Acute Childhood infections

Question 1

Bronchiolitis

Answer 1

Common lower respiratory tract infection in babies under 1yr - caused by Respiratory syntactical virus
affects 1 in 3 children under 1yr and is generally self limiting

Question 2

Symptoms of Bronchiolitis (5,3)

Answer 2

Usually like a cold but can develop into:

low grade Fever, cough, coryza, SOB, tachypnoea, poor feeding and dehydration, difficulty breathing/grunting/recession

Question 3

Management of Bronchiolitis (2,2,2)

Answer 3

If severe give oxygen via nasal prongs or headbox

Tube feeds or IV fluids - consider suction and physiotherapy

Question 4

Epiglottitis

Answer 4

An acute inflammation of the epiglottis causing obstruction of the airway
Generally caused by HIB in kids and crack cocaine in adults - causes fever, dysphagia, drooling, hoarseness and stridor

Question 5

Quinsy

Answer 5

A peritonsilar abscess - a complication of tonsilitis presenting with unilateral throat & swallowing pain, may get ‘hot potato voice’ (muffled)
Treated with antibiotics and drainage - rupture can cause aspiration pneumonia

Question 6

Tracheitis

Answer 6

An infection which is usually bacterial secondary to viral URTI with rapid onset barking cough and inspiratory stridor - if severe may require ICU and IV antibiotics

Question 7

Diphtheria

Answer 7

A now rare bacterial throat infection causing a low fever, difficulty and pain on swallowing, a whitish pseudomembrane & breathing problems - can lead to myocarditis and peripheral neuropathy

Question 8

Tb in children

Answer 8

Mainly in migrant groups - if they have a persistent cough/large mantoux reaction need to investigate - CXR and/or sputum culture - if confirmed treat and trace contacts

Question 9

Meningitis

Answer 9

Presents with fever, behavioural change or confusion, peripheral shutdown and non-blanching purpuric rash- give stat IM penicillin - most commonly neisseria or strep pneumoniae. Lack specific meningitis signs under two yrs

Question 10

Measles

Answer 10

Low grade fever prodrome (2-4days) then 39-41 with maculo-papular rash (kolpik spots - grey white spots in the mouth) 10-14days after infection. Can also have cough, conjunctivitis, mild generalised lymphoadenopathy - can lead to otitis media, pneumonia

Question 11

Rubella

Answer 11

Moderate to low fever (38ish) with maculopapular rash after a short prodrome. will have tender lymphadenopathy - risk to pregnant women

Question 12

Scarlet Fever

Answer 12

High fever on second day which normalises after 5-7days followed by red punctuate, flaking rash. May also have pharyngitis, strawberry tongue with circumoral pallor, risk of 2ary strep infection - treat with penicillin. Caused by an erythrgenic exotoxin from strep pyogenes (risk of Rheumatic fever)

Question 13

Chickenpox

Answer 13

38-39 degree fever with rash (papular>vesicular>cloudy) 2wks after infection. Can develop into pneumonia, meningo-encephalitis, ITP
Will resolve by itself

Question 14

Glandular Fever

Answer 14

occurs 30-50days after EBV infection - remittent fever can be related with maculopaular rash (Especially if given ampicillin or amoxicillin) –> can lead to lymphoadenopathy, splenomegaly, sore throat, nausea, fatigue. Anginose form may require intervention. Test for by Paul Bunnell test

Question 15

Roseola Infantum

Answer 15

a Sudden persistent high fever due to infection by HHV-7, followed after 3-7days by a macular face rash. Can cause febrile seizures & bulging fontanelle

Question 16

Parvovirus 19 infection

Answer 16

remittent mild fever with onset of fine macular rash after 6-12days over limbs which spares palms and soles

Question 17

Malaria

Answer 17

Give a tertian or quartan fever with chills, rigors and risk of splenomegaly and anaemia. Can lead to cerebral malaria

Question 18

Henoch-schonlein purpura

Answer 18

an IgA-mediated, autoimmune hypersensitivity vasculitis of childhood. Causes purpuric rash, arthritis, abdo pain, GI bleeding, orchitis & nephritis

Question 19

Management of epiglottitis

Answer 19

A medical emergency requiring intubation - patient will be distressed, sitting forward in bed holding their head forward
Direct inspection should only be performed in controlled conditions due to the risk of airway spasm - call resus team and PICU,
Adr nebs, Ceftazidime and IV fluids

Question 20

Croup

Answer 20

A post viral inflammation of the upper respiratory tract (steeple sign) which can cause barking cough, hoarseness and stridor, rarely requires admission

Question 21

Imaging in Acute epiglottitis

Answer 21

The thumbprint sign on lateral x-ray indicates there is a swollen epiglottis while the halloween sign on CT indicates that the epiglottis is normal

Question 22

Whooping Cough

Answer 22

Rare now - if not vaccinated then present with sore throat, low-grade fever, persistent cough and she is now scared of coughing - give amoxycillin or erythromycin (to prevent spread) contact tracing if confirmed?

