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Royal College Studying > CPS- ID > Flashcards

CPS- ID Flashcards

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1
Q

iS HCV testing during pregnancy routine

A

Not currently but likely will be once formally adopted by SOGC

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2
Q

global HCV prevalence

A

1%

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3
Q

what is the predominant rf for HCV infection in canada

A

IVDU

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4
Q

vertical transmission rate of HCV

A

5%

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5
Q

vertical transmission rate for HCV with co-infection of HIV

A

10%

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6
Q

what factors increase risk fo HCV vertical transmission

A

higher maternal HCV titers, elevated ALT in the year before pregnancy, maternal IVDU, fetal scalp monitoring, prolonged ROM, infant female sex, being the second born twin

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7
Q

does HCV genotype affect risk of transmission

A

no

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8
Q

what % of children clear HCV infection

A

20-30% by age 2-3

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9
Q

what factors increase likeilihood of spontaenously clearing HCV infection

A

elevated ALT in first 2 years of life, infection with genotype 3, interleukin 28B single nucelotide polymorphism

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10
Q

how do majority of infants with HCV that do not clear present

A

2/3 will have asymptomatic infection with intermittent viremia, normal ALT, no hepatomeglay

1/3 have chronic active infection with persistent viremia, elevated ATL and hepatomegaly in some cases

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11
Q

how does HCV present in children and adoelscents

A

subclinical

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12
Q

factors associated with progression of HCV to cirrhosis

A

genotype 1a, co infection with HIV or Hep B, steatosis on liver biopsy

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13
Q

extrahepatic manifestations of hep c

A

MPGN, sub clinical hypothyroidism, elevated ANA, autoimmune thyroiditis

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14
Q

How to prevent HCV

A

treat reporductive age women before pregnancy, insufficient evidence for treatment during pregnancy

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15
Q

is there a difference in HCV transmission vag delivery vs. c section

A

no

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16
Q

is c section delivery recommended to decrease HCV transmission risk

A

no

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17
Q

does amnio increase HCV transmission

A

no, but should be counselled on risk

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18
Q

can you transmit HCV through breastfeeding

A

no
breastfeeding should be encouraged unless nipples are cracked, bleeding or there is co infection with HIV

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19
Q

what is preferred testing strategy for HCV in infants

A

serology at 12-18 months
infants with reactive serology at 12mo should undergo PCR testing
if cant assure follow up at 12mo, then should do HCV PCR asap, should be done over 2mo of age because sensitivity is limited before then
negative PCR at 2mo usually means vertical transmission did not occur, serology should still be done at 12-18mo to confirm antibody clearance

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20
Q

what does it mean if antibodies are negative over 6mo

A

They dont have HCV, dont need to do further testing with PCR

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21
Q

how to test for hcv in older kids

A

serology adn then if that is positive do PCR testing

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22
Q

how often to test kids at high risk for HCV ie. street involved youth

A

every 6-12mo

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23
Q

can hcv be transmitted through ADLs at home

A

no, no need for special precatusions cant be transmitted in salive, urine, stool
unrestricted child care and activities and parents are NOT obliged to notify that child is HCV positive

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24
Q

Who should be treated for HCV

A

all children over age 3 with evidence of chronic infection, technially the drugs are not approved for <12 but have been shown to be effective and well tolerated so treat

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25
Q

what type of Hib is in vaccine

A

B

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26
Q

what pneumococcal vaccine doe we use in canadad

A

PCV13

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27
Q

when should listeria be considered as cause of meningitis

A

risk factors such as immunosuppresion
brain stem infection

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28
Q

MIC for pen resistant vs suceptible

A

suceptible if MIC <0.06mcg/ml
resistant if >0.12mcg/ml

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29
Q

what should be used empirically for Hib

A

ceftriaxone because increasing beta lactam resistance so not suceptible to amp

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30
Q

rf for poor prognosis in meningitis

A

delay in antibiotic administration, severity of clinical state at presentation, isolation of non penicillin resostant suceptible strep pneumo

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31
Q

most likely organisms for meningitis in children over 2mo

A

strep pneumo and neissseria
consider GBS until 3mo
e coli also in younger

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32
Q

why add vanco for meningitis coverage

A

for possibility of cephalosporine resistant strep pneumo

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33
Q

who needs prophylaxisfor meingococcal disease

A

all close contacts

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34
Q

why gets priohp for hib

A

all occupants if cibtact households with infants < 12mo, children < 4 who are incompletely immunized
immunocomprimised children of any age
any index case <2 not treated with cefotax or ceftriaxone shuld get chemoprophylaxis at ed of therpay

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35
Q

how to treat GBS

A

pen G or amp
add gent for the first 5-7 days or until CSF sterility confirmed

36
Q

evidence for steroids in meningitis

A

when given just before or within 2h of anitbioitcs, decrease hearing loss in Hib
if CSF gram stain shows gram negative coccobacilli consistent with H flu and H flu cultured, continue steroids for 4 ays
if HIb not cultured within 48h, steroids should be dc
same for strep

37
Q

dose of steroids

A

.6mg/kg divided q6h given before or within 4h of antibiotics for better results

38
Q

type of organism Hib

A

gram negative coccobacilli

39
Q

fever after stopping steroids for meningitis

A

normal rebound fever, no need for additional testing if everything else is getting better

40
Q

when to repeat CSF testing

A

if strep pneumo and received dex or resistant to penicillin or ceftriaxone
GBS at 24-48h of therapy
gram negative at 24-48h

