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Year 4 Paediatrics > Infections and Immunity > Flashcards

Infections and Immunity Flashcards

1
Q

In paediatrics, what is pyrexia?

A

A temperature of 38 degrees celsius

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2
Q

In infants of under 3 months, a fever of what is a red flag feature?

A

38 degrees

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3
Q

In children 3-6 months old, a fever of over what is an amber flag feature?

A

39 degrees

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4
Q

What is the recommended method of taking a temperature in babies/children?

A

A thermometer probe in the axilla/tympanic

severe hypothermia need to know a core temperature - indicates for a rectal thermometer

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5
Q

Why does fever matter? (5)

A
  1. May indicate a severe infective cause
  2. Fever is the body’s way of trying to reduce pathogens
  3. Febrile convulsions
  4. Dehydration
  5. Rigors
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6
Q

What % of children attending hospital have a fever?

A

20% - very few have sepsis

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7
Q

What is a febrile convulsion?

A
  1. A febrile convulsion is caused by a rapid rise in temperature, usually at the beginning of an infection
  2. Unconscious
  3. Generalised tonic clonic seizure
  4. In children 6 months to 6 years
    - beyond 6 years this is not often seen
  5. Sleepy afterwards (post-ictal)
  6. Typical or atypical
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8
Q

What % of children have febrile convulsions?

A

2-5%

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9
Q

What is a rigor?

A
  1. Conscious levels are not affected with rigors - they should remain alert
  2. Shivering vigorously due to hot core temperature
  3. Any age
  4. Not usually sleepy afterwards
  5. May go blue around lips, hands, legs
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10
Q

What duration of febrile convulsion is classed as typical as opposed to atypical?

A

Up to 15 minutes is typical

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11
Q

What other features of febrile convulsions are classed as atypical? (3)

A
  1. Duration >15 minutes
  2. More than one in the same illness
  3. Focal signs or symptoms (e.g. right sided fit, or abnormal neurology on examination - residual weakness, Todd’s paralysis)
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12
Q

Why is it important to determine in febrile convulsions are typical or atypical?

A

Atypical febrile convulsions indicate a higher risk of epilepsy

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13
Q

What is the risk for developing epilepsy in the normal population?

A

1%

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14
Q

What are the risk factors for developing epilepsy? (3)

A
  1. Atypical febrile seizures
  2. Abnormal neurology/neurodevelopment prior to event
  3. Family history of 1st degree relative with epilepsy
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15
Q

What is the % risk of epilepsy in someone with two or more risk factors?

A

10%

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16
Q

What is the % risk of having another simple febrile convulsion after experiencing one?

A

30%

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17
Q

What/which antipyretics work?

A

Stay hydrated, paracetamol/ibuprofen, cool room

Sponge/cool cloth, wrapping up warm, ice baths do not work

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18
Q

What are the NICE guidelines for children with pyrexia with no symptoms?

A

They do not need paracetamol/ibuprofen

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19
Q

If the child has a fever with symptoms, what can be given?

A

Calpol/nurofen

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20
Q

Do paracetamol/ibuprofen work in children with febrile convulsions?

A

There is no evidence to suggest they work in febrile convulsions

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21
Q

What are the causes of fever in children? (13 - think systems)

A
  1. Viral URTI
  2. LRTI/pneumonia (viral or bacterial)
  3. Otitis media
  4. Viral gastroenteritis
  5. Tonsilitis
  6. Chicken pox
  7. Appendicitis
  8. UTIs
  9. Osteomyelitis
  10. Unknown - PUO
  11. Meningitis
  12. Kawasaki’s
  13. Others - malignancy, rheumatological
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22
Q

What signs/symptoms/observations are worrying in a child with fever? How may they look unwell? (15)

A
  1. Pale/mottled/ashen/blue
  2. No response to social cues
  3. Appears ill
  4. Does not wake
  5. Weak, high-pitched or continuous cry
  6. Grunting
  7. Recessions
  8. Reduced skin turgor
  9. Temp >38 if 0-2 months
  10. Non-blanching rash
  11. Neck stiffness
  12. Bonding fontanelle (up until 12 months)
  13. Focal seizures
  14. Status epilepticus
  15. Tachypnoea
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23
Q

What is Kawasaki’s disease/how is it diagnosed?

A

Fever - at least 5 days in duration
In the presence of 4 of:
1. Changes in extremities (desquamation (peeling of the skin), erythema, oedema)
2. Bilateral conjunctivitis (non purulent)
3. Rash
4. Cervical lympadenopathy
5. Changes in lips/oropharynx/cracked lips/strawberry tongue

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24
Q

Why is it important not to miss Kawasaki’s?

A

It causes a vasculitis, with a risk of cardiac aneurysms

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25
Q

What is a differential diagnosis for Kawasaki’s?

A

Scarlett fever

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26
Q

What is the treatment for Kawasaki’s?

A

High dose aspirin

IV immunoglobulins

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27
Q

What are the causes of a non-blanching rash?

