Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

Paediatrics - Things I forget > Infection and Immunity > Flashcards

Infection and Immunity Flashcards

1
Q

What are the investigations for meningitis?

A 
• CRP
	• WCC
	• Blood culture
	• PCR
	• Lumbar puncture 
		○ CI: Raised ICP, meningococcal septicaemia
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

What is the management of meningitis?

A

• <3 months
○ IV Cefotaxime and amoxicillin
• >3 months
○ IV ceftriaxone

Dexamethasone may be given if on the CSF you see:
	• Purulent CSF
	• Signs of raised ICP
	• Raised WBC 
	• Bacteria on gram stain
If meningococcal septicaemia: 
	• IM/IV Benzylpenicillin
		○ Used if presents in GP setting before sending to A&amp;E
	• Steroids should NOT be used
	• LP contraindicated, due to likely DIC

Follow-up:
• Audiological assessment for hearing impairment (common complication)

Prophylaxis for family:
• Ciprofloxacin/Rifampicin

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

What are the clinical features of encephalitis?

A
  • Altered consciousness
    • Fever
    • Seizures

Common infectious causes:
• Enteroviruses
• Respiratory viruses
• HSV (Very dangerous)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

What is the management of encephalitis?

A

Investigation:
• PCR to detect HSV in CSF
• HSV encephalitis may show destructive changes on EEG or CT/MRI

Treatment:
• Treat with high dose aciclovir till HSV ruled out
• If HSV confirmed, continue treating with aciclovir for 3 weeks

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

What are the clinical features of toxic shock syndrome?

A

Characterised by:
• High fever (>39)
• Hypotension
• Maculopapular rash

Caused by toxin producing staph aureus, this toxin acts as a superantigen, resulting in organ dysfunction

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

What is the management of toxic shock syndrome?

A
  • ITU if in shock
  • Cephalosporins
  • Clindamycin
  • IVIG
  • IV Linezolid (Can’t use with antidepressants)
  • Surgical debridement
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

What are the clinical features of necrotising fasciitis?

A
  • Severe pain
  • Rapidly enlarging area of necrotic tissue (Very tender to touch)
  • Systemic illness
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

What is the management of necrotising fasciitis?

A
  • Medical emergency
  • Surgical debridement of necrotic area
  • IV broad spectrum antibiotics
  • IV fluids
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

What are the clinical features of impetigo?

A
  • Begins as erythematous macules
  • Becomes vesicular/bullous
  • When vesicle ruptures, forms honey crusted lesions
  • Most commonly on hands, face, neck affecting those with pre-existing skin conditions
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

What is the management of impetigo?

A

• Reassurance:
○ Typically heals by itself
○ Good hygiene encouraged
○ Stay away from school until lesions dry and scabbed over
○ Follow-up if no improvement after 7-days
• Medical treatment
○ Local infection = Topical fusidic acid (7 days)
○ Extensive infection = Oral flucloxacillin (7 days)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

What are the features of (peri)orbital cellulitis?

A 
• Periorbital cellulitis
	○ Fever
	○ Unilateral erythema, tenderness and oedema of the eyelid 
• Orbital cellulitis
	○ Same as above
	○ Proptosis
	○ Painful/limited ocular movement
	○ Reduced visual acuity
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

What is the management of (peri)orbital cellulitis?

A 
• Periorbital cellulitis
	○ IV antibiotics (ceftriaxone) immediately, to prevent posterior spread
• Orbital cellulitis
	○ IV antibiotics
	○ CT/MRI to see spread of infection
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

What are the clinical features of scalded skin syndrome?

A
  • Caused by exfoliative staphylococcal toxins
  • Fever
  • Malaise
  • Purulent, crusting lesions on face
  • Widespread erythema and tenderness of skin
  • Nikolsky sign - Epidermis will separate on gentle pressure
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

What is the management of scalded skin syndrome?

A
  • IV antibiotics (Flucloxacillin)

* Analgesia

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

What are the clinical features of gingivostomatitis?

