Infectious Disease Flashcards
(107 cards)
1
Q
- influenza vaccine – intranasal, 1 yo healthy and 3 yo with asthma, got oral steroids one month ago and now takes low dose inhaled corticosteroids
A) contraindicated in 1 yo
B) contraindicated in 3 yo
C) contraindicated in both
D) both can have it
A
A) contraindicated in 1yo
What are contraindications of LAIV?
- <2yo
- Severe asthma (active wheezing or medically attended wheezing in past 7d, or currently on oral or high dose inhaled corticosteroids)
- Pregnant
- Immunocompromised
- Received influenza antiviral in past 48H
- ASA (Reyes)
2
Q
- 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
A
Can be given to son (>7d ago for medically attended wheezing, no current oral or high dose ICS), but not daughter (b/c <2yo)
3
Q
- 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
A
Two trivalent IM vaccines 1mo apart
If <9yo and first influenza shot, need to get 2 shots at least 4wks apart
IIV has quadrivalent or trivalent. Of course, quad IIV is preferred
4
Q
- 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
A
Give full vaccine in one dose 0.5mL
If have previously had a shot, then just need one per year
5
Q
16. Child got IVIg recently. How long do you have to wait before giving the DTaP vaccine? A. Give now B. Wait 4 weeks C. Wait 8 weeks D. Wait 11 months
A
Give now
Delay MMR+V at least 3m, up to 11mo, depends on dose
- 300-400mg/kg: 8mo
- 1g/kg: 10mo
- 2g/kg: 11mo
Do not need to delay inactivated vaccines (incl’g recombinant) or other live vaccines (rotavirus, influenza, BCG, yellow fever)
Consider checking vaccine titres 6mo after IVIG D/C’d to determine if protective immunity. Then re-immunize if not protective.
6
Q
- A child with ALL finished chemo 1 month ago and is exposed to Varicella. How do you treat?
A. VZV vaccine
B. VZIG
C. VZV vaccine + admit for IV acyclovir
D. Admit for IV acyclovir
A
VZIG
VZIG PEP indicated for (5):
- At risk pregnant women
- Infant of mother with chicken pox 5d before or within 48h of delivery
- Hospitalized prem (>=28wk GA) of mother with unknown status
- Hospitalized prem (<28wk) or low BW <1kg regardless of maternal status
- Immunocompromised child without Hx of varicella or immunization
- give VZIG within 10d of exposure
7
Q
63 A child with nephrotic syndrome has recently been started on a course of oral steroids. Which of the following vaccines is contraindicated? a. Prevnar b. Hep B c. Influenza d. Varicella zoster --------------- 18 month old nephrotic syndrome, steroid responsive. Has been on daily steroids for 1 month duration. What vaccination is contraindicated? a. conjugated pneumococcal vaccine b. influenza c. hepatitis B d. varicella
A
Varicella
When can live vaccines be given?
- 1mo after high dose steroids (systemic equivalent to >=2mg/kg/d or >=20mg/d in 10yo, for >=14d)
- 3mo after immunosuppresive chemo
- 6mo after anti-B cell Tx if underlying disease not active
- 24mo after HSCT if no GVHD, no immunosuppresive meds in past 3mo, transplant team declared immunocompetent
8
Q
- What are the current recommendations for the HPV vaccine?
A. Should be given to girls >9y who have not been sexually active
B. Should be given to girls + boys regardless of sexual activity
C. Should be given to all girls regardless of sexual activity
A
B if had to choose
Give routinely to all children 9-13yo, ideally before onset of any sexual activity to optimize prevention of HPV long term complications
9
Q
- What does guardasil protect against and how?
a. live attenuated against CA
b. recombinant against CA
c. live attenuated against CA and condylomata
d. recombinant against CA and condylomata
—————–
Which of the following is the best description of the vaccine gardasil?
a. Recombinant vaccine for the prevention of cervical cancer
b. Recombinant vaccine for the prevention of cervical cancer and benign condylomatas
c. Live attenuated vaccine for the prevention of cervical cancer and benign condylomatas
d. Live attenuated vaccine for the prevention of cervical cancer
A
Recombinant against CA and condylomata
10
Q
- Rotavirus vaccine
a. Decrease hospitalizations
————-
What would you advice regarding vaccine for Rotavirus:
a. decreases infections for rotavirus by 95%
b. decreases rates of admissions in infections for rotavirus
c. decreases the chances of gastroenteritis from different etiology (horribly remembered)
A
Decrease hospitalizations
Decreases rates of admission
85% efficacy in <2yo
Can decrease sz related hospitalizations in <2yo (febrile sz)
11
Q
- A child at daycare bites another child and causes bleeding but it’s not a deep bite. Both are immunized but their hepatitis B status is unknown. The next best step is:
a. Do HBV serologies on both
b. Give oral clavulin prophylaxis to the bitten child
c. Check both for HBV surface Antigen and antibodies
d. Give Hepatitis B vaccine to both.
—————
Child in daycare, bitten (bloody), next step:
a. Hep B serology
b. Vaccinate for Hep B
c. Give HBIG
—————
Biting incident at daycare, breaks skin superficially, both kids are previously healthy and have all their immunizations but no HepB shots. What do you do?
a. screen them for HIV
b. start Hep B vaccinations in both kids
c. test Hep B serology only in the biter
d. tetanus immunoglobulin
—————- - Kid bit other kids, both immunized but not hep b
a. Vaccinate both
A
If both have unknown status: Give Hep B vaccine to both
12
Q
- 2 year old, un-immunized, but otherwise healthy child presents soon after falling in the playground with a laceration. After cleaning and suturing the laceration, which of the following should he receive:
a. Tetanus toxoid
b. Tetanus immunoglobulin and tetanus toxoid in another site
d. Tetanus toxoid and penicillin
—————
2 year old with no immunizations. Has laceration while playing in park. What do you do?
a. Tetanus immunoglobulin
b. Tetanus immunoglobulin and tetanus vaccine in different sites
c. Tetanus vaccine only
————-
2-year old boy, unimmunized, cuts his foot on a rusty nail. What do you give?
a. First dose of Tetanus toxoid immunization.
b. Tetanus immune globulin IM in one arm, and first dose of immunization in the other.
c. Tetanus immune globulin IM only
A
Tetanus vaccine + TIg
What are “all other wounds”?
