Infectious Disease Flashcards
what is the 5Cs of HIV testing?
consent confidentiality counselling correct test results connect to prevention/care/treatment
How long is the window/eclipse period of HIV testing?
22d for 3rd gen ELISA
17-18d for 4th gen ELISA
everyone will have a detectable HIV antigen or antibody by 6w - 3mo
What is considered potential exposure of HIV indicated for post-exposure prophylaxis (PEP)?
potentially infected fluid comes in contact with subcut tissue (ex. needlestick), mucous membrane (ex. eye, mouth), non-intact skin (ex. <3d old healing wound, skin lesion)
DOES NOT include stool, urine, tears, saliva, vomit sputum, sweat
What is the post-exposure prophylaxis (PEP) of HIV?
Investigations:
- do baseline HIV serology
- CBC, Cr
- Hep (HAV, HBsAg, anti-HB, anti-HBc, HCV)
- assess source person if possible to tailor PEP regimen
Regimen:
- Start PEP in 2-72 hours for up to 28 days (tenofovir, lamivudine, Raltegravir)
Who are considered HIGH RISK indicated for Pre-exposure prophylaxis (PrEP)?
HIGH RISK:
MSM + condomless sex and any of the following
1 ) infectious syphilis
2) ongoing sexual relationship with HIV-positive partner not on stable ART or pVL > 200
3) > 1 PEP
4) > = 10 HIV incidence risk index
- *Heterosexual female or male condomless sex and #2
- *IVDU sharing injection equipment with #2 above
what is the regimen of PrEP?
Investigation:
- confirm HIV neg
- Cr
- STI
- screen Hep + immunize
Regimen: Combo Tenofovir disoproxil fumarate 300mg/ emtricitabine 200mg QD
what is the f/u plan for people on PrEP?
Test the following after 1 mo, then q3mo
- Cr
- HIV, VDRL, G/C
- preg test
q6mo to screen Hep C
what are the symptoms of pre-icteric phase?
- Abrupt onset
- fever
- jaundice (close contact precaution for 1 wk after onset jaundice)
- malaise
- anorexia N/V, abdo pain
- H/A
- hepatosplenomegaly
- bradycardia
- cervical lymphadenopathy
Less likely:
- chills, myalgias, cough, diarrhea, constipation, pruritus, urticaria
What are the symptoms of icteric phase?
- elevated conjugated Bili
- pale clay coloured stool
- dark urine (jaundice)
- jaundice
What is the protocol of close contact post exposure prophylaxis?
close contact post exposure prophylaxis with immunoglobulin (IG) within 2 weeks after the last exposure if NOT immunized
- 68-89% effective
- High risk (immunocompromised, chronic liver disease): hep A vaccine + IG
- Infant < 12 mo: only IG
- All others: Hep A vaccine
common pathogens
- overall
- Neonates (0-1mo)
- Newborn (1-23mo)
- common Gram negative
- common viral
- overall 75% S. pneumonia, N. Meningitides
- Neonate: LEG
- Listeria
- E. coli
- Group B strep
- Newborn: SHN
- S. pneumonia
- H. influenza
- N. Meningitides
- Gram neg bacilli: Klebsiella, E. coli, Serratia, pseudomonas
- Viral: HSV
populations susceptible to LEG
risk factors*
- HIV*
- trauma/neuro surgery*
- immunosuppression/immunocompromised*
- malignancy*
- T2DM*
- hepatic/ renal failure*
- iron overload
- collagen vascular dz
- Alcoholism
prevention of traveller’s diarrhea
- bismuth subsalicylate (Pepto)
- fluoroquinolones (not for children < 16 years old)
- — Norfloxacin
- — Ciprofloxacin
treatment of mild to moderate traveller’s diarrhea (< 3BM/d, no blood no fever)
- Loperamide 4mg x1, then 2mg up to max 8 doses
- Bismuth subsalicylate (pepto)
RX of severe traveller’s diarrhea (> 3BM/d, blood, or fever)
- Azithromycin 1000mg x1 or 500mg BID x 1-3 days
2nd line: norfloxacin
Medical conditions that need prophylaxis for IE (endocarditis)
1) prosthetic heart valve or prosthetic material used for cardiac repair
2) hx of bacterial endocarditis
3) unrepaired cyanotic congenital heart disease
4) during the first 6 months after complete repair of a congenital heart defect with prosthetic material device
5) repaired congenital heart disease with residual defects that inhibit endothelialization
6) cardiac transplantation recipient who develop cardiac valvulopathy
Rx for IE prophylaxis
Amoxicillin 2g (50mg/kg) 30-60 min prior to procedure
Rx of epididymitis
suspected chlamydia/ gonorrhea
—- doxycycline + ceftriaxone IM