A
  1. Meningitis

2. Meningococcal septicaemia

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28
Q

What are the signs/symptoms of meningitis? (2)

A
  1. Photophobia
  2. Neck stiffness
    (unlikely to have a rash)
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29
Q

What is the specific sign/symptoms that distinguishes meningitis from meningococcal septicaemia?

A

A rapidly spreading purpuric rash

may or may not also have meningitis

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30
Q

What is the treatment for meningitis/meningococcal septicaemia?

A

IM penicillin V

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31
Q

What causes a non-blanching rash? - what is it?

A

Blood under the skin - does not disappear when pressed and looks dark red/purple

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32
Q

What is the difference between a petechial spot and purpura?

A

The size is the difference; purpura is larger (2mm - 10mm) in size whereas petechiae is a pin prick size (up to 2mm)

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33
Q

What is ecchymosis?

A

Greater than 10mm in size

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34
Q

What are the other causes of purpura?

A
  1. Bleeding/clotting disorders -
    TTP/ITP (thrombocytopenic purpura)
  2. Henoch-Schönlein purpura (these children will otherwise be completely well, compared to meningococcal septicaemia)
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35
Q

A 3 week old baby girl with a temperature of 39 degrees, crying and irritable and feels hot. What is the immediate assessment?
The baby has a bulging fontanelle, a cap refill of 4 seconds, a heart rate of 180/min, a low blood pressure and is mottled. What are the differentials?

A

ABCDE
- Meningitis (infants are believed to have a less effective blood brain barrier, therefore infections are more likely to cause meningitis)

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36
Q

What septic screen should be done in a child with suspected meningitis?

A
  1. Clean catch urine sample
  2. CXR
  3. Blood cultures
  4. LP - if well enough to tolerate (contraindicated if multiple signs of raised ICP)
  5. Viral nose swabs
  6. Clotting - fear of sepsis/DIC
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37
Q

What is Kernig’s sign?

A

Flexion of the knee and then start extending - if it causes pain in the hamstring

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38
Q

What can a raised red cell count in CSF indicate?

A

A sub-arachnoid haemorrhage

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39
Q

What is brudinski’s sign?

A

Flex the neck and there will be flexion of the hip/knee

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40
Q

How do causes of meningitis differ between neonates and children?

A 
The causes of meningitis in neonates are most commonly:
1. E.coli
2. Group B strep
3. Listeria
The causes of meningitis in children are: 
1. Viral
2. Meningococcal
3. Pneumococcal
4. TB (very rare)
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41
Q

What is the difference in treatment of bacterial meningitis between neonates and children in terms of NICE recommendations?

A

In older children with steroids - dexamethasone

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42
Q

What are the normal findings of neutrophils and lymphocytes in CSF results of neonates and babies >1 month old?

A

0 neutrophils for both
<5 in greater than 1 month old
<11 in neonates

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43
Q

What are the complications of untreated meningitis? (4)

A
  1. Cerebral palsy in <2 years
  2. Deafness
  3. Epilepsy
  4. Coning and death
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44
Q

What are the risk factors for sepsis in a birth history?

A

Prolonged labour
Prolonged pre-rupture of membranes
Maternal pyrexia
Group B strep

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45
Q

Who receives prophylaxis for a baby with meningitis/meningococcal septicaemia?

A

Any one who has kissed the baby / close contact

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46
Q

What are the differentials for a child with a fever and a rash? (9)

A
  1. Measles
  2. Rubella
  3. Scarlet fever
  4. Hand, foot and mouth disease
  5. Chicken pox
  6. Meningococcaemia
  7. Kawasaki’s
  8. Fifth disease
  9. Roseola
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47
Q

What are the differentials for a child with an acute fever? (9)

A
  1. URTI
  2. Tonsilitis
  3. Otitis media
  4. Nonspecific viral infections
  5. Pneumonia
  6. Meningitis
  7. UTIs
  8. Septic arthritis
  9. Non-infectious causes
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48
Q

What are the differentials for a fever with a swelling in the neck?

A
  1. Cervical adenitis
  2. Infectious mononucleosis
  3. Mumps
  4. Thyroiditis (often no fever)
  5. Mastoiditis
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49
Q

What are the three ‘C’s (symptoms) associated with measles?

A

Coryza
Conjunctivitis
Cough

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50
Q

What is the differential diagnosis with suspected tonsillitis?

A

Infectious mononucleosis (glandular fever)

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51
Q

How does glandular fever present?

A
  1. Marked cervical lymphadenopathy
  2. Fever
  3. Sore throat
  4. Enlarged purulent tonsils
  5. Macular rash in 10-20% of cases
  6. Splenomegaly can be commonly found
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52
Q

How is glandular fever investigated?

A
  1. FBC with differential white cell count - if the FBC has more than 20% atypical or reactive lymphocytes
  2. Monospot test (in the second week of the illness)
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53
Q

How is glandular fever different to tonsillitis in terms of the sore throat?

