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LS YEAR 4 Paediatrics > Immunology , infection > Flashcards

Immunology , infection Flashcards

1
Q

which injection does a child have at birth?

A

hep b and BCG if risk factors

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2
Q

injections at 8 weeks

A

6 in 1 :

diphtheria, tetanus, whooping cough, polio, Hib (Haemophilus influenzae type b) and hepatitis B.

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3
Q

another given at 8 weeks

A

rotavirus
men B
pcv Pneumonoccoccal

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4
Q

jab given at 12 weeks

A

oral rota virus

2nd dose - diphtheria, tetanus, whooping cough, polio, Hib (Haemophilus influenzae type b) and hepatitis B.

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5
Q

jabs at 16 weeks

A

3rd dose- diphtheria, tetanus, whooping cough, polio, Hib (Haemophilus influenzae type b) and hepatitis B.

men B
pcv 2nd dose

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6
Q

jabs at one year old

A 
Hib/men c 
pcv 3rd dose 
men b
MMR
flu vaccine
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7
Q

2-3

A

flu vaccine/nasal spray

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8
Q

3-4y/o

A

MMR -in-1 pre-school booster
Protects against: diphtheria, tetanus, whooping cough and polio
Given at: three years and four months of age

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9
Q

12-13 y/o

A

hPV (likely to be for boys too soon!)

3 jabs in 6 months

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10
Q

13-18 y/o

A

3-in-1 teenage booster
Protects against: tetanus, diphtheria and polio
Given at: 14 years
Read more about the 3-in-1 teenage booster
MenACWY vaccine
Protects against: meningitis (caused by meningococcal types A, C, W and Y bacteria)
Given at: 14 years and new university students aged 19-25

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11
Q

what is meningitis ?

A

inflammation of the meninges surrounding the brain and spinal cord

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12
Q

causes in children
and neonates
mengitis

A

neonates - ecoli, listeria, group b strep

children -niesseria meningitides, step pneumonia, h influenza

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13
Q

who has a low threshold for LP?

A

INFANTS As meningism is not a classical presentation

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14
Q

who should vaccinations not be given to?

5 conditions

A

Immunizations should not be given to a child who:
 is younger than indicated in the schedule
 is acutely unwell with fever
 has had an anaphylactic reaction to a previous dose of the vaccine

Repeat immunizations should NOT be given sooner than indicated in the schedule. If a child misses an immunization, it should be given later. There is no need to restart the course.

Live attenuated vaccines (e.g. measles, mumps, rubella, BCG) should not usually be given to children with immunodeficient states (e.g. cytotoxic therapy or high dose steroids)

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15
Q

what causes diptheria?

A

corynebacterium diphtheriae.

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16
Q

what is diphtheria

A

nfection occurs in the throat, forming a pharyngeal exudate, which leads to membrane formation and obstruction of the upper airways. An exotoxin may cause myocarditis, neuritis & paralysis.

barky cough
two to five days after exposure. Symptoms often come on fairly gradually, beginning with a sore throat and fever.

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17
Q

what causes tetanus?

A

Clostridium tetani

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18
Q

what causes whooping cough

A

Bordetella pertussis. I

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19
Q

75% of meningitis occurs when

A

75%of all meningitis is

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20
Q

what are the signs of raised ICP

A 
Signs of raised ICP:
 Papilloedema
 Altered consciousness
 Increased BP
 Decreased pulse
 Bulging fontanelle
 Neck retraction
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21
Q

differentials of meningitis

A

encephalitis
raised ICP
meningismus -neck stiffness due to tonsillitis, otitis media, pneumonia
septicaemia

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22
Q

what is coning?

