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Royal Super 4th Year Brain > Infectious Disease > Flashcards

Infectious Disease Flashcards

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1
Q

What infections to screen for in the immigrant population?

A
  • HIV
  • TB
  • Syphilis
  • Hepatitis A, B, C
  • Strongyloides
  • Schistosomiasis
  • Malaria
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2
Q

When do you expect oral CC’s and epi neb to kick in and when to expect it to fade?

A

CC’s: Within 2-3 hours, off by 24-48 hours.

Epi: Within 10-30 min, off by 1-2 hours.

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3
Q

Bugs causing septic arthritis for <3 mo, >3mo, and >36mo age groups?

A
  • All: MSSA, MRSA
  • <3 mo: GBS, N. gonorrhea
  • 3-36 mo: S. pneumo, GAS, Kingella
  • > 36 mo: N. gonorrhea, S. pneumo
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4
Q

Live vaccines.

A

MMR, rotavirus

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5
Q

Complications of varicella infection

A
  • Encephalitis
  • Cerebellar ataxia
  • Necrotizing fasciitis secondary to GAS bacterial infection
  • PNA
  • Sepsis
  • Death
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6
Q

What antibiotic to give to those following exposure to invasive meningococcal C disease?

A

Rifampin

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7
Q

3 most common parasitic protozoa

A

Entamoeba
Giardia
Cryptosporidium

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8
Q

3 most common parasitic worms

A

Tape worms
Pin worms
Ascaris

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9
Q

Who gets 4th dose of pneumococcal vaccine conjugate 13? (list some medical conditions included)

A

High risk kids! = asplenia, immunosuppressed, transplant, malignancy, chronic neurological condition, cochlear implants, DM

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10
Q

Rare side effect with acellular vaccine (e.g., pertussis)?

A

Hypotonic hyporesponsive episodes in infants

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11
Q

Rocky Mountain Spotted Fever - bug, rash, other features, treatment

A 
Rickettsia rickettsii (tick)
Rash = blanching maculopapular, petechiae (day 1-3), flexure surfaces, involves palms/soles
Other = fever, N/V, myalgia, headache
Treatment = doxy
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12
Q

Roseola - bug, age group, course, rash

A

HHV-6
6-24 months
Course = abrupt onset of fever, no prodrome, rash within 24h of defervescence
Rash = discrete erythematous maculopapular rash to face/neck/trunk, Nakayama spots (erythematous mucosal spots)

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13
Q

HHV 1-8

A
  1. HSV 1
  2. HSV 2
  3. VZV
  4. EBV
  5. CMV
  6. Roseola
  7. HHV-7
  8. Kaposi sarcoma
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14
Q

Causes of elevated CSF protein

A 
Infection = bacterial, viral
Inflammatory = GBS, MS, peripheral neuropathy, post-infectious encephalopathy
Tumor
Vascular events
Degenerative disorder
Metabolic disorder = uremia
Toxins = lead
Prematurity
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15
Q

x1 bacteria and x1 virus that cause both AOM and conjunctivitis

A

Adenovirus

H. influenza

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16
Q

Bacterial conjunctivitis etiologies - neonate, child, adolescent

A 
Neonate = C+G, S. aureus, H. influenzae
Children = S. aureus, S. pneumo, H. influenzae, M. catarrhalis
Adolescent = S. aureus, S. pneumo, H. influenzae, M. catarrhalis, acinetobacter, streptococcus
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17
Q

Bugs causing periorbital and orbital cellulitis

A 
Periorbital = S. pneumo, H. influenzae, S. aureus, GAS
Orbital = Staph, strep, anaerobic
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18
Q

Sources of infection for periorbital vs orbital cellulitis

A 
Periorbital = trauma, direct inoculation, sinuses
Orbital = sinuses
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19
Q

Physical exam findings that differentiate orbital cellulitis from periorbital cellulits

A

Decreased visual acuity, proptosis, decreased EOM, decreased pupillary response

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20
Q

x2 primary mechanisms for resistance to B-lactam Abx. What class of antibiotics can get around this and how can penicillins try to get around this?

A

Mechanisms: Penicillin binding proteins (prevents Abx from binding to active site), B-lactamase (hydrolyze B-lactam ring)

  • Penicillin can increase dose to get around PBP’s
  • Carbapenems can bind PBP’s and are resistant to B-lactamase
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21
Q

What vaccine is important in preventing MRSA related complications?

