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CPS Alia > CPS ID > Flashcards

CPS ID Flashcards

1
Q

RF associated with the spread of community acquired MRSA

A
  • close skin to skin contact
  • openings in the skin/abrasions
  • contaminated items/surfaces
  • crowded living conditions
  • poor hygiene
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2
Q

When should empirical antibiotics be used from the first day of presentation in a child with a skin abscess?

A
  • child < 3 months
  • significant associated cellulitis
  • fever
  • other signs of systemic illness

*Note child < 1 month of age should be admitted for IV Abx (usually vanco) unless the abscess is small (<1 cm)

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3
Q

How can most skin abscesses be treated?

A

I+D alone

Unless child is < 3 months, signs of systemic illness, significant cellulitis, fever

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4
Q

For a child > 3 mo with significant cellulitis, low grade fever, how should they be treated

A

TMP-SMX treats almost 100% of MSSA and CA-MRSA. But has poor coverage of GAS.

Group A strep cellulitis is a rare cause of skin abscesses and those abscesses are likely to resolve without abx, but if you want to cover consider adding cephalexin.

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5
Q

CPS recommends exclusive breastfeeding for how long?

A

6 months

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6
Q

Of the following which are contraindications for BF

1) Mastitis
2) TB
3) Brucellosis
4) Malaria
5) maternal CMV

A

1) Mastitis: continue BF from unaffected breast, if obvious pus - continue to pump milk and discard.
2) Delay BF until mum has had 2 weeks of anti TB therapy. Baby can get expressed breast milk in interim. Breastmilk safe while mom is on therapy. Baby does not need pyridoxine supplementation.
3) Brucellosis is a contraindication to breastfeeding. Infection can be transmitted through BM
4) Malaria: no contraindication. Meds safe unless baby has G6PD.
5) maternal CMV: no contraindication

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7
Q

Of the following, which are NOT contraindicated in BF?

  1. HIV
  2. Human T cell lymphotrophic virus type I or II
  3. Brucellosis
  4. Hep C
A

Hep C - continue BF, baby should get immunization for HBV

  1. HIV - contraindicated in resource rich settings
  2. HTLV type 1 and 2

Although CMV infection the virus reactivates in the breastmilk, but no serious disease placentally transmitted Ab.

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8
Q

What is one medication that would warrant stopping BF?

A

High dose metronidazole, BF should be discontinued for 12-24 hours until dose is excreted

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9
Q

When are individuals with splenectomy at the highest risk of sepsis

A

3 years post splenectomy

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10
Q

True or False, patients who undergo splenectomy for hematologic causes have a higher risk of sepsis than those who have splenectomy for trauma.

A

True

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11
Q

What are the most common organisms responsible for infection in asplenic patients?

A
  • Streptococcus pneumoniae
  • Haemophilus type B (Hib)
  • Salmonella
  • E.Coli
    Less common:
  • Psuedomonas
  • Klebsiella
  • streptococci
  • staphylococci
  • capnocytophagia from cat/dog bites
  • more susceptible to severe
    malaria and babesia (tick bites)
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12
Q

How should you treat an asplenic patient with a dog/cat bite?

A

More susceptible to capnocytophagia species with cat/dog bites, treat with amox-clav.

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13
Q

How many weeks before should immunizations be given prior to splenectomy?

If not possible to do before, how soon AFTER splenectomy can it be given?

A

at least 2 weeks BEFORE

or as early as 2 weeks POST splenectomy but you must weigh the risk, can be immunized prior to discharge from hospital

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14
Q

What percentage of toddlers with asthma become asymptomatic by 6 years of age?

A

60 %

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15
Q

What is the main consequence of wheezing in early life?