> 35 y/o
– ciprofloxacin / Levofloxacin
< 35 y/o OR multiple sex partners
– Cefixime/ Ceftriaxone + Azithromycin/ Doxycycline
symptoms of malignant neuroleptic syndrome
- fever
- delirium (cognitive change)
- diaphoresis (autonomic instability)
- muscle rigidity
- tremor
lab
leukocytosis
elevated CK
management of malignant neuroleptic syndrome
- HOLD antipsychotics
- ABCs
- aggressive hydration
- cooling blankets, ice packs
- ? Dantrolene sodium po + bromocriptine po
IE symptoms
- heart murmur
- petechiae
- subungual (splinter) hemorrhages
- Osler nodes (tender, finger pads)
- Janeway nodes (non-tender, palms/soles macule)
- Roth spots (retinal hemorrhage)
- Neuro (embolic stroke), CHF, stiff neck, delirium
Heat stroke symptoms
- change of LOC (confusion, delirium, coma)
- anhidrosis (non-exertional) or diaphoresis (exertional)
- ataxia, tremor
- convulsion
- hypotension (e.g. dizziness, thirst, weakness)
- pulmonary edema
- arrhythmia
- oliguria, AKI, renal failure
- headache
- flushing
- vomiting, diarrhea, abdominal muscle cramps
- rhabdomyolysis
meds related to heat stroke
cocaine and amphetamines
complications of heat stroke
- AKI or renal failure
- rhabdomyolysis
- pulmonary edema
- CNS damage: cerebellar deficits, dementia, hemiplegia, quadriparesis, and personality changes
- Acute liver failure
management of heat stroke
- aggressive cooling
Immediate administration of benzodiazepines is indicated in patients with agitation and shivering, to stop excessive production of heat
complicated UTIs indications
- male
- pregnancy
- recent urinary tract instrumentation/ catheter
- anatomical abnormality
- chronic renal disease
- T2DM
- immunosuppressed
indications of renal bladder ultrasound
CPS guideline:
all children < 2 y/o within 2 weeks of 1st febrile UTI
Indications of Voiding cysto-urethrogram (VCUG)
CPS guideline
1) abnormal renal bladder ultrasound OR
2) < 2 y/o + 2nd well documented UTI
Criteria of SIRS (systemic inflammatory response syndrome)
2 or more of the following:
(1) Temp < 36 or Temp > 38
(2) Leuks < 4 or > 12 or >10% immature [band] forms
(3) RR > 20 OR SaCO2 < 32
(4) HR > 90
What is the GA safe for medical abortion?
as effective as SA: 49d (7 wks) from LMP
max: 70d (10 wks) from LMP
medications used for medical abortion
mifepristone & misoprostol
contraindications of induction of labour
- previous uterine rupture
- fetal transverse lie
- placenta previa/ vasa previa
- invasive cervical cancer
- active genital herpes
what is the normal range of fetal heart rate (FHR) before delivery?
120-160 bpm
common causes of abnormal FHR
Severe bradycardia (< 100bpm): hypoxia mild bradycardia (100-120): occipital/ temporal position
Severe tachycardia ( > 180-200): chorioamnionitis (mother having fever)
causes of FHR accelerations
FHR accelerations are “reassuring” signs
- fetal movement
- uterine contraction
- umbilical cord compression
- vaginal exam
- external acoustic stimulation
- fetal scalp stimulation
causes of FHR decelerations
Early deceleration (mirror contraction) - reassuring, not associated with fetal distress
- slow onset with the start of contraction and slow return with the end of contraction
- fetal head compression during uterine contraction
Late deceleration - potentially ominous
- “uteroplacental insufficiency” provoked by uterine contraction
- etiology: maternal hypotension/ acidosis, uterine hyperstimulation
VARIABLE DECELERATIONS - non-reassuring
- most common pattern during labour
- due to compression of umbilical cord
absolute contraindications for fibrinolytic use in STEMI
- Prior intracranial hemorrhage (ICH)
- Known structural cerebral vascular lesion
- Known malignant intracranial neoplasm
- Ischemic stroke within 3 months
- Suspected aortic dissection
- Active bleeding or bleeding diathesis (excluding menses)
- Significant closed head trauma or facial trauma within 3 months
- Intracranial or intra-spinal surgery within 2 months
- Severe uncontrolled hypertension (unresponsive to emergency therapy)
- For streptokinase, prior treatment within the previous 6 months
