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Pediatrics- Noelle > ID > Flashcards

ID Flashcards

1
Q

what are the congenital infections?

A 
CHEAP TORCHES
Chicken pox
Hepatitis B, C, E
Enterovirus
Aids
Parvovirus B19
Toxoplasmosis
other (zika etc)
Rubella
CMV
HSV
every other STD
Syphilis
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2
Q

what is the most common congenital infection?

A

CMV

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3
Q

what is the most common cause of acquired hearing loss in childhood?

A

CMV

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4
Q

what are the manifestations of CMV

A

KEY- IUGR, hepatosplenomegaly, thrombocytopenia, microcephaly, periventricular calcifications SNHL, chorioretinits

general- IUGR, prematurity
skin- petechia, purpura, ecchymoses, jaundice
hematopoietic- thrombocytopenia, anemia, splenomegaly
hepatobiliary- hyperbola, elevated ALT, hepatomegaly**
CNS- microcephaly, seizures, periventricular calcifications**
eye- Chorioretinitis, strabismus, optic atrophy, micropthlamia
ear- sensorineural hearing loss

more common presentation: thrombocytopenia, petechiae, may have hepatomegaly
severe end of the spectrum: microcephaly, Chorioretinitis, hearing loss, periventricular calcifications

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5
Q

what type of calcifications are seen with CMV? zika? toxo?

A

CMV- periventricular calcifications
Zika- subcortical calcifications
toxo- intraparenchymal calcifications
HIV- basal ganglia

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6
Q

what is the treatment for congenital CMV

A

moderate to severe (multiple manifestations or CNS involvement)- treat with oral Valganciclovir (within the first month) for 6 months
- monitor neutrophil count and ALT

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7
Q

newborn infant with microcephaly, club foot, dislocated hips, chorioretinal scars. what is the cause?

A

zika

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8
Q

what type of virus is zika

how do you get zika

A

flavivirus
mosquito- borne (aedes mosquitos)
clinical manifestations- 75-80% are asymptomatic

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9
Q

what are the features of congenital zika syndrome

A

KEY- microcephaly, brain malformations, subcortical calcifications, macular scars, contractures

microcephaly with partially collapsed skull
thin cerebral cortices with subcortical calcifications
macular scarring with focal pigmentary retinal mottling
congenital contractures (arthrogryposis, club foot, congenital hip dislocation)
early hypertonia

Neuroimaging: diffuse, subcortical calcifications
ventriculomegaly
hypoplasia of corpus callous
decreased myelination
cerebellar vermis hypoplasia
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10
Q

what is the congenital anomaly risk of zika in pregnancy?

A

5-10% overall

higher risk in first trimester versus 3rd

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11
Q

how do you make an antenatal diagnosis of zika?

A

serology (IgM, IgG, PRNT)
- PRNT is confirmatory test
have to do Dengue serology at the same time
PCR in blood and urine
- remains positive for 3-7d after symptom onset

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12
Q

what is the workup for zika in a newborn

A

serology
- IgM and IgG, dengue IgM and IgG
if positive then PRNT
(zika IgM on CSF)

PCR
- placental and umbilical cord tissue
- serum, urine, CSF (if LP done)
do not use cord blood due to possible contamination with maternal blood

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13
Q

how is congenital zika virus confirmed

A

zika PCR in any specimen from child
highly likely
- detection of zika by PCR from placenta
- zika IgM reactive in baby

positive IgG or PRNT may reflect transplacental maternal antibody

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14
Q

newborn with maculopapular rash (including soles), microcephaly, Chorioretinitis, hepatosplenomegaly, bony changes. what is the most likely diagnosis?

