Term
| what type of immune reaction do inactivated vaccines cause? |
|
Definition
|
|
Term
| interference can occur between two live vaccines given less than ____ days apart. |
|
Definition
|
|
Term
|
Definition
viral: MMR, rubella, varicella/zoster, yellow fever, rotavirus, intranasal influenza, rotavirus, vaccinia.
Bacterial: BCG, oral typhoid |
|
|
Term
| what type of immune response occurs wiht live attenuated vaccines? |
|
Definition
| immune response similar to natural infection. |
|
|
Term
| vaccines given ____ days before the minimum age can be counted but may not be counted by schools etc. |
|
Definition
|
|
Term
| contraindications to live vaccines |
|
Definition
| allergy, encephalopathy, pregnancy, immunosuppression |
|
|
Term
| contraindications to inactivated vaccines |
|
Definition
|
|
Term
| invalid contraindications to vaccination |
|
Definition
| mild illness, antimicrobial therapy, disease exposure or convalescence, pregnant/immunocompromised pt in the household, breastfeeding, preterm birth, allergy to products not present in vaccine, FHx of AE, TB skin testing, multiple vaccines |
|
|
Term
| can a pt with isolated B-Cell deficiency be given the varicella vaccine? |
|
Definition
|
|
Term
| True/False: Mild illness such as otitis media or an upper respiratory infection is a contraindication to vaccination |
|
Definition
|
|
Term
| involve almost any mucous membrane, conjuntivitis, pharyngeal membrane, "bullneck", severe myocarditis, unvaccinated travelers. |
|
Definition
|
|
Term
| insidious onset of exudative pharyngitis, exudate spreads within 2-3 days and may form adherent membrane, membrane may cause respiratory obstruction, fever usually not high but pt appears toxic |
|
Definition
| pharyngeal and tonsillar diphtheria |
|
|
Term
| common complications of Diptheria |
|
Definition
|
|
Term
|
Definition
| used only for treatment of diptheria, neutralizes only unbound toxin. |
|
|
Term
| anaerobic gram positive, spore forming bacteria |
|
Definition
| clostridium tetani, causes tetanus |
|
|
Term
| estimated human lethal dose of tetanospasmin |
|
Definition
|
|
Term
| toxin binds to the central nervous system and causes unopposed muscle contraction and spasm |
|
Definition
|
|
Term
| descending symptoms of trismus (lockjaw), difficulty swallowing, muscle rigidity, spasms |
|
Definition
|
|
Term
| clean minor wound, less than 3 doses of Td what do you do? |
|
Definition
|
|
Term
| clean minor wound, >3 previoud Td doses, what do you do? |
|
Definition
no Td (unless > 10 yrs since last)
no TIG |
|
|
Term
| dirty wound, less than 3 previous Td doses, what do you do? |
|
Definition
|
|
Term
| dirty wound, > 3 previous Td doses, what do you do? |
|
Definition
no Td (unless > 5 yrs since last)
no TIG |
|
|
Term
| highly contagious respiratory infection caused by bordetella pertussis |
|
Definition
|
|
Term
| pertussis clinical featuers (stages) |
|
Definition
| catarrhal = 1-2 wks paroxysmal cough = 1-6 wks convalescence = weeks - months |
|
|
Term
| when do you give DTaP vs. Tdap |
|
Definition
DTaP = children 6 wks - 7 yrs
Tdap = 10-64 yrs (adacel = 11-64) |
|
|
Term
| what vaccines are included in pentacel? |
|
Definition
|
|
Term
| what vaccines are in Pediarix? |
|
Definition
|
|
Term
| what vaccines are in Kinrix? |
|
Definition
|
|
Term
| Pertussis vaccine must never be ______. |
|
Definition
|
|
Term
|
Definition
|
|
Term
| T/F: MMR given before 12 months is invalid and should be repeated |
|
Definition
|
|
Term
| T/F: MMR is contraindicated with an egg allergy |
|
Definition
|
|
Term
| what should you do if the pt needs and MMR and PPD? |
|
Definition
1. Give MMR and PPD on same day.
2. Do PPD today, give MMR when PPD is read.
3. Delay PPD x 4-6 wks if MMR given first. |
|
|
Term
| acute, contagious viral disease consisting of painful enlargement of the salivary glands, most commonly the parotids, up to 1/3 of postpubertal males develop orchitis |
|
Definition
|
|
Term
| causative agent for Mumps |
|
Definition
| RNA virus in genus paramyxovirus |
|
|
Term
| when is mumps most infectious? |
|
Definition
| 1 day before parotid gland swelling until 3 days after swelling subsides. |
|
|
Term
| diagnostic serology for mumps |
|
Definition
|
|
Term
|
Definition
supportive fluids, analgesics, antipyretics, adjust diet to ability to chew.
