Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

ID HR > ID HR > Flashcards

ID HR Flashcards

1
Q

How to investigate asymptomatic infant of mother with active HSV lesions at delivery?

A

-Samples from mouth, nasopharynx, conjunctiva, and anus at ~24h of life for culture/PCR

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

After swabs are taken, how to manage aymptomatic infant of mother with active lesions from first episode of HSV, born vaginally OR by C/S after membrane rupture?

A
  • Empiric acyclovir recommended
  • If 24hr swabs positive - full work-up and treatment
  • If 24hr swabs negative - complete 10 days of IV acyclovir
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

After swabs are taken, how to manage asymptomatic infant of mother with active lesions from first episode of HSV, born by C/S prior to membrane rupture?

A
  • NO empiric acyclovir

- If 24hr swabs positive - full work-up and treatment

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

After swabs are taken, how to manage asymptomatic infant of mother with active lesions from recurrent episode of HSV?

A
  • NO empiric acyclovir

- If 24hr swabs positive - full work-up and treatment

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

How to address infection control for neonate with HSV infection?

A

Contact precautions until lesions crusted

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

How to address infection control for asymptomatic neonate of mother with active HSV lesions?

A

Contact precautions until end of incubation period (14 days) or until 24 hour swabs negative

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

How to address infection control for mothers with active HSV lesions?

A

Contact precautions until lesions crusted

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

How to minimize exposure to HSV for infants <6 weeks?

A
  • Herpes labialis in close contacts –> Use disposable masks until lesions crusted; avoid kissing baby until lesions crusted and dried
  • Avoid breastfeeding from breast with lesions until crusted/dry
  • Skin lesions should be covered in presence of newborn
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

Four-year-old with few days of cough, respiratory symptoms, fever. O2 sat 95% on room air. CXR shows LLL consolidation. Best antibiotic?

A

Amoxicllin

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

Four-year-old with temperature of 40C, tachypneic, ttoxic appearing. O2 sat 96% with FiO2 of 45%. What treatment do you start? Why?

A

Ceftriaxone
Add Vancomycin if case description suggestive of rapidly progressive multilobar disease or pneumatoceles

  • Main pathogen being targeted is still S.pneumo
  • Ceftriaxone offers better coverage against beta-lactamase positive H. influenzae and possibly for S. pneumoniae with high level resistance to penicillin
  • Vanco is MRSA coverage
  • If influenza detected, strongly consider oseltamivir. Don’t forget increased staph with flu.
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

Typical bacterial pathogens causing community acquired pneumonia?

A
  • Streptococcus pneumoniae
  • Staphylococcus aureus
  • Streptococcus pyogenes
  • Non-typeable haemophilus influenzae
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

Atypicals causing pneumonia?

A
  • Mycoplasma pneumoniae
  • Chlamydia pneumoniae
  • Psittacsis (C. psittaci)
  • Coxiella burnetii (Q fever)
  • Legionella pneumophila

*Mycobacterium tuberculosis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

Viral causes of pneumonia?

A
  • RSV
  • Influenza A/B
  • Adenovirus
  • Parainfluenza viruses
  • Coronaviruses
  • HMPV
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

Nine-week-old infant with fever 39.5C. CBC shows WBC 4.5 (60% neutrophils), serum glucose 4.5mmol/L. CSF 400 RBC, 100 WBC, glucose 1.5, protein normal. Gram stain negative. Treatment? Why?

A

IV ceftriaxone and vancomycin

-100 cells abnormal and glucose low, so likely bacterial meningitis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

Pathogens (3) and empiric antibiotic therapy (2) for bacterial meningitis in a neonate?

A
  • GBS, gram negative bacilli (E.coli), Listeria spp.

- Ampicillin + cefotaxime

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

Pathogens (1) and empiric antibiotic therapy (3) for bacterial meningitis in a 1-3 month old?

A
  • Overlap of “neonatal” organisms or those seen in older children
  • Ceftriaxone + vancomycin +/-ampicillin (listeria)
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

Pathogens (3) and empiric antibiotic (2) therapy for bacterial meningitis in a > 3 month old?

A
  • Streptococcus pneumoniae, neisseria meningitidis, haemophilus influenzae type b
  • Ceftriaxone + vancomycin
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

What is the utility of dexamethasone in the context of acute bacterial meningitis? What population? What dose, and optimal timing?

A

-Reduces mortality and hearing loss in meningitis due to H. influenzae and possibly S. pneumoniae

  • Dexamethasone 0.6mg/kg/day in 4 divided doses
  • Should be administered before or within 30 minutes of antibiotics
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

Three yar old child with fever and limp for one day. Tender over distal femur. What is the most sensitive and specific non-invasive test for diagnosis of osteomyelitis?

A

MRI

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

What are the most common pathogens causing osteomyelitis? (2)

A

-Staphylococcus aureus and Kingella kingae (K. kingae uncommon in >4 yo)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

Empiric treatment for osteomyelitis? When can you switch to oral? Duration?

A
  • IV cefazolin (unless suspect MRSA)
  • Switch to oral when clinically improved, CRP decreased, compliance and follow-up assured
  • Duration for uncomplicated: 3-4 weeks
  • Duration for septic hip: 4-6 weeks
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
22
Q

Three year old with abscess on buttock (2cm); no surrounding erythema and no fever. Sibling had similar lesion recently. Management?

A

Incision and drainage, no antibiotics

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
23
Q

Management of skin abscesses pending culture results (post-drainage) in < 1 month old, regardless of clinical features?

A 
IV antibiotics (vancomycin +/- other agents)
May consider PO clindamycin for well babies with no fever, abscesses <1cm
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
24
Q

Management of skin abscesses pending culture results (post-drainage) in 1-3 month old with no fever or systemic signs?

A

TMP-SMX

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
25
Q

Management of skin abscesses pending culture results (post-drainage) in 3 month old or older with low grade or no fever; no systemic signs?

A

-Observe without antibiotics; antibiotics if doesn’t improve or culture grows organism other than S. aureus

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
26
Q

Management of skin abscesses pending culture results (post-drainage) in 3 months old or older with significant cellulitis; low grade or no fever; no systemic signs?

A

TMP-SMX and cephalexin pending culture results

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
27
Q

7 year old with chicken pox x 5 days. New fever last night. Refuses to weight bear. Vital signs stable. Minimal erythema, but indurated and exquisitely tender foot. Blood culture growng S. pyogenes. Management?

A

IV penicillin + clindamycin and surgery consult

If know it is strep, use pen and clinda (toxin inhibition), consider IVIG, urgent surg consult, MRI after consult if stable

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
28
Q

Who gets chemoprophylaxis for contacts of invasive GAS disease?

