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Royal College: Emergency Medicine flashcards
1
Q

Causes of congenital cataracts

A

congenitalle urbella
galactosemia
pierre robin syndrome
oculuocerebral syndrome
oculomandibulofacial syndrome

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2
Q

Frequency of hearing loss as complication of TORCH infections

A

CMV 5-10%, rubella most common manifestation, toxo 25% and syphilis late (>2 years)

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3
Q

What should you screen for if NYD hydrops or stillbirth

A

syphilis

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4
Q

nontrep tests

A

vdrl, rpr

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5
Q

false positives for treopnemal tests

A

collagen vascular diseases, pregnancy, injection drug use, lyme disease

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6
Q

whats more sensitive eia or rpr

A

eia

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7
Q

expected drop of rpr titer

A

at least fourfold at 6 months

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8
Q

common early features of congenital syphilis

A

spontaenous abortion, necrotixing funistis, rhinitis or snuffles, rash, hsm, lympahdenoapthy, neurosuphilis, osteochondritis, perichonridtis

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9
Q

late manifestations of cong syphilis

A

frontal bossing, saddle nose, winged scapula, saber shins, interstitial keratitis, hutchinson teeth, mulberry mplars, nerve deafeness

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10
Q

what to do if mom treated for late latent syphilis

A

serologic testing at 0,6 and 18 mo

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11
Q

treatment for cong syphilis

A

10 day course of IV pen G

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12
Q

when should you lose treponemal antibodies

A

18mo of age if adequately treated

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13
Q

how often to repeat csf in neurosyphilis

A

q6mo

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14
Q

is varicella live vaccine

A

yes

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15
Q

period of contagious for chicken pox

A

24-48h before rash to 3-7 days after onset of rash

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16
Q

presence of lesions in various stages of evolution is characteristic of…

A

varicella

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17
Q

is scarring common with varicella

A

no

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18
Q

when is bad time for moms to get varicella for passing on to infants

A

5 days before delivery to 48h after delivery

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19
Q

congential varicella syndrome features

A

cicatrical skin scarring in a zoter distribution, limb hypo[plasia, neuro abn, eye chorioretinitis, micropthalmia, cataractis, renal system, low brith weight

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20
Q

can people with isolated humoral immunodeficiencies receive varicella

A

yes

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21
Q

how far away from chemo to give varicella

A

3mo

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22
Q

do you give antiviral treatment for infants with congeital VZV

A

no

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23
Q

giardia treatment

A

falgyl

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24
Q

is there problems when mom has lyme disease during pregnancy

A

no

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25
Q

rash with lyme disease

A

ertyehma migrans

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26
Q

later complications of lyme disease

A

isoalted facial enrve palsy, arthritis, heart block, meningitis

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27
Q

are antibodies for lyme disease detectable in first four weeks

A

no so treat clinically

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28
Q

congenital rubella syndrome

A

cataracts, conge heart diseas,e hearing loss, microcephaly, IUGR, retinopathy, interstitial pneumonitiis

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29
Q

common CHD with rubella

A

pda and pps

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30
Q

congenital CMV features

A

HSM, petechial rash, juandice, microcephaly, IUGR, hyperbili, elebated liver enzymes, low plt, choriotetinitis, hearing loss

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31
Q

where are calcifications in CMV vs toxo

A

CMV periventricular, toxo diffuse

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32
Q

what happens to placenta in toxo

A

chronic inflammation and cysts

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33
Q

what is a risk factor for toxo severity

A

HLA DQ3

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34
Q

what do you get brucellosis from

A

unpastueized dairy products, camels, goats, pigs, cattle, sheep, hunting feral swine

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35
Q

brucellosis infection

A

arthralgias, fever, myalgias, back pain, hsm

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36
Q

treatment for brucellosis

A

doxy or septra in combination with rifampin for 6 weeks minmum, longer if more serious ifnection

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37
Q

where do you get tularemia

A

tick or deer fly bites, rabbits, prarie dogs

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38
Q

type of bacteria tularemia

A

gram negative

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39
Q

type of bacteria brucellosis

A

gram negative coccobacillary bacgteria

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40
Q

where do you get bartonella

A

cat scratch, Andes, sand fly

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41
Q

risk factors for HCV infection

A

IVDU*
women in correctional facilities (because of IVDU)
tatooing, piercing
remote risk from blood products, contaminated medical equipment
sexual contact

