ID

Question 1

C diff diagnosis

Answer 1

Enzyme immunoassay for glutamate dehydrogenase, toxins A and B
(EIA less sensitive)
And
Cell cytotoxin assay (labour intensive and expensive)

So EIA for GDH for screen then toxin EIA or cell cytotoxin assay

Question 2

Treatment c diff (mild)

Answer 2

Watery diarrhea without systemic toxicity (<4 abn stool/d) = d/c precipitating antibiotic, follow up and reassess

Question 3

C diff treatment initial episode moderate (or mild not responding to d/c abx)

Answer 3

Moderate (>4 abnormal stools/d) without systemic toxicity = flagyl 30 mg/kg/d divided 4 doses for 10-14 days

Question 4

C diff treatment initial episode severe

Answer 4

Severe (evidence of systemic toxicity - rigours, high grade fever) = vanco 40mg/kg/d PO for 10-14 days

Question 5

C diff treatment initial episode severe, complicated

Answer 5

Complicated (evidence of severe colitis, hypotension, shock, peritonitis, ileus, or megacolon) = vanco PO plus iv flagyl (same doses as above, 10-14 days. For ileus can give vanco PR.

Question 6

C diff treatment for recurrence

Answer 6

First: Same treatment as first episode
Second: vancomycin in a tapered or pulsed regimen (40/kg/d divided 4 times daily for 10-14 days then 10 mg/kg twice daily for 7 days, the 10/kg once daily for 7 days, then every 2-3 days for 2-8 weeks)

Question 7

C diff prevention

Answer 7

Hand hygiene
Identify and remove environmental sources of c diff
Chlorine containing sporicidal agents (alcohol doesn’t kill)
Contact precautions until 48 hours no diarrhea
Private rooms or cohorting and don’t retest stool, go based off of symptoms
Anti microbial stewardship

Question 8

Toxoplasmosis classic triad + other symptoms and timing of infection

Answer 8

1st - most severe, fetal demise
2nd trimester - classic:
- intracranial calcifications
- hydrocephalus
- chorioretinitis 
\+ jaundice, HSM, anemia, hearing loss, microcephaly, developmental delay, LAD, visual problems  
3rd trimester: asyptomatic

Question 9

Congenital toxo diagnosis

Answer 9

organism isolation from the placenta, serum, and cerebrospinal fluid (CSF)
ophthalmologic examination - chorioretinitis, CT head looking for calcifications, and
CSF - elevated protein and pleocytosis

Question 10

congenital toxo treatment

Answer 10

pyrimethamine, sulfadiazine, and leucovorin for 1 year

Question 11

Syphilis bug

Answer 11

gram-negative spirochete Treponema pallidum

Question 12

Congenital Syphilis most common presentation:

Answer 12

majority of infants born with congenital syphilis are asymptomatic at birth

Question 13

Congenital syphilis - early

Answer 13

1-2 months:
maculopapular rash, snuffles, generalized lymphadenopathy, hepatomegaly, thrombocytopenia, anemia, meningitis, chorioretinitis, pneumonia alba, and osteochondritis.

Question 14

Congenital syphilis - late

Answer 14

Hutchinson/peg teeth (small teeth with an abnormal central groove), mulberry molars (bulbous protrusions on the molar teeth resembling mulberries), hard palate perforation, eighth nerve deafness, interstitial keratitis, bony lesions, and saber shins (due to chronic periosteitis)

Question 15

Syphilis nontreponemal tests (2)

Answer 15

venereal disease research laboratory test and rapid plasma reagin are used for screening and monitoring treatment of the disease

Question 16

Syphilis treponemal tests

Answer 16

fluorescent treponemal antibody absorption test or T pallidum particle agglutination are used to confirm diagnosis. Treponemal tests are not used alone due to false positives that may occur with other infections such as Lyme disease

Question 17

Syphilis testing in newborn

Answer 17

same nontreponemal test as the mother if the mother has a nontreponemal titer that increased fourfold; had a positive treponemal test without documented treatment; had a positive treponemal test not treated with penicillin; had a positive treponemal test and was treated less than 1 month before delivery; or if the infant has signs of congenital syphilis.