- Contaminated with dirt, soil, feces, saliva (animal bites)
- Deep puncture
- Avulsion
- Injury due to missile, crush, burn, frostbite
13
Q
Child with sydenhams chorea and no other findings. What would you recommend for antibiotic prophylaxis? (actual wording) A. Until 21 years of age B. Lifelong C. 5 years from illness D. No prophylaxis required
A
Depends on age of pt at time of diagnosis and presence/absence of carditis
ABx prophylaxis to prevent infective endocarditis
Higher risk of carditis with recurrence (i.e. pts with carditis with initial episode):
- long term ABx prophylaxis
Lower risk of carditis:
- Prophylaxis should continue until 21yo or until 5y from last ARF attack, whichever is longer
14
Q
- A 12 year old was in an MVC that resulted in severe splenic laceration requiring splenectomy. What does she need now?
a. Penicillin prophylaxis
b. Penicillin prophylaxis and meningococcal and pneumococcal vaccines
c. Meningococcal and pneumococcal vaccines
d. Nothing required
A
pen prophylaxis (at least 2Y post-splenectomy) and pneumococcal + meningococcal (vaccinate ≥2 wk from surgery)
15
Q
- Contraindications to breastfeeding in North America
a. Active TB
b. Hep B
c. Hep C
d. Mastitis
—————–
Which infection is contraindicated in breastfeeding?
a. TB
b. HIV
c. Hep C
d. Hep B
A
HIV!
What are contraindications for breastfeeding?
- HIV
- HTLV-1 + 2
- Brucellosis
- Active HSV on breast
- TB: avoid if contagious, delay until 2wks of Tx in mom (baby can have EBM during this time)
What are NOT contraindications for breastfeeding?
- Hep B
- Hep C
- CMV
- Mastitis
What are cautions with breastfeeding?
- Metronidazole: hold BF/EBM for 24H to allow for excretion of dose
- Sulfa-drugs: caution if baby has juandice or G6PD deficiency or if child is ill, stressed or premature
- quinines: contraindicated unless both mother + baby have normal G6PD
16
Q
- Which of the following children should be excluded from daycare?
a. Child with pertussis on the 5th day of antibiotics
b. An unvaccinated child who was exposed to chickenpox 3 days ago
c. An 8 month old with campylobacter diarrhea
d. A 2 year old with hepatitis 10 days after it started
A
Campylobacter diarrhea
Pertussis: need full 5d of antibiotics
Chickenpox: if child is well, or until lesions crusted
Hepatitis A: only need 7d from onset of illness or jaundice
17
Q
- You are examining a patient in the ER with diarrhea. As you are taking off your gloves you get some stool on your hands. What do you do?
a. Wash with regular soap and water
b. Wash with antimicrobial soap and water
c. Wash with chlorahexadine
d. Use alcohol hand sanitizer
A
Wash with regular soap and water
18
Q
- You are trying to set up an infection control program in your hospital. What intervention will result in the best form of infection control for RSV?
a. Hand wash with soap and water
b. Hand wash with isopropyl alcohol solution
c. Gown and glove
d. Isolate everyone who is contagious
A
Jess Dunn. Handwash with isopropyl alcohol solution (more foolproof than handwashing)
Sickkids said isolate everyone who is contagious (more likely better enforced than other interventions)
19
Q
5.4 year old boy presents with a few days of cough, respiratory symptoms, fever. Sats are normal (95% in room air). CXR shows a consolidation in the left lower lobe. What is the best antibiotic? A. Ceftriaxone B. Ceftriaxone and azithromycin C. Azithromycin D. AmoxicilliN
A
amoxicillin
TID IN PNA!
20
Q
- 10 year old, non-toxic looking. Admitted to hospital with left lobe infiltrate on chest xray. Best management? [CPS]
a. Ampicillin
b. Clarithromycin
c. Ceftriaxone + azithromycin
d. Ceftriaxone
A
Ampicillin
21
Q
12. 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? A) clindamycin and gentamicin B) ciprofloxacin C) cefuroxime and azithromycin D) ampicillin and gentamicin ---------------------- 109. 3 yo with CP with recurrent symptoms of aspiration. Admitted with pneumonia, abscess and pleural effusion. What would be your choice of antibiotics. a. Vanco + Amp b. Amp + gent c. Clinda + Gent
A
Ideally CFTX (better pen-resistant strep-pneumo coverage) + clinda (anaerobes)
22
Q
- 4y.o. previously healthy with 5 days of fever and cough with this x-ray (complete white out on right). BEST treatment?
a) cefotaxime
b) cefotaxime + erythromycin
c) vancomycin
d) cefotaxime + vancomycin
A
Cefotax + vanco
CFTX/Cefotx + vanco/clinda
for complicated pneumonia
23
Q
- Febrile 12 month old with left lower lobe consolidation, tachypneic and looks unwell. How would you treat?
a. PO amoxicillin
b. IV cefuroxime
c. IV cefuroxime and IV azithromycin
d. IV vancomycin and IV ampicillin
———-
12 mo old with lobar pneumonia. Looks toxic. Tx?
a. Cefotaxime
b. PO Amoxil
c. IV Cefotaxime + Azithromycin
———–
Toxic child with RUL pneumonia. Antibiotics?
a. IV cefuroxime
b. IV cefuroxime + IV azithromycin
A
Cefuroxime - but not best answers based on current CPS statement
If hospitalized and not life threatening would give Amp
Because he is unwell, would treat with 3rd gen cephalosporin (CFTX or cefotaxime)
Consider adding vanco to cover MRSA until Cx back(progressive multilobal disease or pneumatocele)
No azithro b/c unlikely to be atypical pneumonia in non-school aged children
24
Q
- Child appears toxic and has lobar pneumonia. What antibiotics should be used?
a. PO Amoxil
b. Cefuroxime IV
c. Cefuroxime IV and Azithromycin PO
d. Vanco and ampicillin
A
Cefuroxime
Ideally:
Amp if non-life-threatening
CFTX +/- Vanco if life -threatening
25
66. Child admitted with known RSV bronchiolitis. On third day of his admission, develops a fever and CXR shows a small RML infiltrate. What is the most likely cause of his fever?
a. Strep pneumo
b. Chlamydia trachomatis
c. RSV
d. GBS
---------------
1 month old baby admitted for RSV infection. On day 2 of hospitalization develops fever of 39oC. CXR with small RML infiltrate. O2sat 92% on 0.5L/min. what is source of fever?
a. RSV
b. S. pneumonia
c. Group B strep
d. Chlamydia
RSV
CXR usually reveals nonspecific, patchy, hyperinflation + areas of atelectasis, which can be misinterpreted as consolidation -> leads to inappropriate antibiotics
26
97. Child with cerebral palsy and history of recurrent choking episodes, presents now with fever and tachypnea. CXR shows large pneumatocele in LLL with pleural effusion. What is the most likely organism?