A

Influenza

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22
Q

Ddx for fever and petechiae

A
  • ID: sepsis, TSS, viral (adeno, entero, mono), KD, meningococcemia, travel related (rocky mtn, dengue fever, typhus, arbovirus)
  • Thrombocytopenia = HSP, ITP
  • Drug hypersensitivity
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23
Q

CHEAP TORCHES-Z

A

Chicken pox, hepatitis, enterovirus, AIDS, parvo, toxo/TB, other, rubella, CMV, HSV, every other STD, syphilis, zika

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24
Q

Classic findings for CMV congenital infections

A

IUGR, jaundice, thrombocytopenia, hepatomegaly, microcephaly, chorioretinitis, SNHL, seizures

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25
Q

At what day of life is a CMV infection labelled acquired and probable

A

after 21 days

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26
Q

Tx for CMV congenital infections categorized for ALL moderate to severe symptomatic neonates

A

6 months of oral valganciclovir

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27
Q

Risk of vertical transmission with untreated primary or secondary syphilis

A

70-100%

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28
Q

Classic features of congenital syphilis

A

Prematurity, IUGR, snuffles, HSM, aseptic meningitis, salt+pepper chorioretinits, demineralization of bones, rash

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29
Q

Late manifestations of untreated syphilis for children

A

GDD, SNHL, Hutchinson’s teeth, mulberry molars

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30
Q

Cause of false positive RPR for syphilis

A

SLE

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31
Q

Toxoplasmosis congenital infection - classic features

A

Hydrocephalus, macrocephaly, intracranial calcifications, chorioretinitis

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32
Q

Toxoplasmosis - things to avoid in pregnancy

A

Cat urine, game meat, whale blubber

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33
Q

CVS manifestation for congenital rubella

A

PDA

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34
Q

How do you get exposure to TB?

A

Active pulmonary TB

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35
Q

x2 tests for latent TB

A

Mantoux, Quantiferon gold

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36
Q

x3 tests for active TB

A

Gastric aspirate, AFB + mycobacterial culture in sputum/aspirate/BAL, CXR

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37
Q

False negative TST causes

A
  • Poor technique
  • Other infection
  • Medications, vaccines
  • Disease
  • <6 month
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38
Q

TB medications x4

A

R- rifampin
I- isoniazide
P- pyrazinaminde
E- ethambutol

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39
Q

What infection should you always check in setting of immunodeficiency work-up?

A

HIV

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40
Q

High risk features x2 for neonatal HSV

A

First/primary episode for mom, vaginal or C/S with ROM

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41
Q

What to swab for HSV in a newborn/infant?

A

Oral, eye, skin

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42
Q

Classic rash for Lyme Disease

A

Erythema migrans

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43
Q

Skin complication following VZV infection

A

Nec fasc

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44
Q

Length of treatment for uncomplicated bacterial meningitis - GBS, H. influenza, N. meningitidis, and S. pneumo

A

N. meng = 5-7 days, H. influ = 7-10 days, S. pneumo = 10-14 days, GBS = 14-21 days

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45
Q

Complications of GAS pharyngitis?

A
  • suppurative = sepsis, peritonsillar abscess, RPA

- non suppurative = PSGN, ARF

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46
Q

Clinical criteria for GAS pharyngitis

A

CENTOR- must have at least 3

Fever, tender anterior cervical LAD, inflamed/exudative tonsils, no cough

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47
Q

What complication does Abx NOT help prevent in GAS pharyngitis?

A

PSGN

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48
Q

What time frame do you have to start Abx for GAS?

A

Within 9 days of symptom onset

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49
Q

First line tx for GAS pharyngitis

A

10d of amox or penicillin

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50
Q

Abx choice for community (bacterial, atypical) and hospital (uncomplicated, complicated)?

A
  • Outpatient = amox (bacterial), azithro (atypical)

- inpatient = amp, CTX +- vanco (complicated)

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51
Q

Travel infections to consider with jaundice

A
  • viral = hep A/C/E, viral hemorrhagic fever
  • bacterial = typhoid fever, leptospirosis
  • parasite = malaria
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52
Q

Traveller’s diarrhea pathogens (x3 categories)

A
  • viral = rotavirus
  • bacterial = E. coli, shigella, salmonella, campylobacter, yersinia
  • parasitic = giardia, amebiasis
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53
Q

Three most important causes of travel related fever

A

Malaria, traveller’s diarrhea, dengue

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54
Q

Medical emergency for what type of malaria

A

Plasmodium falciparum

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55
Q

Pathogens in typhoid fever

A

Salmonella typhi and paratyphi

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56
Q

Pathogen for dengue fever

A

Flavivirus - from mosquitoes

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57
Q

3 diagnostic criteria for AOE in CPS Statement

A
  • Rapid onset
  • Symptoms of ear canal inflam = otalgia, pruritus, fullness, hearing loss, jaw pain
  • Signs for ear canal inflammation = tragus/pinna tender, edema/erythema, LAD, otorrhea
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58
Q

Management of AOE

A

Topical Abx with steroid for 7-10 days

Analgesia

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59
Q

X2 most common pathogens for AOE

A

S aureus

Pseudomonas

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60
Q

How to distinguish AOE from AOM?