A

Glandular fever is usually more severe, lasting longer and up to 60% will have palatal petechiae, with a ‘whitewash’ exudate on the tonsils

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54
Q

How are children under the age of 12 investigated for glandular fever?

A

Instead of the FBC look at the white cell count, arrange blood tests for Epstein-Barr viral serology after the child has been ill for at least 7 days

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55
Q

In addition to a FBC, serology and Monospot test, what other blood test can be performed in suspected glandular fever and will show elevations 2-3 times the upper limit of normal?

A

LFTs - aspartate aminotransferase (AST) and alanine aminotransferase (ALT) will be elevated

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56
Q

What type of lymphadenopathy is most common in glandular fever?

A

Posterior cervical lymphadenopathy

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57
Q

What is the management for glandular fever?

A
  • Paracetamol and ibuprofen
  • Limit spread of the disease: avoid kissing, sharing eating or drinking utensils
  • Avoid contact sports/heavy lifting to reduce the risk of splenic rupture
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58
Q

Which immunisations are given at 8 weeks old? (4 - but 1 of those covers 6 infections)

A
  1. Diphtheria, tetanus, pertussis, polio, haemophilus influenzae type B (Hib) and hep B
  2. Pneumococcal
  3. Meningococcal group B
  4. Rotavirus gastroenteritis
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59
Q

What is the name of the vaccines given at 8 weeks old? (4)

A
  1. Infranix hexa (6 infections covered - DTaP/IPV/Hib/HepB
  2. Prevenar 13 (Pneumococcal)
  3. Bexsero (MenB)
  4. Rotarix (Rotavirus)
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60
Q

Where are the 8 week old immunisations given- which site? (4)

A
  1. Diphtheria, tetanus, polio etc - thigh
  2. Pneumococcal - thigh
  3. MenB - left thigh
  4. Rotavirus - by mouth
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61
Q

At 12 weeks old, which two immunisations are given?

A
  1. Diphtheria, tetanus, pertussis, polio, Hib, hep B
  2. Rotavirus
    (both same name, same site)
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62
Q

At 16 weeks old, which three immunisations are given?

A
  1. Diphtheria, polio, tetanus, pertissus, Hib, hep B
  2. Pneumococcal
  3. MenB
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63
Q

Which immunisation is given in the left thigh (trade name too)?

A

Meningococcal group B - Bexsero

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64
Q

At 12 months old or just after their first birthday, which immunisations are given? (4)

A
  1. Hib and MenC
  2. Pneumococcal
  3. MMR
  4. Men B
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65
Q

What is the trade name for MMR and where is the site of administration?

A

Priorix - upper arm or thigh

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66
Q

At three years, four months old, which immunisations are given? (2)

A
  1. Diphtheria, tetanus, pertussis and polio

2. MMR

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67
Q

In girls aged 12 to 13 years, which immunisation is given?

A

HPV vaccine known as Gardasil

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68
Q

At 14 years old, which immunisations are given? (2)

A
  1. Diphtheria, tetanus and polio

2. Meningococcal disease

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69
Q

In babies born with parents or grandparents from a country of high incidence of TB, which immunisation is given?

A

BCG

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70
Q

What is meningitis?

A

A condition caused by inflammation of the meninges (the outer membranes covering the brain and spinal cord)

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71
Q

How is meningitis different to encephalitis?

A

Encephalitis is the inflammation of the brain tissues itself

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72
Q

What does meningococcal disease refer to?

A

This term refers to either meningococcal meningitis or meningococcal septicaemia

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73
Q

What are the top 3 common causes of bacterial meningitis in children aged 3 months and over, and adults too?

A
  1. Neisseria meningitidis
  2. Streptococcus pneumoniae
  3. Haemophilus influenzae type B (HiB)
    (NHS)
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74
Q

In neonates, what are the most common causative organisms of meningitis? (4)

A
  1. Streptococcus agalactiae
  2. E.coli
  3. Strep. pneumoniae
  4. Listeria monocytogenes
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75
Q

What are the clinical features of meningococcal septicaemia?

A

There is often a short coryza prodrome, followed by fever, malaise, and the development of a purpuric rash/petechial lesions.

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76
Q

What are the signs that are specific to meningitis but not meningococcal septicaemia? (6)

A
  1. Photophobia
  2. Kernig’s sign
  3. Brudzinski’s sign
  4. Paresis
  5. Seizures
  6. Focal neurological deficit including cranial nerve involvement and abnormal pupils
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77
Q

What is Kernig’s sign?

A

Severe stiffness of the hamstrings - when the hip is flexed at 90 degrees, the leg cannot straight

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78
Q

What is Brudzinski’s sign?

A

When lying supine, flexion of the neck consequently causes hip and knee flexion

79
Q

What are the classical signs of meningitis that are often absent in infants with bacterial meningitis? (3)

A
  1. Neck stiffness
  2. Bulging fontanelle
  3. High-pitched cry
80
Q

What are the non-specific symptoms that children with meningitis commonly present with?

