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Pediatrics > Infectious Disease > Flashcards

Infectious Disease Flashcards

1
Q

What considerations should be taken with a contact lens wearer who has conjunctivitis?

A
  • should remove the contact lens
  • consider first line treatment with fluoroquinolones because of the increased chance of pseudomonas infection
  • may resume wear of lens once the 1) eye is white, 2) no discharge is seen >24 hrs after antibiotics, 3) a new set of contact lenses is used
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2
Q

What are the features of adenovirus conjunctivitis?

A

Pseudomembranes and preauricular adenopathy

  • chemosis and photophobia develop rapidly
  • foreign body sensation
  • large oval follicles appear within the conjunctiva
  • blurred vision (subepithelial corneal infiltrates)
  • may have pharyngitis and URTI symptoms
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3
Q

What are the goals of treatment in bacterial conjunctivitis?

A
  • Limit transmission
  • Limit duration
  • Limit discomfort
  • Reduce time off work/school

(70% improve without treatment by 48 hours; self-limited)

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4
Q

A mother with Hep C is pregnant; what testing should be done and when?

A

anti-HCV antibody testing should be done after 18 months

  • difficult to interpret before 18 months
  • passive antibodies may result in a positive test (95% gone by 12 months of age)
  • results can be distressing to families if tested too early
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5
Q

What are the CPS guidelines on managing uncomplicated pneumonia?

A
  • outpatients should be treated with oral amoxicillin
  • patients that require hospitalization but are not in life threatening condition should get IV ampicillin
  • those with respiratory failure or shock should be started on 3rd gen cephalosporin (CTX or cefotaxime - better H. flu coverage)
  • if progressing, add vancomycin
  • inpatient (7-10 days); outpatient (5 days or more)
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6
Q

What are the most common pathogens for pneumonia in an immunocompetent host?

A
  • Strep pneumo
  • Staph aureus
  • Strep pyogenes (GAS0
  • MRSA
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7
Q

Complicate vs Uncomplicated pneumonia

A

Consider complicated pneumonia if…

  • no improvement in fever after 48-72 hrs of abx
  • worsening respiratory distress
  • signs of hypoxia
  • pleural effusion
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8
Q

What antibiotics should be used in the case of complicated pneumonia?

A
  • cefotaxime or ceftriaxone
    +/- clindamycin or vancomycin
  • treat for 3-4 weeks (may switch to oral amox/clav once pleura has stopped draining and patient is off oxygen)
  • repeat CXR in 2-3 months

Note: children with empyema can have fever persisting for 72 hours despite appropriate therapy (not a sign of treatment failure)

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9
Q

What is the recommended schedule for HPV vaccines?

A

2 doses given 6 months apart for all children aged 9-14, before any sexual activity

3 doses for all 15 and over (0, 1-2, 6 months)

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10
Q

What does the HPV vaccine help prevent?

A
  • 100% high grade vaginal and vulvar lesions
  • 99% genital warts
  • 98% cervical cancer
  • 95.6% HPV infection
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11
Q

Side effects of HPV vaccine (4)

A
  • Pain at the site of vaccination (82-92%)
  • Local reaction (24-44% swelling, 24-48% redness)
  • Anaphylaxis (rare)
  • Post vaccination dizziness (common as with other vaccines)

No evidence for CNS demyelinating disease, GBS, autoimmune diseases, stroke, VTE, ADEM, MS

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12
Q

What does the Grieg Health Screen suggest for teenagers who are sexually active?

A
  • Screen for chlamydia, gonorrhea, HIV (if 15 and over), Hep B/Hep C/Syphilis (in high risk category)
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13
Q

What is the management strategy for chlamydia?

A
  • single, witnessed dose of 1 g azithromycin or doxycycline x 7 days
  • azithromycin or amoxicillin x 7 days if pregnant
  • screen for but do not treat empirically for gonorrhea
  • contact tracing and treatment of sexual partners
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14
Q

What is the management strategy for gonorrhea?

A
  • empirical treatment of chlamydia (screen as well)
  • directly observed taking of 250 mg IM CTX or 800 mg cefixime
  • do not use quinolones
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15
Q

When should you give immediate antibiotic treatment for acute otitis media?

