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NICU Board Review > ID > Flashcards

ID Flashcards

1
Q

What is the most common site of origin of osteomyelitis and common spread?

What about most common site?

A

Metaphysis

Hematogenous spread, therefore can spread to epiphysis bc blood supply is connected until 8-18 mo

Femur is most common site

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2
Q

What is the most common organism in osteo and septic arthritis?

Which organism is more common in septic arthritis?

A

Staph aureus followed by GRoup b strep

Neiserria gonorrhea is more commonly found with septic arthritis than osteo

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3
Q

What are the most common organisms in EOS vs late onset sepsis?

A

EOS: GBs, ecoli, listeria, nontypeable flu and enterococcus

LOS: coag neg staph, mssa, pseudomonas, then gbs ecoli and listeria

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4
Q

Initial treatment for osteo or septic arthritis?

A

Penicillinase resistant penicillins (nafcillin, oxacillin, methicillin) and aminoglycoside or cephalosporin. Narrow based on cultures. Osteo: 21-42 days vs septic arthritis if staph aureus 4-6 weeks vs group b strep 2-3 weeks

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5
Q

Treatment for omphalitis

A

Penicillinase resistant penicillins (methicillin, nafcillin, oxacillin)

Vanco if high local incidence of mrsa

Gent/cephalosporin for gram negative coverage

If umbilical region black-add anaerobic coverage

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6
Q

Infection with which ecoli subtype is more likely to lead to meningitis?

A

Ecoli with K 1 antigen

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7
Q

Which organisms are associated with worse outcomes in meningitis?

A

Gram negative, CSF WBC>500

Gbs if comatose, shock WBC<5000, ANC <1000 or CsF protein>300

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8
Q

Most common neonatal organisms for UTI?

Most common spread?

A

Ecoli (#1), klebsiella, enterobacter

Hematogenous or ascending vs old kids is ascending

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9
Q

What infection shows with placental micro abscesses?

A

Listeria

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10
Q

What are the clinical findings of a mother with rubella infection?

Highest risk of defects at what GA?

A

Fever, coryza, conjunctivitis and althralgia

50% risk 9-12 weeks

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11
Q

When is peak CRP as it relates to sepsis?

A

2-3 days after developing sepsis

Only 20% have this response

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12
Q

Most common cause of EOS in VLBW?

A

E Coli

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13
Q

First abnormality to manifest in xray in neonatal osteomyelitis?

A

Soft tissue swelling
Then bone destruction 7-10 days after
If affects adjacent joint then joint space widening

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14
Q

Cream colored macules on placenta, name the organism?

A

Candida

Wedged shaped microabscesses containing hyphae yeast and neutrophils

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15
Q

Incidence of EOS in VLBW

A

10 in 1000 live births

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16
Q

What is the recommended treatment for severe varicella infection prenatally?

A

IV acyclovir

If mild disease oral acyclovir

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17
Q

Intestinal microbes have nutritional roles including:

A

Synthesis of biotin, folate and Vit K

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18
Q

Full PPE is needed for Airborne organisms such as

A

Varicella, Covid, tuberculosis, measles

Travels long distance

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19
Q

90% of blood cultures are positive by how many hours?

A

36 hrs

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20
Q

Toxo transmission frequency is x with advancing gestation

A

Higher

But severity of disease

Closer to term is higher risk of transmission and with new infection

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21
Q

Which type of conjunctivitis is considered a medical emergency?

A

Gonococcal conjunctivitis which presents 2-5 days bc if not treated w IV cephalosporin can progress to involve cornea and ulceration/penetration

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22
Q

Describe the organism causing chorioretinitis findings for each:

  1. Salt and pepper appearance to fundus
  2. Yellow white exudates
  3. Yellow white fluffy retinal lesion
  4. necrotizing retinitis
  5. Fluffy white balls
A
  1. Early congenital syphilis or congenital rubella
  2. Herpes simplex
  3. cMV
  4. Toxo (seen 80-90%)
  5. candida
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23
Q

Which antibiotics do you use for following gastroenteritis

  1. Salmonella
  2. Shigella
  3. Campilobacter or yersenia
  4. c diff
A
  1. Cefotaxime
  2. Ampicillin
    3 Erythromycin
    4 Vanco
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24
Q

Gram positive rod associated with placental microabscesses

A

Listeria

Also described as chocolate colored mec staining
EOS-mother with prodromal flu like illness, zero type Ia and Ib and baby has sepsis/pneumonia
LOS-from maternal colonization, serotupe IVb, meningitis w milder
symptoms

Tx:amp/gent 14 days or 21 if meningitis

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25
Q

Indicate the precaution type

A 
CMV - Standard
Rubella - Contact + Droplet 
HSV - Contact (lesions)
Toxo + HIV + Listeria - Standard 
TB + Varicella - Contact + Airborne 
HSV - Contact
Parvovirus- Standard + Droplet
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26
Q

Name treponemal and non treponemal tests for syphilis

A

RPR: Initial Screen (non treponemal)

FTA - ABS: Confirmation (treponemal)

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27
Q

Mother with +RPR, + FTA-ABS, and received PCN <4 wk before birth. Next steps for mother and baby?

