
encephalopathy within 7 d of administration of previous dose
absolute C/I to all vaccines?
severe anaphylactic rxn to previous dose
What vaccines must be given at 2,4,6 mo ?
2: DTAP, HIb, IPV, PCV HBV 2
4: "
6: " HBV 3
12-15: HIb4 PCV 4 mmr
15-18: DTAP4
4-6yr: DTAP5 IPV4 mmr2
VZV = > 1yr
chldren w/ asplenia, give what?
MPSV4(plolysaccharide meningococcal) vaccine;
both polysaccharide and conjugate pneumococcal vaccines;
high fever, sore throat, vesicular lesions > ulcers in soft palate, tonsils, and pharynx; in summer or fall? if also has palmar/sole rash lesions?
Herpangina = if palms/soles affected = HF&M disease
enterobacteria causing seizure in 30% of infections?
Shigella
tx of shigella?
supportive; +/- ampicillin or tmp-SMX; if resistance, +/- cef 3rd gen
2 diseases w/ scarlatiniform rash, desquamation, erythemaof mucous membranes, injected pharynx, strawberry toungue, cervical lymphadenopathy?
scarlet fever, Kawasaki's
2 identifying tests for Strep type A
ASO titers; throat swab/culture
tx of acute Kawasaki's?
Aspirin + IV IgG
6mo-18 mo w/scaliness and hair loss?
tinea capitis due to Trichophyton tonsurans ( a dermatophyte)
most common dermatophyte causing tinea capitis?
T tonsurans. (infects inner hair shaft)
wood lamp illuminates?
Microsporum canis (illuminated b/c infects OUTER hair shaft)
skin w/ pink-tan patches that don't tan under sun
T. versicolor caused by M. furfur = spaghetti and meatballs appearance on KOH slide
Parvo B 19 in sickle cell might cause? in pregnant?
sc: aplastic crisis: severe anemia
prego: severe anemia-->hydrops fetalis
mechanism of Anemia causing hydrops fetalis?
profound anemia--> high cardiac output plus ELEVATED CVP --> Hydrops fetalis
acute scrotal swelling plus pyuria in sex active kid?
epididymitis, due to chlamydia or NG
kawasaki's presents mainly at what age?
80% present at < 5 years old
15 mo old w/ otitis media that progresses after tx to fever, rash, irritability... what do first?
FIRST do LP to r/o bacteremia in young, febrile pt with CHANGE IN MENTAL STATUS!! (If neg, should try and change drugs)
Is pertussis prevented by transplacental antibody from mother?
NO!!!! Thus, must give E-mycin immediately to newby with pertussis-positive sick contact (ie sister/mother)
Does pertussis immunity last into later life?
yes if previously infected; if vaccinated, immunity may decrease over time
Other markers of acute EBV infection besides Monospot + test?
AB's to VCA (viral capsid antigen) ;
AB's to anti-D early antigen;
AB's to EBNA (e-b nuclear antigen) (comes later)
site of osteomyelitis?
usually occurs at metaphysis
pathogen m/c causing osteomyelitis?
S. aureus
may follow an episode of deep cellulitis...?
acute osteomyelitis
bone changes in OM may take how long to show up on xray? on bone scan?
xray: up to 12 days!! so must make dx based on clinical findings...
bone scan: 24-48 hours; but OM pts often have false- negative bone scans
Tx of Osteomyelitis and for how long?
high-dose, IV or PICC-line AB's; antistaph broad spectrums ie oxacillin.
tx for at least 3 weeks
tx of neonatal meningitis?
need to cover for G+ (GBS(g+cocci), Listeria (g+rods) and - (Ecoli, HiB)so use amp + gent, or cefotaxime
infants that don't die from resp depression, but survive infant botulism may have what long-term problems?
none!
sudden onset of fever and left-shifting leukocytosis in infant that continues to appear otherwise normal?
Pneumococcal bacteremia
most common cause of orbital cellulitis in children?
infection of paranasal sinuses
proptosis, pain, ophthalmoplegia, and vision changes with fever in kid?
think orbital cellulitis!!!
common LAD seen in Rubella?
retro auricular or posterior cervical or postoccipital LAD!
Rash of Rubella stays or clears by 72 hours?
CLEARS!
rubella vs. measles (rubeola) vs Roseola sx?
Rubella: post-cervical or occipital LAD + LOW fever + m/p rash for 3 days.