A

syphilis

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15
Q

what are the manifestations of congenital syphilis

A

Main ones- snuffles (often bloody), pseudo paralysis, rash involving palms and soles, body changes

general- prematurity, IUGR FTT
mucocutaneous- snuffles **, maculopapular rash followed by desquamation, blistering and crusting, condyloma late
rediculoendothelial- hepatosplenomagly, lymphadenopathy
hematologic- Coombs negative hemolytic anemia, thrombocytopenia
skeletal- pseudo paralysis, oseochonritis diaphysial periostitis, demineralization.destruction of proximal tibia metaphysis, osteitis
neurologic- aseptic meningitis, hydrocephalus, cranial nerve palsies
eyes- salt and pepper chorioretinitis

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16
Q

late onset manifestations of syphilis

prob not that impt

A 
saddle nose deformity
hutchinson's teeth
mulberry molars
ragades(linear scars(
saber shins
global developmental delay
hydrocephalus
seizures
cranial nerve palsies
sensorineural hearing loss
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17
Q

when should you evaluate for syphilis (6) * impt to know

A
  1. signs and symptoms of congenital syphilis
  2. mother not treated or treatment not adequately documented
  3. mother treated with non-penicillin regimen
  4. mother treated within 30 days of child’s birth
  5. less than 4 fold drop in mother’s non-treponema titre or not assessed or documented
  6. mother had relapse or reinfection after treatment
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18
Q

what is the evaluation for a child with suspected congenital syphilis (7)

A

physical exam (must have audiologic testing and an eye exam)
CBC
LFTs
serology
lumbar puncture- to see if there is CNS disease (if so must be repeated in 6 months)
skeletal survey (primarily looking at long bones)
direct detection- dark field microscopy/direct fluorescent Ab

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19
Q

what is the treatment of congenital syphilis

A

10-14 days of IV Pen G

asymptomatic, mother adequately treated- close clinical follow-up

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20
Q

two month old term infant, asymptomatic at birth. Now hypotonic and macrocephalic. what is the cause?

A

toxoplasmosis

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21
Q

what are 3 investigations to confirm toxoplasmosis?

A

serology- IgM/IgG/ IgA
PCR on CSF, serum, urine
placental pathology

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22
Q

what is seen on LP with toxoplasmosis?

A

lymphocytic pleocytosis

elevated CSF protein (often very high)**

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23
Q

what is the classic triad for toxoplasmosis?

A

HCC

hydrocephalus
cerebral calcifications (intraparenchymal calcifications)
chorioretinitis

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24
Q

toxoplasmosis in 3rd trimester- how do they present?

A

untreated the majority will go on to develop disease

Chorioretinitis most common manifestation

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25
Q

what is the treatment of confirmed congenital toxoplasmosis?

A

pyrimethamine+ sulfadiazine+ leucovorin x 12 months

  • frequent monitoring of neutrophil count
  • steroids for eye disease and passively hydrocephalus
  • VP shunt for hydrocephalus
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26
Q

how do you diagnose toxoplasmosis:

A

serology- IgM and IgA can be falsely negative in early infancy
PCR- CSF, blood, urine or tissue samples

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27
Q

cicatrical scars/limb hypoplasia in seen with what congenital infection?

A

congenital varicella

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28
Q

what are the clinical manifestations of congenital varicella?

A

KEY- microcephaly, cicatrical scars, limb hypoplasia, Microphthalmia, GERD

skin- cicatrical scars, skin loss, contractors
MSK- limb hypoplasia, equinovarus, abnormal/absent digits
eye- Microphthalmia, cataract, Chorioretinitis
CNS- mental retardation, seizures, microcephaly, bulbar palsy
GI- GERD, duodenal stenosis, microcolon, barret’s esopahgus
GU- poor or absent bladder sphincter function
IUGR

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29
Q

what is the risk of congenital varicella syndrome if maternal VZV during first 20 weeks of gestation?

A

1%

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30
Q

infant disease by timing of maternal infection with varicella:

first and second trimester
third trimester
perinatal (5d before or 2 d after)

A

first and second trimester- congenital varicella syndrome
third trimester- herpes zoster in infancy or childhood
perinatal- disseminated neonatal varicella

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31
Q

what is given to mother with exposure to varicella in pregnancy if IgG negative

A

VZIG within 10 days of exposure

if develops chicken pox= acyclovir

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32
Q

what is the classic triad for congenital rubella syndrome?

