ID

Question 1

Most common congenital infection?

Answer 1

CMV (0.5%)

Question 2

Clinical Features of congenital CMV infection?

Answer 2

• General. –> IUGR, prem
• Skin: –> Petechia, purpura, achymosis, jaundice
• Heme: –> Thombocytopenia, anemia, splenomegaly
• Liver: –> Hyperbili, ALTs, hepatomegaly
• CNS: –> microcephaly, sz, periventricular calcifications
• Eyes: –> Chorioretinitis, stabismus, optic atrophy, microphtalmia
• Ears: –> SHL

Question 3

Newborn with + CMV PCR urine — treatment ?

Answer 3

Asymptomatic? – nothing

Symptomatic (eg fail HS): Valganciclovir x 6mo

Question 4

Newborn started on Vangancyclovir- what to monitor?

Answer 4

ANC : weekly x 6wks , at 8wks, then monthly

ALT: monthly

Question 5

Congenital Syphillis: early onset findings

Answer 5

1) Gen: Prematurity, IUGR, FTT
2) CNS: Aseptic meningitis, hydrocephalus, CN palsies
3) Eyes: salt & pepper chorioretinitis, uveitis, glaucoma
4) Skin: Snuffles, maculopapular rash –> desquamation, blistering+crusting, condyloma lata
5) Heme: Coomb’s negative hemolytic anemia, thrombocytopenia
6) Organs: HSM, LAD
7) MSK: pseudoparalysis, osteochondritis, osteitis/perisosteitis, demineralization/destruction of tibia metaphysis

Question 6

Congenital Syphillis: Late onset findings

Fyi..wont be asked

Answer 6

1) CNS: GDD, hydrocephalus, CN palsies, Sz, juvenile paresis
2) Eyes: keratitis, healed chorioretinitis, corneal scarring, glaucoma, optic atrophy
3) Ears: SNHL
4) Face: Saddle nose, frontal bossing, protuberant mandible, high palate
5) Teeth: Hutchinsons teeth, mulberry molars
6) Skin: ragades (linear scars), gummas
7) MSK : saber shins, clutton joints, Higoumenakis sign

Question 7

Pregnant mom with syphilis, 1) what level of titer in mom would be considered “treated” ?
2) Management for baby if higher titer?

Answer 7

Need to be 1:32 or less in mom

Baby receives:

• full work up with LP
• IV PCN x 10days (regardless of work up)

Question 8

When to evaluate an infant for congenital syphillis?

CPS

Answer 8

1) has s/s of cong syph
2) mom not tx or tx not adequate
3) mom tx w non PCN Abx
4) mom tx w/in 30 days of birth
5) less than 4x drop in mom titer (or not assessed(
6) mom had relapse/re-infection after tx

Question 9

Evaluation of infant with suspected syphilis (invx)

Answer 9

1) exam: stigmata, opts, audio
2) BW: CBC, LFTs
3) LP: CSF WBC, protein, treponema and non trep serologic tests
4) Skeletal survey
5) Syphilis serology (tree and non tree)
6) Direct detection: micro

Question 10

Treatment of congenital syphilis ?

Answer 10

10d IV PCN

Question 11

Congenital Zika: clinical features

Answer 11

• severe microcephaly
• partially collapsed skull
• retinal mottling
• congenital contractures (arthrogryposis, club foot0

Question 12

Risk of congenital anomaly from Zika in pregnancy?

Answer 12

5-10% overall

1st trim of pregn: 8-13%
2nd/3rd trim: 3-5%

Question 13

If infant of mother with possible zika exposure in pregnancy- what to test?

Answer 13

Maternal serology for Zika (and PCR if exposure in last 4 weeks)
If positive then test infant

Question 14

If assessing for Zika due to unexplained microcephaly- what to test?

Answer 14

Assess possible exposure (time and health habits)
Test mom and baby for serologies + PCR .
Save placenta.
US and MRI

Question 15

Clinical features of congenital rubella?

Answer 15

IUGR
blueberry muffin rash
HSM
cataract*
bony lucency *
Cardiac: PDA *
SNHL

Question 16

Clinical features of congenital Toxo?

classic triad
%age symptomatic vs non

Answer 16

Macrocephaly/Hydrocephalus*
Parenchymal calcification* (vs perventr)
Chorioretinitis***

Symptomatic 85%
Asymptomatic 15%

Question 17

classic triad congenital rubella

Answer 17

cataract
PDA
SNHL

Question 18

Congenital VZV infection- features

Answer 18

cicatrial scars **
limb hypoplasia **
micropthalmia, microcephaly

Question 19

GBS neonate:

1) Classify by onset
2) Type of transmission
3) Manifestations

Answer 19

1) Early (>7d)
Late (>7d)

