Infections - children Flashcards
1
Q
What is the most common viral cause of croup?
A
Parainfluenza virus
2
Q
What is the pathophysiology behind the airway obstruction in croup?
A
Oedema in the larynx narrows the airway, leading to stridor and breathing difficulty
3
Q
Name three other viruses that can cause croup
A
Influenza, adenovirus, and RSV
4
Q
What bacterial infection used to commonly cause croup but is now rare due to vaccination?
A
Diphtheria
5
Q
What are the hallmark symptoms of croup?
A
- Barking cough
- stridor
- hoarse voice
- low-grade fever
- increased work of breathing
6
Q
What is the first-line treatment for mild croup?
A
A single oral dose of dexamethasone
7
Q
How is moderate to severe croup managed?
A
- Oral dexamethasone
- oxygen
- Nebulised adrenaline
- if needed, intubation and ventilation
8
Q
What are alternatives if a child with croup is too unwell for oral medication?
A
IM dexamethasone or nebulised budesonide
9
Q
What is the effect of corticosteroids in croup management?
A
They reduce airway inflammation and improve symptoms
10
Q
A 2-year-old child is rushed to hospital by her parents after waking up with difficulty breathing and a high-pitched cough. Her parents report irritability, fevers and a hoarse voice the previous day. On examination, you note a loud inspiratory noise, subcostal recessions and a high respiratory rate. The child is alert but agitated, and oxygen saturations are 95% on room air.
What is the most appropriate next step in management?
A
Nebulised adrenaline
10
Q
A 2-year-old girl is brought into the Emergency Department in December by her mother with a 3-day history of a barking, seal-like cough and fever.
What is the most likely causative organism?
A
Parainfluenza virus
11
Q
What type of virus causes measles?
A
RNA virus – Paramyxovirus
12
Q
What are Koplik spots and where are they found?
A
White spots on the buccal mucosa – pathognomonic for measles
13
Q
Describe the typical rash pattern in measles
A
Starts behind the ears and spreads down to cover the whole body
14
Q
What is the management for measles?
A
Supportive care + must notify public health due to its notifiable status
15
Q
What is the most common complication of measles?
A
Otitis media
16
Q
What is the most common cause of death in measles?
A
Pneumonia
17
Q
What serious CNS complication can occur 1–2 weeks after measles onse
A
Encephalitis
18
Q
What does the “M-EAR-SLES” mnemonic help you remember?
A
Measles
Starts Ears → body
Airborne spread (very contagious)
Rash, Respiratory symptoms
Spots (Koplik)
Lung (pneumonia = the most common cause of death)
Ear (otitis media = most common complication)
Seizures/encephalitis
19
Q
A 4 year old girl presents to A&E with a rash, coryzal symptoms and fever. She is otherwise healthy and takes no medications.
On inspection, she appears miserable. Oxygen saturations are 97%, respiratory rate 22, heart rate 80, capillary refill time 2 seconds and temperature 41.0C. She has conjunctivitis and a maculopapular rash on the head, torso and limbs. He parents report the rash appeared 48 hours after she developed coryzal symptoms
What is the best investigation to confirm the likely diagnosis?
A
Saliva measles IgM
20
Q
Measles tests
A
Measles-specific immunoglobulin M (IgM) and IgG serology > 3 days
Polymerase chain reaction (PCR) test for measles mRNA <3 days
21
Q
A 15-year-old girl is brought to general practice by her father. She has been unwell for the last 3 days with a high fever, cough, runny nose and red eyes.
Today she has developed a red bumpy rash on her face and behind the ears.
Her father explains that she was not vaccinated as a child due to parental choice.
What is the likely diagnosis, and how long should they be excluded from school for?
A
measles - 4 days
22
Q
Measles presents with what?
A
- Fever
- Cough
- runny nose
- red eyes
- followed by a rash that spreads downwards, starting at the hairline, is classic for measles
- Koplik spots are pathognomonic for measles, but are not always present
23
Q
What virus causes chickenpox?
