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Royal College Exam > Infectious Diseases > Flashcards

Infectious Diseases Flashcards

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1
Q

How is HPV transmitted?

A

Direct epithelial-to-epithelial contact (sexually, vertically from mother to infant, oral mucosa)

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2
Q

Is HPV infection necessary before the development of cervical cancer?

A

Yes! However the infection must have been present for years

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3
Q

What type of cancers is HPV associated with?

A

Squamous cell carcinoma and adenocarcinomas of the cervix, penile / vulvar/vaginal cancers, squamous cell cancers of oropharynx

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4
Q

Which HPV serotypes are associated with most cancers?

A

HPV-16 and HPV-18

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5
Q

What are the other six HPV genotypes associated with the remaining 20% of cervical cancer?

A

HPV-31, -33, -35, -45, -52 and -58

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6
Q

Which HPV serotypes are associated with genital warts?

A

HPV-6 and HPV-11 are responsible for 90% of genital warts

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7
Q

What is the overall prevalence of HPV in canada?

A

11-29%, peak prevalence in young adults

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8
Q

What are risk factors for HPV infection?

A

of sexual partners, early age of first intercourse, never being married, never being pregnant, immunosuppression

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9
Q

Which serotypes does the quadrivalent HPV vaccine protect against?

A

HPV-6, -11, -16, -18

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10
Q

When should the HPV vaccine be given?

A

Before acquisition of the virus

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11
Q

What is the efficacy of the vaccine against the development of pre-cancer lesions?

A

> 98% (98% effective against dysplastic lesions, 100% effective against high-grade lesions, 99% effective against vaginal warts)

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12
Q

What is the vaccination schedule for the HPV vaccine?

A

Depends on age. If you are 9-14 yrs old and immunocompetent, you may receive 2-dose schedule (0 and 6-12 months). Otherwise, you should get 3-dose schedule (0,2,6 months).

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13
Q

Who does the CPS recommend receive the HPV vaccine?

A

Girls between 9-13 yrs of age, and all unimmunized females 13 yrs of age and older. Also: females who have had previous pap abnormalities or warts

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14
Q

What are the two vaccines approved in Canada for HPV?

A

Gardasil or Cervarix

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15
Q

What are infectious etiologies of genital ulcers?

A
  • HSV
  • syphilis (treponema pallidum)
  • chancroid (h. ducreyi)
  • lymphogranuloma venereum (chlamydia)
  • granuloma inguinale (donovanosis)
  • candida
  • secondary bacterial infection
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16
Q

How do you treat first episode of HSV infection?

A

7-10 days of oral acyclovir (if immunocompetent)

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17
Q

What type of virus causes Measles?

A

Paramyxovirus

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18
Q

What are the symptoms of Measles?

A
  • fever
  • malaise
  • cough
  • coryza
  • conjunctivitis
  • maculopapular rash
  • Koplik’s spots
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19
Q

What are some serious complications of measles?

A
  • pneumonia
  • encephalitis (1/1000 cases)
  • death (2-3/1000 cases)
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20
Q

What is a rare long-term sequelae of measles infection?

A

subacute sclerosing panencephalitis (SSPE) - can occur 7-10 yrs after the primary infection

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21
Q

When is a person with measles infectious?

A

From 4 days before the rash until 4 days after the rash

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22
Q

What is the incubation period of the measles virus?

A

approx 14 days (range 7-21)

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23
Q

How many people die from measles each day (in the world)?

A

380!

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24
Q

What type of vaccine is available against measles?

A

live-attenuated (as part of the MMR)

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25
Q

What are recommendations for unvaccinated children who are travelling?

A
  • children ages 6-11 months who travel internationally should receive one dose of the MMR vaccine 2 weeks before leaving
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26
Q

What type of isolation should someone with suspected measles have?

A

airborne precautions

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27
Q

What is the treatment of measles?

A

Supportive care! No anti-virals indicated. Severe cases can be treated with Vitamin A (age specific dosing)

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28
Q

What type of strep causes “strep throat”?

A

Group A streptococcus (GAS) aka streptococcus pyogenes

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29
Q

What type of bacteria is GAS?

A

gram positive coccus in chains

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30
Q

What is the reservoir of GAS?

A

skin and mucous membrane of human host

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31
Q

What are the suppurative complications of GAS pharyngitis?

A 
♣	Necrotizing fasciitis
♣	Bacteremia
♣	Peritonsillar cellulitis / abscess
♣	Otitis media
♣	Sinusitis
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32
Q

What are the non-suppurative complications of GAS pharyngitis?