A
  • Most common form of primary HSV in children
  • 3 months - 10 years most common age
  • Painful vesicular lesions on lips, gums, anterior surface of tongue, hard palate
  • Usually progresses to painful ulceration and bleeding
  • High fevers
  • Pain on eating food, drinking (Risk of dehydration)
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

What is the management of gingivostomatitis?

A
  • Symptomatic

* If severe, IV aciclovir and IV fluids

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

What is the management of VZV infection in an immunocompromised patient?

A

IV aciclovir

Prevention is key:
• VZV immunoglobulins

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

What are the features of EBV infection?

A 
• Causes infectious mononucleosis
	○ Fever
	○ Lymphadenopathy (Typically cervical)
	○ Tonsillitis/Pharyngitis 
	○ Splenomegaly

Investigation:
• Clinical
• Positive monospot test (Heterophile antibodies)

19
Q

What is the management of EBV infection:

A

Investigation:
• Clinical
• Positive monospot test (Heterophile antibodies)

Treatment:
• Paracetamol/Ibuprofen 
• Lasts for 1-3 months
• Can go to work/school
• Avoid contact sports (splenic rupture)
• No amoxicillin/ampicillin
20
Q

What are the clinical features of roseola infantum?

A

Alternate name: Exanthema subitum, Sixth disease
• Caused by HHV-6/HHV-7 infection
• Affects children younger than 2

  • High fever & malaise
  • Generalised macular rash as fever wanes
21
Q

What is the management of roseola infantum?

A
  • Paracetamol/Ibuprofen for symptom relief
  • Resolves over a few days/weeks
  • Risk of febrile convulsions
22
Q

What are the features of erythema infectiosum?

A

Alternative name: Slapped-cheek syndrome, fifth disease
• Caused by human parvovirus B19 infection

  • Initially presents with fever, headache, myalgia
  • After one week, a rash develops on the cheeks
  • This progresses to a maculopapular rash that spreads to the rest of the body
23
Q

What is the management of erythema infectiosum?

A

Paracetamol/Ibuprofen

Fluids

24
Q

What are the features of hand, foot and mouth disease?

A

Painful vesicular lesions on hands, feet and mouth
Mild systemic symptoms
Lasts a few days

25
Q

What is the management of hand, foot and mouth disease?

A

Nothing lol

26
Q

What are the clinical features of measles?

A

Begins with:
• Fever
• Coryza
• Conjunctivitis

Then:
• Koplik spots = White spots on buccal mucosa (Pathognomonic)

Then rash:
• Begins behind the ears
• Spreads to rest of body
• Initially maculopapular, before becoming blotchy

Investigations
• IgM antibodies can be detected within a few days of rash onset

27
Q

What is the management of measles?

A

Investigations:
• IgM antibodies detected within a few days of rash onset

Treatment:
• Notify authorities
• Self limiting
• Symptom relief (paracetamol/ibuprofen)
• Stay away from school for 4 days from the onset of rash

Complications:
• Otitis media is most common
• Pneumonia most common cause of death
• Encephalitis starts 1-2 weeks after onset of illness

28
Q

What are the clinical features of rubella?

A

Maculopapular rash is typically the first sign of infection
• Begins on the face
• Spreads to the rest of the body
• Fades after 5 days

Lymphadenopathy
• Particularly postauricular and occipital

May have low grade fever

29
Q

What is the management of rubella?

A

Investigations:
• IgM antibodies serology from oral fluid sample

Treatment:
• Notify authorities
• Self limiting
• Symptom relief (paracetamol/ibuprofen)
• Stay away from school for 4 days from the onset of rash

30
Q

What are the clinical features of mumps?

A 
Begins with
• Fever
• Malaise
• Parotitis
	○ Initially unilateral
	○ Proceeds to bilateral 
	○ Children complain of earaches and pain when eating/drinking
31
Q

What is the management of mumps?

A

Investigations:
• Oral swab serology

Treatment:
• Notify authorities
• Self limiting
• Symptom relief (paracetamol/ibuprofen)
• Adequate fluids
• Stay away from school for 5 days from the onset of parotitis

Complication:
• Orchitis

32
Q

What are the clinical features of kawasaki disease?

How does it differ from scarlet fever?