A

“CPS”
cataract
PDA
SNHL

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33
Q

what are the clinical features for congenital rubella syndrome

A

KEU- IUGR, blueberry muffin rash, hepatosplenomegaly, cataract, bony lucencies, PDA, SNHL

early manifestations:
low birth weight
hepatosplenomegaly, lymphadenopathy
blueberry muffin rash **
hemolytic anemia
thrombocytopenia
bony lucencies ** (celery stalk appearance)
permanent:
SNHL
cataract, sal and pepper retinitis, microphthalmia
PDA
GDD, seizures
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34
Q

what infection is associated wth blueberry muffin rash?

A

congenital rubella

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35
Q

when do we screen for GBS in mom?

A

35-37 weeks gestation

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36
Q

what are the indications for intrapartum antibiotic prophylaxis

A

mom GBS +
GBS status unknown and any of the following:
- previous infant with GBS disease
- intrapartum fever
- membranes ruptured >18 hours
- delivery <37 weeks
- GBS bacteriuria during current pregnancy

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37
Q

what is the appropriate antibiotic for mom for GBS prophylaxis?

A

penicillin or ampicillin
if mild penicillin allergy: cefazolin (considered adequate prophylaxis for baby)
severe: clindamycin or vancomycin (NOT adequate prophylaxis for baby)

does not prevent late onset GBS disease

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38
Q

what are the risk factors for early onset sepsis in term neonates? (5)

A
  • previous infant with GBS disease
  • intrapartum fever
  • membranes ruptured >18 hours
  • maternal intrapartum GBS colonization during current pregnancy
  • GBS bacteriuria during current pregnancy
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39
Q

what are the most common bacterial pathogens in infants
0-28d
29-90d
3-36mo

A

0-28d: GBS, E.coli
29-90: GBS, E.coli
3-36 mo: Strep pneumo

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40
Q

empiric antibiotics for toxic appearing infants age
0-28
29-90
3-36mo

A

0-28: Amp + gent or cefotaxime
29-90: ceftriaxone+ Vanco +/- ampicillin
3-36: ceftriaxone + vanco

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41
Q

what is the treatment for suspected HSV disease
isolated mucocutaneous disease
disseminated, CNS

A

IV acyclovir 60mg/kg/day
isolated mucocutaneous: 2 weeks
disseminated: 3 weeks + 6 months of suppressive oral acyclovir (improves neurologic outcome for those with CNS disease)
do an LP before completion of treatment to show it is negative

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42
Q

what is the workup for suspected HSV?

A

full septic workup
PCR of vesicle fluids, blood, CSF
LP

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43
Q

what infection should you think of for axillary lymph node?

A

bartonella henselae

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44
Q

what infection is associated with parinaud oculoglandular syndrome? what is that?

A

bartonella henselae

swollen cervical lymph node and ipsilateral conjunctivitis

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45
Q

4 year old with a chronically draining cervical lymph node. what is the most likely bug?

A

atypical mycobacterium

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46
Q

what is on your differential for chronic unilateral adenitis

A

non-tuberculosis mycobacteria
bartonella
mycobacterium tuberculosis

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47
Q

what is on your differential for acute unilateral adeninitis

A

staph aureus

strep pyogenes

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48
Q

what is on your differential for acute bilateral adenitis? chronic?

A 
EBV
CMV
respiratory viruses
enteroviruses
adenovirus
chronic:
EBV
HIV
Toxoplasmosis
CMV
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49
Q

what is the treatment for cat scratch disease (B.henselae)

A

azithromycin for lymphadenitis (shorten disease)
doxycycline + rifampin for neuroretinitis/CNS disease
* risk highest with kittens

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50
Q

when can a teenager with infectious mono return to sports?

A

after 3 weeks

highest risk during first 3 weeks of illness

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51
Q

what is the treatment for acute otitis media in a child <2? >2?