A

♣ Acute rhematic fever
♣ Post-strep glomerulonephritis
♣ Pediatric autoimmune neuropsychiatric disorders associated with strep (PANDAS)

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33
Q

Who gets GAS pharyngitis?

A

School aged children or their younger siblings

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34
Q

What are viral etiologies of acute pharyngitis?

A
  • EBV
  • HIV
  • HSV
  • influenza
  • enterovirus
  • adenovirus
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35
Q

What can you recommend to parents to prevent RSV?

A
  • hand hygiene
  • breastfeeding
  • avoiding cigarette smoke exposure
  • avoiding contact with sick individuals
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36
Q

What is used for RSV prophylaxis?

A

Palivizumab

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37
Q

How is palivizumab dosed?

A

15mg/kg administered IM Q30 days during RSV season (Max 5 doses)

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38
Q

What is a high-risk group for RSV related hospitalization?

A

Inuit children from remote northern communities

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39
Q

who does the CPS recommend palivizumab for?

A
  • CHD or CLD (O2 need at 36 weeks GA) requiring diuretics, bronchodilators, steroids or supplemental O2
  • born at < 30 wks GA and < 6 mos
  • born at < 36 wks GA and < 6 mos and inuit/aboriginal
  • term inuit/aboriginal and live in remote area
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40
Q

Do you treat a child who is asymptomatic but colonized with c.diff?

A

No

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41
Q

What is the recommended treatment for mild or moderate c.diff?

A

Metronidazole PO x 10-14 days

second line: vancomycin PO

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42
Q

What are the features of severe c.diff infection?

A 
●Profuse diarrhea with systemic sxs (fever, rigors, severe abdo pain or distention)
●Hypotension / shock
●Ileus or toxic megacolon
●WBC >15
●Elevated creatinine
●Serum albumin level
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43
Q

which antibiotic is most effective for treatment of c.diff?

A

vancomycin

but flagyl preferred for mild or moderate infections

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44
Q

What are complications of varicella infection?

A
  • invasive group A strep soft tissue infection (cellulitis, myositis, nec fasc, TSS)
  • neurologic complications (encephalitis, acute cerebellar ataxia)
  • Reye syndrome
  • pneumonia (uncommon in children)
  • hepatitis
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45
Q

Definition of invasive GAS infection

A
  • if there is lab confirmation of infection (isolation of GAS from a normally sterile site), invasive disease is defined as:
    o Stretococcal TSS
    o Soft tissue necrosis (myositis, gangrene)
    o Meningitis
    o Combination of all of the above
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46
Q

Who should receive chemoprophylaxis if exposed to someone with invasive GAS?

A

close contacts exposed over past week

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47
Q

What is the definition of close contact (in the context of invasive GAS chemoprophylaxis)

A

o Spent at least 4 hrs per day with the patient in the previous 7 days, or 20 hours per week
o Non household persons who share the same bed or have had sexual relations
o People who have had direct mucous membrane contact
o Injection drug users who shared needles
o Selected contacts in long-term facilities, child care, hospital settings

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48
Q

what is the differential diagnosis for croup?

A
  • Bacterial tracheitis (if high fever, toxic appearance, poor response to epi)
  • Epiglottitis (absence of barky cough, drooling, sitting forward in “sniffing position”)
  • Foreign body
  • RPA
  • Angioedema
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49
Q

what is tamiflu?

A

a neuraminidase inhibitor (oseltamivir)

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50
Q

treatment of outpatient community acquired pneumonia

A

amoxicillin x 5 days
OR
azithromycin x 5 days (if suspect atypical)

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51
Q

treatment of inpatient CAP

A

ampicillin x 7-10 days (can upgrade to 3rd gen cephalosporin +/- vanco if severe)

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52
Q

How do you treat opthalmia neonatorum related to gonorrhea?

A

single dose of ceftriaxone

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53
Q

Who should receive UTI prophylaxis?

A

: antibiotic prophylaxis is NOT routinely recommended, but may be considered in grade IV or V VUR or significant urologic abnormality

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54
Q

what are the usual antibiotic choices for UTI prophylaxis?

A

septra or nitrofurantoin

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55
Q

If the child has a UTI resistant to septra or nitrofurantoin, what do you use for prophylaxis?

A

NOTHING. - Experience suggests that using broader-spectrum agents for prophylaxis (such as cefixime or ciprofloxacin) often results in a UTI with an organism that is resistant to any remaining oral options for therapy.

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56
Q

What are the types of maternal HSV?