A

Check non-treponemal in mom and baby
Check treponemal in baby
Full eval and tx w PCN
FU non treponemal testing throughout 1st year and csf non-treponemal @6mo

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28
Q

Gbs E Coli and listeria penetrate blood brain barrier by which approach?

A

Transcellular

Listeria also uses Trojan horse mechanism

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29
Q

T/F Ribavirin contraindicated in pregnancy

A

True

Administration is orally

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30
Q

Most common cause of scalp osteomyelitis from electrode or after cephalohrmatoma

A

E Coli

31
Q

Most common site of MRSA infection in a previously healthy neonate

A

Breast

Pustulosis<1cm
Abscess >1cm

32
Q

VariZIG is recommended in which population

A

5 days before and 2 days after hospitalized newborn <28weeks or <1kg
Immunocompromised or non immune

33
Q

How does parvovirus lead to hydrops?

A

Aplastic anemia, myocarditis and heart failure which in turn lead to hydrops

MCA doppler helps measure severe anemia

34
Q

Most common cause of EOS in term vs preterm

A

Term GBS

Preterm ecoli

35
Q

Which stool colonizing organism is associated with NEC?

A

Clostridium perfringes

36
Q

Which is the first organ affected in congenital TB?

A

Liver

Transplacental/Hematogenous spread via umbilical vein

37
Q

Treatment for infant with congenital TB?

A

INH, rifampim, pyrazinamide and aminoglycoside (4 drug regimen)

38
Q

What is the treatment of congenital toxoplasmosis?

A

Pyrimethamine and sulfadiazine

39
Q

Torch infections:

  1. Transmission increases with gestation, disease is more severe if acquired earlier in pregnancy
  2. Disease more severe if acquired later in pregnancy
  3. Transmission u shaped distribution but disease more severe if acquired early
  4. Disease more severe if acquired early
A
  1. Toxoplasmosis
  2. Treponema pallidum
  3. Rubella
  4. CMV, varicella

Early w severe disease: CMV, varicella, rubella, toxo

Later: syphilis

40
Q

MCC congenital heart disease in congenital rubella

A

PDA and pulmonary arterial hypoplasia

41
Q

Most common reason to get neonatal tetanus and management?

A

Improper umbilical cord handling
Tx: tetanus immunoglobulin and pen G 10-14 days
Diazepam for spasm
Still need to vaccinate bc doesn’t lead to immunity

42
Q

Describe organism and Treatment of pertussis

A

Gram negative bacillus
Human only host
Oral erythromycin (may lead to infantile hypertrophic pyloric stenosis)
Some use azithro <1mo (not fda approved for this use)

43
Q

Mechanism of action of acyclovir

A

Inhibits viral DNA transcription, activated specifically by thymidine kinase

Duration 14 day for SEM, 21 days for disseminated or CNS disease

44
Q

Management of VTach

A 
If stable (pulse) amiodarone, lidocaine or b blocker (may consider adenosine if reentry SVT)
Unstable (pulseless) DC cardioversion
45
Q

What are the greatest risks for CLABSI’s?

A

Low birth weight
Younger gestational age

Similar rates between UVC (9 days) and PICC (14 days)

46
Q

Name non culture CSF testing that can help to identify meningitis (early on)

A

Latex agglutination
PCR
Microarray
Immunochromatography

47
Q

Risk factors for Hepatitis C transmission

A
  • high maternal HCV viral load
  • High HCV RNA load -
  • maternal coinfection to on withHIV (increased risk 3-5 fold)
  • Female Neonate
48
Q

Most serious side effect of ceftriaxone and MOA

A

Ceftriaxone can displace bilirubin from albumin leading to bilirubin toxicity

49
Q

Most common site for Neonatal osteo

A

Metaphysis of long bones

Femur + tibia&raquo_space;> humerus + fibula

50
Q

Most common presentation of congenital syphilis

A

Hepatosplenomegaly (present in almost all affected

Respiratory distress

51
Q

Pretern with LOS - what is Gram negative infection with highest mortality rate

A

Pseudomonas aeruginisa (45-70%)

