1
Q
how do most cases of polio present?
A
Most cases of polio are asymptomatic or present as a short, self-limiting illness.
2
Q
what percentage of polio presents with paralysis
A
1%
Paralytic poliomyelitis is characterized by an acute onset of ASYMMETRIC flaccid paralysis
3
Q
How do you test for polio
A
stool and throat swab
4
Q
what are the symptoms associated with measles
A
Cough Coryza Conjunctivitis followed after a few days by a descending maculopapular rash endemic in Germany
5
Q
what disease is associated with koplik spots?
A
measles
bluish-white spots on red buccal mucosa
6
Q
what are 4 complications of measles
A
otitis media
pneumonia
meningitis
death
7
Q
how do you test for measles (3)
A
serology, NP swab and urine sample
8
Q
how does a patient with diphtheria present? how is it diagnosed?
A
Sore throat, weakness, fever, and a rapidly progressive swelling of the neck
“bull neck”
clinical diagnosis
9
Q
is there herd immunity for tetanus?
A
No! Herd immunity plays no role in protection
10
Q
How does a patient present with tetanus
A
rigidity and spasms
11
Q
what is the classic presentation for mumps
A
unilateral or bilateral parotitis
Vaccine failure is common with mumps. Therefore, testing should be considered in all cases of parotitis unless the infection is confirmed to be bacterial in origin
12
Q
what strains are in the quadrivalent influenza vaccine
A
2 strains of influenza A
2 strains of influenza B
13
Q
what influenza vaccine should be given to children
A
quadrivalent vaccine is recommended
influenza B causes more mortality and morbidity in children than in adults.
14
Q
what are contraindications to LAIV (3)
A
- age <2 yo
- pregnancy
- immunocompromised
- severe asthma (defined as current active wheezing or currently on oral or high-dose inhaled glucocorticosteroids, or medically attended wheezing within the previous 7 days)
- who are receiving chronic acetylsalicylic acid-containing therapy, because of the association of Reye’s syndrome with acetylsalicylic acid given during influenza infection.
15
Q
when should you receive influenza vaccine?
A
influenza vaccine should be given as soon as it is available, before the onset of the influenza season.
16
Q
what are 2 contraindication to influenza vaccine
A
- An anaphylactic reaction to a previous dose of influenza vaccine or to any of the components of the vaccine with the exception of egg
- onset of Guillain-Barré syndrome within 6 weeks of influenza vaccination without other known cause
17
Q
is egg allergy a contraindication to influenza vaccine?
A
No! egg allergy is no longer a contraindication to the use of IIV
18
Q
what is the dose of the inactivated influenza vaccine
A
0.5mL IM
The dose of LAIV4 is 0.2 mL (0.1 mL administered in each nostril as an intranasal spray)
19
Q
who needs two doses of influenza vaccine
A
The first year that a child younger than 9 years of age receives influenza vaccine (either IIV or LAIV), two doses at least 4 weeks apart are required. If a child less than 9 years of age has received at least one dose of any influenza vaccine in the past, only one dose is required this season. Children 9 years of age or older and adults require only one dose each year.
20
Q
What are two ways that we can build a protective environment for immunocompromised ppl
A
- immunization- especially MMRV and influenza vaccine
family and health care providers - hand hygiene
21
Q
Preventive measures to reduce risk for respiratory infections include the following:
A
Avoid contact with individuals known to have a respiratory illness, especially if symptomatic
Notify physician at the first signs of respiratory illness during influenza season.
Inform the child’s medical team when there is influenza illness within the household.
Minimize exposure to crowded environments, such as shopping malls, during influenza/respiratory virus season.
Avoid primary or secondary exposure to tobacco smoke.
Avoid risk of exposure to fungal pathogens by:
Minimizing exposures to construction, excavation and renovations sites, where fungal spores (e.g., Aspergillus) can thrive,
Minimizing inhalation of fungal spores from plants and animals (i.e. in farms, barns or pigeon coops, or from mulching, turning compost piles or cave exploration),
Not smoking marijuana.