A
  • Highly febrile (≥39 C) without antipyretics
  • Moderately to severely systemically ill
    • severe otalgia
    • poor response to antipyretics
    • irritable
    • difficulty sleeping
  • > 48 hours of symptoms
  • perforated tympanic membrane with purulent drainage
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16
Q

What are some risk factors for AOM?

A
  • Young age
  • Frequent contact with other children (increased exposure to viral illnesses)
  • Orofacial abnormalities (e.g.: cleft lip)
  • Household crowding
  • Exposure to cigarette smoke
  • Pacifier use
  • Shorter duration of breastfeeding
  • Prolonged bottle-feeding while lying down
  • FHx of otitis media
  • IgA deficiency
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17
Q

What is the treatment for AOM?

A
  • High dose amoxicillin (75 mg/kg/day divided BID)
    • 5 days if 2 or over
    • 10 days if perforated or 6 months to 2 years old
  • Amox/clav if initial therapy fails (45-60 mg/kg/day of 7:1 formulation) with the goal of not surpassing 10 mg/kg/day of clavulanate
    • 5 mL (400 mg:57 mg)
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18
Q

What are some intratemporal complications of AOM? (8)

A

1) acute mastoiditis

  • infectious dermatitis
  • TM perforation
  • Chronic suppurative OM
  • CN VII Palsy (facial nerve)
  • CN VI Palsy (abducens - failed ipsilateral eye abduction from petrous bone inflammation/infection - Gradenigo’s syndrome)
  • Cholesteatoma
  • Labyrinthitis
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19
Q

What are some intracranial complications of AOM?

A
  • Meningitis
  • Venous sinus thrombosis
  • Otitic Hydrocephalus
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20
Q

How do you manage Acute Mastoiditis?

A
  • IV antibiotics
  • Myringotomy tube placement (consult ENT)
  • Mastoidectomy (CT scan with contrast)
    +/- consult NSx
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21
Q

How do you categorize C. Diff cases?

A

Mild - watery stools, <4 per day, not toxic
Mod - not responding to d/c of abx, 4 or more stools per day, not toxic
Severe - toxic appearing (high fever, rigors etc)

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22
Q

How do you treat C. Diff cases?

A

Mild - stop Abx
Mod - metronidazole (30 mg/kg/day divided into QID for 10-14 days)
Severe - vancomycin (40 mg/kg/day divided into QID for 10-14 days)

First recurrence (as above)
Second recurrence (Vanco in tapered or pulsed regimen)
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23
Q

How do you prevent C. Diff cases?

A
  • washing with soap and water
  • isolating affected patients
  • using chlorine-containing or other sporicidal cleaning agents to eliminate environmental contamination
  • contact precautions for duration of symptoms
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24
Q

Who should get the flu shot?

A

· People at high risk for influenza-related complications or hospitalization
· All children 6 to 59 months of age
· All children ≥6 months of age, adolescents and adults with chronic health conditions
○ Cardiac or pulmonary disorders, DM, cancer, renal disease, anemia or hemoglobinopathy, neurological or neurodevelopmental conditions, morbid obesity, those on ASA
· Indigenous peoples
· All residents of chronic care facilities
· All pregnant women
· All adults ≥65 years of age
· Household contacts (adults and children) of individuals at high risk
· Household contacts of infants <6 months of age
· Members of a household expecting a newborn during influenza season
· Health care and other care providers in facilities and community settings
· People who provide essential community services

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25
Q

When should children be given rotavirus?

A
  • 2, 4 months (RV1)
  • 2, 4, 6 months (RV5)
  • NICU graduates between 6 and 8 months of age, at regularly scheduled times upon discharge
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26
Q

What are the features of Fifth’s Disease?

A
  • Caused by Parvovirus B19
  • Benign, self-limited
  • gives “slapped cheek” facial flushing appearance that spreads to the trunk (may worsen with exercise, stress, heat)
  • Risk to fetus in prenatal exposure <5% (non-immune fetal hydrops secondary to viral induced RBC aplasia)
    • leads to profound anemia, high output cardiac failure, myocarditis
    • greatest risk in 2nd semester
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27
Q

Which situation presents the greatest risk for neonates regarding HSV?

A

Neonate born vaginally to a non-immune mother who has an active infection which is a primary infection.

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28
Q

What should be done for a baby who was born to a mother with HSV?