A
  1. Fever
  2. Vomiting
  3. Irritability
  4. Upper respiratory tract symptoms
81
Q

As well as presenting symptoms, what are factors are important to take into consideration when querying meningitis?

A
  1. Level of parental/carer concern
  2. How quickly the illness is progressing
  3. Clinical judgement of the overall severity of the illness
82
Q

What is classed as meningococcal disease?

A

Either meningitis with a non-blanching rash OR meningococcal septicaemia

83
Q

In primary care, which drug can be given to someone with suspected meningococcal disease?

A

IM or IV benzylpenicillin (the only contraindication to this is a clear history of anaphylaxis after a previous dose; a history of rash following penicillin is not a contraindication)

84
Q

In secondary care, what is the treatment for a child with a petechial rash with symptoms/signs of meningococcal disease?

A

IV ceftriaxone

85
Q

If a child has a petechial rash with fever, but the diagnosis of meningococcal disease is questionable, which investigations should be carried out? (8)

A
  1. FBC
  2. CRP
  3. Coagulation screen
  4. Blood culture
  5. PCR for N meningitidis
  6. Blood glucose
  7. Blood gas
  8. Lumbar puncture
86
Q

What are the early signs/symptoms of meningococcal septicaemia? (4)

A
  1. Leg pain
  2. Skin mottling
  3. Cold peripheries
  4. Breathing difficulties
87
Q

When does the haemorrhagic rash characteristic with septicaemia tend to appear?

A

Tends to present later in the illness, >12 hours

88
Q

What are the late presentations of septicaemia? (3)

A
  1. Confusion
  2. Seizures
  3. Coma
89
Q

What are the early complications of meningococcal septicaemia?

A
  1. DIC
  2. AKI
  3. Adrenal haemorrhage
  4. Circulatory collapse
90
Q

What are the late complications of meningococcal septicaemia?

A
  1. Deafness
  2. Renal failure
  3. Scarring
  4. Limb amputations (10%)
    (mortality is highest in neonates - they don’t have any reserves)
91
Q

What is the other name for infectious mononucleosis and what causes it?

A

Glandular fever, it is caused b the Epstein-Barr virus (a member of the herpes virus family)

92
Q

How is glandular fever spread?

A

Through contact with saliva, so via kissing, sharing food or drink utensils and children chewing on toys that have been contaminated

93
Q

At what age range do people typically present with acute glandular fever?

A

15 - 24 years

94
Q

What % of children with have detectable EBV antibodies by age 5?

95
Q

What % of people with have EBV antibodies by 25 years old?

A

90%

most these people with have had asymptomatic or subclinical infection

96
Q

Although rare, what are the respiratory complications of glandular fever (infective mononucleosis)?

A

Upper airway obstruction - due to gross enlargement of tonsils or a peritonsilar abscess (quinsy)

97
Q

What are the neurological complications of glandular fever? (5)

A
  1. Encephalitis/aseptic meningitis
  2. Facial nerve palsy
  3. Guillain-Barre syndrome
  4. Brachial plexus neuropathy
  5. Hemiplegia
98
Q

What are the haematological complications of glandular fever? (3)

A
  1. Mild thrombocytopenia (25-50%)
  2. Mild neutropenia (common and self-limiting, however if it is severe neutropenia this can lead to neutropenic sepsis, pneumonia and death)
  3. Autoimmune haemolytic anaemia
99
Q

In 90% of people with glandular fever, what will the LFTs be like?

A

Abnormal - with AST (aspartate aminotransferase) and ALT (alanine aminotransferase) elevated to 2-3 times the upper limit of normal (typically this abnormality peaks at 2 weeks of the illness and normalises by 3-4 weeks)

100
Q

What are the 3 main features of glandular fever?

A
  1. Fever (90% of people)
  2. Lymphadenopathy (100%) - typically posterior cervical lymphadenopathy (however can be anywhere including inguinal and axillary)
  3. Sore throat (90%) - this is usually severe
101
Q

What are the features of the sore throat in glandular fever? (3)

A
  1. Tonsillar enlargement (91%) - the tonsils may meet in the midline
  2. Whitewash exudate on the tonsils
  3. Palatal petechiae (60%) (1-2mm diameter, crops lasting 3-4 days)
102
Q

In addition to the three common presenting features, what are clinical features may support a diagnosis of glandular fever?

A
  1. Prodromal symptoms such as general malaise, fatigue, myalgia, chills, sweats, anorexia, retro-orbital headache
  2. Splenomegaly (up to 50%)
  3. Hepatomegaly
  4. Non-specific widespread rash that presents after being treated with amoxicillin
  5. Jaundice
103
Q

In children younger than 12, what is the investigation for suspected glandular fever?

A

Arrange blood tests for EBV viral serology after the person has been ill for 7 days

104
Q

If the EBV viral serology comes back as negative, what other tests should be considered? (2)

A
  1. Cytomegalovirus

2. Toxoplasmosis

105
Q

In children over the age of 12, what are the investigations that should be carried out?

