ID Flashcards

Question

46. HepBe antigen indicates a) acute infection b) increased risk of infectivity c) chronic infection d) Active infection

Answer 1

increased risk of infectivity

Answer 2

a) I and D CPS Statements (CA-MRSA Abscesses)

Answer 3

cefazolin if anaphylaxis - give clinda (ensure it is snesitive )

Answer 4

b) amp gent

Answer 5

b) bartonella henselae serology

Answer 6

give full vaccine now in one dose 0.5 mL

Answer 7

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.

Answer 8

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

Answer 9

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.

Answer 10

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.

Answer 11

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.

Answer 12

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

Answer 13

hearing screenn

Answer 14

pneumonia if <12 yo with simple skin, DONT TREAT >12 treat with oral acyclovir if immuncompetent if immunocomp IV acylovir Varicella pneumonia is a severe complication that accounts for most of the increased morbidity and mortality in adults and other high-risk populations, but may also complicate infection in younger children. Respiratory symptoms begin 1-6 days after onset of rash and include cough, dyspnea, cyanosis, pleuritic chest pain, and hemoptysis. Smoking is a risk factor.

Answer 15

CXR CTS Canadian Tuberculosis Standards (2014) All exposed children should have a symptom inquiry and TST. Those less than 5 years of age, all close childhood contacts and all symptomatic children should also have a physical examination and chest radiography. Children less than 5 years of age with a negative TST and no evidence of active TB by examination or radiology should be given “window” of preventive therapy to prevent the development of TB. This is because it may take up to 8 weeks after infection for the TST to convert to positive, during which time the infection may progress to disease. For children presumed to have been exposed to a drug-susceptible isolate, INH is recommended. The INH may be discontinued if, after a period of 8 weeks after the last contact, the repeat TST is negative, and the child remains asymptomatic and is immunocompetent and more than 6 months of age (for infants <6months of age, see section on Perinatal Issues: Recommended Management of the Newborn Infant Exposed to TB).

Answer 16

Swab and wait for the culture results. Treat based on results. The clinical presentation of streptococcal and viral pharyngitis often overlap. Criteria such as the McIsaac score have been developed, but even score 4+ is only associated with <70% positive lab tests (overestimates liklihood). Consequently, lab testing is essential for accurate diagnosis. Clinical findings and/or scoring systems can be used to help physicians identify patients in need of testing.

Answer 17

DTap-IPV-Hib and pneumococcal for kids UNLESS u have serology confirming or reliable testing As per NACI, children who have received one or more doses of polio vaccine before arriving in Canada should have their vaccine series completed with IPV-containing vaccine as appropriate for age.

Answer 18

Pneumococcal polysaccharide (23-valent) vaccine (pneumovax) Nelson’s Ch 527: Nephrotic Syndrome Children with nephrotic syndrome are especially susceptible to infections such as cellulitis, SBP and bacteremia. This is a result of many factors, particularly renal loss of IgG and complement factors. There is a significant increased risk of infection with encapsulated bacteria, in particular pneumococcus.

Answer 19

genetic ENT Lecture Congenital SNHL: 50% genetic, 50% acquired Among acquired includes hyperbilirubinemia, TORCH infections (CMV most common), low birthweight recurrent OM is for CONDUCTIVE HEARING LOSS

Answer 20

5 years of age or until 21 --whatever is longer

Answer 21

PO Amoxicillin Early disease treatment: PO antibiotics x14-21 days If 8+ years old: Doxycycline If <8 years old: Amoxicillin

Answer 22

only son LAIV is now available only in the quadrivalent form. It is authorized for use in individuals 2 to 59 years of age. 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 can be used for children and youth, 2 to 17 years of age, who are not immunocompromised.

