Infectious Disease Flashcards
1
Q
What infections to screen for in the immigrant population?
A
- HIV
- TB
- Syphilis
- Hepatitis A, B, C
- Strongyloides
- Schistosomiasis
- Malaria
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.
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
4
Q
Live vaccines.
A
MMR, rotavirus
5
Q
Complications of varicella infection
A
- Encephalitis
- Cerebellar ataxia
- Necrotizing fasciitis secondary to GAS bacterial infection
- PNA
- Sepsis
- Death
6
Q
What antibiotic to give to those following exposure to invasive meningococcal C disease?
A
Rifampin
7
Q
3 most common parasitic protozoa
A
Entamoeba
Giardia
Cryptosporidium
8
Q
3 most common parasitic worms
A
Tape worms
Pin worms
Ascaris
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
10
Q
Rare side effect with acellular vaccine (e.g., pertussis)?
A
Hypotonic hyporesponsive episodes in infants
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
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)
13
Q
HHV 1-8
A
- HSV 1
- HSV 2
- VZV
- EBV
- CMV
- Roseola
- HHV-7
- Kaposi sarcoma
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
15
Q
x1 bacteria and x1 virus that cause both AOM and conjunctivitis
A
Adenovirus
H. influenza
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
17
Q
Bugs causing periorbital and orbital cellulitis
A
Periorbital = S. pneumo, H. influenzae, S. aureus, GAS Orbital = Staph, strep, anaerobic
18
Q
Sources of infection for periorbital vs orbital cellulitis
A
Periorbital = trauma, direct inoculation, sinuses Orbital = sinuses
19
Q
Physical exam findings that differentiate orbital cellulitis from periorbital cellulits
A
Decreased visual acuity, proptosis, decreased EOM, decreased pupillary response
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
21
Q
What vaccine is important in preventing MRSA related complications?
A
Influenza
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
23
Q
CHEAP TORCHES-Z
A
Chicken pox, hepatitis, enterovirus, AIDS, parvo, toxo/TB, other, rubella, CMV, HSV, every other STD, syphilis, zika
24
Q
Classic findings for CMV congenital infections
A
IUGR, jaundice, thrombocytopenia, hepatomegaly, microcephaly, chorioretinitis, SNHL, seizures
25
At what day of life is a CMV infection labelled acquired and probable
after 21 days
26
Tx for CMV congenital infections categorized for ALL moderate to severe symptomatic neonates
6 months of oral valganciclovir
27
Risk of vertical transmission with untreated primary or secondary syphilis
70-100%
28
Classic features of congenital syphilis
Prematurity, IUGR, snuffles, HSM, aseptic meningitis, salt+pepper chorioretinits, demineralization of bones, rash
29
Late manifestations of untreated syphilis for children
GDD, SNHL, Hutchinson's teeth, mulberry molars
30
Cause of false positive RPR for syphilis
SLE
31
Toxoplasmosis congenital infection - classic features
Hydrocephalus, macrocephaly, intracranial calcifications, chorioretinitis
32
Toxoplasmosis - things to avoid in pregnancy
Cat urine, game meat, whale blubber
33
CVS manifestation for congenital rubella
PDA
34
How do you get exposure to TB?
Active pulmonary TB
35
x2 tests for latent TB
Mantoux, Quantiferon gold
36
x3 tests for active TB
Gastric aspirate, AFB + mycobacterial culture in sputum/aspirate/BAL, CXR
37
False negative TST causes
- Poor technique
- Other infection
- Medications, vaccines
- Disease
- <6 month
38
TB medications x4
R- rifampin
I- isoniazide
P- pyrazinaminde
E- ethambutol
39
What infection should you always check in setting of immunodeficiency work-up?
HIV
40
High risk features x2 for neonatal HSV
First/primary episode for mom, vaginal or C/S with ROM
41
What to swab for HSV in a newborn/infant?
Oral, eye, skin
42
Classic rash for Lyme Disease
Erythema migrans
43
Skin complication following VZV infection
Nec fasc
44
Length of treatment for uncomplicated bacterial meningitis - GBS, H. influenza, N. meningitidis, and S. pneumo
N. meng = 5-7 days, H. influ = 7-10 days, S. pneumo = 10-14 days, GBS = 14-21 days
45
Complications of GAS pharyngitis?
- suppurative = sepsis, peritonsillar abscess, RPA
| - non suppurative = PSGN, ARF
46
Clinical criteria for GAS pharyngitis
CENTOR- must have at least 3
| Fever, tender anterior cervical LAD, inflamed/exudative tonsils, no cough
47
What complication does Abx NOT help prevent in GAS pharyngitis?
