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402- Paediatrics > Infection > Flashcards

Infection Flashcards

1
Q

UTI presentation

A

Across all ages
- Abdominal/ suprapubic tenderness/ pain
- Fever
- Foul smelling/ cloudy urine
- Haematuria
- Vomiting

<3 months
- lethargy
- Failure to thrive
- Irritability
- Jaundice

Preverbal > 3months
- Lethargy
- Irritability
- Poor feeding
-

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2
Q

Risk factors for UTI

A

Urinary tract abnormalities
- Vesico-ureteric reflux

Incomplete bladder empyting

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3
Q

First line investigations for UTI

A

Urinanalysis
- Dipstick= positive nitrites, leucocytes
- Microscopy and sensitivity= bacteria >10^5

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4
Q

Atypical UTI in paeds (7)

A

Symptoms
- Very unwell
- Poor urine flow

Signs
- Abdominal/ bladder mass

Investigation/ treatment findings
- Septicaemia
- Failure to respond to antibiotics within 48 hours
- Non- E.coli infection
- Raised creatinine

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5
Q

Acute management of pyelonephritis

A

Severe
- IV fluids and antibiotics
- Analgesia

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6
Q

Causative organisms of UTI

A
  • E.coli
  • Klebsiella
  • Proteus–> forms stones
  • Pseudomonas–> may indicate structural abnormality
  • Enterococcus faecalis
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7
Q

Antimicrobial UTI management
- > 3months upper UTI, lower UTI
- < 3 months

A
  • Trimethoprim (monotherapy for lower)
  • IV for upper

< 3months
- Co-amoxiclav

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8
Q

Ultrasound indications in UTI

A

Acute ultrasound
- <6 months= Atypical and recurrent infection
- >6 months= atypical UTI

6-week ultrasound
- < 6 months, responds to antibiotics in 48 hours

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9
Q

DMSA scan indications

A

Nuclear renal scan that assesses scarring in kidneys.

Indications= 4-6 weeks post-UTI
- < 6 months- < 3 years= recurrent and atypical infections
- > 3 years= recurrent infection

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10
Q

Indications for Micturating cystourethrogram (MCUG)

A

Looks for VUR

  • < 6 months= recurrent and atypical UTI

> 6 months - <3 years= consider if
- Non-E.coli
- Family Hx of VUR
- Poor urine flow
- US showing dilation

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11
Q

Fifth disease
- Official name
- Cause

A

Erythema infectiosum
- Caused by Parvovirus B16

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12
Q

Presentation of erythema infectiosum

A

Prodromal
- low grade fever
- Runny nose

Rash
- Maculopapular on the body
- Erythematous cheeks (slapped cheek)

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13
Q

How long does slapped cheek syndrome last for?

A

Typically resolves in 1 week

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14
Q

Complications of erythema infectiosum

A

Anaemia
- In children with chronic haemolytic disease

Hydrops fatalis in a fetus
- virus can cross placenta

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15
Q

Measles
- Presentation

A

Prodromal
- Fever
- 3 Cs: coryza, conjunctivitis, cough

Rash
- Koplik spots
- Maculopapular rash started on the head, travelling caudally

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16
Q

Measles
- Diagnosis

A

IgM specific antibodies

PCR

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17
Q

Measles
- Complications

A

Pneumonia

Encephalitis

Diarrhoea

Later complication
- Subacute sclerosing panencephalitis (SSPE)

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18
Q

Rubella
- Cause

A

Rubella virus
- Also known as ‘German measles’

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19
Q

Rubella
- Presentation

A

Fever

Lymphadenopathy: sub-occipital, posterior auricular

Forcheimer spots

Rash
- Maculopapular
- Behind ears- trunk- extremities

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20
Q

Forchheimer spots

A

Petechiae on the soft palette associated with Rubella

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21
Q

Congenital rubella syndrome

A

Caused by vertical transmission of rubella

Triad
- hearing loss
- Cataracts
- Heart defects

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22
Q

Rosella
- Cause

A

Also known as exanthem subitum

Caused by HHV-6 and HHV-7

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23
Q

Presentation of roseolla

A

Flu-like symptoms

High fever
- May trigger febrile seizures

Maculopapular rash
- Starts on the trunk
- Spreads to face and extremities

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24
Q

Chickenpox
- Cause
- Incubation period

A

Varicella- Zoster

Incubation period
- 10-21 days

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25
Q

Chickenpox
- Presentation

A

Prodromal
- Flu like illness

Vesicular rash
- Starts on trunk and spreads to extremities
- Very itchy

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26
Q

Chickenpox complications

A

Encephalitis

Cerebellatis

Congenital varicella syndrome
- In first and second trimester

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27
Q

Congenital varicella syndrome features

A

Limb atrophy

Skin fibrosis/ contracture

Ocular defects

Neurological defects

28
Q

The most common cause of viral tonsilitis is _____

A

Rhinovirus

29
Q

Most common cause of bacterial tonsilitis is ______

A

Group A beta-haemolytic strep
- S. pyogenes

30
Q

Complications of tonsilitis

A

Quincy
- Peritonsillar abscess

Scarlet fever

31
Q

Fever PAIN criteria
- Features

A

One point for each: Higher

F- Fever (previous 24 hours)