A

Newly acquired:
-First-episode primary infection (mother has no serum antibodies to HSV-1 or -2 at onset);
- First-episode nonprimary infection (mother has a new infection with one HSV type in the presence of antibodies to the other type)
OR
Recurrent (mother has pre-existing antibodies to the HSV type that is isolated from the genital tract).

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57
Q

what is the impact of c-section on risk of maternally transmitted HSV?

A

Delivery by elective Cesarean section markedly reduces but does not eliminate the risk for newborn infection

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58
Q

how should a woman positive for HSV be treated during pregnancy?

A

prophylaxis with acyclovir from 36 weeks GA to delivery

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59
Q

How can perinatal HSV be classified?

A
  • Disseminated HSV;
  • Localized CNS HSV;
  • Skin, eye and mucous membrane (SEM) infection.
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60
Q

When do symptoms of neonatal HSV infection present?

A

Can present up to 6 weeks after birth

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61
Q

How is neonatal HSV detected?

A
  • viral cultures, PCR, direct immunofluorescent antibody staining of skin lesions, enzyme immunoassays for HSV antigens
62
Q

How is neonatal HSV treated?

A

acyclovir 60 mg/kg/day in three divided doses administered every 8 h

63
Q

What is the length of treatment for neonatal HSV?

A

Treatment duration should be 14 days if the disease is limited to the skin, eyes or mouth, and a minimum of 21 days if the infection involves the CNS or is disseminated.

64
Q

What do you recommend to a mom with active HSV?

A

Mothers with herpes labialis should wear a disposable mask when caring for their infant

65
Q

contraindications to the live-attenuated influenza vaccine (LAIV)

A 
o	pregnant
o	egg allergy
o	immunocompromised
o	hx of severe allergic reaction
o	receiving aspirin
o	2-4 years old with asthma, hx of wheeze in past 12 months
66
Q

what causes bullous impetigo?

A

strains of S. aureus that produce exfoliative toxin A, a toxin that causes loss of cell adhesion in the superficial epidermis by targeting the protein desmoglein 1 (similar to pathology of pemphigus)

67
Q

what is ecthyma?

A

ulcerative form of impetigo in which the lesions extend through the epidermis and deep into the dermis. They consist of “punched-out” ulcers covered with yellow crust surrounded by raised violaceous margins (due to streptococcus pyogenes)

68
Q

what bugs cause impetigo?

A

staph aureus, beta-hemolytic strep (primarily group A)

69
Q

what causes lyme disease?

A

borrelia burgdorferi

70
Q

what is erythema migrans?

A

Erythema migrans is the manifestation of early localized Lyme disease. Erythema migrans is a rash that appears at the site of the tick bite, usually within 7 to 14 days after the bite (range 3 to 30 days)

71
Q

What is the treatment of choice for lyme disease?

A

If > 8 yrs = oral doxycycline, if under 8 yrs = oral amoxicillin or cefuroxime

72
Q

How is hepatitis A transmitted?

A

fecal-oral

73
Q

How do you diagnose hepatitis A?

A

Serum IgM anti-HAV is the gold standard

74
Q

what is the best test for an infant born to an HIV-infected mother?

A

qualitative RNA assays, or PCR if not available

75
Q

Who should receive VariZIG immunoprophylaxis after VZV exposure?

A
  • Immunocompromised patients
  • Newborns of mothers with varicella 5 days before or 2 days after delivery
  • Preterm infants 28-36 weeks GA who are exposed, if their mother does not have immunity
  • Preterm infants
76
Q

How do you treat herpes zoster oticus?

A

Acyclovir and steroids

77
Q

What is the other names for herpes zoster oticus?

A

Ramsey Hunt Syndrome

78
Q

How do you manage tympanostomy tube ottorhea?

A

Uncomplicated cases are typically treated with topical antibiotic ear drops with or without corticosteroids

79
Q

How long after IVIG do you give the DTaP vaccine?

A

As soon as indicated

80
Q

Who do you need to give VZIG to?

A
  • Immunocompromised patients
  • Newborns of mothers with varicella 5 days before or 2 days after delivery
  • Preterm infants 28-36 weeks GA who are exposed, if their mother does not have immunity
  • Preterm infants
81
Q

What common live vaccines? (5)

A

Intranasal influenza vaccine, MMR, varicella, BCG, rotavirus

82
Q

How long should live vaccines be delayed after IVIG?

A

5-11 months (dependent upon the vaccine and dose of IVIG)

83
Q

What type of isolation is necessary for Measles?