PSGN
48
What time frame do you have to start Abx for GAS?
Within 9 days of symptom onset
49
First line tx for GAS pharyngitis
10d of amox or penicillin
50
Abx choice for community (bacterial, atypical) and hospital (uncomplicated, complicated)?
- Outpatient = amox (bacterial), azithro (atypical)
| - inpatient = amp, CTX +\- vanco (complicated)
51
Travel infections to consider with jaundice
- viral = hep A/C/E, viral hemorrhagic fever
- bacterial = typhoid fever, leptospirosis
- parasite = malaria
52
Traveller’s diarrhea pathogens (x3 categories)
- viral = rotavirus
- bacterial = E. coli, shigella, salmonella, campylobacter, yersinia
- parasitic = giardia, amebiasis
53
Three most important causes of travel related fever
Malaria, traveller’s diarrhea, dengue
54
Medical emergency for what type of malaria
Plasmodium falciparum
55
Pathogens in typhoid fever
Salmonella typhi and paratyphi
56
Pathogen for dengue fever
Flavivirus - from mosquitoes
57
3 diagnostic criteria for AOE in CPS Statement
- 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
58
Management of AOE
Topical Abx with steroid for 7-10 days
| Analgesia
59
X2 most common pathogens for AOE
S aureus
| Pseudomonas
60
How to distinguish AOE from AOM?
Tender to tragus and pinna
61
Infection associated with necrotizing funisitis (barbershop pole)
Syphilis
62
Dental manifestations of congenital syphilis
Hutchinson teeth, mulberry molars
63
Tx for congenital syphilis
IV penicillin G x10 days
64
What three patient factors do you worry about for disseminated disease for non-typhoidal salmonella infection?
- Immunocompromised children
- Asplenia
- <3 months old
65
When and for what type of salmonella infection do you need to check for negative stool cultures?
-For typhoid/paratyphoid fever following completion of antibiotics
66
Patients at high risk for severe influenza
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
67
Options for influenza antiviral with type of preparation
- Oseltamivir: oral
- Zanamivir: disk inhaler
- Peramivir: IV
68
Duration of influenza antiviral treatment
5 days
69
Exceptions of immunocompromised populations for live vaccines
IgA def, IgG def, complement def, asplenia, non severe HIV, phagocytize/neutrophil disorders (no live bacteria vaccines)
70
When can you provide vaccines prior to planned immunosuppressive?
- live = at least 4 weeks prior
| - inactivated = at least 2 weeks prior
71
When can you provide vaccines after d/c steroids, chemo, and anti-B Ab
1 month, 3 months, 6 months
72
When can you re-immunize post-hematopoietic stem cell transplant?
- live = 24 months after
| - inactivated = 3-12 months after
73
When can you re-immunize post-solid organ transplant?
- case by case for live
| - Inactivated 3-6 months
74
Non-TB mycobacterial infection - presentation of LAD (location, appearance, symptoms)
- Submandibular or anterior/superior cervical
- Mildly tender
- Intensely erythematous
75
Non-TB mycobacterial infection - management of LAD
- Observation = controversial
- Excision
- Abx - clarithromycin, rifampin, ethambutol
76
Cat scratch disease - organism + how it spreads
Bartonella henselae - oral flora in cats (sometimes dogs)
77
Cat scratch disease - typical presentation (LN's involved)
- LN's = swollen, tender, erythematous, fluctuant
- Location = axillary, cervical, pectoral
- Fever = low/absent
78
Cat scratch disease - management of lymphadenitis
- Most spontaneously resolve without tx
- NO EXCISION
- Abx for severe cases + immunocompromised - azithro, cipro, septra, rifampin, gentamicin x5 days
79
Infectious mononucleiosis - presentation
Fever, pharyngitis, LAD, splenomegaly
| -Other = malaise, HA, anorexia, myalgias, chills, nausea
80
What is EBV associated with from a heme/onc perspective (x4 things)?
- Post transplant lymphoproliferative d/o
- Burkitt lymphoma
- Nasopharyngeal carcinoma
- Undifferentiated T+B cell lymphoma
81
What 3 bugs do patients with asplenia need additional immunization coverage for?
- S. pneumo
- H. influenza
- N. mening.
82
What vaccines (and timing of doses) against pneumococcus should be given for patients with asplenia?
