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Infections/Fever Flashcards

1
Q

What is the virus causing hand, foot and mouth disease?

A

Coxsakie A16

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2
Q

What are the clinical features of hand, foot and mouth disease

A
  • mild systemic upset: sore throat, fever
  • oral ulcers
  • vesicles on palms and soles of feet
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3
Q

Management of Hand, food and mouth disease

A

Symptomatic: analgesia and hydration

Reassure no link to disease in cattle

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4
Q

What are the exclusion rules for hand foot and mouth disease

A

None - keep off in unwell

Contact HPA if large outbreak

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5
Q

Contraindications to Lumbar Puncture

A 
focal neurological signs
papilloedema
significant bulging of the fontanelle
disseminated intravascular coagulation
signs of cerebral herniation
meningococcal septicaemia
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6
Q

Investigations for meningococcal septicaemia

A

Blood cultures

PCR for meningococcus

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7
Q

Meningitis antibiotics in children <3 months

A

IV amoxicillin + IV cefotaxime

aciclovir if worried about viral infection

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8
Q

Meningitis antibiotics

A

IV cefotaxime

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9
Q

What is Brudzinski sign

A

Lay on back, pull neck forward towards chest

If legs bend up/causes distress - positive

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10
Q

What is Kernigs sign

A

Lay down, extend hip and knee 90 degress passivly extend out if pain - positive

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11
Q

What subtle symptoms should you look for in infants

A

irritability
Abnormal/high pitch cry
lethargy
difficulty feeding

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12
Q

What is the managment of meningitis in paeds

A
  1. call senior help
  2. protect airway, high flow O2
  3. IV/IO access
  4. Bloods
  5. Anti-pyretics
  6. LP & Urine cultures
  7. Start Abx
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13
Q

Which bloods should be done if suspecting meningitis

A

lcatate
cultures
PCR for meningococcus

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14
Q

What antibiotics do you given in children >3month with meningitis

A
  • ceftriaxone

erythromycin if pen allergy

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15
Q

What antibiotics do you given in children <3month with meningitis

A
  • Ceftriaxone + amoxicillan (ampicillan)

- covers listeria

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16
Q

When and why do you give steroids with bacterial meningitis

A
  • give dexamethsone in confrimed/suspected if >3 monthd
  • With or W/I 4hrs of first ABX dose
  • decreases hearing loss
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17
Q

What pathogen causes hearing loss in meningitis

A

pneumococcal

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18
Q

What are the RF for bacterial meningitis

A 
Low family income
3-8 month and adolescents
asplenia
day care/crowded places
basal skull fracture
maternal infection/pyrexia at delivery
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19
Q

What would you see on LP in bacterial/pyogenic meningitis

A
  • turbid/cloudy appearance
  • hig neutrophils
  • low lymphocytes
  • Protein >1
  • glucose CSF:blood: low
    High opening pressure
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20
Q

What would you see on LP in viral meningitis

A
  • Clear appearance
  • <100 neutrophils
  • high lymphocytes
  • Protein 0.4-1
  • Glucose CSF:blood normal
  • normal/high opening pressure
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21
Q

What would you see on LP in TB meningitis

A
  • opaque appearance
  • neutrophils <100
  • high lympocytes
  • Very high protein
  • Glucose CSF:blood low
  • high opening pressure
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22
Q

What are the common meningitis pathogens in neonates 0-3 months

A

Group B streptococcus
E. Coli
Listerial monocytogenes

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23
Q

What are the common meningitis pathogens in infants 3mo-5yrs

A

Nisseria meningitide
Streptococcus pneumoniae
Haemophillus influenza B

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24
Q

What are the common meningitis pathogens in children >5yrs

A

Niserria meningitide

Streptococcus pneumoniae

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25
Q

What is group B streptocccus

A

gram positive coccus chains

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26
Q

What is E.coli

A

Gram negative rod

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27
Q

What is listeria monocytogenes

A

gram positive rod

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28
Q

What is Nisseria meningitide

A

gram negative cocci

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29
Q

What is streptococcus pneumoniae

A

Gram positive cocci

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30
Q

What is haemophilus influenzae B

A

Gram negative diplococci

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31
Q

What are the acute complications of meningitis

A 
seizures
raised ICP
coagulatophy
metabolic disturbances
anaemia
coma
death
32
Q

What are the long term complications of meningitis

A 
hearing impairment
psychosocial problems
epilepsy
dev/learning difficulties
neurological impairments
33
Q

What must you remember to do on discharging a child with bacterial meningitis

A

audiology assessment 4w after discharge - 4% hearing loss

34
Q

What constitutes a simple febrile seizure

A

<15 mins
generalised seizure
No recurrence within 24 hours
Complete recovery in one hour

35
Q

What constitures a complex febrile sezire

A

15-30 mins
Focal seizure
Multiple episodes within 24 hours

36
Q

What constitutes febrile status epilepticus

37
Q

What are the clinical features of a febrile seizure

A

usually occur early in a viral infection as the temperature rises rapidly
seizures are usually brief, lasting less than 5 minutes
are most commonly tonic-clonic

38
Q

Typical age for febrile seizure

A
  • 6 months and 5 years

- 3% of children

39
Q

What is the management of a febrile seizure

A

children who have had a first seizure OR any features of a complex seizure should be admitted to paediatrics

40
Q

What is the prognosis & advice for parents of a febrile seizure

A
  • further febrile convulsion = 1 in 3
  • if recurrences, try teaching parents how to use rectal diazepam or buccal midazolam.
  • Parents should be advised to phone for an ambulance if the seizure lasts > 5 minutes
  • regular antipyretics have not been shown to reduce the chance of a febrile seizure occurring
41
Q

What are risk factors for urther febrile seizures

A
  • age of onset < 18 months
  • fever < 39ºC
  • shorter duration of fever before seizure
  • family history of febrile convulsions
42
Q

Do febrile seizures mean they’re going to have epilepsy?