2) Early: vertical
Late: Vertical or horizontal

3) Early: PNA, septicemia, meningitis

Late: Meningitis, OM, ST infections, sepsis

Question 20

Indications for intrapartum GBS proph

Answer 20

Positive GBS Cx (35-37 wks)

Unknown GBS and :

• hx infant w GBS
• GBS UTI
• Deliv <37 wks
• ROM >18
• Maternal fever

Question 21

Congenital HSV: clinical manifestations

Answer 21

Skin, eye, mouth (45%)
- 10-12 DOL

Encephalitis (30%)
- 16-19 DOL

Disseminated (25%)

• 10-12 DOL
• sepsis lik, multi organ

Question 22

Suspected congenital HSV disease: Dx

Answer 22

Culture/PCR of :

1) Vesicle
2) eyes
3) urine
4) stool
5) blood
6) CSF

DO LP even if clinically well.

Question 23

Suspected congenital HSV disease: Tx

Answer 23

▫ IV acyclovir 60 mg/kg/day

• -> Isolated mucocutaneous disease: 2 weeks
• -> Disseminated, CNS disease: 3 weeks

▫ If CSF PCR positive, repeat LP towards end of treatment

▫ PO acyclovir: x 6 mo improves neurologic outcome for those with CNS disease

Question 24

Factors affecting HSV transmission

Answer 24

1) Type of maternal infection & serostatus (1st primary (high), 1st episode non-primary (medium), recurrent (lower)
2) ROM >6h
3) Fetal scalp monitor
4) HSV 1 vs 2 (31% vs 2.7%)
5) C/S reduces risk

NB: majority of HSV infant –no maternal hx of genital herpes

Question 25

HSV: asymptomatic infant of mother with active lesions at delivery : Invx?

Answer 25

1) Sample from mouth, NP, conjunctiva, and anus at ~24h of life for culture/PCR 2) Maternal serologies (HSV-1 or 2) -- recommended by some, not always available

Question 26

HSV: asymptomatic infant of mother with active lesions at delivery : Tx? 1) 1st ep SVD (or CS before ROM) 2) 1st episode: C/S no ROM 3) Recurrent episodes

Answer 26

1) 1st episode SVD or (CS after ROM) - --> emp IV Acyclovir - --> 24h swab +ve : full w/u + tx - --> 24 swab -ve: 10d IV Acyclovir 2) 1st episode: C/S, no ROM - --> NO emp IV Acyclovir - -> if 24h +ve: full wu + tx 3) Recurrent episodes - --> NO emp IV Acyclovir - --> If 24h swabs +ve: ful w/u + tx

Question 27

Role of steroids in meningitis: | what species? what age? what dose?

Answer 27

1) for H. Influenza and S. pneumonia 2) >6weeks 3) 0.6mg/kg/day div 4 doses

Question 28

When to consider repeat LP at 24-36h?

Answer 28

- failure to improve clinically - immunocompromised - S. pneumo resist PCN/Ceph - Gram - bacilli

Question 29

OM: what are 2 most common pathogens?

Answer 29

``` Staph Aureus Kingella Kinge ( >4) ```

Question 30

OM: Tx course and duration

Answer 30

IV ancef (unless MRSA) ``` IV to PO when - clinically improved - CRP down - compliance + fu assured Duration: - Uncomplicated: 3-4 weeks - Septic hip: 4-6 weeks ```

Question 31

Skin abscess (S.Aureus): management for 1) <1mo 2) 1-3 mo no fever/systemic 3) >3mo: low grade or no fever 4) >3mo: sign cellulitis, low grade/no fever, no systemic

Answer 31

1) IV ABx: ( +/- Vancouver) , can consider PO clinda in well and <1cm 2) Septra 3) No Abx. Abx if no improvement or Cx diff org. 4) Septra + Keflex pending Cx results

Question 32

When to give tetanus vaccine and IG for wound?

Answer 32

- Give tetanus Ig only for: - non-clean non-minor wounds for someone received <3 shots of tetanus. - Give tetanus vaccine for: - non-minor and minor wounds for someone received <3 shots of tetanus or if last shot was 10y+ for minor wounds, 5y+ for major wounds

Question 33

Top pathogens per age group and Empiric ABx 1) Neonate 2) 1-3mo 3) >3mo

Answer 33

Neonate: - Group B streptococcus - Gram negative bacilli (E. coli) - Listeria spp. * ** Ampicillin + cefotaxime 1-3 mo. - overlap above and below * ** Ceftriaxone + vancomycin ± ampicillin > 3 mo. - Streptococcus pneumoniae - Neisseria meningitidis - Haemophilus influenzae type b * ** Ceftriaxone + vancomycin