ID Flashcards
0
Q
benefits of rotavirus vaccine
A
- prevent severe disease
- decrease dehydration and need for admission
- give at 2 and 4 months
1
Q
contraindications to rotavirus vaccine
A
- hypersensitivity to vaccine
- Hx of intussusception
- immunocompromised
2
Q
evidence of immunity to varicella
A
- IgG to VZV- natural disease
- documentation of 2 doses of vaccine
- lab confirmed varicella from lesion
- previous Dx of varicella or zoster by health care professional
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
4
Q
For babies exposed to HSV, how long after delivery can they develop symptoms?
A
4-6 weeks
5
Q
what are the natural reservoirs of Yersinia ?
A
Pigs! rodents, rabbits, sheep, cattle, horses, cats and dogs
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
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
8
Q
Contamination rate for bag urine?
A
60%
For girls, sit back ward on toilet
9
Q
Treatment of yersinia
A
Usually self limiting
Treat if young, systemic or immonocompromised
Septra or cefotaxime or ceftriaxone
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
11
Q
What bacteria is least likely to cause UTI in healthy child
- E. coli
- Enterobacter
- Klebsiella
- Entetrococcus
- Citrobacter
- serratia
A
??enterococcus - controvertial
12
Q
Risk of damage from pyelonephristis in healthy children is ?
A
False
13
Q
What grade of reflux needs prophylaxis Abx
A
Grade 4-5
14
Q
cystitis treatment as per CPS
A
Usually teens with dysuria and frequency
PO cefixime for 2-4 days
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
16
Q
What can you diagnose on VCUG?
A
PUV in boys
Reflux
18
Q
treatment for Mild C. difficile
A
discontinue precipitant antibiotics
FU
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
20
Q
Treatment for severe c.diff - initial presentation
A
severe systemic toxicity
Vanco PO 40 mg/kg/day QID for 10-14
21
Q
treatment for first recurrence of c.diff and for second
A
repeat initial treatment
For 2nd, Vanco in tapered or pulsed reg
21
Q
Transmission of HCV, risk factors
A
high viremia
high ALT
HIV co infection
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
23
Q
Timing of vaccines in elective splenectomy
A
2 weeks pre
if cannot do - do 2 weeks post
24
When do post traumatic seizures occur?
in first 24 hours
| rarely beyond 7 days
25
Prophylaxis Abx for asplenic pt
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
26
Factors that increase the risk of post traumatic seizures
```
younge age
GCS <8
cerebral edema
subdural hematoma
skull fracture - open or depressed
```
27
risk factors for melanoma
light skin
freckles
large # of typical or atypical moles
family or personal Hx or melanoma
28
what are the recommendations made regarding tanning
```
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
```
29
what are elements of family based treatement for AN - parent
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
30
What abx do you use for Lyme disease?
PO:
< 8 yrs - Amox
> 8 yrs - Doxy
IV:
ceftriaxone or pen G
32
How do you test for lyme disease
if EM present and acute - just treat
| ELISA
if other features, disseminated or late - ELISA + Western blot
ELISA high false +
33
how do you treat acute LD with one EM
Amox or Doxy PO for 14-21 days
34
How do you treat isolated facial palsy?
Amox or Doxy PO 14-21 days
35
How do you treat carditis, meningitis or late neuro deisease from LD?
IV ceftriaoxone or Pen G 14-28days
35
what are 3 things one can do to prevent LD
1. Avoid playing in wooded areas
2. 20-30% DEET to close or skin
3. Wash within 2 hours of play
36
What is Jarisch-Herxheimer reaction
LD and start or rx = fever, HA, myalgia
Endotoxin-like products released by the death of harmful microorganisms within the body during antibiotic treatment.
37
can we give prophylaxis Abx for LD
debated:
some do one dose of dox for > 8
not enough data for Amox
38
What is the treatment for cat scratch
Bartonella Henselae
Azithromycin for 5 days
39
What is the treatment of blastomycosis
mild - Itraconazole
| disseminated/severe - Ampho B
40
What is the triad of CP seen in brucellosis
1. fever
2. HSM
3. arthritis - SI, ankles, knees
41
How do you treat brucellosis
doxy and aminoglycoside
42
CPS UTI treatment?
Cefixime
for Adm=Gent +/_Amp
43
What is a complicated UTI?