Question 23

Management of Meningitis

Answer 23

ABC, Blood cultures, oxygen, volume support, – lumbar puncture will not change management at this stage - consider others in house and contact communicable disease team

Question 24

Difference between meningitis in babies and children

Answer 24

Infants have bulging fontanelle but minimal meningism while older children have more severe meningism and more localised symptom (headache) - infants will have a rapid systemic progression

Question 25

Mucocutaneous lymph node syndrome

Answer 25

Kawasaki disease - an idiopathic, self limiting systemic vasculitis which effects asian children under 5yrs. Rapid onset persistent high fever for 1-3wks - erythema multiforme, maculopapular and strawberry tongue –> can cause aortic artery anyursms

Question 26

Complications of rubella in pregnant women

Answer 26

50-80% infection of the fetus if infected in 1st trimester, 20-60% in 2nd trimester –> infection leads to abortion or congenital rubella syndrome (CRS)

Question 27

Congenital rubella syndrome (CRS)

Answer 27

At birth - IUGR, microcephaly, micro-ophthalmia, cataracts, thrombocytopenia, CHD, linear bone lesions, retinitis, Convulsion
Later - 20% die in infancy, 90% sensorineural hearing loss, 40-60% CHD, 30-50% developmental delay, thyroid dysfunction, DM, Infantile autism

Question 28

Varicella Neonatorum

Answer 28

can be very severe - maternal rash from 7days prenatal to 2 days post partum indicates infant at high risk — treat with aciclovir

Question 29

Congential varicella syndrome

Answer 29

2% if mother infected in 1st trimester - cicatricial scarring of limbs, cortical atrophy, hypoplasia of limbs, digital defects, retinitis, cataracts

Question 30

Management of Mucocutaneous lymph node syndrome

Answer 30

Fever rapidly responds to aspirin or IV immunoglobin

Question 31

HIV in children

Answer 31

600> children with HIV in uk - 2/3 are in london - MTCT stopped with ART
1/5 present in 1st yr with PCP with severe complications while rest have median survival of 9yrs

Question 32

Hand, foot and mouth disease

Answer 32

A self limiting condition caused by intestinal viruses (coxsackie A16). V. contagious and typically occurs in outbreaks at nurseries. Presents with sore throat, fever, oral ulcers followed by vesicles on the palms and soles. Treat with hydration, analgesia and keep from school if feeling unwell.

Question 33

Congenital Toxoplasmosis

Answer 33

Cerebral calcification
Chorioretinitis (salt and pepper)
Hydrocephalus
More rarely: anaemia, hepatosplenomegaly and cerebral palsy

Question 34

Congential Cytomegalovirus

Answer 34

Growth retardation and purpuric skin lesions.
More rarely: sensorineural deafness, encephalitis/seizures, pneumonitis, hepatosplenomegaly, anaemia, jaundice, cerebral palsy

Question 35

Tetanus infection

Answer 35

Will occur in children who havent been vaccinated and with an injury with rust/earth contamination 4-21 days ago. Principle symptoms are jaw stiffness (lockjaw or trismus) spreading to the body causing neck extension and back arching (opisthotonos). Can also have high fever, sweating, tachycardia and hypertension.

Question 36

Cat scratch disease

Answer 36

Caused by Gram negative rods (Bartonella Henselae). will present with fever, regional lymphadenopathy, headache and malaise. There will be a history of a cat scratch.

Question 37

Fever of 38.4 in 2month old?

Answer 37

Any fever >38 in a child under 3months is a ‘red flag’ and warranting urgent referral to hospital/paediatrician

Question 38

Management of Meningitis in a child under 3months

Answer 38

Give IV amoxicillin in addition to cefotaxime to cover for listeria.

Question 39

Measurement of BP in febrile children?

Answer 39

No necessary - HR, temp, RR, stats should all be measured but not BP

Question 40

Malarial Prophylaxis in children

Answer 40

Can’t use DEET until they are over 2months old and cant use doxycycline until they are over 12yrs old.