ID Flashcards

Question

Acute flaccid myelitis | - eitiology

Answer 1

▫ Non-polio enteroviruses (EV D68, EV A71) ▫ Polioviruses (vaccine derived mainly) ▫ West Nile virus and some other arboviruses

Answer 2

Most likely after 12yo most common - pneumonia • General ▫ Pneumonia ▫ Hepatitis, pancreatitis, nephritis, orchitis ▫ Thrombocytopenia • Bacterial infections ▫ Cellulitis, softtissue abscess, necrotizing fasciitis ``` • Neurologic ▫ Cerebellar ataxia ▫ Encephalitis ▫ Reye syndrome ▫ Stroke ▫ Zoster (including Ramsay Hunt syndrome) ```

Answer 3

• Well appearing ▫ Conjunctival culture ▫ IM ceftriaxone 50 mg/kg (maximum 125 mg) • Unwell ▫ Conjunctival, blood and CSF cultures ▫ Consult ID with established disease

Answer 4

Mild (<4 abn stools/d) Discontinue precipitating Abx; Follow-up First episode; Mild/moderate; No change with Abx stoppage PO metronidazole 10-14 days First episode; Severe uncomplicated PO vancomycin 10-14 days First episode; Severe complicated PO vancomycin 10-14 days PLUS IV metronidazole 10-14 days First recurrence Repeat as above Second recurrence Vancomycin in tapered or pulsed regimen

Answer 5

▫ Malaria ▫ Typhoid fever ▫ Meningococcemia ▫ Viral hemorrhagic fevers

Answer 6

>/= 10 mm in no RF >/= 5mm if RF • HIV infection (well) • Close contact with active contagious case (past 2 years) • Presence of fibronodular disease on CXR (healed TB) • Organ transplant • TNF-α inhibitors • Other immunosuppressive medications (e.g. corticosteroids – equivalent of 315 mg/day for 31 month) • End stage renal disease

Answer 7

Isoniazid, Rifampin, Pyrazinamide, Ethambutol • Latent TB infection ▫ INH for 9months or RIF for 4 months or INH+RIF for 3 months or INH + rifapentine x12 weekly observed doses • TB disease ▫ Start with 4 drugs(INH,RIF,PYR,ETH) ▫ Step down to 3 drugs if fully sensitive strain ▫ Two months of 3-4 drugs, then INH+RIF to complete course (total duration depends on specifics of disease) (4x2mo then 2X4mo) • Consider DOT • Pyridoxine in selected cases (malnutrition, adolescents, pregnancy...) • Vitamin D usually given for children with TB disease

Answer 8

• Antiretroviral therapy (zidovudine = AZT) ▫ Triple ART starting in 2nd trimester (or earlier) ▫ IV zidovudine during labor ▫ Zidovudine to infant for 6 weeks * Elective Cesarean section if VL >1000 copies/mL * Avoidance of breast feeding

Answer 9

HBIG and HB vaccine within 12 hours of birth HB vaccine at 1 and 6 months Check tires at 9-12 mo

Answer 10

Basically those who can't get varicella vaccine Give acyclovir if lesions too 1) Immunocomp children w/o hx of varicella or varicella immunization 2) Susceptible pregnant women 3) Newborn infant whose mother had ONSET of chicken pox within 5 days before delivery or within 48 hours of delivery 4) Hospitalized premature infant (>/= 28 wga) whose mother lacks a reliable history of chicken pox or serologic evidence of protection against varicella 5) Hospitalized premature infant (< 28 weeks gestation or birth weight < 1000 gram) regardless of maternal history of varicella or varicella-zoster virus serostatus

Answer 11

Hep A vaccine within 2 weeks of exposure If less than 6mo or C/I to vaccine, Ig should be given Give vaccine + Ig to immunocomp

Answer 12

Varicella, zoster Measles Tuberculosis Smallpox

Answer 13

* Before touching a patient * Before clean/aseptic procedures * After body fluid exposure/risk * After touching a patient * After touching patient surroundings