A 
Conjunctivitis
Rash - Maculopapular rash that desquamates
Adenopathy - Typically cervical
Strawberry tongue
Hands - Swelling of hands/feet
and
Burn - High fever lasting >5 days

In scarlet fever, the rash is sheet like with fine, tiny papillae
Kawasaki typically presents in <5s
Scarlet fever typically presents in 5-15 year olds

33
Q

What is the management of kawasaki disease?

A

Investigation - Clinical

IVIG
High dose aspirin

Complication:
Coronary artery aneurysm - Hence you do an echocardiogram (Not a angiogram due to radiation)

34
Q

What is the management of scarlet fever?

A

Investigation:
• Throat swab (Start Abx immediately however)

Treatment:
• Oral penicillin V for 10 days
• Patients who have a penicillin allergy should be given azithromycin
• Children can return to school 24 hours after commencing antibiotics
• Scarlet fever is a notifiable disease

Complications:
Otitis media
Rheumatic fever
Acute glomerulonephritis

35
Q

What are the clinical features of tuberculosis?

A 
In children they are NON-SPECIFIC
Prolonged fever 
Malaise 
Anorexia
Weight loss 
Focal signs of infection (e.g. lymph node swelling)

Diagnosed via gastric washings followed by Ziehl-Neelsen stains

36
Q

What is the management of tuberculosis?

A

Rifampicin + Isoniazid = 6 months
Pyrazinamide + Ethambutol = 2 months

Pyridoxine in adolescents to prevent peripheral neuropathy

Prevention:
• BCG vaccine from birth to high risk groups
• If a child <2 years is in contact with someone with TB, they should receive prophylactic isoniazid. If after 6 weeks they are negative for TB, stop meds and give vaccine

37
Q

How is HIV infection detected in children?

A

Child >18 months = HIV antibodies
Child <18 months = HIV RNA PCR

This is because children to HIV positive mothers will have transplacental HIV antibodies from mother. Hence, it is not a reliable indicator of infection in the child. After 18 months these antibodies will be gone if the child is negative for HIV

38
Q

What are the clinical features of Lyme disease?

A 
Erythematous macule at the sight of the bite, that looks like a target shaped rash (erythema migrans)
Headache
Fever
Myalgia
Lymphadenopathy

Late features:
Neurological - meningoencephalitis
Cardiac - myocarditis, heart block
Joint - Episodes of arthritis

39
Q

What is the management of lyme disease?

A

Investigation:
• Clinical (Presence of erythema migrans)
• If no erythema migrans, ELISA, then immunoblot test

Management:
1st line = Doxycycline
2nd line = Amoxicillin
3rd line = Azithromycin

40
Q

What are the clinical features of Henoch-Schonlein Purpura?

A

At presentation, affected children often have a fever.

The rash is the most obvious feature, but HSP affects four systems:
• Skin: Palpable purpuric rash on buttocks and extensors of lower limbs - “gravity-depending areas”.

• Gastro-intestinal system: Non-specific abdominal pain which can be acute and severe.

• Joints: Arthralgia, particularly of the knees and ankles. Long-term damage of the joints does not occur
○ ±Oedema

• Kidneys: Renal involvement is common but is rarely the first symptom.
○ Glomerulonephritis: Over 80% have microscopic or macroscopic haematuria or mild proteinuria.

41
Q

What are the clinical features of threadworm infestation?

A

Children present with intense perianal itching, which is typically worse at night when the worms come out of the anus. Nocturnal itching may lead to disturbed sleep and irritability.

Some people may be asymptomatic, and only notice worms on stool or on the perianal skin.

Girls may also experience itching around the vulva.

42
Q

How is threadworm infestation diagnosed?

A

Based on clinical features. If uncertain can perform adhesive tape test: Transparent tape is applied to the perianal area first thing in the morning and then examined under a microscope to detect threadworm eggs. Stool examination is not recommended.

43
Q

What is the management of threadworm infestation?

A

Generally recommended that all household members are treated at the same time, with an anthelmintic (mebendazole).

Improve hygiene

Paediatrics - Things I forget (11 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions