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General Pediatrics > CPS ID > Flashcards

CPS ID Flashcards

1
Q

UTI prophylaxis

Indications & how

A

Grade 4/5 VUR or significant GU anomalies
Consult Nephro/urology
septra/nitrofuratoin 1/3 of treatment dose OD
duration 3 - 6 days
change/stop if resistance
warn low threshold for testing UA

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2
Q

sinusitis (AAP) diagnosis & Treatment

A
  1. > 10 days cough, nasal discharge
  2. worsening (new discharge, fever, cough)
  3. acute onset (fever > 39, purulent nasal d/c)

Rx: amoxicillin or amox/clav 10 - 28 days
(45mg/kg/day or high dose 90mg/kg/day)

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3
Q

Risk factors for influenza (6)

A 
age < 5
Aboriginals
asthma/CLD/CF etc
cardiac - exclude isolated HTN
DM, CKD, Liver disease, rheumatologic
hemoglobinopathies
immunodeficiency
homes/chronic homes
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4
Q

UTI risk factors

A 
< 12 months old
white race
fever > 39 
fever > 2 days
no obvious source
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5
Q

growth required for UTI

A

clean catch 10^8 CFU/L
catheter 5x10^7 CFU/L
suprapubic - any growth

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6
Q 
UTI microbiology &amp; 
empiric choices (PO + IV)
A 
Klebsiella
Ecoli
Enterococcus fecalis, enterbacter cloacae
Pseudomonas
Staph saprophyticus,   serrata 
citrobacter
Cefixime PO (3rd gen)
IV hospital - gent +/- ampicillin or ceftriaxone/cefotaxime
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7
Q

ID control - pediatric office

Disinfection requirements

A
  1. critical - ie needles - sterilzation
  2. semicritcal (contact MM, non intact skin - speculum) - sterilzation or high level disinfection
  3. non critical (intact skin only - ie BPcuff) - immediate or low level - alcohol wipe
  4. environmental - low level or detergent/water
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8
Q

ID control - pediatric office

health care worker - restrictions from office

A

influenzae, measles, mumps, pertussis, rubella, TB active, varicella

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9
Q

how to prevent mosquitoes and tick bites?

4

A
  1. avoidance- dusk, dawn, woodlands for Ticks
  2. physical barrier - screens, bed nets
    loos, long fitting. lightly colored clothes
    Inspect child at least daily- remove with 24hr prevent Lyme disease
  3. Repellant
    6 mo - 12 years old - icaridin 1st choice
    > 12yo - DEET up to 30%
  4. insecticides - permethrin can be sprayed on clothing
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10
Q

Indications for macrolides

A

atypical pneumonia - H influenzae, morexalla catarrhalis etc
2nd line - life threatening beta lactam allergy in acute GAS pharyngitis
Should not be used for AOM, pneumonia 1st line

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11
Q

mucocutaneeous candidasis

- name 2 types and treatment

A
  1. oropharyngeal (oral) thrush
    - topical gentian violet
    - nystatin suspension - 80% for 2 weeks
    - 1st gen - clometriazole
    - 2nd gen fluconazole if fail conventional/immunocompromised
  2. candida diaper dermatitis
    - topical antifungals (clometrizole, nystatin)
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12
Q

Tinea capitis

- describe lesion and rx

A

single or patches of alopecia with plaques
+/- boggy edematous plaque = Kerion
Rx: oral griseofluvin, terbinafine (lamisil) 4 - 6 weeks

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13
Q

TInea corporis

-describe lesion and rx

A

ringworm - lesions, circular
via direct contact
topical clotrimazole, terbinafne BID 2-3weeks

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14
Q

Tinea Pedis

-describe lesion and rx

A

athelete’s foot. pruitic, erythematous, scaly lesions between toes
topical clotrimazole

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15
Q

Pityriasis versicolor

-describe lesion and rx

A

mild or chronic condition with scaly hypo/hyperpigmentation on trunk.
often adolescent
NOT dermatophyte infection - malassezia
Rx: topica ketaconazole, clotrimazole
nightly 1 -2 weeks, then qmonth x 3 months

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16
Q

Risk factors for invasive meningococcal infection (5)

A 
anatomical/functional asplenia
immunodeficiency
complement or factor D deficiency
Travellers to high risk area
lab personale with exposure
military
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17
Q

when to give MCV-C?

