Core Topics Flashcards
Give the typical presentation of meningitis in an infant
Fever, poor feeding, hypotonia/lethargy, rash (non blanching purpuric rash), vomiting, resp distress, jaujdice
What do you expect to see in the results of a lumbar puncture in meningitis? Bacterial vs viral
Bacterial: very elevated protein, low glucose (<60% of serum glucose), raised neutrophils/polymorphs, turbid csf
Viral: elevated protein, normal glucose, raised lymphocytes, clear csf
(Same as encephalitis)
What would you order for meningitis
Technically for any severe infection as we assume meningitis
FBC, Uand E, CRP, VBG, coag screen, LFT, culture
Lumbar puncture with CSF culture
Imaging: CT/MRI Brain
What are the contraindications for a lumbar puncture
Signs of raised ICP: high bp, coma, papilloedema, full fontanelle
Focal neurological signs (hemiplegia)
Coagulopathy
Thrombocytopenia
Causes delay in giving antibiotics
How would you manage a case of meningitis?
<8 weeks cefotaxime + amoxicillin + gentamicin. >8 weeks only cefotaxime
Prophylaxis for close contacts: ciprofloxacin + vaccine MenACWY vaccine
Viral: acyclovir if HSV and Ganciclovir if CMV
What is this?
How is it treated
Cradle cap / infantile seborrheic dermatitis
Treated via emollients or mild topical steroids (same tx as eczema)
What is this?
How would you treat?
Varicella/ chicken pox (vesicular because fluid inside)
Tx: if healthy, no treatment
If immunocompromised give acyclovir
Do not give ibuprofen
What is this?
What is it caused by?
Describe the rash
What is the treatment?
Erythema infectiosum caused by Parvovirus
Presents as a mild febrile illness with a maculopapular rash characteristically on the face “slapped cheek”
No treatment. If painful, use analgesia or NSAIDS
What is the characteristic rash of coxsackie
How is it treated?
Older children, maculopapilar/vesicular rash on hands and feet and mouth
Only symptomatic treatment
What is the gold standard diagnosis for IBD and what are the findings for each.
Colonoscopy:
Crohns: skip lesions, snail trail ulcers, cobblestone appearance, strictures, abscesses
UC: continuous reddened mucosa with bleeding on contact
Imaging: Barium enema
Crohn’s: strictures, abscesses, and fistulas
UC: lead pipe sign of colon
Biopsy:
Crohn’s: non-caseating granuloma
UC: crypt abscesses
How would you treat each of the IBD?
First line both: exclusive enteral nutrition with nutritionally complete formula for 4-6 weeks
Then
Crohn: oral corticosteroids and sulfalazine/methotraxate => Anti-TNF (infliximab)
UC: 5-ASA (amino salicylic acid) => infliximab
What is the classical presentation of celiac?
Complications/findings on investigation
Faltering growth
Diarrhea specifically steatorrhea that is greasy and foul-smelling or constipation
Recurrent apthous ulcers
!Fe-deficiency anemia! (Inflammation causing reduced absorption of nutrients and minerals including iron), folate, and B12)
IGA deficiency
Bowel malignancy
Osteopenia
Stunted growth
(You can use these complications for IBD as well)
What investigations would you perform to confirm the diagnosis of celiac disease
Serology: anti TTG IgA AND anti-EMA to confirm diagnosis.
If not then biopsy via OGD (esophageogastroduodenoscopy)
Management of celiac disease
Referral to dietitian
Strict and lifelone abstinence from gluten sources such as wheat, rye, and barley
Supplementation: Zinc, iron, calcium and vit ADEK
A mother presents with their child with vaccination concerns specifically related to HPV
When is this vaccine given
What other vaccines are given alongside it? (extra, not essential in marks)
What does the HPV vaccine protect against?
What strains are the most dangerous?
At the first year of secondary schools, students are given
HPV (gardasil 9)
Tdap (Tetanus , diptheria, and pertussis (booster)
Men ACWY booster is also given
1) Protects other individuals who may be immunocompromised or unvaccinated
2) Cervical Cancer, Oropharyngeal cancer, Anal cancer, vaginal, vulvular, penile
3) Genital warts (esp common wart HPV 1)
Strains HPV 16 and 18 are the worst
