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CCFP 2 > Infectious Disease > Flashcards

Infectious Disease Flashcards

1
Q

what is the 5Cs of HIV testing?

A 
consent 
confidentiality 
counselling 
correct test results 
connect to prevention/care/treatment
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2
Q

How long is the window/eclipse period of HIV testing?

A

22d for 3rd gen ELISA
17-18d for 4th gen ELISA
everyone will have a detectable HIV antigen or antibody by 6w - 3mo

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3
Q

What is considered potential exposure of HIV indicated for post-exposure prophylaxis (PEP)?

A

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

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4
Q

What is the post-exposure prophylaxis (PEP) of HIV?

A

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)

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5
Q

Who are considered HIGH RISK indicated for Pre-exposure prophylaxis (PrEP)?

A

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
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6
Q

what is the regimen of PrEP?

A

Investigation:

  • confirm HIV neg
  • Cr
  • STI
  • screen Hep + immunize

Regimen: Combo Tenofovir disoproxil fumarate 300mg/ emtricitabine 200mg QD

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7
Q

what is the f/u plan for people on PrEP?

A

Test the following after 1 mo, then q3mo

  • Cr
  • HIV, VDRL, G/C
  • preg test

q6mo to screen Hep C

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8
Q

what are the symptoms of pre-icteric phase?

A
  • 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

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9
Q

What are the symptoms of icteric phase?

A
  • elevated conjugated Bili
  • pale clay coloured stool
  • dark urine (jaundice)
  • jaundice
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10
Q

What is the protocol of close contact post exposure prophylaxis?

A

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
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11
Q

common pathogens

  • overall
  • Neonates (0-1mo)
  • Newborn (1-23mo)
  • common Gram negative
  • common viral
A
  • 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
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12
Q

populations susceptible to LEG

risk factors*

A
  • HIV*
  • trauma/neuro surgery*
  • immunosuppression/immunocompromised*
  • malignancy*
  • T2DM*
  • hepatic/ renal failure*
  • iron overload
  • collagen vascular dz
  • Alcoholism
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13
Q

prevention of traveller’s diarrhea

A
  • bismuth subsalicylate (Pepto)
  • fluoroquinolones (not for children < 16 years old)
    • — Norfloxacin
    • — Ciprofloxacin
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14
Q

treatment of mild to moderate traveller’s diarrhea (< 3BM/d, no blood no fever)

A
  • Loperamide 4mg x1, then 2mg up to max 8 doses

- Bismuth subsalicylate (pepto)

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15
Q

RX of severe traveller’s diarrhea (> 3BM/d, blood, or fever)

A
  • Azithromycin 1000mg x1 or 500mg BID x 1-3 days

2nd line: norfloxacin

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16
Q

Medical conditions that need prophylaxis for IE (endocarditis)

A

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

17
Q

Rx for IE prophylaxis

A

Amoxicillin 2g (50mg/kg) 30-60 min prior to procedure

18
Q

Rx of epididymitis

A

suspected chlamydia/ gonorrhea
—- doxycycline + ceftriaxone IM

> 35 y/o
– ciprofloxacin / Levofloxacin

< 35 y/o OR multiple sex partners
– Cefixime/ Ceftriaxone + Azithromycin/ Doxycycline

19
Q

symptoms of malignant neuroleptic syndrome

A
  • fever
  • delirium (cognitive change)
  • diaphoresis (autonomic instability)
  • muscle rigidity
  • tremor

lab
leukocytosis
elevated CK

20
Q

management of malignant neuroleptic syndrome

A
  • HOLD antipsychotics
  • ABCs
  • aggressive hydration
  • cooling blankets, ice packs
  • ? Dantrolene sodium po + bromocriptine po
21
Q

IE symptoms

A
  • 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
22
Q

Heat stroke symptoms

A
  • 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
23
Q

meds related to heat stroke

A

cocaine and amphetamines

24
Q

complications of heat stroke

A
  • AKI or renal failure
  • rhabdomyolysis
  • pulmonary edema
  • CNS damage: cerebellar deficits, dementia, hemiplegia, quadriparesis, and personality changes
  • Acute liver failure
25
Q

management of heat stroke

A
  • aggressive cooling

Immediate administration of benzodiazepines is indicated in patients with agitation and shivering, to stop excessive production of heat

26
Q

complicated UTIs indications

A
  • male
  • pregnancy
  • recent urinary tract instrumentation/ catheter
  • anatomical abnormality
  • chronic renal disease
  • T2DM
  • immunosuppressed
27
Q

indications of renal bladder ultrasound

A

CPS guideline:

all children < 2 y/o within 2 weeks of 1st febrile UTI

28
Q

Indications of Voiding cysto-urethrogram (VCUG)

A

CPS guideline

1) abnormal renal bladder ultrasound OR
2) < 2 y/o + 2nd well documented UTI

29
Q

Criteria of SIRS (systemic inflammatory response syndrome)

A

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

30
Q

What is the GA safe for medical abortion?

A

as effective as SA: 49d (7 wks) from LMP

max: 70d (10 wks) from LMP

31
Q

medications used for medical abortion

A

mifepristone & misoprostol

32
Q

contraindications of induction of labour

A
  • previous uterine rupture
  • fetal transverse lie
  • placenta previa/ vasa previa
  • invasive cervical cancer
  • active genital herpes
33
Q

what is the normal range of fetal heart rate (FHR) before delivery?

A

120-160 bpm

34
Q

common causes of abnormal FHR

A 
Severe bradycardia (< 100bpm): hypoxia 
mild bradycardia (100-120): occipital/ temporal position

Severe tachycardia ( > 180-200): chorioamnionitis (mother having fever)

35
Q

causes of FHR accelerations

A

FHR accelerations are “reassuring” signs

  • fetal movement
  • uterine contraction
  • umbilical cord compression
  • vaginal exam
  • external acoustic stimulation
  • fetal scalp stimulation
36
Q

causes of FHR decelerations

A

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
37
Q

absolute contraindications for fibrinolytic use in STEMI

A
  • 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

CCFP 2 (21 decks)

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