Pediatric Board Review: Infectious Disease

Front 1

Abx of choice for serious Staph infection

Back 1

Vancomycin

Front 2

Most common cause of osteomyelitis (not in sickle cell patients)?

Back 2

Staph. aureus

Front 3

If a child has a serious Staph bacteremia, what should you be suspicious for?

Back 3

Endocarditis

Osteomyelitis

Front 4

-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)

Back 4

Toxic shock syndrome

Front 5

-exfoliating dermatitis mediated by exfoliating toxin-NIKOLSKY sign

Back 5

Staph Scalded Skin Syndrome (SSSS)

Front 6

Most common cause of food poisoning in US?

Back 6

Staph aureus, due to preformed enterotoxin

Front 7

Coag negative Staph

Back 7

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!

Front 8

If you don't have a functioning spleen, what 3 bacteria are you at risk for?

Back 8

1. Strep pneumoniae

2. Neisseria meningitidis

3. H. influenzae

Front 9

Most common cause of AOM?

Back 9

S. pneumoniae

Front 10

Most common cause of bacterial pneumonia in children > 1 month?

Back 10

S. pneumoniae

Front 11

Most common cause of bacterial meningitis in infants >2-3 months?

Back 11

S. pneumoniae

Front 12

Empiric treatment for presumed S. pneumoniae meningitis?

Back 12

Vancomycin + Cefotaxime or Ceftriaxone

Front 13

Group A Strep presentation in children vs infants

Back 13

Children: Temp>100F, Tender cervical LAD, exudative tonsils

Infants: Thick, purulent nasal discharge (streptococcosis), low-grade fever, decreased feeding

Front 14

Risk of rheumatic fever is alleviated as long as you start abx within ___?

Back 14

9 days

Front 15

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)

Back 15

Scarlet Fever

Front 16

"Honey-crusted" skin lesions most commonly around the mouth, nose, and extremities

Back 16

Impetigo, Strep pyogenes (aka Group A Strep), Treatment to cover for both strep and staph with Keflex (Cephalexin)

Front 17

-caused by Strep pyogenes (aka Group A Strep)-skin infection of the more superficial, upper dermis layers

-well-demarcated, raised, and can cause lymphangitis

Back 17

Erysipelas

Front 18

-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)

Back 18

Cellulitis

Front 19

Can cellulitis due to Strep pyogenes be responsible for rheumatic fever??

Back 19

NO! However it can cause post-streptococcal glomerulonephritis

Front 20

Treatment of Strep pyogenes (Group A strep)

Back 20

-PCN

-if PCN allergic --> use cephalosporin

-if PCN and ceph allergic --> use erythromycin or azithromycin

Front 21

Strep agalactiae (Group B Strep) - early vs late onset

Back 21

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

Front 22

Strep agalactiae (Group B Strep) - initial treatment

Back 22

PCN G + aminoglycoside (gentamicin)

Front 23

GBS screening

Back 23

-occurs at 35-37 weeks gestation

-prophylaxis must occur at least 4 hours prior to delivery!

Front 24

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?

Back 24

-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

Front 25

Most common organisms for endocarditis?

Back 25

Viridans streptococci > mutans or bovis

Front 26

Gram-positive diplococcus (looks similar to Strep) that causes bacteremia, sepsis, NEC

Treatment?

Back 26

Enterococcus faecalis

-treat with vancomycin, linezolid, or ampicillin (resistant to cephalosporins)

Front 27

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?

Back 27

Listeria monocytogenes

-treat with ampicillin

Front 28

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?

Back 28

Corynebacterium diphtheriae

treat with erythromycin

Front 29

Gram-positive anaerobic rod, history of a puncture wound, causes uncontrollable muscle spasms, arched back or "lock jaw"

treatment?

Back 29

Clostridium tetani

debridement of infected tissue + tetanus Ig + metronidazole

Front 30

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

Back 30

1. TIG + vaccine (Tdap or DTaP)

2. nothing

3. vaccine

4. nothing

Front 31

Gram-positive anaerobic rod, in a child <6 months old with PROGRESSIVE descending weakness, progressive ptosis and poor suck, urinary retention

Treatment?

