ID Flashcards
Child with pulmonary findings, eosinophilia, slightly elevated calcium (2.8)
a. miliary TB
b. sarcoidosis
c. cryptococcus
d. blastomycosis
sacroidosis
You see a mother in clinic with her 6 month-old infant. The mother is anti-HCV positive, and has a history of IV drug use. The infant’s anti-HCV is negative. What do you do for the infant?
a) HCV PCR
b) Reassure
c) Livery Biopsy
d) Repeat anti-HCV in 6 months
b) Reassure
The infant does not have any antibodies present, therefore vertical transmission did not occur or the child cleared Hepatitis C. No further testing is required.
A girl presents for scalp itching and is found to have nits and lice. What do you recommend regarding return to school?
a) After completing treatment
b) Immediately
c) After she is found to have no evidence of infection
a) After completing treatment
There is no sound medical rationale for excluding a child with nits or live lice from school or child care. A full course of treatment and avoiding close head-to-head activities are recommended. The American Academy of Pediatrics and the Public Health Medicine Environmental Group in the United Kingdom also discourage ‘no nit’ school policies.
The families of children in the same classroom or child care group where a case of active head lice has been detected should be alerted. Information on diagnosis and management of head lice from a credible source should be shared, along with clear messages that head lice are neither a disease risk nor a sign of lack of cleanliness.
10 month old recently immigrated from refugee camp in Turkey. He received 3 oral vaccines and 3 injectable vaccines in his lifetime (question did not specify which vaccines). What do you give him at his first visit to you?
a) Pneumococcal + Hib
b) DTAP/IPV/Hib + Pneumococcal
c) DTAP/IPV/Hib + Pneumococcal + Hep B
d) No other vaccination at this time
DTAP/IPV/Hib + Pneumococcal
When a child’s vaccine record is unreliable or unavailable, vaccines should be provided as if the child were non-immunized, as a general rule.1 If a child receives an immunization that was received previously (“re-immunization”), it is usually safe, though there is increased risk of a local reaction with some vaccines. While serological tests may be available for diphtheria, tetanus, hepatitis A, measles, mumps, rubella, varicella and hepatitis B, they are not sufficiently comprehensive (e.g., polio is not available), cost-effective or time-sensitive to be practical in most cases.1
Woman 28 weeks pregnant, with 2 and 5 year old children at home. What is the best way to prevent influenza in the new baby within the first 6 months of life?
- Inactivated vaccine for mom right now
- Inactivated vaccine for mom after birth
- Inactivated vaccine for dad and two kids, no vaccine for mom
- Inactivated vaccine for dad, live attenuated vaccine for two kids, no vaccine for mom
Inactivated vaccine for mom right now
CPS: The benefits of influenza vaccine during pregnancy for the fetus and infant <6 months of age
Influenza vaccines are not licensed or recommended for infants <6 months of age[4] because their immune response, when studied, has been variable and vaccine effectiveness is unclear.[6] Two other immunization strategies to protect the very young have been evaluated: ‘cocooning’ (the immunization of postpartum women and an infant’s household contacts); and immunizing pregnant women.
Cocooning programs have met with some success and evidence suggests that the maternal immunization component provides most of an infant’s protection from influenza.[
ID 9 week old baby presenting with fever (~39.5). Tachycardic and irritable. Labs demonstrated WBC 4.5 (60% neutrophils, 40% leukocytes), serum glucose 4.5. LP done, shows 400 RBCs, 100 WBCs, glucose 1.5, protein normal. Gram stain of CSF is negative for bacteria. How do you treat? Ampicillin and cefotaxime Vancomycin and ceftriaxone Cefuroxime and Acyclovir Acyclovir alone
Vancomycin and ceftriaxone
If an option that includes amp with vanco and ceftriaxone, choose that one
CPS Statement:
Most common organisms in healthy, immunized children >1 month of age - S pneumoniae and N meningitidis. Consider E coli and GBS in infants up to three months of age.
