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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
How do you Dx vesicular rash
``` Clinical Smear of vesicle PCR - fluid / CSF / blood if suspect HSV Blood culture Serology for past infection ```
26
Who is at high risk of complications from chicken pox
Immunocompromised Chemo Nephrotic Newborn
27
What are warning signs of fatal varicella
``` <1 Immunocompromised High fever New lesions >10 days Inflammed blue or black lesions ```
28
What does fatal varicella cause
``` Skin scar Cataract / microphamia Reduced IQ Microcephaly Limb hypoplasia Pneumintiis in mother ```
29
How do you treat chicken pox
Self limitng Infection control until crust over Calamine lotion for itch Paracetamol
30
What do you do if high risk of complications
IV acyclovir if devleop | IV IG if <10 days from exposure and no Sx
31
What do you do for shingles (dermatomal distribution of vesicular rash, painful and unilateral)
Oral analgesia | Aciclovir
32
What do you do if bacterial superinfection on top and what increases risk
Flucloxicillin | Avoid NSAID as increase risk of NF
33
What are complications of chicken pox
``` Dehydration Bacterial infection Conjunctivitis Pneumonia Meningitis Encephalitis Myelitis Arthritis HSP DIC Abnormal LFT ```
34
What does HSV 1+2 cause
``` 1 = stomatitis / cold sores 2 = genital sores ```
35
What does neonatal HSV cause / complications
``` Neonatal herpes Conjunctivitis Sepsis Meningitis Hepatitis Neuropathy - esp if with HIV ```
36
What causes HFMD
Cocksakie (enterovirus)
37
What can cocksackie also cause
``` Conjunctivits Pharyngitis Croup Meningoencephalitis Myocarditis Hepatitis ```
38
What are the symptoms of HFMD
``` 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
How do you Dx HFMD
Clinical Smear vesicle as risk of HSV / VZV PCR if very unwell Serology may show past infection s
40
How do you treat HFMD
Analgesia + hydration Supportive DO NOT need exclusion
41
What causes Roseola infantum / Exanthema Subticum
HSV 6
42
What are symptoms of Roseola infantum
``` 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
How do you treat Roseola infants
Supportive | Fluid and rest
44
What are complications of Roseola infantum
Febrile convulsion ``` If immunocompromised Enecphaliis Myocarditis Hepatitis Aspectic meningitis Thrombocytopenia GBS ```
45
What causes Slap Cheek / Erythema Infectiosum
Paravirus B19
46
What are the symptoms of slap cheek
``` 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
What do you do if exposed in pregnancy and why
IgG and IgM to see if susceptible Can cause foetal death, hydrops fetalis, IUGR GN, HSM, myocarditis
48
What are complications of slap cheek and who is at risk and what do you do for them
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
How do you treat slap cheek
Self -limitng Infectious prior to rash but not infectious once rash started Ig and transfusion rarely needed
50
What causes glandular fever
EBV | CMV rare
51
What are the symptoms of glandular fever and complications
``` 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
How do you Dx
Monospot test
53
How do you treat
Abstain exercise 2 weeks as risk of splenic rupture No Ax Fluid
54
What is a clinical scenario of a child with tonsillitis
Fever 2+ days Rash over face then body Vomiting 24 hours - no bowel HX Enlarged tonsils OE
55
What is Ddx
Tonsillitis Scarlet fever? Gastroenteritis - early EBV - monospot test, enlarged spleen etc
56
What else could cause vomiting
Gastritis Ketones Large tonsils
57
How do you treat
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
What should you do for child vomiting
Always check BG
59
What are the symptoms of measles
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
How do you Dx measles
IgM detected after rash
61
How do you Rx measles and when do you admit
``` Vaccine Vaccine if within 72 hours of contact Supportive Inform public health Admit if immunocompromised ```
62
Complications of measles
``` 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
What are the symptoms of mumps
``` Flu like prodrome Muscle aches Lethargy Fever Parotid gland / sunmandibular enlargemnet = classic Earache Pain on eating Meningeal signs = common ```
64
How do you Dx and treat
PCR saliva Inform public health Supportive -rest, fluid, analgesia Vaccine to prevent
65
Complications fo mumps
``` Orchitis = common but infertility rare Arthritis Pancreatitis Meningoencepahlitis Seonsrineural hearing loss ```
66
What is Rubella and symptoms
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
How do you treat
Vaccine Supportive Stay of school 5 days and avoid pregnant women Inform public health
68
Complications of rubella
``` Thrombocytopenia Encephalitis Arthritis Miscarriage if in 1st trimester Congenital Rubella syndrome ```
69
What does paediatric HIV cause
``` PUO LN HSM Persistent diarrhoea Parotid enlargement Maculopapular rash Recurrent VZV / URTI Oral thrush FTT Development delay ```
70
What puts you at risk of neonatal candida
``` LBW Premature Immunocompromised Catheter Central line Broad Ax Parenteral nutrition H2 blocker Steroid Hypoerglycaemia Abdo surgery ```
71
What are TORCH infection
``` Toxoplasmosis Other - chlmydia/. HIV Rubella CMV HSV ```
72
What are common Sx of TORCH
``` SGA / LBW Microcephaly Fever Poor feed Purpuric rash HSM JAundice Anaemia Sensorineural deaf Cerebral palsy Developmental delay ```
73
What are extra signs of rubella congenital
Cataract / glaucoma PDA or VSD Sensorineural deaf
74
What are extra signs of congenital toxoplasmosis
Calcification Hydrocephalus Anaemia / HSM
75
How do you Rx
Mx specific Vaccination C-section Avoid invasive
76
What causes threadworms
Entrobius vermacilus | Swallowing eggs often from water
77
What are symptoms of threadworms
Pruritus | Vulval in girls
78
How do you Dx
Sellotape to peri-anal area and send to lab
79
How do you treat
Mebendazole if >6 months Anthemetic agent to all household Hygiene
80
DDX of neck mass
Thyroglossal cyst Branchial cyst Cystic hygroma LN
81
What would cause an enlarged LN
Malignancy Infection Autoimmune Iatrogenic
82
What should you do if neck mass
``` 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
What are you looking for in bloods
Cytopenia | Increased LDH
84
What should you beware of
Cervical LN Non-tender Fixed
85
What is blueberry muffin syndrome
Baby born with blue / purple spots / nodules Due to extra-medullary erythropoiesis Bleeding Malignancy
86
What causes
Rubella CMV Metastatic neuroblastoma

Paediatrics (35 decks)

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