A

Close contacts of confirmed case of severe invasive disease

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
29
Q

Who are considered close contacts of confirmed case of severe invasive GAS disease?

A
  • Household contacts - spent greater than or equal to 4 hours/day or 20 hours in total with the case during the previous 7 days
  • Non-household contacts: Share a bed, sexual contact, direct contact with mucous membranes, oral/nasal secretions, open skin lesions
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
30
Q

What constitutes severe invasive disease in GAS?

A
  • Toxic shock syndrome
  • Soft tissue necrosis
  • Meningitis
  • Pneumonia
  • Other life-threatening conditions
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
31
Q

Organisms in TSS? Empiric therapy?

A
  • S. pyogenes, S. aureus
  • Empiric therapy with cloxacillin (or cefazolin) plus clindamycin for most cases
  • Penicillin + clindamycin +/- IVIG for TSS due to GAS
  • Add vancomycin if MRSA is a concern
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
32
Q

4 year old boy with sickle cell disease is admitted with fever. He is hypotensive, grunting and is being transferred tot the ICU. Best management?

A

Ceftriaxone plus vancomycin

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
33
Q

Pathogens in asplenic children? (5)

A

-Streptococcus pneumoniae, Haemophilus influenzae type b (rare due to Hib vaccination), Neisseria meningitidis (uncommon), Capmocytophaga canimorsus (dog saliva exposure), salmonella spp. (reptiles, food and water)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
34
Q

What organism causes 50-90% of overwhelming post-splenectomy sepsis?

A

-Streptococcus pneumoniae

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
35
Q

Immunizations for children post-splenectomy?

A
  • Prevnar 13 and 23-valent polysaccharide vaccine
  • Quadrivalent meningocooccal vaccine and 4CMenB
  • H. influenzae type b
  • Influenza vaccine, annually
  • S. typhi vaccine pre-travel
  • Household comtacts need routine vaccines and annual influenza vaccine
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
36
Q

Antibiotic prophylaxis for children post-splenectomy? Duration? Factors to consider?

A
  • 0-5 years: Amoxicillin 10mg/kg/dose BID
  • > 5 years: Penicillin V 300mg BID or Amoxicillin 250mg BID
  • Minimum two years postsplenectomy and for all children <5 years of age
  • Lifelong prophylaxis in all cases is ideally recommended

-Factor to consider in deciding duration of prophylaxis: -patient’s or family’s compliance, degree of access to medical care, pneumococcal resistance rates, previous episodes of life-threatening sepsis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
37
Q

Education for caregivers of children post-splenectomy?

A

-Urgent assessment for fever

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
38
Q

10 year old with unilateral swollen cervical nodes and ipsilateral conjunctivitis. No fever or atypical lymphocytes. Most likely cause?

A

Bartonella henselae-Parinaud oculoglandular syndrome

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
39
Q

Four year old with chronically draining cervical node. Most likely bug?

A

Atypical mycobacterium

-young age, no fever, unilateral, no TB exposure, no cat exposure

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
40
Q

Etiologies for acute bilateral lymphadenitis?

A

Respiratory viruses, enteroviruses, adenovirus, EBV, CMV

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
41
Q

Etiologies for acute unilateral lymphadenitis?

A

Staph aureus, S. pyogenes (80%)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
42
Q

Etiologies for subacute bilateral lymphadenitis?

A

HIV, EBV, CMV, toxoplasmosis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
43
Q

Etiologies for subacute unilateral lymphadenitis?

A

-Non-TB mycobacteria, M. tuberculosis, Bartonella henselae, tularemia, plague (Y. pestis)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
44
Q

Clinical syndrome caused by Bartonella henselae (Cat Scratch Disease)? (6)

A
  • Lymphadenitis (axillary most common)
  • Perinaud oculoglandular syndrome
  • Hepatosplenic bartonellosis (granulomatous disease)
  • Neuro-retinitis
  • Encephalopathy
  • Fever of unknown origin
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
45
Q

Treatment for bartonella henselae (Cat scratch)?

A
  • Azithromycin for lymphadenitis (shortens duration)

- Doxycycline + rifampin for neuroretinitis/CNS disease

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
46
Q

Five year old who had a tick bite 2-3 weeks ago has fever, malaise and a 5cm single target lesion rash. Which is correct?

a) Heart block occurs in 10% of children
b) The child should be treated with IV ceftriaxone
c) Can be transmitted to humans by dog ticks
d) Erythema migrans occurs in all untreated cases
e) Facial nerve palsy is the most common neurologic manifestation

A

E

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
47
Q

Pathogen causing lyme? Organism that transmits?

A
  • Borrelia burgdorferi

- Ixodes scapularis and Ixodes pacificus

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
48
Q

Clinical manifestations of early localized lyme disease? (4)

A
  • Erythema migrans

- Systemic symptoms (fever, myalgia, neck stiffness)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
49
Q

Clinical manifestations of early disseminated lyme disease? (4)

A

-Multiple EM lesions, meningitis, facial nerve palsy (carditis)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
50
Q

Clinical manifestations of late lyme disease? (3)

A

-Pauciarticular arthritis, peripheral neuropathy, CNS manifestatioins

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
51
Q

6 year old returned from summer trip to Nova Scotia with family. Erythematous rash with red centre and concentric ring around it. Also has low grade fever. Management?

A

Start doxycycline now

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
52
Q

Treatment for early localized lyme disease/erythema migrans?

A
  • Doxycycline x 10 days OR amoxicillin x 14 days OR cefuroxime x 14 days
  • Azithromycin x 7 days - only if unable to take doxy, amox, or cefuroxime
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
53
Q

Doses of oral options for treatment of localized lyme disease?

A
  • Doxycycline 4-4.4mg/kg/day (maximum 200mg) divided BID
  • Amoxicillin 50 mg/kg/day (max 1500mg/day) divided TID
  • Cefuroxime 30mg/kg/day (maximum 1g/day) divided BID
  • Azithromycin 10mg/kg/day (maximum 500mg) once daily
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
54
Q

Indications for intrapartum antibiotic prophylaxis for GBS?

A

-Positive GBS screening culture during current pregnancy (35-37 weeks gestation)
-Unknown GBS status AND any of the following
▫ Previous infant with GBS disease
▫ GBS bacteriuria during current pregnancy
▫ Delivery at < 37 weeks gestation
▫ Membranes ruptured ≥ 18 hours
▫ Intrapartum fever (>38.0oC)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
55
Q

Antibiotics for intrapartum GBS ppx?

