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Y4 Paediatrics > Infection > Flashcards

Infection Flashcards

1
Q

what vaccines are given at 8 weeks?

A
  • 6 in 1 vaccine(diphtheria, tetanus, pertussis, polio, haemophilus influenzae type B (Hib) and hepatitis B)
  • Meningococcal type B
  • Rotavirus(oral vaccine)
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2
Q

what vaccines are given at 12 weeks?

A
  • 6 in 1 vaccine(again)
  • Pneumococcal(13 different serotypes)
  • Rotavirus(again)
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3
Q

what vaccines are given at 16 weeks?

A
  • 6 in 1 vaccine(again)
  • Meningococcal type B(again)
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4
Q

what vaccines are given at 1 year?

A
  • 2 in 1(haemophilus influenza type B and meningococcal type C)
  • Pneumococcal(again)
  • MMR vaccine(measles, mumps and rubella)
  • Meningococcal type B(again)
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5
Q

what vaccines are given at 12-13 years?

A
  • Human papillomavirus(HPV) vaccine (2 doses given 6 to 24 months apart) - ideally before sexually active
    • against strain 6 &11 which causes genital warts
    • 16 and 18 cervical cancer
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6
Q

wat vaccines are given at 14 years?

A
  • 3 in 1(tetanus, diphtheria and polio)
  • ***Meningococcal groups A,C,WandY
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7
Q

What are some risk factors for cadidiasis?

A
  • Hot, humid weather
  • Too much time between diaper changes
  • Poor hygiene
  • Taking medicines such as antibiotics or corticosteroids
  • Health conditions that weaken the immune system, such as diabetes, cancer, or HIV
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8
Q

what are some key points in the history of a patient with candidasis?

A
  • skin - rash, patches that ooze clear fluids, pimples, itching or burning
  • vagina - white or yellow discharge, itching, redness in extrenal vagina, burning
  • penis - redness, scaling, painful rash
  • mouth - white patches on tongue, top of mouth, inside cheeks, pain
  • fever and chills
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9
Q

what is the management of cadidasis?

A
  • exclude risk factors - DM etc
  • miconazole gel, nystatin
  • oral hygiene advice, inhaler advice if steroid inhaler like rinse mouth after
  • if not responding after 2w or recurrent paediatric referral!
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10
Q

what causes cellulitis in children?

A
  • after trauma which causes opening in skin which leads to bacterial invasion
    • group A strep - haemolytic
    • strep pneumoniae
    • staph aureus
    • methicillin-resistant staph aureus
  • Predisposing factors include skin abrasions, lacerations, burns, eczematous skin, chickenpox, etc
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11
Q

how does cellulitis present?

A
  • swelling of skin
  • tenderness
  • warm skin
  • pain
  • bruising
  • blisters
  • fever and chills
  • headache
  • weakness
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12
Q

what are some red flag symptoms of cellulitis?

A
  • very large area of erythema
  • fever
  • numbness, tingling in area
  • skin black
  • if swollen area around eye
  • DM, immunocompromised
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13
Q

how do you manage cellulitis?

A
  • rest
  • oral or IV antibiotics - flucloxacillin
  • cool, wet dressings
  • surgical intervention and debridement if necrotising
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14
Q

what are the pathophysiology of conjunctivitis?

A

new born - chemical (2-4 days), gonococcal from vagina of infected mother
- childhood - large outbreaks in schools or day cares caused by bacteria, viruses like herpes or allergies
- bacteria - s.aureus, h.influenzae, s.pneumoniae, chlamydia
- virus - adenovirus, herpes
- allergies and chemicals like new born eye drops

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15
Q

how might conjunctivitis present?

A

itchy and irritated eyes
discharge - clear for viral, green and thick for bacterial
ear infection in some
swelling of eye lid

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16
Q

how is conjunctivitis managed?

