Shared Flashcard Set

Details

Boards - Infection 2
OBGYN Qualifying exam
220
Other
Post-Graduate
06/28/2020
Click here to study/print these flashcards.

Create your own flash cards! Sign up here.

Additional Other Flashcards

 

 

Cards

Term
toxo forms and their infectability
 Definition
trophosite - invasive, cyst/oocyte - latent
Term
risk of congenital toxo infection per trimester
 Definition
1T 10-15%, 2T 25%, 3T 60%
Term
signs fetal toxo congenital infection - 10
 Definition
ventriculomegaly, miceocephaly, brain calcifications, hydrops, IUGR, seizure, MR, chorioretinitis, hearing loss (delayed), hydrocephalus
Term
class 3 fetal signs toxo
 Definition
brain calcifications, chorioretinitis, hydrocephalus
Term
maternal signs of toxo - 6
 Definition
lymphadenopathy, fatigue, encephalitis, pneumonia, myocardotos, brain masses
Term
treatment of toxo in pregnancy
 Definition
no US signs - spirnomycin, US signs - pyrmethamine, sulfasalazine, folinic acid
Term
percent of babys asymptomatic after toxo infection and prognosis
 Definition
50% asymptomatic, 90% will have long term sequalae
Term
% population immune to varicella
 Definition
90
Term
incubation varicella
 Definition
10-20d
Term
risk of congential varicella by trimester
 Definition
1T 0.4%, 2T 2%, 3T 0%
Term
signs of congenital varicella - 8
 Definition
IUGR, ventriculomegaly, limb abnormalities, echogenic liver foci, cataracts, chorioretinitis, microcephaly, scars
Term
cause of neonatal varicella
 Definition
birth within 5d of lesions or lesions within 2d PP, no IgG can form yet to help baby
Term
treatment of varicella in pregnancy
 Definition
neonatal - give baby VSIG, acute - acyclovir/val/fam
Term
management of varicella exposure in non-immune pregnancy and not
 Definition
not - give vaccine within 3-5d (90 to 70% effective), pregnant - give VZIG within 5-10d (90% effective)
Term
% mortality in pregnant adult with varicella
 Definition
14-50%
Term
adult cases are what % varicella
 Definition
5%
Term
adult cases are what % of varicella mortalities
 Definition
50%
Term
top 3 areas of shingles
 Definition
thoracic, cervical, optic
Term
timeline of shingles
 Definition
prodrome lasts days to weeks, lesions heal in 2-4wk
Term
when do you get shingles vaccine
 Definition
60yo
Term
complications of shingles - 4
 Definition
post-herpatic neuralgia 8-70%, zoster opthalmacus, encephalitis, secondary infection
Term
treatment of post herpatic neuralgia - 5
 Definition
opioids, lidocaine, TCAs, gabapentin, capsacin
Term
#1 risk factor for post perhatic neuralgia
 Definition
age
Term
parvo incubation
 Definition
10-20d
Term
parvo MOA
 Definition
cytotoxic to RBC precursors
Term
% already immune to parvo
 Definition
50%
Term
if exposed % that youll get parvo
 Definition
8%
Term
where are most parvo cases acquired
 Definition
20-50% schools, 17-33% congenital
Term
when is the highest risk of fetal loss by parvo
 Definition
<20wk
Term
fetal signs of parvo - 4
 Definition
hydrops 3%, skin edema, pulmonary edema, myocardial injury
Term
matetrnal signs of parvo - 7
 Definition
fever, headache, sore throat, malaise, arthralgias, aplastic crisis in hemoglobonaopathies, 25% asymptomatic
Term
diagnosis of parvo
 Definition
IgG/M (3-6wk apart)
Term
antepartum management after parvo infection
 Definition
weekly dopplers for 8-12wk
Term
worst prognostic factor for baby in parvo infection - 2
 Definition
worse hydrops = worse prognosis, <20wk 8-17% stillbirth
Term
even if a baby has zero parvo signs at birth, what are they at risk for
 Definition
long term cognitive defects
Term
when is rubella infectious
 Definition
7d pre and post rash
Term
highest risk in pregnancy for congenital rubella
 Definition
<8wk 50%
Term
#2 highest time in pregnancy for congential rubella