Menjugate serotype C

A

all children @ 12months

earlier if risk factors @ 2, 4, 12mo (or by provincial schedule)

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18
Q

When to give MCV-4?

Menatra A, C, Y, W-135

A

ALL booster with MCV4 or MVC-C at ~ 12 yo
if risk factors @ 2 year old
if HIV at anytime if >/= 2 year old

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19
Q

Neisseria Meningitidis

- what is most common serology

A

Vaccinate A, C, Y, W-135, so most common now type B serotype (just new vaccine)
peak incidence < 5 year old.

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20
Q

why Neisseria Meingitidis so bad?

A

Serotype C- associated with outpbreaks, higher rate of sepsis and mortality
can cause meningitis, septic arthritis, pneumonia, conjunctivitis,
extremely variable - occult bactermia to fulminant fatal disease
10% mortality in invasive disease

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21
Q

4CMenB or Bexsero

-who and when to give?

A 
risk of meningococcal invasive disease
-functional/asplenia
-immunocompromise
- complement or factor D deficiency
-(military/lab personale)- unclear for B
When: 3 doses @ 2, 4, 6months 
s/e - higher rates of fever
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22
Q

Neisseria Meningiditis - B serology

epidemiology

A 
vaccine still unsure effectiveness
70% before 6 months
hence @ Vaccine 2, 4, 6mo
mortality 3.8% for infants < 1 year old
ICU for 60%, morbidity 10%
dec IQ, seizures, SNHL, motor impairment, visual loss
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23
Q

what is palivizimab

A

humanized murine monoclonal IgG-1 against RSV
reduces 80% of hospitalizations in premature infants
Decreased parent reported wheezing
No proven short term benefit for ICU/deaty

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24
Q

Indications for RSV palivizimab?

A 
GIVE:
- hemodynamically sig CHD/CLD (need O2 @36GA)  with O2/diuretics/puffers < 12mo old
OFFER (not essential)
-- premature < 30GA &amp; < 6mo old 
-- Remote (air) < 36GA &amp; < 6mo old
CONSIDER: 
- Inuit term, if < 6mo old
- immunocompromised &amp; home O2 < 24mo old
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25
Q

How to give palivizimab

A

eligible - RSV prior to d/c
IM 15m/kg q30 days max 3- 5
if breakthrough - d/c

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26
Q

Types of vascular access device

Name pros/cons

A
  1. peripheral
    - easy insert
    - phebitis common. med extravastion
  2. midline cateter
    - easy insert. more stable than PIV
    - limited # of sites, not widely used
  3. PIC line
    - insertion less invasive than others
    - difficult blooddraw, may need TKVO
  4. Tunnelled/Broviac
    - multiple lumens, blood draws
    - needs GA for insertion. ongoing care
  5. Implanted port
    - lowest infection risk. minimal effect on pt
    - insertion invasive. Not good for daily access
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27
Q

Home IV therapy

common complications

A

mechanical failure - insertion, thrombosis, dislodgement, occlusion, leakage
Infectious
metabolic - eletrolytes, hypoglycemia etc
Treatment related

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28
Q

3 considerations for home IV therapy candidate

A
  1. clinical factor - indication, health of patient, risk for complications
  2. patient/family - compliance, reliable
  3. medication - duration, frequency, .
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29
Q

Prevention of blood infection

4

A
  • restrictive donor selection
  • limit # transfusions
  • manufacturing - aseptic techniques, viral inactivation. Leukocyte reduction
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30
Q

blood transfusion - infection risk

A 
HBV - ~1 in 1 million (1.1-1.7)
HCV -  ~1 in 5 million (5-7)
HIV  -  ~1 in 10 million (8-12)
Syphillis < 1 in 100million
Bacterial (platelets) 1:50,000
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31
Q

Adverse Transfusion events

4

A

rate of adverse events per product transfused 1/3000

  • TACO almost 50%
  • severe allergy/anaphylaxis/anaphlyactoid 15%
  • hypotensive 12%
  • TRALI 10%
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32
Q

what is tested in blood?