A

Herniation of the brain
through the foramen magnum
 Follows a LP
 The release of CSF results in a pressure differential between intracranial and intraspinal compartments
 Causes very acute and severe brainstem signs with paralysis and respiratory inhibition

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23
Q

signs and symptoms of meningitis

A 
positive kerning and brudunski sign
photophobia
fever
neck stifness
altered consciousness 
vomiting 
papilodema is a late sign
lethagy
non blanching rash
headache
poor feeding 
squint 
petachiae haemorrhage
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24
Q

investigations

meningitis

A 
bloods - increased CRP, WBC
u and e, lets 
blood cultures 
DIC cogulatioon 
LP
ct and optholamoscopy if raised ICP suspected
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25
Q

treatment or management key feature to remember

meningitis

A

start antibiotics before Ix

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26
Q

differences between bacterial and viral meninigitis

A

viral - clear, hazy, glucose normal, protein bit high, leucocytes with (20-1000) whereas bacterial is cloudy/purulent, neutrophils 500-5000, low glucose and high protein

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27
Q

what medications can be given?

mengititis

A

in community-benzylpencillin IM
in hospital IV cefotiraxone if over three months
ceftriaxime if under 3 months
consider add amoxicillin to cover listeria

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28
Q

contraindication of ceftriaxone

A

premature, hypoalbumnia acidosis jaundice otherwise safe under 3 months

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29
Q

is meningitis a notifable disease

A

yes

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30
Q

what else can be given if there is signs of meningism

A

dexamethasone to reduce inflammation

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31
Q

what can be given as prophylaxis for those who have been in contact

A

rifampicin

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32
Q

treatment for herpes simples mengitisi

A

acyclovir

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33
Q

key thing about bacterial and under 3 months

A

do NOT use corticosteroids

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34
Q

complications of meningitis

A 
epilepsy
deafness
hydrocephalusAcute adrenal failure
 Deafness
 Major deficit (CP or learning difficulties in 10%)
 Focal paralysis
 Further seizures
 5-10% mortality
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35
Q

what is purpura?

A

not a disease but presentation
non bleaching red or purple discoloured spot on applying pressure
caused by bleeding underneath and have a full range of causes
0.3-1cm in size

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36
Q

what are purpura seen in?

A

can be non thrombocytopenia or thrombocytopenia
including
meningitis
vascular disorders such as heron scholein purpura
platelet disorders such as thrombocytopenia purpura
scurvy
steroid use or sulphonamides
amyloid-pinch purpura
leukaemia
SLE
DIC

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37
Q

how do they differentiate from petachie ?

what is factional Purpura

A

petechia are less than 3mm whereas ecchymoses are over 1cm

inexplicable bleeding or bruising -may represent emotional or psychiatric disturbance or non acc injury/sign of abuse

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38
Q

investigations

when do you give tranfsion

A
  • FBC (leukaemia), ESR (inflamm), platelets
  • LFTs
  • Coagulation screen
  • Plasma electrophoresis
  • Autoantibody screen for CT disorders

if platelets less than <20

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39
Q

what is meningecoccal septicaemia caused by

A

Neisseria Meningitidis

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40
Q

what type of bacteria is niessera meningitis
where is it found
why so significant

A

a gram negative diplococcus found in the nasopharynx (asymptomatic carriers). The leading cause of infectious death in children, which most commonly presents as bacterial meningitis and septicaemia.

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41
Q

which type is the most common

A

group Bt least 13 types but A,B,C,Y and W cause most

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42
Q

which can u get vaccine for

A

c AND B

Before uni you can getA,C,W,Y)

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43
Q

signs and symptoms of septicaemia

A

Early sings: leg pain, cold peripheries, mottling, dyspnoea
- Fever, headache.
- Stiff neck, back rigidity, bulging fontanelle, photophobia.
- Altered mental state, unconsciousness, toxic/moribund state.
- Non-blanching rash (>12 hours)
- Shock:
o Toxic/moribund state; altered mental state/decreased conscious level.
o Unusual skin colour, capillary refill time more than two seconds; cold hands/feet. o Tachycardia and/or hypotension; respiratory symptoms or breathing difficulty.
o Leg pain.
o Poor urine output.
- Kernig’s sign (pain and resistance on passive knee extension with hips fully flexed) and Brudziñski’s sign (hips flex on bending the head forward).
- Paresis, focal neurological deficits (including cranial nerve involvement and abnormal pupils).
- Seizures.