- PCV13: 2, 4, 6, and 12-15 months of age
| - PCV23: given 8 weeks after receipt of above, booster q5 years
83
What bug is important to vaccinate against and what bug is important to prophylax against for patients with asplenia who are travelling?
- Salmonella typhi
| - Malaria prophylaxis
84
Potential adverse effect secondary to rotavirus?
Intussusception
85
At what age must the last dose of rotavirus vaccine be given and why?
By 8 months of age - higher risk of intussusception afterwards
86
Contraindications to rotavirus
- Immunocompromised (e.g., SCID)
- Hypersensitivity to ingredients
- Hx of intussusception or greater risk to intussusception
87
RSV Vaccine recommendations: eligible populations, populations to consider, and ineligible populations?
- 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
88
x7 medical conditions that cause pt to be immunocompromised
- HIV
- HSCT
- Solid organ transplant
- Malignancy
- Asplenia
- SCID
- Aplastic anemia
89
x5 medications that cause pt to be immunocompromised
- High dose CC's
- Chemo
- Antimetabolites
- Transplant immunosuppressive agents
- Biologics
90
What to treat infant born via C/S to mother positive for N. gon?
x1 CTX IM or IV
91
x3 complications of N. gon ophthalmia neonatorum
- Corneal ulceration
- Perforation of globe
- Permanent vision impairment
92
Polio - transmission of infection
Fecal-oral
93
Polio - test sample
Stool
94
Complication of polio (x1) - what is it?
Paralytic poliomyelitis = acute onset of asymmetric flaccid paralysis
95
Measles - classic presentation
- Cough, coryza, and conjunctivitis
- Descending maculopapular rash
- Koplick spots
96
Measles - x4 complications
-AOM, PNA, encephalitis, death
97
What infectious cause MUST be excluded in a child with congenital cataracts?
Congenital rubella syndrome
98
In what vaccine preventable disease does herd immunity play no role?
Tetanus
99
Mumps - classic presentation + x5 complications
- Classic: uni/bi-lateral parotitis, headache, myalgia, low-grade fever
- Complications: orchiditis, mastitis, oophoritis, pancreatitis, meningitis/encephalitis
100
Risk of lyme disease if tick is removed vs if tick is engorged?
3% vs 25%
101
Bug causing lyme disease + host that transmits it
- Borrelia burdorferi
| - Transmitted by infected black-legged tick (Ixodes)
102
Clinical presentation for Lyme Disease
- Early cutaneous disease: EM
| - Late extracutaneous disease: facial nerve palsy, arthritis, heart block/carditis, meningitis, peripheral neuropathy
103
How to diagnosis Lyme Disease?
- Early disease: clinical
| - Late disease: 2-tier with ELISA then Western blot confirmatory test
104
Abx for Lyme Disease - first line
-Doxycycline 4mg/kg
105
Reaction that can occur when starting Abx treatment for Lyme Disease + treatment
Jarisch-Herzheimer reaction = fever, HA, myalgia, aggravated clinical picture
-NSAIDs
106
When to consider post-exposure Abx therapy for Lyme Disease? What abx to give?
- If tick engorged + attached for >36 hours
| - Doxy 4mg/kg x1 dose within 72h of removal
107
x2 populations to consider TB
- Indigenous children
| - Foreign born
108
What source case of TB is highest risk for transmission?
With cavitary disease
109
How does TB spread once in lungs?
By LN's or hematogenous
110
Pulmonary presentation of TB
-Mimic of PNA
111
Disseminated presentation of TB
- Constitutional symptoms
| - Syndromic = PNA, meningitis, sepsis, osteoarticular infections
112
TB reactivation RF's
- Immunosuppression - medications vs medical conditions (HIV)
- Malnutrition
113
Most important Ix for suspected TB (+alternative)
- Sputum culture + AFB
| - Alternative: from bronchoscopy or first AM fasting gastric aspirate
114
What test is important to get in ALL children with TB?
HIV
115
x2 screening TB tests
- TST
| - GuantiFERON-TB gold
116
Treatment for C. diff based on mild, moderate, severe and complicated severe disease
- 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
x1 major complication of C. diff?
-Toxic megacolon
118
What classifies severe disease for C. diff infection?
-Systemic toxicity = high fever, rigors, hemodynamic instability, ileus, peritonitis, toxic megacolon
119
x4 RF's for C. diff
- 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
What chemoprophylaxis to give for invasive meningococcal close contacts?
Rifampin
121
Why do we add on vanco for children with sepsis?
