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OB Gyn Oral Boards Topics > Columbus: viral infections > Flashcards

Columbus: viral infections Flashcards

0
Q

What vaccine is recommended for HIV-positive pregnant patients?

A

Pneumococcus

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1
Q

What vaccines are contraindicated in pregnancy?

A

Live attenuated vaccines. Measles, mumps, rubella, polio, varicella, yellow fever

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2
Q

How long should people wait for pregnancy after MMR?

Can MMR be given while breast-feeding?

How would you counsel a woman who received MMR during first trimester?

A

One month

Compatible with breast-feeding; no risk to newborn

No increased risk of anomaly; not indication for termination

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3
Q

How soon after influenza vaccination do antibodies present?

How long does passive neonatal protection exist

A

Two weeks

Six months

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4
Q

Who should not receive influenza vaccination?

A

Egg allergy
Children under 6 months due to Reye syndrome
Children 6 months to 18 years on chronic aspirin
Current illness with fever
History of vaccine reaction or Guillain Barre syndrome

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5
Q

When should tetanus, diphtheria, pertussis vaccination be given during pregnancy?

How long does newborn passive immunity persist?

When should other newborn caregivers receive Tdap vaccination?

A

At any point but best between 27 and 36 weeks

Three months

At least two weeks prior

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6
Q

What is the tetanus vaccination schedule for women who have never had the series?

A

0, 4 weeks, 6-12 months

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7
Q

What is thiomerosal?

What is the current status of thimerosal as a vaccination preservative?

A

Mercury-based preservative in multidose vials; broken down into ethylmercury and thiosalicylate

Remove from childhood vaccinations as of 2001; replaced by more expensive preservatives with less long-term data

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8
Q

What are the concerns for the fetus associated with maternal fever during pregnancy?

A

Risk of neural tube defects double with fever greater than 103.5° during neural tube closure

Risk of encephalopathy, neonatal seizures with increased fever near delivery

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9
Q

What type of virus is influenza?

A

Single-stranded RNA virus; two subtypes: A and B

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10
Q

How does influenza typically present?

A

Fever, chills, headache, myalgia

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11
Q

Does pregnancy make women more susceptible to influenza?

Is the fetus at risk for infection?

What complications should be considered?

A

No

No evidence of in utero infection

Increased risk of bacterial superinfection or pneumonia
Increased risk of preterm labor

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12
Q

How should influenza be managed?

A

Stay home, fluids, acetaminophen, rest, chicken soup

Oseltamivir 75-150 mg twice daily for five days or 75 mg twice daily 7-10 days for prophylaxis (type A only)

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13
Q

What type of virus causes rubella?

What are the other names for rubella?

How is it transmitted?

A

A togavirus, which is a single-stranded RNA virus

“Third disease” or German measles

Hand-to-mouth, droplet with 90% acquisition rate

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14
Q

When is rubella contagious?

How long is the incubation period?

A

Seven days prior to rash and seven days after

16-18 days

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15
Q

What are symptoms of rubella infection?

A

Low fever
Pink, macular rash starting on head, spreads to trunk and limbs
Transient arthritis in adults

16
Q

How is rubella diagnosed?

A

IgM antibody presents 4 weeks after infection
Four-fold increase in IgG titers
IgG without IgM indicates immunity

17
Q

What is the rate of fetal infection during the first trimester?

What is the rate of fetal infection during the second and third trimesters?

How is fetal infection diagnosed?

A

90%

30-50%

Culture from amniocentesis; no predictive value for fetal injury; late ultrasound findings

18
Q

What is the risk of congenital rubella syndrome at 10 weeks or less?
11-14 weeks?
Greater than 14 weeks?

What is the mortality rate for infants with congenital rubella syndrome?

A

50%
10%
0%

10%

19
Q

What is the most common sequela of congenital rubella syndrome?

What are other sequelae?

A

Cochlear degeneration with deafness 70%

Blindness with retinopathy and Cataracs 20-30%
Microcephaly and retardation 25%
Cardiac anomalies 20%
Hemolytic anemia and thrombocytopenia

20
Q

What viruses are in the herpes family?

What type of viruses are these?

A

Herpes simplex I and II, varicella zoster, CMV, Epstein-Barr virus

Double-stranded DNA virus

21
Q

How long do symptoms from primary HSV infection persist?

How long does viral shedding occur?

When do antibodies develop?

A

3 weeks

4-5 weeks

Within 7 days and peek at 3 weeks

22
Q

What percentage of new genital infections are with HSV-1?

A

80%

23
Q

What is herpetic whitlow?

What is scrum pox?

A

Herpes found on healthcare workers particularly on the finger or thumb

Herpes on rugby players

24
Q

What is the risk of neonatal HSV infection with a primary maternal infection?

Non-primary first episode?

Recurrent genital infection?
Recurrent oral infection?

A

50%

33%

3%
Nearly 0%

25
Q

How does neonatal HSV infection present?

A

45% mild and localized to face
30% herpetic encephalitis with 10% mortality and 20% permanent sequela
25% disseminated with 30% mortality

26
Q

What percentage of the US population are anti-HSV-1 positive?

HSV-2 positive?

Cervical viral shedding of HSV occurs at what percent of deliveries?

A

50%

30%

0.5%

27
Q

What is the most accurate way to diagnose herpes?

What other testing is available?

A

PCR testing of a vesicle

Viral culture of a new vesicle
Serologic testing

28
Q

How should primary or non-primary first episodes of HSV infection be treated?

A

Valacyclovir 1 g twice daily for 7-10 days

Acyclovir 400 mg three times daily for 7-10 days

29
Q

How should recurrent HSV be treated?

How does this differ from prophylaxis dosing?

A

Valacyclovir 500 mg twice daily for three days
Acyclovir 400 mg three times daily for five days

Same; start at 36 weeks

30
Q

What is the effectiveness of HSV prophylaxis during pregnancy?

A

75% reduction in recurrence, 40% reduction in C-section rate, 90% reduction in viral shedding

31
Q

When is C-section indicated for delivery in the setting of HSV?

If recurrent HSV lesions are distant from the genital hiatus, what mode of delivery is recommended?

A

Active lesions or prodromal symptoms

Cover lesion with occlusive dressing and allow vaginal delivery

OB Gyn Oral Boards Topics (82 decks)

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