Hib is still occasionally observed in incompletely immunized patients, but other encapsulated H influenzae cases are being diagnosed with increasing frequency. Listeria if there is an underlying immunodeficiency - add ampicillin
A neonate has congenital CMV and the audiology screen shows sensorineural hearing loss. How do you treat?
a Valganciclovir for 4 weeks
b Valganciclovir for 6 months
c Reassure
Valganciclovir for 6 months
with sx CMV (ie, chorioretinitis, HSM, splenomegaly etc then for sure tx 6 months)
4 year old girl had Kawasaki disease and was treated with IVIg and was discharged from hospital yesterday. She is due for her tetanus/diphtheria/polio booster in your office today. When should she receive her vaccine?
a. At today’s visit
b. In 2 months
c. In 4 months
.A) At today’s visit
for live vaccines MMRV wait 11 months
There is minimal or no interaction between blood products or Ig preparations, hence can GIVE at todays visit
- inactivated vaccines
- live oral vaccines (rotavirus, oral typhoid vaccines)
- live intranasal vaccine (live attenuated influenza vaccine)
- Bacille Calmette-Guerin (BCG) vaccine
- yellow fever vaccine
A 3 year old has erythematous rash, cough, rhinorrhea, and conjunctivitis as well as white spots on his buccal mucosa. What type of isolation should he have in hospital?
a. Airborne
b. Contact
c. Droplet
d. Droplet + contact
airborne
“Measles” - rash head and moves down
Measles is a serious infection characterized by high fever, an enanthem, cough, coryza, conjunctivitis, and a prominent exanthem. After an incubation period of 8-12 days, the prodromal phase begins with a mild fever followed by the onset of conjunctivitis with photophobia, coryza, a prominent cough, and increasing fever.Koplik spots represent the enanthem and are the pathognomonic sign of measles, appearing 1-4 days prior to the onset of the rash
A 10 year old girl has unilateral swollen cervical lymph nodes and ipsilateral conjunctivitis. She has an enlarged spleen. Her CBC shows WBC 13 with mild neutrophilia and NO atypical lymphocytes. Which of the following organisms is most likely to be responsible?
a. Staph aureus
b. Toxoplasma gondii
c. Bartonella henselae
d. EBV
Bartonella henselae
Cat Scratch Disease - subacute, regional lymphadenitis caused by B. henselae. Most common cause of chronic lymphadenitis that persists for >3 wk. 87-99% had contact with cats (often kittens <6 mo), >50% have hx of a cat scratch or bite
atypical presentation is Parinaud oculoglandular syndrome, which is unilateral conjunctiviti
An ex-preterm baby is now 8 weeks old but is still in the NICU. When do you give his first vaccines?
a. Now
b. When he is 8 weeks corrected
c. When he is discharged from the NICU
now
A teen girl presents with a 3 week history of arthritis, thrombocytopenia, hemolytic anemia, and decreased C3/C4 after attending camp. What test of most specific?
a. Borrelia burgdorferii serology
b. ANA
c. Anti ds DNA
Anti ds DNA
Borrelia burgdorferii serology - wouldn’t get decreased C3 C4 and hemolytic anemia, thrombocytopenia with lyme disease (early, erythema migrans and meningits —> chronic is joints , peripheral neuropathy)
14yo M with vesicular, very pruritic rash and work of breathing, tachypnea. Most likely cause:
a. Myocarditis
b. Pneumothorax
c. Varicella pneumonia
Varicella pneumonia
> 12yo means worst prognosis
What is the risk of transmission of HIV in a blood transfusion?
a. 1 in 50,000
b. 1 in 1 million
c. 1 in 10 million
d. 1 in 100 million
1 in 10 million
A pregnant woman is HIV positive and she has been on anti-retroviral therapy since her diagnosis. She is currently 34 weeks pregnant. What is the risk of vertical transmission of HIV for her?
a. 1%
b. 5%
c. 10%
d. 25%
1%
untreated is 15-40%
A 9 month old girl presents to your office for the flu shot, which she has never received before. What should she get?