Resistant strep pneumo, MRSA
122
What other infections should you screen for in an individual with Hep C?
Hep A and B, HIV
123
Is BF recommended with maternal Hep C?
Yes
124
When should you test Hep C serology if there may have been exposure for neonates? What test to follow-up with if positive serology?
12-18 months, PCR
125
Risk factors for Hep C transmission (x6)
- 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
Difference between newly acquired primary infection vs non-primary infection for maternal HSV?
- Primary: no serum Ab
| - Non-primary: present Ab
127
x3 high risk aspects intrapartum for HSV transmission to neonates
- First episode primary infection
- Delivery via SVD (post-ROM)
- OB procedures
128
Why is a primary maternal HSV infection worse for transmission to baby than non-primary infection?
No transplacental transfer of neutralizing Ab
129
x3 types of NHSV infection (and x1 with worse prognosis)
- Disseminated HSV (worse)
- Localized CNS
- Skin, eye, mucous membrane infection
130
Timeframe for neonatal HSV to present
-Typically within first 4 weeks of life (can be up to 6 weeks)
131
Tx for NHSV including medicine, duration depending on type of infection, and x2 SE's.
- Acyclovir 60 mg/kg/day divided q8h
- SEM x14 days
- CNS/disseminated minimum x21 days
- SE: neutropenia, nephrotoxicity
132
What to do for baby if first maternal episode of HSV delivered via SVD or C/S post-ROM?
- 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
3 possible sources of infection for organ transplant patients
- Endogenous reactivation of latent pathogens
- Transmission from donated organ/tissue
- Transmission from within the community
134
How soon before solid organ transplant can you given inactivated and live vaccines?
- 2 weeks = inactivated
| - 4 weeks = live
135
What x8 bugs or opportunistic infections would be expected during the first 1-6 months post-solid organ transplant?
- Viral: EBV, CMV, HHV-6, Hep B, Hep C
| - Other: PJP, listeria, aspergillus
136
What vaccine can you give prior to 6-12 months post-solid organ transplant?
-Influenza
137
What vaccines are contraindicated to give post-solid organ transplant?
- Rotavirus
- Measles, mumps, rubella, varicella
- BCG
138
What antimicrobial prophylaxis do ALL solid organ transplant receipts receive?
-Septra = PJP
139
Targeted age range to give HPV vaccine
ALL children 9-13 years of age
140
What TORCH infection has a rash that involves palms/soles?
Syphilis
141
What TORCH infection has (a) bony lucencies or (b) osteitis/perichondritis?
(a) Rubella
| (b) Syphilis
142
What TORCH infection has cicatricial scars?
VZV
143
What TORCH infections have calcifications localized to (a) periventricular, (b) parenchymal, and (c) subcortical?
(a) CMV
(b) Toxo
(c) Zika
144
What TORCH infection has limb hypoplasia?
VZV
145
What TORCH infection has macrocephaly/hydrocephalus?
Toxo
146
Indication to treat CMV and what anti-viral to use?
Mod-sev symptomatic disease (multiple manifestations or CNS disease)
-Valganciclovir
147
What labs to do for neonate syphilis?
CBC, LFTs, serology (non-treponemal vs treponemal), LP, direct detection (umbilical cord, placental tissue)
148
When to evaluate an infant for syphilis (x5)?
- 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
Tx for neonatal syphilis?
IV penicillin G x10 days
150
When should you wait to conceive following travel to a area endemic with Zika?
- Female = 2 months
| - Male = 3 months
151
If potential maternal Zika exposure, what do you do next?
Test maternal zika virus serology + PCR (if exposure in previous 4 weeks)
152
What x2 situations can you get toxo?
- Cats
| - Undercooked/contaminated meat
153
Classic triad (+quadrad) for congenital rubella?
- PDA
- Cataracts
- SNHL
- Blueberry muffin rash
154
What TORCH infection is associated with thrombocytopenia?
CMV
155
Dosing + duration of treatment of neonatal HSV
IV acyclovir 60 mg/kg/day
- 2 weeks = isolated mucocutaneous disease
- 3 weeks = disseminated + CNS disease
156
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?
- 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
At what point in illness can you discontinue contact precautions for HSV neonatal infections?
-Once lesions are crusted
158
What Abx should be added if you see pneumatoceles on CXR?
Vanco
159
What x2 bugs would you consider adding steroids for bacterial meningitis?
- H. influenzae
| - S. pneumonia
160
Dosing, duration, and timeframe to give dexamethasone for bacterial meningitis?
