General
Labs/Complications
Diagnosis
Treatment
Prevention
100
What are the 3 stages of pertussis?
1) Catarrhal 2) Paroxysmal 3) Convalescent
100
What finding would you expect on "routine" labs in a patient with pertussis? LP
Leukocytosis with lymphocytosis
100
What is the site of collection for the pertussis culture?
Nasopharynx (swab or aspirate)
100
What is the first line treatment for pertussis?
Azithromycin (Z-pack)
100
What is the best way to prevent pertussis in an infant?
Vaccinate all family members and caregivers with Tdap booster (cocoon effect)
200
To whom should probable and confirmed cases of pertussis be reported to?
State/County Public Health Department
200
What eye findings can occur with pertussis?
Retinal or subconjunctival hemorrhage
200
What is replacing culture as the diagnostic test of choice for pertussis diagnosis?
PCR
200
Why is azithromycin preferable to erythomycin for children <1 month of age?
Erythromycin confers increased risk of pyloric stenosis
200
What kind of isolation orders do you need for a patient with confirmed pertussis?
Droplet
300
How long is the incubation period for pertussis?
1-2 weeks
300
In patient <1 year of age, what is the most common complication?
Apnea (67% per CDC)
300
According to the CDC, how long does the cough have to be present in order to fit the clinical diagnosis of pertussis?
2 weeks
300
Why would you treat a patient who was in the paroxysmal stage of pertussis? LP
To reduce contagiousness.
300
Which one of these people would NOT need post-exposure prophylaxis of pertussis? LP
A) The patient's 32 y/o uncle who came to the house to eat dinner at the house. His wife is 18 weeks pregnant. B) The patient's 35 y/o mother who reports receiving the full primary vaccine series. C) The 27 y/o male pediatric resident who didn't wear a mask when examining the patient during the history and physical.
400
What is the name of the form used to report pertussis?
Confidential Morbidity Report
400
Name 7 complications of pertussis in the next 30 seconds (all or nothing).
Apnea, cyanosis, post-tussive emesis, dehydration, weight loss, bradycardia, pneumonia, seizures, encephalopathy, death, pulmonary HTN, pneumothorax, pneumomediastinum, subcutaneous emphysema, petechial hemorrhages, rib fracture, rectal prolapse, intracranial hemorrhage.
400
How late after the onset of cough can PCR be used to detect pertussis?
4 weeks
400
At what age, does the dosing of azithromycin change from 10 mg/kg x5 days to a 10 mg/kg x1 day, then 5 mg/kg x4 additional days?
6 months
400
How long does a patient need to be in isolation if he/she is receiving adequate antibiotic treatment?
5 days (duration of treatment)
500
When should pregnant women be vaccinated with Tdap?
Between 27 and 36 weeks gestation
500
What is the mechanism of hypoglycemia seen in patients with pertussis?
Pertussis toxin increases the sensitization of the beta islet cells of the pancreas --> hyperinsulinemia --> resistant hypoglycemia. Poor PO intake and post-tussive vomiting also contribute.
500
Name 3 of the 4 other diagnostic criteria necessary to meet the CDC's clinical diagnosis of pertussis.
- Paroxysms of coughing - Inspiratory whoop - Posttussive vomiting - For infants <1 year, apnea (with or without cyanosis)
500
What would you give a 3 month old patient who has had anaphylaxis with azithromycin?
TMP-SMX (TMP 8 mg/kg/day in 2 divided doses x14 days)
500
How effective is the vaccine series in the prevention of pertussis (+/- 5%)?
80-85%
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