a. Intranasal vaccine
b. one trivalent intramuscular vaccine
c. two trivalent intramuscular vaccines 1 month apart
d. two trivalent intramuscular vaccines 2 weeks apart
two trivalent intramuscular vaccines 1 month apart
(can also do quadravalent)***
A 5 year old boy has been exposed to his grandfather who has cavitary TB. What is the first step in management?
a. TB skin test
b. CXR r/o active disease first
c. Start INH
d. Start Rifampin
cxr – if they have weird lesions then admit for w/u and start tx
so if less then 5, and asx, and do CXR to see if active disease, but if CXR neg do TST now and then in 3 months with WINDOW prophylaxis
if TST neg later, stop WINDOW prop, but if positive do LATENT tx (2 meds for 9 months)
What is the best treatment for headlice if resistance is prevalent?
a. Permethrin
b. Resultz
Permethrin (try twice and if doesnt work then do a third)
A newborn is diagnosed with sepsis. The gram stain shows gram positive bacilli. Which antibiotic will cover this?
a. Cefotaxime
b. Gentamicin
c. Ampicillin
d. Vancomycin
AMP
NELSON “Listeria” its ike GBS
Members of the genus Listeria are facultatively anaerobic, non–spore-forming, motile, Gram-positive bacilli that are catalase positive. Two clinical presentations are recognized for neonatal listeriosis: early-onset neonatal disease (<5 days, usually within 1-2 days of birth), which is a predominantly septicemic form, and late-onset neonatal disease (>5 days, mean 14 days of life), which is a predominantly meningitic form
other presentations of GAS
CPS - Invasive GAS:
Confirmed case: Laboratory isolation of GAS from a normally sterile site +/- evidence of invasive disease
Invasive GAS:
Streptococcal TSS
Soft tissue necrosis (NF, myositis, or gangrene)
Meningitis
GAS pneumonia (Pneumonia with isolation of GAS from a sterile site or from bronchoalveolar lavage [BAL] fluid should be regarded as a form of invasive disease for the purposes of public health management, if only isolated from BAL, not considered a a sterile site specimen, thus would not meet national case definition)
Other life-threatening condition(s)
Confirmed case resulting in death
- West nile virus: Most common presentation.
a. fever
b. encephalitis
c. Asymptomatic
d. Mild non-specific illness
asx
virus neuroinvasive disease presents as fever in conjunction with meningitis, encephalitis, flaccid paralysis, or a mixed pattern of disease.
4y. o. previously healthy with 5 days of fever and cough with this x-ray. BEST treatment?
a) cefotaxime
b) cefotaxime + erythromycin
c) vancomycin
d) cefotaxime + vancomycin
CEFOTAX - complicated pneumonia
add vanco for pneumaotcele if staph
add azithro if atypical
You receive a report of a positive CMV test on an infant who is now 2 months old but had thrombocytopenia at birth. His thrombocytopenia has resolved and he is asymptomatic. What is the most important thing to do now?
a. Test mother and siblings for CMV
b. MRI head
c. Hearing screen
d. Initiate treatment with gancyclovir for 6 weeks
hearing sc
Congenital CMV
It may not be possible to confirm the diagnosis of congenital CMV infection if testing is performed after the first three weeks of life (because of the possibility of postnatal acquisition). Newborn dried blood spot testing can be helpful if available, but negative results do not exclude congenital CMV infection. A diagnosis of “possible” congenital CMV infection may be made if all of the following criteria are met:
•One or more signs or symptoms of congenital CMV.
•Other conditions that cause these abnormalities have been excluded. (See ‘Differential diagnosis’ below.)
•CMV is detected in urine or saliva samples (via viral culture, shell vial assay, or PCR) or CMV IgG antibody is detected in the blood after the first three weeks of life, up to one year of age.