Measles: HIGH fever, CCC's (conjunctivitis, cough, coryza), rash lasts 5 days, +/-Koplik spots
Roseola: High fever, then rash as fever leaves
Erythema infectiousum rash presents as?
Slapped-cheek sign on cheeks, then to trunk and extremities, then fades CENTRALLY at first
Orchitis in mumps is mostly seen in what age males?
POST-pubertal
swollen area around ear + change in taste sensation may be presentation of what?
mumps!
pre-HEP A jaundice has short or long period of viremia?
short..<2weeks
Hep A more severe in adults or children?
adults
Hep A sx in children?
USUALLY asx, however may see fever, nausea, vomiting,jaundice, dark urine
rash of RMSF ?
flexor surfaces of wrists and ankles, moves centripetally; Palms and soles ARE involved; may become hemorrhagic
Erythema chronica migrans + flulike sx, arthralgia/arrthritis, meningitis?
Lyme disease (and carditis, obviously)
Mantoux test (PPD) becomes positive after how long after infection?
2-10 weeks
when may PPD in TB + pt actually be negative?
In advanced stages (can't mount an immune response) or dirctly after live virus immunizations (ie MMR), or steroid or isuppressive drugs. Otherwise it's positive for life
PPD test +'s?
>15mm in normal kid (no risk factors)
<15 in high risk group ie homeless, prisoner, foreign born, IV /drug abuser, or living w/ adults w/ these rf's)
5mm if kid is HIV +, suspicious xray, or clinical sx of TB, or exposed to adult with contagious TB)
are children w/ + TB contagious?
NO!! they rarely develop cavitary TB and therefore are not contagious
contraindication to LP in baby?
-increased ICP if fontanelle is CLOSED (if open, ok to do LP even if bulging!)
-severe cardiorespiratory distress
-severe TCP causing ie bleeding diaatheses
Cause of whooping cough? barking cough + inspiratory stridor?
WC: pertussis
Barking cough + insp stridor: CROUP (caused by Parainfluenza, RSV, etc OR..... epiglottitis (rare due to HiB vaccine)=toxic appearing kid w/high fever = surgical emergency!!
SX of croup + age
low fever, barking coughk, hoarse, inspiratory stridor.
Age = 6mo-6yrs
bacterial agent often seen as cause of day care center breakouts of diarrhea
Cryptosporidium parvum
Other causes of watery, frothy diarrhea besides Giardia?
Crypto. parvum, amebas, whipworms (trichuriasis), viruses
Does toxoplasmosis ordinarily cause diarrrhea?
NO. causes fever, myalgia, lad, maculopapular rash, Hmegaly, pneymonia, encephalitis, chorioretinitis, or myocarditis
Lab manifestations of Wiskott Aldrich?
first of all, is a mixed Ideficiency = lymphopenia;
Ig's: low IgM, High IgA and E;
TCP
4 types of combined Ideficiencies?
WA
SCID
Ataxia-telangectasia
Chronic mucocutaneous candidiasis
what characteristic result occurs after administration of Amp to EBV pt?
rash
type of GI problem causing epigastric px and relieved by eating, worsened by fasting
H pylori - duodenal ulcer (gastric ulcer worsens directly after eating)
Pathogen causing roseola
Human herpesvirus 6
cough, tachypnea, and conjunctivitis in 2 month old?
Chlamydia trachomatis
OTHER pathogen causing bronchiolitis besides RSV?
Parainfluenza has been implicated
diagnosis of brachial plexus injury?
use chest ULTRASOUND to check for unparallel diaphragm movements = phrenic nerve injury
brachial plexus injury often due to what?
uncontrolled gest. diabetes mothers having LGA babies with shoulder trauma on the way out
value of sweat test =CF?
>60meq/L
40-60 is intermediate
lung abscesses usually caused by what pathogens?
staph aureus, fusobacterium, anaerobic strep, Klebsiella, prevotella
tx of lung abscesses?
AB's ALONE!!! first, then consider surgery (for drainage or resection)
should you induce vomiting in a pt coming in for resp distress due to gasoline inhalation or aspiration after gasoline ingestion?
NO...this may cause aspiration. just support and may need ventilation or intubation...
TB skin test for infants?