a. Staph (if pneumatocele)
b. Anaerobic bacteria
c. Strep
Staph
Staph: unilateral pneumonia, pneumatoceles, empyema, +/- bronchopulmonary fistula
Strep pneumo: focal lobar involvement
GAS: more diffuse interestial pneumonia, often pleural effusion
Staph aureus, strep pneumo, GAS are most common cause of parapneumonic effusions + empyemas
27
38. 4mo with meningitis, gram + cocci in cSF, which antibiotic
a) amp, and cefotaxime
b) cefotaxime
c) cefotaxime and vancomycin
d) Dexamethasone/ceftriaxone
cefotaxime + vanco
28
65. 7 week male, previously healthy, presents irritable, febrile. CBC reveals normal white count, normal differential. Serum glucose normal. CSF with 100 W, 900 R, pn 1.0, glu 1.5. What to start?
a. amp + cefotax
b. amp + gent
c. amp + vanc + ceftriaxone
d. ceftriaxone + acyclovir
-----------------
7 week old baby presents with findings of meningitis. Given CBC, blood glucose 5.4mM. CSF glucose 1.4mM, WBC 100, RBC 500. Gram stain negative.
a. amp/gent
b. amp/cefotaxime
c. amp/vanco/cefotaxime
------------------
7 week old with fever. CBC showed increased WBC with increased polys. CSF protein 1.0, glucose 1.4 (serum glucose 4.5). Gram stain –ve. Mgt?
a. Amg/gent
b. Amp/cefotaxime
c. Vanco/cetriaxone/amp
d. Ceftriaxone/acyclovir
---------------------
81. How do you treat meningitis in an 8-week old?
a. amp/gent
b. amp/cefotaxime
c. vanco/cefotaxime
Vanco + cefotaxime + amp
29
87. A 3 month old girl has an 18 month old brother who got meningococcemia. What would be your management.
a. Provide Ciprofloxacin
b. Provide rifampin
c. Provide rifampin plus menjugate
d. Provide menjugate
Rifampin + menjugate
30
91. Child with purpuric rash, non-blanchable and very unwell with fever. What do you use for prophylaxis of family?
a. ceftriaxone
b. rifampin
c. erythro
d. penicillin
-------------------
A child is brought to ER very unwell. She has a preceding sore throat, headache and fever. She is beginning to have a purple rash that doesn’t blanche. How do you prophylaxis her family?
a. Penicillin
b. Ceftiaxone
c. Rifampin
d. Ciprofloxacin
rifampin
31
53. 1 year old exudative pharyngitis, what is the most likely pathogen?
a. H Flu
b. Grp A Strep
c. Viral pharyngitis
Viral pharyngitis
Most common cause of acute pharyngitis is viruses!
Of bacterial acute pharynigits: GAS is most common
32
113. A mother brings in her 3 children to your office because she thinks they all have Strep throat. The 18 month-old and the 2 ½ year-old both have exudative tonsillitis. The 4 year-old has a red pharynx and mild anterior cervical lymphadenopathy. What should you do?
a. no treatment is necessary now; reassess in a few days
b. treat all 3 children with Pen V TID x 10 days
c. take throat swabs and await the results before treating
d. take throat swabs and treat empirically with Pen V
Take throat swabs + wait for results before treating
Bacterial (GAS) pharyngitis is unknown before 2-3yo
If looks like scarlet fever, positive rapid test or positive throat Cx, or positive household contact, then treat empirically with Pen
33
15. Kid with recurrent AOM. Has myrigotomy tubes. Purulent drainage from ear x7 days. Well and afebrile. Best management
A. culture fluid and wait for results to treat
B. topical antibiotic/corticosteroid drop
C. high dose amox
D. standard dose amox
Topical antibiotic/corticosteroid drop
34
103. Child who got Amoxil for OM but still has red bulging TM. What to give?
a. Clavulin
b. Cephalosporin
Amox-Clav
35
82. Child with fever, purulent nasal drainage x 14 days. What to treat him/her with?
a. amoxicillin
b. keflex
Amoxicillin
| First line for mild to moderate severity of acute bacterial sinusitis
36
89. A ten year old boy presents with purulent nasal discharge and a fever after a couple of days of URTI symptoms. He is complaining of a headache in addition to facial pain and tooth pain. What is the best management?
a. Sinus X-ray
b. Treat with amoxicillin
c. CT of the sinuses
Treat with amoxicillin
Sinusitis is a clinical diagnosis
Radiological studies not usually indicated for diagnosis
Facial pain + purulent nasal discharge are major Sx
H/A + tooth pain are minor Sx
Red flags for urgent referral:
1. Systemic toxicity
2. Altered MS
3. Severe H/A
4. Swelling of orbits or change in visual acuity
Consider CT orbits, sinus if SSx of periorbital/orbital cellulitis
CT orbits, sinus, + Brain if altered MS, nuchal rigidity, severe H/A, focal neuro findings, increased ICP
37
41. Osteomyelitis: MSSA
a) Cefazolin
b) Clinda
c) Vanco
Cefazolin
38
3. Young boy with an axillary lymph node for the last 10 days. He has been afebrile and otherwise well. The node is mildly tender, no overlying erythema. Which investigation would be most useful?
a) Monospot for EBV
b) TB
c) Bartonella
d) excisional biopsy
Bartonella
Chronic regional lymphadenitis is the hallmark (affects nodes draining the site)
- often have primary inoculation papule
Axillary > cervical
Self-limited with spont resolution in weeks to mo, up to 1y
Do not need treatment
39
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23. 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?