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42
Q

increased risk for vertical transmission pf HSV infection

A

higher HCV viral titers elevated ALT in year ebfore pregnancy, maternal IVDU, fetal scalp monitoring, prologned ROM, infant female sex, second born twin

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43
Q

does HCV genotype infleunce risk of vertical transmission

A

no

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44
Q

factors assoicated with high risk of spotaenous clearance of HCV infection

A

higher ALT during the first 2 years of life, infection with genotype 3

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45
Q

extrahepatic manifstations of HCV

A

MPGN, subclinical hypoT, autoimmune thyroiditis, elevated ANA

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46
Q

when should you treat women for HCV infection

A

BEFORE pregnancy, insufficient evidence to treat during pregnancy

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47
Q

do you recommend elective c/s for HCV infection

A

No, no difference in vertical transmission rate between vaginal or c/s

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48
Q

is breastfeeding safe with HCV

A

yes, unless cracked bleeding nipples

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49
Q

how to test bb for HCV infection

A

best test is serology at 12-18months, if positive then do HCV PCR
Can do HCV PCR as early as 2mo (before this limited utility) if concerns about follow-up or if parents are anxious to know, if negative still recommend doing serology at 12-18mo to confirm antibodies ahve cleared

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50
Q

do you need to tell schools/daycare about HCV infection

A

no

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51
Q

how often should you screen youth at risk for HCV infection

A

q6-12mo

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52
Q

what bug to think of if brainstem infection

A

listeria

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53
Q

empiric treatment for meningitis

A

ctx vanco

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54
Q

most likely organisms for meningitis >2mo

A

N meningitidis, strep pneumo
consider GBS and e. coli up to 3mo

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55
Q

who should get prophylaxis for meningitis

A

occupants of contact household with Hib prophy infants < 12mo, chiildren < 4y not vaccinated and immunocmprimised person of any age, any index case not treated with ctx

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56
Q

gbs meningitis treatment

A

amp or pen G, add gent for first 5-7 days

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57
Q

steroid evidence in meningitis

A

decreases hearing loss with Hib, also possible with strep pneumo, give for 48h if netiher HIb or strep pneumo are identified then stop, if they are identified continue for total 4d

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58
Q

type of bacteria hib

A

gram negative coccobacilli

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59
Q

who gets repeat csf testing meningitis

A

if strep pneumo (esp if got steroids/resistant strep pneumo), sometimes for GBS to document sterility at 24-48h, for gram negative enteric pathogens

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60
Q

treatemtn length meningitis N. men

A

5-7d

61
Q

treatment length strep pneumo meningitis

A

10-14d

62
Q

treatment lenght Hib meningitis

A

7-10d

63
Q

treatment length gbs meningitis

A

14021d minimum

64
Q

Types of HSV that cause genital HSV

A

HSV 1 and 2

65
Q

what babies are highest risk for HSV

A

born to mothers who have first episode/primary infectiona t time of delivery with transmission rates up to 60%

66
Q

who is given acyclvoir prophy during pregnancy

A

if they have recurrent HSV from 36 weeks until delivery to lower the recurrence risk and shedding at delivery

67
Q

when does HSV present in bb

A

within 4 weeks but can be up to 6 weeks

68
Q

when should you get samples from bb to diagnose HSV

A

More than 24h after birth because otherwise they are more likely to represent contamination

69
Q

se acyclovir

A

neutropenia, neurotoxicity

70
Q

what to do if bb is born to mom with first clinical HSV episode via vaginal delivery or C/s with ROM

A

swab micous membranes and start acyclovir, controversial whetehr to do this before or after 24h
If swabs negtaive, should still treat for 10 days despite negative swabs
if swabs positive need to get CSF for PCR as well

71
Q

What to do for bb born to mom with recurrent HSV and C/s

A

swab and send home

72
Q

What to do for bb if mom has reucurrent HSV and they were delivered vaginally

A

obtain MM Swabs at 24h and sned home pending results, therapy only if swabs positive or symptoms

73
Q

how long to treat HSV in CNS

A

at least 21 days, repeat CSF then and if positive extend with weekly CSF sampling until negative result obtained
Also need oral treatment for 6 months after acute treatment to try and prevent recurrence