22
Q
Preventive measures to reduce risk of contracting a waterborne illness include the following
A
Not drinking tap water in Canada when ‘boil water’ advisories are in effect.
Drinking only bottled or boiled water when travelling to regions with suboptimal sanitation.
Not drinking well water unless the source is properly screened and monitored by health authorities.
Not drinking water directly from rivers, streams, lakes and ponds.
Not using hot tubs, which have been associated with infections such as Pseudomonas folliculitis [18], Legionella pneumophila infections [19], and mycobacterial infections [20].
Cleaning abrasions with water from a safe source and avoid swimming in water that may be contaminated. Waterborne pathogens can enter through skin abrasions, or the respiratory tract if aspirated.
23
Q
how can you prevent foodbourne illness
A
All milk, fruit and vegetable juices should be pasteurized.
Avoid cheeses produced from raw or unpasteurized milk, especially soft and semi-soft varieties (e.g., Brie, Camembert, and blue-veined cheeses).
Avoid raw meats, seafood and eggs.
Lettuce and all other raw vegetables should be washed thoroughly, even when they are labelled as prewashed.
Avoid cross-contamination when preparing foods. Keep cooked and raw foods separate and use different cutting boards or surfaces for raw and cooked foods
24
Q
what are some preventative strategies for safer sexual practices for immunocompromised ppl (4)
A
Using latex condoms
immunization with hepatitis B and HPV vaccines
having fewer sexual partners
educating the immunocompromised adolescent are essential preventive strategies.
25
who should get chemoprophylaxis for invasive group A strep
Chemoprophylaxis should only be offered to close contacts of a confirmed case of severe IGAS who have been exposed during the period from 7 days before the onset of symptoms in the index case to 24 h after initiating antimicrobial therapy in the case.
close contacts:
(>4h/day or total of 20h)
shared a bed with the index case
sexual relations with the index case
Persons who have had direct contact with the mucous membranes or oral or nasal secretions of the index case
IV drug users who shared a needle
all children and staff in family or home child care settings
NOT recommended in group or institutional child care centres and preschools.
26
when should a person get chemoprophylaxis for invasive group A strep?
Chemoprophylaxis should be started as soon as possible, preferably within 24 h of identifying the case, but is still recommended up to 7 days after the last contact with the case.
27
Recommended chemoprophylaxis regimens for close contacts of invasive group A streptococcal disease? first line? second line?
First line:
1. cephalexin
2. cefadroxil
second line:
1. clindamycin
2. clarithromycin
28
what is empiric treatment for TSS
cloxacillin + clindamycin
29
what is considered SEVERE invasive group a strep
a. Streptococcal TSS
b. Soft-tissue necrosis (including NF, myositis or gangrene);
c. Meningitis
d. Pneumonia (with isolation of GAS from a sterile site such as pleural fluid). Note that bronchoalveolar lavage (BAL) is not considered to be from a sterile site.
e. A combination of the above.
f. Any other life-threatening condition or infection resulting in death
30
how can you confirm invasive GAS
Isolation of group A streptococcus (GAS) from a normally sterile site, with or without clinical evidence of severe invasive disease).