 Definition
8-12wk 25%
Term
#3 highest time in pregnancy for congential rubella
 Definition
3T 10%
Term
fetal signs of congenital rubella - 12
 Definition
immediate deafness 65%, cataracts 20%, cardiac defects 20%, CNS defects 15%, microcephaly, glaucoma, subacute sclerosing panencephalitis, blueberry muffin rash, IUGR, thrombocytopenia, supraventricular pulmonary stenosis, hydrops
Term
maternal signs of rubella - 4
 Definition
maculopapular rash, post-aricular adenopathy, conjunctivitis
Term
how long does symptoms of rubella last in adult
 Definition
3-5d
Term
what percent of those who get MMR seroconvert
 Definition
90%
Term
how long should you wait after MMR for pregnancy
 Definition
4wk
Term
listeria type of bug
 Definition
gram negative bacilli non spore forming bacteria, mobile
Term
listeria incubation
 Definition
11-70d
Term
#1 source of listeria
 Definition
unpasteurized cheese 17%
Term
MOA listeria
 Definition
binds to e-cadherin in meninges and placenta, which is why 13x risk in pregnancy
Term
what percent of listeria cases are in pregnancy
 Definition
10%
Term
highest time of fetal listeria transmission
 Definition
3T
Term
signs of fetal listeria - 7
 Definition
PTD, granulomatous infantseptica (maculopapular rash), stillbirth, meningitis, organ abscesses, placental abscesses, chorioamnitis/villitis
Term
maternal signs of listeria - 5
 Definition
diarrhea, fever, headache, URI, meningoencephaloitis
Term
management of listeria and exposure to listeria in pregnancy
 Definition
exposure and no sx no management needed, exposure and sx give tx and do culture, esposure and fever, no management
Term
treatment for listeria
 Definition
IV ampicillin 2g q4h for 2wk
Term
worst prognostic factor in listeria in pregnancy
 Definition
maternal bacteremia assoc 50% fetal death
Term
rate of fetal death from listeria infection
 Definition
29%
Term
alternative treatment for listeria
 Definition
bactrim
Term
how to use bleach to clean
 Definition
1 tbsp. bleach to 1 gal water for 10m
Term
#1 cause of congenital deafness
 Definition
CMV
Term
#1 congenital infection
 Definition
CMV
Term
risk of congenital CMV by trimester
 Definition
1T 40-70%, 2T 35$, 3T 30%
Term
trimester with highest CMV infection rates for baby
 Definition
3T
Term
percent of neonates affected by CMV
 Definition
0.2-2%
Term
what % of CMV cases occur in pregnancy
 Definition
1-4%
Term
% of population immune to CMV
 Definition
50-80%
Term
risk factors for CMV - 5
 Definition
day cares, sex, STIs, low SES, <15yo first pregnancy
Term
fetal signs CMV (Early) - 17
 Definition
splenomegaly, jaundice, petechiae, echogenic bowel, IUGR, ventriculomegaly, liver damage, ascites, thrombocytopenia, periventricular calcifications, abdominal calcifications, seizure, meconium peritonitis, chorioretinitis, microcephaly, anemia, hydrops
Term
CMV fetal signs (late) - 3
 Definition
progressive hearing loss, psychomotor delays, vision loss
Term
maternal signs of CMV 4
 Definition
fever, malaise, adenopathy, HSM
Term
% of congenital CMV that is severe
 Definition
5-10%
Term
% of congenital CMV resulting in fetal death
 Definition
10%
Term
% of congenital CMV with mild or an isolated symptoms
 Definition
50%
Term
% of congenital varicella that is asymptomatic
 Definition
15%
Term
% of congenital CMV that will have late fetal symptoms
 Definition
25%
Term
management of congenital CMV
 Definition
IgG-/IgM+ give IVIG, IgG+/IgM+ - if low avidity <60% give IVIG
Term
mosquitoes that have zika - 3
 Definition
ageyph, ades, altopictos
Term
incubation zika
 Definition
3-14d
Term
maternal signs zika - 6
 Definition
80% asymptomatic, fever, rash, arthralgia, conjunctivitis, guillian-barre
Term
fetal signs of congenital zika - 13
 Definition