A
  • cleaning with saline or water is all that is required as it resolves spontaneously
  • topical antibiotic eyes ointment eg: chloramphenicol or neomycin
  • if gonococcal infection start treatment immediately as permanent loss of vision can occur
    • 3rd generation cephalosporin IV and cleanse eye frequently
  • chlamydia - oral erythromycin for 2w and treat mother and partner
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17
Q

what is the pathophysiology of epiglottitis?

A
  • acute inflammatory swelling of epiglottis and surrounding tissues mostly caused by infection
  • life threatening emergency as high risk of airway obstruction
  • children higher risk as epiglottis more floppy, broad, long an dangled more into trachea

*H.influenza commonly causes, post vaccination streptococcus, candida and aspergillus in immunocompromised, HSV or parainfluenza etc virally

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18
Q

what are some worrying sign that may lead for you to suspect epiglottitis?

A

‼️ 4D - duration less than 12h, no cough

  • dyspnoea
  • dysphagia
  • drooling
  • dysphonia (hot potato voice)
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19
Q

what are some examination epiglottitis?

A
  • dehydration
  • high grade fever
  • stridor - late sign

*tripod position - lean forwards, outstretched arms, neck extended and tongue out as attempt to position inflamed structures away from airway

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20
Q

what are complications of epiglottitis?

A

mediastinitis, retropharyngeal abscess, pneumonia, meningitis, sepsis

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21
Q

what are the initial investigations for epiglottitis?

A

SECURE AIRWAY
*keep env calm, not supine
- lateral neck XR - thumb print sign, thickened aryepiglottic folds, increased opacity of larynx and vocal cords
- good for ruling out but don’t waste time

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22
Q

what are some management options for epiglottitis?

A

1.secure airway - call anaesthetist, ENT, avoid distress
a. may require tracheostomy
2. oxygen- parent can hold mask near child
3. nebulised adrenaline - bridging therapy while waiting for definitive airway management by reducing oedema
4. IV steroids - benefit not proven
5. IVI - resuscitation and maintenance, NBM until airway improved
6. secure airway in theatre

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23
Q

What is the new vaccination programme for influenza?

A
  • A new NHS influenza vaccination programme for children was announced in 2013. There are three key things to remember about the children’s vaccine:
    • it is givenintranasally
  • the first dose is given at2-3 years, thenannuallyafter that
  • it is alive vaccine
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24
Q

what are some red flag signs of influenza?

A
  • Signs andsymptoms that require hospital admission
  • Presence of alower respiratory tract infection (hypoxaemia, dyspnoea, lung infiltrate)
  • Central nervous system involvement
  • Significant exacerbation of an underlying medical condition
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25
Q

how would you differentiate between common cold and the flu?

A

Flu tends to have an abrupt onset, whereas a common cold has a more gradual onset.

Fever is a typical feature of the flu but is rare with a common cold.

Finally, people with the flu are “wiped out” with muscle aches and lethargy, whereas people with a cold can usually continue many activities.

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26
Q

how is influenza managed?

A

*clinical diagnosis
- paracetamol or ibuprofen for fever and pains
- maintain hydration and feeds
- rest, steam inhalation, nasal drops to help congestion
- gargling with salt water
- oral oseltamivir or inhaled zanamivir - if at risk
- must be taken within 48h of first symptoms to be effective

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27
Q

how does a HSV infection present?

A
  • 2-20 days after contact
  • painful, itchy, burning or tingling skin
  • blisters which become sores
  • sores crust and heal over 1-2w
  • flu-like symptoms - swollen glands, headache, body aches, fever

*may remain dormant and come back with stress, too tired, irritated skin, menstruation

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27
Q

what is the pathophysiology of herpes simplex infection?

A
  • HSV is a very contagious virus
  • HSV-1 causes sores around lips or inside mouth called cold sores
  • HSV-2 causes sores in genitals
  • spreads via direct contact with infected persons mucous membranes, saliva, oozing fluid from sore
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27
Q

what are some red flag signs for HSV sores?