```
HD unstable
high Creat
bladder or abdo mass
no improvement after 24 hrs
No decrease in fever over 48Hr of Abx
```
44
What is the length of treatment for a UTI?
| what Bx and dose
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
45
who should be offered the 4CMenB
```
asplenia
hyposplenia
primary antibody def - compl def, properdin, factor D
if Hx of invasive meningo disease
if work with the organism
```
46
what are work restrictions for mumps, measles, rubella, pertussis, varicella
```
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
```
47
what are risf factors for CA-MRSA outbreak?
1. overcrowding
2. skin to skin contact
3. sharing contaminated items
4. hygiene/cleanliness
5. limited health care
48
what are potential risk factors for transmission of blood borne viruses?
aggressive behaviour
oozing skin lesions
bleeding disorders
49
In what case is HBV prophylaxis required in a daycare setting
if break skin and contact with blood -either biter gets bld in mouth or bitee from saliva into bld
50
what do you do when skin is broken due to a bite
```
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
```
51
what is required when assessing child referred for a bite
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
52
who gets Hep B Ig(0.06ml/kg IM) + vaccine post bite exposure
- 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
53
what do you do if Hep B status of bitee or biter is unknown?
low risk
no testing for hep B
if a child is non immune - vaccin
54
What do you do if Hep B status of both children is unknown
low risk
No testing
give vaccine to both unless already immune
55
what are features of pediculosis
pruritis from being sensitized to louse saliva
| secondary bacterial infection
56
how are head lice transmitted
direct contact
small risk from pillow cases
not from pets
57
how do you treat head lice - first line
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
58
what is second line treatment of head lice
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
59
why is your patient with head lice not getting better
misdiagnosed - need to see live lice
poor compliance
new infestation
60
in special situations, you can use an oral treatment of head lice. Which one?
Ivermectin. Antihelminthic. 2 doses taken 7-10 days apart
need special access
Septra tried but not approved
61
what is a noninsecticide product that can be used for head lice?
Resultz rinse - myristate and cyclomethicone. Apply dry, 10 min, rinse, repeat 7d. Less SE
62
should a child with head lice be excluded from school?
No
suggest treatment
suggest avoid head to head contact
let parents of other children know
63
what are clinical features of scabies?
pruritis - worse at night
located - between fingers, flexor aspects of wrist/elbows, axillae, genitals
can be on scalp of infants
64
how do you diagnose scabies
clinical
| skin scraping
65
how is scabies transmitted?
skin to skin
clothing
linen
mites don's live long off the skin
66
what are risk factors for scabies for the aboriginal population
```
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
```
67
How do you treat scabies
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
68
What is the scabies treatment if less than 2 month old or pregnant?
```
precipitated sulphur (7%) in pretroleum jelly
apply for 24 hours x 3d
```
69
what are suggested control measure for mgnt of scabies
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
70
if suspect mom has rubella during her pregnancy, what test will halp you make the diagnosis?
rubella IgG avidity testing
| can differentiate primary infection from past
71
what physical findings on a baby would make consider investigating for congenital rubella syndrome
```
microcephaly
PDA
cataracts
glaucoma
hearing impairment
HSM
low PLT
radiolucent bone density
```
72
what are the 3 MC complications of RUBELLA
1. Thrombocytopenia - 2 weeks post infection
2. Arthritis - small jt, starts 1 week post, self resolves
3. encephalitis - acute or progressive (and GBS)
73
What are the 2 types of encephalitis related to rubella
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
74
what is the recommendation regarding the flu vaccine and Pt with egg allergies?
can take trivalent or quadrivalent inactivated vaccine
unclear about live attenuated nasal vaccine yet
75
which HPV genotypes are mainly responsible for cancers?
HPV 16 and HPV 18
76
what are recommendations regarding RSV prevention
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
77
which HPV genotypes are mainly responsible for genital warts
HPV 6 and HPV 11
78
What is a rare but severe (Non Ca) complication of HPV6 or 11
respiratory papillomatosis - URT and can spread to the lungs
79
What is the prevalence of HPV in canada
11-29 %
| highest rate of acquisition is within 5 years of starting sexual activities
80
what are the risk factors for HPV
```
# partners
young age of onset of sex
other STI
immunesuppression
never been married
never been pregnant
```
81
when should the Gradasil vaccine bee given?