31
what is seen on CXR for TB
ground glass opacities
hilar, mediastinal or subcarinal lymphadenopathy
disseminated disease: miliary nodules
32
what is seen on LP for TB meningitis
CSF typically shows pleocytosis with lymphocytic predominance
33
what testing is done to diagnose TB
sputum cultures
children who cannot expectorate sputum: fasting gastric aspirates 3x morning samples
send for acid fast bacilli stain and culture
all need testing for HIV
34
children less than 2 should they have TST or IGRA
TST
35
what is the treatment for latent TB (2)
Rifampin, Isoniazid
36
what is the treatment for TB (4)
Rifampin, Isoniazid, Ethambutol, Pyrazinamide
37
what is the treatment for a child who has contact with TB
child <5 with TST <5mm
child >5 with TST <5
child >5 and TST >5
< 5 years with TST < 5mm= prevention prophylaxis (window prophylaxis with 1 TB drug)
Repeat TST 8-10 weeks after initial contact
If repeat test <5mm then dc window prophylaxis
Child ≥ 5 and initial TST <5mm repeat BOC TST 8-10 weeks (no prophylaxis required)
Child ≥ 5 and ≥ 5mm but no symptoms on initial or BOC TST= treat for latent infection
BOC= break of contact
38
When a child or youth is identified as a contact of an index case of TB what should you do? (4)
conducting a history and physical exam
requesting chest radiographs
perform an initial TST are essential steps
Obtaining the index case’s drug sensitivities is also required
39
what are the two types of salmonella
typhoid- salmonella typhi, salmonella paratyphi
| non-typhoid
40
how can you get salmonella
contaminated food/water
| direct contact with reptiles/amphibians
41
what is the treatment for typhoid fever
Azithromycin x 7 days
Fever typically persist 6-8 days from start of antibiotics. Fever is not a contraindication to switch to oral antibiotics or to hospital discharge
42
how should you manage a child that has a positive BLOOD culture for s. typhi
1. send blood culture
2. start ceftriaxone
3. look for signs of disseminated disease
4. admit to hospital
5. repeat blood cultures every 24-48h until negative
43
how should you manage a child that has a positive STOOL culture for s. typhi
if no travel to resource poor country and afebrile then observe, do blood culture if febrile
if febrile, unwell, immunocompromised- do blood culture, start ceftriaxone, look for signs of disseminated disease
44
when should you start treatment for influenza if you are going to treat? how long is the treatment
as soon as possible, start within 48 hours
| duration is typically 5 days
45
what are the 2 antivirals that are used in Canada for influenza
Oseltamivir
Zanamivir (for children ≥ 7)- administered via disk inhaler, not recommended for those with chronic respiratory illnesses such as asthma
46
what is the dose for zanamivir
10mg BID vis disk inhaler (two 5mg inhalations)
47
what is the dose for oseltamivir
≤15 kg 30 mg twice daily
>15 kg to 23 kg: 45 mg twice daily
>23 kg to 40 kg: 60 mg twice daily
>40 kg: 75 mg twice daily
Children 3-12 months = 3mg/kg/dose BID (or daily)
48
who is considered high risk for influenza complications and hospitalizations
All children <59 months of age*
All children ≥6 months of age; adolescents and adults with chronic health conditions (severe enough to require regular medical follow-up or hospital care), specifically:
Cardiac or pulmonary disorders, including bronchopulmonary dysplasia, cystic fibrosis, asthma or conditions associated with an increased risk for aspiration
Diabetes mellitus and other metabolic diseases
Renal disease
Anemia or hemoglobinopathy
Cancer or other immune-compromising conditions (due to disease or therapy)
Obesity, with a body mass index (BMI)≥40 kg/m2 OR a BMI z-scores >3 SD above the mean for age and gender
Neurological or neurodevelopmental conditions
Children and adolescents (<18 years of age) currently undergoing prolonged treatment with acetylsalicylic acid for a chronic condition
All Indigenous persons
All residents of chronic care facilities
All pregnant women, including adolescents, in all trimesters
All adults ≥65 years of age
49
when should you consider treating for influenza
| if they are >1yo?
> 1 yo and have a risk factor for influenza complication apart from age and within 48 hours of symptoms
if beyond 48 hours- consider on a case by case basis
start oseltamivir
50
if your patient is not responding to Oseltamivir what should you do
switch them to Zanamivir
| test for oseltamivir resistance
51
what are some physician approaches to vaccine hesitancy (5)
1. Understand the key role that vaccine advice can play in parent decision-making, and do not dismiss vaccine refusers from your practice
2. Use presumptive and motivational interviewing techniques to understand vaccine concerns
3. Use simple clear language to present evidence of disease risks and vaccine benefits
4. Address pain
5. Community protection (herd immunity) does not guarantee personal protection
52
what are 5 steps to address hesitancy and improve vaccine uptake rates?