microcephaly, eye malformations, ventriculomegaly, cerebellar hypoplasia, brain calcifications, cortical abnormalities, echogenic foci, hypotonia, contractures, SAB, PTD, IUGR, stillbirth
Term
how to tell what caused a microcephaly
 Definition
>2 SD below - repeat it prolly measuring wrong
>3 SD below - isolated
>5 SD below - pathologic
Term
percent of vertical transmission of zika overall and by trimester
 Definition
5-10%, 29% in 1T
Term
pregnant and patient or partner was exposed - when to test for zika
 Definition
asymptomatic: if non-recurring risk don't test, if recurring disk do NAT qTrimester. Symptomatic: if <12wk from incident do NAT/IgM, if >12wk too late
Term
how long should someone exposed or affected by zika abstain
 Definition
men 6mo, women 8wk
Term
how long should someone just visiting a place with zika (not specifically exposed or affected) abstain
 Definition
women 2mo, women 3mo
Term
what are the zika zones and the recommendations for each
 Definition
green - no mosquitoes - no recs, yellow - no zika - prevent bites, purple - piror zika - abstain, red - current zika - abstain
Term
2 chemicals that repel mosquitoes safe in pregnancy
 Definition
permethrin, diethyltoluamide
Term
non-PRINT area - NAT -, IgM zika +, IgM dengue -
 Definition
zika infection unknown timing
Term
non-PRINT area - NAT -, IgM zika +, IgM dengue +
 Definition
zika and or dengue infection unknown timing of either
Term
non-PRINT area - NAT -, IgM zika -, IgM dengue -
 Definition
no zika
Term
non-PRINT area - NAT -, IgM zika equiv, IgM dengue equiv
 Definition
repeat IgMs
Term
non-PRINT area - NAT +, IgM zika _/-, IgM dengue +/-
 Definition
current zika
Term
PRINT area - NAT-S +, NAT-U +, zika IgM +/-
 Definition
acute zika
Term
PRINT area - NAT-S +, NAT-U -, zika IgM +
 Definition
acute zika
Term
PRINT area - NAT-S +, NAT-U -, zika IgM -
 Definition
possible zika - repeat NAT if positive infected, if negative do IgM in 2wk and if positive has zika
Term
PRINT area - NAT-S -, NAT-U +, zika IgM -
 Definition
possible zika - repeat NAT if positive infected, if negative do IgM in 2wk and if positive has zika
Term
PRINT area - NAT-S -, NAT-U +, zika IgM +
 Definition
acute zika
Term
PRINT area - NAT-S -, NAT-U -, zika PRNT >10, dengue PRNT <10
 Definition
zika infection but unknown timing, consider IgM
Term
PRINT area - NAT-S -, NAT-U -, zika PRNT <10, dengue PRNT <10
 Definition
no zika or dengue
Term
PRINT area - NAT-S -, NAT-U -, zika PRNT <10, dengue PRNT >10
 Definition
no zika, dengue present but unknown timing, consider IgM
Term
PRINT area - NAT-S -, NAT-U -, zika PRNT >10, dengue PRNT >10
 Definition
has had zika and dengue at some point but not sure when
Term
signs of hepatitis A - 9
 Definition
malaise, fatigue, nausea, vomiting, anorexia, RUQ pain, jaundice, dark urine, acholic stools
Term
treatment hepatitis A
 Definition
immunoglobin protective within 2wk of exposure and safe in pregnancy
Term
risk of household transmission hepatitis B
 Definition
14-60%
Term
risk of perinatal transmission HBSAg+
 Definition
10-20%
Term
risk of perinatal transmission HBEAg+
 Definition
90%
Term
risk of hepatitis B after a percutaneous exposure
 Definition
6-30%
Term
hepatitis B - natural infection
 Definition
HBSAg negative, anti C/S positive
Term
hepatitis B - susceptible
 Definition
HBSAg negative, anti C/S negative
Term
hepatitis B immunity
 Definition
HbsAg negative, anti C negative, anti S positive
Term
hepatitis B acute infection
 Definition
HbsAg positive, anti C positive, anti C IgM positive, anti S negative
Term
hepatitis B chronic infection
 Definition
HbsAg positive, anti-C positive, anti C IgM negative, anti S negative
Term
hepatitis B inicidence in pregnancy
 Definition
0.7-0.9%
Term