orchitis = scrotal support and bedrest |
|
|
Term
|
Definition
|
|
Term
| MC complications of mumps |
|
Definition
male infertility
meningoencephalitis |
|
|
Term
| T/F: Children less than 24 months may not develop protective antibody after invasive disease, so immunize. |
|
Definition
|
|
Term
| Hib generally not recommended after what age? |
|
Definition
|
|
Term
| who is the pneumococcal polysaccharide vaccine recommended for? |
|
Definition
adults > 64 yo
HIV, immunocompromised audlts
high risk children > 2 yo |
|
|
Term
| pneumococcal vaccine schedule |
|
Definition
|
|
Term
| causative agent for pneumococcal disease |
|
Definition
|
|
Term
| 3 major conditions caused by invasive pneumococcal disease |
|
Definition
| pneumonia, bacteremia, meningitis |
|
|
Term
| abrupt onset fever, shaking chills or rigors, chest pain, cough, SOB, rapid breathing and heart rate, weakness. |
|
Definition
|
|
Term
| presence of HbsAg indicates what? |
|
Definition
|
|
Term
| presence of anti-HbsAg indicates |
|
Definition
| immunity from disease or vaccine. |
|
|
Term
|
Definition
| fulminent hepatitis, hospitalization, cirrhosis, hepatocellular carcinoma, death |
|
|
Term
| sxs = nausea, lack of appetite, tiredness, muscle/joint/stomach pain, fever, diarrhea/vomiting, headache, dark urine, light-colored stools, yellowing of the skin and whites of the eyes (jaundice) |
|
Definition
|
|
Term
| perterm infant Hep B doses |
|
Definition
if Mom is HbsAg+: birth dose and HBIG (within 12 hrs of birth)
if < 2000g and Mom is HbsAg- delay dose until 1 month |
|
|
Term
| minimum interval for Hep B |
|
Definition
1 and 2 = 4 weeks
2 and 3 = 8 weeks
1 and 3 = 16 weeks |
|
|
Term
|
Definition
1 and 2 = 4wks
2 and 3 = 12wks
1 and 3 = 24 wks |
|
|
Term
| management of Hep B non-responders |
|
Definition
| complete a second series of 3 doses. Should be given on the usual schedule 0, 1m, 6m. Retest 1-2m after completing the second series. |
|
|
Term
| increased risk of what with concominant Hep C and Hep A |
|
Definition
|
|
Term
|
Definition
| administer to children 12-23 months 2 doses at a 6 month interval |
|
|
Term
| who is Hep A recommended for? |
|
Definition
| international travelers, men having sex with men, persons who use illegal drugs, persons with occupational risk, persons with chronic liver disease |
|
|
Term
|
Definition
| polio, coxsackie A & B, echoviruses |
|
|
Term
| leading cause of childhood exanthem in the summer and fall |
|
Definition
|
|
Term
| entry into mouth, replication in pharynx/GI tract/local lymphatics, hematologic spread to lymphatics and CNS, viral spread along nerve fibers, destruction of motor neurons |
|
Definition
|
|
Term
| polio is not routinely recommended for who? |
|
Definition
|
|
Term
| causative agent of hand, foot, and mouth disease |
|
Definition
|
|
Term
| most common locations of lesions in hand, foot, and mouth disease |
|
Definition
dorsal surfaces, palms and soles.
hands > feet |
|
|
Term
| treatment of hand, foot, and mouth disease |
|
Definition
|
|
Term
| oropharyngeal lesions, major site = anterior tonsillar pillars |
|
Definition
|
|
Term
| when do varicella epidemics occur? |
|
Definition
|
|
Term
| how long is varicella contagious? |
|
Definition
| 24-48 hrs before rash until vesicles have crusted (3-7d after rash onset) |
|
|
Term
| dew drop on a rose petal, different stages of evolution of vesicular lesion in same area |
|
Definition
|
|
Term
|
Definition
acyclovir for viral suppression, oral for most 20 mg/kg. IV for immunocompromised within 72 hrs of initial sxs.