A
Varicella Zoster Virus
24
What symptoms typically come before the rash in chickenpox?
A brief coryzal prodrome with fever
25
Describe the progression of the chickenpox rash.
Macules → Papules → Vesicles → Scabs
26
What is a key feature of the chickenpox rash?
It is intensely itchy (pruritic)
27
What topical treatment can be used to reduce itching in chickenpox?
Calamine lotion
28
The incubation period for chicken pox is what?
21 days
28
Who should receive Varicella Zoster Immunoglobulin (VZIG)?
Immunocompromised patients and newborns exposed shortly after birth
29
What is the causative organism of scarlet fever?
Group A Streptococcus (Streptococcus pyogenes)
30
What is the appearance of the tongue in scarlet fever?
"Strawberry tongue" – red with prominent papillae
31
What age group is most commonly affected by scarlet fever?
Children aged 2–6 years
32
Which areas are spared by the rash in scarlet fever?
Palms, soles, and area around the mouth
32
Describe the scarlet fever rash
Fine punctate erythema (sandpaper-like), starting on the trunk
33
What is the first-line treatment for scarlet fever?
Oral Penicillin V for 10 days
34
Is scarlet fever a notifiable disease?
Yes – must notify public health authorities
35
When can a child return to school after starting antibiotics for scarlet fever?
24 hrs after starting antibiotics
36
What mnemonic helps recall key symptoms of scarlet fever?
"Strawberry tongue, Sore throat, Scarlet fever"
37
Cause of mumps
Paramyxovirus
38
Symptoms of mumps
Fever, fatigue
Parotitis – “earache/pain on eating”
39
Complication of mumps
Orchiditis (inflammation of testicles)
40
Cause of hand, foot, and mouth disease
Coxsackie virus A16
41
Treatment of hand, mouth and foot disease
self limiting in 1 week-
42
What is the most common cause of urinary tract infections (UTIs) in children?
Escherichia coli (E. coli)
43
Describe E. coli microbiologically
: Gram-negative, facultative anaerobic, rod-shaped coliform bacterium
44
What are signs of a UTI in neonates?
1. Sepsis
2. Increased wet nappies
3. Poor feeding
4. Irritability
45
What imaging is used to assess for underlying renal anomalies in UTI?
Ultrasound
46
What is the recommended urine sampling method in infants?
Clean catch urine sample
47
What is the treatment for a lower UTI in infants <3 months old?
IV Amoxicillin + IV Gentamicin
48
What is the treatment for a lower UTI in children >3 months old?
Oral antibiotics for 3 days – e.g. Trimethoprim or Nitrofurantoin
49
How is an upper UTI (e.g. pyelonephritis) managed in children?
Admitted for IV Amoxicillin + Gentamicin
49
What are two hallmark symptoms of croup?
Barking cough and inspiratory stridor
49
What X-ray finding is associated with croup?
Steeple sign – narrowing of the trachea
50
What are two key signs of epiglottitis?
Drooling and difficulty swallowing
50
What is the most common causative organism of epiglottitis?
Haemophilus influenzae type B
51
What should you avoid in suspected epiglottitis?
Throat examination – can trigger airway obstruction
52
What is the immediate management of epiglottitis?
Call ENT urgently, give IV ceftriaxone and oxygen
53
What virus causes bronchiolitis in most infants?
Respiratory Syncytial Virus (RSV)
54
What is the main treatment for bronchiolitis?
Supportive – oxygen if sats <92%, NG feeding if needed
55
What age group is most affected by bronchiolitis?
Infants under 12 months
56
What are key features of bronchiolitis?
1. Feeding difficulty
2. Wheeze
3. Tracheal tug
4. Sub/intercostal recession
57
What bacteria causes whooping cough?
Bordetella pertussis
57
How is whooping cough diagnosed?
Nasopharyngeal swab
57
What are classic features of whooping cough?
1. Paroxysmal coughing >14 days
2. Inspiratory ‘whoop’
3. Post-cough vomiting
58
What antibiotics are used for whooping cough?
