General Infection

Question 0

What is the most common HSV 1/2 infection in 10m - 3yr olds?

Answer 0

Gingivostomatitis. Vesicular lip, gum and tongue or hard palate lesions. Can lead to painful ulceration and bleeding.
High fever, eating and drinking problems. If severe or dehydrated need IV fluids and aciclovir

Question 1

What are the 8 human herpes viruses HHV?

Answer 1

HSV 1 and 2
VZV
CMV
EBV
HHV 6, 7 and 8

Question 2

3 skin manifestations of HSV 1/2?

Answer 2

HSV 1 = cold sores on lips
Eczema herpeticum - serious, infection over pre-existing eczematous areas
Herpetic whitlows = painful erythematous, oedematous white pustules on fingers (broken skin)

Question 3

Other important presentations of HSV 1 and 2?

Answer 3

Eye - blephorotis, conjunctivitis -> corneal ulceration

CNS or disseminated disease

Question 4

When is a VZV primary infection infectious to others?

Answer 4

From -2 to 5 days or so

Question 5

Course of lesions in primary VZV infection?

Answer 5

Papules -> vesicles -> pustules -> crusts (in crops)

Question 6

Serious complications of primary VZV infection? And when are they indicated?

Answer 6

Secondary bacterial superinfection
-> staphylococcal or group A strep infection - toxic shock or nec fas
Encephalitis (usually not too bad), indicated by ataxia and cerebellar signs
Indicated by persistently high or recurrent fever

Question 7

VZV complications in immunocompromised individuals?

Answer 7

Haemorrhagic lesions
Pneumonia or pneumonitis
Disseminated infection
DIC

Question 8

Medical treatments for primary VZV?

Answer 8

Nothing in most cases
IV aciclovir if immunocompromised
Valaaciclovir for adults or adolescents
VZIG for high risk individuals

Question 9

What viruses can cause infectious mononucleosis (glandular fever)?

Answer 9

Most commonly EBV

Uncommonly CMV

Question 10

What cancerous conditions is EBV implicated in?

Answer 10

Burkitt lymphoma
Nasopharyngeal carcinoma
Lymphoproliferative disease in immunocompromised

Question 11

Common presentations of glandular fever?

Answer 11

Fever and malaise
Severe tonsillopharyngitis (can restrict airway)
Prominent cervical lymphadenopathy, adenopathy

Question 12

Other possible symptoms of glandular fever?

Answer 12

Splenomegaly (50%) or hepatomegaly
Maculopapular rash
Jaundice

Question 13

3 diagnostic methods for glandular fever?

Answer 13

Monospot test
Atypical (big) T lymphocytes on blood film
Seroconversion of IgM and IgG to EBV antibodies

Question 14

What treatment is used for airway compromise in glandular fever and which antibiotics must be absolutely avoided?

Answer 14

Give corticosteroids
Avoid amoxicillin (florid maculopapular rash)

Question 15

Methods of transmission of CMV?

Answer 15

Saliva, genital
Breast milk, transplacental
Blood or organ transplants

Question 16

Which mild CMV infections can occur in normal individuals?

Answer 16

Mild mononucleosis syndrome: fever, pharyngitis, lymphadenopathy
But negative monospot test

Question 17

What pathogen is important in blood or organ transplant and therefore commonly screened for?

Answer 17

CMV

Question 18

What does HHV 6+7 most commonly cause?

Answer 18

Roseola infantum in under 2s

Febrile convulsions

Question 19

What is commonly misdiagnosed as measles or rubella due to the similar nature of its rash and presentation?

Answer 19

Roseola infantum

Question 20

3 types of enterovirus?

Answer 20

Coxsackie, poliovirus and echovirus

Question 21

What might a vomiting/diarrhoea/contact history suggest in a non-specifically ill child?

Answer 21

Enterovirus

Question 22

What feature of enterovirus infection can lead to admission and treatment with ceftriaxone?

Answer 22

Petechial rash (?meningitis)

Question 23

5 specific enterovirus syndrome?

Answer 23

Hand foot and mouth
Herpangina
Meningitis/encephalitis
Pleurodynia
Myocarditis/pericarditis

Question 24

Define febrile convulsion?

Answer 24

Seizure accompanied by fever (>37.8 axillary) in absence of intracranial infection

Question 25

When can febrile seizures occur and when is the peak?

Answer 25

6m-5yr, peak around 18m

Question 26

When do febrile seizures typically occur and what are the most common non-severe causes?

Answer 26

Typically early on in viral infection when temp is rapidly changing
Other causes: otitis media, tonsillitis

Question 27

Serious causes of febrile seizure?

Answer 27

UTI
LRTI
Meningitis/sepsis

Question 28

What illness can precipitate an afebrile seizure?

Answer 28

Gastroenteritis

Question 29

Timelines: at what point do you give meds?
When do you call ambulance?
When is it complex?
When is it status epilepticus?

Answer 29

5 mins meds
10 mins ambulance
15 mins complex
30 mins status epilepticus

Question 30

What meds are used after 5 mins for febrile seizures?

Answer 30

Rectal diazepam

Buccal midazolam

Question 31

Recurrence rate of simple febrile seizures? Risk factors for recurrence? (4)

Answer 31

Recurrence rate 30-40%
RFs: low age first occurrence
Low temp
Early on in illness
Positive family history

Question 32

What makes a febrile seizure complex?

Answer 32

If it’s focal, prolonged (>15 mins) or there are more than one in same illness

Question 33

Differentials for febrile seizure? (6)

Answer 33

Afebrile seizure
Rigors
Syncope
Breath holding spells
Reflex anoxic seizure
Apnoea

Question 34

Cushing’s triad for signs raised ICP?

Answer 34

Bradycardia
Hypertension
Abnormal breathing

Question 35

Antibiotics for bacterial meningitis?

Answer 35

Cefotaxime/ceftriaxone preferred
+ dexamethasone in neonatal period to preserve deafness
Alternatively need benpen shot (IM)

Question 36

Viral causes of meningitis?

Answer 36

EBV
Enteroviruses
Adenoviruses
Mumps

Question 37

Viruses that can cause encephalitis?

Answer 37

Enterovirus, respiratory viruses

HSV, HHV 6, VZV

Question 38

Which viral type of encephalitis is worst and how do we treat everyone with encephalitis?

Answer 38

High dose aciclovir - HSV meningitis has lots of associated complications