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ID Flashcards

0
Q

benefits of rotavirus vaccine

A
  1. prevent severe disease
  2. decrease dehydration and need for admission
  3. give at 2 and 4 months
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1
Q

contraindications to rotavirus vaccine

A
  1. hypersensitivity to vaccine
  2. Hx of intussusception
  3. immunocompromised
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2
Q

evidence of immunity to varicella

A
  1. IgG to VZV- natural disease
  2. documentation of 2 doses of vaccine
  3. lab confirmed varicella from lesion
  4. previous Dx of varicella or zoster by health care professional
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3
Q

Varicella vaccine doses

A

between 12 mo to 12 yrs
min 3 month post first vacc

ontario - 15 mo and 4-6 yrs

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4
Q

For babies exposed to HSV, how long after delivery can they develop symptoms?

A

4-6 weeks

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5
Q

what are the natural reservoirs of Yersinia ?

A

Pigs! rodents, rabbits, sheep, cattle, horses, cats and dogs

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6
Q

What population is at a higher risk for yersinia enterocolitica and why?

A

Yersinia needs Iron so pt with iron overload are at higher risk

  • hemochromatosis
  • Sickle cell
  • Thalassemia
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7
Q

What are the clinical presentations of Yersinia

A

Terminal ILEUM!!!!
Enterocolitis, diarrhea,fever, abdo pain - n get mesenteric adenitis
Diarrhea is watery, can have blood and mucus.
shed for 1-4 weeks

Systemic infection = spleen or liver abscess, osteo, meningitis,endocarditis, mycotic aneurysms, pharyngitis,pneumonia

Reactive = EN, Arthritis, uveitis

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8
Q

Contamination rate for bag urine?

A

60%

For girls, sit back ward on toilet

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9
Q

Treatment of yersinia

A

Usually self limiting
Treat if young, systemic or immonocompromised
Septra or cefotaxime or ceftriaxone

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10
Q

Most specific test for UTI?

A

Nitrites
only if Gram Neg bug

Most specific for UTI but not most sensitive
Either + Nit or leuk = 90 % sensitive

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11
Q

What bacteria is least likely to cause UTI in healthy child

  1. E. coli
  2. Enterobacter
  3. Klebsiella
  4. Entetrococcus
  5. Citrobacter
  6. serratia
A

??enterococcus - controvertial

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12
Q

Risk of damage from pyelonephristis in healthy children is ?

A

False

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13
Q

What grade of reflux needs prophylaxis Abx

A

Grade 4-5

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14
Q

cystitis treatment as per CPS

A

Usually teens with dysuria and frequency

PO cefixime for 2-4 days

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15
Q

Most common presentation of c.diff

A

watery diarrhea

Dx = no culture because of slow turn around
EIA
run on loose stools
Sensitivity high

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16
Q

What can you diagnose on VCUG?

A

PUV in boys

Reflux

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18
Q

treatment for Mild C. difficile

A

discontinue precipitant antibiotics

FU

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19
Q

treatment for moderate c. diff

A

more than >/- abnormal stools no systemic sickness

PO flagyl 30 mg/kg/d div QID for 10-14d

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20
Q

Treatment for severe c.diff - initial presentation

A

severe systemic toxicity

Vanco PO 40 mg/kg/day QID for 10-14

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21
Q

treatment for first recurrence of c.diff and for second

A

repeat initial treatment

For 2nd, Vanco in tapered or pulsed reg

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21
Q

Transmission of HCV, risk factors

A

high viremia
high ALT
HIV co infection

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22
Q

how do you treat severe complicated c.diff

A

toxic and colitis, low BP, shock, peritonitis, ileus or megacolon

***PO vanco and IV flagyl

if bad ileus, d rectal vanco

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23
Q

Timing of vaccines in elective splenectomy

A

2 weeks pre

if cannot do - do 2 weeks post

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24
Q

When do post traumatic seizures occur?