0, 2, 6 months in Grade 8 or between 9-13 yrs
can give after 13 as catch up
82
what are the side effects of Gardasil
```
NO ALLERGY
pain at site
HA
dizziness
N/V
```
83
Who can get Gardasil
```
all girls 8-13
especially high risk
female with HPV
Females with abnormal PAP
Females with genital warts
```
84
Screening program criteria
```
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
when should a pt about to get a transplant be vaccinated with an inactivated vaccine?
> 2 weeks
86
when should a patient who is about to start immunesuppression receive a live vaccine
min 4 weeks
87
1-6 month post transplant, what type of infections are they at risk for?
1. Viral - reactivation, donor or new infection
| 2. opportunistic - Listeria, aspergillus fumigatus, PCP
88
what are infectious complications 6 month or more post transplant?
if doing well, same as everyone else
| If not doing well, risk of opportunistic
89
post transplant, when can a child be vaccinated?
- 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
which vaccine is contraindicated post transplant
Varicella
91
what vaccines are ok post transplant?
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
which vaccines are NOT recommended post transplant?
1. LA influenza
2. MMR
3. Varicella
4. BCG
93
what percentage of acute HCV infection become chronic?
75%
but kids can still clear it
have residual Ab
94
what is the rate of HCV vertical transmission?
5% - 25% of these will clear on their own
| lower in women who are HCV RNA-neg
95
what are maternal risk factors for vertical HCV transmission?
1. high viral titres
2. HIV co-infection
3. high ALT the year prior to pregnancy
4. maternal cirrhosis
96
if a mom has HCV, what else should she be screened for?
HIV
| hep B
97
does being HCV effect mode of delivery or BF
no.
Avoid blood mix procedures such as scalp electrodes or amnio
can BF
98
which moms should be screened for HCV?
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
when do you test a baby born to HCV + mom
serology at 12-18 months
| if +, repeat at 18 month
100
when do you test a baby born to a very anxious HCV + mom
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
what are risk factors for neonatal transmission of HSV
nature of maternal infection
mode of delivery
duration of ROM
instrumentation
102
what percent of NHSV is acquired during delivery?
For HSV 1 - 75% acqured during vag disease that is often asymp or newly acquired
103
what are teratogenic effects of HSV
skin lesions or scar
CNS disorder
chorioretinitis
104
who is at higher risk of HSV transmission based on maternal infection type?
babies born to mom with primary infection-no Ab - 60% transmission rates
if 1st episode non primary infection-< 30%
if recurrent -< 2%
105
up until what age should infants be assessed for NHSV?
up to 42 days
intrauterine infections present at birth
106
what is the best test for CNS HSV?
CSF PCR - more sensitive than culture
| BUT could also be neg in the early stage of infection
107
why cant we use infant serology to diagnose NHSV
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
what is the treatment dose of acyclovir
| what are treatment lengths for SEM, disseminated and CNS
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
how do you manage asymptomatic baby born via c-section before ROM, whose mom had active HSV lesions presumed 1st episode or non primary?
swab before DC +/- blood PCR
educate about signs of NHSV
if + test results-manage as NHSV
110
what testing is required if neonate is exposed and asymptomatic?
swab mucous ( mouth,nose and conjunctiva) mb at least 24 hr post del
111
presumed 1st episode or non primary infection if del vaginally or csection +ROM
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
if baby born via csection to mom with recurrent HSV.
```
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
how do you manage CNS HSV
```
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
mom wth labial HSV wants info on mgnt of her baby
if baby less than 6 week, mom need s to wear face mask until lesions are crusted
should avoid kissing baby
115
what are BF recommendations for TB
if active and untreated, can give EBM for the first 2 weeks of treatment
give baby TB rophylaxis
116
what are BF recommendations for brucellosis
don not BF until treated
117
BF recommendations for hepA
can BF +
| Immunoglobulin prophylaxis
118
BF recommendations for VZV
if perinatal-give VZIG
if post partum - consider VZIG
continue BF
119
BF recommendations forHep B
give baby HBIG within 12 hrs
give hep B vaccine within 12 hrs
continue BF
120
what antimicrobial are contraindicated during BF
high dose flagyl
primaquine, quinine - unless baby and mom have neg G6PD
watch out for sulphas and ?G6PD
121
who should get Abx to manage MRSA skin abscesses
< 3mo
systemically unwell - T ...