hepatitis B screening for disease and immunity indication - 9
 Definition
pregnancy, adolescent, contact with HBSAG+, >1 sexual partner in past 6mo, MSM, IV drugs, dialysis, healthcare workers, inmates
Term
hepatitis B treatment in pregnancy
 Definition
get viral load at 28wk, treat with tenovir 28-32wk if DNA >6-8 log 10 IU/mL
Term
is breastfeeding ok with hepatitis B
 Definition
yes
Term
is amniocentesis ok with hepatitis B
 Definition
only if DNA <7
Term
% that will clear hepatitis B
 Definition
90%
Term
% with hepatitis B that will develop chronc infection
 Definition
15%
Term
percent of hepatitis B with chronic infection that will develop hepatitis or cirrhosis
 Definition
15%
Term
percent of hepatitis B with chronic infection that will develop fulminant hepatitis and death
 Definition
<1%
Term
incidence of hepatitis C positive in pregnant patients
 Definition
0.6-6%
Term
rate of hepatitis C from a blood transfusion
 Definition
1:2,000,000
Term
#1 cause of liver failure
 Definition
hepatitis C
Term
#1 cause of need for liver transplant
 Definition
hepatitis C
Term
risk of hepatitis C for a percutaneous exposure
 Definition
1.8%
Term
what years are 75% of the hepatitis C patients born in
 Definition
1945-1965
Term
prevalence of hepatitis C in ths born 1945-1965
 Definition
3.25%
Term
% of hepatitis C that will develop chronic infection - ie not clear it
 Definition
75-85% get chronic infection, 10-15% clear it
Term
% of hepatitis C that will develop chronic liver disease and cirrhosis
 Definition
60-70% chronic liver disease, 5-20% cirrhosis
Term
% of hepatitis C that will die of liver cancer or cirrhosis
 Definition
1-5%
Term
after clearing hepatitis C can you get it again
 Definition
yes
Term
#1 way to get hepatitis C
 Definition
IV drug use
Term
transfusion before what year has hepatitis C risk
 Definition
1992
Term
what can increase the perinatal hepatitis C transmission and %
 Definition
HIV increases it from 5% to 44%
Term
what is the rate of transmission of hepatitis C if there is not viremia
 Definition
almost none
Term
what is most correlated with hepatitis C viral load
 Definition
ALT
Term
when do you do a CD for hepatitis C
 Definition
you dont
Term
is hepatitis C in breastmilk
 Definition
it is but it is inactivated, breastfeeding is ok
Term
who should be screened for hepatitis c - 10
 Definition
once if born 1945-1965, IV drug user, clotting factors <1987, HIV, dialysis, persistent elevated aLT, prior transplant or transfusion <1992, healthcare worker with needle stick, born to HCV mom
Term
who is it not needed but should consider hepatitis C screening - 4
 Definition
recipient of transplanted tissue only, non-IV drug user, tattoo/piercing, history of multiple HCV positive sex partners
Term
should you screen household contacts of those with hepatitis C
 Definition
no
Term
after an occupational exposure how is hepatitis C screened for if the patient is HCV positive and the worker HCV positive
 Definition
do HCV RNA - if positive right now they ALREADY had hepatitis C, if negative then repeat it in 3wk, if negative then they cleared it, if positive then refer to care
Term
after an occupational exposure how is hepatitis C screened for if the patient is HCV positive and the worker is HCV negative
 Definition
test for the RNA in 3wk, if positive refer to care, if negative no disease
Term
in what time frame would someone clear hepatitis C on their own
 Definition
6mo
Term
rate of cirrhosis in hepatitis D
 Definition
70-80%
Term
risk of mortality in hepatitis D
 Definition
25%
Term
rate of hepatitis B carriers with hepatitis D
 Definition
25%
Term
transmission of hepatitis E
 Definition
fecal oral
Term
which hepatitis has highest mortality in pregnancy
 Definition
E
Term
% women colonized with GBS
 Definition