A

in first 24 hours

rarely beyond 7 days

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25
Q

Prophylaxis Abx for asplenic pt

A

all children less than 5 yrs
minimum of 2 yrs post splenectomy
ideal for life long prophylaxis

0-3mo = amoxiclav OR penicillin or amoxicillin BID
> 3mo to 5 yrs =penicillin BID or Amox BID

if allergic - need testing Start ERYTHROMYCIN

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26
Q

Factors that increase the risk of post traumatic seizures

A 
younge age
GCS <8
cerebral edema
subdural hematoma
skull fracture - open or depressed
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27
Q

risk factors for melanoma

A

light skin
freckles
large # of typical or atypical moles
family or personal Hx or melanoma

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28
Q

what are the recommendations made regarding tanning

A 
not if less than 18
need public education
industry to acknowledge that tanning is carcinogenic
tax needed - like cigarettes
ban all unsupervised tanning beds
MD should screen  and advocate
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29
Q

what are elements of family based treatement for AN - parent

A
  1. you are not to blame
  2. your child cannot care for themselves, you have to
  3. parent needs to be in charge of nutrition and exercise
  4. support and supervise meals
  5. must understand that without treatment, they will not improve
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30
Q

What abx do you use for Lyme disease?

A

PO:
< 8 yrs - Amox
> 8 yrs - Doxy

IV:
ceftriaxone or pen G

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32
Q

How do you test for lyme disease

A

if EM present and acute - just treat

ELISA
if other features, disseminated or late - ELISA + Western blot
ELISA high false +

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33
Q

how do you treat acute LD with one EM

A

Amox or Doxy PO for 14-21 days

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34
Q

How do you treat isolated facial palsy?

A

Amox or Doxy PO 14-21 days

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35
Q

How do you treat carditis, meningitis or late neuro deisease from LD?

A

IV ceftriaoxone or Pen G 14-28days

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35
Q

what are 3 things one can do to prevent LD

A
  1. Avoid playing in wooded areas
  2. 20-30% DEET to close or skin
  3. Wash within 2 hours of play
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36
Q

What is Jarisch-Herxheimer reaction

A

LD and start or rx = fever, HA, myalgia

Endotoxin-like products released by the death of harmful microorganisms within the body during antibiotic treatment.

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37
Q

can we give prophylaxis Abx for LD

A

debated:
some do one dose of dox for > 8
not enough data for Amox

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38
Q

What is the treatment for cat scratch

A

Bartonella Henselae

Azithromycin for 5 days

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39
Q

What is the treatment of blastomycosis

A

mild - Itraconazole

disseminated/severe - Ampho B

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40
Q

What is the triad of CP seen in brucellosis

A
  1. fever
  2. HSM
  3. arthritis - SI, ankles, knees
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41
Q

How do you treat brucellosis

A

doxy and aminoglycoside

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42
Q

CPS UTI treatment?

A

Cefixime

for Adm=Gent +/_Amp

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43
Q

What is a complicated UTI?

A 
HD unstable
high Creat 
bladder or abdo mass
no improvement after 24 hrs
No decrease in fever over 48Hr of Abx
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44
Q

What is the length of treatment for a UTI?

what Bx and dose

A

7-10 days

PO cefixime 8mg/kg/day daily
amox 50 mg/kg/day TID

IV Gent 5-7.5 mg IV/IM daily
Amp 200mg/kg/day QID
ceft 50-75 daily

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45
Q

who should be offered the 4CMenB

A 
asplenia
hyposplenia
primary antibody def - compl def, properdin, factor D
if Hx of invasive meningo disease
if work with the organism
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46
Q

what are work restrictions for mumps, measles, rubella, pertussis, varicella

A 
Mumps - 9 days after onset of parotitis
measles - 4 days after onset of rash
rubella - 7 days after onset of rash
pertussis - after 5 days of ANTIBIOTICS
Varicella - when all lesions have crusted
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47
Q

what are risf factors for CA-MRSA outbreak?