1) Detecting under-immunized subgroups, diagnosis and targeted interventions
2) Educating all health care workers on best practices
3) Employ evidence-based strategies to increase uptake
4) Educating children, youth and adults on the importance of immunization for health
5) Working collaboratively with government, nongovernmental organizations, community leaders and health services
53
what infectious diseases do you worry about in a returning traveller
Malaria
Typhoid fever
Meningococcemia
Viral hemorrhagic fevers
54
what are the initial investigations for a returning traveller with a fever
```
CBC with differential
electrolytes
LFTs
BUN/CRE
blood culture
malaria smears (thick and thin)
urinalysis +/- culture
```
Other tests, to be done more selectively:
Serology (EBV, CMV, hepatitis viruses, HIV, dengue, chikungunya, Zika, brucellosis, strongyloidiasis…)
CXR
Stools for C/S, O/P
55
Ddx for fever in a returning traveller
```
Malaria
Typhoid Fever
Dengue Fever
Traveller's diarrhea
infectious hepatitis
Chikungunya virus
Zika virus
viral hemorrhagic fever (Ebola)
```
56
how long before immunosuppression do you give live vaccines? inactivated vaccines?
Inactivated vaccines should be given at least two weeks before
live vaccines must be given at least four weeks before
57
when can you give live vaccines following high dose steroids?
High dose Steroids (>2mg/kg/day): live vaccines 1 month post-discontinuation
High dose steroid therapy is defined as systemic treatment with the equivalent of prednisone ≥2 mg/kg/day or ≥20 mg/day if weight >10 kg for ≥14 days
58
when can you have live vaccines following chemotherapy
live vaccines 3 months after chemo
59
what vaccines are required after stem cell transplant
Stem cell transplant: require repeat of all vaccines
Inactive starting 3-12 months post transplant, live vaccines 24 months post
assuming that there is no evidence of CGVHD, immunosuppression has been discontinued for at least 3 months, and immunocompetent
60
when can vaccines be given after solid organ transplant? what vaccines cannot be given?
inactivated vaccines 3-6 months post
| Live vaccine contraindicated!!
61
how do most mothers with zika virus present
asymptomatic
62
how can you diagnose zika
zika serology
| zika RNA PCR
63
what investigations should be completed regularly for a child with congenital zika
audiology- annually up until age 6
ophthalmology
ultrasound and MRI head- not regularly
64
what type of calcifications are seen with zika
subcortical calcifications
65
what are the features of congenital zika syndrome
KEY- microcephaly, brain malformations, subcortical calcifications, macular scars, contractures
66
What is the most common bacterial pathogen causing pneumonia in children of all ages
Streptococcus pneumonia
67
what is the initial investigation for pneumonia? when should it be repeated
CXR
| repeat x-ray if no improvement within 48-72 hours on antibiotics
68
what are physical exam findings suggestive of bacterial pneumonia
Physical signs suggesting pneumonic consolidation include dullness to percussion, increased tactile fremitus, reduced normal vesicular breath sounds and increased bronchial breath sounds
The predominance of wheezing and hypoxia should suggest the possibility of bronchiolitis or mucous plugging from asthma, rather than pneumonia.
69
```
RR for tachypnea for the following ages: *table
<2 months
2–12 months
1–5 years
>5 years
```
<2 months 60
2–12 months 50
1–5 years 40
>5 years 30
70
what should outpatients with lobar or broncho-pneumonia usually be treated with?
oral amoxicillin to cover for strep pneumonia
71
Patients who require hospitalization for pneumonia but do not have a life-threatening illness should usually be started empirically on?
IV ampicillin
72
when should you consider Ceftriaxone for pneumonia? Vancomycin?
Children who experience respiratory failure or septic shock associated with pneumonia should receive empiric therapy with a third-generation cephalosporin because it offers broader coverage.
rapidly progressing multilobar disease or pneumatoceles, the addition of vancomycin is suggested empirically to provide extra coverage for MRSA
73
what is the treatment for M pneumonia or C pneumonia
a macrolide antibiotic (azithromycin for five days or clarithromycin for 7 days).
74
How long do we treat for pneumonia
outpatient- 5 days
| in patient- 7-10 days
75
what is the most common STI among males and females
HPV
| 75% lifetime risk
76
which HPV types lead to cervical cancer? warts?
