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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
Chickenpox - Presentation
Prodromal - Flu like illness Vesicular rash - Starts on trunk and spreads to extremities - Very itchy
26
Chickenpox complications
Encephalitis Cerebellatis Congenital varicella syndrome - In first and second trimester
27
Congenital varicella syndrome features
Limb atrophy Skin fibrosis/ contracture Ocular defects Neurological defects
28
The most common cause of viral tonsilitis is _____
Rhinovirus
29
Most common cause of bacterial tonsilitis is ______
Group A beta-haemolytic strep - S. pyogenes
30
Complications of tonsilitis
Quincy - Peritonsillar abscess Scarlet fever
31
Fever PAIN criteria - Features
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
Centor criteria - Features
Used in ADULT patients Tonsillar exudat
33
A score of 0-1 in FeverPAIN shows _____ likelihood of bacterial infection
13-18%
34
A score of 2-3 in FeverPAIN shows _____ likelihood of bacterial infection
34-40%
35
A score of 4-5 in FeverPAIN shows _____ likelihood of bacterial infection
62-65%
36
Centor criteria - Features
Tonsillar exudate Tender anterior cervical lymphadenopathy Fever Absence of cough
37
A score of 3-4 on Centor criteria is a ____ likelihood of bacterial tonsilitis
32-56%
38
First line antibiotic of bacterial tonsilitis
Penicillin V Pen allergy - Clarithromycin/ erythromycin
39
ENT referral tonsilitis is indicated for ______ in 1 year ______ per year in 2 years or ______ per year in 3 years
- 7 - 5 - 3
40
______ is indicated first line for mild-moderate fungal tonsilitis
Nystatin
41
__________ is indicated for widespread fungal tonsilitis
Fluconazole
42
Follow up features tonsillitis
No improvement with 3-4 days of antibiotics Pain +/- fever not improving in 3 days Breathing/ swallowing difficulty Unilateral neck/ tonsillar swelling
43
Presentation of quinsy
Tender cervical lymphadenopathy Referred ear pain Trismus - Unable to open mouth Hot potato voice
44
Management of Quinsy
ENT referral for incision and drainage - Under GA Broad-spectrum antibiotic - Co-amoxiclav/ local guidelines Dexamethasone - Reduce swelling.
45
Complications of acute otitis media [6]
Perforated tympanic membrane Mastoiditis Meningitis Sinus thrombosis CN7 paralysis Intracranial abscess
46
Bacterial causes of acute otitis media [3]
Haemophilus influenzae S.pnuemoniae Moraxella catarrhalis
47
ENT referral indications for AOM
<3 months with fever >38 3-6 months with fever >39
48
Indications for immediate antibiotic prescription in AOM
Systemically unwell Bilateral AOM and <2 years Otorrhoea Immunocompromised,
49
Typical course of AOM is _____
3-7 days
50
Indication for delayed antibiotic prescription in AOM
No improvement/ worsening of symptoms in 3 days.
51
First line antibiotic treatment in AOM
Amoxicillin - 5-7 days
52
Second line antibiotic treatment in AOM
Co-amoxiclav 5-7 days
53
Glue ear - Initial management
Hearing loss- referral to audiometry Watchful waiting for 3 months
54
Management of persistent glue ear (> 3months)
Refferal to ENT - Especially if hearing/ development is affected
55
The most common surgical option for otitis media with effusion is ______
Myringotomy with Grommets
56
Follow up for grommets
Follow up until the grommets have been forced out and the eardrum has healed.
57
The most common complication of grommets is ______
Otorrhoea
58
Complications of grommets [6]
Infection Tympanosclerosis Perforation of the tympanic membrane. Fibrosis. Cholesteatoma. Bleeding.
59
The 6 in 1 vaccine includes:
DiTaP - Diptheria - Tetanus - Pertussis IPV - Polio Hepatitis B Hib (H. influenza b)
60
Diagnosis of parvovirus
Serology
61
Most common causes of meningitis is neonates are...
Group B streptococcus Listeria E. coli Pneumococcus Staph. aures
62
Most common causes of meningitis is children >1 month
N. Meningitides (most common) Pneumonoccocus HiB
63
Meningococcal Gp C vaccine is routinely given is given at ages ______ and ______ as part of tje 12 months of the ______ vaccine
12 months and 14 years - Part of the MenACWY vaccine
64
_______ is the most common meningococcal strain that causes meningitis
Meningococcal group B
65
Dose of iv aciclovir for HSV encephalitis in children
500mg/ M2 for up to 21 days
66
Formula for body surface area (m2)
M3= (square root) weight x height (cm) / 3600

402- Paediatrics (15 decks)

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