A

Tender to tragus and pinna

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61
Q

Infection associated with necrotizing funisitis (barbershop pole)

A

Syphilis

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62
Q

Dental manifestations of congenital syphilis

A

Hutchinson teeth, mulberry molars

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63
Q

Tx for congenital syphilis

A

IV penicillin G x10 days

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64
Q

What three patient factors do you worry about for disseminated disease for non-typhoidal salmonella infection?

A
  • Immunocompromised children
  • Asplenia
  • <3 months old
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65
Q

When and for what type of salmonella infection do you need to check for negative stool cultures?

A

-For typhoid/paratyphoid fever following completion of antibiotics

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66
Q

Patients at high risk for severe influenza

A

Children <5 years old, cardiac or pulmonary disorders, DM, renal disease, anemia or hemoglobinopathy, cancer, immune improvised state, obesity, neuro conditions, prolonged tx with ASA, indigenous patients, chronic care facilities, pregnant women

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67
Q

Options for influenza antiviral with type of preparation

A
  • Oseltamivir: oral
  • Zanamivir: disk inhaler
  • Peramivir: IV
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68
Q

Duration of influenza antiviral treatment

A

5 days

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69
Q

Exceptions of immunocompromised populations for live vaccines

A

IgA def, IgG def, complement def, asplenia, non severe HIV, phagocytize/neutrophil disorders (no live bacteria vaccines)

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70
Q

When can you provide vaccines prior to planned immunosuppressive?

A
  • live = at least 4 weeks prior

- inactivated = at least 2 weeks prior

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71
Q

When can you provide vaccines after d/c steroids, chemo, and anti-B Ab

A

1 month, 3 months, 6 months

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72
Q

When can you re-immunize post-hematopoietic stem cell transplant?

A
  • live = 24 months after

- inactivated = 3-12 months after

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73
Q

When can you re-immunize post-solid organ transplant?

A
  • case by case for live

- Inactivated 3-6 months

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74
Q

Non-TB mycobacterial infection - presentation of LAD (location, appearance, symptoms)

A
  • Submandibular or anterior/superior cervical
  • Mildly tender
  • Intensely erythematous
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75
Q

Non-TB mycobacterial infection - management of LAD

A
  • Observation = controversial
  • Excision
  • Abx - clarithromycin, rifampin, ethambutol
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76
Q

Cat scratch disease - organism + how it spreads

A

Bartonella henselae - oral flora in cats (sometimes dogs)

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77
Q

Cat scratch disease - typical presentation (LN’s involved)

A
  • LN’s = swollen, tender, erythematous, fluctuant
  • Location = axillary, cervical, pectoral
  • Fever = low/absent
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78
Q

Cat scratch disease - management of lymphadenitis

A
  • Most spontaneously resolve without tx
  • NO EXCISION
  • Abx for severe cases + immunocompromised - azithro, cipro, septra, rifampin, gentamicin x5 days
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79
Q

Infectious mononucleiosis - presentation

A

Fever, pharyngitis, LAD, splenomegaly

-Other = malaise, HA, anorexia, myalgias, chills, nausea

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80
Q

What is EBV associated with from a heme/onc perspective (x4 things)?

A
  • Post transplant lymphoproliferative d/o
  • Burkitt lymphoma
  • Nasopharyngeal carcinoma
  • Undifferentiated T+B cell lymphoma
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81
Q

What 3 bugs do patients with asplenia need additional immunization coverage for?

A
  • S. pneumo
  • H. influenza
  • N. mening.
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82
Q

What vaccines (and timing of doses) against pneumococcus should be given for patients with asplenia?

A
  • PCV13: 2, 4, 6, and 12-15 months of age

- PCV23: given 8 weeks after receipt of above, booster q5 years

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83
Q

What bug is important to vaccinate against and what bug is important to prophylax against for patients with asplenia who are travelling?

A
  • Salmonella typhi

- Malaria prophylaxis

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84
Q

Potential adverse effect secondary to rotavirus?

A

Intussusception

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85
Q

At what age must the last dose of rotavirus vaccine be given and why?

A

By 8 months of age - higher risk of intussusception afterwards

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86
Q

Contraindications to rotavirus

A
  • Immunocompromised (e.g., SCID)
  • Hypersensitivity to ingredients
  • Hx of intussusception or greater risk to intussusception
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87
Q

RSV Vaccine recommendations: eligible populations, populations to consider, and ineligible populations?

A
  • Eligible: CLD, hemodynamically significant CHD, remote communities requiring air transport for <36+0wk
  • Consideration: Preterm (<30+0wk), home O2, prolonged hospitalization for pulmonary disease, severely immunocompromised
  • Ineligible: immunodeficiencies, Down Syndrome, CF, upper airway obstruction, chronic pulmonary disease, breakthrough RSV infection
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88
Q

x7 medical conditions that cause pt to be immunocompromised

A
  • HIV
  • HSCT
  • Solid organ transplant
  • Malignancy
  • Asplenia
  • SCID
  • Aplastic anemia
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89
Q

x5 medications that cause pt to be immunocompromised

A
  • High dose CC’s
  • Chemo
  • Antimetabolites
  • Transplant immunosuppressive agents
  • Biologics
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90
Q

What to treat infant born via C/S to mother positive for N. gon?