Answer 23

1. contraindicated in 1 yo cant give till 2 yo

Answer 24

ultrasound

Answer 25

d) No prophylaxis indicated If a child has a urinary isolate that is resistant to both trimethoprim/sulfamethoxazole and nitrofurantoin, consider discontinuing prophylaxis. 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. CPS Statement: Prophylactic antibiotics for children with recurrent UTIs Antibiotic prophylaxis is no longer routinely recommended after a UTI but may still be considered when a child is known to have a grade IV or V VUR, or a significant urological anomaly. For cases in which prophylaxis is still used, it should generally last for no longer than three to six months. If the abnormality persists, prophylaxis should be reassessed. Antibiotic resistance increases with prolonged prophylaxis. Trimethoprim/sulfamethoxazole or nitrofurantoin are the usual choices for prophylaxis, unless contraindicated or the child has urinary isolates resistance to these drugs.

Answer 26

Conjunctival culture, IM ceftriaxone (as long as the baby is well) Conjunctival culture, CBC, blood culture, CSF, IV Ceftriaxone (if unwell)

Answer 27

9 mo ex 33+6 wk with chronic lung disease requiring home O2 usually only given at 1 yaer of age, upto 2 years if still needing oxygen) - need CLD and less then 12 month of age (at RSV season at nov) - less then 6 month old for PREM - remote: if u hve to fly them hospital <36w and term innuit if less then 6 months from Nov - immunodef + home oxygen - if breakthrough RSV then dont get it

Answer 28

Follow-up, no additional abx needed if <4 stools then just stop abx and no additional tx if more 4 then oral metron x14d if severe then vanco 10-14d

Answer 29

c) Bartonella

Answer 30

pen and clinda GAS and S. aureus, may occur in up to 5% of children with varicella. The more invasive infections, including varicella gangrenosa, bacteria sepsis, pneumonia, arthritis, OM, cellulitis and necrotizing fasciitis, account for much of the morbidity and mortality of varicella in otherwise healthy children. TSS may also complicate varicella. if no varciella before then nec fasc give Vancomycin + Piptazo

Answer 31

today IF LIVE vaccine For IVIG therapy given for KD or ITP: suggested time frame to wait is 11 months after

Answer 32

Should be given to girls + boys regardless of sexual activity

Answer 33

Enterobacter sakazaki Cronobacter sakazakii — Cronobacter sakazakii (formerly known as Enterobacter sakazakii) is a gram-negative rod that causes invasive disease among neonates and children aged three days to four years of age.. Infection with this pathogen has been associated with contamination of powdered formula. Manifestations may include necrotizing enterocolitis, bacteremia or meningitis; mortality ranges from 40 to 80 percent.

Answer 34

wo trivalent intramuscular vaccines 1 month apart (old question, now CPS recommends quadrivalent for all children)

Answer 35

``` Gram positive bacilli include Listeria Corynebacterium Clostridium Bacillus ```

Answer 36

hearing screen

Answer 37

``` Ethambutol Optic neuritis (usually reversible), decreased red-green discrimination, GI disturbance ``` Rifampin Orange discoloration of secretions or urine, staining of contact lenses, vomiting, hepatitis, flu-like reaction, thrombocytopenia, pruritis; OCP may be ineffective!!

Answer 38

cefotax and vanc

Answer 39

HIV DNA PCR

Answer 40

active TB Contraindications to breast feeding in North America a. Active TB b. Hep B - continue breasfeeding. HB immunoglobulin at birth then HBV vaccine. c. Hep C - continue breastfeeding immunization with the HBV vaccine. d. Mastitis - continue breastfeeding unless there is obvious pus, in which case pump from the infected breast and discard the milk. Continue to breastfeed from the unaffected breast.

Answer 41

amox amoxicillin < 8 years, Doxycycline > 8 years

Answer 42

hiv low Consider depth and extent of trauma (scratch or deep cut, injection of blood and bleeding at the site). Injuries with actual blood injection are high risk. Superficial scratches are low risk. If exposure limited to mucous membranes or nonintact skin, consider extent of exposure. For example child put syringe with visible blood into mouth and possibly injected blood – high risk; suspected but unobserved splash onto eyes or lips – low risk. Splashes involving a large volume of blood (not just a few drops) coming into contact with extensive areas of nonintact skin – high risk.

