Infection

Question 1

give examples of systemic manifestations caused by group A streptococcal infection?

Answer 1

impetigo 
erysipelas 
glomerulonephritis
necrotising fasciits
rheumatic fever

Question 2

what is kawasaki’s disease?

Answer 2

vasculitis of medium sized arteries

self limiting

Question 3

what is the presentation of kawasaki’s disease?

Answer 3

fever for 5 days plus;

• bilateral conjunctival infection
• cracked lips/ strawberry tongue
• cervical lymphadenoapthy
• polymorphous rash
• changes of the extremities i.e. coffee coloured hands, swelling

Question 4

how is kawasaki’s disease diagnosed?

Answer 4

clinical diagnosis

• do microbiology to test for bacterial or viral cause

Question 5

what is the management for kawasaki’s disease?

Answer 5

aim prevent complications (coronary aneurysms)

• immunoglobulins
• aspirin
• steroids
• immunosuppressive agents
• cardiology assessment

Question 6

in what age groups is varicella zoster more serious?

Answer 6

< 1 year old

adults

Question 7

what are the complications of herpes simplex virus in neonates?

Answer 7

high mortality rate if not treated (> 50%)

majority have disseminated infections

• sepsis
• meningoencephalitis
• hepatitis (jaundice, bleeding)

Question 8

what is the causative organism of hand foot and mouth?

Answer 8

enteroviruses

• coxsackie A16
• enterovirus 71

Question 9

what is the common age prevalence of hand foot and mouth?

Answer 9

< 10 yrs

Question 10

what is the clinical presentation of hand foot and mouth?

Answer 10

exanthema
painful
painful lesions

Question 11

what time of the year is hand foot and mouth most common?

Answer 11

summer / early autumn

Question 12

what are warning features of immunodeficiency in children?

Answer 12

faltering growth
deep skin infections or organ abscesses
need for IV antibiotics (> once)
family history

others;
> 4 ear infections/year
> 2 sinus infections/year
>2 pneumonias
>2 months antibiotics 
persistent thrush/fungal infections

Question 13

what investigations would you carry out if you suspected immunodeficiency in a child?

Answer 13

FBC 
immunoglobulins 
HIV test 
functional antibodies 
lymphocyte subsets 
Nitroblue test TBT (tests for chronic granulomatous disease)

Question 14

if a child presented with severe meningococcal sepsis and you suspected an immunodeficiency, what investigation would you carry out?

Answer 14

specific complement testing

Question 15

what is the main risk factor for transmission of HIV from mother to baby?

Answer 15

high viral load

Question 16

a 5 year old boy presents unwell with abdominal pain and fever.
he has recurrent skin infections and chronic diarrhoea and occasional cough.
investigations;
USS shows liver abscess
CXR shows aspergilloma
NBT test is positive

what is the diagnosis?

Answer 16

chronic granulomatous disease

Question 17

what are the red flag features of an immunodeficiency?

Answer 17

SPURSS

Serious infection (hospitalisation or IV antibiotics)
Persistent 
Unusual (organisms i.e. PJP)
Recurrent 
Runs in the family

Question 18

what are differentials of a vesicular rash + fever in a child?

Answer 18

herpes zoster virus (shingles)
herpes simplex virus
varicella zoster virus (chicken pox)
hand foot and mouth

Question 19

what antibiotic is used against streptococcal infections?

Answer 19

penicillin

Question 20

what antibiotic is used against staphylococcal infections?

Answer 20

flucloxacillin

Question 21

what is the presentation of scarlet fever?

Answer 21

malaise, fever, pharyngitis
rash - sandpaper like, spares perioral area
strawberry tongue
squamation of hands and feet

Question 22

what is the causative organism of scarlet fever?

Answer 22

group A streptococcus

Question 23

what is the treatment for scarlet fever?

Answer 23

penicillin

Question 24

what is the causative organism of hand foot and mouth?

Answer 24

enteroviruses i.e. coxsackie A16

enterovirus 71

Question 25

what is the presentation of hand foot and mouth?

Answer 25

vesicular rash + fever
painful lesions
exanthema

Question 26

at what time of the year is hand foot and mouth most common ?

Answer 26

summer/ early autumn

Question 27

in what age group is hand foot and mouth most common?

Answer 27

< 10 years

Question 28

how is HSV transmitted from mother to baby?

Answer 28

direct contact through the birth canal

Question 29

give 2 differentials of a strawberry tongue.

Answer 29

scarlet fever

kawasaki’s disease