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Y5 Paediatrics > Infection and Immunity > Flashcards

Infection and Immunity Flashcards

1
Q

How is fever identified <4 weeks?

A

electronic thermometer in axilla

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2
Q

How is fever identified 4 weeks to 5 years

A

electronic / chemical dot thermometer in axilla

OR infrared tympanic thermometer

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3
Q

What is a fever in a child considered to be?

A

Body temp >37.5 degrees

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4
Q

What are risk factors for infection?

A 
ill close contacts 
lack of immunisation 
recent travel abroad 
contact with animal s
immunodeficiency
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5
Q

What are red flag features for a feverish child?

A 
fever >38 if <3m, >39 if 3-6 months 
colour (pale, mottled, cyanosed) 
reduced consciousness 
neck stiffness 
bulging fontanelle 
status epilepticus 
focal Neuro signs 
seizures 
respiratory distress 
bile-stained vomit 
RASH
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6
Q

How do you manage a febrile child?

A

If not seriously ill: discharge home with paracetamol/ibuprofen
Safety net parents + keep child away from school

If seriously ill: admit to paeds assessment unit, A&E, children ward

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7
Q

What is most of the damage in meningitis caused by=

A

by the host response to infection (i.e. release of inflammatory mediators, recruitment of inflammatory cells, endothelial damage) which causes cerebral oedema, raised ICP, reduced blood flow

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8
Q

what are causatrive organisms for meningitis in neonate -3months old

A

GBS
E coli
Listeria monocytogenes

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9
Q

What are causative organisms in children 1m-6 yrs

A

NSH:

Neisseria meningitides
Strep pneumonia
Haemophilius influenzar

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10
Q

What are causative organisms for BACTERIAL meningitis in children> 6 years

A

Neisseria meningitides

Strep pneumonia

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11
Q

what investigations are appropriate for meningitis

A

Bloods - CRP, WCC, blood culture, coag
Rapid antigen test for meningitis organism
LP

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12
Q

How do you manage bacterial meningitis ‘ at GP

A

IM benzylpenicillin single dose at GP

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13
Q

What are complications of bacterial meningitis

A 
hearing impairment 
vasculitis > CN palsies 
Cerebral infarction 
Subdural effusion 
Hydrocephalus
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14
Q

What must you give to household contacts of meningococcal meningitis

A

ciprofloxacin (or rifampicin)

to eradicate nasopharyngeal carriage

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15
Q

What is the most dangerous cause of viral encephalitis?

A

HSV

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16
Q

How do you treat HSV encephalitis?

A

high dose IV acyclovir

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17
Q

What causes toxic shock syndrome?

A

Toxin from S aureus

Group A strep

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18
Q

What is presentation of TSS?

A

fever >39 degrees
hypotension
diffuse erythematous macular rash

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19
Q

What does the toxin do in TSS

A 
it acts as a SUPERANTIGEN 
causes organ dysfunction 
- mucositis 
- GI dysfunction 
- renal impairment 
- liver impairment 
- clotting abnormality
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20
Q

what antibiotics fro you give for TSS=

A

Ceftriaxone
clindamycin
IVIG

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21
Q

What toxin causes necrotising fascitis

A

Staph a

Group A strep

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22
Q

What is management for necrotising fasciitis

A

surgical emergency
debride all infected tissue
IV fluids
empirical IV antibiotica

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23
Q

what are sx of meningococcal septicaemia?

A

purpuric rash

non-blanching, irregular in size and colour, necrotic centre

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24
Q

What is the most common cause of meningococcal septicaemia

A

group B meningococci

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25
Q

What is eczema herpeticum?

A

widespread vesicular rash resulting in secondary bacvgertial infection > septicaemia

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26
Q

What are herpetic whitlow

A

painful herpetic pustules on fingers, at site of broken ski

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27
Q

What is Kawasaki disease

A

a systemic vasculitis

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28
Q

what is the epidemiology of Kawasaki disease

A

more common in japanese children
6 m to 4 yrs
young infants are more severely affected

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29
Q

What are cardinal fts of Kawasaki

A

CRASH and burn

Conjunctivitis 
Rash 
Adenopathy 
Strawberry tongue 
Hand swelling / erythema / desquamation on hands and feet

Burn - fever difficult to control

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30
Q

WHAT ARE blood markers like in Kawasaki disease

A

high inflamm markers

platelets rise in 2nd week

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31
Q

what occurs to coronary arteries in Kawasaki disease

A

Croronary arteries can be affected

  • aneurysm
  • myocardial ischaemia, sudden death
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32
Q

What is management of Kawasaki disease

A

IVIG
High dose aspirin
corticosteroids, infliximab, plasma exchange

“AEIO”

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33
Q

What are clinical fts of TB like in children

A 
Very non speicfic 
- prolonged fever 
- malaise 
- anorexia 
.- WL 
- lymph node swelling
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34
Q

What are ix for TB in children

A 
Gastric washings on 3 consec mornings (as children swallow sputum
TB clture 
PCR 
tuberulin skin test 
interferon gamma release assay
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35
Q

How do you manage TB in children

A

RIPE
Rifampicin + isoniazid 6 months
pyrazinamide + ethambutol first 2 months

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36
Q

How do you treat bacterial meningitis in hospital if <3m

A

IV amoxicillin + cefotaxime

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37
Q

How do you treat bacterial meningitis in hospital if >3m

A

IV ceftriaxone

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38
Q

How long do you give IV ceftriaxone based on the causative organism?

