UW pertusis (mehl. jau sukurtos) 04-01 (2)

Question 1

UW. table postexposure. INDICATIONS REGARDLESS OF VACCINATION Hx). 2

Answer 1

Close contacts with symptomatic patient (eg household members, direct contact wit hsecretions)

High risk-patients, even with limited exposure (eg pregnant, infant, immunodeficiency)

Question 2

UW. table postexposure. Tx age <1 month.?

Answer 2

Azithromycin

Question 3

UW. table postexposure. Tx age >=1 month?

Answer 3

azithromycin, clarithromycin or erythromycin

Question 4

UW. table postexposure. Tx gali ats but in general macrolides

Answer 4

.

Question 5

UW. pertussis transmission?

Answer 5

highly contagious
transmitted via respiratory droplets

Question 6

UW. CP?

Answer 6

mild cough + rhinorrhea for 1-2w (catarrhal stage) => develop to whooping cough (is paroxysmal stage).

Question 7

UW. although most contagious during catarrhal stage, but disease can spread during early paroxysmal stage

Answer 7

.

Question 8

UW. first line Tx?

Answer 8

MACROLIDES

within first 3 weeks. when give during cathraral stage, it shortens the course of illness, decr. transmission.

If given only during paroxysmal - decr. spread, does not effect duration of disease

Question 9

UW. what prevents pertusis?

Answer 9

vaccination

Question 10

UW. why need to give prophylactic antibiotics?

Answer 10

despite immunization, immunity can wane.

Question 11

UW. whats about postexposure vaccine?

Answer 11

not effective.

If patient is not immunized, follow vaccination schedule.

Question 12

UW table. mos?

Answer 12

bordetella pertussis (gram-negative coccobacilli)

Question 13

UW table. Cp. catarrhal (weeks 1-2)?

Answer 13

mild cough, rhinitis

Question 14

UW table. Cp. paroxysmal (weeks 2-8)?

Answer 14

SEVERE COUGHING SPELLS +/- inspiratory whoop, POSTTUSSIVE EMESIS,
apnea/cyanosis (in infants)
posttussive syncope (older patients)

Question 15

UW table. Cp. convalescent (weeks 8+)?

Answer 15

symptoms resolve gradually

Question 16

UW table. Diagnosis - clinical?

Answer 16

cough + paroxysmal symptoms and/or pertussis exposure

supportive findings: low grade/no fever, leukocytosis with lymphocytosis, normal/nonspecific xray

Question 17

UW table. Diagnosis - confirmatory?

Answer 17

pertussis CPR (sensitive) and culture (specific)

Question 18

UW table. Tx?2

Answer 18

Macrolides
Droplet precautions

Question 19

UW table. prevention? 3

Answer 19

vaccination
macrolide for close contacts regardless of immunization status

Question 20

UW. can occur facial petechiae and/or subconjutival hemorrhages, why?
emesis, why?

Answer 20

forceful coughing -> capillary rupture

incr. intrathoracic/intraabdominal pressure -> emesis

Question 21

UW. sometimes can cause syncope, why?

Answer 21

incr. intrathoracic pressure -> decr. cardiac preload and CO -> transient hypotension -> decr. cerebral perfusion -> syncope