A

complications of encephalitis in children!! can cause death in neonates!

  • non healing
  • signs of pus, redness etc
  • sores near eyes
  • immuno-compromised
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28
Q

how is an HSV infection managed?

A
  • antivirals
  • acetaminophen, paracetamol, ibuprofen for pain
  • infected areas kept dry
  • wash hands often
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29
Q

what is the pathophysiology of malaria?

A
  • most commonly imported tropical disease to the UK, more commonly seen in children as susceptible UK born children accompany overseas born parents to visit endemic areas
  • commonly plasmodium falciparum P.falciparumand these infections usually present in first few months after exposure
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30
Q

how might a malaria patient present?

A
  • suspect malaria in a patient with fever and recent travel to a malaria‐endemic area
  • non-specific symptoms in uncomplicated - fever, lethargy, malaise, N+V+D, abdominal pain
  • severe : respiratory disease, hypoglycaemia
  • severe cerebral malaria : reduced GCS, seizures, altered respiration
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31
Q

what are some complications of malaria?

A
  • cerebral malaria
  • acute renal failure
  • ARDS
  • hypoglycaemia
  • DIC
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32
Q

how is malaria investigated?

A
  • antigen tests
  • thick and thin blood films

*If initial tests are negative arrange to repeat after 12, 24 and 48hrs if child remains unwell and no clear focus of infection evident

  • blood gas including glucose
  • FBC - thrombocytopenia highly suggestive
  • LFT, U&Es, blood glucose, clotting profile
  • G6PD screen
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33
Q

how is malaria managed?

A

notify public health
admit all patients
4h observations and blood glucose monitoring
repeat thick films

*oral artemether with lumefantrine
*severe - IV artesunate
*supportive care

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34
Q

what is the pathophysiology of measles?

A
  • highly contagious viral infection spread by aerosol breath, cough or sneeze
  • infects respiratory tract and spreads through body
  • RNA paramyxovirus
  • infective until 4 days after rash starts
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35
Q

what are some clinical features of measles?

A
  • high fever (may spike to more than 104°)
  • cough,
  • runny nose (coryza), and
  • red, watery eyes
  • 2-3 days after - koplik spots in mouth
  • 3-5 days after rash begins
36
Q

what are the examination findings of measles?

A
  • prodromal - conjunctivitis
  • Koplik spots
  • rash - starts from behind ear and spreads to whole body
    • made up of small red-brown, flat or slightly raised spots that may join together into larger blotchy patches
37
Q

what are some complications of measles?

A

encephalitis
otitis media
pneumonia
febrile convulsions
resp - croup, tracheitis
neuro - febrile seizures
other - diarrhoea, hepatitis

38
Q

how is measles diagnosed?

A
  • IgM antibodies
  • nose and throat swab
39
Q

how is measles managed?

A
  • mainly supportive
  • paracetamol and ibuprofen for fever or pains
  • admission in immunosuppressed
  • stay off school until 4 days after rash
  • stay away from unvaccinated or pregnant
    • if child not vaccinated and came in contact offer MMR within 72h
  • stay hydrated
  • notify public health!!
40
Q

what is the pathophysiology of meningitis?

A
  • inflammation of the meninges which line the brain and spinal cord, most likely caused by bacteria or viruses
    • neisseria meningitidis - gram negative
41
Q

what are the key clinical features of meningitis?

A
  • fever
  • neck stiffness
  • headache
  • photophobia
  • altered consciousness
  • seizures
  • neonates - hypotonia, poor feeding, lethargy, hypothermia
42
Q

what are some examination findings for meningitis?

A

altered consciousness
non-blanching rash
kernig’s test
brudzinski

43
Q

differentiate between kernig’s and brudzinski.

A
  • Kernig’s test - lie flat, flex one hip and knee to 90 and slowly straighten knee while hip flexed at 90
  • Brudzinski - flat on back, use hands to lift head and neck off bed and flex chin to chest and observe if involuntary flex in hips and knees
44
Q

what are the complications of meningitis?

