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Paediatrics > Common Infection and Rashes > Flashcards

Common Infection and Rashes Flashcards

1
Q

What causes tonsillitis

A

Viral - EBV = most common

Bacterial - Strep A

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2
Q

What are the symptoms of tonsillitis

A 
Fever
Sore throat
Painful swallowing 
Enlarged tonsils
If young can present non-specific with fever / poor feed / abdo pain
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3
Q

What score is used to determine whether viral or bacterial and what does it look like

A 
Centor - suggest more bacterial 
Tonsillar exudate / pus 
Cervical LN
Fever Hx
Absence of cough
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4
Q

How do you Dx tonsillitis

A

Clinical
Always assess ears - TM and cervical lymphadenopathy
Throat swab NOT routine unless recurrent

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5
Q

When do you admit with tonsillitis

A 
Stridor
Resp difficulty
Peri-tonsillar abscess
Immunocomprised 
Systemically unwell 
Dehydrated
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6
Q

How do you treat tonsillitis

A

10 days penicillin if bacterial, immunocomprised, co-morbid
Clarithroymcin if allergic
Can give delayed prescription and advise to collect if not better in 2-3 days
NOT amox as risk of due to EBV which causes rash
Paracetamol
Ibuprofen
Fluid
Tonsillectomy if recurrent >7

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7
Q

What do you do if not eating or drinking

A

Oral
Diorlyte (contains sugar and salt)
NG if no IV access

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8
Q

What is risk if too much sugar

A

Osmotic diuresis leading to more dehydration

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9
Q

Complications of tonsillitis

A 
Peritonsillar abscess 
Otitis media 
Scarlet fever
RHeumatic fever
Post strep GN
Post strep reactive arthritis
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10
Q

What are the symptoms of scarlet fever

A

Malaise
Fever
Tonsillitis
Pinhead exanthema rash - rough / sandpaper (12 hours after fever)
Strawberry tongue (white coat with red papillae)
Desquamation of hands and feet
Cervical lympahdenoapthy

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11
Q

How do you Dx scarlet fever

A

Throat swab

Start Ax

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12
Q

How do you treat scarlet fever

A

Penicillin 10 days

Report public health

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13
Q

What are complications of scarlet fever

A 
Otitis media = common
Rheumatic fever post 3 weeks
GN - 10 days 
Meningitis
Strep toxic shock
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14
Q

What is Kawasaki

A

Self limiting vasculitis

Occuring in children with COVID 19

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15
Q

What are the symptoms diagnostic of Kawasaki

A

Fever 5+ days - resistant
4/5 of
Bilateral conjunctivits - non-exudative
Mucous membranes - dry lips / strawberry tongue
Cervical LN
Polymorphous rash
Change of extremities - red fingers or toes peeling (desquamation) / oedema

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16
Q

What are other symptoms of Kawasaki

A

Peripheral oedema = under appreciated sign
Lethargy
Irritable
Tachycardia

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17
Q

How do you investigate and treat Kawasaki

A

FBC - anaemia, high WCC and platelet
LFT - hypoalbumin and elevated LFT
Urinanalysis
Increased acute phase reaction - platelet, ESR, neutrophil

Rx
IV Ig to reduce risk of aneurysm 2mg / kg
Aspirin to reduce thrombosis

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18
Q

What should you avoid

Why is aspirin usually CI in kids

A

Steroid

Risk of Reye’s

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19
Q

What do you do as follow up after Kawasaki

A

ECHO at 2+6 weeks and 6 months to monitor for coronary aneurysm

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20
Q

If conjunctivitis is unilateral what should you think

A

Is it orbital cellulitis as usually bilateral

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21
Q

What causes chicken pox

A

Primary VZV infection

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22
Q

How do you get chicken pox

A

Can get from someone with shingles
Can’t get shingles if haven’t had chicken pox
Life long immunity if get it once
Virus lays dormant in DRG and CN and can later be reactivated as Shingles or Ramsay Hunt

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23
Q

How do you get shingles

A

Reactivation of VZV in DRG
Known as herpes zoster
Dermatomal distribution of rash which is painful

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24
Q

What are the symptoms of chicken pox

A 
Mild malaise 
Fever = often 1st symptom 
NOT SICK
High contagious vesicular rash 
Macules -> papules ->vesicles -> pustules
Typically start on chest / face and spread outward 
Crust over = non-infectious
Itchy
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25
Q

How do you Dx vesicular rash

A 
Clinical 
Smear of vesicle 
PCR - fluid / CSF / blood if suspect HSV  
Blood culture 
Serology for past infection
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26
Q

Who is at high risk of complications from chicken pox

A

Immunocompromised
Chemo
Nephrotic
Newborn

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27
Q

What are warning signs of fatal varicella

A 
<1
Immunocompromised
High fever
New lesions >10 days
Inflammed blue or black lesions
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28
Q