Answer 14

``` Streptococcus pneumoniae (25% to 40%) ▫ Non-typeable Haemophilus influenzae (10% to 30%) ▫ Moraxella catarrhalis (5% to 15%) ```

Answer 15

S. aureus, Group A streptococcus Impetigo: PO: Cloxacillin, Cephalexin Cellulitis: IV: Cloxacillin, Cefazolin PO: Cloxacillin, Cephalexin Necrotizing Fasciitis: IV: Cloxacillin (or Cefazolin or penicillin) + clindamycin ± vancomycin

Answer 16

If unknown status - vaccinate that child If one of the children has HepB, give HBIG & vaccine to the other child if they are non immune or incompletely immunized

Answer 17

``` HIV HTLA HSV if active lesions on breast TB if contagious Mastoiditis (pump and dump on that breast, BF from other) ```

Answer 18

Asymptomatic 80% | Fever 20% Neurologic disease <1% aseptic meningitis, encephalitis, acute flaccid paralysis

Answer 19

9-14 give 2 doses, otherwise give 3 doses (at least 6 mo apart) Also give 3 doses to immunocompromised and HIV children

Answer 20

Give preterm on same schedule as term Start no later than 15 weeks Complete by 8 mo

Answer 21

most common: fever

Answer 22

only yellow fever

Answer 23

Once treatment applied

Answer 24

After 5 days of tx

Answer 25

Diarrhea resolves

Answer 26

Diarrhea resolves

Answer 27

7 days after onset of jaundice

Answer 28

actue infection - active viral replication

Answer 29

CXR then LN biopsy

Answer 30

16&18 - cervical cancer and squamous cell cancer HPV 6&11

Answer 31

IV ceftazidine and tobramycin

Answer 32

HIV PCR at 2-3 wk, 1-2mon, 4-6 mon HIV serology at 12-18 months Transmission : 1% if compliant 25% if no meds

Answer 33

Equally effective * age < 24 months * severe asthma (current high-dose inhaled steroids or systemic steroids) * medically attended wheezing in past 7 days * immunodeficiency, pregnancy * ASA treatment

Answer 34

* all children aged 6-59 months * anyone with basically any chronic medical condition * all indigenous children * all residents of chronic carefacilities

Answer 35

LAIV MMR Rotavirus Varicella

Answer 36

if systemic steroids > 2 mg/kg/day (>20 mg/d) dosed for >14 days: wait 1 month

Answer 37

Salmonella Cipro, ceftriaxone

Answer 38

Q fever: coxiella burnetii - Acute infection = flu-like illness, pneumonia, hepatitis - Incubation = 20 days - RF = farm animals or downwind from farm animals - Dx -> early = PCR, after 1 week = IFA - Tx: within 3 days of symptoms, doxycycline x 2/52 if >8yo, cipro or septra <8 with short course of doxy (5 days) to start

Answer 39

Staphylococcus

Answer 40

Basically you are only treating if - Obviously perforated - MEE + bulging TM and one of: - -Mod-severely ill - -Unable to sleep - -Irritable - -Not responding to tylenol - -Severe otalging - >= 39 in absence of antipyretics - >48h of symptoms

Answer 41

H flu, M catarrhalis

Answer 42

Evidence of GAS infection + 2 major or 1 major and 2 minor ``` J<3NES criteria - major : Joints - migratory arthritis <3 = carditis pericardium/epi/myo/endocardium Mitral valve Pericardial friction rub 1st degree heart block, N = subcutaneous Nodules E = Erythema marginatum S = sydenham chorea ``` ``` Minor Fever (38.5 PO; 38 accepted in certain popn) Arthralgias Elevated ESR/CRP ESR >60, CRP > 30 Prolonged PR interval ```

Answer 43

Permethrin 5% Apply to entire body down from neck Leave on overnight Repeat in 1 week

Answer 44

Ceftriaxone + macrolide

Answer 45

Ceftriaxone and azithro

Answer 46

Give HB vaccine and HBIg within 12 hours of birth Give vaccine at 1 and 6 months

Answer 47

pyrethrins and permethrin remain first-line treatments in Canada permethrin 1%

Answer 48

Hib meningitis, for which there is evidence that steroids decrease hearing loss in children if they are administered just before or with the initial antimicrobial Therapy (ask staff)