Answer 43

rubella Nelsons 1549: Pathologic Findings in Congenital Rubella Syndrome CVS: PDA, pulmonary artery stenosis, VSD, myocarditis CNS: chronic meningitis, parenchymal necrosis, vasculitis with calcification Eye: micropthalmia, cataract, iridocyclitis, ciliary body necrosis, glaucoma, retinopathy Ear: cochlear hemorrhage, endothelial necrosis Lung: chronic mononuclear interstitial pneumonitis Liver: hepatic giant cell transformation, fibrosis, lobular disarray, bile stasis Kidney: interstitial nephritis Adrenal gland: cortical cytomegaly Bone: malformed osteoid, poor mineralization of osteoid, thinning cartilage Spleen: extramedullary hematopoeisis Thymus: histiocytic reaction Skin: ertyhropoeisis in dermis

Answer 44

Do nothing. - Danielle’s group said this was the best answer as per lecture since baby would be Ab + by 6 months of age. but baby shoudl have got vaccine and immunoblogin hepb

Answer 45

no further test

Answer 46

DO NOTHING

Answer 47

d. Give Hepatitis B vaccine to both. Prophylactic use of antibiotics should only be considered for bites that cause moderate or severe tissue damage; deep puncture wounds; or bites to the face, hand, foot, or genital area that are more than simple superficial abrasions [5][33]. These situations are very unlikely to be encountered in a child care setting. If the HBV status of both children is unknown, low risk of infection does not justify HBV testing. Both children should be given HBV vaccine, unless already fully immunized

Answer 48

An 8 month old with campylobacter diarrhea exposure to chicken pox, 8 days AFTER exposure as before its inubtation and shed 2 days before u get the lesions Airborne precautions from 8 days after the first day of exposure to 21 days after the last day of exposure; to 28 days if given varicella zoster immune globulin

Answer 49

Type II (monomicrobial): most commonly caused by group A Streptococcus (also known as hemolytic streptococcal gangrene). VARICELLA is risk factor. pip clinda

Answer 50

c. Provide rifampin plus menjugate The close contacts of any patient diagnosed with meningococcal disease or Hib should be treated with rifampin or another suitable alternative according to local public health guidelines.

Answer 51

staph toxic shock sx toxic shock syndrome include fever, hypotension, and skin manifestations. Additional symptoms and signs include chills, malaise, headache, sore throat, myalgias, fatigue, vomiting, diarrhea, abdominal pain, and orthostatic dizziness or syncope.

Answer 52

tx amox Persistent symptoms (nasal discharge or cough or both) for >10 days without improvement, or ●Severe symptoms (onset with temperature of ≥39°C [102.2°F] and purulent nasal discharge for ≥3 consecutive days), or ●Worsening symptoms (respiratory symptoms that worsen after initial improvement) or onset of new fever or severe headache

Answer 53

hydrops 19 infection during pregnancy may be associated with fetal loss or hydrops fetalis. However, there do not appear to be long-term developmental sequelae of infection in children who do not develop hydrops fetalis.

Answer 54

strep vaginitis

Answer 55

do nothing

Answer 56

a. she can’t return for 1 week

Answer 57

CPS Statement: Lyme disease in Canada caused by bacterial spirochete - borrelia burgdorferi transmitted to humans via the bites of black-legged ticks (ixodes scapularis) treatment - oral meds > 8 years - doxycycline - 4mg/kg/day div in two doses <8 years (or unable to tolerate doxy) - then AMOX 50 mg/kg/day div TID penicillin allergic - cefuroxime 30mg/kg/d div BID duration is usually 14-21 days, may be up to 28 days in some cases (ex: arthritis)