A
  1. overcrowding
  2. skin to skin contact
  3. sharing contaminated items
  4. hygiene/cleanliness
  5. limited health care
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48
Q

what are potential risk factors for transmission of blood borne viruses?

A

aggressive behaviour
oozing skin lesions
bleeding disorders

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49
Q

In what case is HBV prophylaxis required in a daycare setting

A

if break skin and contact with blood -either biter gets bld in mouth or bitee from saliva into bld

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50
Q

what do you do when skin is broken due to a bite

A 
let wound bleed gently
clean with soap and water
apply mild antiseptic
write report 
notify both parents
report to local public health who will refer both children for evaluation
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51
Q

what is required when assessing child referred for a bite

A
  1. check tetanus status and update if necessary
  2. proph Abx if bite causes mod/severe tissue damage, deep puncture wounds, bites to face, hand, foot, genitals
  3. see questions on hepB,HIV,hepc
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52
Q

who gets Hep B Ig(0.06ml/kg IM) + vaccine post bite exposure

A
  • if bite-er has hep B and Biteee is nonimmune or incompletely immune or vice versa

check Hep B serology 6 mo post HBV exposure

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53
Q

what do you do if Hep B status of bitee or biter is unknown?

A

low risk
no testing for hep B
if a child is non immune - vaccin

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54
Q

What do you do if Hep B status of both children is unknown

A

low risk
No testing
give vaccine to both unless already immune

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55
Q

what are features of pediculosis

A

pruritis from being sensitized to louse saliva

secondary bacterial infection

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56
Q

how are head lice transmitted

A

direct contact
small risk from pillow cases
not from pets

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57
Q

how do you treat head lice - first line

A

insecticides:

  • pyrethrins - apply to dry hair, add some H2O, 10 min, rinse. Repeat 7-10 later
  • permethrin 1% - towel dry hair, apply, 10min, rinse. Repaet 7 days later

SE: itching/burnin

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58
Q

what is second line treatment of head lice

A

Lindane - apply dry, add H2O, 4 min, rinse. Repeat 7-10 d

SE: neurotoxic, anemia, CI if hX of sz, CI if pregnant/nursing/infants

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59
Q

why is your patient with head lice not getting better

A

misdiagnosed - need to see live lice
poor compliance
new infestation

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60
Q

in special situations, you can use an oral treatment of head lice. Which one?

A

Ivermectin. Antihelminthic. 2 doses taken 7-10 days apart
need special access
Septra tried but not approved

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61
Q

what is a noninsecticide product that can be used for head lice?

A

Resultz rinse - myristate and cyclomethicone. Apply dry, 10 min, rinse, repeat 7d. Less SE

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62
Q

should a child with head lice be excluded from school?

A

No
suggest treatment
suggest avoid head to head contact
let parents of other children know

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63
Q

what are clinical features of scabies?

A

pruritis - worse at night
located - between fingers, flexor aspects of wrist/elbows, axillae, genitals
can be on scalp of infants

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64
Q

how do you diagnose scabies

A

clinical

skin scraping

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65
Q

how is scabies transmitted?

A

skin to skin
clothing
linen
mites don’s live long off the skin

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66
Q

what are risk factors for scabies for the aboriginal population

A 
overcrowding
high pediatric population
lack of running water
lack of medical or nursing care
failure to recognize infestation
faulty application of treatment
failure to treat close contacts
failure to kill scabies off clothing and linen
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67
Q

How do you treat scabies

A

if > 2 month - Permethrin 5%
- wash off after 8hr if less than 6 yr, 12 hr if older

  • if see live mites again, repeat in 1-2 weeks

Second line - Lindane

WASH - clothes and linen in hot water daily!
if itchy - antihistamine

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68
Q

What is the scabies treatment if less than 2 month old or pregnant?