A

airborne

84
Q

Diagnosis of Measles?

A
  • Positive IgM antibodies
  • Isolation of virus
  • Rise of IgG
85
Q

What causes cat scratch disease?

A

Bartonella henselae (bacteria)

86
Q

What causes perinaud’s oculoglandular syndrome?

A

Bartonella henselae, a bacteria causing cat scratch disease. Symptoms = conjunctivitis in one eye, lymphadenopathy

87
Q

Which bacteria has been found to contaminate powder based formula?

A

Enterobacter sakazaki

88
Q

What is the risk of transmission of HIV in a blood transfusion?

A

1 in 10 million

89
Q

What is the risk of transmission of HepC in a blood transfusion?

A

1 in 6 million

90
Q

What is the risk of transmission of HepB in a blood transfusion?

A

1 in 1.5 million

91
Q

What type of bacteria is Listeria?

A

Gram positive bacilli

92
Q

Most common presentation of West Nile Virus?

A

Asymptomatic!

93
Q

Diagnosis of congenital CMV?

A

urine or saliva sample within first three weeks of life - viral culture or PCR

94
Q

Timeline for treatment of congenital CMV?

A

Antivirals only benefit within first month of life

95
Q

Which anti-TB drug is associated with oculo-toxicity?

A

ethambutol

96
Q

What serology indicates active HepB infection?

A

HBsAg, HBeAg

97
Q

What antibody develops after HepB immunization?

A

Anti-HBs (surface)

98
Q

Duke criteria for endocarditis

A

Major:

  • 2 positive blood cultures
  • endocarditis on ECHO

Minor:

  • fever
  • embolic-vascular signs
  • immune complex phenomena (GN, arthritis, RF, osler nodes, roth spots)
  • single positive blood culture
  • soft ECHO signs
  • predisposing conditions

Can have 2 major, one major + 3 minor, or 5 minor

99
Q

bugs implicated in endocarditis

A
  • strep viridans

- staph aureus

100
Q

HPV types that gardasil protects against

A

6, 11, 16, 18

101
Q

what pathogens must be considered in meningitis in the unimmunized child?

A

strep pneumo, haemophilus influenzae

102
Q

what are the 5 serogroups implicated in neisseria meningitis infections?

A

A, B, C, Y, W-135

103
Q

which serogroup is the most common cause of meningoccal infection in canada?

A

B

104
Q

what groups are at increased risk of meningococcal meningitis?

A
  • anatomical or functional asplenia (HbSS)
  • primary antibody deficiency disorder
  • complement, properdin, factor D deficiency
  • travelling to a place where there is a high meningococcal risk
  • lab personnel with exposure to meningococcus
  • military
105
Q

as per CPS, when should canadian children be immunized against neisseria meningitidis?

A

Children should be immunized with MCV-C (polysaccharide vaccine) at 12 months of age

106
Q

Treatment of congenital syphilis

A

IV penicillin 10-14 days

107
Q

CSF findings toxoplasmosis

A

lymphocytic pleocytosis and very high CSF protein

108
Q

classic triad of toxoplasmosis

A

hydrocephalus, cerebral calcifications, chorioretinitis

109
Q

what is the upper limit of time that you can give VZIG after an exposure?

A

10 days

110
Q

classic triad for rubella?

A

cataracts, PDA, sensorineural hearing loss

111
Q

what do you do for a documented maternal exposure to parvovirus B19?

A

obtain maternal serology (IgM, IgG). if negative, repeat in 2-3 weeks

112
Q

GBS positive mom, mild penicillin allergy. what intrapartum prophy?

A

cefazolin

113
Q

GBS positive mom, severe penicillin allergy. what intrapartum prophy?

A

clindamycin

114
Q

treatment of skin, eye, mouth HSV in neonate?

A

acyclovir 60 mg/kg/day x 2 weeks

115
Q

treatment of disseminated / CNS HSV?

A

acyclovir 60 mg/kg/day x 3 weeks AND oral acyclovir x 6 months

116
Q

treatment of latent TB Infection

A

isoniazid x 9 months

117
Q

What serologies do you test for in needle-stick injuries?

A

serology for hep B, hep C, and HIV

118
Q

when do you do bloodwork after a needle-stick injury?

A

baseline, 6 weeks, 3 months, 6 months

119
Q

which vaccines do you have to delay after IVIG?