A
  • hearing loss
  • seizures and epilepsy
  • cognitive impairment and learning disability
  • memory loss
  • cerebral palsy with focal neurological deficits like limb weakness or spasticity
45
Q

what are some investigations done for meningitis?

A

sepsis screen
LP - if under 1m with fever, 1-3m fever and unwell
viral PCR

46
Q

what are some contraindications for an LP?

A
  • focal neurological signs
  • papilloedema
  • significant bulging of the fontanelle
  • disseminated intravascular coagulation
  • signs of cerebral herniation
  • *blood cultures and PCR for meningococcus should be obtained.
47
Q

how is meningitis managed?

A
  • notify public health
  • community - IM benzylpenicillin
  • under 3m cefotaxime plus amoxicillin
  • dexamethasone over 3m
  • fluids
  • post-exposure prophylaxis - single dose of ciprofloxacin
  • acyclovir for HSV or VZV
48
Q

what is the pathophysiology of mumps?

A

viral infection which is self limiting within 1 week, droplet spread

RNA paramyxovirus, winter, spring

49
Q

what are some key clinical features of mumps?

A

initial flu prodromal. which occurs before parotid swelling
fever, muscle aches, lethargy, reduced appetite
parotitis

  • parotid swelling which can be unilateral or bilateral (with associated pain)
  • tenderness to touch
50
Q

what are some complications of mumps?

A
  • pancreatitis - abdominal pain
  • orchitis - testicular pain
  • meningitis or encephalitis - confusion, neck stiffness and headache
  • sensorineural hearing loss
51
Q

what are the initial investigations of mumps?

A
  • PCR testing on saliva swab
  • antibodies to mumps virus testing via blood or saliva
52
Q

how is mumps managed?

A
  • notifiable disease so notify public health if suspected or confirmed
  • supportive management as self limiting
    • rest
    • fluids
    • analgesia
  • manage complication as needed
53
Q

what is the pathophysiology of tonsillitis?

A
  • inflammation of palatine tonsils, which is a part of Waldeyer’s ring
  • commonly viral infection, hence do not require Abx
  • bacterial - group A strep pyogenes or strep pneumoniae
  • may accompany otitis media, rhino-sinusitis
  • children of 5-10 or those 15-20
54
Q

what is the clinical presentation of tonsilitis?

A
  • fever, sore throat, painful swallowing
  • non specific - fever, poor oral intake, headache, vomiting, abdominal pain

*-throat examination shows red, inflamed and enlarged tonsils with or without exudates
- otoscopy - TM
- palpate for cervical lymphadenopathy

55
Q

what are some complications of tonsillitis?

A
  • admission if immunocompromised, systemically unwell, dehydrated, stridor, respiratory distress, peritonsillar abscess, cellulitis
  • trapped pus abscess in region of tonsils - trismus, change in voice ‘hot potato voice’, uvula deviation away from affected side due to unilateral swelling
  • complications - chronic tonsillitis, quinsy, otitis media, scarlet fever, rheumatic fever, PSGN, reactive arthritis
56
Q

what are the centor criteria for tonsilitis?

A
  • A score of3 or more gives a 40 – 60 % probability ofbacterial tonsillitis, and it is appropriate to offer antibiotics. A point is given if each of the following features are present:
    • Fever over 38ºC
    • Tonsillar exudates
    • Absenceof cough
      -Tenderanterior cervical lymph nodes (lymphadenopathy)
57
Q

what are the fever pain criteria for tonsillitis?

A
  • Feverduring previous 24hours
  • P–Purulence (pus on tonsils)
  • A–Attended within 3days of the onset of symptoms
  • I–Inflamed tonsils (severely inflamed)
  • N–No cough or coryza
58
Q

what are some management options of tonsillitis?