A

HIV, HBV, HCV, syphillis
HTLV 1, 2, WNV
Bacteria on platelets
(CMV select units only)

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33
Q

what are the risk factors for invasive pneumococcal disease?

A

immunocompromised (HIV, CRF, nephrotic, meds)
functional/asplenia
immunocompetent: CHD, CLD, DM, CSF leaks

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34
Q

8 steps vaccine safety system

A
  1. pre-license review & process (gv’t regulator)
  2. manufacture regulations (strict procedures)
  3. independent expert review (NACI)
  4. immunization competencies for providers
  5. surveilence for AEFI (AE following immunizations) - passive & active
  6. AEFI - causality assessment
  7. effective signal detection
  8. research network and special immunization clinics
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35
Q

what is Lyme disease caused by?

A

Borrelia burgdorferi (bacterial)
lxodes blacklegged (ticks)
primary hosts: mice, rodents, small mambles, birds, white tailed deer
climb & wait on grass/shrubs

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36
Q

Lyme disease

(3) manifstations

A
  1. Early local/Erythema Migrans
    - 7-14 days after tick bite. erythematous macule w/ central clearing
    - painless, non pruritic
    - +/-fever, malaise, myalgia
  2. early disseminated
    - multiple EM
    - secondary annular erythematous lesions
    - neurological - facial nerve palsy, lymphocytic meningitis
    - Lyme carditis (heart block, rare)
  3. late disease
    - pauriarticular arthritis (large)
    - peripheral neuropathy,
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37
Q

Lyme disease diagnosis

A

EM - history and clinically needed only

Early disseminated & Late: 2 step serological

1) ELISA
2) western blot
- antibodies not detected within first 4 weeks
- if menigitis - CSF IgG and IgM possible

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38
Q

Lyme disease treatment

A

PO - amox < 8, doxy > 8 (alt cefuroxime 2nd)

1) EM - self resolve 4 weeks but rx PO 2-3ks
2) isolated Facial palsy PO 14 - 21 days
3) arthritis - PO 28 days

IV Pen G or cetriaxone

1) carditis/heart block IV 2 - 3 wks
2) meningitis 2-4wks
3) encephalitis/late 2 - 4 wks

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39
Q

Complications of Lyme disease (2)

A

Jarish-Herxheimer reaction

  • fever, headache, aggravated clinical <24hr when Rx started
  • NSAIDs, continue

Post-treatment Lyme disease syndrome

  • unknown etiology
  • 10-20% persistent fatigue, joint/muscle ache
  • prolong abx course not helpful
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40
Q

S/E tetracyclines

A

discoloration of teeth/staiing
s/e nausea, diarrhea, rash, photosensitivyt
rare - hepatotoxicity, neutropenia

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41
Q

Why is Autism not related to vaccines

A

1998 Wakefield report based on 8 pts. retracted, pulled,
Causuality interpretation - fails consistency, strenghth, specificity
Thimersol - ASD inc despite removed from vaccines (was only in Influ and HBV)

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42
Q

Breastfeeding Contraindications

A

HIV, HTLV1, 2
Brucellosis
active TB (until rx 2weeks)
infant - classic galactosemia

Possible:
Active HSV lesions (cover with mask. if breast lesions, interrupt until crusted or use EBM)
Mastoiditis with pus (can pump/other side)

Med:
high dose metronidazole - d/c 12-24 for discard
caution antimalaria/sulfa med if G6PD

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43
Q

Tuberculin skin test

false negatives

A 
young children (< 6mo)
during incubation period (2-10weeks)
administration technique
concurrent - Measles, varicella, etc.
overwhelming TB
malnutrition
immunosuppression
immunocompromised (ie HIV)
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44
Q

TST

false positives

A

previous bcg vaccine
non-tuberculosis mycobacterium
incorrect technique
incorrect interpretation

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45
Q

TST interpretation

who positive < 10mm

A

0-4mm if child < 5 years old AND high risk TB infection

5 -9mm if immunosuppressed
(HIV, organ transplant, corticosteroid, TNF alpha, ESRD)
contact with active TB in past 2 years
fibronodular dz on CXR

> /=10mm all others

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46
Q

Who to screen for TB with TST?