Reduction of pruritis = calamine lotion, oatmeal bath, atarax.
Prevention of superinfection = bacitracin to denuded lesions until scab forms. |
|
|
Term
| complications of varicella |
|
Definition
| pneumonia, secondary bacterial infection, encephalitis and acute cerebellar ataxia, Reye's syndrome, progressive varicella |
|
|
Term
| varicella vaccine schedule |
|
Definition
12-15m, 4-6y
may be administered simultaneously with MMR |
|
|
Term
| who is postexposure varicella prophylaxis recommended for? what is given? |
|
Definition
| VZIG is recommended for immunocompromised patients. |
|
|
Term
| when is zostavax recommended? |
|
Definition
|
|
Term
| yearly epidemics in winter lasting 4-5 months (peak Jan, Feb, March) |
|
Definition
|
|
Term
| #1 infection causing bronchiolitis |
|
Definition
|
|
Term
|
Definition
| humidified oxygen, fluids, trial of a bronchodilator. Coritcosteroids are not indicated unless it's an older child with asthma. |
|
|
Term
| when are antibiotics indicated with RSV? |
|
Definition
| older infants with interstitial pneumonia, when consolidation is found, or in a critically ill child. |
|
|
Term
| when is Ribivirin indicated for RSV, how is it administered? |
|
Definition
| very sick or high risk infant. delievered by small partical aerosol along with required concentration of oxygen for 20-24hrs/day x 3-5 days |
|
|
Term
|
Definition
| hospital precautions, passive immunoprophylaxis to protect high risk children from serious complications of the disease. |
|
|
Term
| when is passive immunoprophylaxis for RSV not given? |
|
Definition
| children with cyanotic congential heart disease |
|
|
Term
| occurs during winter. sxs = vomiting, diarrhea, fever. dx = stool study immunoassay |
|
Definition
|
|
Term
|
Definition
| manage sxs and maintain hydration. |
|
|
Term
|
Definition
2m, 4m, 6m
dose 1 as early as 6 wks
dose 3 no later than 8m of age
don't start series in child > 15w |
|
|
Term
| fever, upset stomach, vomiting, followed by diarrhea (3-7d). Child may lose interest in eating and drinking and become very dehydrated |
|
Definition
|
|
Term
|
Definition
0m, 2m, 6m (timeframe not ages)
girls and boys age 9-26yo |
|
|
Term
| visible genital warts or pre-cancerous changes on the cervix, vulva, anus, or penis |
|
Definition
|
|
Term
| what is the age range for meningococcal vaccine? |
|
Definition
|
|
Term
| meningococcal vaccine rules |
|
Definition
1 dose to children 2-10 with risk factors: asplenia, persistent complement deficiency, endemic to region, outbreak.
All 11-18yo (1 dose)
revaccinate all high risk children through 18yo |
|
|
Term
| fever, malaise, muscle aches, general discomfort, nausea, vomiting |
|
Definition
|
|
Term
|
Definition
| acetaminophen, no abx or ASA |
|
|
Term
| contraindications to the flu vaccine |
|
Definition
anaphylaxis for the vaccine, allergy to eggs or it's other components.
LAIV = pregnancy, asthma, RAD, or chronic d/o of CV/Pulmonary systems. |
|
|
Term
| influenza vaccine schedule |
|
Definition
yearly from 6m-18yo.
LAIV for healthy people age 2-49.