16 and 18= cervical cancer
| 6, 11= warts
77
what are some risk factors for STI's?
```
Inconsistent or no condom use
Contact with someone known to have STI
New partner
>2 partners in past year
No contraception or only non-barrier contraception
Injection drug use
Any drug use
previous STI
sex workers
street involvement
```
78
how often should screening for Chlamydia be offered?
All sexually active youth younger than 25 years of age should be offered screening at least annually, with more frequent screening offered to individuals with additional STI risk factors
79
after treatment for Chlamydia when should screening be repeated
After treatment, screening should be repeated every six months if the risk of reinfection persists
80
what is the most sensitive and specific test for Chamydia
The nucleic acid amplification test (NAAT) is the most sensitive and specific test for C trachomatis.
First-catch void urine, vaginal (including self-collected), endocervical or urethral specimens are all suitable for NAAT testing
81
how do you screen for Gonorrhea
A first-catch urine sample or self-collected vaginal swab is recommended for screening asymptomatic individuals, Pharyngeal specimens should be obtained when there is a history of oral sex, and rectal samples if there is a history of receptive anal intercourse.
NAAT is validated for urine, vaginal, urethral and cervical samples.
82
when should you do test of cure for Chlamydia
Test-of-cure 3 to 4 weeks after treatment if:
– Compliance is uncertain
– Second-line or alternative treatment was used
– Re-exposure risk is high
– An adolescent is pregnant
83
what is the diagnostic test for syphilis
Serology remains the usual diagnostic test unless the patient has lesions compatible with syphilis
Treponemal-specific screening assays (e.g., EIA) are more sensitive than non-treponemal tests,
84
followup for syphilis
Primary, secondary, early latent infection: Repeat serology at 1, 3, 6, and 12 months after treatment
Late latent infection: Repeat serology 12 and 24 months after treatment
Neurosyphilis: Repeat 6, 12, and 24 months after treatment
85
what is the preferred treatment for Chlamydia/ Gonorrhoea
Ceftriaxone 250 mg IM in a single dose PLUS azithromycin 1 g PO in a single dose
OR cefixime 800 mg PO in a single dose PLUS azithromycin 1 g PO in a single dose
86
what is the treatment for trichomonas
Metronidazole 2 g PO in a single dose OR metronidazole 500 mg PO twice daily for 7 days
87
What is the treatment for first episode HSV infection
Valacyclovir 1000 mg PO twice daily for 10 days
OR
Famciclovir 250 mg PO three times/day for 5 days
OR
Acyclovir 200 mg PO five times/day for 5 to10 days
88
what is the treatment for recurrent HSV infection
Valacyclovir 500 mg PO twice daily or 1000 mg PO daily for 3 days
OR
Famciclovir 125 mg PO twice daily for 5 days
OR
Acyclovir 200 mg PO 5 times/day for 5 days (800 mg PO three times/day for 2 days may be as efficacious)
89
What samples should be collected based on common clinical syndromes?*
Males with symptoms of urethritis (2)
Urethral swab for Gram stain and culture for gonorrhea (NAAT may also be used, when available)
AND
First-catch urine for C trachomatis (NAAT)
90
What samples should be collected based on common clinical syndromes?*
Women with symptoms of cervicitis (4)
Vaginal or cervical swab for Gram stain, N gonorrhoeae (culture or NAAT if culture unavailable) and C trachomatis (NAAT or culture)
Swab of cervical lesions (if present) for HSV
Vaginal swab for wet-mount
91
What samples should be collected based on common clinical syndromes?*
Asymptomatic males or females with risk factors
First-catch urine for Chlamydia trachomatis, Neisseria gonorrhoeae (or vaginal swab)
Pharyngeal and/or rectal swabs for C trachomatis, N gonorrhoeae (history of unprotected receptive oral or anal exposure)
Serology for:
Syphilis
HIV
```
Other serological tests to consider:
Hepatitis A (particularly with oral-anal contact)
Hepatitis B (if no history of vaccine)
Hepatitis C (particularly in PWIDs)
```
92
What samples should be collected based on common clinical syndromes?*
Genital ulcer disease
Swab of lesions for HSV culture OR HSV PCR
AND
Serology for syphilis.