A 
precipitated sulphur (7%) in pretroleum jelly
apply for 24 hours x 3d
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69
Q

what are suggested control measure for mgnt of scabies

A

prophylaxis Rx Bc can take 3 weeks to show signs

  • treat all household mb
  • wash all clothing and dry hot
  • if can’t wash - put in plastic bags for 7d
  • return to school/daycare the day after treatment
  • education
  • health care my need prophylaxis
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70
Q

if suspect mom has rubella during her pregnancy, what test will halp you make the diagnosis?

A

rubella IgG avidity testing

can differentiate primary infection from past

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71
Q

what physical findings on a baby would make consider investigating for congenital rubella syndrome

A 
microcephaly
PDA
cataracts
glaucoma
hearing impairment
HSM
low PLT
radiolucent bone density
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72
Q

what are the 3 MC complications of RUBELLA

A
  1. Thrombocytopenia - 2 weeks post infection
  2. Arthritis - small jt, starts 1 week post, self resolves
  3. encephalitis - acute or progressive (and GBS)
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73
Q

What are the 2 types of encephalitis related to rubella

A
  1. acute post infectous - within 1 week of rask, HA, ataxia, focal neuro, sz, coma. Mortality 20%. most recover well. No virus in CSF
  2. Progressive rubella panencephalitis - can occur post infectious or congenital. Similar to Subacute sclerosing panencephalitis. +virus in Bx
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74
Q

what is the recommendation regarding the flu vaccine and Pt with egg allergies?

A

can take trivalent or quadrivalent inactivated vaccine

unclear about live attenuated nasal vaccine yet

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75
Q

which HPV genotypes are mainly responsible for cancers?

A

HPV 16 and HPV 18

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76
Q

what are recommendations regarding RSV prevention

A
  1. Hand hygiene
  2. Avoid high risk people
  3. CLD second to prematurity + ongoing Rx
  4. HD significant CHD < 24 mon at start of RSV season
  5. < 32 week and < 6 month at start of RSV
  6. consider for isolated communities - if born< 6 mo at start of RSV season - get 5 doses
  7. consider some high risk babies too - depend on province
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77
Q

which HPV genotypes are mainly responsible for genital warts

A

HPV 6 and HPV 11

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78
Q

What is a rare but severe (Non Ca) complication of HPV6 or 11

A

respiratory papillomatosis - URT and can spread to the lungs

79
Q

What is the prevalence of HPV in canada

A

11-29 %

highest rate of acquisition is within 5 years of starting sexual activities

80
Q

what are the risk factors for HPV

A 
# partners
young age of onset of sex
other STI
immunesuppression
never been married
never been pregnant
81
Q

when should the Gradasil vaccine bee given?

A

0, 2, 6 months in Grade 8 or between 9-13 yrs

can give after 13 as catch up

82
Q

what are the side effects of Gardasil

A 
NO ALLERGY
pain at site
HA
dizziness
N/V
83
Q

Who can get Gardasil

A 
all girls 8-13
especially high risk
female with HPV
Females with abnormal PAP
Females with genital warts
84
Q

Screening program criteria

A 
I Understand SCREEN
Importance of disease
Understanding disease process
Sensitive/specific test
Common problem with serious mortality/morbidity
Risk outweights benefit 
Early stage can be ID
Expense - low
Non-invasive test if possible
85
Q

when should a pt about to get a transplant be vaccinated with an inactivated vaccine?

A

> 2 weeks

86
Q

when should a patient who is about to start immunesuppression receive a live vaccine

A

min 4 weeks

87
Q

1-6 month post transplant, what type of infections are they at risk for?

A
  1. Viral - reactivation, donor or new infection

2. opportunistic - Listeria, aspergillus fumigatus, PCP

88
Q

what are infectious complications 6 month or more post transplant?

A

if doing well, same as everyone else

If not doing well, risk of opportunistic

89
Q

post transplant, when can a child be vaccinated?

A
  • not for 6-12 mo except for the inactivated flu vaccine which should be given a month post transplant
  • family gets flu vac too
90
Q

which vaccine is contraindicated post transplant

A

Varicella

91
Q

what vaccines are ok post transplant?