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44
Q

how does septicaemia differ from meningitis

A

when bacteria or virus enters blood

Meningitis is caused when bacteria enter the bloodstream and travel to the meninges, where they multiply and cause inflammation. Septicaemia is caused when bacteria enter the bloodstream and multiply rapidly.

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45
Q

risk factors for septecemia

A 
<1 year old
diabetes
chemotherapy
burns 
AIDS
HB Ss DISEASE
CONGENITAL heart disease
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46
Q

key features in appearance and behaviour

A

appearance- mottled, cyanosis, non blanching rash ashen appearance
behaviour - weak high pitch cry does not wake
ill no response to social cues
altered behaviour

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47
Q

investigations for septcemia

A

Blood cultures, FBC (WCC), CRP, U&Es, renal function tests, LFTs.

PCR: for N. meningitidis to- meningococcal disease and to serogroup.

DIC: prothrombin time and activated partial thromboplastin time (aPTT) is elevated,

platelet count and fibrinogen level is low.

Pharyngeal swab.

Lumbar puncture once the patient is stable, and an assessment made to rule out raised intracranial pressure (may need a CT scan). Send cerebrospinal fluid for microscopy, culture, glucose and PCR. Aspirate from other sterile sites suspected of being infected (eg, joints) for microscopy, culture and PCR.

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48
Q

management of septecemia

A

call 999
admit
treat same way as meningitis there is a non-blanching rash, give parenteral antibiotics whilst waiting for the ambulance, if this
will not delay admission to hospital:
o Benzylpenicillin (600mg or 300mg if <1) unless immediate penicillin allergy.

o Cefotaxime may be used as an alternative.
- Antibiotics should IV or IM in adults and IM in children (quads).

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49
Q

what is chicken pox?

A

Highly infectious disease which usually occurs under 5 years of age due to contraction of the varicella zoster virus.

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50
Q

how does it present c chicken pox

A

small itchy blisters which occur all over but typically start on back chest and face
start as papule then vesicles then vesicles and end as a scab

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51
Q

who can they be harmful in

chicken pox

A

pregnant women
neonate
immunocompromised -last weeks and take ages to clear up with bleeding

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52
Q

when do they present and how long do they last

A

10-21 days after exposure and last 5-7 days on average

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53
Q

symptoms

chikenpox

A 
itching
tiredness
fever
nausea
abdo pain
loss of appetite
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54
Q

management of chicken pox

A

self limiting but can manage to improve symptom
Encourage fluid intake
 Paracetamol
 Antihistamines and emollients
 Aciclovir not recommended unless at risk of complications
 In immunocompromised give high dose steroids but if new lesions after 8 days the IV
acyclovir.
 In >12 years age, pregnancy or close contacts:
o 5-7 days oral acyclovir, 800mg 5 daily

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55
Q

chicken poxcaution in pregnancies include

A

increase risk of prematurity and 30% risk of death
virus. transmitted but antibody isn’t
treat with aciclyovir
can acquire congenital varicella syndrome if in 2nd or third trimester

risk is very low

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56
Q

what is congenital varicella syndrome

A

extremely rare disorder in
distinctive abnormalities at birth

includes :
- low birth weight and - characteristic abnormalities of the skin; the arms, legs, hands, and/or feet (extremities); the brain; the eyes; and/or, in rare cases, other areas of the body.

  • range and severity of associated symptoms vary depending upon when infection occurred during fetal development.
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57
Q

what is conjuctivitis

A

infection of the conjunctiva

using dilation of conjunctival blood vessels so the eye appears red.

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58
Q

symptoms of conjuctivitis

A 
red eye
itchy eye
gritty feel 
pus, watery or stringy discharge 
burninng sensation
mild photophobia
Vision is usually normal, although 'smearing', particularly on waking, is common.Eyes may be difficult to open in the morning, glued together by discharge.
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59
Q

three classifications in children of conjunctivitis

A

infective-viral or bacterial
allergic
neonatal

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60
Q

what can. be given if bacterial

A

Chloramphenico

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61
Q

difference in discharge between different type

conjunctivitis

A

bacterial pus
allergic stringy
viral watery

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62
Q

when does neonatal conjucitivitis occur

A

conjunctivitis occurring within the first 28 days.