Back 31

Clostridium botulinum (toxin inhibits presynaptic release of acetylcholine)

Supportive care

Front 32

sore throat, deviated uvula, difficulty opening mouth (trismus), drooling, "hot potato voice"

Treatment?

Back 32

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

Front 33

fever, LAD, painful swallowing, drooling, hyperextension of the neck

Back 33

Retropharyngeal abscess

Front 34

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?

Back 34

Rocky Mounted Spotted Fever

Doxycycline

Front 35

Appears similar to RMSF but has associated liver dysfunction?

Back 35

Ehrlichia

Front 36

brain abscess

Back 36

Citrobacter

Front 37

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?

Back 37

Lymphogranuloma venereum (LGV) caused by Chlamydia

Treat with Doxycycline

Front 38

obligate intracellular anaerobe,"intracytoplasmic inclusions"

Back 38

Chlamydia

Front 39

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.

Back 39

Mycoplasma pneumoniae

Front 40

unimmunized or asplenic kid with epiglottitis/bactermia/PNA/meningitis/otitis and Gram-negative "pleomorphic organisms"

Treatment?

Back 40

Hemophilus influenzae

Treat with Ceftriaxone

Front 41

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?

Back 41

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!

Front 42

history of nail puncture wounds or "hot tub rash", causes osteomyelitis, PNA in CF kids, otitis externa...

Treatment?

Back 42

Pseudomonas aeruginosa

Treat with anti-pseudomonal drugs: ceftazidime, cefepime, ticarcillin, piperacillin, gentamycin, tobramycin

Front 43

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?

Back 43

Salmonella non-typhi

does NOT require antibiotic treatment (unless immunocompromised then Ceftriaxone)

* Treating can cause a carrier state and prolong shedding

Front 44

fever, diarrhea, abdominal pain, and “ROSE SPOTS” ( small, flat, rose-colored macules) with PERSISTENT FEVER after the diarrhea has resolved

Back 44

Salmonella typhi (aka Typhoid fever)

Treat with Ceftriaxone

Front 45

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?

Back 45

Shigella

Treat sicker patients with ceftriaxone or azithromycin

Front 46

bloody diarrhea with kidney failure, thrombocytopenia with purpura, hemolytic anemia

Treatment?

Back 46

EHEC (Enterohemorrhagic) O157:H7 E.coli

NO ABX! Contraindicated

Front 47

non-bloody diarrhea with cramps, fever, vomiting, recently went on vacation

Treatment?

Back 47

ETEC (Enterotoxigenic) E.coli

"Traveler's diarrhea"

Self-limited, loperamide is ok

Front 48

watery/mucoid/bloody diarrhea, TENESMUS,

liver abscesses, takes WEEKS to develop, history of travel to SW US/Mexico

Back 48

Entamoeba histolytica (aka Amebiasis)

Treat with metronidazole if colitis or liver abscesses present

Front 49

non-bloody diarrhea with fairly quick onset (about 10 hours), ingestion of raw turkey or raw beef

Back 49

Clostridium perfringens

Front 50

ingestion of raw pork or unpasteurized milk, fever and diarrhea, can cause PSEUDO-appendicitis, erythema nodosum, reactive arthritis

Back 50

Yersinia enterocolitica

Front 51

diarrhea with FAST onset (within 1-8 hours) - one is associated with eating rice

Back 51

Staph aureus and Bacillus cereus diarrhea (rice)

Front 52

intermittent watery diarrhea for weeks, history may include camping or child in daycare

Back 52

Giardia

Diagnose by STRING test + ELISA

Treat with metronidazole

Front 53

history of bird exposure, travel to NW US, causes cavitary pneumonia, meningitis, or disseminated (more often in T-cell deficient patients)

Back 53

Cryptococcus

Treat meningitis or disseminated with amphotericin

Treat pneumonia with fluconazole

Front 54

broad-based budding yeast, usually found near water, can present as pneumonia or flu-like illness, skin lesions