A
  • Determine mother’s history (primary infection? immune or non-immune?)
  • Try to deliver the baby by C/S prior to rupture of membranes if possible
  • If baby is well, and mother’s HSV infection has been well controlled with antiviral medication prior to delivery, may discharge home for observation if caregivers are reliable
  • If babe may have had exposure in non-primary mother, take swabs at 24 hrs and discharge home if well for observation. Must admit for IV acyclovir if swabs return positive
  • if babe may have had exposure in primary infected mother, must take swabs, LP and serum cultures, transaminases, admit to hospital for IV acyclovir x 14-21 days
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29
Q

Pneumonia in an infant. CBC reveals eosinophilia, what should be considered?

A

Chlamydia trichomatits; treat with macrolide (azithromycin/erythromycin)

(must also consider if the child does not have fever or wheezing)

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30
Q

What should be considered in the case of an animal bite?

5 Cs

A

Cleanse - debride and irrigate with NS
Culture - if >8 hrs, appears infected, CAT bite, deep/extensive, immunocompromised
Camera - image if involving penetrating foreign body over bone/joint spaces, ?fracture, concern for osteo
Closure - do not close, approximate with steri strips
Consider - tetanus/rabies

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31
Q

How do you treat a baby who may have been exposed to gonorrhea as a newborn?

A

○ Ensure “system” to ensure none are missed
○ If results not available @ dx, ensure plan: Ensure easy contact & watch for eye discharge <7d & come in if unwell
§ If doubt re: compliance/ follow-up, consider IM CTX x1 for infant
○ Infants born to mom w/ untreated Gonorrhea:
§ Conjunctival swab @ birth (don’t wait for results)
§ Treat immediately
○ Treatments:
§ If well: CTX 50 mg/kg (max 125 mg) IM or IV ONCE (in 1% lidocaine without epi, 0.45 mL); alternative cefotaxime 100 mg/kg IV/IM once
§ (Single dose not risk for biliary stasis)
§ If unwell: BCx/LP & consult ID & ongoing Tx

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32
Q

What constitutes as proof of immunity re: Varicella?

A
  • documentation of 2 vaccine series
  • documented history of previous infection
  • lab evidence of immunity
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33
Q

What are the possible complications of varicella?

A
  • Neurologic: meningitis/encephalitis, cerebellitis, facial palsy, stroke
  • skin superinfection
  • GAS infection i.e. nec fasc
  • pneumonia
  • osteomyelitis
  • Ramsay Hunt
  • HUS
  • hepatitis, myocarditis, orchitis
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34
Q

What is the time period where infants are most at risk with regards to severe varicella?

A

1) When the mother has an active infection up to 5 days prior to delivery and 2 days afterwards
2) all infants born <28 weeks GA to a mother with active varicella at delivery

(these children must receive VZIG ASAP)

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35
Q

What are the features of congenital varicella syndrome?

A

“MiCCHyLL” - “Michael”

  • Microcephaly
  • Cicatrix (zigzag scarring in a dermatomal distribution)
  • Chorioretinits, micropthalmia, cataracts
  • Hydroureter, hydronephrosis
  • Low birthweight
  • Limb hypoplasia
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36
Q

What are the features of congenital CMV infection?

A
  • prematurity
  • chorioretinitis
  • microcephaly
  • hearing loss
  • thrombocytopenia
  • rashes
  • jaundice/hyperbilirubinemia
  • IGUR
  • asymptomatic
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37
Q

What is the clinical presentation of West Nile Virus?

A

Asymptomatic (80%)
West nile fever (20%) - flu-like illness
Aseptic meningitis/encephalitis/acute flaccid paralysis (<1%)

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38
Q

What are the features of congenital Zika Virus?

A
  • Severe microcephaly, cerebral atrophy, abnormal cortical development
  • Diffuse subcortical calcifications
  • Redundant scalp with partially colapsed skull
  • Abnormal fetal tone can result in clubfoot or fetal akinesia deformation sequence (arthrogryposis)
  • Microphthalmia, cataracts, and retinal abnormalities
  • Sensorineural hearing loss
  • IUGR
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39
Q

What is the test required to confirm ZIKA?

A
  • Antibody serology with plaque reduction neutralization test (PRNT) confirmation - 3-7 days of symptoms
  • ZIKA RNA by PCR testing (blood or urine) - first 4 days of symptoms
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40
Q

What is the window for Zika exposure regarding sexual contact during pregnancy with a man who has previously traveled to a Zika endemic area?