underlying medical problem
surrounding cellulitis
123
how do you manage a < 1 month old post abscess drainage
1) if baby is perfect, abscess , 1cm and parents reliable = Clindamycin x 7d
2) otherwise, Admit for IV VAncomycin - MOST would be admitted****
124
how do you manage a skin abscess (post drainage) in a 1-3 month old who has no fever and is well
culture pus
| TMP/SMX
125
how do you manage a skin abscess (post drainage) in a > 3 month with no or low grade T and well
drain
culture pus
if not staph - treat
126
how do you manage a skin abscess in a > 3 month who has cellulitis or low or no temp
septra and cephalexin PO
await cultures
for > 8 yrs - can use doxy
127
what are risk factors for AOE
```
swimming
wearing hearing aid
immunocompromised
chronic otorrhea
trauma
foreign body
tight head scarfs
```
128
how do you diagnose AOE? 3
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
how do you differentiate AOE and AOM+otorrhea
AOE has pain on pushing tragus or pulling pinna
130
what are the MC organism causing AOE
Pseudomonas and staph aureus
131
how do you treat mild to moderate AOE
- topical Abx +/- steroid for 7-10 days
- pain mgnt
- if cannot see ear canal = WICK
132
what are the MC presentations of invasive GAS
```
necrotising fasciitis
myositis
pneumonia
bacteremia without a source
Toxic Shock Syndrome
```
133
what is considered clinical evidence of invasive GAS
1. Step TSS
2. soft tissue necrosis - NF, myositis, gangrene
3. meningitis
134
what are features of strep TSS
```
low BP
renal impairment
caogulopathy
inc LFT
ARDS
erythematous macular rash + desquamation
```
135
what is the prophylaxis treatment of invasive GAS
NO cultures needed
1. Cephalexin for 10 d
2. if Pen allergic - erythromycin for 10d
136
who should receive prophylaxis for invasive GAS
family mb
all in home daycare
(Not in large daycare or school)
137
How do you manage invasive GAS
penicillin + Clindamycin IV
| IV Ig - unclear how but works
138
what are preventative measures for infants < 6 mo regarding influenza
1. vaccinate the family
| 2. Vaccinate pregnant women
139
Infants that are high risk for meningococcal disease should receive what vaccination?
MCV-C at 2, 4, 12 months
AND
MCV 4 at 2 years
140
Normal children should receive what type of meningococcal vaccination?
MCV-C at 12 month
| AND either booster or MCV 4 in teens
141
What is the most common meningo serogroup
| Which one effects teens?
1. Men B
| 2. Teens get C with high rates of septicemia and higher mortality
142
for women who test HIV positive, what is the general mgnt of their pregnancy?
1. antepartum combination therapy
2. Intrapartum zidovudine
3. baby gets 6 week PO zidovudine
4. NO BF!!!!
143
who should get post varicella exposure treatment
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
if immune def and high risk of meningitis, what are the Abx
ceftriaxone + Vanco + amp ( listeria)
145
GBS meningitis Abx
penicillin or AMPICILLIN
+
Gent for 5-7 days for synergistic effect
146
What % of neonates are asympt carriers
3-33%
147
what are the risk factors for c. Diff
```
GI path
recent hospital adm
recent Abx
immunosuppressed
tube feeds
```
148
how long do you do contact precautions for c.diff
48 hours post stop of diarrhea
149
who is most likely to get admitted with RSV
healthy term infants
150
what is the time between varicella doses
12 mo
| 4-6 years
151
Risk factors for AOM
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
what bug most common in AOM
H. flu
153
risk factors for Abx resistance for AOM
```
less than 2 yr
attend daycare
frequent AOM
recent Abx
failed Rx
```
154
what vaccines should an asplenic pt receive?
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
who is more at risk, pt with hemoglobinopathies or pt who lost their spleen from trauma?
Hb
156
when are asplenic patients most at risk?
3 yrs post splenectomy or
| 3 yrs if congenital asplenia
157
what is the MC pathogen causing sepsis in asplenic pt
strep pneumo
| H inf type b, N mening, salmonella, E. Coli
158
asplenic pt are also at risk of non bacterial infections such as
Capnocytophaga species - cat/dog bites
more severe malaria
and babesia
159
if asplenic pt presents with HiB sepsis, what else will be part of their management?