Answer 49

tx if toxic | PO azithromycin or erythromycin

Answer 50

erythromycin

Answer 51

Albendazole (400mg PO with repeat dose 2 weeks later)

Answer 52

varicella gradual onset of gait disturbance, nystagmus and slurred speech

Answer 53

infection from the oropharynx extends to cause septic thrombophlebitis of the internal jugular vein and embolic abscesses in the lungs fusobacterium necrophorum, an anaerobic bacterial constituent of the oropharyngeal flora presentation: healthy adolescent or young adult with a history of recent pharyngitis who becomes acutely ill with fever, hypoxia, tachypnea, and respiratory distress Blood cultures

Answer 54

Usually viral but HiB if unvaccinated Acute rapidly progressive course of high fever, sore throat, dyspnea, respiratory obstruction Toxic, swallowing difficulty, labored breathing Drooling and neck hyperextended in attempt to maintain airway Tripod – sitting up and leaning forward, chin up, mouth open, bracing on arms Stridor is late finding – near complete obstruction Xray - thumb sign (epiglottis is think like a thumb)

Answer 55

As soon as they feel well enough | infectious until rash appears

Answer 56

tx: <12mo: Ig 1-40yo: Hep A vaccine Exclusion 7 days post onset of sx

Answer 57

Amoxil for <5yo | Pen V or Amoxil for >5yo

Answer 58

A macrolide agent should be given promptly to all household contacts and other close contacts, such as those in daycare, regardless of age, history of immunization, and symptoms. Azithro, erythro clarithro

Answer 59

Healthy: give vaccine Immunocomp: give VZIG If lesions give acyclovir

Answer 60

(atypical Bartonella) after scratch or inoculation around the eye ipsilateral conjunctivitis + pre-auricular lymphadenopathy + splenomegaly

Answer 61

gram postive rods

Answer 62

Amox Cefuroxime Amox Clav

Answer 63

``` <2yo have a cochlear implant immune suppressed chronic organ disease (such as kidney, liver, lung or heart disease) diabetes or asthma Asplenia ```

Answer 64

- Respiratory infections: - -Pneumonia- most common cause of death (direct viral infection or secondary bacterial) → bronchiolitis obliterans - -Croup, tracheitis, bronchiolitis - Acute otitis media (mastoiditis, sinusitis)- most common complication - Eye disease with corneal ulcer and loss of vision (especially with Vit A deficiency) - Diarrhea/vomiting → dehydration - CNS: Encephalomylitis, subacute sclerosing pamencephalitis)(Chronic, 10 years later, behavioral and intellectual - Higher rate of TB activation - hemorrhagic measles “black measles”- fatal condition

Answer 65

Measles serology IgM (appears 1-2 days after rash onset, and lasts up to 1 month; if sample is collected <72 hours after onset of rash and is negative, it should be repeated) 4-fold rise in IgG antibodies Viral isolation from blood, urine, respiratory secretions - culture RNA PCR

Answer 66

Campylobacter bloody diarrhea unpasteurized cow's milk

Answer 67

gram-negative encapsulated diplococcus that colonizes the nasopharynx

Answer 68

amox, clarith and PPI

Answer 69

give vaccine within 12h Hep B serology on mom give HBIG if serology + give within 7 days

Answer 70

decrease risk of meningitis

Answer 71

Children: Apnea and pneumonia Adolescents: URTI sx severe: syncope, weight loss, sleep disturbance, incontinence, rib fractures, and pneumonia immunize adolescents to redue transmission to children

Answer 72

Skin: Erythema migrans (EM- resolves spontaneously over a four-week) CNS: like facial nerve palsy, papiledema, meningitis, peripheral neuropathy and CNS disease Heart: Heart-block (carditis) possible but rare MSK: pauciarticular arthritis at weeks to months post,

Answer 73

``` asplenia/hyposplenia (ie. sickle cell) immunodeficiency (ie. primary, HIV) potential for exposure healthcare workers endemic areas ```

Answer 74

PO terbinafine

Answer 75

``` High fever 3 C's Cough Coryza Conjuntivitis ``` Rash comes when fever subsides Cranial to caudal fine red papules