A

Arrange a FBC with differential WCC and a Monospot test in the second week of the illness

106
Q

If there are clinical features of glandular fever but what EBV serology comes back as negative, what may be important to do?

A

Repeat the test 7 days later

107
Q

What in the full blood count will indicate it is glandular fever?

A

If the FBC has more than 20% atypical or ‘reactive’ lymphocytes OR more than 10% atypical lymphocytes and the lymphocyte count is more than 50% of the total WCC

108
Q

What are the differential diagnoses for glandular fever? (9)

A
  1. Streptococcal sore throat
  2. Leukaemia
  3. CMV
  4. Acute toxoplasmosis
  5. Acute viral hepatitis
  6. Primary HIV infection
  7. Rubella
  8. Roseola
  9. Mumps
109
Q

What are the differences in presenting features between glandular fever and strep. throat?

A

In streptococcal throat, lymphadenopathy is usually anterior as opposed to posterior.
Splenomegaly is not typical and fatigue is less prominent.

110
Q

What is the management for glandular fever? (5)

A
  1. Paracetamol/ibuprofen
  2. Explain expected course of illness - 2-3 weeks, tiredness is common and lasts longer than other symptoms
  3. Return to normal school/work and avoid kissing etc.
  4. Avoid heavy contact sports or lifting due to risk of splenic rupture
  5. Safety netting - seek urgent medical attention if develop stridor, have difficulty swallowing, become systemically unwell or have severe abdominal pain
111
Q

What causes scarlet fever?

A

Streptococcus pyogenes (also known as group A streptococcus)

112
Q

What age range is most common time for scarlet fever to occur?

A

2-8 years, with peak being 4 years of age

113
Q

Scarlet fever is seasonal, when are most cases likely to occur?

A

In the winter and spring months

114
Q

What are the characteristic clinical features of scarlet fever? (3)

A
  1. Sore throat
  2. Fever
  3. Extensive, red, sandpaper-like rash
115
Q

Although rare, what are the suppurative complications of scarlet fever? (7)

A
  1. Otitis media
  2. Throat infection
  3. Acute sinusitis/mastoiditis
  4. Streptococcal pneumonia
  5. Meningitis cerebral abscess
  6. Endocarditis, osteomyelitis, liver abscess
  7. Necrotising fasciitis and streptococcal toxic shock syndrome
116
Q

When are the suppurative complications of scarlet fever most likely to occur?

A

In the beginning of the illness

117
Q

What is a food allergy?

A

A food allergy describes an adverse immune-mediated response, which occurs when a person is exposed to specific food allergens.

118
Q

What are the different classes of food allergy?

A
  1. IgE-mediated
  2. Non-IgE-mediated
  3. Mixed IgE and non-IgE-mediated
119
Q

What happens with an IgE-mediated food allergy?

A

This follows exposure and sensitization to trigger food allergens with the development of serum-specific IgE antibody. It produces immediate and consistently reproducible symptoms which may affect multiple organs including the skin, GI tract, respiratory, CV and neurological systems.

120
Q

What is a non-IgE-mediated food allergy?

A

Involves a cell-mediated mechanism, such as food protein-induced enterocolitis syndrome which tends to occur in young children and presents with GI symptoms such as vomiting with or without diarrhoea, abdominal cramps, colic and sometimes faltering growth

121
Q

What is cows’ milk protein allergy?

A

It is an immune-mediated allergic response to proteins in milk - milk contains casein and whey fractions, each of which have five protein components, and a person can be sensitized to one or more of these components.

122
Q

What are the different classifications of cows’ milk protein allergy?

A
  1. IgE-mediated reactions
  2. Non-IgE-mediated reactions
  3. Mixed
123
Q

How does an IgE-mediated cows’ milk protein allergy present?

A

Reactions are acute and frequently have a rapid onset. They occur up to 2 hours after ingestion of cows’ milk and most commonly within 20-30 minutes

124
Q

How does a non-IgE-mediated cows’ milk protein allergy present?

A

The reaction is generally delayed and non-acute. They manifest up to 48 hours or even 1 week after ingestion of cows’ milk protein

125
Q

What does food sensitization mean?

A

It describes the production of serum-specific IgE antibodies to food allergens, without the clinical symptoms of an allergic reaction on food exposure

126
Q

What is a food intolerance?

A

It is a non-immune adverse reaction to food and/or food additives which are distinct from food allergy. They often present non-specifically with GI upset, headache, fatigue, and MSK symptoms. Typically there is a delay in symptom onset and a prolonged symptomatic phase. The cause is unknown but they may be due to enzyme deficiencies or pharmacological reactions to chemicals such as caffeine or tyramine.

127
Q

What are the most common food allergens? (7)

A
  1. Cows’ milk
  2. Hens’ eggs
  3. Peanuts and other legumes (soybean, pea and chickpea)
  4. Tree nuts (walnuts, almonds, hazelnuts, pecan, cashews, pistachio, brazil nuts)
  5. Crustacean shellfish and fish
  6. Wheat
  7. Celery, mustard, sesame, lupine, molluscan shellfish
128
Q

What are the common raw food allergens for oral allergy syndrome?