A

x1 CTX IM or IV

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91
Q

x3 complications of N. gon ophthalmia neonatorum

A
  • Corneal ulceration
  • Perforation of globe
  • Permanent vision impairment
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92
Q

Polio - transmission of infection

A

Fecal-oral

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93
Q

Polio - test sample

A

Stool

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94
Q

Complication of polio (x1) - what is it?

A

Paralytic poliomyelitis = acute onset of asymmetric flaccid paralysis

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95
Q

Measles - classic presentation

A
  • Cough, coryza, and conjunctivitis
  • Descending maculopapular rash
  • Koplick spots
96
Q

Measles - x4 complications

A

-AOM, PNA, encephalitis, death

97
Q

What infectious cause MUST be excluded in a child with congenital cataracts?

A

Congenital rubella syndrome

98
Q

In what vaccine preventable disease does herd immunity play no role?

A

Tetanus

99
Q

Mumps - classic presentation + x5 complications

A
  • Classic: uni/bi-lateral parotitis, headache, myalgia, low-grade fever
  • Complications: orchiditis, mastitis, oophoritis, pancreatitis, meningitis/encephalitis
100
Q

Risk of lyme disease if tick is removed vs if tick is engorged?

A

3% vs 25%

101
Q

Bug causing lyme disease + host that transmits it

A
  • Borrelia burdorferi

- Transmitted by infected black-legged tick (Ixodes)

102
Q

Clinical presentation for Lyme Disease

A
  • Early cutaneous disease: EM

- Late extracutaneous disease: facial nerve palsy, arthritis, heart block/carditis, meningitis, peripheral neuropathy

103
Q

How to diagnosis Lyme Disease?

A
  • Early disease: clinical

- Late disease: 2-tier with ELISA then Western blot confirmatory test

104
Q

Abx for Lyme Disease - first line

A

-Doxycycline 4mg/kg

105
Q

Reaction that can occur when starting Abx treatment for Lyme Disease + treatment

A

Jarisch-Herzheimer reaction = fever, HA, myalgia, aggravated clinical picture
-NSAIDs

106
Q

When to consider post-exposure Abx therapy for Lyme Disease? What abx to give?

A
  • If tick engorged + attached for >36 hours

- Doxy 4mg/kg x1 dose within 72h of removal

107
Q

x2 populations to consider TB

A
  • Indigenous children

- Foreign born

108
Q

What source case of TB is highest risk for transmission?

A

With cavitary disease

109
Q

How does TB spread once in lungs?

A

By LN’s or hematogenous

110
Q

Pulmonary presentation of TB

A

-Mimic of PNA

111
Q

Disseminated presentation of TB

A
  • Constitutional symptoms

- Syndromic = PNA, meningitis, sepsis, osteoarticular infections

112
Q

TB reactivation RF’s

A
  • Immunosuppression - medications vs medical conditions (HIV)
  • Malnutrition
113
Q

Most important Ix for suspected TB (+alternative)

A
  • Sputum culture + AFB

- Alternative: from bronchoscopy or first AM fasting gastric aspirate

114
Q

What test is important to get in ALL children with TB?

A

HIV

115
Q

x2 screening TB tests

A
  • TST

- GuantiFERON-TB gold

116
Q

Treatment for C. diff based on mild, moderate, severe and complicated severe disease

A
  • Mild: Supportive, d/c offending agent
  • Moderate: Flagyl x10-14 days PO
  • Severe: Vanco x10-14 days PO
  • Complicated: Vanco PO + IV flagyl x10-14 days
117
Q

x1 major complication of C. diff?

A

-Toxic megacolon

118
Q

What classifies severe disease for C. diff infection?

A

-Systemic toxicity = high fever, rigors, hemodynamic instability, ileus, peritonitis, toxic megacolon

119
Q

x4 RF’s for C. diff

A
  • Hx of Abx therapy in last 12 weeks
  • Hx of anti-neoplastic agents
  • Hospitalization
  • Association with other diseases: immunosuppression (IBD, HIV, hypogamma) + manipulation of GI tract (GI surgery, feeding tube)
120
Q

What chemoprophylaxis to give for invasive meningococcal close contacts?

A

Rifampin

121
Q

Why do we add on vanco for children with sepsis?

A

Resistant strep pneumo, MRSA

122
Q

What other infections should you screen for in an individual with Hep C?

A

Hep A and B, HIV

123
Q

Is BF recommended with maternal Hep C?

A

Yes

124
Q

When should you test Hep C serology if there may have been exposure for neonates? What test to follow-up with if positive serology?