0.6 mg/kg/day divided q4h x4 days
| To be given within 4 hours of Abx
161
x3 scenarios when rifampin prophylaxis should be used for all household contacts in Hib
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
What x2 empiric Abx options for osteomyelitis are there and why would you choose one over the other?
- Cefazolin + cloxacillin
| - Choose cefazolin if child <4 years as higher risk of Kingella
163
Duration of Abx treatment for osteomyelitis
- Uncomplicated 3-4 weeks
| - Septic hip 4-6 weeks
164
GAS pharyngitis clinical decision rule + criteria
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
x4 risk factors for necrotizing fasciitis
- 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
What antibiotics would you consider for necrotizing fasciitis?
- Piptazo
- Clinda
- Vanco
167
What antibiotic (and duration) would you use for invasive GAS contact chemoprophyalxis?
Cephalexin x10 days
168
Who would meet criteria for GAS chemoprophylaxis?
- 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
What is considered a severe case of invasive GAS disease (x3 examples of disease)?
TSS, soft tissue necrosis, meningitis
170
For toxic shock what bug do you NOT require isolation for diagnosis?
Staph
171
Strep TSS criteria
- 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
Staph TSS criteria
- Hypotension
- Fever
- Diffuse erythroderma
- Desquamation
- Dysfunction of at least 3 organ systems: renal, hepatic, blood, GI, mucous membranes, CNS
173
x5 bacterial pathogens to think about for patients with asplenia
- S. pneumo
- N. meningitidis
- H. influenzae
- Capnocytophaga canimorsus (dog saliva)
- Salmonella (food, water, reptiles)
174
What bug (+syndrome) causes unilateral cervical nodes with ipsilateral conjunctivitis + splenomegaly?
- Bartonella heselae (cat scratch)
| - Perinaud oculoglandular syndrome
175
What LN area is most likely to be affected by bartonella?
axillary
176
What bug causes a chronically draining cervical node in a younger child with no TB or cat exposure?
Mycobacterium avium complex
177
What are the two most common bacterial pathogens responsible for an acute unilateral adenitis?
- S. aureus
| - S. pyogenes
178
How to diagnosis lyme disease?
- Clinical if erythema migrans present
| - Two step serologic testing: (1) screening ELISA + (2) confirmatory immunoblot for IgM and IgG
179
Manifestations of late lyme disease (x4)?
- Arthritis
- Carditis
- Isolated facial palsy
- Meningitis
180
Tx of early and late (range) lyme disease?
Early: doxycycline x10 days
Late: doxycycline x14-28 days
181
When to consider prophylaxis for lyme disease?
-If exposure in known endemic region AND tick attached for >36 hours and within 72 hours of tick removal
182
Difference between mild, moderate, severe, and severe complicated classifications of C. diff?
- Mild: <4 stools per day
- Moderate: >4 stools per day, minimal systemic toxicity
- Severe: systemic toxicity
- Complicated: shock, peritonitis, ileus, megacolon
183
Management plan for (a) mild, (b) moderate, (c) severe, and (d) severe complicated C. diff?
(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
Who should have STI testing?
Anyone who is sexually active or a victim of sexual assault/abuse
185
First line options for uncomplicated gonococcal STI anogenital infection?
- CTX 250mg IM x1 or cefixime 800mg PO x1
| - PLUS azithro 1g PO x1
186
x5 most important STI's to test for and how to test?
- First void NAAT: C+G
| - Serology: HIV, syphilis, hepatitis B/C
187
If untreated maternal N gonorrhea...what is Ix and Tx for neonate if (a) well vs (b) unwell?
- If well: conjunctival Cx, CTX IM x1
| - If unwell: blood/conjunctival/CSF Cx, ID consult (IV CTX)
188
If untreated maternal chlamydia...what is Ix and Tx for a well neonate?
- Monitor for PNA and conjunctivitis
| - No culture required if asymptomatic
189
What would you treat with in neonate with PNA and eosinophilia?
Erythromycin
190
Complication of erythromycin in neonates
Pyloric stenosis
191
MIS-C Criteria
- 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
Who should be screened for TB (x5)?
- 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
What to do if well child following TB exposure with normal CXR if (a) <5 years and (b) >5 years?