A

6 months

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41
Q

What should be done for a child whose mother has positive Zika serology?

A
  • If the child is clinically asymptomatic send for PCR or serology PRNT testing and head U/S
  • If the child is clinically symptomatic, must be admitted and sent for serology and MRI head; if MRI results are concerning, must also arrange audiology and ophthalmology
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42
Q

What populations are at highest risk for disseminated disease with respect to Salmonella typhi?

A
  • Immunocompromised
  • Asplenic individuals
  • <3 months
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43
Q

What rash is classically seen in typhoid fever?

A

Rose spots

44
Q

What is the treatment of choice for typhoid fever?

A
  • Azithromycin 7 days
  • Cefixime 7-14 days, 10-14 days for CTX, 14 days for amoxicillin or TMP-SMX
  • no quinolones
45
Q

What age group is at greatest risk for chronic infection with Hepatitis B? What are the medical consequences/complications of chronic infection?

A

Infants

Hepatocelluar carcinoma, cirrhosis and non-Hodgkin lymphoma

46
Q

When should the Hep B vaccine be given?

A

For a potentially exposed child, Hep B vaccine should be given within the first 12 hours of delivery (along with Hep B Ig). Afterwards, series should be completed at 1 month and 6 months (additional vaccine at 2 months for infants <2 kg at birth) and antibodies checked 4 months after the last dose

47
Q

What organism is responsible for Lyme Disease?

A

Borrelia burgdorferi

48
Q

What are the two main vector organisms in Canada?

A
  • Ixodes pacifica and Ixodes scapularis
49
Q

What should be done in cases of early localized disease with respect to Lyme Disease?

A
  • Erythema migrans, fever, malaise, joint/neck stiffness, myalgias/arthralgias
  • treat with 2 weeks of amoxicillin (50 mg/kg/day) or 10 days of doxycycline (4 mg/kg/day)
50
Q

What should be done in cases of later extracutaneous disease with respect to Lyme Disease?

A
  • Isolated facial nerve palsy, arthritis (most common late stage symptom), heart block or carditis, meningitis (severe headache and fever)
  • oral agents for 14 days unless arthritis (28 days)
  • Two-tiered serological testing: ELISA screening test followed by Western blot test
51
Q

When should prophylaxis for Lyme disease be given?

A

Within 72 hours of removing the tick, if the tick has been attached for equal to or >36 hours

Doxycycline 4.4 mg/kg/dose x 1 dose

52
Q

Features of pubic lice?

A

Maculae ceruleae - steel-grey spots in the pubic area, chest, abdomen and thighs

Treat with 1% permethrin cream, applied for 10 mins then washed off

53
Q

How are head lice transmitted?

A

Person to person via direct head-to-head contact. Pets are not a vector and the role of fomites is controversial

54
Q

How long can head lice survive away from human hosts?

A
  • 1-2 days for nymphs and adults

- 3 days for eggs

55
Q

Treatment options for lice?

A

First line: 1% permethrin or pyrethrin/piperonyl butoxide
2nd line: Resultz rinse (isopropyl myristate) or dimeticone solution

All must be put on for 10 mins, rinsed off and then repeated in 1 week

Lindane is no longer considered acceptable due to neurotoxicity and bone marrow suppression

56
Q

Who should be considered for RSV prophylaxis?

A

• Children with hemodynamically significant CHD/CLD needing oxygen at 36 wks GA, should receive prophylaxis only if they also:
○ Are <12 months at the start of the RSV season AND require ongoing diuretics, bronchodilators, steroids or supplemental oxygen

• Infants in remote communities who require air transportation for hospitalization, born before 36+0 wks GA who are also <6 months of age at that start of the RSV season

• Consider for children who are <24 months of age who are:
○ On home oxygen
○ Have had a prolonged hospitalization for severe pulmonary disease
○ Severely immunocompromised

57
Q

How long should a child be monitored if there is concern for HSV exposure?

A

42 days of life

In most cases, the initial symptoms of NHSV infection present within the first four weeks of life. Occasionally, disease presents for the first time between four and six weeks after birth

58
Q

What are the contraindications to receiving the live attenuated influenza vaccine?