Back 54

Blastomycosis

Front 55

recent travel out SW US (Arizona, California, Texas), pneumonia with coin lesion or flu-like illness

Back 55

Coccidiodomycosis

Front 56

recent travel to Mississippi or Ohio River valleys, flu-like illness, interstitial pneumonia, palate ulcers, splenomegaly, mediastinal/hilar calcifications (can look like TB)

Back 56

Histoplasmosis

Front 57

asthmatic that worsens despite treatment with steroids, increased eosinophilia and lung infiltrates

Back 57

Allergic Bronchopulmonary Aspergillosis (ABPA)

Front 58

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

Back 58

TB

Front 59

if PPD is >5mm, positive for?

Back 59

patients with TB X-ray findings

history of close contact with documented case

immunocompromised (or receiving >15mg/day prednisone for >1 month)

Front 60

if PPD is >10mm, positive for?

Back 60

recent immigrants

prisoners

health care workers

diabetics

children <4 years of age

Front 61

PPD + moms:

1. if mom is asymptomatic and has negative X-ray

2. if mom has active dz OR positive X-ray

Back 61

1. check PPD in baby every 3 months

2. infant gets FULL treatment

Front 62

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

Back 62

1. INH prophylaxis for 12 weeks

2. INH prophylaxis for 9 months

3. triple or quad therapy

4. triple or quad therapy + steroids + streptomycin

Front 63

To check for how infectious a TB patient is?

Back 63

obtain sputum samples or gastric aspirates for AFB smear

Front 64

fever, sore throat (often exudative), LAD, malaise, URI sx, atypical lymphocytes (basophilic-staining with "foamy" cytoplasm), periorbital and eyelid edema

Back 64

EBV (mono)

-although leukemia also has atypical lymphocytes

Front 65

high fever, rash appears a few days AFTER the fever subsides, may have seizures or encephalopathy, infants can have bulging fontanelles

Back 65

HHV-6 (aka Roseola)

Front 66

fever, seizures, and mentioning of the temporal lobe on CT

Back 66

herpes simplex virus encephalitis

Front 67

vesicular rash that appear in different stages, starts on the trunk then to the face/extremities

Back 67

Varicella zoster

Front 68

When to give VZV immunoglobulin to newborns?

Back 68

If mother developed symptoms with 5 days prior to delivery

Front 69

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?

Back 69

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)

Front 70

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.

Back 70

Coxsackievirus

Front 71

fever, irritability, dysphagia, and drooling associated with vesicular lesions in the posterior oropharynx, which generally spare the tongue and gingival surfaces

Back 71

Herpangina (caused by Coxsackie A)

Front 72

“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)

Back 72

Parvovirus B19, fifth disease

Front 73

exudative pharyngitis, conjunctivitis, otitis, gastroenteritis, NO rash, often in summer

Back 73

Adenovirus

Front 74

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

Back 74

Measles (aka Rubeola)

Front 75

When are patients contagious for Measles?

Back 75

four days prior to the onset of the rash until four days after the rash disappears

Front 76

if <3 days since measles exposure in an unimmunized child >6 mo or unknown

Back 76

give MMR

also needs to be given again at 1 year of age

Front 77

if >3 days since measles exposure in an unimmunized child or unknown

Back 77

give measles immunoglobulin (MIG)

Front 78

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

Back 78

German measles (Rubella)

Front 79

infant with cataracts, microphthalmia, deafness, PDA, blueberry muffin syndrome

Back 79

Congenital Rubella

Front 80

bilateral parotiditis with low-grade fever, also orchitis, pancreatitis or meningitis

Back 80

Mumps

Front 81

large flat "bullseye" or "target" lesion, also CAN have carditis, arthritis (usually at large joints like knees), neuritis (Bell's palsy or neuropathy)

Back 81

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)

Front 82

conjunctival suffusion, transient rash, abdominal pain, headache, or evidence of non-bacerial meningitis, transmitted through urine of animals

Back 82

Leptospirosis

Treat with PCN

Front 83

yellow-green, bubbly, frothy, vaginal discharge with pH >4.5, strawberry cervix, intensely pruritic

Back 83

Trichomonas vaginalis

Treat with metronidazole

Front 84

watery diarrhea lasting a long time (more than 7 days!)