A

12-18 months, PCR

125
Q

Risk factors for Hep C transmission (x6)

A
  • Born to mother with HCV
  • Born or lived in region with high HCV prevalence
  • Injection, intranasal, or inhalation drug use with shared equipment
  • Unprotected sexual behaviours
  • Victim of sexual assault
  • Exposure to non-sterile procedures or where IPC practices are not standardized
126
Q

Difference between newly acquired primary infection vs non-primary infection for maternal HSV?

A
  • Primary: no serum Ab

- Non-primary: present Ab

127
Q

x3 high risk aspects intrapartum for HSV transmission to neonates

A
  • First episode primary infection
  • Delivery via SVD (post-ROM)
  • OB procedures
128
Q

Why is a primary maternal HSV infection worse for transmission to baby than non-primary infection?

A

No transplacental transfer of neutralizing Ab

129
Q

x3 types of NHSV infection (and x1 with worse prognosis)

A
  • Disseminated HSV (worse)
  • Localized CNS
  • Skin, eye, mucous membrane infection
130
Q

Timeframe for neonatal HSV to present

A

-Typically within first 4 weeks of life (can be up to 6 weeks)

131
Q

Tx for NHSV including medicine, duration depending on type of infection, and x2 SE’s.

A
  • Acyclovir 60 mg/kg/day divided q8h
  • SEM x14 days
  • CNS/disseminated minimum x21 days
  • SE: neutropenia, nephrotoxicity
132
Q

What to do for baby if first maternal episode of HSV delivered via SVD or C/S post-ROM?

A
  • Take swabs
  • Start acyclovir
  • Even if Ix negative - still treat with x10 days of ACV
  • If swab positive - then full work-up to determine length of treatment (disseminated/CNS = 21 days, SEM = 14 days)
133
Q

3 possible sources of infection for organ transplant patients

A
  • Endogenous reactivation of latent pathogens
  • Transmission from donated organ/tissue
  • Transmission from within the community
134
Q

How soon before solid organ transplant can you given inactivated and live vaccines?

A
  • 2 weeks = inactivated

- 4 weeks = live

135
Q

What x8 bugs or opportunistic infections would be expected during the first 1-6 months post-solid organ transplant?

A
  • Viral: EBV, CMV, HHV-6, Hep B, Hep C

- Other: PJP, listeria, aspergillus

136
Q

What vaccine can you give prior to 6-12 months post-solid organ transplant?

A

-Influenza

137
Q

What vaccines are contraindicated to give post-solid organ transplant?

A
  • Rotavirus
  • Measles, mumps, rubella, varicella
  • BCG
138
Q

What antimicrobial prophylaxis do ALL solid organ transplant receipts receive?

A

-Septra = PJP

139
Q

Targeted age range to give HPV vaccine

A

ALL children 9-13 years of age

140
Q

What TORCH infection has a rash that involves palms/soles?

A

Syphilis

141
Q

What TORCH infection has (a) bony lucencies or (b) osteitis/perichondritis?

A

(a) Rubella

(b) Syphilis

142
Q

What TORCH infection has cicatricial scars?

A

VZV

143
Q

What TORCH infections have calcifications localized to (a) periventricular, (b) parenchymal, and (c) subcortical?

A

(a) CMV
(b) Toxo
(c) Zika

144
Q

What TORCH infection has limb hypoplasia?

A

VZV

145
Q

What TORCH infection has macrocephaly/hydrocephalus?

A

Toxo

146
Q

Indication to treat CMV and what anti-viral to use?

A

Mod-sev symptomatic disease (multiple manifestations or CNS disease)
-Valganciclovir

147
Q

What labs to do for neonate syphilis?

A

CBC, LFTs, serology (non-treponemal vs treponemal), LP, direct detection (umbilical cord, placental tissue)

148
Q

When to evaluate an infant for syphilis (x5)?

A
  • Signs/symptoms of congenital syphilis
  • Mother not treated or treatment not adequate (e.g., non-penicillin regimen)
  • Mother treated within 30 days of delivery
  • Less than a 4-fold drop in mother non-treponemal (RPR) titre or not documented
  • Mother had relapse or re-infection after treatment
149
Q

Tx for neonatal syphilis?

A

IV penicillin G x10 days

150
Q

When should you wait to conceive following travel to a area endemic with Zika?

A
  • Female = 2 months

- Male = 3 months

151
Q

If potential maternal Zika exposure, what do you do next?

A

Test maternal zika virus serology + PCR (if exposure in previous 4 weeks)

152
Q

What x2 situations can you get toxo?

A
  • Cats

- Undercooked/contaminated meat

153
Q

Classic triad (+quadrad) for congenital rubella?

A
  • PDA
  • Cataracts
  • SNHL
  • Blueberry muffin rash
154
Q

What TORCH infection is associated with thrombocytopenia?

A

CMV

155
Q

Dosing + duration of treatment of neonatal HSV

A

IV acyclovir 60 mg/kg/day

  • 2 weeks = isolated mucocutaneous disease
  • 3 weeks = disseminated + CNS disease
156
Q

If asymptomatic infant with mother with first episode of HSV active lesions born via SVD or C/S after ROM - what to do for Ix and Tx?