A
  1. Birch pollen - apple, pear, peach, plum, cherry, apricot, carrot, celery, parsley, almond, hazelnut
  2. Timothy grass - swiss chard, orange
129
Q

What is oral allergy syndrome?

A

AKA pollen-food syndrome, describes a localised food allergy which may occur due to cross-reactivity between aeroallergens, such as birch pollen, fresh vegetables, fruits and nuts

130
Q

What are the risk factors for developing a food allergy? (4)

A
  1. Presence of a known food allergy increases the likelihood of additional food allergies
  2. Known atopic eczema - severe eczema below the age of one year is associated with the development of egg, milk, and peanut allergy
  3. Family history of food allergy
  4. Family history of atopy
131
Q

What % of children and adults have a primary nut allergy respectively?

A

2% of children and 0.5% of adults

132
Q

What % of infants and adults respectively have an egg allergy?

A

2% infants and 0.1% adults

133
Q

What are the complications of food allergies? (3)

A
  1. Severe and life-threatening reactions (food allergy is the most common trigger of anaphylaxis in community)
  2. Stress and anxiety
  3. Reduced quality of life (dietary restrictions, impact on social interactions)
134
Q

Many children outgrow their food allergy, however which food allergies are most likely to persist? (4)

A
  1. Peanuts
  2. Tree nuts
  3. Fish
  4. Shellfish
135
Q

Which factors may increase the likelihood of a severe food allergy? (4)

A
  1. History of asthma (especially if it is poorly controlled)
  2. A history of atopy
  3. History of previous systemic allergic reactions
  4. Allergy to the food classes of peanut, tree nuts, fish and shellfish
136
Q

What systemic clinical features would indicate a suspected IgE-mediated food allergy? (8)

A

Systemic features (life-threatening anaphylaxis) -

  1. Respiratory distress
  2. Severe wheezing
  3. Hypotension
  4. Bradycardia
  5. Drowsiness
  6. Confusion
  7. Collapse
  8. LOC
137
Q

What clinical features of the skin would suggest an IgE-mediated food allergy? (5)

A
  1. Urticaria
  2. Angioedema (lips, face, around the eyes)
  3. Erythema
  4. Generalised itching
  5. Flushing
138
Q

What are the gastrointestinal features that would suggest an IgE-mediated food allergy? (4)

A
  1. Nausea
  2. Vomiting
  3. Diarrhoea
  4. Abdominal pain
139
Q

What are the respiratory features of an IgE-mediated allergic reaction to food? (9)

A
  1. Persistent cough
  2. Hoarseness
  3. Wheeze
  4. Breathlessness
  5. Stridor
  6. Nasal discharge
  7. Congestion
  8. Itching
  9. Sneezing
140
Q

What are the symptoms of oral allergy syndrome?

A

Typically mild;

  1. Transient localised urticaria
  2. Tingling, itching and swelling of the lips, tongue and throat
  3. Co-morbid allergic rhinitis symptoms after ingestion of fresh fruit and vegetables
141
Q

What is important to ask in the history of someone with suspected food allergy?

A
  1. Causal food or foods
  2. The symptoms, frequency, speed of onset, duration, timing of the reaction in relation to the suspected allergen exposure
  3. Form of the food e.g. raw, semi-cooked, baked and quantity of the food
  4. Setting of the reactions
  5. Age when started
  6. Co-morbid atopic conditions
142
Q

When examining someone with a suspected food allergy, what is important to do?

A

Nutritional status - weight, height and BMI

and any signs of clinical reaction, co-morbid conditions e.g. eczema, asthma

143
Q

What investigations should be arranged for someone with suspected food allergy? (2)

A
  1. Skin prick testing

2. Serum-specific IgE allergy testing

144
Q

What are the differentials for an IgE-mediated food allergy? (4)

A
  1. Acute spontaneous urticaria and angioedema (often a viral infection, no trigger)
  2. Carcinoid syndrome
  3. Food intolerance (should be suspected if delay in symptom onset and prolonged symptoms
  4. Food poisoning
145
Q

In addition to food allergies, what are the other causes of anaphylaxis? (5)

A
  1. Stings (wasp, bee etc)
  2. Antibiotics
  3. Anaesthetic drugs e.g. suxamethonium, vecuronium, atracurium
  4. Contrast media
  5. Othes (rarely), hair dye, latex
146
Q

Which allergy causes death most rapidly from contact?

A

IV/injected drugs

147
Q

How long does it take for a food reaction to cause respiratory arrest?

A

30-35 minutes

148
Q

What are the ABCDE problems associated with anaphylaxis?