A
  • contacts known active TB
  • children suspect active TB
  • known risk factors for progression from infection to dz
  • Travel > 3 mo in endemic area
  • From endemic areas within previous 2 years
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47
Q

Who is high risk of development of active TB?

A 
AIDS
transplant (related to med)
silicosis
CRF needing HD
carcinoma head and neck
recent TB (2 years)
abnormal CXR - fibronodular
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48
Q

Pros of IGRA testing

A

measures in vitro production of Interferon gamma by sensitized lymphocytes in response to TB. SPECIFIC antigens, not in BCG vaccine/non TB strains. = 1. more specific

  1. . single visit (fast turn around)
  2. less subjective to interpretation
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49
Q

When to test IGRA?

A 
children > 5 + BCG vaccine
unable to return for TST read
To facilitate TST for dx
- not correspond to clinical suspicion to inc sensitivity
-non TB disease suspected
-low risk contact situations
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50
Q

What is bronchiolitis?

A

acute inflammation, edema, necrosis of epithelial lining of small airways & increased mucous production

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51
Q

Risks factors for severe bronchioloitis

A

premature < 35GA
< 3 months at presentation
hemodynamically significant Cardiac dz
Immunodeficient

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52
Q

discharge criteria for bronchiolitis

A 
tachypnea and WOB improved
O2 > 90 without O2 or stable home o2
adequate PO
education provided
f/u arranged
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53
Q

In Rx of bronchiolitis, what is NOT recommended and what is equivocal?

A

Equivocal

  • epi neb
  • HTS nebs
  • nasal suction
  • epi/dex combo

NOT

  • ventolin
  • steroids
  • antibiotics
  • antivirals
  • cool mist therapies
54
Q

what is transmission risk for congenital syphilis?

A

primary/secondary untreated 70 - 100%
early latent - 40%
late latent < 10%

55
Q

when is syphilis tested for in pregnancy?

A

@ first prenatal visit
rescreen 28 - 32weeks & @ delivery if HIGH RISK
If unexplained hydrops/stillbirth, screen post partum

56
Q

When to evaluate for congenital syphilis

A

-signs and symptoms
-mother not treated or adqeuate documentation
-treated within 30 days delivery
-treated with NON-penicillin
-< 4fold drop in other non treponemal titre
Relapse or reinfection

57
Q

What are clinical findings congenital syphilis

A 
snuffles
maculpapular rash w desquamation
DAT neg hemolytic anemia
psuedoparalysis 
chorioretinitis, glaucoma
58
Q

What is the clinical scenario NOT to work up for cong. syphilis

A
  1. appropriate treatment during pregnancy (not within 30 days of delivery)
  2. 4fold or greater drop in maternal RPR titer
  3. infant RPR non reactive or = mothers
  4. infant asymptomatic

–> clinical and serological f/u 18 months

59
Q

Evaluation of congenital syphillis

A 
P/E - stigmata + ophtho + audiology
CBC, LE, LP
syphilis - RPR &amp; treponemal testing
skeletal survey
direct detect - placental, umbiliical via darkfield microscopy
60
Q

what is treatment for congenital syphilis?

A
  • proven, probable disease OR
  • asymptomatic, risk based on history:

IV Pen G 10 - 14 days

61
Q

risk factors CA-MRSA?

A 
overcrowding
frequent skin-skin
activities that result compromised skin surface
share contaminated personal items
difficult personal hygiene/cleanliness
limited access health care
Aboriginal, athletes
day care attendees
IVDU, MSM
Prisoners
62
Q

CA-MRSA skin abscess treatment (empiric) ?

A

< 1 month - IV Vanco + admit
1-3mo + WELL = I&D, PO septra
>3mo + WELL = I&D only
>3mo + sx* = I&D + septra AND keflex

*significant cellulitis, < 38 fever
PO duration = 7 days.
cephlexin - better coverage of GAS

63
Q

Head lice treatment

A

Permethrin 1%
-shampoo, leave 10mins, rinse cool water
- repeat in 1 week
s/e itch & mild burning sensation on scalp

  • NO require school exclusion
64
Q

Why 2 dose varicella vaccines?

A

Primary failure = protective ab not produce (unable to detect immunity with vaccines)
secondary failure = weaning immiunity

65
Q

When to give Varicella vaccines?