A
  • Empiric acyclovir
  • 24 hour swabs of mouth, nasopharynx, conjunctiva, and anus
  • If swabs positive = full work-up + treatment
  • If swabs negative = complete 10 days of IV acyclovir
157
Q

At what point in illness can you discontinue contact precautions for HSV neonatal infections?

A

-Once lesions are crusted

158
Q

What Abx should be added if you see pneumatoceles on CXR?

A

Vanco

159
Q

What x2 bugs would you consider adding steroids for bacterial meningitis?

A
  • H. influenzae

- S. pneumonia

160
Q

Dosing, duration, and timeframe to give dexamethasone for bacterial meningitis?

A

0.6 mg/kg/day divided q4h x4 days

To be given within 4 hours of Abx

161
Q

x3 scenarios when rifampin prophylaxis should be used for all household contacts in Hib

A
  1. At least one child <4 years of age who is unimmunized or incompletely immunized
  2. Child <12 months who has not completed primary Hib
  3. Immunocompromised child
162
Q

What x2 empiric Abx options for osteomyelitis are there and why would you choose one over the other?

A
  • Cefazolin + cloxacillin

- Choose cefazolin if child <4 years as higher risk of Kingella

163
Q

Duration of Abx treatment for osteomyelitis

A
  • Uncomplicated 3-4 weeks

- Septic hip 4-6 weeks

164
Q

GAS pharyngitis clinical decision rule + criteria

A

CENTOR - for 3-14 years old

  • Do a throat swab is =/> 3 points
  • One point for each: fever, cervical LAD, exudate on tonsils, no cough
165
Q

x4 risk factors for necrotizing fasciitis

A
  • GAS (recent pharyngitis, chickenpox)
  • Colonization of MRSA
  • Water-borne pathogen exposure (Aeromonas hydrophilia, Vibrio)
  • Clostridial or polymicrobial (recent GI surgery, abdo/pelvic focus, penetrating trauma)
166
Q

What antibiotics would you consider for necrotizing fasciitis?

A
  • Piptazo
  • Clinda
  • Vanco
167
Q

What antibiotic (and duration) would you use for invasive GAS contact chemoprophyalxis?

A

Cephalexin x10 days

168
Q

Who would meet criteria for GAS chemoprophylaxis?

A
  • Close contacts of CONFIRMED cases of SEVERE invasive disease
  • Household contacts = spend >4h/d with cause during previous 7 days
  • Non-household contacts = shared bed, sexual contacts, direct contact with mucous membranes, oral/nasal secretions, open skin lesions
169
Q

What is considered a severe case of invasive GAS disease (x3 examples of disease)?

A

TSS, soft tissue necrosis, meningitis

170
Q

For toxic shock what bug do you NOT require isolation for diagnosis?

A

Staph

171
Q

Strep TSS criteria

A
  • Hypotension/shock
  • PLUS at least 2 of: renal dysfunction, coagulopathy, scarlet fever rash, soft tissue necrosis, hepatic dysfunction, ARDS
  • PLUS isolation of S. pyogenes from a normally sterile body site
172
Q

Staph TSS criteria

A
  • Hypotension
  • Fever
  • Diffuse erythroderma
  • Desquamation
  • Dysfunction of at least 3 organ systems: renal, hepatic, blood, GI, mucous membranes, CNS
173
Q

x5 bacterial pathogens to think about for patients with asplenia

A
  • S. pneumo
  • N. meningitidis
  • H. influenzae
  • Capnocytophaga canimorsus (dog saliva)
  • Salmonella (food, water, reptiles)
174
Q

What bug (+syndrome) causes unilateral cervical nodes with ipsilateral conjunctivitis + splenomegaly?

A
  • Bartonella heselae (cat scratch)

- Perinaud oculoglandular syndrome

175
Q

What LN area is most likely to be affected by bartonella?

A

axillary

176
Q

What bug causes a chronically draining cervical node in a younger child with no TB or cat exposure?

A

Mycobacterium avium complex

177
Q

What are the two most common bacterial pathogens responsible for an acute unilateral adenitis?

A
  • S. aureus

- S. pyogenes

178
Q

How to diagnosis lyme disease?

A
  • Clinical if erythema migrans present

- Two step serologic testing: (1) screening ELISA + (2) confirmatory immunoblot for IgM and IgG

179
Q

Manifestations of late lyme disease (x4)?

A
  • Arthritis
  • Carditis
  • Isolated facial palsy
  • Meningitis
180
Q

Tx of early and late (range) lyme disease?

A

Early: doxycycline x10 days
Late: doxycycline x14-28 days

181
Q

When to consider prophylaxis for lyme disease?

A

-If exposure in known endemic region AND tick attached for >36 hours and within 72 hours of tick removal

182
Q

Difference between mild, moderate, severe, and severe complicated classifications of C. diff?