Staph aureus
Toxoplasma gondii
Bartonella henselae
EBV
```
Bartonella henselae
Parinaud oculoglandular syndrome
- UL conjunctivitis (usually not painful) followed by preauricular LND
40
45. 6y girl with 2 enlarged and tender left-sided cervical lymph nodes, 5cm each, no overlying erythema. Nodes noted x 2 weeks. Also an erythematous papule on the left arm. Which is the most likely pathogen?
a) Staph aureus
b) Actinomyces Israeli
c) Bartonella
d) Mycobacterium avium
Bartonella
Subacute unilateral
Staph aureus: acute and unilateral, would likely have overlying erythema
```
Mycobacterium avium:
NTM
subacute unilateral
- firm, painless, mobile, not erythematous, >1.5cm
- Superior ant cervical or submandibular
- consult ID: multidrug
- excise the node if possible
```
Actinomyces: Gram pos bacteria
- granulomatous, suppurative disease, with scarring inflammatory process
- Hallmark: spread fails to respect tissue or fascial planes
- characteristic: organisms in sulfur granule
- surgical + prolonged ABx
41
```
7. 8 yo boy with 1.5 x 2cm left supraclavicular node, non tender, smooth, noticed in the last few days
A. ebv
B. TB
C. Excisional biopsy
D. Bartonella
```
Excisional biopsy
Reasons to Bx:
1. Constitutional Sx
2. SUPRACLAVIULAR node
3. Mediastinal mass
4. Hard or matted nodes
5. Increase in size or no decrease by 4-6wks
42
39. 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
Bartonella henselae serology
43
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24. 15 year old girl has cervical lymphadenopathy which has been waxing and waning over the last 8 months. She had a CXR which showed a widened mediastinum. Which of the following is the most appropriate next test?
A. Cervical node excision
B. TST
C. CT chest
D. Bartonella serology
```
CT chest is imaging of choice for mediastinal mass
Need tissue diagnosis
Widened mediastium to chest width ratio >0.25
What is DDx for mediastinal lymphadenopathy?
1. ALL
2. Lymphoma
3. Metastatic malignancies
4. Primary lung cancer
5. Sarcoidosis
6. Infection: pneumonia, pulmonary TB, coccidiodomycosis, blastomycosis
44
35. Adolescent returned from Ghana following bloody diarrhea, now has bruising, hypertensive, edematous
a. HUS
b. Schistosomiasis
c. Typhoid
d. Dengue
HUS
Classic triad
1. MAHA
2. Renal insufficiency
3. Thrombocytopenia
45
A mother brings in her three children with concerns over strep throat.They are ages 18 mo, 2.5 years and 4 years. They have low grade fever. The tonsils are enlarged on the two youngest and has exudate.. The older sibling has tender lymphadenopathy. What is your approach?
A.Treat all with Pen V, no swabs
B. Swab and wait for the culture results. Treat based on results.
C. Swab and treat.
D. Follow-up in 48 hours
F/U IN 48H
Likely viral infection. GAS pharyngitis unlikely in <2-3yo. Most common in 5-15yo.
CPS antibiotic stewardship:
- If suspected bacterial pharyngitis, do throat swab or rapid antigen detection test for GAS
- If child not severely ill, can wait for result before starting ABx
- Do not do throat swab in asymptomatic person or if pharyngitis with cough/rhinorrhea/hoarse voice b/c may should GAS colonization, which shouldn't be treated as true bacterial pharyngitis
46
31. Invasive GAS – other possible presentations?
| A. Pneumonia
Pneumonia
47
47. Most likely pathogen in spontaneous bacterial peritonitis?
a. Strep pneumo
Strep pneumo
SBP due to ascites from nephrotic syndrome + cirrhosis
Need paracentesis
Infected fluid WBC >=250cell/mm3, with >50% PML
Treat with cefotaxime empirically
48
48. Kid w GAS
| a. Transient tic disorder
Transient tic disorder
49
83. 6 year old girl with yellow discharge on underwear. Red labia majora extending to perineum. Needs to touch herself frequently. Diagnosis?
a. pinworms
b. foreign body
c. GAS
-------------------
93. 5 year old with vaginal discharge, mildly itchy, redness on outer labia and yellow discharge on underwear, fluid collecting is posterior fourchette
a. foreign body
b. strep vaginitis
c. candidiasis
--------------
3 yo F with 1 wk of yellow discharge on panties. On exam inside of labia majora red and yellow secretions pooled in posterior fourchette and around urethra. Most likely diagnosis.
a. Candida
b. Foreign body
c. GAS
d. Pinworms
What is the DDx for vulvovaginitis
GAS/strep vaginitis
DDx for vulvovaginitis
1. Pinworms: itching, esp at night
2. Bacteria: GAS most common in prepuberta. If purulent discharge, do vaginal cultures. GAS treat with pen. Hygiene measures.
3. FB (e.g. toilet paper): chronic vaginal discharge, intermittent bleeding, foul smell
4. Candida: if on ABx, immunosuppressed, wet diapers
5. Gardnerella vaginalis: no vaginal D/C
6. N gonorrhea: green/mucoid D/C
7. Chlamydia trachomatis: often ASx
9. HPV: condylomata acuminate
10. HSV
11: trichomonas vaginalis: rare in prepuberta
IF STI, THINK ABUSE!
50
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20. A 3 year old boy develops an abscess on his buttocks. His brother has recently had an abscess. What is the most appropriate treatment?
A. Cefazolin
B. Cloxacillin
C. Cefazolin + Vancomycin
D. Incision and Drainage
```
Incision and drainage
For post-I+D management, pending culture:
- start empiric Abx from day of presentation if child <3mo, has fever or other systemic signs of illness, or sig assoc'd cellulitis
51
88. A ten year old girl presents with hypotension and a diffuse erythematous rash. She has evidence of liver and renal failure. What is the likely diagnosis?
a. Stevens Johnson Syndrome - no organ involvement, bullous, mucocutaneous involvement
b. Staph toxic shock syndrome
Staph toxic shock syndrome
```
TSS clinical criteria
Acute fever, hypotension, diffuse erythematous macular rash AND 2 or more of:
1. Renal failure
2. Liver involvement
3. ARDS
4. GI: vomiting, diarrhea
5. Coagulopathy
6. Soft tissue necrosis
7. mucous membrane inflammation
8. Muscle abnormalities
```
Definite criteria of TSS = clinical + GAS in typically sterile location
Probable criteria of TSS = clinical + GAS in non-sterile location
Staph aureus, GAS
Tampons!
52
101. Sick 3 yr old girl with high fever, muscle pain, high liver enzymes, red skin rash, maybe diarrhea. Diagnosis?
a. toxic shock
b. Staph scalded skin
Toxic shock
53
95. Child has nasal swab +ve for H. influenza. You:
a. do nothing
b. treat with Amoxicillin
c. treat with cephalexin
d. repeat culture
-------------------
A child has low grade fever, URTI symptoms. A nasal culture is done and reveals H. influenza. What is your management?
a. Do nothing
b. Repeat culture
c. Start amoxil
d. Start septra
------------------
107. A child presents with purulent nasal discharge and low-grade fever for one week. Nasal swab culture reveals Haemophilus influenza. What do you do?
a. Treat with Clavulin
b. Treat with a cephalosporin
c. re-culture nose
d. ?