A

2 doses
@ 12 - 18 months
@4 - 6 years

provide to people who only have 1 shot
post-partum if mom not immune

66
Q

Approach to vaccine hesitant families?

A
  1. understand specific concerns of parent (dont add more)
  2. clear, focused language
  3. inform rigor of vaccine safety system
    - independent, NACI, CPS, tracking, special clinics
  4. Do not dismiss from practice
  5. F/U, consider referral to peds ID
67
Q

Strategies for antimicrobial stewardship (5)

A
  1. Accurate diagnosis
    - delay Rx if viral likely
    - test judiciously
    - know contamination vs infection
  2. antibiotic selection
    a) narrowest spectrum
    b) optimize dosing to obtain max benefit (ie aminoglycosides OD for dose dependent dosing)
    c) if drug reaction - address
  3. antibiotic duration
  4. prevention - vaccinations
68
Q

what is recommendation for egg allergy & influenza vaccines?

A

FULL dose inactivated trivalent or quadrivalent SAFE
-observation as with other vaccines

not use live attenuated (intranasal) - insufficient data

69
Q

What is rate of HIV vertical transmission with and without intervention?

A

25% no intervention
<2% (antepartum, intrapartum, neonatal Rx)
+ about 9%/yr if BF allowed

70
Q

Strategies in HIV vertical transmission

A

HIV offered all preg early
1) Antenatal care
tripe ART 2nd T (or earlier)

2) intrapartum
- IV zidovudine during labor
- viral load < 1000copies/ml SVD or C/S

3) neonatal
Zidovudine 6 weeks
avoid BF

71
Q

HCV vertical transmission what is rate?

Confounding factor?

A

5% transmission rate

  • lower if HCV-RNA neg
  • HIV coinfection (up to 25%)
  • high maternal viral titre
  • mat cirrhosis
72
Q

what is natural history of HCV in peds?

A

25% appear to clear (persistent HCV ab)

75% chronic - active viral duplication > 6 mo

73
Q

How to minimize HCV vertical transmission

A

avoid mix blood (scalp electrodes, etc)
No absolute for C/S
Not C/I for BF

other: consider HBV vaccine 1st month and HAV vaccine > 1 year

74
Q

HCV vertical - testing

A

diagnostic: 18month old HCV antibody

can do > 2mo HCV RNA test
if positive, repeat q6mo
-if neg, do 18mo testing

75
Q

C.difficilie who to test & how?

A

any pt with abx within 3mo or signs bloody diarrrhea +/- systemic
immunocompromised w/ chemo/abx within 3 months with diarrhea illness (watery/blood)

Investigation: stool toxin
(+ not signficant in asymptomatic)

76
Q

Rx c. diff

A

mild: d/c abx. no active rx. RTC if no improve 48hr
mod: Oral flagyl 10- 14d
severe: PO vanco 10- 14d

severe complicated (ileus, megacolon, peritonitis, HypoTN)
- IV flagyl AND PO vanco 10-14d

if recurrent - repeat rx above
if 2nd recur - Vanco pulse with tapered wean

77
Q

Risk factors C.diff Infetion

A 
long hospital stay
older age
multiple abx exposure
chemotherapy
hypoalbuminemia
GI sx, gut manipulation, tube feeting
78
Q

2 prevention strategies for influenza protection infants < 6mo

A
  1. cocooning - vaccinate close contacts

2. immunize pregnant women - passive transfer in BF (inactivated vaccine at any stage)

79
Q

pneumonia microbiology

A 
streptococcus pneumona
GAS
staph aureus
h. influenza
atypical:
mycoplasma pneumonaie
chlamydophilia pneumonaie
80
Q

pneumonia investigations

for hospitalized

A

if hospitalized
CBC, diff, CXR, Blood cuture
viral - if influenza season

81
Q

uncomplicated pneumonia Rx

A

IV amp - hospital, not septic
IV ceftriaxone/cefot - resp failure or septic shock

+ IV vanco - progressive multilobar or pneumatoceles
+ macrolide if persistent cough or seriously ill
duration 7 - 10 days

82
Q

Infective endocarditis indications (patient)