A

No Pen Allergy –> Pen or Amp
Mild Pen Allergy –> Ancef
Severe Pen Allergy –> Vanco or clinda, but considered INADEQUATE IAP

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
56
Q

37 week newborn, GBS negative mother. Membranes ruptured x20 hours before delivery. Intrapartum fever. Ampicillin 5 hours prior to delivery. Newborn appears well. Management?

a. Routine care, discharge at 24 hours
b. Observe closely with vital signs every 3-4hours for 24-48 hrs; consider CBC 4 hours after birth
c. Observe closely with vital signs every 3-4 hours for 48 hrs; do CBC and blood culture at birth
d. Investigate promptly, full sepsis workup, empiric antibiotic coverage

A

B

2 Risk factors

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
57
Q

Risk factors for early onset sepsis in term neonate?

A
  • Maternal intrapartum GBS colonization during current pregnancy
  • GBS bacteriuria during current pregnancy
  • Previous infant with invasive GBS disease
  • Prolonged rupture of membranes (≥ 18 hours)
  • Maternal fever (≥ 38.0oC)
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
58
Q

7-day-old infant with small vesicular lesion; Systemically
well; normal physical exam. You suspect HSV. Management?

a. Lesion scraping for HSV; if positive, treat with IV acyclovir
b. Lesion scraping for HSV; initiate acyclovir; D/C acyclovir if PCR negative
c. Full sepsis workup; HSV PCR of lesion scraping, blood and CSF; initiate IV acyclovir
d. Lesion scraping + mouth/eye swabs for HSV PCR; initiate IV acyclovir; D/C acyclovir if PCR negative

A

C

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
59
Q

Diagnosis of suspected HSV disease in infant?

A

Culture/PCR/EM of vesicle fluid, nasopharynx, eyes,
urine, stool, blood, CSF
▫ Do LP even if clinically well (e.g. isolated mucocutaneous disease)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
60
Q

Treatment of suspected HSV disease in infant?

A

▫ Intravenous acyclovir 60 mg/kg/day
▫ Isolated mucocutaneous disease: 2 weeks
▫ Disseminated, CNS disease: 3 weeks
▫ If CSF PCR positive, repeat LP towards end of treatment
▫ Suppressive oral acyclovir for 6 months improves neurologic outcome for those with CNS disease

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
61
Q

• 32-year-old G1L0 woman with recurrent genital HSV-2; lesions noted postpartum. Well appearing child, born vaginally at term. Management?

a. Surface swabs, blood & CSF for HSV PCR; start IV acyclovir
b. SurfaceswabsforHSVPCR;notreatmentpendingPCR results
c. Surface swabs for HSV PCR; IV acyclovir pending PCR results
d. Noneedforswabsasrecurrentdisease;monitor clinically, workup and treat if symptomatic

A

B

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
62
Q

Options for prevention of mosquito and tick bites?

A

• Physical barriers
▫ Screens on windows/doors
▫ Fine mesh netting for cribs, strollers etc.
▫ Long loose-fitted clothing, hat, closed shoes
• Repellents
▫ DEET
– 10% for children =12 years
30% for children >12 years
▫ Icaridin for children 6 months – 12 years
• After being outdoors (in tick endemic regions)
▫ Inspect skin at least daily for ticks
▫ Shower/bathe within 2 hours

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
63
Q

When should prophylaxis for lyme disease be considered? What do you use?

A

• Prophylaxis should be considered for exposures in “known endemic regions” AND
▫ Tick attached for ≥ 36 hours (tick engorged) ▫ Within 72 hours of tick removal
• Antibiotic options
▫ Single dose of doxycycline for all age groups for high-
risk exposures (200 mg or 4.4 mg/kg if < 45 kg) ▫ No evidence for amoxicillin

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
64
Q

• Child with unilateral facial weakness, and vesicles in ear canal. Best management

a. Acyclovir
b. Steroids
c. Acyclovir + steroids
d. Noeffectivetreatment

A

C

Ramsay Hunt

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
65
Q

Causes of facial nerve palsy in children?

A 
• Idiopathic (Bell’s palsy)
▫ HSV suggested as possible important cause
• Infection related
▫ Otitis media
▫ Lyme disease
▫ Varicella zoster virus (Ramsay Hunt syndrome)
• Tumors
▫ Cholesteatoma
▫ Facial nerve schwannoma
▫ Vestibular schwannoma, meningioma etc
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
66
Q

Treatment for Bells Palsy?

A

▫ Corticosteroids shown to improve outcome ▫ No benefit to antiviral therapy

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
67
Q

Treatment for Ramsay Hunt?

A

Antiviral + corticosteroids

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
68
Q

• Which is the most common manifestation of west Nile virus infection

a. Non-specific febrile illness
b. Maculopapularrash
c. Asymptomatic
d. Meningitis
e. Acuteflaccidparalysis

A

C

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
69
Q

Neurologic syndromes associated with WNV?

A

Acute flaccid myelitis (poliomyelitis-like)
Aseptic meningitis
Encephalitis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
70
Q

Definition of confirmed acute flaccid myelitis? Probable?

A

Confirmed: acute focal limb weakness and MRI findings of mainly grey matter lesions involving one or more spinal cord segments
• Probable: acute focal limb weakness and CSF pleocytosis (>5 cells/μL)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
71
Q

Etiologies for acute flaccid myelitis?

A

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

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
72
Q

15 yo boy develops varicella. Two days later he become tachypneic and has difficulty breathing. Admitted to hospital for oxygen supplementation. What is the most likely cause of his presentation?

a. Myocarditis
b. Pulmonary embolus
c. VZV pneumonia
d. Sepsis
e. S.aureus pneumonia

A

C

73
Q

Complications of chicken pox?

A 
• General
▫ Pneumonia
▫ Hepatitis, pancreatitis, nephritis, orchitis
 ▫ Thrombocytopenia
• Bacterial infections
▫ Cellulitis, soft tissue abscess, necrotizing fasciitis
• Neurologic
▫ Cerebellar ataxia
▫ Encephalitis
▫ Reye syndrome
▫ Stroke
▫ Zoster (including Ramsay Hunt syndrome)
74
Q

Complications of enterovirus infections?

A

Meningitis, encephalitis, acute flaccid myelitis, myocarditis, hepatitis

75
Q

Complications of EBV infection?

A

Upper airway obstruction (adenopathy), splenic rupture, encephalitis, X-linked lymphoproliferative disease, ITP

76
Q

Complications of influenza infection?

A

Otitis media, secondary bacterial pneumonia, myositis, encephalopathy/encephalitis, Reye syndrome

77
Q

Complications of measles infection?

