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TC Oral boards > Infectious Disease > Flashcards

Infectious Disease Flashcards

1
Q

CMV

Clinical symptoms

A

DS DNA herpes virus

Mono like syndrome with fever, chills, myalgias, malaise, abnormal liver function tests, lymphadenopathy

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2
Q

Clinical findings of congenital CMV

A 
Chorioretinitis
Microcephaly
IUGR
Mental retardation
Abdominal , liver, Cerebral calcifications

** most common congenital infection**

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3
Q

What is the typical sequelae of secondary CMV infection

A

Congenital hearing loss

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4
Q

What is parvovirus B 19

What are clinical manifestations?

A

SS DNA virus that replicates in bone marrow

Children may have facial rash, slapped cheek, fever, body rash, joint pain

In adults, reticular rash on trunk, peripheral arthropathy, aplastic crisis. Most are asx

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5
Q

Fetal effects of Parvovirus

A 
SAB
HYDROPS* (most often from aplastic anemia but can result from heart failure, chronic fetal hepatitis)
Periventricular calcifications
STILLBIRTH
MYOCARDITIS

Increased risk of Neurodevelopmental impairment in fetuses with hydrops

Need weekly US for 2 mo after exposure

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6
Q

US findings of congenital CMV

A 
Abdominal and liver calcifications
HSM
Bowel or kidneys, echogenic
Ascites
Intracranial calcifications
Microcephaly
Cerebral ventriculomegaly
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7
Q

What are the signs of congenital varicella

When is the risk highest

A

Skin scarring
Limb hypoplasia
Chorioretinitis
Microcephaly

Second trimester, 2%

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8
Q

Ultrasound findings suggestive of congenital varicella

A

Hydrops, cardiac malformation, microcephaly, growth restriction
Limb deformities

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9
Q

What is the greatest Maternal threat with varicella

A

Up to 20% of pregnant patients with varicella develop varicella pneumonia which has a 40% mortality rate

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10
Q

Manifestations of congenital rubella syndrome

A 
Eyes- Cataracs, retinopathy
Heart- PDA
Deafness
Microcephaly
Neurologic,  Behavioral disorders and mental disability

Risk of infection is highest if exposure is less than 11 weeks

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11
Q

Treatment for Toxo

A

Pregnant women: spiramycin

Fetus: pyrimethamine, sulfadiazine, folinic acid

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12
Q

When is risk of CMV transmission highest?

Most severe?

A

Third tri

More serious sequelae after 1st tri infection

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13
Q

What is Toxo?

Sxs?

A

Intercellular parasite

Asx cervical LAD, Fever, malaise, night sweats, HSM

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14
Q

Neonatal sequelae of Toxo

A

Chorioretinitis
Hearing loss
Developmental delay
Visual impairment

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15
Q

HIV-status unknown presenting in labor

A 
Rapid testing
Negative result is not definitive
If positive, treat without waiting for confirmatory testing
Deliver for CD if SROM HAS NOT occurred
Postpone breastfeeding until confirmed
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16
Q

Route of delivery for HIV

A

VL >1000 CD 38w
<1000 vag del

No need to admin Zidovudine if VL consistently <1000 in third tri AND pt is taking cART

VL unknown and SROM has not occurred CD

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17
Q

Classic triad for Toxo

A

Chorioretinitis
Hydrocephalus
Intracranial calcifications

18
Q

Diagnostic criteria for intra-amniotic infection

Treatment

A

38-38.9
Plus fetal tachy for 10 min
Leukocytosis 15K
Purulent cervical d/c

OR

fever 39 C

Amp/gent
Mild PCN al: an ancef//gent
SEVERE: Gent /clinda or Vanc
Alt: unasyn zosyn

Administer one additional dose of antibiotics after cesarean plus Clinda or metronidazole to cover anaerobes

19
Q

Maternal treatment for varicella

Fetal treatment

A

Acyclovir oral

Varicella zoster Immunoglobulin should be given to infants of women who develop varicella 5 days before to 2 days after delivery
If sxs, treat with IV acyclovir

20
Q

Pre-exposure prophylaxis for HIV

A

Tenofovir

Emtricitabine

21
Q

Intrapartum antiretroviral therapy

A

Zidovudine 2mg/kg 3 hours before CD then 1 mg/kg/h

Not necessary if VL less than 50

22
Q

Mortality rate for hepatitis D

A

25%
Hepatic failure
Co-infection with Hep B

23
Q

What is the leading cause of chronic liver disease in the United States

Worldwide?

A

Hepatitis C

Hepatitis B

24
Q

Is breast-feeding contraindicated and women chronically infected with hepatitis B

A

Not as long as the infant received HBIG and vaccine

Not contraindicated with Hep C

25
Q

Treatment for hepatitis B

A

Tenofovir preferred

Lamivudine

26
Q

Treatment for Hep C

A

Ribavirin

Contra-indicated in pregnancy

27
Q

Treatment for newborns of Hep B pt

A

HBIG

and hepatitis B vaccine within 12 hours of birth

28
Q

Characteristics of early congenital syphilis

A

Less than two years of age

HSM, desquamating skin rash, osteochondritis, anemia, thrombocytopenia

29
Q

Characteristics of late congenital syphilis

A

> 2 yrs of age
Hutchinson’s triad: notched teeth, deafness, interstitial keratitis
Developmental delay, seizures, nerve palsy’s also may occur

30
Q

Treatment for congenital syphilis

A

Aqueous PCN G 18-24 million u/d IV For 10-14d

31
Q

Characteristics of primary syphilis

A

Three weeks after infection

Painless chancre, lymphadenopathy

32
Q

Clinical manifestations of secondary syphilis

A

4-10w after appearance of chancre
Maculopapular skin rash, Mucosal lesions, genital condyloma, generalized LAD
Malaise, arthralgia, fever

33
Q

Treatment for primary and secondary and latent syphilis

A

2.4 million units IM PCN G
Two weekly doses for primary and secondary
Three weekly doses for latent

34
Q

Placenta manifestations of syphilis

A

And gross examination, large, pale, hydropic

Micro examination, enlarged terminal villi, chronic villitis, Hofbauer cells

35
Q

Direct and indirect diagnostic test for syphilis

A

Direct detection
Darkfield microscopy
PCR

OR

Serological tests

Nontreponemal
RPR
VDRL

TREPONEMAL
fluorescent treponemal antibody
Absorption
T. Palladium particle agglutination

36
Q

Adverse pregnancy outcomes of congenital syphilis

A 
Stillbirth
Preterm birth
IUGR
HYDROPS
polyhydramnios 
Neonatal mortality
37
Q

Treatment after exposure to syphilis

A

Treatment for a presumed early syphilis is recommended for women exposed to a partner with primary, secondary or early late and syphilis in the past 90 days

38
Q

Jarisch-Herxheimer reaction

A

Acute febrile reaction characterized by myalgia, fever, headache, possible preterm labor and fetal heart rate tracing abnormalities

39
Q

Definition of adequate treatment response to syphilis

A

Fourfold decline in non-treponemal titers within 6 to 12 months after therapy

40
Q

When should re-infection but I suspect

A

RPR titer 1:8 or greater

TC Oral boards (38 decks)

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