A
  • viral: analgesia for fever and pain
  • abx: phenoxymethylpenicillin for 10 days, clarythromycin
  • delayed prescription
  • admission if immunocompromised, systemically unwell
  • tonsillectomy
59
Q

When would you consider a tonsillectomy?

A

7 episodes in 1 year, 5 per year for 2 or 2 episodes of quinsy

60
Q

what is the pathophysiology of otitis media?

A

inflammation of middle ear between TM and inner ear where cochlea, vestibular apparatus and nerves found, caused by virus or bacteria strep. pneumoniae

61
Q

what are the clinical features of otitis media?

A
  • earache, young children tugging ear
  • reduced hearing
  • fever, cough, sore throat, coryzal symptoms
  • restlessness
  • balance issues and vertigo
  • discharge if perforation
  • *non specific in young children - poor feeding, vomiting, lethargy, fever, generally unwell
62
Q

what are some complications of otitis media?

A
  • can complicate to TM perforation, facial nerve involvement, mastoiditis or even intracranial complications
  • HL, recurrent infection, abscess
63
Q

how would you manage otitis media?

A
  • specialist and consider admission in infants younger than 3m, temp 38c 3-6m old with temp. over 39c
  • most resolve without antibiotics in 3 days and upto a week
  • safety net, education, advise on when to seek attention
  • simple analgesia for pain and fever
  • prescribing Abx - immediate, delayed or none
  • consider prescribing when child has significant systemic illness, immunocompromised, less than 2 years with BL or with otorrhoea
    • amoxicillin for 5 days, erythromycin otherwise
64
Q

what is viral gastroenteritis?

A
  • temporary disorder due to an enteric infection characterised by sudden onset diarrhoea with or without vomiting
  • diarrhoea 5-7 days, stop within 2w and vomiting 1-2 days up to 3 days
  • commonly viral - rotavirus, norovirus and adenovirus
65
Q

what are some features of recognised dehydration risk in young children with viral gastroenteritis?

A
  • younger children under 6m
  • passed >5 diarrhoea stools in last 24h
  • vomited >2 in last 24h
  • children who stopped breast feeding during illness
66
Q

what are some complications viral gastroenteritis?

A
  • haemolytic uraemic syndrome - rare but serious as can cause acute renal failure, haemolytic anaemia
  • toxic megacolon - rotavirus complication
  • acquired or secondary lactose intolerance - lining of intestine being destroyed, improved with lining healing
67
Q

when would you consider an alternative diagnosis for a child presumed to have viral gastroenteritis?

A
  • temp over 38c or 39c if over 3m
  • breathlessness or tachypnoea
  • altered GCS
  • meningism
  • blood in stool
  • bilious vomit
  • severe and localised abdominal pain
  • abdominal distension or guarding
68
Q

what are some investigations that can be carried out for viral gasteoenteritis?

A
  • stool sample send if sepsis suspected, blood in stool, child immunocompromised
  • bloods not routine but measure sodium, potassium, creatinine, urea, glucose if IVF ongoing, or hypernatraemia signs seen (jittery, increased muscle tone, convulsions, drowsiness or coma)
  • measure acid-base balance and chloride concentration if shock suspected
69
Q

what are some management of viral gastroenteritis?

A
  • not clinically dehydrated: continue breastfeeding, encourage fluid intake and not fizzy
  • dehydrated - IVF, oral therapy, NGT
  • post-hydration: full strength milk straight away etc
70
Q

what is pre-septal cellulitis?

A

inflammatory disease of orbit limited to the tissues anterior to the orbital septum

*

71
Q

what is orbital cellulitis?

A

inflammatory disease of the superficial and deep structures of the orbit

*cannot open eye, lid erythema, swollen conjunctiva, impaired visual acuity, painful eye movement, proptosis, asymmetrical pupils, fever

72
Q

what are the key points in the history?

A
  • peri-orbital
    • lid swelling and redness
  • orbital
    • General malaise, pain, blurred vision, double vision, loss of colour vision, sinus headache
73
Q

how does pre-septal vs orbital cellulitis present?