A
  • Mild: <4 stools per day
  • Moderate: >4 stools per day, minimal systemic toxicity
  • Severe: systemic toxicity
  • Complicated: shock, peritonitis, ileus, megacolon
183
Q

Management plan for (a) mild, (b) moderate, (c) severe, and (d) severe complicated C. diff?

A

(a) Stop offending agent
(b) PO flagyl x10-14 days
(c) PO vanco x10-14 days
(d) PO vanco + IV flagyl x10-14 days

184
Q

Who should have STI testing?

A

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

185
Q

First line options for uncomplicated gonococcal STI anogenital infection?

A
  • CTX 250mg IM x1 or cefixime 800mg PO x1

- PLUS azithro 1g PO x1

186
Q

x5 most important STI’s to test for and how to test?

A
  • First void NAAT: C+G

- Serology: HIV, syphilis, hepatitis B/C

187
Q

If untreated maternal N gonorrhea…what is Ix and Tx for neonate if (a) well vs (b) unwell?

A
  • If well: conjunctival Cx, CTX IM x1

- If unwell: blood/conjunctival/CSF Cx, ID consult (IV CTX)

188
Q

If untreated maternal chlamydia…what is Ix and Tx for a well neonate?

A
  • Monitor for PNA and conjunctivitis

- No culture required if asymptomatic

189
Q

What would you treat with in neonate with PNA and eosinophilia?

A

Erythromycin

190
Q

Complication of erythromycin in neonates

A

Pyloric stenosis

191
Q

MIS-C Criteria

A
  • Fever for =/+ 3 days
  • Clinical signs of multisystem involvement - at least 2 of the following:
    (a) Rash, bilateral non-purulent conjunctivitis, or mucocutaneous inflammation
    (b) Hypotension or shock
    (c) Cardiac dysfunction, pericarditis, valvulitis, or coronary abnormalities - echo or elevated trop/BNP
    (d) Coagulopathy - D-dimer, PT/PTT
    (e) Acute GI symptoms
  • Elevated markers of inflammation
  • No other obvious microbial cause of inflammation
  • Evidence of SARS-CoV-2 infection
192
Q

Who should be screened for TB (x5)?

A
  • Suspected active TB
  • Contact of known active TB
  • Visiting area for >3 months
  • Immigrating from area within last 2 years
  • Known risk factors for progression to disease (immunodeficiency)
193
Q

What to do if well child following TB exposure with normal CXR if (a) <5 years and (b) >5 years?

A

(a) TST negative = isoniazid (window prophylaxis) + rpt TST in 8-10 weeks
- TST positive = full course of prophylaxis
(b) Prophylaxis only if baseline or 8-10 week TST is positive

194
Q

Strategies to prevent vertical transmission of HIV

A
  • Antiretroviral therapy: triple ART (2nd trimester), IV zidovudine during labour, zidovudine x4 weeks for infant
  • Elective C/S if maternal viral load >1000/mL
  • Avoid breastfeeding
195
Q

x2 most common side effects of zidovudine

A

Anemia, neutropenia

196
Q

Evaluation of infant exposed to HIV - how to r/o HIV and how to confirm a dx of HIV for an infant

A
  • R/O HIV by x2 negative PCR at >1 month and >2 months of age
  • Confirmation by x2 positive PCR <18 months or reactive serology after 18-24 months
197
Q

x4 important aspects of evaluation for HIV+ child who presents to ED

A
  • Clinical status
  • Viral load
  • Immunologic status (CD4 count and percentage)
  • Antiretrovirals (therapy + adherence)
198
Q

x2 important things to note for children with HIV from an immune perspective - hint: one re: vaccines and two regarding increased risk for a certain bug

A
  • Vaccine responses are not as optimal

- At increased risk for pneumococcal disease

199
Q

If child is fully vaccinated against Hep B what is your first step in assessment/management following a potential exposure?

A

HBsAb

200
Q

If child is fully vaccinated against Hep B and HBsAb as well as HBsAg is negative following a potential exposure, what do you do?

A

HBIG + vaccine

201
Q

If child is NOT fully vaccinated against Hep B, what is your first step in assessment/management following a potential exposure?

A

HBsAg + HBsAb

202
Q

If child is NOT fully vaccinated against Hep B and HBsAg/HBsAb are both negative following a potential exposure, what do you do?

A

HBIG + vaccine

203
Q

If child is NOT fully vaccinated against Hep B and HBsAb is positive following a potential exposure, what do you do?

A

Complete vaccine series

204
Q

What x3 aspects should be included in risk assessment for HIV transmission in terms of needle stick injury?