74
Q

why is orbital ceullitis more common in kids

A

thinnner bony septa, greater porosity of bones, open suture line snad larger vasular foramina

75
Q

organisms for orbital ceullitis

A

GAS, strep species, anaerobes, staph aureus

76
Q

Complications from orbital cellulitis

A

virual loss secondary to an increase in orbital pressure, cavernous sinus thrombosis, meningitis, empyeme, optic atorphy, exposure keratitis, retinal or choroidal ischemia

77
Q

When should you drain a subperiosteal abscess

A

drain if over 9, if under 9 can wait until 48h of IV antibiotics and then drain if not improving, decreased vision or pupila banormlaities

78
Q

What is the most common congeital infection

A

CMV

79
Q

what is leading cause of SNHl

A

CMV

80
Q

Physical exam findings CMV

A

SGA, microcephaly, jaundice, hydrops, petechiae, pneumonitiis, HSM, seizures, poor suck, hypotonia, lethargy, chorioretininit,s optic atrophy, micropthalmia, retinal scars, cortical visual impairemnt
Hearing

81
Q

labs findings congenital CMV

A

low platelets most common, eleavted ALT< increased conjugated bilirubin, pleocytosis in CSF< positive CMV PCR, eevated protein

82
Q

Head imaging findings CMV

A

calcifications, ventriculomegaly, atophy, cerebellar, ependymal, parenchymal cysts. polymicrogyria, lissenecpehaly, porencephaly, schizenpahly, extensive encpehaly, lenticulostriate vasulopathy

83
Q

Who should you test for CMV

A

maternal CMV infection, fetal ultrasounnd findings suggestive of CMV, placental pathology consistent with CMV< HIV exposure, primary immunodefiiency, symtomatic CMV, failed newborn hearing screen or confirmend SNHL

84
Q

Gold standard test for CMV

A

Urine CMV PCR before 21 days postnatal age

85
Q

What tests to do if infant + for CMV

A

CBC, bilirubin, ALT, AS, CSF if seziures or sepsis, head ultrasound unless neuro concerns then MRI, MRI if HUS abnormal, hearing evaluation, optho evaluation

86
Q

Who should you treat for CMV

A

CNS disease, chorioretinitis, sever single or multiorgan disease

87
Q

treatment for CMV

A

start within 1mo with valgancyclvoir and continue for 6mo

88
Q

Followup while on valgancyclovir

A

CBC weekyl for a month, every two weeks for two months then monthyl for three months, AST, ALT< ur, cr every 6 months

89
Q

CMV followup

A

audiology freuently for first 2-3 uears then yearly, close dev followup for first two years, dental followup

90
Q

rate of recurrent c. diff infection

A

25%

91
Q

Who to treat for C. diff

A

dont treat if mild infection other than disconitnuing the antibiotic they are on. If moderate illness (>4 stools per day) then treat with falgyl for 10-14 days. if severe then treat with vanco PO

92
Q

How to give vanoc for c. diff

A

PO, not effective if given IV

93
Q

How to treat c. diff recurrence

A

first recurrence can repeat the original regimen or give PO vanco. If second or later recurrence then should be given vancomycin

94
Q

What is there evidence for using probiotics for

A

antibiotic associated diarrhea, viral gastro, IBS, prevent NEC, colic

95
Q

Is BCG a live vaccine

A

yes

96
Q

Who is esp vulnerable to developing symptoms of Tb

A

infants less than 5 years

97
Q

xray findings in kids with Tb

A

pneumonitis, subtle fround glass opacities usually wiht hilar lymphadenoapthy

98
Q

what type of hypersensitivity reaction is Tb skin test

A

Type 4

99
Q

Cutoffs for TB skin testing

A

> 5mm in immunocomprimised and >10mm in others

100
Q

What is rpeferred test for Tb in kids under 2

A

skin test because more specific

101
Q

How long to isolate a patient in hosptial with Tb

A

until three sputum specimens are negative, if initial smears are negative or after a full two weeks of DOT has been given

102
Q

How to treat child under 5 who has had Tb contact

A

preventative prophylaxis with one drug and do a second TST 8-10 weeks later following last contact