A

A - airway swelling, hoarse voice, stridor
B - SOB, wheeze, exhaustion due to tachypnoea, confusion due to hypoxia, cyanosis, respiratory arrest
C - shock (pale and clammy), tachycardia, hypotension, LOC, cardiac arrest
D - neurological status change due to decreased brain perfusion
E - urticaria, erythema, mucosal changes - angioedema

149
Q

What are the differentials for anaphylaxis?

A
  1. Faint
  2. Panic attack
  3. Breath-holding episode in children
  4. Idiopathic urticaria
150
Q

What is the management of someone in anaphylactic shock?

A
  1. Recognise patient is seriously unwell
  2. Call for help immediately
  3. ACBDE assessment (give high-flow oxygen!)
  4. Adrenaline IM 1:1000 (repeat after 5 minutes if no better)
  5. IV fluid challenge
  6. Chlorphenamine (antihistamine)
  7. Hydrocortisone
151
Q

What is the dose for adrenaline in anaphylaxis based on ages?

A

Adult = 500mcgs IM (0.5mls)
Child >12 = 500 mcgs IM
Child 6-12 = 300mcgs IM (0.3mls)
Child <6 = 150mcgs IM (0.15mls)

152
Q

What is the appropriate IV fluid challenge for a child with anaphylaxis?

A

Crystalloid 20ml/kg

153
Q

How does adrenaline work to treat anaphylaxis? (its effects on alpha and beta receptors?)

A
  1. Adrenaline eases breathing difficulties and restores adequate cardiac output.
  2. It is an alpha-receptor agonist, it reverses peripheral vasodilation and reduces oedema.
  3. Its beta-receptor activity dilates the bronchial airways, increases the force of myocardial contraction and suppresses histamine and leukotriene release
154
Q

Where does an IM adrenaline injection need to be given in anaphylaxis?

A

The anterolateral aspect of the middle third of the thigh - needle must be long enough to access the muscle

155
Q

In addition to the drugs in the anaphylaxis pathway (adrenaline, antihistamine, steroid) what else can be considered? (by a specialist) (2)

A
  1. Bronchodilators

2. Cardiac drugs e.g. vasopressin, glucagon, atropine

156
Q

If someone has a suspected food allergy but not anaphylaxis, what is the management for them?

A

Refer to an allergy specialist for further assessment and management. The urgency of this depends on the clinical features/judgement

157
Q

If food allergy tests do not correspond with the clinical history, what is the gold standard test for diagnosis of a food allergy?

A

Oral food challenge - performed under medical supervision. It involves increasing quantities of the food allergen, starting with direct mucosal exposure (allergen contact with the lips) and then titrated oral ingestion as tolerated. If symptoms are not provoked, the test is negative and clinical allergy can be excluded

158
Q

At eight weeks old, which immunisations are given/recommended to be given to all babies in the UK? (9)

A
  1. Diphtheria
  2. Tetanus
  3. Pertussis
  4. Polio
  5. Haemophilus influenzae type b
  6. Hepatitis B
  7. Pneumococcal
  8. Meningococcal group B
  9. Rotavirus gastroenteritis
159
Q

At 12 weeks old, which vaccinations are recommended in the UK? (7)

A
  1. Diphtheria
  2. Tetanus
  3. Pertussis
  4. Polio
  5. Hib
  6. Hepatitis B
  7. Rotavirus
160
Q

At 16 weeks old, which vaccinations are recommended to be given in the UK? (8)

A
  1. Diphtheria
  2. Tetanus
  3. Pertussis
  4. Polio
  5. Hib
  6. Hep B
  7. Pneumococcal
  8. Men B
161
Q

At one year old, which vaccinations are recommended to given in the UK? (5)

A
  1. Hib
  2. MenC
  3. Pneumococcal
  4. MMR
  5. MenB
162
Q

Which vaccination is given seasonally in children aged 2 - 8 years old?

A

Live attenuated influenza vaccine

163
Q

Which two vaccinations are given at 3 years, 4 months old?

A
  1. Diphtheria
  2. Polio
  3. Tetanus
  4. Pertussis
  5. MMR
164
Q

Which vaccination is given to girls aged 12-13 years old?

A

HPV (two doses, 6-24 months apart) - protecting against cervical cancer, and genital warts)

165
Q

Which vaccinations are given to children aged 14 (school year 9)? (4)

A
  1. Tetanus
  2. Diphtheria
  3. Polio
  4. Meningococcal groups A, C, W, and Y
166
Q

Why is it important to receive the haemophilus influenzae type B (Hib) vaccine?

A

It is responsible for causing meningitis, epiglotitis and bacteraemia

167
Q

What advice is important to give to parents/carers of children younger than 1 receiving vaccinations? (5)

A
  1. Explain the benefits of vaccination - prevents serious illness in children, e.g. meningitis, whooping cough, tetanus
  2. Reassure vaccinations are safe - pain, reddening at site of injection are common and systemic effects are usually limited to mild fever
  3. Infranix vaccine contraindicated in children with hypersensitivity to neomycin, polymyxin and polysorbate 80
  4. If the MenB vaccine is given advise calpol as soon as possible after the vaccination, then 4-6 hours after the first dose
  5. Offer written information - public health england leaflets, or NHS choices website
168
Q

Which vaccinations are associated with egg proteins and therefore what is the advise for those with egg allergies?