A

pre-septal: can open eye to examine, lid erythema, white conjunctiva, normal visual acuity, normal painless movements of eye, no proptosis, equal pupil reaction, systemic wellness

orbital: cannot open eye, lid erythema, swollen conjunctiva, impaired visual acuity, painful eye movement, proptosis, asymmetrical pupils, fever

74
Q

what are some red flags regarding orbital cellulitis?

A
  • cannot open eye, lid erythema, swollen conjunctiva, impaired visual acuity, painful eye movement, proptosis, asymmetrical pupils, fever
  • SIGHT THREAT!!
75
Q

how would you manage pre-septal cellulitis?

A
  • If under 3 months old - admit under medics and refer to ophthalmology and ENT
  • If over 3 months old – If systemically well, sensible parents and mild features may be discharged on PO antibiotics (co-amoxiclav) 7-10 days?
  • Give clear instructions to return immediately if condition worsens
76
Q

how is orbital cellulitis managed?

A
  • admission!! IV access
  • ENT and ophthal referral and review
  • IV ceftriaxone 10-14 days
  • +/- IV metronidazole if sinuses involved
  • 4h obs
  • surgery maybe required incase of abscess needing draining
77
Q

what is toxic shock syndrome?

A
  • exotoxin-mediated acute severe condition
  • children susceptible due to immature immunity, colonisation of wound or burn with toxic producing strains of staph A and group A strep causes, MRSA
  • exotoxins in bloodstream act as superantigens causing T cell activation and massive release of cytokines causing massive
  • rapid progression to septic
    shock and multi-organ failure
78
Q

what is TSS associated with usually?

A
  • TSS is usually associated with burns or wounds (including surgical), skin infections
    • e.g. in association with varicella infection or bites, or any other recent infection, tampon use
  • in UK commonly - small surface area burn in a child (3). It is typically
    associated with children aged 1-4 years, two days after a small burn
79
Q

what are some key features of TSS?

A
  • high fever - 38.9c <
  • vomiting or diarrhoea
  • muscle pain
  • confusion
  • lethargy
  • diffuse macular erythroderma
  • hypotension
  • pyrexia
  • reduced consciousness
80
Q

how would you investigate TSS?

A
  • CLINICAL
  • BP
  • U&E - CK levels, creatinine high
  • blood cultures
  • FBC - platelets low, CRP may be raised
  • coagulation
  • blood gas - lactate
  • blood glucose
  • group and save
81
Q

how is TSS managed?

A
  • A-E
  • high flow oxygen
  • fluid resuscitation - 10ml/kg bolus and reassess
  • IV antibiotics - IV flucloxacillin, IV clindamycin if TSS suspected
  • analgesia
  • clean infected wound
  • administer platelets if needed
  • BP medication if low
  • MDT review
82
Q

what are some reg flags regarding URTI?

A
  • have a fever lasting more than five days
  • are having difficulty breathing
  • wheezing and difficulty breathing
  • less energy and irritable
  • are not managing to drink enough fluid
  • are less than three months old and have a fever above 38 degrees Celsius
83
Q

what management options do you give for someone with a URTI?

A
  • paracetamol or ibuprofen for high fever, upset, pain
  • ensure hydration - sugar-free ice lollies
  • throat lozenges for older children
  • babies saline nose drops to ease blockage
84
Q

what is viral exanthema?

A
  • eruptive skin rash that is often related to a viral infection
  • The most common childhood viral exanthems include chickenpox (varicella), fifth disease, measles (rubeola), roseola, and rubella (German measles), covid, hand, foot and mouth
85
Q

how is viral exanthema managed?

A
  • clinical
  • cultures
  • swabs maybe
    • lotions to reduce itchiness
  • NSAIDs
  • self limiting
86
Q

TB

A

finish

87
Q

Rubella

A

finish

88
Q

primary immune deficiency syndrome

A

finish

Y4 Paediatrics (16 decks)

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