Pediatrics Study Test Questions And Answers

Pediatrics examination Generally how is HIV transmitted from person to person? - Answer- Horizontal (sex, IV drug use, blood transfusion) or vertical (mother to baby). What is the mode of transmission from mother to baby? - Answer- Vertical transmission is passage of HIV from mom to baby through breastfeeding. Vertical transmission rate has dropped because of better treatment (ZVD) and continues to decrease in the USA, while rates of horizontal transmission are increasing in the USA (although only 1% prevalence). How can vertical transmission be decreased? - Answer- Vertical transmission can be decreased with the use of Zidovudine (ZVD) during pregnancy of HIV+ women. Discuss management of care for an HIV positive expecting mother. - Answer- Expecting mothers should take antiretroviral prophylaxis (ZVD) during pregnancy and labor and to the infant for 6 weeks after birth to reduce risk of vertical transmission What is the current recommendation regarding breastfeeding for an HIV positive mother in the United States? - Answer- HIV+ mothers should completely avoid breastfeeding List several clinical manifestations of HIV/AIDS. - Answer- • Chronic or recurrent diarrhea • Developmental delays • Failure to thrive • Hepatosplenomegaly • Lymphadenopathy • Oral candidiasis • Parotitis (inflammation of the parotid gland along jaw) How does HIV differ in children and adults? - Answer- • Shorter time from infection and AIDS diagnosis (adults 5-10 years; kids 1 year) • Signs may be physical and developmental failure to thrive (not meeting milestones) • Experience earlier opportunistic infections & greater number of bacterial infections from childhood illnesses; kids get sick more easily because building up antibodies • Perinatally acquired pneumocystis jiroveci pneumonia (PJP), prophylaxis starts as early as 4 weeks of age; respiratory infection and children can get it earlier than adults that are HIV+, so that's why they start on prophylactic meds as early as 4 weeks ELISA/Western Blot is most accurate in children older than...? - Answer- 18 months This is because you could get a false positive. The test may read the mother's antibodies instead of babys. which test is used to screen infants between 1-3 months. With a positive result, a second confirmation test is needed between ---- mo.? - Answer- HIV DNA - PCR; 1-2 months and 4-6 months. HIV DNA-PCR test is the most accurate diagnosis for baby but need two positive blood tests to ensure. 95% of infected infants are diagnosed by 1-3 months but HCP will continue to do a couple of tests to confirm positive/negative. Discuss the management of infants born to HIV positive mothers, as well as the management of the mothers during pregnancy, including medications used postnatally and prophylactically. - Answer- Management of mothers during pregnancy: • Elective C-section before onset of labor & before ROM for women with an HIV viral load of 1000 copies/mL • Administration of antiretroviral prophylaxis (ZVD) during pregnancy and labor Management of infants born to HIV+ mothers: • Administration of antiretroviral prophylaxis (ZVD) to the infant for 6 weeks after birth • Complete avoidance of breastfeeding in USA • PJP prophylaxis (trimethoprine-sulfamethoxazole) at 4-6 weeks of age & continues until 1 year of age or when determined to be HIV- If a baby is born to a mother who is HIV positive and the newborn's test comes back negative, what is the next step? - Answer- Repeat HIV DNA-PCR test again at 1-2 months and repeat again at 4-6 months. At 4-6 months, if they are confirmed HIV+ they will start combined therapy. If they are negative, they will stop the ZVD. May confirm absence of HIV infection with HIV antibody assay testing at 12-18 months. Progression of symptom for clinical stage N? - Answer- Infected but not symptomatic Progression of symptom for clinical stage A? - Answer- Mild symptoms Progression of symptom for clinical stage B? - Answer- Moderate symptoms Progression of symptom for clinical stage C? - Answer- Severe symptoms (AIDS) Level of suppression for immunological stage 1? - Answer- No evidence of suppression Level of suppression for immunological stage 2? - Answer- Evidence of moderate suppression Level of suppression for immunological stage 3? - Answer- Severe suppression, AIDS What do you use in pediatrics...CD4 count or percentage - Answer- CD4% because CD4 counts vary depending