10-30%
Term
mom is colonized and untreated what is the rate of GBS infection in baby, what is the mortality
 Definition
<5% without risk factors with <5% mortality, 50% if risk factors with 35% mortality
Term
risk factors that make GBS exposure more likely to cause infection in baby - 10
 Definition
GBS positive in prior pregnancy, prematurity, prolonged ROM, intrapartum fever, prior affected child, <20yo, heavy maternal colonization, late prenatal colonization, anti-GBS Ab, AA
Term
when is GBS screened for
 Definition
35-37qk valid for 5wk
Term
primary treatment of GBS
 Definition
PCN G 5 mill U IV --> 2.5-3 million U q4h --- OR --- ampicillin 2g IV --> 1g IV q8h
Term
GBS treatment PCN allergy no hives
 Definition
cefazolid 2g IV --> 1g IV q8h
Term
treatment of GBS PCN allergy, suspeptible
 Definition
susceptible to clinda and erythromycin - clindamycin 900mg IV q8h
Term
treatment of GBS PCN allergy, unknown susceptabilities or not susceptible
 Definition
vancomycin 1g q12h
Term
who gets treated for GBS if GBS unknown - 7
 Definition
<37wk, ROM >18h, >100.4F, NAAT+, GBS positive in prior pregnancy, prior GBS baby
Term
GBS effect on baby - 3
 Definition
sepsis, pneumonia, meningitis
Term
incidence of asymp bacturia in pregnancy and population
 Definition
2-14% pregnancy, 5% population
Term
% asymptomatic bacteria will turn into pyelo
 Definition
20-40%
Term
cause of most asymptomatic bacteria
 Definition
E. coli
Term
definition of asymptomatic bacturia
 Definition
>100,000 bacteria per millimenter in single midstream collection without symptoms
Term
complications of asymp bacteria - 3
 Definition
pyelo, PTD, LBW
Term
prevention of asymptomatic bacteria (after already identified)
 Definition
monthly urine cultures
Term
incidence of pyelonephritis not in pregnancy
 Definition
1-2%
Term
#1 cause of septic shock in pregnancy
 Definition
pyelonephritis
Term
incidence of pyelonephritis in pregnancy
 Definition
2-7%
Term
risk factors for pyeo - 8
 Definition
age, mutliparity, DM, sickle cell anemia, nephrolithiasis, drug use, urinary tract abnormalities, history of pyelo
Term
prevention of pyelo
 Definition
Macrobid 100mg/d for pregnancya nd PP
Term
3 organisms most likely to cause pyelo
 Definition
E. coli, klebsielle, proteus
Term
what happens if you give tocolytics in pyelo
 Definition
sepsis, pulmonary edema
Term
antibiotics for pyelo
 Definition
amp and gent or single agent ceftriaxone
Term
complications of pyelo - 4
 Definition
bacteremia 20%, ARDS 1-8%, PTD 6-50%, infectious endocarditis
Term
what pyelo bug is most likely to cause infectious endocarditis
 Definition
gram positive cocci
Term
recurrence rate of pyelo
 Definition
6-8%
Term
how well does prophylatric treatment prevent pyelo
 Definition
95%
Term
#1 type of urinary stone
 Definition
calcium oxylate
Term
cause of struvite urinary stones
 Definition
chronic proteus UTI
Term
% of urinary stones that will pass
 Definition
80%
Term
how is a TB PPD done
 Definition
0.1mL STU PPD into volar forearm, read in 48-72h
Term
for whom is a >5mm PPD positive for - 5
 Definition
HIV, close contacts with TB, CXR with fibrotic changes, TNFa inhibitors, chronic steroids
Term
for whom is a >10mm PPD positive for - 12
 Definition
CRD, DM, cancer, silicosis, underweight, jugenal bypass, IV drug users, <40yo, born in country high risk, healthcare workers, prisoners, homeless
Term
for whom is a >15mm PPD positive for
 Definition
everyone
Term
who should get a quantiferon Gold / T-spot test - 2
 Definition
wont return for PPD, BCG vaccine
Term
who has a high risk of the latent TB turning active / just getting active TB instead of latent - 12
 Definition
HIV, transplant, cancer, CXR with fibronodular changes, silicosis, renal failure, TNFa inhibitor, DM, steroids, <12yo, infected in past 2y, elderly, inconsistent treatment
