Infectious Diseases

Question 1

antibiotics for AOM

Answer 1

< 24 yo

• poor risk of f/u
• chronic illneses
• recurrent, severe, perforate dAoM

Question 2

treatment of AOM?

Answer 2

amoxicillin = 1st line
-if no improvement w/in 48 hrs
(2nd line = amox-clavulanic, oral 2nd/3rd gen cephalosporin, IM ceftriaxone)

Question 3

complication of AOM?

Answer 3

otitis media with effusion

Question 4

when to place ear tubes?

Answer 4

OME persisting more than 3 weeks

• +4 episodes of AOM w/in 6 mo
• 5 episodes w/in 12 mo

Question 5

copmlications of AOM?

Answer 5

excessive scarring / tympanosclerosis
cholestatoma formation
chronic suppurative AOM
rarely: mastoiditis

Question 6

presentation of acute bacterial sinusitis

Answer 6

1) persistent respiratory symptoms > 10-14 days w/o improvement + nasal d/c (clear/purulent) & daytime cough
2) severe symptoms of high fever / purulent nasal d/c for > 3 days

Question 7

complications of acute bacterial sinusitis

Answer 7

-bony erosion, orbital cellulitis, intracrnial extension

Question 8

what are complications of group A strep?

Answer 8

• suppurative (peritonsillar / retropharyngeal abscess)

- nonsuppurative (rheumatic fever, post-strep glomerulonephritis)

Question 9

treatment of group A strep

Answer 9

10-day course of oral penicillin / single-dose IM benzathine penicillin G

Question 10

treatment of scarlet fever

Answer 10

same as GAS pharyngitis

-10 day oral penicillin / single-dose Im benzathine penicillin G

Question 11

GAS treatment for penicillin allergy

Answer 11

erythromycin, azithromycin, clindamycin

Question 12

diagnostic criteria for acute rheumatic fever/

Answer 12

JONES criteria
Major: carditis, polyarthritis, chorea, erythema marginatum, subQ nodules
Minor: fever, arthralgia, elevated ESR/CRP, prolonged PR interval
Other: +throat culture/rapid antigen test / incr. ASO titers

Question 13

EBV + misdiagnosis & amoxi/amp?

Answer 13

skin rash = maculopapular, on face/trunk

Question 14

eval of EBV?

Answer 14

leukocytosis

• lymphocytes >50% of leukocytes
• heterophile antibody test = rapid EBV detection
• no detectable heterophile antibodies

Question 15

croup presentation?

Answer 15

upper airway obstruction - hoarse voice/barky-seal-like cough + inspiratory stridor –> respiratory distress

• laryngotracheal inflammation
• parainfluenza virus, influenza, RSV
• more pronounced in 6-36 mo (narrow airway)

Question 16

croup treatment

Answer 16

1) cool air / humidity
2) expect resolution w/in 4-7 days
3) nebulized racemic EPI; oral/IV/IM corticosteroids

Question 17

bronchiolitis

Answer 17

• acute viral lower respiratory tract infection –> obstruction of peripheral airways
• lymphocytic infiltrate into peribronchial/peribronchiolar epithelium –> submucosal edema

Question 18

bronchiolitis pathogen

Answer 18

typically RSV

• nov-april
• > 50% younger than 1 yo

Question 19

clinical bronchiolitis signs

Answer 19

• neonates - at risk for apnea

- resolve w/in 5-10 days

Question 20

CXR consistent w/ RSV

Answer 20

• lung hyperinflation
• peribronchial thickening/cuffing
• incr. interstitial markings

Question 21

indications for palivizumab?

Answer 21

prophylaxis for pts > 2 yo

risk for severe disease (premature infants / children w/ bronchopulm dysplasia, req . O2)

Question 22

what is palivizumab?

Answer 22

IM RSV monoclonal antibody

Question 23

what is respigam?

Answer 23

IV polyclonal immunoglobulin + high RSV antibody concentration

Question 24

pertussis presentation

Answer 24

afebrile, prolonged cough (2-8 wks)

• catarrhal phase - follows 7-10 day incubation (1-2 wks of low grade fever, cough, coryza)
• paroxysmal phase - intense coughin spasms + sudden inhalation
• convalescent phase

Question 25

pertussis eval

Answer 25

-detected by fluorescent antibody staining, PCR, culture

Question 26

treatment of pertussis

Answer 26

- hospitalization of young infants w/ severe disease | - erythromycin / macrolides - shorten duration of illness, if given in catarrhal phase & dec. infectivity

Question 27

what are causes of PNA in children?