Oral macrolides – erythromycin, azithromycin, clarithromycin
= First line is oral azithromycin for five days
59
What is the most common cause of pneumonia in children?
Streptococcus pneumoniae
60
What is the first-line antibiotic for paediatric pneumonia?
Amoxicillin
61
What gene mutation causes cystic fibrosis?
CFTR gene on chromosome 7
62
What is the gold standard test for diagnosing CF?
Sweat test - raised chloride
63
What are the classic features of cystic fibrosis in children?
1. Failure to thrive
2. Recurrent chest infections
3. Malabsorption
4. Steatorrhoe
64
What neonatal condition is associated with CF?
Meconium ileus (bowel obstruction)
65
What daily treatment is essential for CF patients?
Chest physiotherapy (twice daily)
66
What antibiotic is commonly used for CF exacerbations?
Co-amoxiclav
67
What is the typical presentation of GORD in infants?
Regurgitation of feeds, often self-resolving by 1 year
68
What condition presents with projectile, non-bilious vomiting about 30 minutes after feeds?
Pyloric stenosis
69
What are key features of pyloric stenosis on examination?
Olive-shaped mass in the RUQ and visible gastric peristalsis
70
What electrolyte disturbance is associated with pyloric stenosis?
Hypochloraemic, hypokalaemic metabolic alkalosis
71
What imaging confirms the diagnosis of pyloric stenosis?
Ultrasound – shows thickened pyloric muscle
72
What is the definitive treatment for pyloric stenosis?
Ramstedt pyloromyotomy
73
What are the classic symptoms of intussusception?
1. Colicky abdominal pain
2. Red currant jelly stool
3. Sausage-shaped mass
74
What is the first-line investigation for intussusception?
Abdominal ultrasound – target or donut sign
75
How is intussusception treated?
Air enema (non-surgical), or laparoscopic surgery if not resolved
75
What is the first investigation for suspected malrotation with volvulus?
Abdominal X-ray to rule out perforation
75
What does bilious (green) vomiting suggest in a neonate?
Malrotation with volvulus – a surgical emergency
76
What is the next step after X-ray if malrotation is still suspected?
Upper GI contrast study
77
What is the management for malrotation with volvulus?
Urgent surgical intervention
78
What is the gold standard in diagnosing meningitis or encephalitis?
Lumbar puncture
79
A 3-day-old neonate is reviewed by the on-call paediatric doctor with his concerned parents. He was born at 39+2 weeks following spontaneous vaginal delivery. His parents are worried as this morning he vomited a large quantity of bile-stained vomitus. He has yet to pass meconium. On examination of the abdomen, distension is noted, but there are no palpable masses.
What is the most likely diagnosis?
Meconium Ileus
80
A 3-year-old child presents with an acute onset of vomiting and diarrhoea for the past 24 hours. She has had decreased oral intake and has been lethargic. She has no fever, and her physical exam is otherwise unremarkable. The child is up to date with vaccines.
What is the most likely cause of her symptoms?
Norovirus gastroenteritis is now the most common cause of acute onset of vomiting and diarrhoea in children
81
An eight-month-old child presents with recurrent vomiting and low weight for age. On further questioning of the primigravida mother, she informs you that the child was born prematurely, and she has noticed that the child has a chronic cough. Examination is unremarkable
What is the most likely diagnosis?
Gastro-oesophageal reflux disease
82
A 32-year-old primigravida attends a routine GP appointment with her partner to discuss the risk of having a child with cystic fibrosis. Her partner is a carrier of the cystic fibrosis gene, and she is not
What is the risk of their first child being affected by cystic fibrosis?
No risk
83
A one-year-old girl presents to the Emergency department with intermittent abdominal pain. Her father explains that during these episodes, the child becomes irritable, pale, and draws her legs up towards her abdomen. There has been no vomiting, but the child has refused feeds for two days. The abdomen is soft, but there is a palpable, sausage-shaped mass in the right flank.
Given the likely diagnosis, what is the first line management after resuscitation?