A

Otitis media, secondary bacterial pneumonia, hepatitis, thrombocytopenia, encephalitis, SSPE

78
Q

Complications of mumps infection?

A

Meningitis, encephalitis, orchitis/oophoritis, arthritis, pancreatitis

79
Q

Complications of parvovirus B19 infection?

A

Papular-purpuric gloves and socks syndrome, transient aplastic crisis, chronic bone marrow failure, polyarthropathy syndrome

80
Q

16 year old girl, with new sexual partner. She in on the birth control pill and both she and boyfriend are well. You recommend:
a. No STI testing needed as both asymptomatic
b. NAAT on first catch urine for C. trachomatis and
N. gonorrhoeae, HIV serology, syphilis serology
c. Serology for C. trachomatis, N. gonorrhoeae, HIV and
syphilis
d. NAAT on first catch urine for C. trachomatis and N. gonorrhoeae

A

B

81
Q

Who should be offered STI screening?

A

Anyone who is sexually active or is a victim of sexual assault or abuse

82
Q

Risk factors for STIs?

A

▫ Inconsistent or no condom use
▫ Sexual contact with someone known to have an STI
▫ New sexual partner, >2 partners within past year, serial monogamy
▫ No contraception or only non-barrier contraception
▫ Injection drug use or substance abuse (including alcohol)
▫ Previous STI
▫ Unsafe sexual practices (e.g. exchange of blood, sharing sex toys)
▫ Sex worker, survival sex, street involved, homelessness
▫ Anonymous sex
▫ Sexual assault or abuse

83
Q

Major STI pathogens and testing?

A 
Chlamydia trachomatis -->Nucleic acid amplification test (NAAT) • First catch urine or urethra/vaginal/
cervical swab
Neisseria gonorrhoeae -->• Nucleic acid amplification test (NAAT) • First catch urine or urethra/vaginal/
cervical swab
• Rectal/pharyngeal swab as appropriate
Treponema pallidum --> serology
HIV--> Serology
Hepatitis B/C --> Serology
84
Q

Samples and STI screening tests for asymptomatic male with risk factors?

A
  • First catch urine or urethral swab for C. trachomatis & N. gonorrhoeae
  • HIV and syphilis serology
  • Consider hepatitis A/B/C serology
85
Q

Samples and STI screening tests for asymptomatic female with risk factors?

A
  • First catch urine or vaginal swab for C. trachomatis & N. gonorrhoeae
  • HIV and syphilis serology
  • Consider hepatitis A/B/C serology

Screening for C. trachomatis and N. gonorrhoeae recommended for all sexually active females at least annually regardless of risk factors

86
Q

Samples and STI screening tests for male with urethritis?

A
  • Urethral swab for N. gonorrhoeae

* First-catch urine for C. trachomatis

87
Q

Samples and STI screening tests for female with cervicitis?

A
  • Vaginal/cervical swab for N. gonorrhoeae & C. trachomatis
  • If lesions present, swab for HSV
  • Vaginal swab for wet-mount ǂ

Wet mount for diagnosis of vulvovaginitis, candidiasis, bacterial vaginosis and trichomonas

88
Q

Samples and STI screening tests for suspected pharyngeal gonorrhea?

A

• Swab for culture (directly inoculate culture medium or place in transport medium)

89
Q

Treatment of uncomplicated anogenital (urethra, endocervix, vaginal, rectal) gonococcal infection in children >/= 9 y? Pharyngeal infection?

A

Ceftriaxone 250 mg IM SD plus Azithromycin 1 g SD
or
Cefixime 800 mg PO SD plus Azithromycin 1 g SD

Pharyngeal:Ceftriaxone 250 mg SD plus Azithromycin 1 g SD

90
Q

Treatment of uncomplicated anogenital (urethra, endocervix, vaginal, rectal) gonococcal infection in children <9 y? Pharyngeal infection?

A

Ceftriaxone 50 mg/kg IM (max 250 mg) SD plus Azithromycin 20 mg/kg (max 1 g) SD
or
Cefixime 8 mg/kg PO BID x 2 doses plus Azithromycin 1 g SD

Pharyngeal: Ceftriaxone 50 mg/kg IM (max 250 mg) SD plus Azithromycin 20 mg/kg (max 1 g) SD

91
Q

• Newborn infant of mother with untreated gonorrhea. Next step in management?

a. CBC; cultures of conjunctiva, blood, CSF; IV ceftriaxone
b. CBC; cultures of conjunctiva, blood; IV ceftriaxone
c. Culture of conjunctiva; IM ceftriaxone
d. Culture of conjunctiva; treat according to results

A

C

92
Q

Management of well appearing infant of mother with untreated gonorrhea?
Unwell?

A

Well appearing
▫ Conjunctival culture
▫ IM ceftriaxone 50 mg/kg (maximum 125 mg)

• Unwell
▫ Conjunctival, blood and CSF cultures
▫ Consult ID with established disease

93
Q

Four week old baby with pneumonia on chest x-ray. Complete blood count shows eosinophilia. Management?

a. Ceftriaxone
b. Ampicillin
c. Erythromycin
d. No treatment

A

C

94
Q

Risk of conjunctivitis in infant of mother with untreated chlamydia trachomatis?

A

30% to 50% risk of conjunctivitis

▫ 10% to 20% risk of pneumonia

95
Q

Management of infant exposed to chlamydia trachomatis?

A

▫ Antibiotic prophylaxis not recommended (due to risk of pyloric stenosis)
▫ Close clinical follow-up
▫ PCR testing recommended if develop symptoms
▫ Treat if PCR testing is positive

96
Q

4 yo old develops two episodes of bloody diarrhea and mild abdominal pain after starting Clavulin. Afebrile and otherwise well. Stool tests positive for C. difficile. What would you do in addition to stopping antibiotics?

a. Metronidazole PO for 10 days
b. Clarithromycin PO for 10 days
c. Vancomycin PO for 10 days
d. Close follow-up with no antibiotics

A

D

97
Q

Definition of mild C.diff? Treatment?

A

Watery diarrhea without systemic toxicity; typically <4 abnormal stools/day

Tx: D/c precipitating antibiotic; Follow-up

98
Q

Definition of moderate C.diff? Treatment of first episode; mild/moderate; or no change with stopping antibiotics?

A

Typically >/= 4 abnormal stools/day; no or minimal systemic toxicity (mild abdominal pain, low grade fever)

Tx: PO metronidazole 30mg/kg/day divided QID, 10-14 days (max 2g/day)

99
Q

Definition of severe C.diff? Treatment of first episode of severe, uncomplicated C.diff?