-----------------
55. A young child has low grade fever, URTI symptoms. A nasal culture is done and reveals H. influenza. What is your management?
a. Do nothing
b. Repeat culture
c. Start amoxil
d. Start septra
Do nothing
| - viral Sx, suggests viral illness with H influenza colonization
54
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2. 4 yo old girl is treated with amox - clav then develops 2 episodes of bloody diarrhea and mild abdominal pain. She is afebrile and otherwise well. Her stool culture is positive for C.diff. Other than stopping her antibiotics, what else would you do?
A. Oral metronidazole x 10 days
B. Oral clarithromycin x 10 days
C. Oral vancomycin x 10 days
D. Follow-up, no additional abx needed
```
Follow up, no additional ABx needed
Mild
Suspect C diff if ABx within previous 12wks and bloody diarrhea +/- systemic toxicity, fever, abdo pain
55
```
26. Which of the following bacteria has been found to contaminate powder based formula in stores?
A. E Coli
B. Enterobacter sakazaki
C. Staph aureus
D. Klebsiella
E. Listeria
```
Enterobacter sakazaki
56
4. Young boy with varicella infection. A lesion on his leg has become larger and red. Now has large painful indurated area that is a bluish hue overlying. Which antibiotics to use?
a) penicillin and clinda
b) ceftriaxone and vanco
c) Cloxicillin
d) pipercillin and tazobactam
- ----------
72. Kid with varicella who is unwell, and has high fever. Deep bluish lesions down his leg. What antibiotics?
a. penicillin, clindamycin
Pen and clinda
57
```
19. A 15 year old boy develops varicella. Two days later he becomes tachypneic and has difficulty breathing. He is admitted to hospital for oxygen supplementation. What is the most likely cause of his presentation?
A. Myocarditis
B. Pulmonary Embolus
C. Varicella Pneumonia
D. Sepsis
```
Varicella pneumonia
58
54. Symptoms of nec fasc post varicella, what is your first line treatment
a. clinda and penicillin
b. vanco and ceftriaxone
c. amp and gent
Pen + clinda
59
```
13. Child described with Unilateral facial weakness, and vesicles in ear canal. Best management
A. Acyclovir and steroids
B. Acyclovir alone
C. steroids alone
D. …
```
Acyclovir + steroids
Ramsay-Hunt syndrome
- unilateral facial nerve palsy: upper + lower portion of face paretic, corner of mouth droops, +/- unable to close eye, loss of taste on ant 2/3 of tongue
- vesicles in auricular canal (VZV)
- 85% recover spontaneously with no facial weakness
60
102. 7 yr old boy presents with unable to move R side of face (can’t close eye, etc). On exam, vesicles in R ear canal + normal TM. Management:
a. Tympanocentesis
b. Acyclovir + steroids
c. Antibiotics
------------
A child presents with inability to move the muscles of the right side of his face. You examine the ears and find the right tympanic membrane to be red but not bulging. External ear canal has pustular lesions. How do you treat?
a. oral amoxicillin
b. oral cephalosporin
c. oral acyclovir and steroids
d. no treatment
Acyclovir and steroids
Ramsay-hunt syndrome
- unilateral facial nerve palsy: upper + lower portion of face paretic, corner of mouth droops, +/- unable to close eye, loss of taste on ant 2/3 of tongue
- vesicles in auricular canal (VZV)
- 85% recover spontaneously with no facial weakness
61
```
22. 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
E. Droplet + contact
```
Airborne
Airborne: Measles, VZV, TB, small pox
Measles: coryza, conjunctivitis, cough, Koplik spots
All should get vitamin A!
ANtivirals not effective
Pneumonia is most common cause of death in measles
62
64. A 13 y.o. boy with HIV is diagnosed with measles. The only proven treatment is:
a. Acyclovir
b. Vitamin A
c. Inhaled amantadine
d. Vitamin E
--------------
Patient with HIV and developed measles. Which medication has been shown to have an effect here?
a. inhaled amantadine
b. vitamin E
c. vitamin A
d. acyclovir
Vitamin A
63
21. 4 month old baby who lives in with grandfather who has been diagnosed with cavernous tuberculosis.
What is the 1st thing to do to this baby?
1. CxR
2. BCG VACCINATION
3. RIFAMPIN
4. ISONIAZID
CXR
64
36. Teenager with meningitis caused by tuberculosis. What medication will require ophthalmology assessment?
a. pyrazinamide
b. ethambutol
c. isoniazid
d. rifampin
Ethambutol
| E for eyes!
65
8.5 year old with tick bite 2 week ago. Now has developed large erythematous lesion with central clearing. Which of the following would you give?
A. PO Amoxicillin
B. PO doxycycline
C. IV ceftriaxone
PO Amox
Lyme disease
<8yo: amox
>8yo: doxy
For clear Sx of early EM, treat without lab confirmation
Otherwise, can do ELISA screening test and confirmatory Western blot test
66
32. West nile virus: Most common presentation.
a. fever
b. encephalitis
c. Asymptomatic
d. Mild non-specific illness
Asymptomatic
67
92. What is the most common presentation of West Nile virus
a. asymptomatic
b. non-specific febrile illness
c. meningoencephalitis
d. maculopapular rash
---------------
Mom concerned about possibility of west Nile in her child. What is the most common presentation of west nile in children?
a. Asymptomatic
b. Mild fever
c. Encephalitis
Asymptomatic
68
59. Return to sport with EBV after splenomegaly. On exam, no spleen palpable. Imaging not done previously.
a. 4 weeks
b. 3 weeks
If NON-contact sports at 50% level: 3 wks
If all other activities, incl'g contact: 4 wks
Since no imaging, consider delay by 1-2 wks
69
62. An 8mo old Caucasian child presents to the ER with a 24h history of fever. His temperature is 39.2 degrees. His immunizations are up to date. He has no travel history. He is otherwise asymptomatic. On exam, he is a happy, smiling child with appropriate vital signs aside from the temperature. What is the next best step?
a. Admit for IV antibiotics
b. Do a CBC and blood culture
c. Give a dose of ceftriaxone and discharge home
d. Discharge home with follow-up the next morning
---------------
8 month old immunized child presents with 24 hr history of fever, now rising. Well, asymptomatic. Temp 40 degrees, HR 150, RR 25. WBC 10, urinalysis normal. What do you do?
a. admit for IV cefotaxime
b. lumbar puncture
c. observe and reassess tomorrow
Discharge home with F/U the next morning
```
FWS in 8mo, immunized
Consider urine for:
1. all girls
2. all boys <6mo
3. all uncircumcised boys <2yo
4. all children with recurrent UTIs
```
If unimmunized
T>39, WBC >15, empiric ABx (even if well appearing)
FUO = documented fever, no cause identified after 3wks as outpt or 1wk hospitalized
70
```
18. 7yo African male. Recently immigrated to Canada. Tired, paroxysmal fevers and chills with pallor. Hepatosplenomegaly. Vitals stable.