A

MMR and VZV

120
Q

Toxoplasmosis triad

A

hydrocephalus, chorioretinitis, cerebral calcificiations

121
Q

toxoplasmosis - CSF findings

A

lymphocytic pleocytosis, elevated protein

122
Q

most common neurologic manifestation of Lyme

A

facial nerve palsy

123
Q

treatment of Lyme in child < 8yrs old

A

amoxicillin OR cefuroxime

124
Q

Most common clinical symptom of west nile virus

A

asymptomatic

125
Q

Neurologic symptoms of west nile virus

A

aseptic meningitis, encephalitis, acute flaccid paralysis

126
Q

Post-bite (breaking the skin) - when to check serology for Hep B, Hep C and HIV?

A

Hep B: 6 months
Hep C: 6 months
HIV: 6 weeks, 3 months, 6 months

127
Q

When to prophylax needle stick injury?

A

If fresh blood, blood injected and < 72 hrs since needle stick occurred = HIGH RISK, should have 3 drug prophylaxis (AZT) x 28 days

(low risk: consider 2 drug prophylaxis)

128
Q

Side effects of AZT

A

nausea, vomiting, abdo pain, diarrhea, anorexia
mild neutropenia, anemia
elevated liver enzymes

129
Q

Members of flavivirus family

A 
Zika
West Nile
Dengue
Japanese encephalitis
St. Louis encephalitis
Yellow fever
130
Q

Congenital Zika Syndrome - features

A

o Severe microcephaly w/ collapsed skull, redundant scalp
o Thin cerebral cortices, subcortical calcifications
o Macular scarring, focal pigmentary retinal mottling
o Contractures, arthrogryposis

131
Q

Zika virus - diagnosis

A

o Serology (IgM or IgG or neutralizing antibody)

OR

o Detection of ZIKV RNA by PCR

132
Q

How would you work up suspected Congenital Zika Syndrome?

A
  • Serology and PCR on blood and urine of mother and infant
  • U/S and MRI brain for infant (non-urgent)
  • Save placenta
133
Q

What anti-fungal medication would you use for invasive aspergillosus?

A

Voriconazole

134
Q

Risk factor for invasive group A strep in children

A

Varicella infection

135
Q

Signs of invasive GAS infection

A

TSS
Soft tissue necrosis (nec fasc)
Meningitis

136
Q

Treatment of invasive GAS

A

Penicillin

Clindamycin

137
Q

Chemoprophylaxis of GAS

A

1st generation cephalosporin (keflex)

138
Q

Conditions that need prophylaxis for IE

A

o Prosthetic cardiac valve or previous IE
o Congenital heart disease – unrepaired cyanotic, repaired in last 6 mos, repaired with leak/defect
o Cardiac transplant recipients with valvulopathy

139
Q

How do you test for syphilis?

A

Non-treponemal test (RPR)

and treponemal test

140
Q

What do you monitor if you are treating for syphilis?

A

RPR (want a fourfold drop in titre at 6 mos)

141
Q

What is a “barbershop pole” umbilical cord associated with?

A

Congenital syphilis

142
Q

Signs of congenital syphilis at birth

A

Rhinitis / snuffles, neurosyphilis, anemia/thrombocytopenia, necrotizing funisitis (‘barbershop pole’ umbilical cord)

143
Q

Signs of congenital syphilis within first 8 weeks of life

A

Hepatosplenomegaly

Rash

144
Q

Tooth abnormalities in congenital syphilis

A

o 13-19 mos: Mulberry molars

o Permanent teeth – Hutchinson’s teeth (widely spaced, notched)

145
Q

MSK anomalies in Congenital Syphilis

A

Osteochondritis, pseudoparalysis, frontal bossing, saddle nose, winged scapula, sabre shins, Clutton’s joints (recurrent arthropathy, painless knees effusions)

146
Q

Which organism causes tinea versicolor

A

Malassezia

147
Q

What should you use to treat tinea capitis?

A

Terbinafine

Itraconazole is also good, but not first choice

148
Q

What are the vector + host of West Nile Virus?

A 
Culex mosquitoes (vectors)
Birds (hosts)
149
Q

Complications of West Nile Virus

A

Encephalitis, meningitis

Flaccid paralysis

150
Q

Risk of Reye’s syndrome with which two viruses (and ASA)

A

Influenza

VZV

151
Q

The HPV vaccine prevents… (4 things)

A
  • Warts
  • Adenocarcinoma - cervical cancer
  • Squamous cell cancers - penile, vaginal, oropharyngeal
  • Recurrent respiratory papillomatosis
152
Q

Gram negative rod in returning traveller….

A

Salmonella typhi!

Tx: ceftriaxone or ciprofloxacin

Royal College Exam (32 decks)

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