ID & Immunization Flashcards
CPS recommends all children > ___ years should be offered mRNA vaccine for COVID 19.
12
What rare side effect must you discuss when providing informed consent for an mRNA COVID vaccine?
Informed consent should include discussion about the rare reports of myocarditis and pericarditis following this vaccine, what warning signs to watch out for, and the fact that the vaccine’s benefit of preventing hospitalization for COVID-19 infection outweighs the risk of myocarditis or pericarditis.
COVID19 mRNA vaccine cannot be given with routine immunizations. True or false?
COVID-19 vaccines may be given simultaneously with, or at any time before or after, any other vaccine(s).
Name 3 groups of patients who warrant a third dose of mRNA COVID vaccine.
Active Rx for malignancies, receipt of solid organ transplant and on immunosuprpessants, HSCT within 2 years, immunodeficiency (DiGeorge, WAS), untreated HIV, on immunosuppressive therapies
A woman presents in labour and does not have a documented HIV status. What do you do?
Rapid HIV testing of mom - If she declines, then test baby, if she refuses that.. you may need to involve child protection services.
A rapid HIV test is done for mom and found to be positive. Within what time frame do you start antiretroviral prophylaxis?
Immediately and no later than 72 hours post-delivery. Also, If rapid HIV antibody testing is unavailable and there is concern that the mother is at high risk for HIV infection, starting newborn antiretroviral prophylaxis pending test results should be considered.
A mother asks if she can breast feed her baby while awaiting results of a rapid HIV test. What do you say?
No. Breastfeeding should be deferred until the confirmatory HIV antibody test result is available and proves negative.
What are the short and long term side (2 each) effects that need to be monitored for infants exposed to HIV infection or antiretroviral agents?
Short term: anemia, neutropenia
Long term: growth, neurodevelopment
Name 2 risk factors for perinatal HIV transmission.
Late or no prenatal care, injection drug use, recent illness suggestive of HIV seroconversion, regular unprotected sex with a partner known to be living with HIV (or with significant risk for HIV infection), diagnosis of sexually transmitted infections during pregnancy, emigration from an HIV-endemic area or recent incarceration.
What are the most common pathogens causing acute osteomyelitis and septic arthritis (2)?
S. aureus (most common >4yrs) and K. kingae (Kingae esp. in infants). Other common orgs: S. pneumoniae, S. pyogenes.
What is the empiric antimicrobial choice for acute osteomyelitis and septic arthritis and what is the duration of treatment?
IV cefazolin. Duration is 3-4 weeks (4-6 weeks in hip SA). Dose: 100mg/kg/day to 150mg/kg/day divided Q6H or Q8H.
What is the most sensitive and specific noninvasive test for acute osteomyelitis?
MRI using gadolinium enhancement. Radionucleotide bone scans may be useful when MRI is not available, but it is important to note that they have a lower sensitivity and specificity compared with MRI. XR: lytic lesions and localized periosteal lifting.
When can IV therapy be stepped down to PO in a patient with acute osteomyelitis or septic arthritis?
Clinical improvement, normalizing inflammatory markers, and compliance and F/U is assured. CRP is recommended to monitor response to therapy and should be N prior to D/C. Step down therapy: cephalexin 120-150mg/kg/day, TID dosing.
What is the most common site for acute osteomyelitis?
Metaphysis in long tubular bones (such as femur, tibia or humerus).
A 5yo presents with hip pain, limp and T38.0. He is able to weight bear. History of URTI 2 weeks ago. CRP 14. Pain is improved w/ NSAIDs. No swelling or point tenderness of bones. Appears non-toxic. What is the most likely dx? A. Acute osteomyelitis B. Transient synovitis of hip C. Fracture D. Lyme disease arthritis
B. Usual age is 4–10 years. Hip pain and new limping, fever generally low-grade. Child can usually weight-bear but also may not. History of upper respiratory tract infection in the preceding 2 weeks. Nontoxic appearance, usually < 38.5°C fever. CRP is usually < 20 mg/L. Gradually improves over several days, which may be hastened by nonsteroidal anti-inflammatory agents.
What is the gold standard for diagnosis of acute osteomyelitis?
Bone specimen
What is the optimal method for diagnosis of septic arthritis?
Joint aspiration
What is prevented by HPV vaccination?
Because the vaccine prevents infection with the papillomavirus (a necessary first step in cancer development), the cellular dysplasia (intraepithelial neoplasia) that predates invasive cancer does not occur, effectively preventing the development of cancer. If vaccine is administered before exposure to the targeted HPV types, efficacy is close to 100% against type-specific cervical disease.
True or false? HPV is associated with Guillain-Barré syndrome, autoimmune diseases, stroke, venous thromboembolism, acute disseminated encephalomyelitis, multiple sclerosis or any other serious health condition.
False. There is no association.
What is the recommended age for HPV vaccination?
9-13 years to increase likelihood of vaccine administration before onset of sexual activity. Vaccine should be given in 2 doses, 6 months apart.
What are the risks of neonatal circumcision?
Minor bleeding (1.5%), local infection (minor), severe infection (rare), death from bleeding (rare), unsatisfactory cosmetic results, meatal stenosis (<1% when petroleum jelly is applied for 6months post op)
Does the CPS recommend the routine circumcision of every newborn?
No
What are the benefits of neonatal circumcision?
Prevention of phimosis, decrease in early UTI or UTI in those with RFs, decreased acquisition of HIV, HSV, HPV, penile cancer, cervical cancer in female partners
What is the treatment for phimosis?
Apply topical therapy (ex. betamethasone 0.05%) BID accompanied by gentle traction.