A

<2 years old: amoxicillin x 10 days

>2 years old: 5 days

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52
Q

what are the common pathogens for acute otitis media?

A

bacteria:
strep pneumonia
hemophilus influenza
moraxella catarrhalis

viruses

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53
Q

what are the antibiotic options for AOM?

A

amoxil
if mild allergy to amoxil- cefuroxime, ceftriaxone
severe amoxil allergy- azithro, clarithro, clinda
treatment failure- amox-clav or ceftriaxone for 3 doses

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54
Q

what pathogens cause acute bacterial pneumonia

A 
strep pneumo
staph aureus
strep pyogenies
hemophilus influenza
mycobacterium tuberculosis

mycoplasma pneumonia
legionella
coxiella= Q fever

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55
Q

when should you consider adding vancomycin for pneumonia?

A

rapidly progressing multi lobar disease or pneumatoceles

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56
Q

what is the empiric therapy for hospitalized children with uncomplicated pneumonia?

A

ampicillin

respiratory failure or septic shock- ceftriaxone +/- Vancomycin

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57
Q

what is the treatment for chlamydia pneumonia?

A

erythromycin
* see eosinophilia
typically presents at 3- 6 weeks

58
Q

why is antibiotic prophylaxis not recommended for chlamydia trachomatis? what should you do? when do you treat?

A

due to risk of pyloric stenosis
recommend close clinical follow-up
PCR testing if symptoms
treat if PCR testing is positive

59
Q

what is empiric therapy for meningitis:
neonate
1-3 mo
>3 mo

A

neonate: amp+ cefotax
1-3 mo: ceftriaxone + vancomycin +/- ampicillin
ceftriaxone and vancomycin

60
Q

what bugs do we worry about for meningitis:
neonate
>3 mo

A

neonate: GBS, e.coli, listeria

>3 mo: strep pneumo, Neisseria meningitidis, hemophilus influenza type b

61
Q

why do we consider dexamethasone for meningitis?

A

reduces mortality and hearing loss in meningitis due to hemophilus type and possibly strep pneumonia
* has to be administered before or within 30 minutes of antibiotics

62
Q

what is the treatment of toxic shock?

A

cloxacillin + clindamycin

staph aureus, GAS

63
Q

what is the treatment for skin abscess?

A

incision and drainage

64
Q 
what is the treatment for skin abscess pending culture results?
<1mo
1-3 mo
>3 mo with low grade fever or no fever
>3 mo significant cellulitis
A

<1 mo: IV antibiotics (Vanco +/- other agents)
1-3 mo: Septra
>3mo: observe without antibiotics
>3 mo: Septra + cephalexin

65
Q

what is the treatment for Necrotizing Fasciitis

A

IV penicillin + clindamycin + surgery consult

associated with GAS and chicken pox

66
Q

what bugs cause impetigo? tx?

A

staph aureus
GAS
tx: cloxacillin, cephalexin

67
Q

when do we do chemoprophylaxis for contacts of invasive GAS disease?

A

only for CLOSE contacts of CONFIRMED case of SEVERE disease

close contact: >4h per day or >20h per week
share bed, sexual relations, direct mucous membrane contact with oral/nasal secretions

severe disease: toxic shock syndrome, soft tissue necrosis, meningitis, pneumonia, other life threatening conditions

68
Q

what are some complications of chicken pox?

A

pneumonia
hepatitis, pancreatitis nephritis, orchitis
thrombocytopenia

Bacterial infections:
cellulitis
soft tissue abscess
necrotizing fasciitis

Neurologic:
cerebellar ataxia
encephalitis
reye syndrome
stroke
zoster (Ramsay hunt syndrome)
69
Q

what are some complications of influenza? (5)

A 
otitis media
secondary bacterial penumonia
myositis
encephalopathy/encephalitis
reye syndrome
70
Q

what are some complications of enterovirus?