(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
Strategies to prevent vertical transmission of HIV
- 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
x2 most common side effects of zidovudine
Anemia, neutropenia
196
Evaluation of infant exposed to HIV - how to r/o HIV and how to confirm a dx of HIV for an infant
- 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
x4 important aspects of evaluation for HIV+ child who presents to ED
- Clinical status
- Viral load
- Immunologic status (CD4 count and percentage)
- Antiretrovirals (therapy + adherence)
198
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
- Vaccine responses are not as optimal
| - At increased risk for pneumococcal disease
199
If child is fully vaccinated against Hep B what is your first step in assessment/management following a potential exposure?
HBsAb
200
If child is fully vaccinated against Hep B and HBsAb as well as HBsAg is negative following a potential exposure, what do you do?
HBIG + vaccine
201
If child is NOT fully vaccinated against Hep B, what is your first step in assessment/management following a potential exposure?
HBsAg + HBsAb
202
If child is NOT fully vaccinated against Hep B and HBsAg/HBsAb are both negative following a potential exposure, what do you do?
HBIG + vaccine
203
If child is NOT fully vaccinated against Hep B and HBsAb is positive following a potential exposure, what do you do?
Complete vaccine series
204
What x3 aspects should be included in risk assessment for HIV transmission in terms of needle stick injury?
- 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
Indications for VZIG (x5)
- 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
Time window after exposure to give VZIG
Within 10 days
207
If tetanus vaccines are up to date, last DTap was <10 years ago, + clean minor wound, what do you give?
Nothing
208
If tetanus vaccines are up to date, last DTap was >10 years ago, + clean minor wound, what do you give?
Vaccine
209
If tetanus vaccines are not up to date + clean minor wound, what do you give?
Vaccine
210
If tetanus vaccines are not up to date + dirty wound, what do you give?
Vaccine + TIG
211
If tetanus vaccines are up to date, last DTap was >5 years ago, + dirty wound, what do you give?
Vaccine
212
If tetanus vaccines are up to date, last DTap was <5 years ago, + dirty wound, what do you give?
Nothing
213
Most important/common serogroup for invasive meningococcal disease
B
214
High risk groups for invasive meningococcal disease
- Asplenia
- Complement deficiency
- HIV
- Lab workers
- Military living in close quarters
- Travellers to endemic areas
- Close contacts of a IMD case
215
What meningococcal vaccine (+when) is offered to ALL children in Canada?
-Men-C-C at 12 months
216
If high risk population, what IMD vaccines should be given and when?
- Men-C-ACYW (quad): at 2 months x2 doses
| - 4C-MenB: x2 doses
217
How many doses of palivizumab does CPS recommend?
3-5
218
Eligible populations for palivizumab?
- 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
Risk factors for AOM
- 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
Abx choices for AOM (including med, dose, duration)
- 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
What to do if child is >6 months, MEE present AND bulging TM, and mildly ill?
-Watchful waiting over 24-48h with close follow-up + analgesia
222
What does moderately-severely ill look like in AOM?
- Irritable, difficulty sleeping
- Significant pain despite appropriate analgesia
- Fever >39
- Duration of illness >48 hours
223
What do you do if AOM with perforated TM with purulent drainage?
Tx with Abx x10 days
224
Complications of AOM
- Mastoiditis
- CN 6 and 7 palsy
- Labyrinthitis
- Meningitis
- Venous sinus thrombosis
225
x4 indications to give VZIG
- Immunocompromised
- Pregnant
- If mother has VZV 5 days prior or 2 days after delivery
- Hospitalized + premature with mother with no immunity
226
When should you give rotavirus vaccine to a premature infant in the NICU?
- At discharge
| - When 8 weeks old
227
Patient with parvo rash - when can they return to school + why?
- As soon as feeling better
| - Once rash appears = no longer contagious
228
What is a significant amount of glucose in CSF compared to serum in bacterial meningitis?
<60% of serum glucose
229
What is Ramsay Hunt and what is the treatment?
- Triad of ipsilateral facial paralysis, ear vesicles, and ear pain from VZV reactivation
- Tx with steroids + acyclovir
230
What bug is Parinaud Oculoglandular Syndrome associated with?
-Cat scratch disease
231
Risk of HIV transmission in blood products?
1 in 10 million
232
HepBe antigen indicates...
Risk of infectivity
233
Tx of measles
Vitamin A
234
What is the risk of vertical transmission of HIV if (a) all precautions taken vs (b) no precautions taken?
(a) 1%
| (b) up to 25%
235
What bug to think about in a newborn with gram + bacilli
Listeria
236
What should you consider as a test for TB in someone who has a history of bcg vaccine?
interferon gamma release assay
237
How old must you be to receive (or consider) a live influenza vaccine?
>2 yo