What does fatal varicella cause

A 
Skin scar
Cataract / microphamia
Reduced IQ
Microcephaly
Limb hypoplasia
Pneumintiis in mother
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29
Q

How do you treat chicken pox

A

Self limitng
Infection control until crust over
Calamine lotion for itch
Paracetamol

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30
Q

What do you do if high risk of complications

A

IV acyclovir if devleop

IV IG if <10 days from exposure and no Sx

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31
Q

What do you do for shingles (dermatomal distribution of vesicular rash, painful and unilateral)

A

Oral analgesia

Aciclovir

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32
Q

What do you do if bacterial superinfection on top and what increases risk

A

Flucloxicillin

Avoid NSAID as increase risk of NF

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33
Q

What are complications of chicken pox

A 
Dehydration 
Bacterial infection
Conjunctivitis 
Pneumonia
Meningitis
Encephalitis 
Myelitis 
Arthritis
HSP
DIC
Abnormal LFT
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34
Q

What does HSV 1+2 cause

A 
1 = stomatitis / cold sores 
2 = genital sores
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35
Q

What does neonatal HSV cause / complications

A 
Neonatal herpes 
Conjunctivitis 
Sepsis
Meningitis 
Hepatitis 
Neuropathy - esp if with HIV
36
Q

What causes HFMD

A

Cocksakie (enterovirus)

37
Q

What can cocksackie also cause

A 
Conjunctivits
Pharyngitis
Croup 
Meningoencephalitis
Myocarditis
Hepatitis
38
Q

What are the symptoms of HFMD

A 
Prodromal flu 
Viral URTI 
Mild unwell
Sore throat
Fever
Exanthema rash + blisters over body which may be itchy 
Vesicles on HFM (painful and small) after 1-2 days
Oral ulcers 
Anorexia
Abdo pain
Can get bacterial superinfection on top
Rare cause of encephalitis
39
Q

How do you Dx HFMD

A

Clinical
Smear vesicle as risk of HSV / VZV
PCR if very unwell
Serology may show past infection s

40
Q

How do you treat HFMD

A

Analgesia + hydration
Supportive
DO NOT need exclusion

41
Q

What causes Roseola infantum / Exanthema Subticum

42
Q

What are symptoms of Roseola infantum

A 
Fever
May have coryza symptoms 
Maculopapular rash at end of 4th febrile day - starts on limbs
Cough
Diarrhoea
Nagayana spot on uvula and soft palate
43
Q

How do you treat Roseola infants

A

Supportive

Fluid and rest

44
Q

What are complications of Roseola infantum

A

Febrile convulsion

If immunocompromised 
Enecphaliis
Myocarditis 
Hepatitis
Aspectic meningitis
Thrombocytopenia
GBS
45
Q

What causes Slap Cheek / Erythema Infectiosum

A

Paravirus B19

46
Q

What are the symptoms of slap cheek

A 
Mild illness
FLu
Fever
Headache
Coryza symptoms
Malar erythema on face + limbs 1-4 days after which can be itchy 
6 weeks to fade
47
Q

What do you do if exposed in pregnancy and why

A

IgG and IgM to see if susceptible
Can cause foetal death, hydrops fetalis, IUGR
GN, HSM, myocarditis

48
Q

What are complications of slap cheek and who is at risk and what do you do for them

A

Usually none
At risk if immunocompromsied, pregnant, haematological conditions - sickle, thalassaemia, hereditary spherocytosis + haemolytic anaemia
- Serology to confirm Dx
- FBC + reticulocyte to look for aplastic anaemia
Arthritis
Aplastic crisis - if RBC short (sickle cell / thalassaemia)

49
Q

How do you treat slap cheek

A

Self -limitng
Infectious prior to rash but not infectious once rash started
Ig and transfusion rarely needed

50
Q

What causes glandular fever

A

EBV

CMV rare

51
Q

What are the symptoms of glandular fever and complications

A 
Anorexia
Malaise
Fever
Lymphadenopathy 
Sore throat
Petechiae on palate
White exudate
Fatigue
Splenomegaly
Intense itchy maculopapular rash if amoxicillin 
Splenic rupture
GN
Thrombocytopenia
Hameolytic anaemia
Chronic fatigue
Burkitt's lymphoma
52
Q

How do you Dx

A

Monospot test

53
Q

How do you treat

A

Abstain exercise 2 weeks as risk of splenic rupture
No Ax
Fluid

54
Q

What is a clinical scenario of a child with tonsillitis

A

Fever 2+ days
Rash over face then body
Vomiting 24 hours - no bowel HX
Enlarged tonsils OE

55
Q

What is Ddx

A

Tonsillitis
Scarlet fever?
Gastroenteritis - early
EBV - monospot test, enlarged spleen etc