A 
meningitis
encephalitis
acute flaccid myelitis
myocarditis
hepatitis
71
Q

when should you consider a renal and bladder ultrasound for febrile UTI

A

recommended for first febrile UTI <2 years of age

VCUG is not indicated after first febrile UTI

72
Q

what are the indications for VCUG (3)

A

hydronephrosis on ultrasound
renal scarring
recurrent febrile UTI

73
Q

when would you consider prophylaxis for UTI?

A

grade IV-V VUR

if given should be reassessed after 3-6 months

74
Q

what are the first line agents for UTI prophylaxis?

A

Septra

nitrofurantoin

75
Q

if a child has a UTI resistant to prophylactic antibiotics septra and nitrofurantoin what should you do?

A

STOP prophylaxis

broader spectrum agents not recommended due to risk of infection with highly resistant organisms

76
Q

what is the treatment for dog bite or human bite? puncture wound of foot with sneakers? no sneakers

A

PO amox-clav
IV cloxacillin + penicillin
with sneakers (pseudomonas): piperacillin or ciprofloxacin +/- gentamicin
no sneakers (staph aureus): po cloxacillin or keflex

77
Q

what is the most important organism that causes severe invasive disease in patients with asplenia? other organisms of concern?

A

strep pneumonia

Neisseria meningitidis
hemophilus influenza
salmonella
capnocytophaga ( if they own dogs*)

78
Q

What is the organism and vector causing lyme disease? what are 2 antibiotics for the treatment of Lyme disease?

A

Organism = Borrelia burgdorferi
Vector = black-legged ticks: Ixodes scapularis
Tx: amoxicillin, doxycycline, cefuroxime, IV ceftriaxone

79
Q

highest rate of baby getting HSV is when mom has what type of lesion

A

first episode primary (first time getting a lesion)

80
Q

when should you swab a baby when you are worried about HSV

A

at 24 hours

if you swab too soon it may just be transient colonization from mom

81
Q

Mom has first episode of HSV. Babe is born vaginally or by c section after rupture of membranes. What do you do?

A

treat with acyclovir
if swabs positive- full workup and treatment
if swabs negative- treat for 10 days with IV acyclovir

82
Q

Mom has first episode of HSV. Babe is born by c section PRIOR to rupture of membranes. What do you do?

A

do not need to treat empirically with acyclovir

if swabs positive- full workup and treatment

83
Q

Mom has recurrent HSV. What do you do?

A

do not need to treat empirically with acyclovir

if swabs positive- full workup and treatment

84
Q

if mom has herpes labialis what precautions (4)

A

avoid kissing the baby until lesions are crusted
wear a mask
avoid breastfeeding from breast with active lesions until crusted
skin lesions should be covered in the presence of newborn

85
Q

Mother has recurrent HSV. There were no active lesion at delivery. For how long after delivery is the infant at risk for PERINATAL transmission?

A

6 weeks

86
Q

what is required to consider watchful waiting for acute otitis media

A
  1. non-severe illness (mild otalgia, fever <39, responding to antipyretics, mild-moderate TM bulge)
  2. no underlying conditions of concern
  3. parents capable of recognizing signs of worsening disease
87
Q

what is a common complication after chicken pox, especially if older than 12 or pregnant

A

VZV pneumonia

88
Q

what is the most common cause of acute flaccid paralysis

A

enterovirus

also caused by west nile virus

89
Q

what is the presentation of acute flaccid paralysis

A

acute focal limb weakness and MRI findings of mainly grey matter lesions involving one or more spinal cord segments

90
Q

what is the most common presentation of west nile virus

A

asymptomatic

91
Q

what is considered mild c. diff? moderate?severe

A

mild: <4 episodes of diarrhea
moderate: >4 episodes
severe: evidence of systemic toxicity (high grade fevers, rigors)

92
Q

what is the treatment for mild, moderate, severe c diff

A

mild: stop antibiotic
moderate: PO metronidazole 10-14 d
Severe uncomplicated: PO vancomycin x 10-14d
Severe complicated: PO vanco + IV metronidazole

93
Q

what type of hand cleaning is required for c diff

A 
sporicidal agents (chlorine-based)
alcohol based hand hygiene will not work for c diff!
94
Q

what is the treatment for gonorrhea

A

Ceftriaxone 250 mg IM in a single dose PLUS azithromycin 1 g PO in a single dose

95
Q

Three year old boy exposed to a suspected case of pulmonary TB in the home. Clinically well, TST negative, CXR normal. How do you treat him?