A
  1. Pneumococcal- esp heart transplant pt. 13 valent conjugate vaccine … 8 weeks later, 23 valent vaccine
  2. Men conjugate quadrivalent
  3. HPV for male and female transplant
  4. Hep B - double the usual dose
  5. Hib if not received
  6. inactive flu
92
Q

which vaccines are NOT recommended post transplant?

A
  1. LA influenza
  2. MMR
  3. Varicella
  4. BCG
93
Q

what percentage of acute HCV infection become chronic?

A

75%
but kids can still clear it
have residual Ab

94
Q

what is the rate of HCV vertical transmission?

A

5% - 25% of these will clear on their own

lower in women who are HCV RNA-neg

95
Q

what are maternal risk factors for vertical HCV transmission?

A
  1. high viral titres
  2. HIV co-infection
  3. high ALT the year prior to pregnancy
  4. maternal cirrhosis
96
Q

if a mom has HCV, what else should she be screened for?

A

HIV

hep B

97
Q

does being HCV effect mode of delivery or BF

A

no.
Avoid blood mix procedures such as scalp electrodes or amnio
can BF

98
Q

which moms should be screened for HCV?

A
  1. past or current IVDU
  2. bld transfusion before 1990 in dev world or anytime in developping
  3. pt with high ALT of unknown cause
  4. pt who had trasnplant from unscreened donor
99
Q

when do you test a baby born to HCV + mom

A

serology at 12-18 months

if +, repeat at 18 month

100
Q

when do you test a baby born to a very anxious HCV + mom

A

if anxiety or fear of loss to FU
do HCV RNA at 2 months + serology at 12-18
if HCV is + , redo test and ALT q 6 month

101
Q

what are risk factors for neonatal transmission of HSV

A

nature of maternal infection
mode of delivery
duration of ROM
instrumentation

102
Q

what percent of NHSV is acquired during delivery?

A

For HSV 1 - 75% acqured during vag disease that is often asymp or newly acquired

103
Q

what are teratogenic effects of HSV

A

skin lesions or scar
CNS disorder
chorioretinitis

104
Q

who is at higher risk of HSV transmission based on maternal infection type?

A

babies born to mom with primary infection-no Ab - 60% transmission rates
if 1st episode non primary infection-< 30%
if recurrent -< 2%

105
Q

up until what age should infants be assessed for NHSV?

A

up to 42 days

intrauterine infections present at birth

106
Q

what is the best test for CNS HSV?

A

CSF PCR - more sensitive than culture

BUT could also be neg in the early stage of infection

107
Q

why cant we use infant serology to diagnose NHSV

A
  1. Can’t tell mom IgG from baby
  2. Sick babies can’t make good Ab
  3. The test we have is not good
108
Q

what is the treatment dose of acyclovir

what are treatment lengths for SEM, disseminated and CNS

A

60 mg/kg/day divided TID all IV
SEM -14 d
CNS or diss -21 d (retest CSF at 21d, id still +, do longer)

if ocular disease - also need trifluridine + OPHTHO consult

109
Q

how do you manage asymptomatic baby born via c-section before ROM, whose mom had active HSV lesions presumed 1st episode or non primary?

A

swab before DC +/- blood PCR
educate about signs of NHSV
if + test results-manage as NHSV

110
Q

what testing is required if neonate is exposed and asymptomatic?

A

swab mucous ( mouth,nose and conjunctiva) mb at least 24 hr post del

111
Q

presumed 1st episode or non primary infection if del vaginally or csection +ROM

A

test mom Ab to assess if recurrent or not
swab mucous mb
start ACV

if test + : must do CSF PCR for treatment length
if test -: can stop ACV if maternal Ab show recurrent disease
if test -: but mom Ab show 1st - must continue ACV for 10 d

112
Q

if baby born via csection to mom with recurrent HSV.