93
What samples should be collected based on common clinical syndromes?*
Symptoms of vaginitis
Collect pooled vaginal secretions, if present
If no vaginal secretions are present, swab the vaginal wall in the posterior fornix to prepare a smear
Wet-mount and Gram stain smears are useful in the diagnosis of trichomonas as well as non-STI causes of vaginitis
94
what causes lyme disease
tick-borne infection
| caused by borrelia burgdorferi
95
what is early localized lyme disease
erythema migrans 7-14 days after bite
| resolves spontaneously within 4 weeks
96
what is late extracutanous lyme disease
Facial palsy, arthritis, heart block (or carditis) or meningitis (severe headache, fever), which is usually lymphocytic predominant
Pauciarticular arthritis most common late-stage symptom (oligoarticular, large joints – especially the knees) about 4 months post-bite
97
what are the oral treatment options for lyme disease? IV option?
doxycycline
amoxicillin
cefuroxime
or azithromycin is unable to take doxycycline, amoxicillin or cefuroxime
IV ceftriaxone
98
what is the duration of treatment for erythema migrans
doxycycline- 10 d
amoxicillin- 14 d
cefuorxime- 14 d
azithromycin- 7d
99
```
what is the duration of treatment for:
facial palsy
arthritis
carditis/heart block
meningitis
```
facial palsy- doxycycline x 14 days
arthritis- oral agent for 28 days
carditis/heart block- doxycycline or IV ceftriaxone 14-21d
meningitis- doxycycline of IV ceftriaxone 14 days
100
Jarisch-Herxheimer reaction
fever, HA, myalgia, worsening clinical picture in <24h
Can occur with treatment initiation
Nonsteroidal anti-inflammatory agents should be started and the antimicrobial agent continued.
101
Post-treatment Lyme Disease Syndrome (PTLDS)
10-20% cases have prolonged symptoms (fatigue, joint and muscle aching) > 6 months
no role for longer antibiotics
102
what are some mechanisms to prevent lyme disease
```
Where play spaces adjoin wooded areas, landscaping can reduce contact with ticks
20-30% DEET
Do a ‘full-body’ check every day
Remove any ticks asap
Shower within 2 hours of being outdoors
```
103
what is post-exposure antibiotics therapy for ?Lyme disease
Doxycycline 200mg as a single dose for children and youth after a tick bite
Prophylaxis can be started within 72 h of removing a tick, even if it has been attached for ≥36 h.
As the risk of infection is extremely low if attachment is <36 hours, prophylaxis is not indicated in this circumstance
104
Two potentially serious but preventable diseases acquired from biting arthropods
West Nile virus
| lyme disease
105
what are some methods to prevent diseases from bitting arthropods
1. DEET (no more than 10% DEET for children ≤12 years), >12 up to 30%
2. inspect daily for ticks and remove asap
3. long clothing that covers arms/legs
4. Light-coloured clothes make it easier to see and remove ticks before they bite, and do not attract mosquitoes as much as dark clothing.
5. Use screens on windows and doors at home and while camping, and keep them in good repair.
106
what is considered to be the repellent of first choice by the Public Health Agency of Canada’s Canadian Advisory Committee on Tropical Medicine and Travel for travellers six months to 12 years of age.
Icardin
107
two insect/tick repellants
DEET
| Icardin
108
when should a patient get vaccines pre-transplant
> 2 weeks before transplant for inactivated vaccine, > 4 weeks before transplant for live vaccines
109
what investigations should be done for a febrile transplant patient
Abnormal exam + focus: Minimum of CBC and Blood Cx, may need hospital admission
Normal exam, no focus: CBC, Blood Cx, Urine Cx
In the first months following a transplant, the site of infection often relates to the surgical procedures performed.
