Infections

Question 1

What is Tonsillitis?

Answer 1

A form of Pharyngitis where intense inflammation of the tonsils leads to a purulent exudate

Question 2

What are some of the common causative pathogens of Tonsillitis?

Answer 2

Group A Strep

Epstein-Barr Virus

Question 3

What are some symptoms of Tonsillitis?

Answer 3

Headache
Apathy
Abdominal Pain
Painful Swallow
White Tonsillar exudate
Cervical Lymphadenopathy

Question 4

Which diagnostic criteria can be used to assess the severity of Tonsillitis?

Answer 4

Fever-Pain

CENTOR

Question 5

What are the criteria for Fever-Pain?

Answer 5

Fever
Absent Cough
Symptom onset <3d ago
Inflamed Tonsils
Tonsillar Exudate

Question 6

What does a Fever-Pain of 1 suggest?

Answer 6

Abx are not indicated

Question 7

What does a Fever-Pain of 2-3 suggest?

Answer 7

Consider delayed Abx script

Question 8

What does a Fever-Pain of 4-5 suggest?

Answer 8

Antibiotics are indicated

Question 9

What are the criteria for CENTOR?

Answer 9

Fever
Tonsillar Exudate
Absent Cough
Anterior Cervical Lymphadenopathy
Age 3-14

Question 10

Which CENTOR score suggests treatment with Abx is necessary?

Answer 10

3 or more

Question 11

Which Antibiotic should be given if required for Tonsillitis?

Answer 11

Penicillin V

Erythromycin if Penicillin allergic

Question 12

When should children be referred for a tonsillectomy?

Answer 12

If they present with recurrent tonsillitis

Question 13

What are some indications for a tonsillectomy?

Answer 13

Recurrent severe tonsillitis
Presence of a Peritonsillar Abscess (Quinsy)
Obstructive Sleep Apnoea

Question 14

What are some clinical features of a Measles infection?

Answer 14

Rash
Conjunctivitis and Coryza
Koplik Spots
Fever
Marked malaise

Question 15

How does the rash present in Measles?

Answer 15

Discrete Maculopapular rash which becomes blotchy and confluent. Starts initially behind the ears, spreads to the entire body

Question 16

What are Koplic spots?

Answer 16

White spots found on Buccal Mucosa, Pathognomic for Measles

Question 17

How should a confirmed Measles case be managed?

Answer 17

Supportive

Question 18

What are some complications of a Measles infection?

Answer 18

Respiratory - Pneumonia, secondary infection
Neuro - Seizures, Encephalitis
Other - Diarrhoea, Hepatitis, Appendicitis

Question 19

When does a Mumps infection usually present?

Answer 19

Winter and Spring Months

Question 20

What are some features of a Mumps infection?

Answer 20

Fever
Malaise
Parotiditis
Earache/Pain when E+D

Question 21

How severe is a Mumps infection usually?

Answer 21

Mild, self-limiting

Question 22

What are some potential complications of a Mumps infection?

Answer 22

Viral Meningitis and Encephalitis
Orchitis
Hearing loss - Unilateral, transient

Question 23

What is Rubella?

Answer 23

A mild disease in childhood that usually presents in winter and spring

Question 24

Which patients have to be particularly wary of a Rubella infection?

Answer 24

Pregnant women, as there are risks to the Fetus

Question 25

How does Rubella present?

Answer 25

Maculopapular rash initially of the face, then spreading to the entire body
Prominent lymphadenopathy

Question 26

How should a Rubella infection be managed?

Answer 26

Supportive

Question 27

What are some potential complications of a Rubella infection?

Answer 27

Arthritis
Encephalitis
Thrombocytopenia
Myocarditis

Question 28

When do children recieve the MMR vaccine?

Answer 28

First Dose - 1y

Second Dose - 3y 4m

Question 29

What is Acute Epiglottitis?

Answer 29

Swelling of the epiglottis and surrounding tissues

Question 30

Which organism is responsible for Acute Epiglottitis?

Answer 30

H.Influenza B

Question 31

When is acute epiglottitis most common?

Answer 31

1-6y

Question 32

What are some signs of potential acute epiglottitis?

Answer 32

High fever in a very ill, toxic-looking child
Intensely painful throat that prevents speaking or swallowing
Drooling of saliva down chin
Inspiratory stridor with increasing respiratory difficulty
Child sitting immobile and upright with an open mouth to optimise airway
Minimal/absent cough

Question 33

Why shouldn’t you examine the throat of a child with suspected Epiglottitis?

Answer 33

This can lead to acute oedema, giving airway obstruction and death

Question 34

How should acute epiglottitis be managed?

Answer 34

ENT management
Intubation under GA
Blood Cultures
IV Cefotaxime
Prophylactic Rifampicin for close household contacts