Most commonly arises due to contamination from maternal GU tract.- Chlamydia most common but gonococcal also.

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63
Q

management of neonatal conjuctivitis

A

All referred to ophthalmology.

Gonococcal - purulent discharge with swelling within first 48 hours. IV cefotaxime (oral if older).

Chlamydial - end of the first week of life. 2 week course of oral erythromycin or doxycycline and topical tetracycline.

If viral then acyclovir.

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64
Q

what is seen with allergic
what can be done as management
conjunctivitis

A

apid onset lid swelling and chemosis (conjunctival oedema). Most commonly type 1 reaction.

opical antihistamines or topical mast cell stabilisers such as sodium cromoglicate.

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65
Q

differentials of conjunctivitis

A

Blepharitis, uveitis, acute glaucoma, keratitis, scleritis, episcleritis, orbital cellulitis, ocular HSV.

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66
Q

other symptoms which may present with conjunctivitis

A

runny nose and sneezing
ear infection
crusty lesions on eyes

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67
Q

what is a food allergy

A

chemical within food that cause an allergic reaction - reaction of immune system to specific foods

68
Q

symptoms of a food allergy

A

dependent on severity
anaphylaxis -difficulity breathing, anangioaedema, loss of consciousness or faint

  • itchy sensation inside mouth, throat and/or ear
    raised itchy rash or hives
    swelling of the face, around eyes , lips , tongue and of roof of mouth
69
Q

how to manage
and prevent
anaphylaxis

A

call 999 and administer adrenaline
use epipen , jextpen
anti histamine
avoid triggers

70
Q

what are common allergies

A 
nuts
egg
milk
shellfish
soya
wheat
kiwi
71
Q

what increases likeliness of analyphalxis

A

igE allergy

72
Q

how does it differ from intolerance

A

intolerance is result of difficulity digesting and is not life threatening
includes lactose intolerance-cramps, diarrhoea, vomiting

73
Q

questions to ask in the history

A

Why is a food allergy suspected?
What foods do they feel are implicated?
What are the symptoms that occur after eating the food?
At what age did the symptoms start?
How much food is needed to cause symptoms?
Do symptoms occur every time?
How long does it take for symptoms to occur?
What is the worst reaction that the person has had?
Is there a personal or family history of allergy?
Feeding history, age of weaning, formula or breast-fed? Previous treatments… Have any exclusion diets been tried? Is their diet nutritionally adequate?

74
Q

which allergies are not usually grown out of

A

peanuts, shellfish, fish, tree nuts

75
Q

how to investigate an allergy

A

Food diary
If IgE mediated suspected then: skin-prick testing and serum IgE testing (ELIZA & FEIA).
If non IgE then trial elimination diet (normally for between 2-6 weeks). Examples of these are:
 Food protein-induced enterocolitis - projectile vomiting,
diarrhoea and failure to thrive in the first few months of life. Cow’s
milk and soy protein formulas.
 Eosinophilic oesophagitis and gastroenteritis - nausea,
abdominal pain, reflux, and failure to thrive. There is no response to
antacids.
 Coeliac disease

76
Q

what is infectious mononucleosis known as

A

epstein barr virus

glandular fever

77
Q

symptoms of glandular fever

A

tiredness -can last months
sore throats-3-5 days after being infected
fever
enlarged lymph nodes

78
Q

is it self-limiting glandular fever

A

usually within 2-4 weeks yes

79
Q

other complications glandular fever g

A

spleen rupture

hepato or splenomegaly

80
Q

what is known as

glandula

A

kissing disease

spread through saliva

81
Q

how is diagnosis mader fever for glandular fever

A

clinically
but antibodies can confirm
raised lymphcoytes

82
Q

is there a vaccine for EBV

A

no

83
Q

management of ebv

A

drink fluids
rest
pain relief
avaoid contact sport , physical activity and ampicillin can increase risk of splenic rupture

Advise the person to seek urgent medical advice if they:
Develop stridor or respiratory difficulty.
Have difficulty swallowing fluids or have signs of dehydration, such as reduced urine output.
Become systemically very unwell.
Develop abdominal pain (may indicate splenic rupture).

84
Q

what is Kawasaki disease

other name

A

condition causing inflammation of the arteries, veins and capillaries

it is a condition that mainly affects children under the age of 5. It’s also known as mucocutaneous lymph node syndrome

85
Q

how does it present kawasaki

A 
fever lasting more than 5 days 
presents with :
-a rash 
-swollen glands in the neck
-dry cracked lips
-red eye/bilateral conjunctivitis 
-red fingers/toes/soles/palms
-strawberry red tongue
86
Q

who does it affect Kawasaki

A

sian, 6 months – 5 years old children, more common in boys
 8/100,000 in the UK
 Autoimmune-mediated systemic vasculitis that affects small- and medium-sized arteries

87
Q

other symptoms of Kawasaki

A 
gallbladder enlargement
temporary hearing loss
d and vardiovascular - pancarditis, aortic or
mitral incompetence, tachycardia
2. Gastrointestinal - hydrops of
gallbladder, jaundice, hepatomegaly,
diarrhoea.
3. Blood - mild anaemia.
4. Renal - sterile pyuria, mild proteinuria.
5. CNS - aseptic meningitis.
6. Musculoskeletal - arthritis, arthralgia.
7. Others - anterior uveitis, BCG-site
inflammation
88
Q

risk factors for kawaski

A 
sibling who had it
<5 years
asian
boys
asian or Pacific Island descent, such as Japanese or Korean, have higher rates of Kawasaki disease.
89
Q

what is its relevance of Kawasaki

A

most common heart disease in children

if left untreated

90
Q

is recurrence of Kawasaki common

A

Recurrences are uncommon

91
Q

investigations of Kawasaki

A

no specific tests but can use

Urinalysis – sterile pyuria & proteinuria
 Leukocytosis and neutrophilia
 ESR and CRP
 Thrombocythaemia
 Elevation of transaminases and bilirubin
 Gallbladder distension on US
 ECG and echocardiogram

echo to look for heart changes and ecg
bloods
echest xray for heart failure

92
Q

how do you manage kawaski disease?

A

admit due to cardiac manifestations

self limiting or administer IV immunoglobulins over 12 days but needs to be within 10 days of fever
daily aspirin for four days
may need longer treatment of 6-8 weeks of aspirin to prevent clotting or heart attack
need to be cautious as can cause Reyes syndrome In paes with aspirin

corticosteriods

93
Q

what do immunoglobulin reduce risk of

A

conoary artery aneurysms by 20%

94
Q

complications of kawsaki

A 
 Coronary artery aneurysms
o PCI if high risk of ischaemia
o CABG
o Aspirin + warfarin or LMW heparin o Most regress after 2 years
 Sudden cardiac death (MI)
 Pericarditis/ Myocarditis
 Valvular disease
 Cardiac dysrhythmia
 Heart failure
 Acute arthritis
95
Q

other management options of Kawasaki

A

PCI or CABG if coronary artery problems

 Anti-TNF and immunosuppressive treatments

96
Q

what type of infection is measles

A

respiratory often spread by droplet /airborne

97
Q

what is the causative agent of measles

A

morbillivirus of the parmyoxvirus family

single stranded ran

98
Q

When do symptoms of measles present

A

10-12 days post exposure

99
Q

how long does measles last

A

7-10days

100
Q

what does it present with

in measles

A 
runny nose blocked 
sneezing
watery eye
swollen eyelides
red sore eye
fever
spots in mouth-white grey
aches and pain
tiredness
measlesrash -2-4 days later
raised spots jointed to form blotchy patch)
loss of appetite and cough
101
Q

is there a vaccine for measles

A

MMR yes

part of national immunisation porogramme

102
Q

when to see gp for measles

A

If not vaccinated and been in contact with someone who had it

103
Q

another key thing about measles

A

its a notifable disease
need to let local health protection/authority know
seek advice esp if patient is less than1, immunocpromised or pregnant

104
Q

how do you manage measles?