110
when can a patient have immunizations post transplant
Not for 6-12 months, inactivated influenza no earlier than 1 month after transplant and yearly thereafter
Contraindications:
Live influenza, measles, mumps, rubella, varicella, Rotavirus, BCG
111
which transplant patients in particular are at high risk of pneumococcal infection
Heart transplant patients are particularly vulnerable
112
which antibiotics decrease the level of immunosuppressants
rifampin
rifabutin
cytochrome p450 inducers
113
which antibiotics increase the level of immunosuppressants
```
azithromycin
clarithryomycin
erythromycin
metronidazole
ciprofloxacin
levofloxacin
cytochrome p450 inhibitors
```
114
what infections are seen in the first month following transplant?
from 1-6 months?
Greater than 95% of infections occurring in this critical period are similar to infections incurred by nonimmunosuppressed patients who have undergone a comparable surgical procedure
opportunistic infections
1. viral- CMV, EBV, human herpes virus 6, and hepatitis B and C viruses.
2. Listeria monocytogenes, Aspergillus fumigatus and Pneumocystis jirovecii.
115
What is a distinguishing sign of acute otitis external from acute otitis media with otorrhea?
A distinguishing sign of AOE from acute otitis media with otorrhea is the finding of tenderness of the tragus when pushed and of the pinna when pulled in AOE
116
what are the two bugs that cause otitis externa
Pseudomonas aeruginosa and Staph aureus
| Rare fungal infections have been described with Aspergillus species and Candida species
117
what is the treatment for mild to moderate otitis externa
Topical antibiotic +/- steroid x 7- 10 days
Ciprodex 4 drops BID for 7 days
Pain control with Tylenol/NSAIDs/ oral opioids
Should see improvement in 48-72 hours, full response in 6 days
118
how can you prevent otitis externa
soft ear plugs while swimming
remove water from ears after swimming
using hard earplugs should be avoided because they can cause trauma
119
what 3 things are suggestive of a diagnosis of acute otitis externa
1. Rapid onset (generally within 48 h) in the past three weeks
AND
2. Symptoms of ear canal inflammation, including
otalgia (often severe), itching or fullness
WITH OR WITHOUT hearing loss or jaw pain*
AND
3. Signs of ear canal inflammation, including
tenderness of the tragus, pinna, or both
OR
diffuse ear canal edema, erythema, or both
WITH OR WITHOUT otorrhea, regional lymphadenitis, tympanic membrane erythema, or cellulitis of the pinna and adjacent skin
120
what are some risk factors for MRSA
crowding, poor hygiene, athletes, daycare, aboriginal, military, IV drug users, MSM
121
how are uncomplicated skin abscesses in previously well children typically managed?
Uncomplicated skin abscesses in previously well children are typically managed with drainage alone
antibiotics reserved for <3mo or for children who are systemically unwell, have underlying medical problems or have significant surrounding cellulitis.
122
Management of skin abscess in child < 1 month
| *table
Most should be admitted for intravenous antibiotics (usually vancomycin with or without other agents).
123
Management of skin abscess in child 1-3 months with no fever, not systemically unwell
*table
Septra orally
124
Management of skin abscess in child >3 months with surrounding cellulitis
Septra and cephalexin orally pending culture results
125
what is the preferred treatment for invasive pulmonary aspergillosis.
voriconazole
126
what does fluconazole cover
Good for Candida, NO Aspergillus coverage
127
what antibiotics are used for endocarditis prophylaxis?
amoxicillin
if unable to take oral: Ampicillin or Ceftriaxone
allergy to penicillin: cephalexin, clindamycin, azithromycin or clarithromycin
128
who needs antibiotic prophylaxis for endocarditis before high risk procedures? (4)
1) a prothetic heart valve
2) a history of endocarditis
3) a heart transplant with abnormal heart valve function
4) certain congenital heart defects including:
- cyanotic congenital heart disease
- a congenital heart defect that has been completely repaired with prosthetic material for the first 6 months after repair
repaired congenital heart disease with residual defects such adjacent to the prosthetic device
129
what is the first line treatment for oral thrush
Nystatin 200,000 units QID after feeds is effective within 2 weeks (80% cure)
it should be administered after feeds
Second line - Fluconazole
130
what organism causes Pityriasis versicolor? treatment?