A

Neisseria 7 days
Strep p 14 days
Haemophilius influenza 10 days

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39
Q

What other drug can you give if CSF in meningitis is very concerning ?

A

Add IV dexamethasone

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40
Q

When must you NEVER give IV dexa in meningitis

A

If meninogococcal septicaemia

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41
Q

What is the most common form of primary HSV in children

A

Gingivostomatitis

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42
Q

How does gingivostomatitis present

A

vesicular lesions on lips, gums, tongue, palate
Progresses to extensive painful ulceration and bleeding
with high fever

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43
Q

What are the causative organisms for hand foot and mouth disease

A

viral (cocksackie A16, enterovirus 71)

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44
Q

Who is hand foot and mouth disease common in

A

children under age of 5

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45
Q

what are symptoms of hand foot and mouth disease

A

low grade fever, malaise
sore throat, N&V, anorexia, irritability

RASH - moth sores (yellow ulcer with red halo on buccal mucosa)
- erythematous macule (flat, discoloured) that progress to grey vesicles ON HAND, FOOT

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46
Q

How do you manage hand foot and mouth disease

A

analgesia (self limiting)

no need to exclude from school

47
Q

Explain spread of chicken pox

A

HIGHLY infectious
spreads via respiratory route
can be caought from someone with shingles

48
Q

Explain when the infectious period is in chicken pox

A

-4 to 5 days around rash

49
Q

What are symptoms of chicken pox

A

200 lesions start on head and trunk
progressing to peripheries

lesions appear as crops of papule, vesicles, with surrounding erythema

itching and scratching
results in permanent depigmented scar

50
Q

How do you manage chicken pox

A

Supportive

  • calamine lotion
  • school exclusion until 5 days from rash onset
51
Q

What are major complications of chicken pox

A

Secondary bacterial infections (staph/Group A strep) > TSS/necrotising fascitis

Encephalitis (good prognosis)

Purpura fulminant

52
Q

What symptoms is chicken pox encephalitis associated with

A

VZV associated cerebellitis

53
Q

What is purpora fulminans

A

disseminated haemorrhage chicken pox

causes loss of large areas of skin by necrosis

54
Q

What viruses cause roseola infantum

A

HHV6, HHV7

55
Q

What are symptoms of roseola infantum?

A

high fever, malaise, generalised macular rash

56
Q

What does human parvovirus B19 cause in derm children (give all names for it=)

A

Erythema infectious

Fifth disease

Slapped cheek syndrome

57
Q

How is P B19 transmitted

A

via respiratory secretions / vertical transmission / infected blood products

58
Q

What is the presentation of erythema infectiosum

A

fever, malaise, headache, myalgia > red cheeks, peri oral pallor (SLAPPED CHEEK)> progresses to lace like rash on trunk, limbs

59
Q

What is the pathological organism causing measles

A

Morbillivirus (pox)

60
Q

How is measles transmitted

A

(via resiratory tract - droplet spread)

61
Q

What are the symptoms of measles

A 
fever, cough, coryza
maculopapular rash (from head to body), may desquamate in second week 
Koplik spots (white spots on mouth)
62
Q

How do you manage measles

A

Notify HPT
Conservative management

Stay away from school for 4 days after rash develops

63
Q

How do mumps spread

A

Through respiratory droplepts

64
Q

What are symptoms of mumps

A

incubation period 2 weeks
fever, malaise, parotitis

PAROTITIS - unilateral, then becomes bilateral

Also have earache and pain when eating / drinking

65
Q

How do you manage mumps

A

Notify HPU

Self limiting

66
Q

How do you diagnose mumps

A

oral swab

67
Q

What are appropriate investigations for suspected Kawasaki

A

FBC, U&E, LFT, CRP, ESR

urine MC&S

Troponin

Echo, ECG

68
Q

What are blood results of Kawasakiu

A

RAISED ALT, platelets, WCC, albumin

69
Q

What are negative effects of Kawasaki on vascular system

A

Aneurysm > rupture, pericardial effusion
Thrombosis > MI > sudden death!!!!
Regurgitation

70
Q

What causes Lyme disease

A

Borrelia burgdorferi

HARD TICKS

71
Q

What are clinical features of lime disease

A

Erythema migrant - erythematous macule that enlarges to form a painless red expanding lesion

Fever, headache, malaise
Myalgia, arthlagia
Lymphadenopathy

72
Q

What are late features of Lyme disease

A

Neuro (encephalitis, neuropathy)
Cardiac (myocarditis)
Joint (arthritis - 50% of patients)