P- Purulence

A- Attends rapidly (within 3 days)

I- Inflammed tonsils

N- No cough/ coryza

32
Q

Centor criteria
- Features

A

Used in ADULT patients Tonsillar exudat

33
Q

A score of 0-1 in FeverPAIN shows _____ likelihood of bacterial infection

A

13-18%

34
Q

A score of 2-3 in FeverPAIN shows _____ likelihood of bacterial infection

A

34-40%

35
Q

A score of 4-5 in FeverPAIN shows _____ likelihood of bacterial infection

A

62-65%

36
Q

Centor criteria
- Features

A

Tonsillar exudate

Tender anterior cervical lymphadenopathy

Fever

Absence of cough

37
Q

A score of 3-4 on Centor criteria is a ____ likelihood of bacterial tonsilitis

A

32-56%

38
Q

First line antibiotic of bacterial tonsilitis

A

Penicillin V

Pen allergy
- Clarithromycin/ erythromycin

39
Q

ENT referral tonsilitis is indicated for
______ in 1 year
______ per year in 2 years
or
______ per year in 3 years

A
  • 7
  • 5
  • 3
40
Q

______ is indicated first line for mild-moderate fungal tonsilitis

A

Nystatin

41
Q

__________ is indicated for widespread fungal tonsilitis

A

Fluconazole

42
Q

Follow up features tonsillitis

A

No improvement with 3-4 days of antibiotics

Pain +/- fever not improving in 3 days

Breathing/ swallowing difficulty

Unilateral neck/ tonsillar swelling

43
Q

Presentation of quinsy

A

Tender cervical lymphadenopathy

Referred ear pain

Trismus
- Unable to open mouth

Hot potato voice

44
Q

Management of Quinsy

A

ENT referral for incision and drainage
- Under GA

Broad-spectrum antibiotic
- Co-amoxiclav/ local guidelines

Dexamethasone
- Reduce swelling.

45
Q

Complications of acute otitis media [6]

A

Perforated tympanic membrane

Mastoiditis

Meningitis

Sinus thrombosis

CN7 paralysis

Intracranial abscess

46
Q

Bacterial causes of acute otitis media [3]

A

Haemophilus influenzae

S.pnuemoniae

Moraxella catarrhalis

47
Q

ENT referral indications for AOM

A

<3 months with fever >38

3-6 months with fever >39

48
Q

Indications for immediate antibiotic prescription in AOM

A

Systemically unwell

Bilateral AOM and <2 years

Otorrhoea

Immunocompromised,

49
Q

Typical course of AOM is _____

A

3-7 days

50
Q

Indication for delayed antibiotic prescription in AOM

A

No improvement/ worsening of symptoms in 3 days.

51
Q

First line antibiotic treatment in AOM

A

Amoxicillin
- 5-7 days

52
Q

Second line antibiotic treatment in AOM

A

Co-amoxiclav 5-7 days

53
Q

Glue ear
- Initial management

A

Hearing loss- referral to audiometry

Watchful waiting for 3 months

54
Q

Management of persistent glue ear (> 3months)

A

Refferal to ENT
- Especially if hearing/ development is affected

55
Q

The most common surgical option for otitis media with effusion is ______

A

Myringotomy with Grommets

56
Q

Follow up for grommets

A

Follow up until the grommets have been forced out and the eardrum has healed.

57
Q

The most common complication of grommets is ______

A

Otorrhoea

58
Q

Complications of grommets [6]

A

Infection

Tympanosclerosis

Perforation of the tympanic membrane.

Fibrosis.

Cholesteatoma.

Bleeding.

59
Q

The 6 in 1 vaccine includes:

A

DiTaP
- Diptheria
- Tetanus
- Pertussis

IPV
- Polio

Hepatitis B

Hib (H. influenza b)

60
Q

Diagnosis of parvovirus

A

Serology

61
Q

Most common causes of meningitis is neonates are…

A

Group B streptococcus

Listeria

E. coli

Pneumococcus

Staph. aures

62
Q

Most common causes of meningitis is children >1 month

A

N. Meningitides (most common)

Pneumonoccocus

HiB

63
Q

Meningococcal Gp C vaccine is routinely given is given at ages ______ and ______ as part of tje 12 months of the ______ vaccine

A

12 months and 14 years
- Part of the MenACWY vaccine

64
Q

_______ is the most common meningococcal strain that causes meningitis

A

Meningococcal group B

65
Q

Dose of iv aciclovir for HSV encephalitis in children

A

500mg/ M2 for up to 21 days

66
Q

Formula for body surface area (m2)

A

M3= (square root) weight x height (cm) / 3600

402- Paediatrics (15 decks)

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