56
Q

What else could cause vomiting

A

Gastritis
Ketones
Large tonsils

57
Q

How do you treat

A

Paracetamol 15mg / kg 4 hourly max 4 doses
Ibuprofen - anti-inflammatory
If septic / bacterial then won’t improve
Fluid therapy
NG if no access

58
Q

What should you do for child vomiting

A

Always check BG

59
Q

What are the symptoms of measles

A

Measle virus spread by respiratory droplet
Prodromal fever
Cough / conjuncitivtis / coryza triad
Koplik spot - white on buccal mucosa (pathognomic for measles)
Maculopapula rash on trunk - starts behind ears 4-7 days after fever

60
Q

How do you Dx measles

A

IgM detected after rash

61
Q

How do you Rx measles and when do you admit

A 
Vaccine
Vaccine if within 72 hours of contact
Supportive 
Inform public health 
Admit if immunocompromised
62
Q

Complications of measles

A 
Sepsis 
Otitis media
Hearing or vision loss 
Pneumonia
Encephalitis
Meningitis 
Febrile convulsion
Corneal ulceration 
Diarrhoea
Appendicitis 
Myocarditis
Subacute sclerosis encephalitis 5-10 years later
- Rapid onset dementia and neurodegeneration
63
Q

What are the symptoms of mumps

A 
Flu like prodrome 
Muscle aches
Lethargy 
Fever
Parotid gland / sunmandibular enlargemnet = classic
Earache
Pain on eating
Meningeal signs = common
64
Q

How do you Dx and treat

A

PCR saliva
Inform public health
Supportive -rest, fluid, analgesia
Vaccine to prevent

65
Q

Complications fo mumps

A 
Orchitis = common but infertility rare
Arthritis 
Pancreatitis 
Meningoencepahlitis 
Seonsrineural hearing loss
66
Q

What is Rubella and symptoms

A

Virus spread by respiratory droplets
Non-specific pink rash - erythematous and macular
Fever
Mild illness
Malaise
Generalised LN - behind ears and back of neck
Arthralgia if older

67
Q

How do you treat

A

Vaccine
Supportive
Stay of school 5 days and avoid pregnant women
Inform public health

68
Q

Complications of rubella

A 
Thrombocytopenia
Encephalitis 
Arthritis
Miscarriage if in 1st trimester
Congenital Rubella syndrome
69
Q

What does paediatric HIV cause

A 
PUO
LN
HSM
Persistent diarrhoea
Parotid enlargement 
Maculopapular rash
Recurrent VZV / URTI
Oral thrush
FTT
Development delay
70
Q

What puts you at risk of neonatal candida

A 
LBW
Premature
Immunocompromised
Catheter
Central line
Broad Ax
Parenteral nutrition
H2 blocker
Steroid
Hypoerglycaemia
Abdo surgery
71
Q

What are TORCH infection

A 
Toxoplasmosis
Other - chlmydia/. HIV
Rubella
CMV
HSV
72
Q

What are common Sx of TORCH

A 
SGA / LBW
Microcephaly
Fever
Poor feed
Purpuric rash
HSM
JAundice 
Anaemia 
Sensorineural deaf
Cerebral palsy
Developmental delay
73
Q

What are extra signs of rubella congenital

A

Cataract / glaucoma
PDA or VSD
Sensorineural deaf

74
Q

What are extra signs of congenital toxoplasmosis

A

Calcification
Hydrocephalus
Anaemia / HSM

75
Q

How do you Rx

A

Mx specific
Vaccination
C-section
Avoid invasive

76
Q

What causes threadworms

A

Entrobius vermacilus

Swallowing eggs often from water

77
Q

What are symptoms of threadworms

A

Pruritus

Vulval in girls

78
Q

How do you Dx

A

Sellotape to peri-anal area and send to lab

79
Q

How do you treat

A

Mebendazole if >6 months
Anthemetic agent to all household
Hygiene

80
Q

DDX of neck mass

A

Thyroglossal cyst
Branchial cyst
Cystic hygroma
LN

81
Q

What would cause an enlarged LN

A

Malignancy
Infection
Autoimmune
Iatrogenic

82
Q

What should you do if neck mass

A 
Look for infection
Examine testis as lymphoma spread 
Look for splenomegaly - EBV
Look for other LN 
Blood - urgent FBC 
USS if unknown cause 
Biopsy 
Refer
83
Q

What are you looking for in bloods

A

Cytopenia

Increased LDH

84
Q

What should you beware of

A

Cervical LN
Non-tender
Fixed

85
Q

What is blueberry muffin syndrome

A

Baby born with blue / purple spots / nodules
Due to extra-medullary erythropoiesis
Bleeding
Malignancy

86
Q

What causes

A

Rubella
CMV
Metastatic neuroblastoma

Paediatrics (35 decks)

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