A

Reduction in lung function by 6 years age age ~ 10% reduction in FEV at 1 second (FEV1)

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16
Q

What is the preferred diagnostic method of asthma in preschoolers?Dd

A

signs of airflow obstruction (documented wheeze by physician OR convincing parental report) with evidence of reversibility of airflow obstruction (documented improvement in signs of airflow obstruction to SABA - short acting beta agonist by physician or trained healthcare provider OR convincing parental report of symptomatic response to a 3 month trial of medium dose ICS)

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17
Q

What do you prescribe for a toddler with >8 days/month of symptoms or > 2days/week of asthma like symptoms or 1 episode moderate-severe asthma-like exacerbation episode (hospitalization or oral corticosteroids)?

A

medium dose ICS (200-250 ug/day)

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18
Q

What are 4 features of congenital zika virus syndrome ?

A
  • microcephaly
  • subCORTICAL calcifications
  • cerebral atrophy
  • abnormal cortical development
  • callosal hypoplasia
  • ventriculomegaly (head circumference can be N with ventriculomegaly)
  • arthrogryposis (clubfoot)
  • microopthalmia
  • cataracts
  • retinal abnormalities
  • IUGR
  • SNHL
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19
Q

How do you diagnose congenital Zika virus transmission?

A
  • IgM: positive 7 days following symptom onset, persists 3 months (baby with first trimester infection will be unlikely to have positive IgM)
  • IgG: 10 days after symptom onset
  • infection must be confirmed by PRNT (plaque reduction neutralization test) looks for Zika antibodies
  • positive IgM
  • positive PCR in blood and urine
  • positive PRNT can be from passive transfer from mom to baby, but if positive beyond 18 mo of age then diagnostic
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20
Q

What are the features that distinguish congenital zika virus from other congenital infectious diseases?

A
  • severe microcephaly
  • subcortical calcifications
  • partially collapsed skull
  • thin cerebral cortices
  • congenital contractures
  • macular scarring with retinal mottling
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21
Q

What are 5 early signs of congenital syphilis

A
  • Neurosyphilis
  • Rash (maculopapular, but can evolve into bullous and desquamation)
  • osteochondritis
  • snuffles/rhinitis (common early sign)
  • hydrops/spontaneous abortion
  • hepatomegaly and splenomegaly
  • pseudoparalysis
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22
Q

What are 5 late signs of congenital syphilis

A
  • frontal bossing
  • sensorineural hearing loss
  • interstitial keratitis
  • hutchinson’s teeth, mulberry molars
  • GDD
  • anemia, thrombocytopenia, coombs negativeery
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23
Q

When should you evaluate a baby for congenital syphilis?

A
  1. infant has signs and symptoms of congenital syphilis
  2. mother completed treatment within 30 days of delivery
  3. mother treated with a non-penicillin regime
  4. mother did not have 4 fold drop in RPR (non treponemal titer)
  5. mother had relapse/re-infection after treatment
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24
Q

How do you know a mother has been adequately treated for syphilis

A

4 fold drop in RPR at 6 months (eg from 1:32 to 1:8 dilutions)

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25
Q

What investigations should you order for a baby with suspected syphilis

A
  1. Optho exam
  2. Hearing screen
  3. LP + send CSF for treponemal testing
  4. Skeletal survey
  5. Syphilis serology (treponemal and non treponemal testing)
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26
Q

In an asymptomatic baby born to a mother who did not have a 4 fold drop in RPR, what is appropriate management?

A

Even if your work up is negative (LP, skeletal scan, RPR serology, optho and hearing screen), baby must still receive 10 day course of IV penicillin G 50,000 U

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27
Q

Baby born in india has cataracts, PDA and SNHL.

What infection is likely?

A

Rubella

28
Q

Baby has hydrocephalus, intracerebral calcifications and chorioretinitis. What infection is likely?

A

CMV

29
Q

When should VZIG be given?

A

Within 10 days of exposure

30
Q

What vaccine should all non pregnant immigrant and refugee women recieve?

A

If no documentation of vaccination or immunity, all nonpregnant refugees and immigrants should receive the MMR vaccine

31
Q

What 4 congenital infections can cause SNHL?

A
  1. CMV (most common)
  2. Syphilis
  3. Rubella
  4. Toxoplasmosis
32
Q

What 4 congenital infections can cause fetal hydrops?

