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MFM Oral Boards 2020 > Infectious disease ABC > Flashcards

Infectious disease ABC Flashcards

1
Q

low CD4 count- what interventions are needed

A 
prevent PCP (bactrim), toxoplasmosis
MAC (mycobacterium avium complex) - Azithromycin

below 50
cryptococcus prevention with fluconazole

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2
Q

delivery/intrapartum with HIV.

A

viral load <1000
vaginal delivery
aviod AROM, FSE, operative vaginal bleeding
<400 viral load AZT not required but could be given
2 mg /kg bolus than 1mg/kg/hr (2 hours prior to c-section)

baby washed at delivery

scheduled delivery at 38 weeks if CD is needed

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3
Q

hiv diagnosis

A

hiv ag/ab screen

  • negative no HIV
  • positive send HIV 1/2 multispot (reactive - has HIV, non-reactive- send HIV-1 RNA qualitative and rtPCR
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4
Q

3rd trimester HIV testing for what population

A 
high rate of HIV in population 
incarceration 
sign/symptoms of infection 
STI in last year
new partner
more than 1 partner during pregnancy
known infected partner 
personal or partner IV drug use
prostitution
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5
Q

labs for new dx of HIV

A 
viral load
CD4
antiretroviral drug resistance 
6PD and HLA-B5701
toxo igg
hep B antigen/antibody
Hep A total antibody
Hep C antibody 
PPD
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6
Q

preconception for HIV

A 
contraception 
VL <1000 
Review CART
discuss if partner is aware 
offer partner testing 
ensure she is vaccinated
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7
Q

HIV management during pregnancy

A

cd4 every 3 months
viral loads monthly
vaccines to consider: pneumococcal, influenza, Hep A, Hep B
If on protease inhibitor check glucose

If VL >500 in 2nd trimester- check adherance, consider HIV genotyping

In 3rd trimester
RPR, GC/Chlam
viral load at 34-36

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8
Q

Risk factors for HIV transmission to the fetus

A 
no therapy 
no prenatal care
AIDs, Low CD4, High viral load
illicit drug use
preterm delivery
breastfeeding
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9
Q

% of hiv transmission that occurs intrapartum

A

70-80%

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10
Q

Hep B management in pregnancy

A

check viral load in 3rd trimester and consider tonofovir (>6-8 log 10 copies/ml)
avoid amnio (greater risk at 7 log 10 copies)
test partner

Hep B vaccine and HIB

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11
Q

Hep B panel

A

sAg(-) antic (-) anti s(-) suceptible
sAg(-) antic(+) antis (+) immune (natural infection)
sAg (-) antic (-) antis (+) immune (vaccination)
sAG(+) antic (+) Igm antic(+) anit s (-) acute infection
sAg(+) antic (+) antic igM (-) antis (-) chronic infection
sAg (-) anti c (+) antis (-)
- resolved /false positive/chronic/resolving

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12
Q

chronic hep b rates
neonatal
child
adult

A

neonatal- 90 %
children 10-25%
adults 5-10%

chronic hep B
20% end stage liver disease, cirrhosis, liver cancer

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13
Q

what pregnancy risks are considered with cirrhosis

A

increase in maternal/ fetal death, gHTN, abruption, PTB, FGR

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14
Q

Chicken pox

  • diagnosis
  • Risks to pregnancy
  • Follow-up
  • Treatment
A

Dx: VZV IgM
Risks: fetal demise, FGR, congenital anomalies (microcephaly, ventriculomegaly, echogenic foci in liver, limb abnormality)

Follow-up: serial growth utlrasound

Treatment: VZIG OR acyclovir/valacyclovir

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15
Q

39 week varicella

A

5 days-2 weeks after delivery (not enough protective antibodies)

minimize contact with lesions.

VZIG or acyclovir/valacylovir

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16
Q

Is there a recommended time to delay pregnancy after getting a varicella vaccine?