Hib Vaccine because infection does not confer lifelong protection
160
who should get postsplenectomy prophylaxis Abx?
if less than 5 yr
and/or
min 2 yrs post
But ideal is life long
161
what can patients with asplenia do when on country with malaria
sleep under net
sleep in AC room
use insect repellent
for up to a 1 year, if get fever must tell MD
162
what are the initial Abx choices for asplenic pt and ? sepsis?
ceftriaxone + VAncomycin
if pen allergy = Vanco + ciprofloxacin
163
what are early complications of meningitis?
SIADH
| inc ICP
164
what are the meningitis bugs in neonates
GBS
E.Coli
Listeria
165
what are Abx choices for meningitis in neonate?
Amp + cefotaxime
166
what are Abx choices for meningitis in 1-3 month old
cefotaxime/ceftriaxone AND Vancomycin ( S pneumo resistant) + if immune comp add amp for listeria
167
What are meningitis Abx for > 3month
ceftriaxone and Vancomycin
168
close contact prophylaxis for meningitis. WHo gets what?
if Hib or meningococcal
| Rifampin for 2 days
169
for Strep pneumo or N. Mening meningitis> what are abx:
if penicillin susceptible
if pen resistant
1. penicillin G or amp
| 2. Cefotax/ceftriaxone
170
For H. inf meningitis, what are Abx choices
1. ampicillin
| 2. or ceft if resistant to amp
171
what are the Abx for GBS meningitis?
Pen G or Amp + gent for the first 5-7 days
172
when do you use steroid in meningitis
if think Hib or strep pneumo
| if CSF positive, continue for 2 days
173
For mneingitis, when should you repeat LP
if no improvement
if GBS to confirm sterilization - 24-48hrs post
if GN bugs - E.Coli
174
when is imaging required for meningitis
if fail to sterilize CSF
if neuro symptoms
if any complications
175
when should a child with meningitis have their hearing test
before DC OR
| within one month
176
what is the length of treatment for Strep pneumo meningitis
10-14 days
177
what is the length of treatment for Hib meningitis
7-10 days
178
what is the length of treatment for N. mening meningitis
5-7 days
179
what is the length of treatment for GBS meningitis
14-21 days
180
How do you treat LD arthritis
PO amox or Doxy for 28 d
if still present:
Try another 4 week course OR IV Ceftriaxone
181
if a patient has ? influenza and secondary bacterial pneumonia, what is your Abx choice for non severe and severe?
non - amoxiclav PO or cefuroxime IV
| severe - ceftriaxone/cefotax + clarithro/azithro +/- clox IV for MRSA
182
if pt has pleural effusion - what are the Abx choices?
cetriaxone + clinda for anaerobes
183
how long should an uncomplicated pneumonia be treated for?
7-10 days
| 5 days for azithromycin
184
when should you consider antiviral in a pt with a pneumonia
if influenza identified
if acute onset of symptoms
if high risk or needs admission
185
if pt has true allergy to penicillin, what Abx to use for uncomplicated pneumonia?
azithromycin or clarithromycin
186
Who should get a more extensive assessment for uti and IV abx?
Hd unstable
High creatinine
Poor urine flow
Not clinical improvement after 24 hours or fever not trending down by 48 hours of abx
187
How long do you treat cystitis?
PO 2-4 days
188
How do we test HIV in pregnancy?
1st - enzyme immunoassay
| 2nd - if + - do western blot for HIV Ab
189
what are the modes of delivery for a mom with HIV
CS or vaginal if Viral load < 1000 copies /ml
190
does HIV co-infection Inc the risk of hep C vertical transmission?
yes
| from 5% up to 25%
191
what is the main SE of rubella vaccine
arthritis - 5-10%
192
what is considered a UTI if sample taken suprapubic?
any growth
193
what is a UTI if sample is catheter
>5 x 10 7 CFU/L (10 4 if CFU/ml)
194
what is a UTI if sample taken via clean catch
> 10 8 CFU/L (>105 CFU/ml)
195
who should not receive topical ear drops
tympanostomy tubes or a
| perforated tympanic membrane because there is an increasing body of literature concerning ototoxicity