A 
swab baby
if swab neg - donothing
if swab +: readmit for CSFand blood PCR and LFTs
treat for 14d if PCR neg OR 
21d if CSF or blood pos PCR
113
Q

how do you manage CNS HSV

A 
21 d of ACV
restest CSF at 21 days
May need longer Treatment
PO ACV TID for 6month as suppressive therapy
CBC, urea, creat should be done monthly 
adjust dose for growth
regular dev assessment and optho
114
Q

mom wth labial HSV wants info on mgnt of her baby

A

if baby less than 6 week, mom need s to wear face mask until lesions are crusted
should avoid kissing baby

115
Q

what are BF recommendations for TB

A

if active and untreated, can give EBM for the first 2 weeks of treatment
give baby TB rophylaxis

116
Q

what are BF recommendations for brucellosis

A

don not BF until treated

117
Q

BF recommendations for hepA

A

can BF +

Immunoglobulin prophylaxis

118
Q

BF recommendations for VZV

A

if perinatal-give VZIG
if post partum - consider VZIG
continue BF

119
Q

BF recommendations forHep B

A

give baby HBIG within 12 hrs
give hep B vaccine within 12 hrs
continue BF

120
Q

what antimicrobial are contraindicated during BF

A

high dose flagyl
primaquine, quinine - unless baby and mom have neg G6PD
watch out for sulphas and ?G6PD

121
Q

who should get Abx to manage MRSA skin abscesses

A

< 3mo
systemically unwell - T …
underlying medical problem
surrounding cellulitis

123
Q

how do you manage a < 1 month old post abscess drainage

A

1) if baby is perfect, abscess , 1cm and parents reliable = Clindamycin x 7d
2) otherwise, Admit for IV VAncomycin - MOST would be admitted**

124
Q

how do you manage a skin abscess (post drainage) in a 1-3 month old who has no fever and is well

A

culture pus

TMP/SMX

125
Q

how do you manage a skin abscess (post drainage) in a > 3 month with no or low grade T and well

A

drain
culture pus
if not staph - treat

126
Q

how do you manage a skin abscess in a > 3 month who has cellulitis or low or no temp

A

septra and cephalexin PO
await cultures

for > 8 yrs - can use doxy

127
Q

what are risk factors for AOE

A 
swimming
wearing hearing aid
immunocompromised
chronic otorrhea
trauma
foreign body
tight head scarfs
128
Q

how do you diagnose AOE? 3

A
  1. rapid onset AND
  2. SYMPTOMS of ear canal inflammation - otalgia/itchin or fullness +/- hearing loss/jaw pain AND
  3. SIGNS of ear canal inflammation - tenderness of tragus/pinna

OR
diffuse ear canal edema/erythema
+/- otorrhea, LN, tympanic mb erythema, cellulitis

129
Q

how do you differentiate AOE and AOM+otorrhea

A

AOE has pain on pushing tragus or pulling pinna

130
Q

what are the MC organism causing AOE

A

Pseudomonas and staph aureus

131
Q

how do you treat mild to moderate AOE

A
  • topical Abx +/- steroid for 7-10 days
  • pain mgnt
  • if cannot see ear canal = WICK
132
Q

what are the MC presentations of invasive GAS

A 
necrotising fasciitis
myositis
pneumonia
bacteremia without a source
Toxic Shock Syndrome
133
Q

what is considered clinical evidence of invasive GAS

A
  1. Step TSS
  2. soft tissue necrosis - NF, myositis, gangrene
  3. meningitis
134
Q

what are features of strep TSS

A 
low BP
renal impairment
caogulopathy
inc LFT
ARDS
erythematous macular rash + desquamation
135
Q

what is the prophylaxis treatment of invasive GAS

A

NO cultures needed

  1. Cephalexin for 10 d
  2. if Pen allergic - erythromycin for 10d
136
Q

who should receive prophylaxis for invasive GAS

A

family mb
all in home daycare

(Not in large daycare or school)

137
Q

How do you manage invasive GAS

A

penicillin + Clindamycin IV

IV Ig - unclear how but works

138
Q

what are preventative measures for infants < 6 mo regarding influenza

A
  1. vaccinate the family

2. Vaccinate pregnant women

139
Q

Infants that are high risk for meningococcal disease should receive what vaccination?