Psuedomonas is responsible for 2-5% of late onset infections with ELBW pts

52
Q

Determine fetal risk by maternal parvo immunoglobulin levels

A

Maternal IgG +
Maternal IgM -
= Past infection
No risk to fetus

Maternal IgG +
Maternal IgM +
= Infection within last 7-120 days
Possible risk to fetus

Maternal IgG -
Maternal IgM +
= Acute infection
High risk to fetus

Maternal IgG -
Maternal IgM -
= Non immune pregnant 🤰🏽
No sign of acute infection
*Consider repeating test in few weeks to assess if IgM becomes + (acute infection)
No risk to fetus unless + IgM with repeat testing

53
Q

Risk of late onset sepsis on VLBW

A

20%

54
Q

Adverse antibiotic effects with VLBW

A

-Alteration of micro biome
-Increased risk of candida infections (especially with 3rd generation cephalosporin in VLBW)
/increased risk for Nev
Increased risk for late onset sepsis
Inctrssed mortality

55
Q

Most common risk factors for CLABSI

A 
Young gestation age 
Low bw
Length of hospitalization 
Parentéral nutrition (>21 d)
Mechanical ventilation 
Lack of enteral feedings
56
Q

Early onset GBS characteristics

A

Ascending infection from colonization
Prolonged ROM
EOS likely due to capsular polysaccharide serotypes 1a, 1n, 2, 3, 5

57
Q

Which intestinal microbe is most associated with pseudomembranous colitis?

A

Clostridium difficile

58
Q

Independent risk factor for gram

negative LOS

A

Parenteral nutrition

59
Q

Which combination of markers have been shown to yield highest diagnostic sensitivity and specificity for LOS?

A

Interleukin 6 and crp or procalcitonin

60
Q

What is the diagnostic criteria for sirs?

A 
Physiologic and/or lab abnormalities 
Low or high temp
Leucopenia/leukocytosis or >10% bands
Low/high Hr
Increases RR or need mechanical ventilation

Must meet temp and WBC criteria (2/4)

61
Q

Most common organism for LOS?

A

CONS

62
Q

Which side effect has been reported with fluconazole prophylaxis?

A

Transient hepatic dysfunction

63
Q

If HepC is diagnosed after 18 mo and confirmed at 3 years which vaccines must be given to this child?

A

Hep A and HepB because a second cause of infectious hepatitis can increase cause of morbidity and mortality

64
Q

Baby with HSV has been treated with acyclovir (IV) x 10 days. How do we minimize future neuro developmental disabilitues?

A

PO Acyclovir x 6 months

65
Q

Infant with failed hearing screen, negatuve HUS, normal LFTs and paltelets, urine CMV PCR positive. Next best step?

A

Close audiologic followup q6 months for 3 years. If progressive hearing loss, offer early intervention. 10-15-% of asymptomatic infnats can have SNHL.

Failed hearing screen and otherwise asymptomatic wouldnt meet criteria for valgancyclovir treatment.

Only those w moderate to severe symptoms should begin treatment within 1 mo of birth

66
Q

Hep B is a _____ _NA virus

A

Double stranded DNA

67
Q

Which Hep B antigen is present when virus is rapidly replicating?

A

HepBeAg

Usually present before symptoms and disappears before clinical symptoms resolve

68
Q

How do you distinguish HepB immunity from prior infection vs vaccine?

A

Prior infection
HepBsAg neg, AntiHepBc positive, AntibHepBs positive

Vaccine
HepBSAg negative, Anti-HepBc negative and AntiHepBs positive

Remember you cannot have antibody core without having had hardcore HepB infection

69
Q

Where does parvovirus replicate?

A

Within the RBC precursors

Single stranded DNA

70
Q

Celery stalking of long bone metaphysis. Which infection most likely?

A

Rubella

Other associations: cataracts, salt and pepper chorioretinitis

71
Q

Cmv is ____Stranded __NA virus

A

Double stranded herpes DNA virus

Intranuclear and cytoplasmic inclusions

72
Q

In patients of heterotaxy and poly/asplenia, which vaccines are recommended?

A

PCV 13 regular scheduke and PCV-23 after 2 years. Meningococcal vaccine 2,4,6 and 12 months as well. In addition to routine vaccines.

73
Q

Zidovudine toxicity manifests as

A

Lactic acidosis and hepatic abnormalities

Macrocytic anemia and neutropenia are also possible effects of AZT treatment

NICU Board Review (19 decks)

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