first time vacinees from age 6m-8yo get 2 doses separated by 4 wks. |
|
|
Term
| recommended vaccines for teens and college students living in dorms |
|
Definition
| Tdap, MCV4, HPV, Hep B, IPV, MMR, Varicella, Influenza, PPV, Hep A |
|
|
Term
| discreten nonspecific blanching, maculopapular lesions, morbilliform, rash is generalized. conjunctivitis, rhinitis, pharyngitis, preauricular LAD. Peak = late winter thru early summer. |
|
Definition
|
|
Term
| low grade fever, mild malaise, LAD, HA, sore throat, coryza, discrete pinkish-red fine maculopapular rash beigns on face and spreads cephalocaudally, becomes generalized in 24 hrs, then fades and clears completely in 72 hrs |
|
Definition
|
|
Term
| small reddish spots on the soft palate, seen on day 1 of the rash |
|
Definition
| Forchhemer spots = Rubella |
|
|
Term
| highly contagious (4days before and after rash), fever, malaise, dry cough, coryza, conjunctivitis. Exanthem seen on day 3-4 as sxs and fever peak. Blotchy, erythematous, blanching, maculopapular eruption, starts at hairline and spreads cephalocaudally over 3 days, ultimately involves palms and soles. |
|
Definition
|
|
Term
| complications of rubeola (measles) |
|
Definition
| OM, PNA, Acute encephalitis |
|
|
Term
| tiny bluish white dots surrounded by red halos. Halos increase in number and then fade over 2-3 days. |
|
Definition
| Koplik spots = rubeola (measles) |
|
|
Term
| labs for rubeola (measles) |
|
Definition
WBC may decrease, multinucleated giant cells on mucosal scrapings.
serum IgM ab level > 2d after start of rash. |
|
|
Term
|
Definition
| supportive, vaccination prevents disease if given to contacts within 72 hours, immune globulin will prevent or modify measles if given within 6 days |
|
|
Term
| affects children 6-36 months, abrupt rise in temp, anorexia, irritability, rash = erythematous, maculopapular exanthem after fever subsides, discrete rose pink macules that begin on the rtunk and spread rapidly to the extremities, neck, face, and scalp, may last several hours to 1-2 days before resolution. |
|
Definition
| roseola infantum (exanthem subitum) |
|
|
Term
| causative agent of roseola |
|
Definition
|
|
Term
| causative agent of erythema infectiosum |
|
Definition
|
|
Term
| exanthem begins on face with large, bright red erythematous patches appearing over both cheeks, warm, non-tender macular with circumscribed borders. facial lesions fade, then a slightly raised erythematous, lacy rash appears on the extensor surfaces of the extremities, then the flexor surfaces, buttocks, and trunk. Resolves in 3-7 days. |
|
Definition
| erythema infectiousum (Fifth Disease) |
|
|
Term
| what is unusual with Fifth disease |
|
Definition
| fever and constitutional symptoms |
|
|
Term
| what can Fifth Disease cause in pts with sickle cell disease? |
|
Definition
| aplastic crisis because the disease replicates in RBC precursors within the bone marrow. |
|
|
Term
| causative agent of infective mononucleosis |
|
Definition
|
|
Term
| fever, fatigue, pharyngitis, LAD, splenomegaly, atypical lymphocytosis, positive heterophile antibody response. Prodrome = 3-5 days, fatigue, malaise, anorexia, fever HA, sweats, chills |
|
Definition
|
|
Term
| diagnostic tests for mono |
|
Definition
lymphocytosis, elevated liver enzymes, EBV antibody titers, PCR tests
Heterophil antibodies (monospot test) |
|
|
Term
|
Definition
| supportive, avoid contact sports |
|
|
Term
| diagnostic test for Herpes Simplex |
|
Definition
|
|
Term
| occurs sporadicaly 1-6yo, mild prodrome, crops appear abruptly. Lesions = discrete, firm, lichenoid papules with flat tops 1-10mm in diameter, flesh colored, pink, red, dusky, coppery, or purpuric. Distributed symmetrically over the extremities (includes palms and soles), buttocks, and face. Spares the trunk and scalp. |
|
Definition
|
|
Term
| what is contraindicated in the tx of Gianotti-Crosti syndrome? |
|
Definition
|
|
Term
| causative agent of lime disease |
|
Definition
|
|
Term
| exanthem = erythema migrans |
|
Definition
|
|
Term
| nuero/CV manifestations of lyme disease |
|
Definition
| aseptic meningitis, unilateral/bilateral facial nerve palsy, carditis |