A

MCV-C at 2, 4, 12 months
AND
MCV 4 at 2 years

140
Q

Normal children should receive what type of meningococcal vaccination?

A

MCV-C at 12 month

AND either booster or MCV 4 in teens

141
Q

What is the most common meningo serogroup

Which one effects teens?

A
  1. Men B

2. Teens get C with high rates of septicemia and higher mortality

142
Q

for women who test HIV positive, what is the general mgnt of their pregnancy?

A
  1. antepartum combination therapy
  2. Intrapartum zidovudine
  3. baby gets 6 week PO zidovudine
  4. NO BF!!!!
143
Q

who should get post varicella exposure treatment

A

Significant exposure AND:

  • Mom has varicella within 5 days before and 48 hours after delivery
  • Neonates < 28 weeks’ gestation or <1000 g regardless of maternal immunity
  • Pregnant women without evidence of immunity
  • Immunocompromised persons without evidence of immunity
144
Q

if immune def and high risk of meningitis, what are the Abx

A

ceftriaxone + Vanco + amp ( listeria)

145
Q

GBS meningitis Abx

A

penicillin or AMPICILLIN
+
Gent for 5-7 days for synergistic effect

146
Q

What % of neonates are asympt carriers

A

3-33%

147
Q

what are the risk factors for c. Diff

A 
GI path
recent hospital adm
recent Abx
immunosuppressed
tube feeds
148
Q

how long do you do contact precautions for c.diff

A

48 hours post stop of diarrhea

149
Q

who is most likely to get admitted with RSV

A

healthy term infants

150
Q

what is the time between varicella doses

A

12 mo

4-6 years

151
Q

Risk factors for AOM

A
  1. daycare
  2. smoking
  3. not BF
  4. young age
  5. prem
  6. crowding
  7. immunodef
  8. FHx
  9. first nation
  10. orofacial abnormalities
  11. bottle feeding
  12. Soothers
152
Q

what bug most common in AOM

A

H. flu

153
Q

risk factors for Abx resistance for AOM

A 
less than 2 yr
attend daycare
frequent AOM
recent Abx
failed Rx
154
Q

what vaccines should an asplenic pt receive?

A

1) PCV 13 - 4 doses ( 2,4,6 and 12 mo) - if 1-2 yr get 2 doses, if > 2yrs get one dose
2) IF > 2 yrs = PPSV 23 ( > 8 weeks post PCV)and booster after 5 year
3) 4MenB
4) if > 5 yrs, another dose of HiB
5) yearly influenza
6) if travel abroad - Salmonella Typhi vacc
7) all household contacts should have their vaccinations

155
Q

who is more at risk, pt with hemoglobinopathies or pt who lost their spleen from trauma?

A

Hb

156
Q

when are asplenic patients most at risk?

A

3 yrs post splenectomy or

3 yrs if congenital asplenia

157
Q

what is the MC pathogen causing sepsis in asplenic pt

A

strep pneumo

H inf type b, N mening, salmonella, E. Coli

158
Q

asplenic pt are also at risk of non bacterial infections such as

A

Capnocytophaga species - cat/dog bites
more severe malaria
and babesia

159
Q

if asplenic pt presents with HiB sepsis, what else will be part of their management?

A

Hib Vaccine because infection does not confer lifelong protection

160
Q

who should get postsplenectomy prophylaxis Abx?

A

if less than 5 yr
and/or
min 2 yrs post
But ideal is life long

161
Q

what can patients with asplenia do when on country with malaria

A

sleep under net
sleep in AC room
use insect repellent
for up to a 1 year, if get fever must tell MD

162
Q

what are the initial Abx choices for asplenic pt and ? sepsis?

A

ceftriaxone + VAncomycin

if pen allergy = Vanco + ciprofloxacin

163
Q

what are early complications of meningitis?