103
Q

How to treat a child over 5 with TB contact

A

still needs repeat skin test 8-10 weeks later but no treatment

104
Q

oncogenic types of HPV

A

16 and 18

105
Q

what is HPV Vaccine against

A

6, 11, 16 and 18

106
Q

Do you get eosinophilia with pinworms

A

no because they dont invade tissues

107
Q

treatment for pinworms

A

albendazole with one dose and repeat treatment in 2 weeks

108
Q

Who to treat in pinworm infectin

A

Entire household regardless of symptoms because other household members are at risk given high transmission rates

109
Q

preferred pinworm treatment for pregnant women

A

pyrantel

110
Q

First line treatment for lice

A

pyrethrin and permeterhin are first line
give treatment and then repeat 7 days later

111
Q

lice treatment options

A

first line- pyrethrin permeterhrin
diemticon solution or isopropyl nyristate (reslux)
DO NOT use lindane

112
Q

Do you keep kids with lice home from school

A

NO no reason to do that

113
Q

Is environmental cleaning or disinfection folowing head lice case warranted

A

no

114
Q

When is deadline to give rotavirus vaccine

A

8mo, after this associated with increased risk for intussuception

115
Q

risk of rotavirus

A

intussuception, esp in first week after giving the vaccine

116
Q

contraindications to rotavirus vaccine

A

intussuception history, hypersensitivity to ingredients, immunodeficiency

117
Q

do you repeat rota vaccine if they spit it out

A

no

118
Q

when to give prems rotavirus vaccine

A

at or following discharge from nicu

119
Q

What to do for bb exposred to N gonorrhae untreated at time of delivery who are healthy and term

A

single dose fo CTX IV or IM
conjunctival culture for N gonorrhae
if unwell should also do blood and CSF cultures

120
Q

What to do for bb born to mom with untreated chlamydia infection

A

monitor for symptoms, no routine cultures, no prophylaxis

121
Q

risk of macrolides

A

pyloric stenosis

122
Q

How to prevent Hep B in bb born to mother with HbsAg positive mothers

A

Hb immunoglobulin and HBV immunization within 12h of life

123
Q

Does breastfeeding increase risk of hep B transmission

A

No

124
Q

Who to treat for Hep b

A

immune active form of disease evidenced by elevated ALt, AST, fibrosis on liver biospy

125
Q

What percentage of babies born to GBS + mom will get GBS EOS without anitbiotics

A

1-2%

126
Q

what is adequate GBS prophylaxis

A

pen/amp or Cefax within 4h one dose

127
Q

what to give for GBS proph is true anaphylaxis to penicillin and is this adequate prophy

A

clinda or vanco and No

128
Q

What to do for bb with GBS + mom who received inadequate Abx

A

Physical exam at birth, observe for 24 and reassessment between 24-48h
Well after 24h d/c home
NO investigations

129
Q

What to do if mom is GBS + with addition rf

A

at minimum observe for 24-48h, may need sepsis workup, CBC after 4h may be helpful

130
Q

What to do for bb born to mom with chorio

A

Cna osberve for 24h (CPS)
or culture and antbiotics (CDC and AAP)

131
Q

what to do if GBS unknown and bb less than 37 weeks

A

given antibiotic prophy to mom
should observe for longer (48h)

132
Q

what type of organism is c.diff

A

gram positive bacillus

133
Q

what else do you have to treat for if someone has Tb

A

HIV

134
Q

pinworms treatment

A

albendazole/mebendazole
if pregnant- pyrentel pamoate
Treat the whole house
Repeat the treatment in 2 weeks

135
Q

What age can you use resultz in

A

> 4

136
Q

What age can you use dimeticone in

A

> 2

137
Q

what age can you use pyrtehrin and permtherin in

A

> 6mo

138
Q

what % perinatal transmission for HCV

A

5%, 20% of these will clear spontaenously

139
Q

what age can you give Hep A vaccine

A

over 12mo

140
Q

brucellosis treatment

A

doxy or irfampin

141
Q

listeria gram stain

A

gram + bacillus

142
Q

what to use to treat yersinia

A

cephalosporin, septra, fluoroquinilones

143
Q

how long to treat tine corporis

A

14 days minimum, 14-21 to prevent relapse

144
Q

what % with c diff have recurent infection

A

25%

145
Q

what is risk with flagyl

A

neurotoxicity with long term use

146
Q

should you plan a csection for mom with HIV

A

yes if not on ARVT

147
Q

Gram stain salmonella

A

gram negative bacilli

148
Q

N. meningitidies gram stain

A

Gram negative diplococcus

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