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Paediatrics > Infections + immunity > Flashcards

Infections + immunity Flashcards

1
Q

Meningitis pathology

A

Usually in first 5 years of life
Inflammation of leptomeninges surrounding brain tissue

Release of inflammatory mediators + activated leucocytes
Endothelial damage = causes cerebral oedema, raised ICP + decreased cerebral blood flow
Inflammatory response causes vasculopathy - causes cerebral cortical infarction
Fibrin deposits block reabsorption of CSF
Causes hydrocephalus

75% occur before age of 15

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2
Q

Incubation period for bacterial meningitis

A

2-10 days

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3
Q

Bacteria causing meningitis

A

Neonates = group B strep, E coli, Listeria
Infants + kids = Neisseria, strep pneumonia, Haemophilus influenza B
Adolescents = neisseria, strep pneumonia

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4
Q

S+S meningitis (+ for ages)

A 
Shock = tachycardia, tachypnoea, prolonged cap refill
General = fever, headache, photophobia, irritability, hypotonia, purpuric rash 
Infants = poor feeding, respiratory distress, coma 
Infants = lethargy, unsettled, refusing food 
Adolescents = muscle aches + pains, neck stiffness, N+V
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5
Q

Kernigs + Brudzinskis sign

A

Kernig = child lies supine, hips + knees flexed, back pain on extension of knee

Brudzinski’s = flexion of neck causes flexion of knees + hips

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6
Q

Complications of menigitis

A 
Hearing loss 
Vasculitis 
Cerebral infarction = seizures 
Subdural effusion = especially H influenza 
Hydrocephalus 
Cerebral abscess
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7
Q

Investigations for meningitis

A 
Lumber puncture 
Septic screen
Bloods + glucose, lactate, cultures + gas 
Urine for M,C +S 
Nasal + throat swabs 
Viral/ bacterial PCRs
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8
Q

Management of bacterial meningitis

A 
<3 months cefotaxime + amoxicillin 
Ceftrixone >3 months
IM benpen in community 
Dexamethasone 
Rifampicin to family
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9
Q

S+S neonatal meningitis

A

Bulging fontanelle

Hyperextension of neck (opisthotonus)

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10
Q

Sepsis vs severe sepsis vs septic shock

A 
Sepsis = infection + systemic inflammatory response 
Severe = sepsis + CV dysfunction/ acute respiratory distress
Shock = Severe sepsis + CV dysfunction
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11
Q

Boundaries for tachycardia in children

A

<12 months = >160
12-24 months = >150
2-5 years = >140

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12
Q

Chicken pox incubation period + S+S

A

10-21 days (average 14)
Fever + itchy vesicular rash - mainly on trunk
Lasts 7 days

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13
Q

Complications of chicken pox

A

Secondary infection
Necrotising fasciitis
Encephalitis
VZV associated cerebellitis = ataxia + cerebellar signs = resolves within a month

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14
Q

Management of chicken pox

A

Fluids, paracetamol, calamine lotion

IV acyclovir if immunocompromised

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15
Q

Conjunctivitis organisms

A

Neonates = chemical (<24hrs), Neisseria gonorrhoea (<1 week), chlamydia (1-2 weeks)
Infants = H influenza, strep pneumoniae
School age = VZV, HSV, viral, allergic

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16
Q

S+S conjunctivitis

A 
Purulent discharge (chlamydia + gonorrhoea)
Blepharitis + dendritic ulcers (HSV) 
Red eye, discharge
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17
Q

Allergic vs chemical vs viral vs bacterial conjunctivitis symptoms

A 
Allergic = itchy, swelling, watery discharge
Chemical = neonatal 
Viral = sudden onset, pre-auricular lymphadenopathy, watery discharge 
Bacterial = purulent discharge
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18
Q

Management of conjunctivitis

A

Clean with saline
Neomycin
Gonococcal = cephalosporin
Chlamydia = erythromycin

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19
Q

Food allergy cause

A

IgE mediated
Infants = milk, egg, peanut
Older kids = peanuts, fish

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20
Q

S+S food allergies (IgE mediated vs not)

A

IgE mediated: facial swelling, anaphylaxis

Non IgE = D+V, abdo pain

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21
Q

Pathology of anaphylaxis

A

Maldistribution of fluid
Allergen reacts with IgE ab on mast cells + basophils (type 1 hypersensitivity reaction)
Causes capillary leakage, mucosal oedema + shock