A
  • < 2 years of age
  • severe asthma (active wheeze, steroids or hospitalization)
  • on ASA treatment (risk of Reye’s syndrome)
  • those who are pregnant
59
Q

Which treatments have the best evidence with regards to bronchiolitis?

A
  • supplemental oxygen

- hydration

60
Q

What criteria should be considered when deciding to admit a patient with bronchiolitis?

A
  • Signs of severe respiratory distress (eg, indrawing, grunting, RR >70/min)
  • Supplemental O2 required to keep saturations >90%
  • Dehydration or history of poor fluid intake
  • Cyanosis or history of apnea
  • Infant at high risk for severe disease
  • Family unable to cope
61
Q

Which groups are at greater risk for complications from bronchiolitis?

A
  • age <3 months
  • immunocompromised
  • those with hemodynamically significant cardiac dx
  • infants born <35 wks GA
62
Q

What interventions are not recommended by CPS for treatment of bronchiolitis?

A
  • Salbutamol
  • Corticosteroids
  • Antibiotics
  • Antivirals
  • 3% hypertonic saline nebulization
  • Chest physiotherapy
  • Cool mist therapies or therapy with saline aerosol
63
Q

What organisms are asplenic or functionally asplenic children at greater risk for?

A
  • TOP 3: Strep pneumonia, Haemophilus influenza (type b), Neisseria meningitides
  • Mnemonic: “Some Nasty Killers Have Some Capsule Protection”
    ○ Strep pneumoniae, Neisseria meningitidis, Klebsiella pneumoniae, Haemophilus influenzae, Salmonella typhi, Cryptococcus neoformans, Pseudomonas aeruginosa
    ○ +Capnocytophaga canimorsus (dog saliva)
    ○ Salmonella (reptiles, food, water)
64
Q

What anticipatory guidelines should be followed by asplenic children with regards to disease prevention?

A
  • Vaccination (complete standard series, extra vaccines i.e. prevnar 23, annual vaccines i.e. influenza)
  • Antibiotic prophylaxis (amoxicillin or Pen V if >5 yr)
  • Education (must seek medical attention if febrile, consider MedicAlert bracelet)
65
Q

How long should you delay vaccines after receiving IV IG?

A
  • non-live vaccines - no delay
  • live vaccines (10 months for MMR, 5 months for varicella)
  • any live vaccines given < 14 days before IV IG must be repeated
66
Q

What are the principle areas of transmission with regards to malaria?

A

Areas endemic to female anopheles mosquito

- Bangladesh, Central America, India, Pakistan, Sri Lanka, Haiti, New Guinea, most nations of sub-saharan Africa

67
Q

What are the main symptoms seen in Malaria?

A
  • Fever: when the erythrocytes rupture and release merozoites into the circulation (every 48-72 hours or so)
  • Anemia: hemolysis, sequestration of erythrocytes in the spleen and other organs, bone marrow suppression
  • Tissue anoxia: excessive production of proinflammatory cytokines
  • Hypoglycemia: anaerobic metabolism of glucose and lactic acidemia
68
Q

What form of malaria is the most severe? The most common?

A

Falciparum - higher density parasitemia, cerebral malaria, ARF, resp distress

Malariae (also the only one with nephrotic association)

69
Q

What test is diagnostic for Malaria?

A

Thick and thin smears, giemsa-stained

70
Q

What treatment is used for Malaria?

A
  • Artesunate IV or Quinine (not as ideal, more toxic)
  • RBC transfusion to maintain hematocrit >20%
  • Exchange transfusion in P. falciparum if parasitemia is >10%
  • IV glucose
  • O2
  • anticonvulsants as required
71
Q

What viruses are responsible for bronchiolitis?

A

RSV

human metapneumovirus, rhinovirus, influenza, adenovirus, parainfluenza

72
Q

What does the CPS advise regarding the treatment of skin abscesses in children?

A
  • all abscesses should be drained and cultured to rule out MRSA
  • all children <1 month must be admitted for IV Abx
  • if previously and currently well without fever, 1-3 months of age, TMP-SMX
  • if previously well and ≥3 months, with low grade fever, observe after drainage with Abx given only if condition worsens or grows something other than MSSA
  • if ≥3 months with surrounding cellulitis and low grade fever, TMP-SMX and cephalexin

All other scenarios need IV abx

73
Q

What are the contraindications to receiving the MMR vaccine?