A
  1. prosthetic cardiac valve
  2. previous IE
  3. unrepaired cyanontic CHD (include palliative shunt, conduit)
    4 completely repaired CHD with device during 1st 6 mo
  4. repaired CHD with residual defects close to prosthetic
  5. cardiac transplant with valvuloplasty
  6. rheumatic disease if prostheic valves/material
83
Q

IE indications (high risk procedures)

A

dental procedure - gums/lining injured
Resp - incision/biopsy of mucosal like T&A (+/- bronch)
GI/GU surgery trough area infected
SSTI - if infected skin/MSK

84
Q

Describe IE prophylaxis

A

single dose 30-60min before procedure, up to 2hr after

PO Amox 50mg/kg
IV amp or cefazolin or ceftriaxone
a
Alt: cephalexin, clinda, azithro, vanco

85
Q

Rx of complicated pneumonia

A 
ANTIBIOTICS:
IV ceftriaxone/cefotax
\+/- clinda for anerobic or CaMRSA 
\+/- vanco - MRSA suspect
total 3-4 weeks
switch PO when drained, clinically improve
Procedure
chest tube +/- tPA up to 3 days
VAT 
open thoracotomy
repeated thoracocentesis

f/u
CXR 2 - 3month until near normal

86
Q

infection control chicken pox

school vs hospital

A

IFwell, return regardless of state of rash
-notify school for immunosuppressed kids
Hospital - day 8 to day 21 from contact

acquisition up to 24-96hr BEFORE rash develop on sick contact

87
Q

c/I to rotavirus vaccine

A

immunocompromised (esp SCID)
allergic reaction
history of intussusception

88
Q

rotavirus vaccine

  • when
  • advice to parents
A

ALL infants unless C/I
start between 6 week, compete by 8 months (separate 4 weeks)
premature - give between 6-32weeks PNA
LIVE attenuated - Rotarix 2 doses

Slightly higher risk intussusception 1 week following.

89
Q

Risk factors AOM

A 
young age
frequent contact other children
orofacial abN
household crowding
cigarette exposure
pacifier use, 
prolonged bottle lying down
FmHx, first nations, inuit
90
Q

When treat AOM

A

buldging TM, high fever (>39)
mod/severe systemically ill
severe otalgia or
ill > 48hrs

91
Q

watchful waiting AOM

A

> 6months, mild illness

92
Q

AOM diagnosis

A

Otalgia AND signs of effusion AND inflammation or ruptured TM

93
Q

AOM microbiology

A

strep pneumo, GAS >

morexella catarrhalis, H influ

94
Q

AOM treatment

A

** Amox BID high dose
5 days if > 2year old uncomplicated
10 days if 6-23mo OR perforate

IF recent amox (30d) - amox clav (7:1) 45-60mg/kg/d
IF otitis-conjunctivitis syndrome (more Hflu, M.Cat)
- amox clave or 2nd gen (cefuroxime)
IF amoxclav failed/NPO - IV/IM ceftri x 3 days
IF anaphlyaxis - azithro/macrolide

95
Q

organ transplant - PRIOR prevention steps

A 
optimize vaccine 
Inactivated - minimum 2 weeks
live - minimum 4 weeks prior
vaccinate household
counsel - high risk lifestyle, food, travel in immediate period
96
Q

Organ transplant

vaccine recommendations

A

hold vaccines s/p 6 - 12mo
except for influenza inactivated s/p 1mo okay

PCV 13 series then PCV23
Men conjugate quad if > 2 year old
HPV - male and female
Hep A, B 
if no Hib prior - give
97
Q

Natural history of infection risk - organ transplant

A
  1. first month s/p
    similar to non-suppressed pts
    other: infection present in recipient prior to transplant
  2. 1 - 6mo s/p = immunosuppression noticable
    viruses: cmv, ebv, HH6, hep B, C
    bacteria: listeria, aspergillus, PJP
  3. 6mo +
    if well, similar to healthy community acquired infection
    higher risk: PJP, Listeria, crytpococcus, nocardia
98
Q

HPV vaccination recommendations

A

HPV 6, 11, 16, 18 (cancer 16, 18)
Girls 9-13 year old
(males - unable to make recommendation - efficacy unknown but likely beneficial)
IM @0, 2, 6 months
Still need PAP routine PAP smears
S/E rare - bronchospasm, GI, H/A, HTN, vaginal hemorrhage

99
Q

acute otitis externa

diagnosis, microbiology

A
  1. rapid onset (48hrs)
  2. symptoms (otalgia, fullness)
  3. signs - tender tragus/pinna, canal findings etc

micro: staph aureus, pseudomonas

100
Q

risk factors otitis externa

A 
trauma
FB in ear, hearing aid
dermatological condition
tight scarves, ear piercing
chronic otorrhea
immunocompromised
101
Q

Rx otitis externa

A

topical antibiotic +/- topical steroids 7-10 days
ie ciprodex 4 drops BID x 7 days
pain control
expect improvement 48-72 hrs

102
Q

Complication otitis externa

A 
malignant otitis externa
- invasive infection of cartilage/bone of canal
Facial N palsy and pain
nocturnal pian, extend to TMJ, pain with chewing
risk: DM, immunocompromised
Lx: CT/MRI
IV cipro or piptazo (pseudomonas).
 If aspergillosis, vori
103
Q

Risk factors of fatalities with cold and cough medications

A

NOT advise for children < 6 years

Risk factors:
age < 2 years
used for sedation
used daycare setting
combine 2+ meds
failure to use measuring device
product misidentification
used products for adults
104
Q

daycare bites

HBV

A

overall very low
if unknown status both –> Vaccinate only (no test needed)
if one unimmunzed, one known HBV –> IM HBIG and vaccinate, serology 6 months

105
Q

day care bites

HIV

A

extremely low - prophy only with ID consult and exeptional
if known contact AND blood exposure
- start ASAP, within 72hrs f/u 6 wk, 3, 6 months

106
Q

apslenia - what bacteria at risk for?

A

streptococcus pneumon > HiB, Neisseria menigiditis, salmonella, ecoli

  • less: pseudomonas, klebsiella
  • cat/dog bites- capnocytophagia
107
Q

asplenia - vaccination recommendations

A

ideally 2 weeks prior to splenectomy. or 2wks post

ALL childhood vaccines
1) influenza - starting at 6mo
2) PCV 13 - 4 doses
PCV23 @ 2 yr + BOOSTER (5yr after)
3) MCV4 as primary series or 2 doses if missed - booster q5 years
4) Hib- routine (4doses). if > 5 missed x1 dose
+ travel immunizations (malaria)

108
Q

asplenia prophylaxis

A

until 5 years old or longer if invasive disease (some lifetime)

< 3 mo - cover ecoli and klebsiella
otherwise, primarily for strep pneumo

Birth -3mo: amoxclav + Pen VK
> 3mo -5yo - Pen VK or amoxicillin (10mg/kg/dose BID)
if pen allergy - erythromycin + allergy testing

109
Q

febrile asplenia - management

A

high mortality - medical alert bracelet
mortality 50-70% in < 2 years old
highest risk first 3 yrs of life (Congenital) or 3 years post splenectomy

CBC, diff, blood culture,
IV ceftriaxone +/- IV vancomycin
if allergy - ciproflox and canco

110
Q

Congenital rubella

clinical symptoms

A

1st trimester - spont abortion in 20%, anomalies in 80%
uncommon anomalies after 16 weeks GA

Classic triad = catarcts, PDA, SNHL
other:
unexplained microcephaly
cataracts, glaucoma, blueberry muffin rash
pigmentary retinopathy
hearing impairment
thrombocytopenia
radiolucent bone density
111
Q

bacterial meningitis

- when add steroids

A

Hib meningitis - decreases hearing loss if administered before or with initial abx
+/- strep pneumo
IV dex 0.6mg/kg/day immediate or within 30min of first antibiotic
total 2 days then d.c otherwise

112
Q

bacterial meningitis

- when for audiology testing

A

before d/c or within 1 month

113
Q

(not empiric) antibiotic choices for bacterial meningitis & duration

A

HiB - Amp 7 - 10 days
N meningitidis - PenG/Amp 5 - 7 days
s pneumo- Pen (ceftria +/- Vanco) 10 -14 days
GBS PenG /Amp (add gent first 5-7days) - 2- 3 weeks

114
Q

what defines invasive GAS infection?

A

1) lab confirmation +/- clinical
2) Streptococcus TSS
3) soft tissue - Nec fac, myositis, gangrene
4) meningitis
5) combo of above

115
Q

risk factors invasive GAS

A

HIV, cancer, heart disease, DM,
lung disease, alcohol abuse
IVDU
varicella (in children major risk factor)

116
Q

GAS chemoprophylaxis indications

A

close contact with CONFIRMED severe GAS
(ie not bactermia or septic arthritis)
7 days before onset sx to 24hr initiate rx

117
Q

GAS chemoprophylaxis - how and when

A

ASAP, ideally < 24hr but up to 7 days
1st 1st gen Cep (cephalexin) 10days
2nd line erythromycin, clinda, clarithro 10 days

118
Q

scabies - treatment

A

5% permethrin cream
neck to toes, leave 12-14hrs then wash off
repeat 7 days later
all bed linen - laundry hot or seal 5 - 7 days
Can return to school after 1st treatment

119
Q

scabies risk factors

A 
poverty, overcrowding
bedsharing
malnurtrition
Aboriginal
young children, elderly
immunocompromised
lack of clean running water
120
Q

influenzae vaccine (live) contraindications

A

severe asthma (currently high dose ICS/oral)
pregnancy, immunocompromised
children 2 - 17 yrs on ASA (Reye syndrome)

121
Q

Who to screen STI in males? (6)

A 
If risk factors:
- contact with known STI
- previous STI
- new sexual parter or >2 in past year
IVDU
unsafe sexual practices
anonymous sexual partners
sex workers, survival sex
homeless
detention facility
sexual assault/abuse
122
Q

Who to screen STI in feamles

A

ALL who are sexually active or victims of assault/abuse

largely asymptomatic

123
Q

What STI to test for?

A

first urine catch OR (m=urethral, f=vaginal) swab for Chla, gonorrhea
serology - syphilis, HIV
other consider: HAV, HBV, HCV

124
Q

Primary & secondary prevention for STI

A

Primary:
vaccination - HBV, HPV
condom use
behavioral change

Secondary:
partner notification
screen & treat STI in asymptomatic

125
Q

who to do test of cure?

A

prepubertal children with Ngonorrea and/or chalmydial

retest 6 mo for adolescent/adults for N gonrrhea and/or chlamydia due to risk of reinfection

126
Q

Treatment of uncomplicated gonococcal infection

A

IM ceftriaoxone 250mg PLUS 1 dose azithro 1g OR
PO cefixime single dose PLUS 1 dose azithro

if pharyngeal infection
IM ceftriaxone plus azithromycin
(covers for chlamydia co-infection)

127
Q

Chlamydia treatment

A

Doxycycline PO 7 days OR
azithromycin single dose
alternative - erythromycin

128
Q

syphilis treatment

A

Primary - IM pen G x1 dose

129
Q

zika virus - what is it?

A

flavirus transmited by aedes aegypti and aedes albopictus
transmitted via semen, blood, sexual contact
80% asymptomatic
maculopapular rash,low grde fever
rare - encpehalititis, hearing loss, GBS, TTP

130
Q

congenital zika - distinguishing features (4)

A

severe microcephaly with partially colapsed skull
thin cortical cortices with subcortical calcificaiton
macular acarring, focal pigmentary retinal molding
congenital contractures
marked early hypotonia and extrapyramidal movements

131
Q

if clinical congenital zika, what investigations?

A

ZIVK serology & blood & urine ZIKV serology on mom and child
Save placenta
U/S and MRI head non urgent

-if child with IgM ZIKV, confirm with PRNT assay (plaque reduction neutralization test)

132
Q

biologics and infection risk

A

TB, fungal, non-TB mycobacteria
MANAGEMENT
evaluate for latent TB infection
-TST and CXR (5mm cut off)
if high, empiric 9mo isonizaid
-food -avoid undercooked meats, unpasteurized etc
- avoid direct contact with kitty (toxo, barotnella), reptiles, (salmonella)
- construction sites, cave exploration, farmlands (fungal spores)
- vacination PRIOR
(inactivated 2 wks prior, live 4 weeks prior)
Live vaccines C/I in treatment
household vaccination

General Pediatrics (19 decks)

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