If the infant’s nontreponemal titer is more than fourfold higher than the mother’s or if there is any clinical finding consistent with congenital syphilis, the infant must be treated and undergo a venereal disease research laboratory test of CSF, liver function tests, complete blood count, and long bone radiographs.

Question 18

Syphilis treatment

Answer 18

Pen G

Question 19

Mom HBsAg + treatment and tests

Answer 19

–> HBV vaccine and hepatitis B immune globulin within 12 hours of birth!
These infants should then complete the HBV vaccine series with two more additional immunizations per the CDC’s recommended schedule, as well as undergo HBsAg and anti-HBs testing after 9 months of age.

Question 20

Mom Hep B status unknown at delivery

Answer 20

Test mom immediately

Baby gets Hep B vaccine within 12 hours and if mom is positive Hep B IG within 7 days

Question 21

Maternal VZV

Answer 21

Treat baby with VZV IG if mom develops varicella 5 days before or 2 days after delivery

Question 22

Maternal HIV - who gets a c/s

Answer 22

viral load > 1000 copies/mL

Question 23

Baby to HIV + mom - when to test

Answer 23

HIV-1 DNA or RNA PCR should be analyzed at: 14 to 21 days after birth, 1 to 2 months of age, and 4 to 6 months of age

Question 24

HIV + mom - when is baby considered uninfected?

Answer 24

1) two negative HIV-1 DNA or RNA assays, one obtained after 1 month of age and the other at 4 months of age or older, or
2) two negative HIV-1 antibody tests from separate specimens obtained at 6 months of age or older.
Some practitioners may follow antibodies until after 18 months of age because maternally derived antibodies rarely persist beyond this age

Question 25

HIV + mom - treatment for baby

Answer 25

6 weeks of zidovudine. If confirmed infection then continue long term ARV

Question 26

Parvo virus B19 baby risk

Answer 26

hydrops, pleural/pericardial effusion, IUGR, death

infection during 1st half of preg has greatest risk

Question 27

Parvo virus B19 baby treatment

Answer 27

supportive care

IVIG may be helpful

Question 28

Congenital rubella (german measles)

Answer 28

blueberry muffin rash (extramedullary hematopeoisis), radiolucent bone disease, IUGR, interstistial pneumonitis, LAD, HSM, thrombocytopenia, cataract
endocrinopathies - DM

Question 29

Congenital rubella eye findings

Answer 29

cataract! also glaucoma, microphthalmos, pigmentary retinopathy

Question 30

Congenital rubella cardiac findings

Answer 30

Pulmonic stenosis, PDA

Question 31

Congenital rubella CNS s/e

Answer 31

developmental delay, encephalitis, SNHL

Question 32

Congenital rubella diagnosis

Answer 32

infant rubella IgM
rising rubella IgG
virus isolated from CSF, serum, oral/nasal secretions

Question 33

Most common congenital infection

Answer 33

CMV (0.5-1%)

Question 34

CMV presentation

Answer 34

most are asymptomatic!

SNHL, HSM, jaundice, thrombocytopenia, periventricular calcifications, retinitis, IUGR, microcephaly

Question 35

Congenital CMV diagnosis

Answer 35

CMV in urine or pharyngeal secretions in first 3 weeks - culture or PCR
Antibodies not helpful (IgG doesn’t tell you when mom got it, IgM not sens/specific)

Question 36

Cong CMV treatment

Answer 36

Ganciclovir to improve SNHL and neurodevelopment

Question 37

Maternal HSV highest risk

Answer 37

primary infection late in preg (3rd trimester)

Question 38

Congenital HSV age of presentation

Answer 38

birth-6 weeks

Question 39

How often is there a maternal Hx of HSV in infants with congenital HSV?

Answer 39

12.5%

Question 40

HSV classification (3)

Answer 40

• primary skin, eyes, mucosa
• primarily CNS
• disseminated with multiple organ involvement

Question 41

Best test for HSV CNS

Answer 41

PCR (sensitivity 75-100%)

Question 42

Best test for HSV skin lesions

Answer 42

viral culture of skin lesion