Air enema
84
A 10-month-old baby boy develops rapid-onset abdominal pain. His mother tells you he has been off his food and not his usual temperament for 3 days before this. He is producing regular wet nappies, and there are no rashes. He has vomited once, and this morning he passed one episode of blood-stained stools. On examination, he looks pale, and his abdomen has a small mass in the right upper quadrant, which is very tender on palpation
What is the most likely diagnosis?
Intussusception
85
A patient presents with cystic fibrosis. What vitamins are they deficient in?
Vitamin A, D, E and K
86
Where is a double-bubble sign seen in?
duodenal atresia
87
Hypertrophic sphincter on ultrasound is seen where?
Pyloric stenosis
88
Target sign on the ultrasound is seen where?
intussusception
89
A 4-week-old male, born at 36 weeks weighing 3.8kg, is brought in for persistent vomiting over the past 48 hours. He now weighs 5.1kg. His mother has Type 1 diabetes, and the pregnancy was otherwise uneventful. This is her first child
His mother reports that vomiting has become more frequent, forceful, and projectile. His vomit is white with no blood. He is feeding less but still wetting his nappies, though has not passed stool today.
On examination, the baby appears well, hydrated and no significant weight loss is noted. What is the likely diagnosis and what would be the most appropriate definitive treatment for his condition?
Pyloromyotomy is the definitive treatment for pyloric stenosis
90
A 3-week-old boy presents to paediatric A&E with persistent vomiting. The mother reports that vomiting always occurs soon after feeds and often hits the kitchen walls. A diagnosis of pyloric stenosis is suspected
What investigations is most likely to confirm this?
Ultrasound abdomen
91
A 3-week-old boy presents to the ED with non-bilious projectile vomiting and failure to thrive. On examination, the abdomen appears distended, and palpation reveals a mobile, spherical mass in the right upper quadrant.
What is the definitive management for the most likely diagnosis?
Pyloromyotomy
= pyloric stenosi
92
A 1-day-old infant presents with abdominal distension and bilious green vomiting. The infant has not passed stool. Abdomen examination shows distension with no palpable mass. A plain abdominal radiograph demonstrates dilated loops of bowel filled with meconium
What is the most likely diagnosis?
Meconium ileus
93
The hallmark symptom for pyloric stenosis is usually what?
projectile vomiting after feeding, typically presenting around 3-6 weeks of age
= Prematurity is a significant risk factor
94
A 5-year-old girl is brought into A&E by her father. He reports that she has woke up with a severe sore throat, noisy breathing and wasn't able to go into school as she couldn't eat her breakfast. There is no cough. On examination, she is sat upright but appears very sleepy and some drooling is noticed on the right side. An inspiratory stridor can be heard and a temperature of 38.9 is noted.
What is the most likely causative organism?
H. influenzae
= acute epiglottitis
95
RSV is the most common cause of what?
bronchiolitis
96
A three-year-old boy presents to the ED with his mother. One day previously, the boy reportedly fell from a tree and hit his arm. The mother is unsure of the story, and the boy is shy and uncooperative. He also has bruises on his chest and back.
What is the next most appropriate investigation?
The later presentation, vague history, and unlikely pattern of injuries make non-accidental injury the most likely, and important, diagnosis. An urgent investigation however to carry out in any child with unexplained bruising is an FBC, to rule out other sinister causes of unexplained bruising such as a haematological malignancy
97
What is whooping cough bacterial culture?
Gram-negative coccobacillus
98
What is the most common cause of respiratory tract infections in a patient with cystic fibrosis?
1. Pseudomonas aeruginosa
2. Other common pathogens include Staphylococcus aureus and Haemophilus influenzae
99
A 2-month-old baby boy with DiGeorge syndrome is brought in to PAU by his worried mother due to his recent episodes of non-bloody and non-bilious vomiting, which have been occurring regularly after most of his feeds. He is predominantly formula fed, having been weaned at 6 weeks.
The pregnancy and delivery were both uncomplicated, and he was born at term. He has continued to feed as normal, and no change has been noted in his bowel movements. He was born weighing 3.5 kg and now weighs 4.8 kg
Given the presenting history, what is the most likely diagnosis?