A

SIADH

inc ICP

164
Q

what are the meningitis bugs in neonates

A

GBS
E.Coli
Listeria

165
Q

what are Abx choices for meningitis in neonate?

A

Amp + cefotaxime

166
Q

what are Abx choices for meningitis in 1-3 month old

A

cefotaxime/ceftriaxone AND Vancomycin ( S pneumo resistant) + if immune comp add amp for listeria

167
Q

What are meningitis Abx for > 3month

A

ceftriaxone and Vancomycin

168
Q

close contact prophylaxis for meningitis. WHo gets what?

A

if Hib or meningococcal

Rifampin for 2 days

169
Q

for Strep pneumo or N. Mening meningitis> what are abx:
if penicillin susceptible
if pen resistant

A
  1. penicillin G or amp

2. Cefotax/ceftriaxone

170
Q

For H. inf meningitis, what are Abx choices

A
  1. ampicillin

2. or ceft if resistant to amp

171
Q

what are the Abx for GBS meningitis?

A

Pen G or Amp + gent for the first 5-7 days

172
Q

when do you use steroid in meningitis

A

if think Hib or strep pneumo

if CSF positive, continue for 2 days

173
Q

For mneingitis, when should you repeat LP

A

if no improvement
if GBS to confirm sterilization - 24-48hrs post
if GN bugs - E.Coli

174
Q

when is imaging required for meningitis

A

if fail to sterilize CSF
if neuro symptoms
if any complications

175
Q

when should a child with meningitis have their hearing test

A

before DC OR

within one month

176
Q

what is the length of treatment for Strep pneumo meningitis

A

10-14 days

177
Q

what is the length of treatment for Hib meningitis

A

7-10 days

178
Q

what is the length of treatment for N. mening meningitis

A

5-7 days

179
Q

what is the length of treatment for GBS meningitis

A

14-21 days

180
Q

How do you treat LD arthritis

A

PO amox or Doxy for 28 d
if still present:
Try another 4 week course OR IV Ceftriaxone

181
Q

if a patient has ? influenza and secondary bacterial pneumonia, what is your Abx choice for non severe and severe?

A

non - amoxiclav PO or cefuroxime IV

severe - ceftriaxone/cefotax + clarithro/azithro +/- clox IV for MRSA

182
Q

if pt has pleural effusion - what are the Abx choices?

A

cetriaxone + clinda for anaerobes

183
Q

how long should an uncomplicated pneumonia be treated for?

A

7-10 days

5 days for azithromycin

184
Q

when should you consider antiviral in a pt with a pneumonia

A

if influenza identified
if acute onset of symptoms
if high risk or needs admission

185
Q

if pt has true allergy to penicillin, what Abx to use for uncomplicated pneumonia?

A

azithromycin or clarithromycin

186
Q

Who should get a more extensive assessment for uti and IV abx?

A

Hd unstable
High creatinine
Poor urine flow
Not clinical improvement after 24 hours or fever not trending down by 48 hours of abx

187
Q

How long do you treat cystitis?

A

PO 2-4 days

188
Q

How do we test HIV in pregnancy?

A

1st - enzyme immunoassay

2nd - if + - do western blot for HIV Ab

189
Q

what are the modes of delivery for a mom with HIV

A

CS or vaginal if Viral load < 1000 copies /ml

190
Q

does HIV co-infection Inc the risk of hep C vertical transmission?

A

yes

from 5% up to 25%

191
Q

what is the main SE of rubella vaccine

A

arthritis - 5-10%

192
Q

what is considered a UTI if sample taken suprapubic?

A

any growth

193
Q

what is a UTI if sample is catheter

A

> 5 x 10 7 CFU/L (10 4 if CFU/ml)

194
Q

what is a UTI if sample taken via clean catch

A

> 10 8 CFU/L (>105 CFU/ml)

195
Q

who should not receive topical ear drops

A

tympanostomy tubes or a

perforated tympanic membrane because there is an increasing body of literature concerning ototoxicity

CPS (10 decks)

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