A
  • Source: known HIV positive source
  • Device: Needle size, presence of blood
  • Injury: Extent of trauma, blood injected +/-, extent of exposure (non-intact skin, mucus membranes)
205
Q

Indications for VZIG (x5)

A
  • Immunocompromised without vaccination or or history of VZV
  • Hospitalized preterm >28 weeks GA whose mother lacks reliable VZV history
  • Hospitalized pretern <28 weeks GA regardless of mother’s status
  • If maternal VZV within 5 days pre or 2 days post delivery
  • Susceptible pregnant women
206
Q

Time window after exposure to give VZIG

A

Within 10 days

207
Q

If tetanus vaccines are up to date, last DTap was <10 years ago, + clean minor wound, what do you give?

A

Nothing

208
Q

If tetanus vaccines are up to date, last DTap was >10 years ago, + clean minor wound, what do you give?

A

Vaccine

209
Q

If tetanus vaccines are not up to date + clean minor wound, what do you give?

A

Vaccine

210
Q

If tetanus vaccines are not up to date + dirty wound, what do you give?

A

Vaccine + TIG

211
Q

If tetanus vaccines are up to date, last DTap was >5 years ago, + dirty wound, what do you give?

A

Vaccine

212
Q

If tetanus vaccines are up to date, last DTap was <5 years ago, + dirty wound, what do you give?

A

Nothing

213
Q

Most important/common serogroup for invasive meningococcal disease

A

B

214
Q

High risk groups for invasive meningococcal disease

A
  • Asplenia
  • Complement deficiency
  • HIV
  • Lab workers
  • Military living in close quarters
  • Travellers to endemic areas
  • Close contacts of a IMD case
215
Q

What meningococcal vaccine (+when) is offered to ALL children in Canada?

A

-Men-C-C at 12 months

216
Q

If high risk population, what IMD vaccines should be given and when?

A
  • Men-C-ACYW (quad): at 2 months x2 doses

- 4C-MenB: x2 doses

217
Q

How many doses of palivizumab does CPS recommend?

A

3-5

218
Q

Eligible populations for palivizumab?

A
  • CLD with ongoing O2 need/steroids/bronchodilators if <12 months at start of season
  • Hemodynamically significant CHD +/- ongoing diuretics if <12 months old at start of season
  • Preterm infants and Inuit term infants in remote communities if <6 months old at start of season
219
Q

Risk factors for AOM

A
  • Craniofacial abnormalities
  • Younger age
  • Around lots of children
  • Crowded home environment
  • Pacifier use
  • Exposure to cigarette smoking
  • Short duration of BF
  • Bottle feeding while lying down
  • First Nations + Inuit ethnicity
  • Fmhx of AOM
220
Q

Abx choices for AOM (including med, dose, duration)

A
  • Amoxcillin 75-90 mg/kg/day divided BID or 45-60 mg/kg/day divided TID x5 days (if >2yr) or x10 days (if <2 yr)
  • x10 days if TM perforated
  • Amox-clav: if tx failure, recent tx within 30 days
221
Q

What to do if child is >6 months, MEE present AND bulging TM, and mildly ill?

A

-Watchful waiting over 24-48h with close follow-up + analgesia

222
Q

What does moderately-severely ill look like in AOM?

A
  • Irritable, difficulty sleeping
  • Significant pain despite appropriate analgesia
  • Fever >39
  • Duration of illness >48 hours
223
Q

What do you do if AOM with perforated TM with purulent drainage?

A

Tx with Abx x10 days

224
Q

Complications of AOM

A
  • Mastoiditis
  • CN 6 and 7 palsy
  • Labyrinthitis
  • Meningitis
  • Venous sinus thrombosis
225
Q

x4 indications to give VZIG

A
  • Immunocompromised
  • Pregnant
  • If mother has VZV 5 days prior or 2 days after delivery
  • Hospitalized + premature with mother with no immunity
226
Q

When should you give rotavirus vaccine to a premature infant in the NICU?

A
  • At discharge

- When 8 weeks old

227
Q

Patient with parvo rash - when can they return to school + why?

A
  • As soon as feeling better

- Once rash appears = no longer contagious

228
Q

What is a significant amount of glucose in CSF compared to serum in bacterial meningitis?

A

<60% of serum glucose

229
Q

What is Ramsay Hunt and what is the treatment?

A
  • Triad of ipsilateral facial paralysis, ear vesicles, and ear pain from VZV reactivation
  • Tx with steroids + acyclovir
230
Q

What bug is Parinaud Oculoglandular Syndrome associated with?

A

-Cat scratch disease

231
Q

Risk of HIV transmission in blood products?

A

1 in 10 million

232
Q

HepBe antigen indicates…

A

Risk of infectivity

233
Q

Tx of measles

A

Vitamin A

234
Q

What is the risk of vertical transmission of HIV if (a) all precautions taken vs (b) no precautions taken?

A

(a) 1%

(b) up to 25%

235
Q

What bug to think about in a newborn with gram + bacilli

A

Listeria

236
Q

What should you consider as a test for TB in someone who has a history of bcg vaccine?

A

interferon gamma release assay

237
Q

How old must you be to receive (or consider) a live influenza vaccine?

A

> 2 yo

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