Answer 27

- viruses = most common - chlamydia trachomatis - 2-3 mo - s. pneumo = community-acquired

Question 28

school aged PNA

Answer 28

- mycoplasma pneumo / chlamydia pneumonai | - not common if < 5 yo

Question 29

unusually causes of PNA?

Answer 29

nontypeable H. flu, m. catarrhalis, S. aureus, N. meningitidis, GAS

Question 30

risk factors for bacterial PNA

Answer 30

chronic lung disease (CF/asthma) neuro impairment (swallowing dysfunction / NMJ disease) GERD w/ aspiration Upper airway anatomic defects (tracheoesphageal fistula/cleft palate) Hemoglobinopathy (sickle cell) Immunodeficiency/immunosuppresion

Question 31

most common signs of PNA in id?

Answer 31

tachypnea / dyspnea out of proprtion to fever

Question 32

pulm exam findings of viral/atypical PNA

Answer 32

- diffuse wheezing / crackles = multiple areas involved | (m. pneumo, c. pneumo, c. trachomatis)

Question 33

pulm exam findings of bacterial PNA

Answer 33

focal crackles / dec. breath sounds dullness to percussion egophony bronchophony

Question 34

outpt treatment of bacterial PNA

Answer 34

amoxicillin or amoxi-clavulanic acid

Question 35

walking PNA

Answer 35

m. /c pneumo | - treat w/ macrolides 9erythromycin, clarithromycin, azithromycin)

Question 36

IV a/b for PNA

Answer 36

ampi-sulbactam clindamycin cefuroxime, ceftriaxone, azithromycin, vanco

Question 37

causes of mengingitis < 1 mo

Answer 37

GBS, e. coli, gram neg bacili, HSV, listeria, strep pneumo

Question 38

meningitis 1-2 mo

Answer 38

e. coli s. pneumo enteroviruses h. influenza GBS

Question 39

2mo - 6 yr - meningitis

Answer 39

``` strep pneumo n. meningitidis enteroviruses borrelia burgdorferi h. influ type b ```

Question 40

school age/adolescent meningitis

Answer 40

s. pneumo n. meningitidis enteroviruses b. burgdoreferi

Question 41

features of lyme meningitis

Answer 41

low grade fever, headache, stiffneck, photophobia | ?cranial nerve palsies

Question 42

signs of meningitis on PE

Answer 42

kernig (flexion of leg at the hip + subsequent pain on knee extension) brudzinski (involuntary leg flexion on passive neck flexion)

Question 43

CSF findings for bacterial meningitis

Answer 43

WBC > 1000 neutrophils > 75% protein: incr.!! glucose (down)

Question 44

CSF findings for viral meningitis?

Answer 44

WBC < 500 lymphocytosis protein: nL glucose: nL

Question 45

CSF findings for lyme meningitis

Answer 45

WBC < 100 neutrophils: < 30% protein nL/incr. glucose: nL

Question 46

IV a/b for meningitis - infants / adolescents?

Answer 46

vanco + 3rd gen cephalosporin (cefotaxime / ceftriaxone) | 10-14 days

Question 47

neonate meningitis treatment

Answer 47

amp - GBS / Listeria cefotaxime - gram - pathogens 14-21 days

Question 48

special considerations for meningitis treatment

Answer 48

5-7 days for meningococcal meningitis | -lyme - 14-28 days

Question 49

most common causes of bacterial GI

Answer 49

salmonella, shigella, e. coli,yersinia enterocolitica, campylobacter jejuni, v. cholera

Question 50

signs of bacterial diarhea

Answer 50

fever, abdominal cramping, malaise, tenesmus | stools w/ mucus + blood

Question 51

complications of salmonella bactermia

Answer 51

osteomyelitis / meningitis

Question 52

erythema nodosum

Answer 52

``` yersinia enterocolitca infxn - 30% speudoappendicitis picture (localizes to RLQ) ```

Question 53

when to use a/b for salmonella diarrhea?

Answer 53

a/b prolongs salmonella shedding | reserve for bactermia / extraintestinal dissemnation for (< 3 mo / immunocompromise) w/ noninvasive gastroenteritis

Question 54

treatment of shigellosis

Answer 54

TMP-SFX

Question 55

C. jejuni treatment

Answer 55

erythromycin

Question 56

treatment of epiglotttis + presentation

Answer 56

toxic appearance + drooling severe, progressive respiratory distress -endotracheal intubation + direct visualization

Question 57

transmission of HAV/HEV?

Answer 57

fecal oral

Question 58

transmission of HB/C/DV

Answer 58

bodily fluids