Adolescent returned from ghana following bloody diarrhea, now has bruising, hypertensive, edematous
a. HUS
b. Schistosomiasis
c. Typhoid
d. Dengue
HUS
Schistosomiasis - Urinary symptoms, liver involvement, infected patients may demonstrate anemia, chronic pain, diarrhea, exercise intolerance, and undernutrition.
- HepBe antigen indicates
a) acute infection
b) increased risk of infectivity
c) chronic infection
d) Active infection
increased risk of infectivity
2yo presents with abscess on buttocks, brother had same disease recently. There is no surrounding erythema and he is otherwise well.
a) I and D
b) start clinda
c) start septra and I and D
d) IV vanco
a) I and D
CPS Statements (CA-MRSA Abscesses)
- Mom with GBS and hx of maculopapular rash when given Pen in last delivery. What antibiotic
a) penicillin
b) cefazolin
c) clinda
d) erythromycin
cefazolin
if anaphylaxis - give clinda (ensure it is snesitive )
3 week old baby admitted with RSV proven bronchiolitis. Two days into his hospitalization he develops a fever to 39C. There is no change in his physical exam. He has been requiring 0.5L O2 since admission and remains tachypneic. A CXR is done after the fever and shows a small RML infiltrate. What is your management?
a) supportive care
b) amp gent
c) Ceftriaxone
d) Racemic Epi
b) amp gent
- 4yo kid with axillary node (not red), mildly tender, no other signs of infection on that arm, no travel history, no hepatosplenomegaly or systemic symptoms. No marks, not draining. What test to confirm diagnosis
a) PPD skin test
b) bartonella henselae serology
c) Mycobacterium TB
b) bartonella henselae serology
. 6yo Kid with previous flu vaccine last year with no reaction, what do you do this year?
a) give full vaccine now in one dose 0.5 mL
b) give vaccine in divided dose, 1/2 now and 1/2 in four weeks
c) gets two vaccinations
d) Give vaccine 0.25 mL
give full vaccine now in one dose 0.5 mL
. 14 mo old kid with multiple pneumonia (x2), ear infections (x4), and has buttocks abcesses (serratia). Has lymphadenitis. Which test would determine the diagnosis?
a) NBT
b) Immunoglobulins
c) T cell subsets
NBT
CGD is characterized by neutrophils and monocytes capable of normal chemotaxis, ingestion, and degranulation, but unable to kill catalase-positive microorganisms because of a defect in the generation of microbicidal oxygen metabolites.
4 yo girl with fever, splenomegaly, diffuse lymphadenopathy, purpuric rash on legs. Ulcerated pharynx. WBC 24, HB 80, Plts 20. Likely diagnosis?
a) leukemia
b) lymphoma
c) Mononucleosis
d) ?
leukemia
Osteomyelitis: MSSA
a) Cefazolin
b) Clinda
c) Vanco
cefaz
Endocarditis prophylaxis is indicated for
a) TOF
b) MVP with MR
c) Bicuspid Ao Valve
TOF
AHA Guidelines for infective endocarditis dental prophylaxis
1. prosthetic cardiac valve or prosthetic material used for cardiac valve repair
2. a history of infective endocarditis
3. certain specific, serious congenital (present from birth) heart conditions, including
o unrepaired or incompletely repaired cyanotic congenital heart disease, including
those with palliative shunts and conduits
o a completely repaired congenital heart defect with prosthetic material or device,
whether placed by surgery or by catheter intervention, during the first six months
after the procedure
o any repaired congenital heart defect with residual defect at the site or adjacent to
the site of a prosthetic patch or a prosthetic device
4. a cardiac transplant that develops a problem in a heart valve
3 yr old boy with cerebral palsy presents with fever and tachypnea. On CXR there is an air collection surrounded by consolidation and a significant pleural effusion on the LLL. what is the most appropriate management? clindamycin and gentamicin ciprofloxacin cefuroxime and azithromycin ampicillin and gentamicin
clinda and gent
(aspiration - ceft (GN) and CLINDA (anareobic and GP)
could also pip tazo
Hospital-acquired pneumonia — Empiric treatment of hospital-acquired pneumonia should include coverage for S. aureus, Enterobacteriaceae, Pseudomonas aeruginosa, and anaerobes. Acceptable broad spectrum regimens usually include an aminoglycoside (for gram-negative pathogens) and another agent to address gram-positive pathogens and anaerobes.