No...usually negative in infants of age < 4 months, even if active disease is going on
repeated episodes of fever, respiratory infection ie lobar pneumonia, and hemoptysis in 4 y/o. with clear radiographs after each resolution...positive fecal occult blood, low iron, anemia
Idiopathic pulmonary hemosiderosis: chronic bleeding into the lungs
Test for Idiopathic pulmonary hemosiderosis:
Bronchioalveolar lavage to check for hemosiderin -laden macrophage
subset of patients with pulmonary hemosiderosis have what else that may be causing it?
Heiner syndrome = sensitivity to cows' milk; stop cows milk and patient may improve
diagnosis of OSA? tx of OSA?
dx: Polysomnography;
tx: home CPAP, tonsillectomy, adenoidectomy
recognized complications of staph pneumonia? (2)
Often fast progressing, seen in pts <1yo with staph pneumonia:
empyema
tension pneumothorax/pyopneumothorax
sudden hypotension and low O2sats in respiratory distressed pt,think?
TENSION PT!!!!!!!!!!!!!! (Or, if cardio involvement,t think TAMPONADE, but would have bilaterally similar lung findings and muffled heart sounds)
severe and life threatening complication of laryngiotracheobronchitis?
bacterial tracheitis = acute high fever, TOXIC appearance, respi distress, BIPHASIC stridor
Croup vs
bacterial tracheitis vs
epiglottitis? (cause, tx)
Croup: Viral; tx =calm down child; mist tent/ humidifier; no other tx. If severe stridor: inhaled epi + oral steroids. (acetaminophen for fever)
Bacterial tracheitis: acute high fever, TOXIC look, respi distress, BIPHASIC stridor; tx = INTUBATION!!! + IV AB's!!!!
epiglottitis: HiB; DROOLING and dysphagia, tx with INTUBATION!!! + IV AB's!!!! (ie ceftriaxone)
Bacterial tracheitis dx?
laryngoscopy: sub-glottal inflammation with lots of PURULENT mucus
thumbprint sign seen in which pathogen for epiglottitis?
ALL! = GAS, HiB, M catarrhalis, S. pneumonia
pathogens causing epiglottitis TODAY?
GAS, HiB, M catarrhalis, S. pneumonia
respi difficulty + Hsplenomegaly in kid who eats dirt with dog at home. DX?
Toxocara canis. Dx: doesn't stay in intestine, so can't see ova/parasites in stool. Do ELISA for Toxocara to dx
cold > 10 days with facial pain and fever? Tx?
sinusitis
Tx = oral antibiotics for 14 days
visualizing which meatus discharge means which sinus infection?
medial meatus = ant ethmoid, maxillary, or frontal sinusitis

superior meatus = posterior ethmoid or sphenoidal sinusitis
Theophylline in asthmatics mustn't be given with which medications?
P-450 inducers/inhibitors
Tx of mycoplasma pneumonia?
macrolide
Staph pneum is usually seen in what age group?
"infants < 6mo old"
After giving an allergen for test, kid gets flushed face and muffled voice... how tx?
"immediate endotracheal intubation"
for anaphylaxis....O2,
Then give sub-q epinephrine;
+/-diphen
fast onset of respi distress, cough, and high fever in sickle cell child NSiM?
immediate hospitalization (no labs/er course nec; this is most likely pneumonia, pulm embolus, or sepsis!!!)
triad of Kartagener's syndrome?
= defect in arm ofdynein protein

1 situs inversus, 2 chronic sinusitis/otitis media, 3 airway disease (also infertility, bronchiectasis)
In baby w/o pre-natal dr. visits:
Multiloculated mass in left hemithorax, with N/G tube showing stomach below diaphragm...?
CCAM = congenital cystic adenomatoid malformation = embryological malformation usually picked up in 20th week ultrasound. tx = surgical removal of affected lung
abrupt fever, drooling, sore throat, and dysphagia, muffled breathing in pt with 3 day history of pharyngitis? causative agent? tx?
retropharyngeal abscess; S. aureus;
surgical incision and drainage under gen anasthesia
Is topical tx for conjunctival chlamydia in newborn successful in clearing nasopharynx of pathogen?
NO..! kid may still get chlamydial pneumonia few weeks later. tx with oral macrolides
complication of oral macrolides in neonate, infant to tx chlamydial pneumonia?
idiopathic hypertrophic pyloric stenosis
cause of one-sided hyperinflated lung seen on expiratory xray but not inspiratory; in otherwise healthy kid with recurrent cough
foreign body aspiration!!!
do rigid bronchoscopy for dx and removal