73
Q

How do you diagnose Lyme disease

A

Clinical

ELISA if without erythema migricans > immunoblot

74
Q

How do you manage Lyme disease

A

Doxycycline

75
Q

What vaccine can you give at birth

A

BCG if AT RIsk

76
Q

What are key times for vaccines

A

2m
3m
4m
12m

3y 4m
13yo
18yo

77
Q

What vaccine do you give at 2 m

A

6 in 1
Rotavirus

Men B

78
Q

What vaccine do you give at 3 m

A

6 in 1
Rotavirus
Pneumococcus (PCV)

79
Q

What vaccine do you give at 4m

A

6 in 1

Men B

80
Q

What vaccine do you give at 12 m

A

Hib, Men C
MMR

Booster: pneumococcus, men B

81
Q

What vaccine do you give at 3 y 4m

A

Booster: DTPP

MMR 2nd dose

82
Q

What vaccine do you give at 13years

A

HPV

Booster: DTP

83
Q

What vaccine do you give at 18years

A

Men ACWY

To freshers and all 17/18 yo

84
Q

What is the 6 in 1

A

DTPPHH

Diphteria 
Tetanus 
Pertussis 
Polio 
Hep B 
Hib
85
Q

When do you give 6 in 1 vaccines

A

2m
3m
4m

86
Q

When do you give 6 in 1 boosters

A

3 years 4 months DTPP (diphtheria, tetanus, Polio, Pertusssis)

13 years: DTP (diphtheria, tetanus, pertussis9

87
Q

When do you give MMR

A

1 year

3y 4 m

88
Q

what should you add to treatment plan for meningitis in child who has travelled recently

A

vancomycin

89
Q

when should you add dexamethasone to meningitis tx

A

if >3m AND CSF analysis shows following:

  • purulent CSF
  • WBC >1000
  • raised CSF WBC and protein conc >1g/L
  • bacteria on gram stain
90
Q

what should you organise as discharge and follow up in child who has meningitis

A

review by paediatrician 4-6 weeks post discharge

formal audiological assessment

91
Q

what should YOU NOT FORGET to do as holistic tx when a child has meningitis

A

treat contacts (anyone who had close contact with ptient over past 7 days) with CIPROFLOXACIN

92
Q

what are key components of traffic light system

A 
CARCO 
Colour 
Activity 
Resp 
Circulation and Hydration 
Other
93
Q

what colour places child in RED traffic light system

A

pale, mottled, ashen, blue

94
Q

what activity level places child in RED traffic light system

A

no response to socia

95
Q

what resp places child in RED traffic light

A

grunting
tachypnoea RR >60
moderate/severe chest intrawing

96
Q

what hydration status places child in RED traffic light

A

reduced skin turgor

97
Q

what other features place child in RED traffic light

A 
age <3m &temp >38
non-blanching rash
bulging fontanelle 
neck stiffness 
status epilepticus 
focal neuro signs 
focal seizures
98
Q

what colour places child in YELLOW traffiuc light

A

pallor reported by parent

99
Q

what activity level places child in AMBER. traffic light

A

not responding normally to social cues
no smile
wakes only on prolonged stimulation
decreased activity

100
Q

what resp features place child in AMBER traffic light

A

nasal flaring
tachpynoea (RR>50 if 6-12m, RR>40 if >12m(
ox sat <95
chest crackles

101
Q

what circ/hydration place child in amber traffic light

A 
tachycardia (>160 if <12m, >150 if 12-24m, >140 if 2-5yo) 
CRT >3
dry mucous membranes 
poor feeding 
redu ed urine output
102
Q

what other features place child in amber traffic light

A 
3-6m, temp >39 
fever for >5 days 
rigors
limb swellinng 
non weight bearing limbv
103
Q

how should you manage child in red traffic light

A 
refer urgently to paeds specialisy 
FBC, CRP, blood culture 
urine dip + MC&S 
CXR, LP, serum electrolytes, blood gas 
Consider starting empirical antibiotics
104
Q

how do you manage roseola infantum (HSV6/7)

A

partacetamol or ibuprofen for pain relief

should self resolve

105
Q

how do you treat baby with HIV + motgher

A

ZIDOVUDINE for 6 weeks

106
Q

How do you manage non-bullous neonatal impetigo (non-MRSA vs MRSA)

A

nonMRSA: erythromycin 7 days || MRSA: vancomycin 7 days
HYGENE: 2x daily wash with soap and water

107
Q

How do you manage impetigo in infants/children

A 
fusidic acid (topical) 
oral fluclox / clindamycin
108
Q

how do you prevent impetigo recurrence

A

intranasal mupirocin

109
Q

HOW DO YOU MANAGE staphylococcal scalded skin syndrome

A

hospital admission
IV fluclox
analgesia
emollient for pruritus and tendnerness

110
Q

how do you manage suspected typhoid

A

ceftriaxone +/-azithromycin

111
Q

how do you manage known typhoid

A

ciprofloxacin days 7

112
Q

what are complications of measles

A

Neuro: encephalitis, subacute sclerosing panencephalitis
Resp: pneumonia, otitis media
Other: myocarditis, diarrhoea

113
Q

What are complications of mumps

A
  • hearing loss
  • meningitis, encephalitis
  • orchitis
114
Q

What are complications of rubella

A

arthritis, encephalitis, thrombocytopoenia, myocarditis

Y5 Paediatrics (30 decks)

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