A
  1. Parvovirus (if IgG-, or IgM+) then must do US weekly for 12 weeks
  2. toxoplasmosis
  3. syphilis
  4. CMV
33
Q

Name 5 indications for intrapartum antibiotic prophylaxis in a mother whose GBS status is unknown

A
  1. maternal fever (T> 38 C)
  2. prolonged ROM (>18 hours)
  3. previous child with invasive GBS disease
  4. GBS bacteruria at anytime during pregnancy
  5. less than 37 weeks (less than term)
34
Q

Without intrapartum abx, what is the incidence of early onset GBS sepsis?

A

1-2%

35
Q

What antibiotic regimes are considered to offer ADEQUATE prophylaxis?

A

IV penicillin
IV ampicilln
IV cefazolin (if mild allergy to pencillin)
Note: erythromycin and clindamycin are NOT considered adequate.

36
Q

Management of baby born to GBS positive mother with inadequate prophylaxis?

A 
Vitals q3-4H x 24 hours
no CBC (sensitivity of clinical signs >CBC)
parents must understand symptoms and signs of sepsis and have access to health care (if don't understand, keep baby for a total of 48 hours)
37
Q

How long can infants with early respiratory signs without RF for sepsis be observed for before initiating treatment?

A

6 hours

38
Q

How long MUST late preterm (35-36 week) be observed for?

A

48 hours minimum

39
Q

An infant is born to a mother whose GBS status is unknown, in addition she has one other RF (maternal fever, OR previous GBS bacteruria OR prolonged ROM > 18 hours OR previous baby with invasive GBS infection). How should this infant be managed?

A

examine the infant at birth
vitals q3-4 H
admit for 24 hours
can be discharged if parents understand signs of sepsis and when to seek medical care AND there is ready access to healthcare

40
Q

Which of the following is NOT a manifestation of early disseminated disease?

a) facial nerve palsy
b) arthritis
c) meningitis
d) heart block/lyme carditis

A

b) arthritis is a manifestation of late disease

41
Q

Kid presents with > 5 cm lesion on thigh 2 weeks after being in a wooded area. What stage of disease is this considered to be? How can you confirm a diagnosis of lyme disease?

A

early localized disease.

clinical diagnosis, serology testing for borrelia burgdorferi is negative in the first 4 months

42
Q

In early disseminated lyme disease how can a diagnosis be confirmed?

A

ELISA screening

Western blot confirmation (IgG and IgM)

43
Q

How to treat lyme disease in child who is 10 years old? What about child who is 5 years old?

A 
10 years (>8 years) doxycycline
5 years (< 8 years) amoxicillin
44
Q

When can prophylaxis for lyme disease be started?

A

within 72 hour after removal of tick even if it has been attached for > 36 hours
note: only for children > 8, only for doxycycline.

45
Q

Name 3 ways to prevent lyme disease

A
  1. when play spaces adjoin wooded areas, landscaping can reduce contact with ticks
  2. apply 20-30% deet on body/clothing
  3. bathe within 2 hours of being outdoors to wash off unattached ticks
  4. do “full body check for ticks”
46
Q

What is the first choice repellent for children 6 months - 8 years?

A

Icaridin

Products containing up to 20% are considered safe

47
Q

What offers the best protection against mosquito and ticks?

A

Wearing permetherin treated clothing (permethrin cannot be applied directly to the skin), applying DEET/icaridin to exposed skin

48
Q

A child is 11 years old, what is the recommended insect repellant

A

icaridin

49
Q

Child is 5 years, what is the recommended DEET percentage?

A

10 % if < 12 years
30% if > 12 years
but really, icaridin recommended age 6mo-12 years

50
Q

Child has 5 watery stools per day, mild fever, mild abdo pain, how should they be treated?

A

First test with GDH (EIH - enzyme immunoassay) (glutamate dehydrogenase) then confirm with toxin EIA

This is considered moderate c. diff infection (>4 stools/day) –> treat with metronidazole x 10-14 days

51
Q

Child having 5 watery stools per day and fever with rigors, how to treat?

A

severe uncomplicated C diff infection

10-14 days of oral vancomycin

52
Q

How to manage a baby born to an untreated mother with gonorrhea?

A

IV ceftriaxone + conjunctival swabs

neonatal opthalmia develops in 30-50% of exposed babies, can progress to corneal ulceration and perforation of the globe

53
Q

How to manage baby born to mother with untreated chlamydia?

A

routine cultures, swabs or serology not recommended, just monitor for the development of conjunctivitis

54
Q

Causes of false negative TST?

A
  • Malnutrition
  • Concomitant viral illness (varicella)
  • Immunocompromised
  • Improper technique
  • Young age (< 4 months)
  • corticosteroids
55
Q

Which anti TB drug causes optic neuropathy (decreased acuity, decreased visual fields, color blindness)?

A

Ethmabutol

56
Q

Define a positive TST in a diabetic patient?

A

> 10 mm in healthy individuals

- includes patients with DM, hematologic malignancies

57
Q

Positive TST in child on corticosteroids for > 1 month?

A

> 5mm

- includes patients with HIV, close contact of infectious case, organ transplant, immunosuppressive medications

58
Q

Risk of HIV from blood transfusion

A

1 in 10 million

59
Q

Name 4 contraindications for the live attenuated influenza vaccine (LAIV)

A
  1. pregnancy
  2. chronic ASA therapy
  3. severe asthma (on oral corticosteroids or high dose ICS) recall the CPS statement defines high dose as 250mcg BID for kids > 5 years, in toddlers anything above 250 mcg DAILY is high dose.)
  4. immune compromising conditions
60
Q

Name 2 contraindications to the inactivated influenza vaccine (IIV)

A
  1. GBS within 6 weeks of receiving influenza vaccine previously
  2. anaphylaxis to the vaccine or any part of the vaccine

Note: egg allergy is no longer a contraindication

61
Q

6 year old well child has received influenza vaccine last year, what vaccine is recommended for this year?

a) either live attenuated or inactivated one dose
b) either live attenuated or inactivated 2 doses separated by 4 weeks

A

either live attenuated or inactivated ONE dose

The first year that a child < 9 years get the influenza vaccine, they must get 2 doses separated by 4 weeks.

If a child < 9 years has received 1 previous dose of any influenza vaccine in the past, they only require 1 dose this season.

62
Q

Under which circumstances is infective endocarditis prophylaxis warranted?

a) calcified aortic stenosis
b) repaired VSD 1 year ago
c) PDA repaired
d) repaired VSD 2 years ago but with residual patch defect

A

IE prophylaxis is warranted for

  1. prosthetic cardiac valve
  2. previous infective endocarditis
  3. unrepaired cyanotic CHD incl. palliative shunts and conduits
  4. completely repaired CHD with prosthetic material WITHIN 6 months
  5. repaired CHD with residual leak at/adjacent to site of a prosthetic patch or prosthetic device
  6. cardiac transplant recipients with cardiac valvulopathy
  7. rheumatic heart disease if prosthetic valves or prosthetic material used in valve repair
63
Q

What prophylaxis would you recommend?

A

Amoxicillin prior to the procedure, if missed can be given 2 hours later.

64
Q

Under what circumstances would it be appropriate to give a healthy term infant VZIG?

A
  • Mum had rash within 5 days before delivery or within 48 hours AFTER delivery
65
Q

Name 5 indications for VZIG

A
  1. Pregnant women with no hx of varicella or immunization
  2. Infant whose mother had a rash 5 days before delivery or 2 days after delivery
  3. Hospitalized prem > 28 weeks (maternal Ab should be present) but mother has unreliable hx of varicella protection or previous chicken pox
  4. ALL prem babies < 28 weeks regardless of mum’s status
  5. immunocompromise children (e.g. ALL on chemo) give ASAP but can be given within 10 days

CPS Alia (2 decks)

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