A. Malaria
B. GBS
C. Ebola
D. Dengue
```
Malaria! until proven otherwise
Paroxysms of fever, chills, sweats, fatigue, anemia + splenomegaly
Dengue: biphasic fever; classic erythematous reticulate rash over thorax, face, flexion area.
71
94. What is the purpose of Salmonella treatment
| a. to prevent meningitis
To prevent meningitis
ABx to minimize complications
If no complications, will resolve within 2-4wks
Complications (all rare in children)
- intestinal perforation, intestinal hemorrhage
- hepatitis, jaundice, cholecystitis
- myocaritis
- increased ICP, delirium, psychosis
- DIC, HUS, nephrotic syndrome
72
96. A teenage girl presents with a one week history of periumbilical pain, fever of 39.2 degrees. She has just returned from a trip to Pakistan. She looks unwell and a blood C+S shows gram negative rods. Despite her fever and condition her HR is only 85. Which antibiotic will you treat her with:
a. Ciprofloxacin
b. Gentamicin
c. Metronidazole
d. Penicillin
Ciprofloxacin
Or azithro Or CFTX
Treat to minimize complications
Salmonella = gram neg bacilli
Relative bradycardia at height of fever is sign of typhoid fever!
High grade fever, vomiting/diarrhea, abdo pain, HSM
Dx: positive BCx or culture from other site
73
98. 13 year old girl with fever for over 5 days but no tachycardia, normal blood pressure, and hepatomegaly present. Blood culture are positive for gram negative rods. Brady of 70 despite fever >39C. What antibiotics would you treat with?
a. Ciprofloxacin
b. Gentamicin
c. penicillin
d. flagyl
------------
Description of girl with diarrhea and low HR in face of high temp. What do you treat with?
a. Ciprofloxacin
b. Penicillin
c. Gentamicin
------------
A child presents with diarrhea, hypotension and a normal heart rate. Blood culture reveals gram negative rods. Treatment:
a. ciprofloxacin
b. penicillin
c. gentamicin
d. metronidazole
Ciprofloxacin
Or azithro or CFTX
Treat to minimize complications
Salmonella = gram neg bacilli
Relative bradycardia at height of fever is sign of typhoid fever!
High grade fever, V/D, abdo pain, HSM
Dx: positive BCx or culture from other site
74
108. 12 yo girl presents with >5 days of fever, unwell. Hepatomegaly. HR 85 despite the temperature of 39.5, BP normal. CBC and urine tests normal. Blood culture shows gram negative bacilli. What is the cause?
a. pyelonephritis
b. ovarian torsion
c. typhoid fever
Typhoid fever
Salmonella = gram neg bacilli
Relative bradycardia at height of fever is sign of typhoid fever!
High grade fever, V/D, abdo pain, HSM
Dx: positive BCx or culture from other site
75
104. Child has recently visited a farm. Now presents with fever, hepatomegaly. Diagnosis?
a. Psiticossis
b. Q fever
c. Legionella
Q fever = Qattle
- goat, sheep, cattle
- flu-like Sx + hepatitis
- most don't need Tx
- Doxycycline if needed
Psittacosis = Parrot fever
- fever, H/A, cough, myalgia, PNA on CXR
- tetracycline
Legionella = swilling in the Legion pond
- fresh water bacteria
- fever, cough, CP, PNA on CXR
- sputum is gold standard
- azithro + clarithro + FLQ
Bats = Histoplasmosis
76
11. 34 week old premature baby is diagnosed with congenital CMV. Normal CSF. Most appropriate management?
A. PO valgancyclovir
B. IV acyclovir
C. Regular hearing screen
Regular hearing screen
Note: if baby was symptomatic, then PO valganciclovir
IV acyclovir is NOT indicated for CMV
77
34. 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 ganciclovir for 6 weeks o [rest of answer missing]
Hearing screen
Test mother + sibs: who cares
MRI: would do, but not most important in an aSx kid
Too late for ganciclovir, should be in neonatal period, and should be for 6 months
78
46. 3y with hepatitis A. What do you counsel? (similar previous question)
a. No day care x 7d
b. Vaccinate the siblings
c. Administer IM HepA immune globulin
d. Give a low fat diet
No day care for 7d
Reasonable to vaccinate the siblings too if within 2wks of exposure and sibs are >=6mo
PEP for HepA:
- Hep A vaccine within 2wks of exposure in those >=6mo
- Consider for beyond 2wks of exposure
- If <6mo or vaccine contraindicated, give Hep A immuneglobulin
- Give vaccine + Hep A immune globulin for immunocompromised hosts
79
80. An 8 year old girl with fever, nausea, vomiting, diarrhea, malaise, and mild jaundice upon returning from Mexico. Labs show AST and ALT >1000. Which of the following is true regarding her return to school?
a. she can’t return for 1 week
b. she can’t return until she’s asymptomatic
c. she can’t return until her LFTs have normalized
d. she can return now as long as there’s good hand washing
---------------
Child returning from Mexico, fever, diarrhea. When can she return to daycare?
a. in a week
b. as soon as she is feeling well
c. 3 days
d. 10 days
Cannot return for 1wk
Hep A
- acute febrile illness with abrupt anorexia, N/V, malaise, jaundice
- May have LND + splenomegaly
- 7-10d duration
80
37. HepBe antigen indicates
a) acute infection
b) increased risk of infectivity
c) chronic infection
d) Active infection
Increased risk of infectivity
HBeAg is present in active acute or chronic infections
It is a marker of infectivity
Note: HBeAb = seroconversion
81
57. Mom has HepB+ and HepC PCR +ve. Baby born and at 6 months is HBSAg Antibody (anti-HBs) +ve. What do you want to do? May have had some information about Hep C status.
a. Repeat HepB Sag Ab (anti-HBs) in 6 months
b. Check HepB PCR DNA?
Repeat HBsAg + HBsAb in 6mo
If mother is HepB pos, assuming HbsAg pos, baby should get HBIG and HBV vaccine within 12H.
Should do baby's HBsAg and HBsAb at 9-12mo.
- If pos HBsAg -> refer
- If neg HBsAg, pos HBsAb -> protective!