A 
hydration
analgesia
avoid contact with others
seek help if SOB, fever, convulsions, altered consciousness 
vit a supplementation
105
Q

the four cs in measles

A

fever and 1 of
cough
catarrh
corzya and conjucvitis

106
Q

complications of measles

A 
Bronchopnemonia
 Giant cell pneumonitis
 Cervical adenitis
 Otitis media
 Enchephalitis
 Vitamin A deficiency and blindness
 Lymphopenia
 Miscarriage, low birth weight, preterm birth
107
Q

can MMR vaccine be given acutely

A

yes if over 6 months within 72 hours

108
Q

what is koplik spots

A

Koplik’s spots: buccal mucosa - opposite the second molar teeth - small, red spots with a bluish-white speck (grain of rice)

109
Q

what causes rubella?

A

rubivirus togaviridae

110
Q

what is most common cause of congenital deafness

A

rubella

111
Q

other name for rubella

A

German measles

112
Q

is it common in uk rubella

A

NO. because of MMR vaccination programme

113
Q

is It self limiting
transmitted
rubella

A

yes usually

airbrne/droplet

114
Q

symptoms of rubella

A 
swollen glands- neck head
red pink rash -14 days after exposure
fever
cold like symptoms
joint aches
115
Q

gold standard ix for rubella

A

pcr or serology

116
Q

what is the mAin concern with rubella

A

if caught in pregnancy can have detrimental effect on mother and baby

117
Q

when is greatest concern with rubella

A

in first 20 weeks can cause miscarriage and cause congenital rubella syndrome

118
Q

what does this mean for the baby

rubella

A 
cataracts
brain damage
deafness
heart abnormalities
inure
HAemolytic anaemia
insulin dependent diabetes 
rash 
lymphodeompathy
119
Q

management of rubella

A

self limiting

control with ibuprofen , paracetamol and reduce pain and fever - avoid and aspirin -reyes risk

120
Q

how many children in the world have HIV

A

2.1 million children were living with HIV/AID in 2007

with 2 million in sub-saharan

121
Q

how do most children acquire hIV

A

through vertical transmission or from mother or during pregnancy /breast feeding

122
Q

can you prevent mother tp baby transmission

A

yes can be reduced to 2% if successful intervention

most countries have limited resources so this is almost not possible to achieve

123
Q

how does HIV present?

A

failure to thrive

swollen lymph nodes
intermittent diarrhoea 
oral thrush
fever
hepatitis
reccurent infections
kidney disease
pneumonia
124
Q

investigations of hIV

A

virology at birth, 1-2 months and 4-6 months if mother is positive
need 2 positive samples

125
Q

is there a cure his

A

no but treatments to slow down progression and prevention mother to infant transmission
also mother should be encouraged not to breastfeed

126
Q

where does amyloid pinch purpura appear

A

cheeks

127
Q

DIC purpura apperance

A

ecchymosisis with irregular border go deep purple colour and erythematous halo
evolve to haemorrhage bullae and blue-black gangrene
distal extremities , area of pressure, lips , ears nose and trunk

128
Q

steroid use Purpura

A

extensor surfaces of hands arms and thighs

widespread purpura and bruising

129
Q

what is preseptal and orbital cellulitis

A

infection of the eye preseptal and orbital regions
orbital is uncommon but more serious and life threatening as of risk of blindness
infection can come from distant sites

130
Q

presentation of orbital cellulitis

A 
disturbances in vision
abrnomal pupillary reflex
pain
unilateral swelling 
redness warmoth
ptosis and proptosis 
blurred vision
fever and mailaise
131
Q

management of cellulitis

A

diagnostics - bloods dns swaps
ct to look at sinuses and rule out raised ICP, consider lP IF CNS SIGNS BUT NEED TO BE SURE NO raised ICP
keep in hospital and rule out orbital
if preseptal give co-amoxiclav of ibr ceftriaxone and involve end if sinuisitis
if orbital need to used cefotaxime and flucloaxcillin and metronidazol

monitor optic nerve function four hourly

132
Q

what if theres a penicillin allergy

A

clindamycin and cpirofloxacin

133
Q

complications at risk from orbital cellulitis

A

keratopathy, raised IOCP, rental or vein occlusion and topic neuropathy
blidnesness