Back 84

Cryptosporidium (protozoan)

Treatment is supportive

Front 85

cycles of cold, harsh chills, then high fever with diaphoresis (all within 6 hour periods), HSM, hemolytic anemia, diagnose with blood smear

Back 85

Malaria

Front 86

which types of malaria relapse?

Back 86

Plasmodium vivax and ovale

Front 87

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

Back 87

Trypanosoma cruzi

Front 88

child with itchy butt, diagnose with tape test

Back 88

Enterobius vermicularis (pinworms)

Treat with albendazole x 1 dose (may repeat two weeks later)

Front 89

travel to tropical climate or immigrant, abdominal pain, pancreatitis, INTESTINAL OBSTRUCTION, also RESPIRATORY symptoms and SHIFTING INFILTRATES on serial CXRs associated with eosinophilia

Back 89

Ascaris lumbricoides

Diagnose by examining stool for worms or barrel-shaped eggs

Treat with albendazole or pyrantel pamoate

Front 90

flukes/flatworms, chronic intermittent abodminal pain, possible blood in stool and HSM

Back 90

Schistosomiasis

Treat with praziquantel

Front 91

tapeworm from pork, GI discomfort, can also cause NEUROCYSTICERCOSIS and seizures

Back 91

Taenia solium

Treat with albendazole or praziquantel

Front 92

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

Back 92

Toxocara canis

Often self-limited, can treat with albendazole

Front 93

hookworm that infects the skin and migrates for weeks, leaves itchy red serpiginous tracks

Back 93

Cutaneous larva migrans

Treat with albendazole or ivermectin

Front 94

whip worm that causes diarrhea and rectal prolapse

Back 94

Trichuris

Front 95

acute sinusitis is caused by what bugs?

Back 95

Haemophilus, Moraxella, Strep pneumo

Front 96

chronic sinusitis (>4 weeks) is caused by what bugs?

Back 96

<90 days: usually HMS bugs, tx with Amox

>90 days: think STAPH AUREUS, tx with Cefazolin

Front 97

For uncomplicated OM in children > 6 mo, what is the longest you can choose to withhold abs?

Back 97

3 days

Front 98

How many episodes of AOM in one year warrants tubes?

Back 98

5 or more

Front 99

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

Back 99

cholesteatoma

needs ENT! requires excision

Front 100

chronic otorrhea bugs?

Back 100

pseudomonas and staph

Front 101

cervical or submandibular LAD in neonate/infant

Back 101

think Staph or Strep pyogenes

Front 102

preauricular LAD

Back 102

think adenovirus or mono

Front 103

pleomorphic gram-negative organisms

fever, LAD, ULCERS, h/o deer or rabbit exposure

Treatment?

Back 103

Tularemia

Treat with gentamicin or streptomycin+tetracycline

Front 104

>3 weeks of chronic, draining & tender LAD, possible history of cat exposure

Treatment?

Back 104

Bartonella henselae (cat scratch disease)

Supportive care

Front 105

freely mobile painless node without any other symptoms, PPD is slightly indurated but not large enough for TB

Treatment?

Back 105

Atypical mycobacteria

treatment is surgical excision

Front 106

gram-negative organism

fever, chronic cervical LAD, myalgias, HSM, exposure to farm or unpasteurized milk

Back 106

Brucellosis

Treat with trimethoprim or if old enough, tetracycline

Front 107

"intracytoplasmic inclusions"

starts as small nontender papule then a tender unilateral inguinal lymph node, pain relieved if ruptured, can drain for months

treatment?

Back 107

Lymphogranuloma venereum serovar (caused by Chlamydia trachomatis)

treat with doxy

Front 108

painless cervical or supraclavicular LAD in a teenager, with fever, night sweats, weight loss, negative PPD

Back 108

Hodgkins lymphoma

Diagnose by Reed Sternberg cells by biopsy