- If neg HBsAg, neg HBsAb -> repeat vaccine series
Also would do HCV PCR. If pos, follow serology at 12-18mo
82
61. HepB prophylaxis in baby of HBsAG+ mom
| a. Ig + vaccine within 12 hr and 3 days respectively -> ?
GIve HBIG + vaccine within 12H of birth
83
50. Best herpes test? [cps]
| a. CSF PCR
Testing depends on presentation, but PCR is key
CSF PCR for HSV DNA is diagnostic method of choice for CNS HSV
○ Standard tests for HSV: CSF PCR, swabs of vesicular lesions + MM
○ If suspect disseminated NHSV: blood for HSV PCR, serum transaminase levels
○ If infants has pneumonia: NP specimen
84
68. HSV positive mom with ROM x 6hrs. When would you do the swabs on babe?
a. 48 hours
b. after a bath
c. immediately
d. 24 hrs
--------------
Baby born to mother with HSV history. PROM > 6 hours. Otherwise baby looks well. When to do urine culture/mucocutaneous swabs?
a. now
b. 48 hrs
--------------
Mom with PROM X 6 hours. C-section. When to do HSV cultures?
a. 48 hours
Swab at 24H: conjunctiva, nares, mouth, anus
First episode, SVD or C/S after ROM:
- empiric acyclovir
- if swab+: full w/u + Tx
- if swab-: complete 10d IV acyclovir
First episode, C/S before ROM
OR Recurrent episodes
- no empiric acyclovir
- If swab pos, then full W/U + Tx
Tx:
- SEM: 2wks
- CNS or disseminated (ie. CSF or blood PCR pos): 3wks
85
79. Mother with oral herpetic lesions and wants to breastfeed – found on day 4 post birth. Baby is healthy. What do you recommend:
a. Start oral acyclovir to mom
b. Stop breastfeeding
c. Wear mask when breastfeeding
d. Start acyclovir for baby
---------------
Breastfeeding mom with herpes labialis. What do you recommend?
a. cover up lesions with mask when breastfeeding
b. no rooming in with baby
c. avoid breastfeeding
---------------
Newborn baby, now 4 days old. Mom getting a lesion consistent with herpes labialis. What do you advise?
a. wear a mask when breastfeeding
b. apply topical acyclovir to lesion
c. stop breastfeeding
d. infant needs IV acyclovir
Wear mask when breastfeeding
Not contraindicated unless active lesion on breast
Don't separate baby from mom b/c already exposed
If herpes labialis
Use disposable mask until lesions crusted over
Don't kiss baby
Cover up skin lesions in presence of newborn
86
111 Baby born vaginally to mom with active recurrent genital herpetic lesions. What should be done to minimize spread to baby and others?
a. Baby should “room in” with mom; no breastfeeding
b. Babe to “room in” with mom; allowed to breastfeed
c. Isolate baby from mother, baby should not breastfeed
d. Contact and respiratory isolation for mom and baby; allowed to breastfeed
babe to room in with mother, allowed to breastfeed
Contact precautions for mom and baby
- Mother: Until mother's active lesion crusted
- Neonatal of mother with active lesions: until end of incubation period (14d) or swab neg
87
71. Kid (unless newborn) with hearing loss. Test most likely to help with etiology?
a. + CMV in urine
b. MRI
------------
Newborn baby failed his hearing screen. What is most useful diagnosis?
a. urine for CMV
b. Rubella serology
Urine for CMV
Serology not helpful to differentiate congenital + perinatally acquired
88
75. baby with cataracts, sensorineural hearing loss, and bony lesions
a. toxoplasmosis
b. syphilis
c. rubella
d. CMV
----------------
Newborn with cataracts, bony lesions and hepatosplenomegaly on exam. Which of the following is the most likely congenital infections?
a. CMV
b. Rubella
c. Syphillis
d. Toxoplasmosis
----------------
IUGR neonate with bony changes, cataracts and hepatosplenomegaly. What’s the most likely diagnosis?
a. congenital syphilis
b. congenital rubella
c. congenital CMV
d. congenital toxoplasmosis
Congenital rubella
1. IUGR
2. *Cataracts
3. *SNHL - usu bilateral (vs UL in CMV)
4. *PDA/cardiac anomalies
5. HSM
6. Bony lucencies
7. Blueberry muffin rash
1st TM infections
- usually SA in 20%
- multiple congenital anomalies in 80%
After 16wk, congen anomalies uncommon
No treatment
89
105. Baby with tachypnea, afebrile, nontoxic, has eosinophilia. CXR shows bilateral interstitial markings, areas of atelectasis. What is the likely pathogen?
a. GBS
b. Chlamydia trachomatis
c. Ureaplasma urealiticum
d. RSV
Chlamydia trachomatis pneumonia
Risk of disease if mother untreated:
50% risk of conjunctivitis
20% risk of pneuonia
1-3mo
Often AFEBRILE. Persistent cough+ tachypnea. No wheeze.
Staccato, paroxysmal cough!
CXR: hyperinflation. Interstitial markings.
PERIPHERAL EOSINOPHILIA!
Dx: PCR/Cx of conjunctiva or NP
Tx:
- ABx ppx NOT recommended (risk of pyloric stenosis)
- Close clinical F/U
- If PCR positive: azithro x3d, erythro x14d
90
90. A pregnant woman has symptoms of arthralgia after her two year old son had an episode of an infection characterized by an erythematous facial rash. What is her fetus at risk for?
a. Deafness
b. Congenital defects
c. hydrops fetalis
Hydrops fetalis
Parvo B19
Test mother's serology!
91
56. Mom has syphillis during pregnancy and titres was 1:128 (or something) and was treated. Repeat RPR test the day before delivery is 1:8. What do you want to do with newborn?
a. Reassure mom/no treatment
b. Concern or treat if hepatosplenomegaly
c. Treat for syphilis
Reassure/no treatment
Mother treated with >4X fall in maternal RFR titre
92
```
27. 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
93
```
28. 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%
HIV vertical transmission
1. intrauterine (30-40%)
2. intrapartum
3. breastfeeding (least common)
What increases risk of HIV vertical transmission?
1. ROM >4H (2X risk!)
2. BW <2500g (2X risk!)
3. Prem <34wk
4. Low mat antenatal CD4 count
5. Use of recreational drugs during pregnancy
What are 3 interventions to prevent vertical transmission?
1. Antiretroviral therapy
- start triple ARVT in mother by 2nd TM (or earlier)
- give zidovudine IV during delivery
- zidovudine x6wks to infant
- zidovudine SE: anemia, elevated lactate (usu not Sx)
- consider combined ARVT to infant if mother's VL high
2. Elective C/S if VL>1000 copies/mL
- elective C/S + zidovudine decreases transmission by ~85%!
