Common infections

Question 1

3 year old with a maculopapular itchy rash, began in cheeks and spread to torso, arms, legs. Temperature started before the rash appeared. What is the most likely cause?

Answer 1

Fifth disease or slap cheek syndrome

Question 2

What is the organism that causes fifth disease?

Answer 2

parovirus B19

Question 3

What is the management of fifth disease?

Answer 3

Simple analgesia and oral fluids= self-limiting illness

Question 4

3 week old baby with 38.2 temp, slightly pale but otherwise normal obs. What is the initial management?

Answer 4

refer to hospital for IV broad spectrum antibiotics and blood cultures. All neonates under 1 month get full septic screen= blood cultures, bloods, LP. Even if they look well, this is not a reassurance. Main worry is meningitis

Question 5

4 year old girl with itchy crops of erythematous macules evolving to papules, then vesicles containing serous fluid. 2 days prior with mild fever malaise and headache. What is the likely diagnosis and management?

Answer 5

Chicken pox, worsening advice and encourage fluids

Question 6

3 year old boy with fever headache positive kernig’s. As you examine him his GCS drops to 8. What is the initial investigation?

Answer 6

blood cultures

Why not CT head? Doesn’t give you much information on meningitis Don’t do LP due to low GCS

Question 7

Name two examples of live attenuated vaccines?

Answer 7

rotavirus, BCG, MMR

Question 8

Why is it important to know whether a vaccine is live?

Answer 8

You can’t give to immunocompromised children/adults

Question 9

A 15 month old boy presents to the paediatric assessment unit with a 2 day history of pyrexia and vomiting. He appears lethargic and miserable with a pyrexia of 38.8oC. A clean catch urine is collected and urinalysis carried out.

Which is most suggestive of a Urine Tract Infection?

Answer 9

Urinary nitrates

Question 10

A 15 year old boy is found to have warts on his fingers. He is undistressed by these. What is the most likely causative organism?

Answer 10

HPV-1

Question 11

A 15 year old boy is admitted to paediatric intensive care having come in unconscious. Examination had revealed an evolving purpuric rash. What is the most likely causative organism?

Answer 11

Neisseria meningitidis B (there is also a type A…)

Question 12

Eary-onset sepsis in a male neonate born 39 weeks gestation by spontaneous vaginal delivery. Which organism is the likely cause?

Answer 12

group B strep

Question 13

You are performing the routine neonatal examination for a well full term infant born to Vietnamese parents. You recognise that this baby therefore may be eligible for neonatal BCG vaccination.

Which of the following is a contraindication to BCG vaccination in the neonatal period?

Answer 13

Maternal HIV where baby’s HIV status is unknown.

(live attenuated vaccine…)

Question 14

An 18-month-old boy presents to the GP with his mother, who is concerned about a new rash. His mother reports that the rash came on suddenly 1 day ago. His mother recalls he had a cold with a high fever two weeks ago, but this appears to have settled now. Otherwise he is normally fit and well.

On examination, there is an erythematous rash across the child’s trunk and limbs. The rash does not appear itchy and blanches with pressure.

What is the most likely diagnosis?

Answer 14

Roseala infantum

Question 15

3 year old with erythematous rash that started behind the ears and then spread to the rest of the body. He has koplik spots and a fever. What is the likely infective agent?

Answer 15

Measles typically presents with an erythematous rash that classically starts behind the ears and then spreads to the rest of the body. It is associated with fever, conjunctivitis, coryzal symptoms and white koplik spots on the inside of the mouth.

Question 16

2 year old had a fever for 3 days, followed by a rash on cheeks. What is the likely causative agent?

Answer 16

Parovirus B19
Parvovirus B19 is also known as slapped cheek disease because the rash first appears on the cheeks, before spreading to the trunk and arms. It is usually preceded by 2-5 days of mild fever and non-specific viral symptoms.

Question 17

7 year old girl with tonsilitis who then develops rash on trunk. She has a strawberry tongue and cervical lymphadenopathy. What is the likely causative agent?

Answer 17

Scarlet fever. Caused by group A streptococcal bacteria and usually begins as tonsillitis. It is a red-pink rash that begins on the trunk. It is associated with fever, a strawberry appearance of the tongue, and cervical lymphadenopathy.

Question 18

A 5-year-old boy from a travelling community presents to the Emergency Department with breathing difficulties. On examination he has a temperature of 38.2ºC, stridor and a toxic looking appearance. A diagnosis of acute epiglottitis is suspected. Which one of the following organisms is most likely to be responsible?

Answer 18

H.influenzae

Question 19

WHat is the most common complication of measles?

Answer 19

The most common complication of measles is otitis media because the respiratory virus can easily spread to the ear canals. This would likely present with unilateral ear pain and fever, as well as redness/swelling of the tympanic membrane on examination.

Question 20

What is the treatment for whooping cough?

Answer 20

Azithromycin but only within first 21 days of symptoms

Notifiable disease

Question 21

2 day old has sensironeural deafness, harsh murmur, and absent fundal reflexes bilaterally. The mother had a rash during early pregnancy. What is the likely diagnosis?

Answer 21

Congenital rubella syndrome

congenital cataracts and deafness. associated with patent ductus arteriosus

Question 22

What is the causative agent of roseola infantum?

Answer 22

human herpes 6

Question 23

On examination, the boy has bright red cracked lips, injection of the conjunctiva, palpable lymph nodes in the cervical region and the palms of his hands and soles of his feet are red.

Given the likely diagnosis, what medication should be administered?

Answer 23

Kawasaki disease

High dose aspirin

Occurs in children <5

Question 24

Why is aspirin contraindicated in children?

Answer 24

Aspirin is usually contraindicated in children due to the risk of developing Reye’s syndrome (a rapidly progressive encephalopathy), but in patients with Kawasaki disease, it is indicated.

Question 25

What is Reye’s syndrome?

Answer 25

a child’s blood sugar level typically drops while the levels of ammonia and acidity in his or her blood rise. At the same time, the liver may swell and develop fatty deposits. Swelling may also occur in the brain, which can cause seizures, convulsions or loss of consciousness.

Question 26

Why must ibuprofen or other NSAIDs not be given to children with chicken pox?

Answer 26

NSAID use increases the risk of necrotising fasciitis in these patients.