134
Q

jabs order number to help me remember

A

423412

135
Q

what does meningitis affect

A

LEPTOmeningies of brain and spinal cord

136
Q

signs of viral meninigitis

A

mucus membrane affect
snuffly cold like primary virema
then secondary vireo affecting organs and CNS

137
Q

causes of viral mengitis

prognosis

A

enterovirus parechovirus and HSV
hsv 1/2 have long term complication s
more common excellent prognosis

138
Q

bacterial meningitis

A

usually affects nasopharyngeal first
enters blood stream
worse prognosis but less common
altered cerebral blood flow

139
Q

which cause deafness in menigitis

A 
s pneumonia 
h influenza (Vaccination present)
140
Q

when to give antibiotics for meningitis

A

within an hour

golden hour

141
Q

what is given in < 3 months meningitis

A

cefurotaxmine and AMOXICILLIN

142
Q

CI for LP

A 
pupura
raised ICP
clotting disorder
shock 
site of LP has infection 
convulsion  (mx first)
respiratory insufficiency `(mx first)
143
Q

what would lP show for TB

A

clear, slightly cloudy
LYMPHOCYTES (differentiates from bacterial)
high protein levels > 1.5

144
Q

protein in bacterial meningitis

A

high if > 1

145
Q

complications to warn patient in meningitis

A

seizures
focal paralysis
if less than 2 year old CP!!!
deafness most common so hearing test 6 weeks later

146
Q

bacterial which has worst prognosis

A

pneumococcal

147
Q

signs of septicaemia

A

leg pain
mottling
breathing difficulities

rash indicated after 12 hour of onset

148
Q

kernig vs brudkinski

A

knee flex when neck is flexced - brud

kernig- knee flexed, pain when straighened

149
Q

calcium-containing infusions are being administered, do not use ceftriaxone. what to give

A

nstead, use cefoTAXime[9].

150
Q

which is used in septicaemia

A

cefatriaxone

151
Q

what is added if been outside uk

A

vancomycin

152
Q

how long if h influenza

A

10 days

153
Q

how long treated if s pneumonia

A

14 days

154
Q

group b strep

A

14 days

155
Q

l myogenes

A

amoxicillin 21 days

gent maybe for first 7 days

156
Q

if unconfirmed < 3 months and over 3 months

A

under 14 days

> 3 months 10 days

157
Q

meningococcal confirmed and unconfirmed

A

7 days

158
Q

when is cefotiaxone ci

A

PREMATURITY
HYPOALBUMINEMIA
ACIDOSIS
JAUNDICE

159
Q

Close contact prophylaxis

A

within 7 days nearby contact in house closeby e.g. childminder in same room, staying overnight in same house
uni kitchen same halls etc
sharing dormitories

160
Q

doses of dex given in meningitis

A

0.15mg or 150microgram per kg
max 10mg
4 times daily 6 hourly

161
Q

when do u give dex

A 
OVER 3 MONTH
if evidence of bacterial 
WCC RAISED >1000
or wcc raised and protein > 1 
purulent CSF
162
Q

when to do hearing assessment for meningitis

A

within 4 weeks of being well/fit for test
see paediatrician agter
inform school/gp nurse to monitor
cochlear transplant assessment needed

163
Q

when can dexmetahone be started

A

ideally asap, and within 4 hr of abx but not after 12 hr

164
Q

benzylpencillin doses

A

IV or IM
300mg < 1 y/o
1-9. give 600mg
10 plus 1200mg

165
Q

which vaccines are live attenuated

A

Rotavirus
influenza
BCG
MMR

BRIM!!! FROM imms schedule

typhoid
yellow fever
varicella

LS YEAR 4 Paediatrics (24 decks)

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