A

MMR - the BNF says it is safe to given to a child with egg allergy, even if they have had anaphylaxis, as it contains minimal egg protein (if any)
Influenza vaccine - if a person has had an anaphylactic reaction to egg before, then avoid, but if only minor, then should be safe, as it contains very small amounts of egg protein

169
Q

What are the rare complications of chickenpox? (4)

A
  1. Pneumonia
  2. Encephalitis
  3. Disseminated haemorrhagic chickenpox
  4. Arthritis, nephritis, and pancreatitis
170
Q

What is another term used to described molluscum contangoisum?

A

Pox disease

171
Q

What type of arthritis often follows a bacterial infection - commonly of GI or GU origin?

A

Reactive arthritis - common organisms include shigella, salmonella

172
Q

What is the name of the syndrome when children with sickle cell disease can present with tender swelling of the hand, wrists and feet. With such episodes being precipitated by stress of cold.

A

Hand-foot-syndrome

173
Q

What are the three types of juvenile idiopathic arthritis?

A
  1. Monoarticular- single joint
  2. Pauciarticular - <4 joints (aka oligoarticular)
  3. Polyarticular - >4 joints
174
Q

How long does a joint have to be swollen for in a child, before it is classed as JIA?

A

6 weeks or more

175
Q

What are the complications of JIA?

A
  1. Chronic anterior uveitis
  2. Flexion contraction of the joints
  3. Amyloidosis
176
Q

What is Still’s disease?

A

A systemic form of juvenile arthritis, that is though to be an autoimmune disorder.

177
Q

When does Still’s disease normally begin?

A

At 3-4 years of age and is more common in girls

178
Q

What are the features of Still’s disease?

A

Intermittent high pyrexia, salmon-pink rash with aches and pains of the joints and muscles. Other features include hepatosplenomegaly, lymphadenopathy and pericarditis.

179
Q

What infection can cause acute rheumatic fever?

A

Group A beta-haemolytic streptococcal pharyngitis

180
Q

What is the process of molecular mimicry which is seen in rheumatic fever?

A

In susceptive individuals exposed to group A beta-haemolytic strep pharyngitis, the antibodies formed against the bacterial carbohydrate cell wall cross-react with antigens in the heart, joints and skin.

181
Q

In developing acute rheumatic fever, what is the consequence of the immune response on the heart?

A

In the heart it leads to myocarditis, pericarditis, and endocarditis, resulting in valve destruction, conduction defects and arrhythmia, and congestive heart failure.

182
Q

What diagnostic tool is used to help diagnose rheumatic fever?

A

Duckett Jones criteria - requires evidence of streptococcal infection - serial anti-streptolysin O titres

183
Q

What are the major criteria of the Duckett Jones diagnostic tool? (5)

A

Major:

  1. Pancarditis
  2. Polyarthritis
  3. Sydenham’s chorea (St Vitus’ dance)
  4. Erythema marginatum
  5. Subcutaneous nodules
184
Q

What are the minor criteria of the Duckett Jones diagnostic tool?

A
  1. Fever
  2. Arthralgia
  3. High erythrocyte sedimentation rate or WCC
  4. Heart block
185
Q

What is enteropathic arthritis?

A

It is an asymmetrical pauciarticular arthritis predominately affecting the larger joints of the lower limb. It occurs with underlying IBD.

186
Q

What test is important to do in a baby presenting with jaundice and seizures?

A

A TORCH screen

187
Q

What is involved in the TORCH screen?

A 
Testing for :
Toxoplasmosis
Other e.g. syphilis
Rubella
Cytomegalovirus
Herpes simplex
188
Q

What features are common to all TORCH infections? (8)

A
  1. Low birth weight
  2. Prematurity
  3. Jaundice
  4. Microcephaly
  5. Seizures
  6. Anaemia
  7. Failure to thrive
  8. Encephalitis
189
Q

Name 4 gram-positive cocci?

A
  1. Staph. aurerus
  2. Staph. epidermis
  3. Strep. pneumoniae
  4. Strep. pyogenes
190
Q

Name some gram-positive bacilli? (4)

A
  1. C. diff
  2. C. perfringens
  3. C. diphtheria
  4. Listeria monocytogenes
191
Q

Name some gram-negative bacilli? (8)

A
  1. E.coli
  2. Klebsiella pneumoniae
  3. Salmonella
  4. Shigella
  5. Haemophilus influenzae
  6. Legionella pneumophilia
  7. B. Pertussis
  8. Proteus Mirabilis
192
Q

Name 2 gram-negative diploccoci?

A

Neisseria meningitidis

Neisseria gonorrhoea

193
Q

Name the spiral shaped bacteria that causes syphilis?

A

Treponema pallidum

Year 4 Paediatrics (18 decks)

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