Answer 58

vanco/cefotaxime CPS Statement: guidelines for the management of suspected and confirmed bacterial meningitis in Canada > 1 mos of age EMPIRIC THERAPY more common bugs in children > 1 mos = Neisseria and s. pneumo but need to consider E coli and GBS in all infants < 3 mos of age empiric therapy for children > 1 month = ceftriaxone OR cefotaxime AND vanco can add ampicillin if patients at risk due to immunosuppression (for listeria) If bcx/csf neg or not performed then can do ceftriaxone OR cefotax wihtout vanco (can add if evidence of strep pneumo resistnence)

Answer 59

amox CPS- stwardship nonserious infection such as AOM, using the beta-lactam amoxicillin in a twice-per-day regimen is reasonable if the dose is sufficiently high (75 mg/kg/day to 90 mg/kg/day). However, for more serious infections, such as pneumonia, cellulitis, cervical adenitis, sinusitis or abscess, a beta-lactam should be given three or four times per day treat with a high dose amox clav if (80-90 mg/kg/day of amox) risk factors: abx in last 1-3 months, in daycare, < 2 yrs old those who fail to respond to amox within 72 hrs

Answer 60

GAS perianal strep dermatitis -GAS infects skin around anus (other pathogens inc: strep pyogene (most common), n menignitis, h lu, M catarrhalis, even shigella, yersinia) sharply demarcated redness, local swelling and itch around area of anus - can have inflam of vulva and vagina in girls, or end of penis in boys, pain on passing stool, constipation, cracks in the anus, and discharge of pus or blood from rectum can swab it and treat with Amox x 14 days pinworm-worst at night

Answer 61

. Recombinant vaccine for the prevention of cervical cancer and benign condylomatas The aim of the vaccine is to prevent infections and, thus, the diseases subsequently associated with HPV-6, -11, -16 and -18 HPV 16 and 18 are for cancer, and hpv 6 and 11 for genital warts and recc resp papillomatosis

Answer 62

GAS Children who present with abrupt onset of OCD/tic disorder be evaluated for GAS infection. -Diagnosis of PANDAS (pediatric autoimmune neuropsychiatric disorder associated with group A streptococci) requires prospective evaluation with documentation of an episode of neuropsychiatric symptoms associated with evidence of GAS infection (positive throat or skin culture, rapid antigen detection test, or rising antistreptococcal antibody titers).

Answer 63

tyhpoid -tx cipro (nowadays ceft) Typhoid fever usually presents with abdominal pain, fever, and chills approximately 5 to 21 days after ingestion of the causative microorganism. Classic manifestations include relative bradycardia, pulse-temperature dissociation, and "rose spots" (faint salmon-colored macules on the trunk and abdomen). Hepatosplenomegaly, intestinal bleeding, and perforation may occur, leading to secondary bacteremia and peritonitis. Laboratory findings may include anemia, leukopenia, leukocytosis, and abnormal liver function tests.

Answer 64

staph Pneumatocele → Pneumatoceles are thin-walled, air-containing cysts of the lungs. They are classically associated with S. aureus, but may occur with a variety of organisms [129,130]. Pneumatoceles frequently occur in association with empyema [129]. S. aureus pneumonia can be suspected on the basis of chest x-ray that reveal pneumatoceles, pyopneumothorax, or lung abscess

Answer 65

tb Contraindications: Active TB → delay breastfeeding until mother gets 2 weeks of therapy. But infant can be fed EBM during that time (TB transmission is airborne, not through breast milk). TB medications are safe; so okay to breastfeed if mother is on TB meds. Brucellosis - discontinue breastfeeding as this can be passed through breast milk HSV ½ - discontinue breastfeeding if there are active lesions on the breast (until lesions are crusted over). Can use EBM. HIV - breastfeeding and EBM both contraindicated Human T cell lymphotrophic virus (HTLV 1 or 2) → contraindicated (BF and EBM)

ID Flashcards

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