A
  • hx of anaphylatic reaction to neomycin or gelatin
  • 3 months within receiving IV Ig
  • 4 months from receiving rabies vaccine
  • 5 months within receiving VZIG
  • 8 months since receiving Ig replacement for immunodeficiency
  • 10 months from Kawasaki Disease treatment
74
Q

What are the adverse side effects associated with measles vaccine?

A
  • fever (6-12 days post vaccine)
  • rash (5%0
  • transient thrombocytopenia
  • slightly increased risk of seizures
75
Q

What are the pathognomonic signs of measles infections?

A
  • fever
  • conjunctivitis
  • white spots on tongue and buccal mucosa (koplik spots)
  • cough/coryza
  • maculopapular rash that begins on forehead and behind ears, spreading to the torso, extremities, palms and soles of feet
76
Q

Management strategies for measles?

A
  • Airborne precaution and isolation
  • Admit to hospital
  • Supportive therapy with hydration, O2 support and comfort measures the goals of care
  • Vitamin A therapy
  • Note: antivirals are not effective and prophylactic abx are not effective
77
Q

What is the daycare exclusion policy for measles?

A

Must exclude until 4 days after the onset of rash

Unprotected children who were exposed should receive MMR vaccine within 72 hrs and measles IgG within 6 days of exposure. Vitamin A 200 000 PO x 2 days

78
Q

What are the two chronic complications of measles?

A
  • Subacute sclerosing panencephalitis

- Encephalitis

79
Q

What infectious agent should be considered in the case of a child with chronic (>3 wks), tender regional lymphadenopathy?

A

Bartonella henselae

80
Q

What clinical features are specific to bartonella henselae?

A
  • > 3 wks of chronic, tender, regional lymphadenopathy (axillary > cervical > submandibular)
  • parinaud oculoglandular syndrome
  • scratch or bite from infected cat
81
Q

What are the treatment options for bartonella henselae?

A
  • no I&D - persistent sinus tract may develop
  • +/- node biopsy in atypical cases
  • antibiotics (azithromycin 5D preferred)
82
Q

What is the risk of transmission in the event of a transfusion for the following diseases in Canada? HIV, HCV and HBV?

A
  • HIV - 1 in 8-12 million
  • HCV - 1 in 5-7 million
  • HBV - 1 in 1.1-1.7 million
83
Q

What is the risk of pernatal transmission with respect to HIV when…

a) the mother is not on treatment?
b) the mother is on multi-drug suppressive therapy?

A

a) 25%

b) <2% (if the child receives 4 weeks of zidovudine

84
Q

What 3 medications are used to treat infants with suspected HIV exposure?

A

Zidovudine
Lamivudine (3TC)
Nivirapine (NVP)

85
Q

What should be done for a child who has a known contact who has tested positive for TB?

A
  • must obtain detailed hx including, drug sensitivities for contact’s TB, child’s age, pmhx and signs of concurrent/active illness
  • TST to be done along with CXR
  • if <5, start prophylaxis and repeat TST in 8-10 weeks, if negative, may stop, if positive, must treat
  • > or equal to 5, must repeat TST in 8-10 weeks but no need to start prophylaxis. If initial test positive, must be treated for latent infection
86
Q

Match the side effect to the medication:

hepatotoxicity, peripheral neuropathy - ?

hepatotoxicity, hypersensitivity reactions, memory impairment, body fluids turn orange - ?

hepatotoxicity, increased uric acid levels - ?

optic neuropathy (poor acuity, decreased visual fields, colour blindness) - ?

A

Isoniazid

Rifampin

Pyrazinamide

Ethambutol

87
Q

When is a child with Hepatitis A still contagious for disease?

A

2 weeks prior to the onset of symptoms and 7 days after the onset of jaundice

88
Q

What is considered appropriate prophylaxis for a child traveling to an HAV endemic area?

A
  • should get Hep A Ig if <12 months (3 months protection)
  • child and their family should get Hep A vaccine at any time prior to travel

Post exposure:
Hep A Ig if within 2 weeks (if <12 months and >40 yoa)
Hep A vaccine 12 months to 40 years old

89
Q

What is the preferred HIV screening test in newborns?

A

HIV RNA PCR

90
Q

What additional screening must be done if there is concern for congenital syphilis in an infant?