GORD
100
A 12-month-old child with severe intermittent abdominal pain in the right iliac fossa is seen in the Paediatric Assessment Unit with bilious vomiting, abdominal distension and passage of stool with blood-stained mucus. An ultrasound scan shows concentric echogenic and hypoechogenic bands
Given the information provided, which of the following is the most likely diagnosis?
Intussusception
101
A concerned mother has brought her 2-year-old daughter to the GP after finding her to be drowsy. For the last two days, she has been difficult to settle and crying in the evening with a fever, headache and two episodes of vomiting, which her mother puts down to a viral infection.
Today, she has lost energy and is difficult to rouse. She is moaning and withdrawing from pain. Her eyes are open and she responds to commands but she seems withdrawn. Her chest is clear to auscultation with normal vesicular breath sounds throughout. There is no rash on her limbs or trunk, though her cheeks are slightly flushed (blanching to touch)
What is the most likely diagnosis?
Meningitis
102
A 2-week-old male neonate is brought to the Emergency Department with the sudden onset of green bilious vomiting for the past 4 hours. Furthermore, the mother complains of observing blood in his nappies since morning. He was otherwise normal since birth, with appropriate weight gain and regular passage of stools and urine. Vital signs are normal
An abdominal X-ray shows dilatation of the stomach and proximal loops of the bowel. Barium enema indicates partial obstruction of the duodenum and malposition of caecum.
What is the single most likely diagnosis?
Malrotation and volvulus
103
A 3-week-old baby presents with bilious vomiting and abdominal distension. The baby had normal bowel movements initially but developed constipation. An abdominal X-ray shows multiple air-fluid levels and absence of gas in the rectum.
What is the most likely diagnosis?
Malrotation
104
A two-month-old baby is brought to the GP by his parents. They are concerned that he seems more unsettled than usual and has been spiking a temperature. A urine dipstick is positive for leucocytes and nitrates.
What is the most appropriate next step in management?
NICE guidelines suggest that children under three months of age with a suspected urinary tract infection require admission to hospital for intravenous antibiotics
105
Symptoms in pyloric stenosis
1. Projectile non-bilious vomiting after feeds
2. Hungry after vomiting (feeds eagerly)
3. Weight loss or poor weight gain
4. Dehydration
5. Palpable olive-shaped mass in the epigastrium
6. Visible peristalsis across the
abdomen (left to right)
7. Typically presents at 2–8 weeks of age and more common in first-born males
106
A 6-week-old baby presents with poor feeding, lethargy, and a bulging fontanelle. What is the most likely diagnosis?
Mengititis
107
'Currant jelly' stools mean what?
blood and mucus
108
A 5-year-old boy is brought to the GP by his parents with a 2-day history of a pink, maculopapular rash that started on his face and has since spread to his trunk and limbs. He has had a mild fever and appears otherwise well. On examination, he has tender suboccipital and postauricular lymphadenopathy. His parents mention that he recently attended a birthday party where another child had a similar rash. His vaccination history is incomplete
What is the most likely diagnosis?
Rubella
109
Monospot test is used in what disease
glandular fever - EBV virus
110
Serological testing is first lien for what disease?
Rubella - IgM specific antibodies
111
A 5-year-old girl presents with a rash that started on her face and spread to her trunk. She also has a low-grade fever and swollen lymph nodes behind her ears
What viruses is most likely causing her symptoms?
Rubella virus
112
Necrotising fasciitis following chickenpox is more commonly caused by ...
Streptococcus pyogenes
113
Vomiting after being laid flat and crying with arching of the back and drawing up the knees to the chest is characteristic of what disease and what is the management?
GORD
= Reassure and discharge with infant Gaviscon
114
This child, with chronic respiratory disease including bronchiectasis (coughing up large volumes of sputum), most likely has what?
cystic fibrosis
= Immunoreactive trypsinogen will be raised
115
What investigation would provide a definite diagnosis for biliary atresia?
Cholangiography