3. NO breastfeeding!
- mixed bf + formula has greater risk than exclusive bf'g
94
49. Best HIV newborn test? [cps]
a. HIV PCR
b. P24 antigen
-------------------
69. Best test to confirm HIV in newborn
a. HIV DNA pcr
b. p24 Ag
c. ELISA
d. Western blot
---------------
Born to HIV-positive mother newborn. Best test to diagnose HIV infection in baby
a. ELISA
b. Western blot
c. P24 antigen
d. HIV DNA PCR
HIV DNA PCR
95
74. Mom frantic because child picked up a syringe in a playground. Did not touch plunger of syringe. Scratched by the needle. After taking serologies for HIV, HepB and Hep C and giving HBIG and hep B vaccine, what do you do?
a. Start HIV meds
b. Start ribavirin
c. Reassure mom that risk of HIV infection is low
Reassure mom that risk of HIV infection is low
Superficial wound with no visible blood see on needle
96
67. GBS positive mom with antibiotics given 4hrs before delivery. Would like to go home. What would be your plan?
a. can be discharged at 48 hrs
b. normal newborn care
--------------
GP calls you about a mom who delivered a term baby. She is GBS+ and received intrapartum Ampicillin 4 hrs prior to delivery. Baby is well.
a. routine newborn care
b. administer IV antibiotics
Routine newborn care
If baby is unwell, then need W/U + empiric ABx
97
```
30. 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
```
Ampicillin
Listeria: Gram pos bacilli - Amp
E coli: Gram neg cocci - Gent
GBS: gram pos cocci - Amp
98
42. 2 y.o brother w meningococcal meningitis. 5 y.o sibling unvaccinated, what to do? [CPS]
a. Cipro only
b. Rifampin only
c. Vaccinate and rifampin
d. Vaccinate only
vaccinate + rifampin
99
43. HPV vaccine is most effective against? [CPS]
a. Cervical cancer
b. Genital warts
Genital warts
90% against genital warts
70% against cervical cancers
100
73. Mom who is IVDU comes to you with her 6 month old baby. Mom is anti-HCV+, and HBsAg+. Baby is anti-HCV negative, and HBsAg neg. What do you do?
a. HCV RNA
b. Repeat HCV antibody in 6 months
c. no further testing
No further testing for Hep C
- if the baby had been anti-HCV positive, would have wanted to repeat HCV Ab in 6mo
- At 6mo, HCV serology is not reliable because still have passive Ab from mother
- Primary diagnostic test is HCV serology at 12-18mo
- If parental anxiety or worried about infant being lost to follow up, could do HCV RNA PCR at ≥2mo
- If HCV RNA PCR positive, would need to repeat HCV RNA PCR and aminotransferases Q6mo to determine if chronic infection or will have spontaneous clearance
- If HCV RNA PCR negative, would need repeat serology at 12-18mo to confirm seroreversion
- No known benefit of early detection
- Would repeat HBsAg/Ab in baby at 9-12mo
101
77. 6 mo baby of IV drug user. Mom is Hep C-positive. Baby’s anti-HepBs positive and anti-HCV positive. What do you do?
a. no further testing
b. repeat anti-HCV in 6 months
c. do HCV RNA PCR now
d. P24 antigen
Repeat anti HCV in 6mo
But if parental anxiety or fear of losing to follow up → do RNA PCR now
102
76. Mother is Hep B surface Ag positive, Hep C antibody positive with positive HCV RNA PCR, negative for HIV. Baby born at term without problems. At 6 months of age baby is Anti-HepB negative and Hep C antibody negative. You would:
a. Repeat Hep C antibody in 6 months.
b. Do nothing.
c. Do Hep C RNA PCR
---------------
Mom with Hep C RNA + and Hep B SAb + in pregnancy. You see baby at 6 months and its HepB SAb + and Hep C Ab is - You order:
a. Hep C RNA
b. Hep C Ab in 6 months
---------------
Mom has HCV-antibody, HBSAg. She has brought her 6 month old kid to see you. Kid has a negative HCV-antibody and is HBSAb-negative. What to do?
a. HCV RNA
b. repeat HCV antibody in 6 months
c. no further testing
Do nothing for Hep C
Have had enough time at 6m to clear their mother’s transplacental HCV antibodies so if they are still neg for HCV antibodies than they have cleared or never had HCV
103
114. What is the best test for HSV encephalitis?
a. PCR on CSF
b. Viral culture of CSF
c. HSV IG in CSF
d. Differential on CBC
CSF PCR
104
A young boy is walking down the street. Suddenly a stray dog, unprovoked, bites him. What do you do?
A. Give rabies prophylaxis
B. Quarantine the dog; if shows signs of rabies, give prophylaxis
C. Sacrifice the dog; if pathologic evidence of rabies, give prophylaxis
D. shoot the dog and eat it
Give rabies prophylaixs
105
Family vacationing in cottage country, staying in cabin. A dead bat is found in the cabin one morning. No Hx of bite or direct contact of any kind by the bat. What would you do?
A. Give rabies prophylaxis
B. Give prophylaxis if bat shown to be rabid
C. No need for prophylaxis as no Hx of bite or scratch
D. No need for prophylaxis as bats do not carry rabies
?No need for prophylaxis as no Hx of bite or scratch
Maybe give rabies prophylaxis
- direct contact with a bite
- bite, scrate, or saliva exposure to wound or mucosal surface cannot be excluded
106
Family vacationing in cottage country, staying in cabin. A dead bat is found in the cabin one morning. No Hx of bite or direct contact of any kind by the bat. What would you do?
A. Give rabies prophylaxis
B. Give prophylaxis if bat shown to be rabid
C. No need for prophylaxis as no Hx of bite or scratch
D. No need for prophylaxis as bats do not carry rabies
?No need for prophylaxis as no Hx of bite or scratch
Maybe give rabies prophylaxis
- direct contact with a bite
- bite, scrate, or saliva exposure to wound or mucosal surface cannot be excluded
107
```
Child who lives on a farm presents with abdo pain + diarrhea. His small bowel follow through reveals narrowing of his distal ileum. Which organism would be important to rule out prior to getting a colonoscopy?
A. Entamoeba histolytica
B. Yersinia enterocolitica
C. Shigella dysenteriae
D. Campylobacter jejuni
```
Yersinia enterocolitica
| TB also causes terminal ileal thickening
