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Paediatrics > Infections cont'd > Flashcards

Infections cont'd Flashcards

1
Q

What is a food allergy?

A

An abnormal immunological response to a specific food- an immediate allergic reaction involves production of food specific igE antibodies.

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2
Q

What are the most common allergens?

A

Cow’s milk protein • Soya
• Eggs • Shellfish
• Peanuts • Fish
• Wheat • Tree nuts

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3
Q

What are the clinical features of a food allergy?

A

Diarrhea +/ blood or mucus, vomiting, dysphagia, GORD symptoms, asthma symptoms, anaphylaxis, abdo pain, faltering growth, excema, urticaria and erythematous rash, usually peri-oral.

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4
Q

How do non-IgE mediated diseases tend to differ?

A

Eg coeliac- they tend to have more of an insidious onset and a delayed presentation

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5
Q

How do you investigate for IgE mediated reactions?

A

Skin-prick test and RAST (radioallergosorbent) blood test that identifies specific IgE antibodies (not available for all allergens).

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6
Q

How do you investigate for non-IgE mediated reactions?

A

Dietary exclusion

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7
Q

When will the majority of infant allergies resolve by and what is the exception?

A

2 years, with peanuts being the exception

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8
Q

What is a food intolerance?

A

Non-immune modulated hypersensitivity to food. Less severe & more common than
food allergy. Presentation is similar to that of food allergy

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9
Q

What causes infectious mononucleosis? (IM)

A

EBV in 90% or CMV

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10
Q

How does IM spread?

A

Via oropharyngeal secretions, the virus infects B lymphocytes in the pharyngeal lymphoid tissue and this spreads to the rest of the lymphatic system.

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11
Q

What is the incubation period for IM and what is the prodrome?

A

4-6 weeks, prodrome of flu like symptoms, head-ache, low grade fever and chills for 3-5 days.

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12
Q

What are the symptoms of IM?

A

Exudative pharyngitis, generalised tender lymphadenopathy, hepatosplenomegaly

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13
Q

What is the triad of findings when you investigate for IM?

A

Lymphocytosis (80-90% WBC), >10% atypical WBC on peripheral blood film and positive serology for EBV.

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14
Q

What other findings may you have in IM, excluding the classic triad?

A

IgM & IgG raised in early disease

Raised LFT, thrombocytopenia

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15
Q

What is the treatment of IM and/or splenomegaly?

A

Supportive. If there is splenomegaly, you should avoid contact sports for 1 month and adolescents should refrain from alcohol.

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16
Q

What are the complications of EBV?

A

GI & abdominal → hepatitis, splenomegaly, splenic rupture
• CNS → aseptic meningitis, encephalitis, Guillian-Barre syndrome*****
• Post viral tiredness → self limiting, may take months
• Other → lymphoma, orchitis, myocarditis, pneumonia

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17
Q

What would happen if you used amoxacillin/ampicillin in those with suspected tonsillitis/infectious mononucleosis?

A

EBV infection will cause intense itchy maculapapular rash which can last for months. ‘ampicillin rash’

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18
Q

What is kawasaki disease?

A

A systemic vasculitic disease with coronary arteritis leading to coronary artery aneurysms. (most common complication- occurs in 20-30%)

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19
Q

Name some other complications associated with kawasaki disease?

A

Dysrythmias, MI, coronary thrombosis and sudden death.

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20
Q

What is the most common cause of acquired heart disease in kids in the UK?

A

Kawasaki

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21
Q

What age group does kawasaki mainly affect and boys or girls more?

A

6 months- 4 years. Boys>girls

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22
Q

What is critical for the diagnosis of kawasaki?

A

The child MUST of had a fever of >38.5 for at least 5 days, as well as 4/5 of the following:
-Bilateral non-purulent congestion of conjunctivae (94%)
-Changes of the lips & oral cavity with either: dryness, erythema, fissuring of lips, strawberry tongue, diffuse erythema of oral & pharyngeal mucosa (without discreet
lesions)
- Changes of the extremities, either erythema on palms or soles: indurative erythema; periungal desquamation of fingers and toes
-polymorphous exanthem (usually truncal)
-Non-suppurative cervical lymphadenopathy
THEY DO NOT HAVE TO BE PRESENT AT THE SAME TIME

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23
Q

Apart from the 5 main ones, which clinical features may be present in kawasaki?

A

Irritable and may have inflammation at BCG vaccination site.