Aspiration pneumonia — Empiric antibiotic regimens for community-acquired aspiration pneumonia must cover oral anaerobes.
Child described with Unilateral facial weakness, and vesicles in ear canal. Best management
Acyclovir and steroids
Acyclovir alone
steroids alone
Acyclovir and steroids
Ramsay Hunt
The major otologic complication of VZV reactivation is the Ramsay Hunt syndrome, which typically includes the triad of ipsilateral facial paralysis, ear pain, and vesicles in the auditory canal and auricle [41,42]. Taste perception, hearing (tinnitus, hyperacusis), and lacrimation are affected in selected patients. For most patients, we administer valacyclovir (1 g three times per day for 7 to 10 days) and prednisone (1 mg/kg for five days, without a taper). In severe cases (eg, vertigo, tinnitus, or hearing loss), IV therapy can be initiated, and the patient can then be transitioned to an oral antiviral agent when the lesions begin to crust.
Mom comes in with 1 yo daughter and 5 yo son. You are talking to them about the live intranasal influenza vaccine. Daughter has been well. Son was admitted 1 month ago for moderate asthma exacerbation and had 5 day PO course steroids. You tell her:
a Vaccine can be given to both
b Can only be given to son; contraindicated in daughter
c Can only be given to daughter; contraindicated in son
d Contraindicated in both
Can only be given to son; contraindicated in daughter
IF it was 7 days ago THEN CANT GIVE
LAIV is now available only in the quadrivalent form. It is authorized for use in individuals 2 to 59 years of age [2]. LAIV is not licensed for use in children <2 years of age because of a small, but significant, increased rate of wheezing two to four weeks following vaccination observed in this age group.
LAIV, because it is a live vaccine, is contraindicated in individuals with immune-compromising conditions. LAIV is also contraindicated for individuals with severe asthma (defined as active wheezing, currently on oral or high-dose inhaled glucocortico-steroids or medically attended wheezing within the previous seven days) and during pregnancy.
LAIV is also contraindicated in children and adolescents, 2 to 17 years of age, receiving chronic acetylsalicylic acid-containing therapy because of the association of Reye’s syndrome with acetylsalicylic acid given during influenza infection.
3. Child got IVIg recently. How long do you have to wait before giving the DTaP vaccine? Give now Wait 4 weeks Wait 8 weeks Wait 11 months
NOW
A child with ALL finished chemo 1 month ago and is exposed to Varicella. How do you treat? VZV vaccine VZIG VZV vaccine + admit for IV acyclovir Admit for IV acyclovir
VZIG
5. 7yo African male. Recently immigrated to Canada. Tired, paroxysmal fevers and chills with pallor. Hepatosplenomegaly. Vitals stable. Malaria GBS Ebola Dengue
malaria
Malaria should be suspected in patients with any febrile illness if they have had exposure to a region where malaria is endemic. The initial symptoms of malaria are nonspecific and may also include tachycardia, tachypnea, chills, malaise, fatigue, diaphoresis (sweating), headache, cough, anorexia, nausea, vomiting, abdominal pain, diarrhea, arthralgias, and myalgias. Physical findings may include mild anemia and a palpable spleen.
MALARONE
can also treat doxy
3week old baby, admitted with bronchiolitis. Mildly tachypneic, and retractions on exam. Requiring O2 0.5L/min. Day 2 of admission, febrile 39C. Exam otherwise unchanged. What is cause for fever? GBS strep pneumo GAS RSV
RSV
34 week old premature baby is diagnosed with congenital CMV. Normal CSF. Most appropriate management.
PO Valgancyclovir → if the question tells you that the child is symptomatic
IV Acyclovir
Regular hearing screen
hearing screenn