|
|
Term
|
Definition
| IgM immunoassay, CSF/Serum analysis if neruo S&S, western immunoblot assay |
|
|
Term
|
Definition
children older than 8 = doxy
amoxicillin/cefuroxime for adults, younger children, and pregnant/breast feeding women |
|
|
Term
|
Definition
|
|
Term
| rash begins distally on teh wrists, ankles, palms, and soles. Erythematous, blanching, fine, macular or maculopapular eruption, spreads centripetally and becomes petechial. Conjunctival erythema and photophobia present with rash. |
|
Definition
|
|
Term
|
Definition
| doxycycline (vibramycin) BID until 3 days after the rash subsides. |
|
|
Term
| most common sites of folliculitis |
|
Definition
| scalp, face, extensor surfaces of the extremities |
|
|
Term
| predisposing factors for folliculitis |
|
Definition
| dry, atopic skin, keratosis pilaris |
|
|
Term
| causative agents of impetigo |
|
Definition
|
|
Term
| causative agent for impetigo lesions that begin as a papule, then become a thin walled vesicle with erythematous halo |
|
Definition
|
|
Term
| causative agent for impetigo lesions that form small, thin-walled pustules or larger flaccid bullae |
|
Definition
|
|
Term
| causative agent for impetigo lesions that are tiny pustules |
|
Definition
|
|
Term
| ulcerative skin infection that penetrates more deeply than impetigo |
|
Definition
|
|
Term
| where is ecthyma more common? |
|
Definition
|
|
Term
| difference in lesions of impetigo and ecthyma |
|
Definition
| ecthyma lesions are painful and crusts are harder, thicker, and more adherent |
|
|
Term
| MC causative agent of ecthyma |
|
Definition
| Group A Beta Hemolytic Strep |
|
|
Term
| causative agent of ecthyma grangrenosum |
|
Definition
| septicemia with pseudomonas aeruginosa |
|
|
Term
| superficial abscess that develops underneath the cuticle or along the nail fold of the finger or toe. |
|
Definition
|
|
Term
|
Definition
| staph/strep access to a traumatized hangnail |
|
|
Term
| perifollicular dermal abscess creased by coag-positive staph |
|
Definition
|
|
Term
| predisposing factors to furuncle |
|
Definition
| hairy areas subject to friction or maceration, skin contact with oils, tars, and adhesives |
|
|
Term
|
Definition
| bactrim, clindamycin, rifampin |
|
|
Term
| apocrine gland is site of infection/abscess formation. Keratin plugging of the apocrine gland. |
|
Definition
|
|
Term
| tx of hiradenitis suppurativa |
|
Definition
abx = bactrim
surgical consult |
|
|
Term
| causative agent of cat-scratch disease |
|
Definition
| bartonella henselae (gram negative rickettsial bacterium) |
|
|
Term
| red papules or a series of papules noted at the site of innoculation, regional nodes are enlarged. |
|
Definition
|
|
Term
| tx of cat-scratch disease |
|
Definition
supportive tx, may resolve without abx.
abx = azithromycin |
|
|
Term
| most common pathogens of ostemyelitis |
|
Definition
| staph aureus and beta-hemolytic strep |
|
|
Term
| MCC osteomyelitis in sickle cell patients |
|
Definition
|
|
Term
| MCC osteomyelitis after puncture wounds to the feet |
|
Definition
|
|
Term
what age group of osteomyelitis?
no systemic symptoms, low grade fever,, irritability, anorexia, decreased movement, swelling |
|
Definition
|
|
Term
what age group of osteomyelitis?
rarely toxic, c/o pain at site, point tenderness |
|
Definition
|
|
Term
what age group of osteomyelitis?
deep, intense, constant pain, joint flexion, muscle spasm |
|
Definition
|
|
Term
| bacterial invasion of the synovial membrane |
|
Definition
|
|
Term
| what percent of spetic arthritis cases affecting young children occur in <5yo |
|
Definition
|
|
Term
| predisposing factors to septic arthritis |
|
Definition
| URI/Hib, gonococcal urethritis, vaginitis/cervicitis, trauma |
|
|
Term
| bacterial pathogens in septic arthritis |
|
Definition
sickle cell = salmonella
multiple joints = N. Gonorrhea
H. Flu
neonate or 2-5yo = staph
1m-2yo = strep |
|
|
Term
| diagnostic tests for septic arthritis |
|
Definition
| arthrocentesis, peripheral WBC or sedimentation rates |
|
|
Term
|
Definition
|
|
Term
| what type of HIV is endemic to West Africa? |
|
Definition
|
|
