Board Review

1. Board Review ID Rapid Fire

2. Conjunctivitis Koplik spots Fever, photophobia, runny nose, dry cough. Measles - Rubeola

3. Rubeola • Measles! • Macular papular rash – head down • Koplik spots • Conjunctivitis • Fever, cough, coryza • Most contagious 5 days before and 5 days after rash • Think if patient is not immunized

4. Rubella Forchheimer spots Low Grade Fever, Malaise, LAD, Fine Maculopapular Rash, Arthritis

5. Rubella German Measles Low grade fever, rash, occipital LAD Mild viral illness unless you are PREGNANT

6. Varicella Fever, runny nose then develops this itchy rash. Started on trunk and then spread all over.

8. Varicella • Rash starts at trunk and spreads out • Superficial vesicles, pustules and crusts in varying stages • Vesicles with red halos • Contagious few days before the rash, until it crusts (7-10 days) • Complications • Secondary skin infections • Disseminated • Viremia, pneumonia, encephalitis

9. Newborns and Varicella • A baby is considered exposed if: • Mom gets chickenpox 5 days before to 2 days after delivery • Treatment • VZIG

10. Fever, sore throat, runny nose. Adenovirus

11. Adenovirus Conjunctivitis, pharyngitis, adenopathy Also cause GI illness More common in summer Preauricular LAD

12. Coxsackievirus – Hand Foot Mouth My child has bumps and they hurt!!

13. Fifth Disease – Parvo B19

14. Fifth Disease Erythemainfectiosum – Parvovirus B19 Starts with fever, sore throat, runny nose, HA, malaise Then get “slapped cheek” rash Rash can spread to extremities Diagnosis – clinical (can get IgM titers)

15. I had fever and then got this rash… ROSEOLA

16. Roseola – HHV ?? HHV 6 3-5 days of high fever Rash after fever resolves Can be associated with febrile seizures Diagnosis - Clinical

17. Mononucleosis Fever, fatigue, pharyngitis, LAD, splenomegaly

18. EBV • Acute, self-limited • Oral contact – “kissing disease” • Fever, fatigue, pharyngitis, LAD, splenomegaly • Anterior cervical LAD – most common • Labs • Atypical lymphs, +heterophile antibodies • Complications • Aseptic meningitis, GuillainBarre, pericarditis

19. CMV • Acquired • Presents like mono • Treat immunosuppresed - Gancyclovir • Congenital • HEARING LOSS - sensorineural • Mental retardation • Hepatomegaly • Chorioretinitis • Cerebral calcifications (periventricular) • Thrombocytopenia (blueberry muffin) • Diagnosis: urine culture in first 3-4 weeks of life - definitive

20. Herpetic Gingivostomatitis

21. Herpes Simplex Virus • HSV-1 – most common • Affects skin and mucus membranes • HSV-2 – usually genital • Presentation • Grouped vesicular lesions, mucuosal inflammation • Diagnosis • Clinical • Tzank smear – multinucleated giant cells • Culture • PCR • DFA

22. Herpetic Whitlow

23. Ocular Herpes Call Optho!! Keratoconjunctivitis – can cause permenant visual impairment.

24. High fever, pain, and history of excema ExcemaHerpeticum– lesions can develop into pustules and can become hemorrhagic. Treat – IV Acyclovir

25. More Herpes

26. Zoster

27. Mumps THINK: If the question says immigration, adoption or no vaccines!!!

28. Mumps • Paramyxovirus • Usually have bilateral parotid gland swelling • Fever, HA, malaise • Can also have swelling of testicles • Complications: • Meningitis/encephalitis • Orchitis – doesn’t usually result in infertility • Pancreatitis

29. Congenital Rubella Cataracts Heart Disease – PDA Sensorineural deafness HSM Thrombcyotopenia – purpura Blueberry Muffin Rash – dermal erythropoiesis SGA Myocarditis

30. Neonatal Herpes I am doing well until DOL 4 – develop these lesions…

31. Congenital HSV • Think – seizure in newborn • Esp if temporal lobe • Usually mom has no history of lesions • Sepsis, meningitis, seizures • Negative gram stain - elevated WBC, elevated protein • Diagnosis – HSV PCR

32. Cong Syphillis Infants – SGA, HSM, hyperbilirubinemia, thrombocytopenia, LAD If untreated: Snuffles, demineralization of bones, horse cry, saddle nose, Hutchinson teeth, Keratitis, Deafness, Sabre shin, frontal bossing, clutton joints, mental retardation

33. 13 year old with thrush and candidal rash CHECK FOR HIV *also think about DM, but this is ID Board Review.

34. PCP in AIDS patient Hypoxia Bactrim for prophylaxis “Ground Glass”

35. Molluscum – HIV patient

36. Kaposi Sarcoma

37. HIV • Think when you have chronic nonspecific symptoms • Wt loss, fever, night sweats, FTT, thrush! • Testing • Start with ELISA • Confirm with Western Blot

38. Baby exposed to HIV • Dramatically reduce transmission by AZT treatment during pregnancy • Testing – DNA PCR • Birth • 2 months • 4 months • 6 months

39. Rabies • Fox, bats, raccoons, skunks, ferrets • Raccoon is common in US • If baby in room with bat – have to treat • Treatment • Don’t need to treat if can watch animal • HRIG – if highly suspect • If haven’t had previous immunization • Vaccine – 5 doses

40. RSV • Most common cause of bronchiolitis in infants • Infant with wheeze, retractions, tachypnea, fever, and URI symptoms • CXR – diffuse infiltrates and hyperinflation • Diagnosis • Treatment • Supportive • Albuterol trial • What is the best way to prevent? • Hand washing

41. Rotavirus • Fever, watery diarrhea, and vomiting • Commonly causes dehydration • Diagnosis • Antigen test of stool • Treatment • supportive

42. THE END!!