24
Q

How is diagnosis made for kawasaki?

A

Based on clinical findings, raised CRP, WCC, platelets

25
Q

How do you treat kawasaki?

A

High dose immunoglobulin within first 10 days is shown to decrease risk of aneurysm
• Aspirin → reduces risk of thrombosis

26
Q

What is the incubation period for measles?

A

8-12 days

27
Q

How long does measles usually last?

A

6-8 days

28
Q

What is the prodrome associated with measles?

A

Coryzal prodrome- infection in nose, cough, conjunctivitis etc. Sometimes KOPLICK spots can be seen- grains of sugar sign on mucosa.

29
Q

What are the clinical features of measles?

A

Exanthematous rash- maculopapular rash which starts on the face and spreads

30
Q

How long does the rash typically last?

A

6-8 days

31
Q

How is measles treated?

A

In immunocompromised ribavirin is used, prevention with vaccine most successful.

32
Q

What are the complications of measles?

A

Pneumonia, otitis media, encephalitis(rare but serious).

33
Q

What is the incubation period for the mumps?

A

14-28 days

34
Q

What are the clinical features of the mumps?

A

Parotitis, nearly always bilateral, rarely- a morbilliform measles like rash.

35
Q

What are the complications of the mumps?

A

Meningitis, may cause unilateral deafness and pancreatitis and orchitis after puberty.

36
Q

How does the rash spread in the measles?

A

Downward from behind the ears to the whole body. It is a discrete maculopapular rash initially, becomes blotchy and confluent.

37
Q

What is periorbital cellulitis and what is it caused by?

A

It is infection of the skin around the eye due to s.aureus, group A strep of HIb (if no jabs). It may occur secondary to paranasal or dental abscesses in older children. UNILATERAL. also with fever, and can often follow trauma to the eye.

38
Q

When should you refer periorbital cellulitis to opthal?

A

If there is complete ptosis and eye movements are not visible

39
Q

What are the complications of peri-orbital cellulitis?

A

Untreated may develop orbital cellulitis with ocular proptosis (like in graves), limited movements
Local abscess, meningitis, cavernous sinus thrombosis may also occur

40
Q

What is Rubella?

A

Mild disease in childhood occurring in winter and spring

41
Q

What is the incubation period for rubella?

A

14-21 days

42
Q

How long does rubella normally last?

A

2-3 days

43
Q

When is rubella infective?

A

From 7 days before the rash until 7 days after the rash.

44
Q

What is the prodrome for rubella?

A

Child may have mild illness and low grade fever during incubation period

45
Q

Describe the rash which occurs with rubella?

A

Maculopapular rash which spreads rapidly from face and fades within 3-5 days, rash is not itchy. Also lymphadenopathy is prominent especially in sub occipital and post-auricular nodes.

46
Q

How is rubella treated?

A

Supportive- prevention with vaccine.

47
Q

What are the complications with rubella?

A

(RARE)Arthritis, encephalitis, thrombocytopenia &myocarditis.

48
Q

What does rubella cause in the unborn child (triad)?

A

Sensorineural deafness, eye abnormalities (picture with cataracts) & congenital HD, however no child has been born with congenital rubella syndrome in the past 20 years.

49
Q

How is HIV diagnosed in children?

A

> 18 months- infection is diagnosed via detection of antibodies to the virus
<18 months- children who are born to HIV pos mothers, IgG HIV antibodies will be present via trans-placental transmission. A positive test confirms HIV exposure but not infection, HIV DNA PCR

50
Q

What is the most sensitive test for HIV in <18 months?

A

HIV DNA PCR. (2 negative PCRs within the first 3 months of life indicate the infant is not infected).

51
Q

What CNS effects can HIV have on an infant?

A

Delayed development, cerebral palsy.

52
Q

How is vertical transmission prevented?

A

Antenatal, peri and postnatal anteretrovirals, delivering by c-section and avoiding breast feeding.

53
Q

How is PCP pneumocystis pneumonia prevented?

A

Prophylaxis with co-trimazole

54
Q

What are AIDS defining illnesses in infants?

A

Lymphocytic interstitial pneumonitis, pneumocystis carinii (PCP), candida oesophagitis.

55
Q

Check for HIV in children who….?

A

Have persistant lymphadenopathy, hepatosplenomegaly, recurrent fever, parotid swelling, thrombocytopenia or any suggestion of SPUR infections (serious, persistent, unusual, recurrent).

Paediatrics (23 decks)

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