41
Q

when to image in meningitis

A

CSF not sterilized
neurologic symptoms o other specific complications

42
Q

how long to treat strep pneumo, neisseria, hib, GBS

A

strep pneumo 10-14 days
neisseria 5-7 d
hib 7-10 days
GBS 14-21d

43
Q

what is more common type of HSV

A

HSV 2 (75%), 25% HSV 1

44
Q

factors that influence HSV transmission

A

mode of delivery, maternal infection, duration of ROM, use of itnrapartum instrumentation

45
Q

in utero HSV effects

A

very rare
can cause skin lesions or scars, CNS disorders and chorioretinitis

46
Q

transmission rates for first episode of HSV

A

60%
30% if first episode nonprimary (ie they have antibdies to another type of HSV but this is first presnetation with another type) ebcause of cross reactivity of antibodies there is still some protection

47
Q

risk of transmission with recurrent HSV infection

A

2%

48
Q

how to manage women with recurrent genital HSV

A

acyclovir starting at 36weeeks until delivery, this decreases risk for shedding but unclear if transfers to reduced risk for baby of getting HSV

49
Q

what are main organs impacted in disseminated HSV

A

liver and lungs

50
Q

time period for hsv to present

A

up to 6 weeks, usually within 4 weeks

51
Q

does absence of skin lesions mean they dont have hsv

A

no

52
Q

which type of hsv has worst mortality

A

disseminated
85% with disseminated and 50% with CNS disease died

53
Q

when are HSV swabs more reliable

A

over 24h after birth

54
Q

does negative HSV PCR mean no HSV on CSF

A

no, can repeat within 72h, might be negative early in disease course

55
Q

is infant serology useful for diagnosing HSV

A

no
transplacental antibodies

56
Q

how long to treat SEM disease HSV

A

14 days

57
Q

how long to treat disseminated disease HSV

A

21 d

58
Q

risk of acyclvoir

A

neutropenia
renal tox

59
Q

what to add for ocular disease in bb with HSV

A

triffluridine 1% in addition to acyclovir

60
Q

diagnosis of CNS HSV

A

PCR from CSF

61
Q

what to do for baby born to mom with HSV lesions, asymptomatic and born by C section without ROM

A

swabs from mm and nasophayrngeal at 24h, discharge pending results

62
Q

what to do for bb born to mom with first episode HSV at time of delivery born by vaginal delivery or c section with ROM

A

mm swabs
start acyclvoir
if swabs or blood positive, need CSF
if negative swabs, need acyclvoir for 10 days minimum

63
Q

what to do for bb when mom had recurrent HSV born by c section

A

swabs at 24h and send home pendng results

64
Q

what to do for bb when mom had recurrent HSV and vaginal delivery

A

mm swabs at 24h and discharge pending resukts

65
Q

what to do when mom has known history of hsv but no active lesions at delivery

A

observe for signs of HSV
no swabs or treatment required

66
Q

acyclvoir dose

A

60mg/kg div q8

67
Q

do you repeat csf for hsv meningitis

A

yes at end of 21d treatment
if still positive, treatment should be extended with weekly sampling to determine stop time

68
Q

when to give oral acyclvoir for bbbs

A

for suppression after treatment for CNS disease
less convincing evidence for skin disease but could still be offerred

69
Q

what to follow on acyclvoir

A

monthyl cr, ur, cbc

70
Q

contact precautions for bbs with HSV

A

contact when skin lesions present and until they have crusted over
asymptomatic neonates with mothers had active lesions until 14 days or swabs come back negative should ahve contact precautions

71
Q

precatuions for mother with hsv

A

contact if active lesions until crusted over
whena mask if herpes labalis and bb under 6 weeks until lesions are cruested and dried, dont kiss their infant, can bf unless herpetic lesion on breast
cover skin lesions

72
Q

encapsulated organisms

A

strep pneumo
Hib
neisseria
salmonella
capnocytophaga (cat and dog bites, high mortality)

73
Q

how to give PCV13 vaccine

A

4 primary doses 2,4,6mo and 12-18mo
patients over 12mo-24mo withoutnprevious PCV doses should receive 2 doses 8 weeks apart
patient over 24mo only neeed one dose

74
Q

when is highest risk for sepsis with asplenia

A

first 3 years of life if congenital
first 3 years after splenectomy

75
Q

pen alternative for proph for asplenia

A

clarithromycin but not as good, more pneumococcal resistance

76
Q

current vertical transmission rates for HIV

A

<2%
without intervention can be as high as 25%

77
Q

rf for HIV transmission in preg

A

late or no prenatal care, IVDU, recent illness suggestive of HIV seroconversion, unprotected s with partner with HIV, diagnosis of STI in preg, emigration from HIV endemic area, recent incarceration

78
Q

when does hiv transmission occur

A

time of delivery usually
some in utero

79
Q

how to test for HIV in mom preg

A

first step is testing for HIV antibodies using enzyme immunoassay
if EIA is reactive, sample is re-tested using a more specific confirmatory test for HIV antibodies such as western blot

80
Q

how to test for hiv in bb

A

HIV PCR, also used to quantify viral load

81
Q

what to do is positive HIV test for mom or bb

A

immediate antiretrovirals for bb, ideally wihtin 72h

82
Q

effects of antiretrovirals

A

anemia, neutropenia
general health, growth,m neurodev

83
Q

how long to precatution for measles

A

4 d after onset of rash and for duration if immunocomprimised

84
Q

how long to precatuion for measles contact

A

5 days from first day of exposure to 21 days after last day of exposure

85
Q

how long precatuion mumps

A

9 days after swelling

86
Q

precautions for varicella contact

A

from 8 days from first exposure to 21 days after last exposure to 28 days if VZIG given

87
Q

what are spread airborne

A

varicella, measles, Tb, smallpox

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