A

Start isoniazid now; discontinue in 3 months if still clinically well and repeat TST negative

96
Q

What is the difference between TB infection and TB disease

A

TB infection- positive TST

TB disease- clinical symptoms or abnormal CXR

97
Q

who should be screened for LTBI

A 
contacts of infectious case
immigrants from high burden countries
children who travelled/resided endemic areas for 3 or more months
HIV
pre-transplant
pre- TNF alpha inhibitors

**testing for TB should not be routine

98
Q

what is considered a positive TST if less than 5 AND high risk of TB infection

A

0-4mm

99
Q

Positive TST >5mm if what conditions

A
  • HIV infection (well)
  • Close contact with active contagious case (past 2 years)
  • Presence of fibronodulardisease on CXR(healed TB)
  • Organ transplant
  • TNF-αinhibitors
  • Other immunosuppressive medications (e.g. corticosteroids –equivalent of ≥15 mg/day for ≥1 month)
  • End stage renal disease
100
Q

what are 4 reasons for a reactive TB skin test

A

Mycobacterium tuberculosis infection
Non-tuberculous mycobacteria infection
BCG in past
Incorrect technique (measurement)

101
Q

what are some causes of a false negative TB test (8)

A 
Incorrect technique
Active TB disease
Immunodeficiency states
Corticosteroids
Young age
Malnutrition
Viral infections (measles, varicella, influenza)
Live attenuated vaccines (measles)
102
Q

what is the treatment for latent TB

A

Isoniazid for 9 months
OR rifampin for 4 months
OR isoniazid and rifampin for 3 months

103
Q

what is the treatment for TB disease

A

Isoniazid
Rifmapin
Pyrazinamide
Ethambutol

104
Q

which TB medication requires ophthalmology assessment

A

ethambutol

associated with optic neuropathy (decreased visual acuity, decreased visual fields, color blindness)

105
Q

what is a common side effect of isoniazid, rifampin and pyrazinamide

A

hepatotoxicty

- pyrazinamide the most likely to give you hepatotxocity

106
Q

What is the risk of transmission of HIV in a blood transfusion?

A

1 in 10 million

107
Q

The leading cause of HIV infection in women in Canada is?

A

heterosexual transmission

108
Q

what is used for chemoprophylaxis after close contact diagnosed with n. meningitidis

A

rifampin

109
Q

who should get the HPV vaccine

A

all boys and girls older than 9 years of age

regardless of sexual activity

110
Q

who can get 2 doses of HPV vaccine instead of 3

A

9-14 years of age

children >/= 15 years of age or immunocompromised should get 3 doses!

111
Q

what are 4 things that HPV vaccine prevents

A 
anal cancer
penile cancer
vulvar cancer
genital warts
vaginal cancer
oral cancer
cervical cancer
112
Q

HPV 6 and 11 are associated with what

A

genital warts

113
Q

When should rotavirus vaccine be given

A

series needs to be completed prior to 8 months of age

first dose no later than 15 weeks!

114
Q

up to what age should children get 2 doses of influenza vaccine

A

2 doses 4 weeks apart

up to 9 years of age, first year getting the vaccine

115
Q

what age child can receive intranasal influenza vaccine

A

> 2 y of age

116
Q

when should Hep A post exposure vaccine be given

A

HepA vaccine recommended as post exposure prophylaxis (>6 months) and should be given within 2 weeks of exposure
if <6 months of age or vaccine contraindications then give Hep A immunoglobulin

117
Q

when do you testing on a baby for hep c

A

between 12-18 months

118
Q

infant of HCV infected mother, what is the mode of delivery

A

doesn’t matter! avoid invasive procedures (scalp probe)

no evidence to recommend elective c section

119
Q

what is the management for rabies exposure

A

notify public health
domestic animal- can be observed for 10 days to see if there are signs of rabies
wild animal- euthanize and test for rabies
rabies immune globulin into the wound
rabies vaccine series (4-5 doses)

120
Q

what are the indications of palivizumab?