Malassezia
Treatment usually consists of applying shampoo preparations, such as ketoconazole 2% or selenium sulfide as a 2.5% lotion or 1% shampoo
131
what is the first line treatment for tinea capitis
systemic therapy
oral terbinafine (1st line treatment)
itraconazole
132
what is the treatment for Onychomycosis
Itraconazole
133
what are 3 treatment options for oral candiasis
nystatin (mild)
fluconazole
clotrimazole
134
what are the most common fungal infections in infants and children (5)
```
mucocutaneous candidiasis
pityriasis versicolor
tinea corporis
tinea pedis
tinea capitis
```
135
what is the maximum incubation period for salmonella typhi or salmonella paratyphi
60 days
| people in Canada have non-typhoidal salmonella
136
who should get vaccinated for typhoid fever? how effective is the vaccine?
>24 months and travelling to Asia or Africa
| 50% effective, only the oral vaccine is effective for P typhi
137
what is the treatment for congenital syphilis
IV Pen G for 10 days
138
what is the first line treatment for thrush
oral nystatin
139
what toxicity is associated with terbinafine
hepatotoxicty
| liver enzymes should be monitored especially if treatment extends beyond 4 weeks
140
For any patient presenting with acute flaccid paralysis or suspected Guillain-Barré syndrome what testing should be done on the stool?
Even when there is no such history, stool should be submitted for poliovirus testing.
141
what is the criteria for toxic shock syndrome
TSS characterized by hypotension (systolic blood pressure of 90 mmHg or less in adults, or less than the fifth percentile for age in children) AND at least two of the following signs:
Renal impairment (creatinine level of at least 2X the upper limit normal for age or 2X the patient’s baseline)
Coagulopathy (platelet count of 100×109/L or lower, or disseminated intravascular coagulation)
Liver function abnormality (levels of aspartate aminotransferase, alanine aminotransferase or total bilirubin >2X the upper limit normal for age)
Acute respiratory distress syndrome
Generalized erythematous macular rash that may later desquamate;
142
what are some examples of Non-severe IGAS
Non-severe IGAS: Includes bacteremia, cellulitis, wound infections, soft tissue abscesses, lymphadenitis, septic arthritis, osteomyelitis, without evidence of streptococcal TSS or soft tissue necrosis
143
Respiratory viruses associated with the greatest risk for severe illness in immunocompromised are?
Respiratory viruses associated with the greatest risk for severe illness are respiratory syncytial virus, influenza virus and adenovirus
144
what conditions are considered significantly immunocompromised
A hematopoietic stem cell transplant (within 2 years of transplantation or still taking immunosuppressive drugs)
A solid-organ transplant
Any current or recently treated malignancy
Aplastic anemia
Asplenia, with specific risk being encapsulated organisms such as Streptococcus pneumoniae, Neisseria meningitidis or Haemophilus influenzae type b (Hib)
HIV infection (specifically with a CD4+ count of <200/mm3 in children 5 years or older or a CD4+ count of <15% in infants and children younger than 5 years)
Severe combined congenital immunodeficiency disease (SCID)
145
people taking what medications are considered immunocompromised
High-dose corticosteroids (specifically >2 mg/kg of body weight or ≥20 mg per day of prednisone or equivalent in individuals weighing >10 kg), when administered for ≥2 weeks
Cancer chemotherapeutic agents
Antimetabolites (e.g., azathioprine)
Transplant-related immunosuppressive drugs
Biologics
CPS statements
flashcards
Decks in class (24)
# Cards
-
Child and Youth Maltreatment17
-
Allergy17
-
Adolescent45
-
Bioethics12
-
Community Peds70
-
CPS/Canadian thoracic society10
-
Endo5
-
Digital task force9
-
Drug therapy and hazardous substances committee12
-
Early Years Task Force7
-
First Nations27
-
Global Health12
-
Healthy active living33
-
NICU140
-
Hospital pediatrics8
-
Pediatric sports and exercise medicine8
-
Pediatric Environmental Health Section9
-
Nutrition34
-
Mental Health51
-
Infectious Diseases- Practice Points145
-
Injury prevention committee8
-
ID- Position statements104
-
acute care9
-
CPS 201996