A

risk factors for developing epilepsy

  • family history of epilepsy
  • having complex febrile seizures
  • background of neurodevelopmental disorder
  • children with no risk factors have 2.5% risk of developing epilepsy
  • if children have all 3 features the risk of developing epilepsy is much higher (e.g. 50%)
43
Q

What are the key features of Kawasaki’s disease

A

Fever for >5 days and 4 of below

  • Dry cracked lips
  • Bilateral conjunctivitis
  • Peeling of skin on fingers and toes
  • Cervical lymphadenopathy
  • Red rash over trunk
44
Q

How do you diagnose Kawasakis

A
  • clinical diagnosis, no specific test
45
Q

What is the management of Kawasaki’s Disease

A
  • high-dose aspirin
  • intravenous immunoglobulin (reduces coronary art. aneurysm)
  • echo: coronary artery aneurysms
46
Q

Why is aspirin usually contraindicated in paediatrics

A
  • Kawasaki disease is one of the few indications

- risk of Reye’s syndrome

47
Q

What is the main complications of Kawasaki’s disease

A

coronary artery aneurysm

48
Q

Investigations for Kawasaki disease

A
  • ESR/CRP
  • LFTs: bilirubin raised & AST
    FBC: increased platelets
49
Q

What is the pathogen involved in Scarlet fever

A

Exotoxins from strep. pyogenes

50
Q

What are the symtoms fo scarlet fever

A
  • Sore throat
  • Fever
  • Sand paper rash devs on chest, axilla, behind ears 12-24 hours after sore throat
  • Swollen glands
  • Facial flushing
  • Strawberry tongue
  • Desquamation of digits post infection
51
Q

Management of scarlet fever

A
  • Penicillin V for 10 days

- Clarithromycin if pen allergic

52
Q

most common cause of paraneumonic empyema

A

streptococcus pneumoniae

53
Q

What is a rare complication of sinusitis

A

subdural empyema - Do an MRI!

streptococcus anginosa - Group H strep

54
Q

hand foot and mouth disease

A

coxsackie virus

55
Q

Key features of measles

A

high fever
wide spread maculopapular rash
conjunctivitis

56
Q

Key features of rubella

A

widespread blanching rash that starts on the face
fever
suboccipital and posterior cervical chain lymphadenopathy

57
Q

Which live bactrial vaccine is currently in use in the UK

58
Q

Which live viral vaccines are used in the UK

A 
MMR
rotavirus
influenza
oral polio
varicella]yellow fever
59
Q

Which vaccines are contraindicated in a patient with HIV and low CD4 count

A

BCG

yellow fever

60
Q

What is passive anti-body protection

A

Provide IgG antibodies to protect against infection

Immediate but short lived protection (4w)

61
Q

Which conditions call for passive antibody protection

A
  • human tetnus immunoglobulin
  • zoster immunoglobulin if immunosurpressed
  • human immnoglobulin - measles
  • Palivizumab (synagis) - RSV
  • HEP B immunoglobulin
62
Q

Who is eligible for palivizumab (synagis)

A
  • ex premature with chronic lung disease
  • other resp conditions who are in O2
  • haemodynamically significant CHD
  • ## SCID (severe immmune deficiency)
63
Q

What is giardia intestinalis

A
  • protozoal parasite
  • endemic in areas with poor sanitation - food and water outbreak
  • 1-4YO
  • cystic fibrosis and IgA deficiency at higher risk
64
Q

What is the presentation of giardia intestinalis

A
  • can be asymptomatic
  • acute diarrhoeal disease
  • chronic diarrhoea and malabsorption
65
Q

what findings are in keeping of giardia intestinalis on histoligy

A

partial villous atrophy in small bowel (similar to coeliacs)

66
Q

What is the diagnosis of giardia intestinalis

A

stool sample showing cysts

duodenal aspirate at small bowel biopsy

67
Q

What is the management of giardia intestinalias

A

good hydration + nutrition

oral metronidazole

68
Q

What is the management of c.difficile toxin positive

A
  • metronidazole if mild

- vancomycin if severe/recurrent episodes

69
Q

Which allergies preven children having the MMR

A
  • neomycin + kanamycin
70
Q

Key features of IgA immunodeficiency

A

recurrently URTI + LRTI
recurrent otitis media
association with atopic and autoimmune conditions

71
Q

Key features of severe combined immunodeficiency (SCID)

A
  • Ok first few months
  • 3-4 months persistent diarrhoea and faltering growth
  • oral candidiasis
  • atypical infections
72
Q

what do you often see on sereum immunoglobulins in a patient with HIV

A

High IgG
Low IgA
Low IgM

73
Q

organism for typhoid fever

A

salmonella typhi

74
Q

Features of typhoid fever

A 
high fever
abdo pain
headache
thrombocytopaenia
leucopaenia
Raised ALT
bradycardia
75
Q

Clinical findinds of leptospirosis

A
  • jaundice w 2

- leucopaenia and thrombocytopaenia in early ifection

76
Q

Key features of DIC

A

thrombocytopaenia
prolonged PT
Prolonged APTT
low fibrinogen

Paediatrics (21 decks)

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