A

Children < 12 months of age with CLD of prematurity who require ongoing medical therapy at the start of the RSV season
Children < 12 months of age with hemodynamically significant heart disease
Consider in infants < 30 weeks and < 6 months of age at the start of the RSV season
Consider in infants who live in remote communities and born at < 36 weeks at the start of RSV season

121
Q

is palivizumab recommended for children hospitalized with RSV?

A

No, do not need to continue palivizumab

122
Q

what are the 3 main contraindications to breastfeeding

A

HIV

Human T-Lymphotropic Virus Type 1/2

123
Q

what type of mask is required for measles?

A

N95 mask

it is airborne

124
Q

what 3 viruses are airborne

A

measles
tuberculosis
varicella

125
Q

what is the treatment for cutaneous larva migrans

A

albendazole

126
Q

what is the oral rash seen with measles

A

koplik spots

127
Q

how do we prevent influenza in infants <6 months of age?

A

to prevent influenza in infants <6 months of age, the best evidence-based strategy is to administer influenza vaccines during pregnancy.

128
Q

Pregnant woman in contact with meningococcal meningitis. Tx:

A

Ceftriaxone

129
Q

HBe Ag what does it tell you about the person

A

active viral replication

130
Q

A child eats at a picnic and develops vomiting and diarrhea four hours later. What is the likely causative organism:

A

staph aureus

- onset between 1-6h (toxin)

131
Q

what causes q fever

A

farm animals

- hepatitis, pneumonia

132
Q

when can live vaccines be given after high dose steroids

A

1 month after stopping high dose steroids

133
Q

gram positive rod in a baby suggests what bug

A

Listeria

134
Q

4 indications for VZIG

A

1) Immunocompromised child with no evidence of immunity or history of varicella or herpes with exposure
2) Immunocompromised child with lesions suggestive of varicella
3) Pregnant with no evidence of infection or immunity
4) Baby born to a mum who gets CP 5 days prior or 2 days post delivery
5) Hospitalized preterm <28 weeks or <1000g who is exposed (regardless of maternal history)
6) Hospitalized preterm >=28 weeks who is exposed, with no maternal immunity

135
Q

A 10 year old girl presents to your office having arrived in Canada from the Sudan 1 week ago. She complains of fever, headache and sore throat of 48 hours duration.
Name 3 diagnoses on your differential

A

Malaria
Typhoid
Meningococcemia

136
Q

What is the antibiotic treatment for acute chest syndrome

A

3rd generation cephalosporin + macrolide

137
Q

The most common bug in febrile neutropenia

A

gram positive organisms

138
Q

What is pertussis close contact exposure prophylaxis

A

azithromycin x 5 days or erythromycin x 14 days

139
Q

What are three high-risk groups for invasive pneumococcal disease?

A

sickle cell disease
asplenia/hyposplenia
immunocompromised

140
Q

Child with inguinal adenopathy found 1 week ago by parent while bathing
Give 4 indications for biopsy

A
  1. hard
  2. matted
  3. > 2cm
  4. increasing in size over 2 weeks
  5. no resolution by 4 weeks
  6. associated with fever, weight loss, hepatosplenomegaly
  7. if supraclavicular node
141
Q

what is the treatment for head lice

A

permethrin 1%, repeat in 7-10 days

they can return to school

142
Q
  1. An infant is born to a mother with a history of recurrent genital herpes which was not active at the time of vaginal delivery. For how long after delivery is it possible for this infant to develop herpes:
A

Most NHSV will present in the first 4 weeks

Pediatrics- Noelle (28 decks)

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