Term
who has a slight increasd risk of latent TB turning active - 3
 Definition
underweight <85% ideal, smokers, CXR with solidary granuloma
Term
top 3 sites for extrapulmonary TB
 Definition
1 - nodes, 2- pleural effusions, 3 - urogenital
Term
after TB exposure what is the work up other than the TB tests themselves - 2
 Definition
HIV, CXR
Term
what tests can diagnose latent TB - 2
 Definition
TB skin testing, INF-gamma release assay
Term
what tests can diagnosis TB in someone who had vaccine - 2
 Definition
INF-gamma release assay, t-spot/quantiferon gold
Term
which tests can diagnose active TB - 2
 Definition
sputum testing then stain for acid fast bacilli not very sensitive, sputum culture gold standard but takes 3wk
Term
after TB exposure how long is latency
 Definition
2-3wk
Term
signs of latent TB
 Definition
none, but could have lymphoma B symptoms
Term
lymphoma B symptoms - 7
 Definition
weight loss, sweats, loss of appetite, fever, fatigue, cough >3wk, coughing blood
Term
% of TB with extrapulmonary diseases
 Definition
20%
Term
after exposure what is given for TB prophylaxis
 Definition
300mg QD x9mo INH
Term
SE INH - 2 and their preventions
 Definition
peripherial neuropathy (B6), liver disease
Term
who should have LFTs monitored in TB treatment - 5
 Definition
pregnancy, liver disease, drug reaction suspected, therapy with pyrazinamide for everyone, abnormal baseline LFTs
Term
treatment of TB
 Definition
RICE for 1-2mo - rifampin, isoniazid, pyrazinamide, ethambutol or streptomycin --> 2 drugs for 4-6mo depending ons usceptibility
Term
how is TB treated in pregnancy
 Definition
active - 9mo INH, RIF, EMB. Latent - 300mg INH for 6-9mo
Term
how effective is the prevention INH for TB
 Definition
60-90%
Term
what increases the risk of congenital TB
 Definition
HIV
Term
cause of lyme disease
 Definition
B burgdorferi a spirochete
Term
transmission of lyme disease
 Definition
iodes tick on deer and mice, highest in north america
Term
testing for lyme disease - 2
 Definition
culture in Barbour-stonner-kelly medium (definitive), ELIZA with blot (IgG present in 1mo)
Term
signs of lyme disease 4
 Definition
erythema migrans (legs, feet, burn, itch), AV block, aseptic meningitis, arthritis
Term
treatment of lyme disease
 Definition
doxy 14-21d (amox or amp alternate)
Term
rate of chorio
 Definition
1-4% births
Term
risk factors for chorio - 6
 Definition
prolonged labor, prolonged ROM, GBS, genital tract infection, meconium, multiple SVE
Term
diagnosis of chorio - 5
 Definition
>/= 39C once -- OR -- 38-39C/100.4 on 2 occasions ------ PLUS ONE ---- elevated WBC, fetal tachycardia, purulent cervical DC
Term
treatment of chorio
 Definition
amp/gent +clinda if CD
Term
complicaitons of chorio - 11
 Definition
dysfunctional labor, CD, PPH, transfusion, endometritis, abscess, bacteremia 10%, shock, DIC, ARDS, death
Term
fetal complications of chorio - 7
 Definition
septic shock, pneumonia, IVH, cerebral white matter damage, CP, asyphixa, death
Term
rate of neonatal sepsis caused by chorio
 Definition
40%
Term
criteria for sepsis 6
 Definition
infection plus 1 - temp >101 or <98.6, tachycardia, tachypenia, altered mental status, WBC >12 <4 or >10% bands, hypotension
Term
criteria for severe sepsis - 5
 Definition
sepsis +1 - oliguria, Cr >1.1, DIC, thrombocytopenia, hyperlactemia >1
Term
signs of septic shock - 5
 Definition
hypotension, fever, tachycardia, tissue hypoperfusion, low urine output
Term
risk factors for septic shock - 5
 Definition
extremes of age, immune deficiency, wounds, burns, hospitalization
Term
which pressor is used in septic shock
 Definition
norepinepherine
Supporting users have an ad free experience!