A

3 months

17
Q

Treatment regimens for Herpes

A

Primary - valtex- 1 gm BID x10 days

Recurrent valtrex 1 gm x 5 days

supression- valtrex 500 mg BID

Severe- acyclovir 5-10 mg/kg IV than switch to valacylovir 1 gm BIDx 10 days

18
Q

Is herpes screening recommended in pregnancy

A

No

19
Q

Cesarean delivery for herpes

A

Recommended for genital lesions, or prodromal symptoms

can offer with outbreak in the 3rd trimester

20
Q

IgG CMV avidity testing

A

high- likely 6 months prior
low- likely < 4 months

early antibodies have lower antigen avidity

21
Q

CMV on ultrasound

A 
cerebral calcifications
microcephaly, 
echogenic bowel, 
FGR, 
subependymal cysts (cyst lining the walls of the brain), 
ventriculomegaly, pericardial effusions
hyperechoic kidneys
hepatomegaly
placentamegaly
placental calcifications
liver calcifications
hydrops
22
Q

Neonatal CMV

A 
jaundice
rash 
hepatosplenomegly
death 
deafness
neurodevelopmental impairment
23
Q

Congenital Syphilis

A

can infect at 6 weeks

- ultrasound concerns usually don’t start till 16 weeks

24
Q

Stages of syphilis

A

Primary - chancre (screening and confirmatory test may be negative)
2nd - skin rash starts on trunk/palms/soles

early latent within 1 year - asymptomatic but serology + and contangious

late latent- > 1 year (not contagious sexually but can transmit to fetus)

teriary - eye/ear/gumma/CV disease (aortic aneuysm)
Argyll roberton pupil (does not react to light)
neurosyphilis

25
Q

Congenital syphilis

A

1 or 2ndary/early latent have highest risks ( 40-50%)
3rd/late latent (<10%)

stillbirth
non-immune hydrops
placentamegaly
hepatomegaly
- most asymptomatic at birth 
maculopapular rash
snuffles
mucous patches in mouth 
hepatosplenomegaly
jaundice
osteocondritis 
chorioretinitis 
iitis 
huthcinson teech 
mulberry molars
8th nerve deafness
saddle nose
saber shins
CNS concerns
26
Q

syphilis screening

A

non-specific antibody (RPR)

confirm with treponemal FTA (positive will stay positive)

27
Q

syphillis treatment

A

2.4 million units penicillin (1x primary 3x late latent)

Jarisch- Herxheimer- fever, decreased fetal movement, contractions, chills, myalgia, headache, hypotension, - resolves in 24-36 hours

Reexamine at 28 weeks/and delivery
- need a four fold (2 dilutional) decrease in non-treponemal titer by 1 year after treatment

28
Q

TB
dx
treatment
latent definition and treatment

A

Evaluation: sputum culture

Treatment: INH, rifampin, pyrazinamide (not in pregnancy) ethambutol

Latent: postitive TB without symptoms, negative CXR - treat with INH

Evaluate for HIV

No breastfeeding until 2 weeks after treatment for active infections

29
Q

Screening for TB
type
who to screen

A

Screen with ppd (not with BCG within 10 years)

HIV
contact with TB
Born in high risk places
low income
alcoholics
IV drug use
Jail
30
Q

Confirmation of + PPD

A

CXR: adenopathy
multinodular infiltrates
cavitations
loss of upper lobe volume

AM sputum for acid-fast bacilli

31
Q

Treatment with
PPD+ with symptoms

Treatment for PPD+/ CXR negative
no symptoms

A

symptoms- 3 am sputums, and eval for extrapulmonary TB
+ treat with INH/Rifampin/Ethambultol for 6 months

  • <35 treat with INH/B6 postpartum for 6 months

No symptoms-
converted recently <2 years- INH after 1st trimester- 6 months postpartum + B6

Old conversions- >2 years or 1st PPD - 35 years or younger treat postpartum with INH/B6

** do not treat >35 if low risk due to risk for hepatotoxicity with INH

  • 20% of those treated with INH get elevated LFT which resolve
  • don’t use streptomycin due to cranial nerve 8 deafness in kiddos
32
Q

Testing/treatment for fetus if mother has TB

A

PPD at birth and 3 months

  • (if active) INH until mom has tested negative for 3 months

MFM Oral Boards 2020 (25 decks)

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