Conditions 3

Question 1

Micro-investigations in Infectious mononucleosis (EBV)?

Answer 1

• Atypical lymphocytes (numerous large T-cells on blood film)
• Positive Monospot test (although often -ve in young children)
• Seroconversion: w/production of IgM + IgG to EBV antigens.

Question 2

What happens in Mumps?

Answer 2

The virus replicates within epithelial cells + gains access to the parotid glands.
Plasma amylase levels often elevated.

Question 3

Complications of Mumps?

Answer 3

• Hearing loss can follow: usually transient + U/L.

- Orchitis: uncommon in prepubertal males.

Question 4

What causes Periorbital cellulitis?

Answer 4

Young, unimmunised: Haem. influenzae type B.

Older children: spread from paranasal sinus infection/ dental abscess.

Question 5

Mx of Periorbital cellulitis?

Answer 5

• Treat asap w/IV abx to prevent posterior spread to become an orbital cellulitis.
• If orbital cellulitis suspected > CT scan to assess post. spread, lumbar puncture to exclude meningitis.

Question 6

What is Kawasaki disease + what is it caused by?

Answer 6

A systemic vasculitis.
A result of immune hyperreactivity to a variety of triggers in a genetically susceptible host (a polymorphism in the ITPKC gene on chr.9).

Question 7

Presentation of Kawasaki disease?

Answer 7

Classic: Fever >5days and:

• non-purulent conjunctivitis
• red mucous membranes
• cervical lymphadenopathy
• rash
• red/oedematous palms/soles, or peeling fingers/toes.

Strikingly irritable + high fever.
Coronary/peripheral artery aneurysms, myocarditis, pericarditis (1/3rd) within 6wks,

Question 8

Mx of Kawasaki disease?

Answer 8

• IV immunoglobulin within 10days (reduce risk of thrombosis)
• Aspirin: high dose until fever subsides, then continue low dose until ECHO @6wks reveals presence/absence of aneurysms.

Question 9

Description of the rash in measles?

Answer 9

Discrete, maculopapular rash initially, becomes blotchy + confluent.
Spreads down from behind the ears to whole body.
May desquamate in 2nd week.

Question 10

What are 2 severe complications of measles?

Answer 10

1. Encephalitis (~8days after illness onset)- initial sx of headache, lethargy + irritability.
2. Subacute sclerosing panencephalitis (~7yrs after measles)- loss of neurological function, progresses over several years to dementia + death. Most 1st infection <2yrs.