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3 - PAEDS > Infections > Flashcards

Infections Flashcards

1
Q

Main causative organisms of bacterial meningitis for each age category?

A

Neonates - Group B strep, E.coli, listeria

1 month - 6 years - HiB, Neisseria

Adolescents - Neisseria, strep pneumoniae

Uni age - Neisseria, Men A/C/W/Y

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2
Q

What are Kernig’s and Brudzinski’s signs?

A

Kernig = K for Knee, pain on extension of knee with hips flexed

Brudzinski’s = Hips and knees flex when neck flexed

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3
Q

Purpura in a febrile child?

A

Always assume meningococcal sepsis until proven otherwise

Administer IM Ben Pen and refer to hospital immediately for assessment

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4
Q

Contraindications to lumbar puncture?

A

Cardiorespiratory instability
Raised ICP - focal neurology, coma, papilloedema
Coagulopathy
local site of infection

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5
Q

CSF results in LP for bacterial meningitis

A

Cloudy/turbid appearance
Protein high (>1g/L)
Glucose low
Cells - neutrophils

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6
Q

LP CSF results for viral meningitis?

A

Clear appearance
Protein normal/raised
Glucose normal
Cells - lymphocytes

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7
Q

Management of bacterial meningitis?

A

IM Ben Pen in Primary care

IV Cefotaxime + Ceftriaxone
+ IV Dexamethasone to reduce ICP and neurological sequelae

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8
Q

Criteria for needing prophylaxis in bacterial meningitis

A

Family members + close contacts (>4hrs in the same room)

Rifampicin

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9
Q

Most important viral meningitis?

A

Herpes Simplex Virus - associated with hearing loss

Treated with Aciclovir

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10
Q

Difference between sepsis and septicaemia

A

Sepsis = infection + SIRS - systemic inflammatory response syndrome

Septicaemia = specifically an infection of the bloodstream, often co-existing with meningitis (60%)

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11
Q

Causative organisms and Mx of septicaemia?

A

Neonates - Group B strep
Others - Strep pneumoniae

Same Mx as meningitis:
IV Cefotaxime + Ceftriaxone
IM Ben Pen in primary care

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12
Q

Clinical course of Chicken Pox (VZV)

A

Fever, malaise for up to 4 days
rash: popular –> vesicular –> pustule –> crust
Very itchy, covers head neck and trunk

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13
Q

Management of chickenpox

A

Minimise itching - antihistamines and emollients

Avoid contact with pregnant women/neonates/immunocompromised

School exclusion until lesions crusted over

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14
Q

Management of conjunctivitis?

A

Clean eyes with saline/water
Topical Neomycin
if more concerning consider bacterial gonococcal/chlamydia infection (3rd gen Ceph)

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15
Q

Investigations for suspected food allergy?

A

Skin prick test –> -ve test unlikely to be IgE mediated, more likely food intolerance

RAAST test - measures circulating levels of IgE

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16
Q

Which food allergies persist and which resolve?

A

Cow’s milk and egg - typically resolves over time

Nuts and seafood - usually persists into adulthood

17
Q

Clinical features of Infectious mononucleosis (IM)/EBV / glandular fever

A

low grade fever, prolonged malaise
sore throat and tonsillar enlargement
fatigue potentially persisting for several months

EBV associated with Burkitt’s lymphoma

18
Q

Investigations of IM

A

Monospot test

heterophile antibodies specific to EBV

19
Q

Clinical course of Kawasaki disease

A

Fever >5 days - typically >39 degrees
Conjunctivitis
Widespread polymorphous rash
Red cracked lips, dry inflamed (strawberry) tongue
Unilateral cervical lymphadenopathy
Swelling and desquamation of hands and feet

Acute phase 1-2 weeks, sub-acute 2-8 weeks

20
Q

Management of Kawasaki Disease

A

Admit for support + monitoring of cardiac complications
Echocardiogram at diagnosis, in 2nd week and 2 months after diagnosis

IV immunoglobulin to cause defervescence
High dose Aspirin initially, then low dose for 8 weeks

21
Q

Investigations in Kawasaki disease

A

FBC - show marked rise in platelets in 2nd/3rd week - up to 1000 x 10^9
Serum ESR and CRP ^^

22
Q

Cause and clinical course of Measles

A

Paramyxovirus infection
2 week incubation

Cough + conjunctivitis, coryza
Koplik’s spots - white dots on Buccal mucosa (pathognomonic)
Morbilliform rash - red macular lesions 2-10mm

23
Q

Investigations in Measles infection

A

Measles specific immunoglobulin M (IgM)

24
Q

Management for measles

A

Viral, self limiting infection - supportive - antipyretics

Consider vitamin A supplementation

25
Q

Presentation of peri-orbital/orbital cellulitis?

A

Red, swollen eyes, eyelid oedema
Chemosis
Decreased acuity, proptosis, external ophthalmoplegia and temp >37.5 suggestive of orbital cellulitis

26
Q

Investigations in peri-orbital cellulitis

A

Clinical examination - check afferent pupillary reflex
CT sinus and orbits with contrast
Bloods - WCC^, cultures often negative
Serology of sinus/nasal swabs

27
Q

Management of peri-orbital cellulitis

A

Treat as orbital until proven otherwise
Broad spec Abx:
PO co-amoxiclav or IV Ceftriaxone

Orbital = IV cefotaxime + flucloxacillin + metronidazole

28
Q

What are the 3 AIDs defining infections?

A

1) Lymphocytic interstitial pneumonitis
2) Pneumocystitis carinii pneumonia (PCP)
3) Candida oesophagitis

29
Q

What alterations to the immunisation schedule should be made for children with HIV?

A

Schedule should remain the same EXCEPT -
Remove all live vaccines:
BCG, MMR, live Polio vaccine

Consider additional vaccination for influenza, Hep A/B and VZV

30
Q

How should delivery in an HIV +ve mother be managed

A

ART therapy antenatal/intrapartum/postnatal

C-section to avoid labour and birth canal
Avoid breastfeeding

31
Q

Cause and clinical course of Rubella

A

Rubivirus togaviridae

low grade fever, headache, sore throat, coryza
Forchheimer spots - petechiae on soft palate
Pink rash - similar to measles rash but less intense

32
Q

Investigations for Rubella

A

Serology/PCR is gold standard

33
Q

Management of Rubella

A

Keep away from pregnant women (congenital rubella syndrome), neonates, immunocompromised

Self-limiting, supportive
Avoid aspirin - Reye’s syndrome (encephalopathy)
School exclusion for 4 days after onset of rash

3 - PAEDS (13 decks)

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