A

Evidence of systemic toxicity (e.g. high grade fevers, rigors)

Tx: PO vancomycin 40mg/kg/day divided QID, 10-14 days (max 500mg/day)

100
Q

Definition of severe complicated C.diff? Treatment of first episode of severe, complicated C.diff?

A

Evidence of systemic toxicity and severe colitis, including hypotension, shock, peritonitis, ileus or megacolon

Tx: PO vancomycin 40mg/kg/day divided QID, 10-14 days (max 500mg/day) PLUS IV metronidazle 30mg/kg/day divided QID, 10-14d ays

101
Q

Treatment for first recurrence of c.diff? Second recurrence?

A

1st - Repeat same dependent on severity

2nd - vancomycin in tapered or pulsed regimen

102
Q

Infection control for C.diff?

A

• Hand hygiene
• Identifying and cleaning environmental sources
▫ Sporicidal agents (chlorine-based, other)
▫ Alcohol-based hand hygiene products do not kill spores
• Contact precautions for duration of symptoms • Private rooms or cohorting
▫ Isolation should be based on symptoms

103
Q

Acute medical emergencies to consider with fever in a returned traveler?

A
  • Malaria
  • Typhoid fever
  • Meningococcemia
  • Viral hemorrhagic fevers
104
Q

What to think about with prolonged fever of delayed onset?

A
  • TB
  • Brucellosis
  • Leishmaniasis
  • Typhoid fever
105
Q

A 4 month old boy was exposed to his grandfather who was diagnosed with cavitary pulmonary TB. He is clinically well. Management?

a. Treat with rifampin b. Give BCG
c. Treat with isoniazid
d. Do chest x-ray
e. If asymptomatic, no need for any interventions

A

D

106
Q

Three year old boy exposed to a suspected case of pulmonary TB in the home. Clinically well, TST negative, CXR normal. Which is most appropriate?

a. No treatment is needed
b. No treatment at present; 9 months of isoniazid if repeat TST positive in 3 months
c. Start isoniazid now; discontinue in 3 months if still clinically well and repeat TST negative
d. Start 9 month course isoniazid now

A

C

107
Q

Definition of TB exposure?

A
  • Significant contact with a person with suspected or confirmed contagious pulmonary TB
  • Asymptomatic, negative TST, normal CXR
108
Q

Definition of TB infection?

A

-Asymptomatic, normal CXR, but positive TST

109
Q

Definition of TB disease?

A

-Disease in person with TB infection in whom signs and symptoms or radiographic manifestations are apparent

110
Q

Reasons for reactive TST?

A
  • Mycobacterium TB infection
  • Non-TB mycobacteria infection
  • BCG in past
  • Incorrect technique (measurement - e.g. measuring redness instead of induration)
111
Q

Some causes of false negative TB skin test?

A
  • Incorrect technique
  • Active TB disease
  • Immunodeficiency states
  • Corticosteroids
  • Young age
  • Malnutrition
  • Viral infections (measles, varicella, influenza)
  • Live attenuated vaccines (measles)
112
Q

Advantages of IGRA? When is it most useful?

A
  • More specific for M. tuberculosis than TST - doesn’t cross react with BCG and most non-TB mycobacteria
  • Does not require follow-up visit in 48-72 hrs

-Most useful for diagnosis of LTBI in BCG recipient

113
Q

Caveats of IGRA use?

A
  • Cross reacts with some non-TB mycobacteria species
  • TST can boost IGRA response (typically if IGRA done >72h after TST)
  • Important limitations:
  • Cannot distinguish LTBI from active TB
  • Like TST, can be negative in active TB disease
  • Sensitivity decreased by temporary anergy of acute illness
  • Reduced sensitivity in immune compromised individuals (including HIV)
114
Q

Populations at increased risk of TB disease?

A
  • Infants and post-pubertal adolescents
  • Recently infected (past 2 years)
  • Immunodeficiency states: -Primary immunodeficiency (CMI/IFNy receptor deficiency) - HIV
  • Malignancy
  • Organ transplant
  • Immunosuppressive meds (steroids, chemo, TNF antagonists)
  • Malnutrition
115
Q

Diagnosis of pulmonary TB?

A

-TSTs and IGRAs often done, but do not distinguish LTBI from active disease, and do not “rule out” pulmonary TB

  • CXR
  • Gastric aspirates: -three consecutive early morning aspirates; must be taken before ambulation or feeding
  • Bronchoalveolar lavage in select cases
  • Microbiology - acid fast staining, culture, DNA probes (AMTD); PCR
116
Q

Treatment for latent TB infection? TB disease?

A

• Latent TB infection
▫INH for 9 months 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)
• Consider DOT
• Pyridoxine in selected cases (malnutrition, adolescents, pregnancy…)
• Vitamin D usually given for children with TB disease

117
Q

Side effects of isoniazid?

A

Hepatotoxicity; peripheral neuropathy (interferes with pyridoxine metanbolism)

118
Q

Side effects of rifampin?

A

Hepatotoxicity; hypersensitivity reactions; memory impairment; drug interaction (OCP); body fluids turn orange

119
Q

Side effects of pyrazinamide?

A

Hepatotoxicity; increased uric acid levels

120
Q

Side effects of ethambutol?

A

Optic neuropathy (decreased acuity, decreased visual fields, colour blindness)

121
Q

Medical intervention to prevent vertical HIV transmission?

A

• Antiretroviral therapy
▫ Triple ART starting in 2nd trimester (or earlier)
▫ Intravenous zidovudine during labor
▫ Zidovudine to infant for 6 weeks
▫ Combination antiretroviral therapy to infant may be warranted if mothers VL elevated

• Elective Cesarean section if VL >1000 copies/mL

• Avoidance of breast feeding
▫ Breast feeding contraindicated in Canada
▫ Mixed breast and formula feeding greater risk compared to exclusive breast feeding

122
Q

How to finalize HIV status in exposed infant? What to do in meantime?

A

Finalizing HIV status
▫ Exclusion of HIV requires 2 separate negative PCR tests
taken at >/=1 and >/=2 months of age
▫ HIV infection confirmed by positive PCR x2 prior to 18
months or reactive serology after 18 months

• Zidovudine for 4-6 weeks

-Exclusive formula feeding for Canadian setting

123
Q

Most common adverse effects of zidovudine?

A

Anemia, elevated lactate (rarely symptomatic)

124
Q

How are the immune systems of children infected with HIV impacted?

A
  • Vaccine responses not as good as healthy children

- Increased risk of pneumococcal disease

125
Q

Assessment of HIV infected child in ER?

A

Clinical status
▫ Immunologic status (CD4 count & CD4 percent) ▫ Virologic status (viral load)
▫ Antiretroviral therapy and adherence

126
Q

Approach to vaccines for HIV-infected children?

A

Should receive all routine childhood vaccines

• Live virus vaccines
▫ MMR should be given in absence of severe immune compromise (immunologic category C)
▫VZV vaccine should be considered in asymptomatic children with CD4 percentage > 25%
▫ BCG & oral polio vaccine contraindicated in developed countries

• Other vaccine
▫ Annual influenzav accine
▫Polysaccharide pneumococcal vaccine (after Prevnar13)
▫Meningococcal vaccine ( Menactra, 4CMenB)

127
Q

A 7 year old boy stepped on a discarded needle while walking barefoot on the beach. He was bleeding. He was previously vaccinated against hepatitis B. Initial management?

a. Given hepatitis B vaccine and immune globulin
b. Give hepatitis B immune globulin
c. Send testing for anti-hepatitis B surface antigen
d. Reassure as previously vaccinated

A

C

128
Q

Risk assessment for HIV transmission after needle stick?

A

-Source
• Known HIV positive source For HIV positive source, viral load is the most important risk factor
• Unknown status, but presumed or known high prevalence in
injection drug user population

-Device
• Needle size, whether hollow bore, visible blood, probability of needle exposure to drying, heat, freezing
• Large lumen devices with visible blood highest risk

-Injury
• Depth and extent of trauma
• High risk if blood injected; low risk for scratches
• For mucus membranes or non-intact skin, assess extent of exposure

129
Q

When is HIV post-exposure prophylaxis recommended? Time frame?

A

• Recommended if all of the following present:
▫ Source considered likely to have HIV
▫ Needle/syringe with visible blood
▫ Blood may have been injected

▫ Within 72 hours of exposure

130
Q

What is the risk of transmission of HCV to an infant of an infected mother? What are the risk factors for transmission?

A

▫ Average risk ~5%

▫ Risk factors include HIV co-infection, higher HCV viral load, elevated ALT, cirrhosis

131
Q

Recommendation about mode of delivery for HCV infected mothers?

A

▫No evidence to support routine elective Cesarean section

▫Should avoid invasive procedures (scalp electrodes etc.)

132
Q

Recommendation about breastfeeding for HCV infected mothers?

A

▫No evidence of transmission via breast-milk

▫Cannot completely exclude possibility of transmission

133
Q

Testing for infant exposed to HCV via infected mother?

A

▫ HCV serology at 12 to 18 months

▫RNA after 2 months selectively (parental anxiety)

134
Q

What to do for infant of HBsAg positive mother?

A
  • HBIG and HB vaccine within 12h of birth
  • HB vaccine at 1 and 6 months (at 0, 1, 2 and 6 mos for infants <2.0kg at birth)
  • HBsAg and anti-HBs at 9-12 months
135
Q

• A child with ALL finished chemotherapy 1 month ago and was exposed to varicella zoster virus (VZV) 8 days ago. How do you treat?

a. VZV vaccine
b. VZIG
c. VZV vaccine and admit for IV acyclovir
d. Admit for IV acyclovir

A

B

136
Q

Indications for VZIG (post-exposure)

A
  • Immunocompromised children without history of varicella or varicella immunization
  • Susceptible pregnant women
  • Newborn infant whose mother had onset of chicken pox within 5 days before delivery or within 48 hours of delivery
  • Hospitalized premature infant (>/= 28 weeks gestation) whose mother lacks a reliable history of chicken pox or serologic evidence of protection against varicella
  • Hospitalized premature infant (< 28 weeks gestation or birth weight = 1000 gram) regardless of maternal history of varicella or varicella-zoster virus serostatus

-VZIG should be given as soon as possible within 10 days of exposure

137
Q

Indications for 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 at the start of the RSV season
  • Consider in infants without CLD born at < 30 weeks gestation if they are < 6 months of age at the start of the RSV season
  • Consider in infants who live in remote communities and born at < 36 weeks gestation if < 6 months of age at the start of the RSV season
  • Consider in full-term Inuit infants < 6 months of age at onset of RSV season living in remote communities with persistently high rates of RSV hospitalization
  • May be considered in children < 24 months of age who are on home oxygen, have had a prolonged hospitalization for severe pulmonary disease or are severely immunocompromised
138
Q

A young child is bitten by a cat. Started on amoxicillin-clavulanate, but returns to ER with increasing redness and swelling. What should you do?

a. IV vancomycin and ceftriaxone
b. IV piperacillin-tazobactam
c. IV cloxacillin (or cefazolin)
d. Refer for surgical debridement

A

D
cat bites tend to be deep and narrow
if don’t respond to amox clav (should cover main pathogens) prob need surgical debridement - if gwo anything, modify atbx

139
Q

Organisms associated with dog and cat bites? Empiric antibiotic therapy?

A
  • Pasturella multocida
  • Streptococci sp.
  • S. aureus
  • Anaerobes
  • Others
  • PO amox-clav
  • IV cloxacillin + penicillin
  • Vancomycin instead of clox/cefazolin if suspect MRSA
140
Q

Organisms associated with human bites? Empiric antibiotic therapy?

A

-Streptococci, S.aureus, anaerobes

  • PO amox-clav
  • IV cloxacillin + penicillin
  • Vancomycin instead of clox/cefazolin if suspect MRSA
141
Q

Organisms associated with puncture wound of foot when wearing sneakers? Empiric antibiotics?

A
  • Pseudomonas aerugenosa

- Piperacillin OR ciprofloxacin +/- gentamicin

142
Q

Organisms associated with puncture wound of foot without sneaker? Empiric antibiotics?

A

-S. aureus

  • PO cloxacillin or cephalexin
  • IV cloxacillin or cefazolin
143
Q

Considerations regarding rabies? PEP?

A

• The animal & the exposure
▫ Dogs, cats, raccoons, skunks and bats most common
▫ Provoked versus unprovoked attack

• Notify public health

• Evaluation of the animal
▫Domestic animals can be observed 10days for signs of rabies
▫ If wild animal–euthanize and test immediately
▫ If animal not available manage as if rabid

• Post-exposure prophylaxis (don’t forget tetanus)
▫ Rabies immune globulin
–-20 IU/kg; as much as possible infiltrated into wound
-Remainder can be given IM
▫Rabies vaccine (Human diploid cell vaccine)
– 4-5 doses of vaccine on days 1, 3, 7, 14, (28) (IM injections)

144
Q

Two year old whose 5 year old sibling has meningococcal meningitis. What to do?

a. Ciprofloxacin only
b. Rifampin only
c. Vaccine + rifampin
d. Vaccine only

A

C

Vaccine selection depends on serotype

145
Q

Indications for chemoprophylaxis for meningococcal disease?

A

Close contacts:
▫ Household contact
▫Persons who share sleeping arrangement with index case
▫ Childcare and preschool contact
▫Direct exposure to index secretions (kissing etc)
▫HCW who have intensive unprotected exposure
▫ Seated next to index case during flight >8hours

146
Q

• Three-year-old child, day 3 of chickenpox. Now afebrile and generally quite well. Few lesions, but not all crusted over.

a. Can return to daycare
b. Cannot return to daycare until all lesions crusted
c. Cannot return to daycare until 5 days after onset of rash regardless of lesion status
d. Cannot return today care until 5 days after onset of rash and all lesions crusted

A

A

discrepancy between CPS and red book

CPS says if well enough, can go back

redbook says have to be crusted

147
Q

All of the following should be excluded from daycare except

a. Three year old with suspected scabies
b. Pertussis, 3 days after initiating erythromycin
c. E. coli 0157:H7, after resolution of diarrhea
d. Campylobacter, day 4 of illness
e. HepatitisA, 10 days after onset of jaundice

A

E

pertuss 5 days

ecoli neg stools

campylo until resolution of diarrhea

148
Q

• Two-year old child admitted with fever, cough, rinorrhea and conjunctivitis. What infection control precautions do you recommend?

a. Gown, gloves and regular mask
b. Gown, gloves and N95 mask
c. Regular mask and alcohol rub when leave room
d. N95 mask and alcohol rub when leave room

A

A

149
Q

5 hand hygiene moments?

A
  • Before touching a patient
  • Before clean/aseptic procedures
  • After body fluid exposure/risk
  • After touching a patient
  • After touching patient surroundings
150
Q

Antibiotic stewardship principles?

A

• Use clinical judgment
▫ Accurate diagnosis
▫ Investigate judiciously (CXR to confirm pneumonia)
• Treat infection, not contamination/colonization
▫ Use appropriate samples when indicated
– No bag urines
– Throat culture only when symptoms suggestive of disease – Surface swabs often reflect colonization
• Assessment of antibiotic allergy
▫ Rash versus anaphylaxis
▫ Viral rashes often labeled as possible antibiotic allergy•
-Know your local antibiogram
• Selecting an antibiotic
▫ Narrowest spectrum needed
▫ Optimize dosing (as recommended) ▫ Optimize duration
• Promote vaccinations to reduce likelihood of disease

151
Q

• Six year old girl with ear pain x3 days, controlled by analgesics. Afebrile. Tearful, dull tympanic membrane, middle ear effusion. Next step in management?

a. 10 days amoxicillin
b. 5 days amoxicillin
c. 3 days amoxicillin
d. No antibiotics, reassess in 48 hours

A

D

152
Q

Considerations for watchful waiting for children >/= 6 months old with AOM?

A

• Non-severe illness
▫ Mild-moderate TM bulge
▫ Mildly ill, alert, mild otalgia, low grade fever (<39.0oC)
▫ Responding to antipyretics

• Other factors to consider (not mentioned in guideline)
▫ No underlying conditions of concern
– Immunodeficiency, chronic cardiac or pulmonary disease, anatomic abnormalities of head/neck, history of complicated otitis media, down syndrome
▫Parents capable of recognizing signs of worsening disease and can readily access medical care

153
Q

21-month-old girl with AOM presents with fever (40.3oC) and earache x24 hours. Alert, but very irritable. Best treatment?

a. Ceftriaxone 50 mg/kg IM x1 dose
b. Amoxicillin 45mg/kg/day bid;5days
c. Amoxicillin 75 mg/kg/day bid; 10 days
d. Azithromycin 10mg day 1, then 5 mg/kg/day for 4 days
e. No antibiotics; Advil/Tylenol & reassess in 24hours

A

C

154
Q

Pathogens for acute otitis media?

A

• Bacteria
▫ Streptococcus pneumoniae (25% to 40%)
▫ Non-typeable Haemophilus influenzae (10% to 30%)
▫ Moraxella catarrhalis (5% to 15%)
▫ Other less commonly seen pathogens include group A streptococcus, S. aureus (3% to 5%)
• Viruses account for up to 20% of acute otitis media cases (bacterial cultures negative)

155
Q

First line antibiotic therapy for AOM? If mild amoxicillin allergy? If severe amoxicillin allergy? Treatment failure?
Also duration?

A
  • First line: Amoxicillin 75-90 mg/kg/day divided BID or Amoxicillin 45-60 mg/kg/day divided TID
  • Mild amox allergy: Cefuroxime 30mg/kg/day divided BID or Ceftriaxone 50mg/kg IM/IV x 3 doses
  • First line; severe amoxicillin allergy: Azithromycin, clarithromycin, clindamycin
  • Treatment failure: Amoxicillin claulanate 45-60mg/kg/day divided TID (= 34kg) or 500mg TID (>35kg) x 10 days or Ceftriaxone 50mg/kg/day for 3 doses

-Standard duration:
Children >/=2 years - 5 days
Children <2 years - 10 days

156
Q

Previously well 18 month girl with fever for 3 days. She is not toxic. Urinalysis is positive for leukocytes and nitrite. Best management?

a. Oral antibiotic; ultrasound and vesicoureterography (VCUG) as outpatient
b. Oral antibiotic; VCUG as outpatient
c. Oral antibiotic; ultrasound; VCUG selectively depending on ultrasound findings
d. Oral antibiotic; no investigations as this is a first UTI
e. IV antibiotics; ultrasound+VCUG as inpatient

A

C

157
Q

How to diagnose febrile UTI?

A

• Sterile urine specimen is essential
▫ Transurethral catheterization
▫ Clean catch
▫ (Suprapubic aspiration)
• Bag specimens are notoriously unreliable
▫ Good negative predictive value
▫ High false positive rate (85%)
• Presumptive diagnosis (urinalysis, microscopy)
▫ Microscopy (presence of bacteria, WBC)
▫ Urinalysis (leukocyte esterase, nitrites)

158
Q

Antibiotic management for febrile UTI in children >2 months of age? Indication for parenteral therapy? Duration?

A

• Majority can be managed with oral antibiotics
▫ Cephalosporin, amoxicillin-clavulanate, TMP SMX
• Indication for parenteral therapy
▫ Toxic appearance
▫ Unable to retain oral intake (including medications)
▫ Immunocompromised host (selectively)
▫ Ampicillin + gentamicin (other options as well)
• Antibiotic therapy should be given for 7-10 days
• Antibiotic prophylaxis not routinely recommended
after first febrile UTI

159
Q

Radiologic investigations after first febrile UTI?

A

• Renal and bladder ultrasound recommended after first febrile UTI in children < 2 years of age
• Voiding cystourethrography (VCUG) is not indicated after first febrile UTI
• Indications for VCUG
▫ Ultrasound evidence of hydronephrosis, renal scarring or other findings suggestive of high grade vesicoureteral reflux or obstructive uropathy
▫ Recurrence of febrile UTI

160
Q

• Child with grade IV VUR has completed treatment for her second UTI. The organism was resistant to TMP SMX and nitrofurantoin. You are thinking about starting prophylaxis – what do you start?

a. Amoxicillin
b. Cefixime
c. TMP SMX
d. Ciprofloxacin
e. Noprophylaxis

A

E

161
Q

Recommendations for prophylaxis for UTIS?

A

• Prophylaxis not recommended for grade I-III VUR
▫ May be considered for grades IV-V VUR
• If given prophylaxis should be reassessed after 3-6 months
• Antibiotic choices
▫ TMP SMX, nitrofurantoin are the recommended first line agents
▫ If child has UTI due to organism resistant to these – consider stopping prophylaxis
▫ Broader spectrum agents not recommended due to risk of infection with highly resistant organisms

162
Q

Impetigo: Predominant organisms? Empiric therapy?

A
  • Staph aureus, GAS
  • Cloxacillin, cephalexin (topical mupirocin)
  • Consider vancomycin if suspect MRSA
163
Q

Cellulitis: Predominant organisms? Empiric therapy?

A
  • Staph aureus, GAS
  • IV: Cloxacillin, cefazolin; PO: cloxacillin, cephalexin
  • Consider vancomycin if suspect MRSA
164
Q

Pyomyositis: Predominant organisms?

A
  • Staph aureus, streptococci
  • IV: Cefazolin, cloxacillin
  • Consider vancomycin if suspect MRSA
165
Q

Necrotizing fasciitis: Predominant organisms? Empiric therapy?

A
  • Group A streptococcus, staph aureus
  • IV: Cloxacillin (or cefazolin) + clindamycin +/- Vancomycin
  • Penicillin + clindamycin if suspect group A streptococcal disease (e.g. varicella)
166
Q

Child in bitten in daycare by another child; HBV status unknown for both. The bitten child is bleeding. Best management regarding hepatitis B prevention?

a. No testing of either child; initiate HBV vaccination for both
b. Test both for HBsAg & HBsAb; HBIG to bitten child; initiate vaccination if biter is HBsAg positive
c. Test both for HBsAg & HBsAb; initiate HBV vaccination for the bitten child
d. Test biting child for HBsAg & HBsAb; no HBIG; initiate vaccination if biter is HBsAg positive

A

A

167
Q

Management of daycare bite wounds?

A

• Local wound care
▫ Allow to bleed freely
▫ Clean with soap and water, apply mild antiseptic
• Preventive interventions
▫ Tetanus immunization where appropriate
▫ Prophylactic antibiotics indicated only if moderate or severe tissue damage or
-Deep puncture wounds or
-More than superficial injury to face, hand, foot, genitalia
▫ HIV post-exposure prophylaxis only if
-One of the children is HIV infected and
-The bite results in exchange of blood

168
Q

Baby born to mother who is hepatitis B surface antigen reactive. Given HBIG at birth and vaccine at birth, 1 month and 6 months. At 9 months he is well – most likely serologic pattern?

a. HBeAg+, HBcAg+, HBsAg+, HBaAb+, HBsAb+
b. HBeAg-, HBcAg-, HBsAg+, HBcAb+, HBsAb+
c. HBeAg-, HBcAg-, HBsAg-, HBcAb+, HBsAb+
d. HBeAg-, HBcAg-, HBsAg-, HBcAb+, HBsAb-

A

C

169
Q

Infectious contraindications to breastfeeding?

A
  • HIV
  • HTLV-1
  • HTLV-2
  • HSV if lesions on breast until crusted
  • TB if contagious; delay until 2 weeks of treatment in Mom
  • Mastitis if obvious pus–> pump and discard
170
Q

Risk factors for severe influenza?

A

• Children at risk of influenza related complications
• Children 6-59 months of age
• Children with chronic health conditions
▫ Cardiovascular, liver, renal, metabolic disease
▫ Neurologic or neurodevelopmental conditions
▫ Anemia or hemoglobinopathy
▫ Malignancy and other immune compromising conditions
• Children and adolescents on chronic ASA therapy
• Pregnancy
• Aboriginal peoples

171
Q

Clinical features of peritonsillar abscess?

A
  • Preadolescents and adolescents
  • Fever, sore throat, muffled voice, pooling of saliva, trismus, bulging of palatine tonsil, contralateral deviation of uvula; fluctuance of tonsilar fullness
172
Q

Clinical features of lateral pharyngeal abscess (parapharyngeal or pharyngomaxillary space)

A
  • Preadolescents and adolescents
  • Fever, neck pain, trismus, head tilt toward side of lesion, neck swelling, tender swelling below angle of mandible, odynophagia, lateral wall bulge, tonsil nott very inflamed, torticollis
173
Q

Clinical features of retropharyngeal abscess?

A
  • Infancy and early childhood
  • Fever, sore throat, odynophagia, muffled voice, neck stiffness, torticllis or retrocollis
  • Anterior bulge of retroharyngeal wall, posterior wall fluctuance
174
Q

Pathogens in peritonsillar, lateral pharyngeal and retropharyngeal abscesses?

A

S. pyogenes, S. aureus, H. influenzae, oral anaerobes (Fusobacteria, Bacteroides and others)

175
Q

Dog, cat bites: Organisms? Empiric therapy?

A
  • Pasturella multocida, Streptocoocci spp., S. aureus, anaerobes, others
  • PO: amox-clav
  • IV: clox and pen
  • Use vanco instead of clos if suspect MRSA
176
Q

Human bites: Organisms? Empiric therapy?

A
  • Streptococci, Staph aureus, anaerobes
  • PO: amox-clav
  • IV: clox + pen
  • Use vanco instead of clox if suspect MRSA
177
Q

Puncture wound of foot with sneakers: Organisms? Empiric therapy?

A
  • Pseudomonas aerugenosa

- Piperacillin or ciprofloxacin +/- gentamycin

178
Q

Puncture wound of foot, no sneakers: Organisms? Empiric therapy?

A
  • Staph aurea
  • PO: cloxacillin or cephalexin
  • IV: cloxacillin or cefazolin
  • Use vanco instead of clox/cefaz if suspect MRSA

ID HR (1 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2025 Bold Learning Solutions. Terms and Conditions