A

HIV

91
Q

What agents are used to treat infants with congenital syphilis?

A

aqueous Pen G (IV) and procaine pen G (IM)

92
Q

What is considered adequate decrease in non-treponemal titres?

A

4 fold decrease for either mother during pregnancy or in the infant following diagnosis

93
Q

A teenager has contracted EBV mononucleosis; when can he return to sports?

A

No contact sports during the first 2-3 weeks of illness or while splenomegaly is present

94
Q

What is the classic triad of symptoms seen in EBV?

A

Fatigue, pharyngitis and cervical lymphadenopathy

95
Q

What steps should be taken in the event of a needlestick injury?

A
  • clean wound thoroughly with soap and water ASAP
  • do not squeeze the wound to induce bleeding
  • determine the child’s immunization status (tetanus, HBV)
  • document circumstances of the injury
  • bloodwork: HBV, HIV, HCV status
    • also CBC + diff, ALT, AST, alk phos, BUN/Cr if starting antiretrovirals
  • do not test needles, but test needle user if known
96
Q

What is the window for prophylaxis with regards to HIV?

A

Ideally within the first 1-4 hours of the injury or exposure. Not indicated if it cannot be initiated within 72 hours of injury. Duration lasts 28 days

97
Q

What follow up is necessary in cases of needle stick injuries?

A
  • 4 weeks - 2nd dose of HBV vaccine
  • 4-6 weeks - anti-HIV antibody
  • 3 months - anti-HIV and anti-HCV antibody
  • 6 months - anti-HIV, anti- HCV and anti-HBsAg antibody + 3rd dose of HBV
  • 8 months - HBsAg (for vaccine response)
98
Q

When is maternal rubella infection most concerning during pregnancy?

A

First 8 weeks of gestation

After 16 wks, defects are uncommon

99
Q

What findings are classic for congenital rubella infection?

A
  • nerve deafness (most common)
  • IUGR
  • salt-and-pepper retinopathy
  • 1/3 will have unilat-/bilateral cataracts
  • PDA, PA or other valvular disease
  • meningoencephalitis
  • rash - Forchheimer spots - petechial hemorrhages on the soft palate
100
Q

When should you test for HIV in an infant, if the mother is a known HIV+ person?

A

HIV DNA/RNA PCR within the first 48 hours, in 1-2 months and again in 4-6 months. Then, serology at 18 months of age

101
Q

What are the criteria of the modified CENTOR score?

A

1 point each for:

  • Fever >38 C
  • Absence of cough
  • Tender/swollen anterior cervical lymphadenopathy
  • Tonsillar swelling or exudate
  • Age 3-14

-1 point if ≥45 years of age

Treat only if pt has a positive throat culture and has a CENTOR score ≥2

102
Q

What is the purpose of giving antibiotics in a child with Pertussis and 3 weeks of symptoms?

A
  • reduce spread
103
Q

What are 4 population strategies to limit the burden of disease of pertussis?

A
  • universal vaccination
  • education regarding symptoms and need to seek medical attention
  • booster in adolescence and as a child
  • vaccination of those who are at greater risk of exposure i.e. healthcare workers
  • identification of index cases/public health reporting
  • treatment of close contacts
104
Q

What are the 3 stages of pertussis disease?

A
  • catarrhal stage (1-2 weeks) - congestion, rhinorrhea, low grade fever and sneezing
  • paroxysmal stage (2-6 weeks) - coughing
  • convalescent stage (2 weeks) - gradual resolution
105
Q

For how long should the following children be excluded from childcare?

  • 4 year old with chicken pox
  • 6 year old with mumps
  • 3 year old with purtussis on day 1 of antibiotics
  • 2 year old with campylobacter diarrhea
  • 9 year old with measles
A
  • no exclusion as long as they are well
  • 5 days post onset of symptoms
  • after 5 days of antibiotics
  • may return as long as diarrhea is contained
  • must be excluded until 4 days after onset of rash; all non-immune peers should be excluded for 2 wks
106
Q

Which infectious agent is most likely to cause pneumatoceles?

A

Staphylococcus aureus

107
Q

Which infectious agent is associated with hepatosplenomegaly, fever, and exposure to livestock such as goats/sheep?

A

Q-fever or coxiella burnetti

Pediatrics (27 decks)

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