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22
Q

Management of anaphylaxis

A

> 12 years = 500mcg IM adrenaline
6-12 = 300mcg
<6 = 150mcg

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23
Q

S+S infectious mononucleosis

A 
Malaise
Anorexia 
Low grade fever 
Tonsillitis/ pharyngitis 
Lymphadenopathy 
Spleno + hepatomegaly 
Maculopapular rash
24
Q

Blood test results for infectious mononucleosis

A

Increased mononuclear cells
Atypical lymphocytes
Thrombocytopenia
Heterophile antibodies

25
Q

Management of infectious mononucleosis

A

Supportive

DO NOT GIVE AMOXICILLIN

26
Q

Pathology of Kawasaki’s disease

A

Systemic vasculitis

27
Q

S+S of Kawasakis

A 
Fever >5 days 
Non-purulent bilateral conjunctivitis 
Red mucous membranes 
Inflamed mouth, cracked lips 
Cervical lymphadenopathy 
Polymorphous rash 
Red palms + soles + peeling
28
Q

Complications of Kawasakis

A

Coronary artery aneurysm leading to myocardial ischaemia

29
Q

Management of Kawasakis

A

IV Immunoglobulin

Aspirin to reduce risk of thrombosis - continue until echo at 6 weeks shows no aneurysm

30
Q

Measles incubation period + organism causing

A

7-12 days

Rubeola virus

31
Q

S+S measles

A

Fever, cough, runny nose
Koplik spots, maculopapular rash
Rash starts behind ears on day 4 then spreads to face + trunk

32
Q

Complications of measles + long term effects of this

A

Encephalitis - occurs about 8 days after onset
S+S = headache, convulsions
Long term effects: deafness, hemiplegia, learning difficulties

Pneumonia
Otitis media

33
Q

Why is periorbital cellulitis a concern in children?

A

May be secondary to underlying bacterial sinusitis or due to spread from primary infection

34
Q

What are complications of periorbital cellulitis?

A

Sub-periosteal abscess, cavernous sinus thrombosis, intracranial abscess

35
Q

How to diagnose HIV in infants?

A

<18 mths = HIV DNA PCR

Over 18mths = detecting ab to virus

36
Q

Incubation period for rubella

A

15-21 days

37
Q

Pathology of rubella

A

RNA Rubella virus spread by droplet infection

Also called German measles

38
Q

What are the complications of congenital rubella?

A

Malformations in cardiac, ocular, CNS + skeletal system

39
Q

S+S of rubella

A

Headache, conjunctivitis, runny nose, maculopapular rash on face then spreading
Lymphadenopathy

40
Q

Contraindications for LP

A

raised ICP,
thrombocytopaenia,
local infection at site of LP, extensive purpura
shock - stabilise first
after convulsions - stabilise first
respiratory insufficiency - stabilise first

41
Q

CSF results for bacterial meningitis

A

Cloudy/ turbid
High protein (>1)
Low glucose
Neutrophils present

42
Q

CSF results for viral meningitis

A

Clear fluid
Normal/ high protein
Normal glucose
Lymphocytes present

43
Q

CSF results for TB meningitis

A

Clear/ slightly cloudy
High protein >1.5
Low glucose
Lymphocytes + acid-fast bacilli present

44
Q

What infection is caused by herpes 4?

A

EBV

45
Q

What antibodies are involved in HSP?

A

IgA + IgG interact + deposit in organs

46
Q

What complication is associated with men B?

A

Febrile convulsions

47
Q

Which vaccines are live?

A

MMR + BCG – avoid in immunocompromised kids

48
Q

Describe the course of viral meningitis

A

starts with infection in mucus membrane, then lymph nodes, then causes initial viraemia then secondary viraemia (CNS infection)

49
Q

What pathogens commonly cause viral meningitis?

A

entero, parechovirus, herpes (worst)

begin acyclovir for herpes one

50
Q

What are the complications of meningitis + what measures are in place to detect these?

A

Septic shock, DIC, cerebral oedema, seizures
Long term: hearing loss, seizure, focal paralysis, cerebral palsy
All kids to have hearing test after 6 weeks from discharge

51
Q

Which organism causing meningitis has the highest mortality?

A

Pneumococcal

52
Q

What is the most common cause of meningococcal sepsis?

A

gram negative diplococci = Neisseria meningitis

53
Q

What are the early S+S of sepsis?

A

leg pain, skin mottling, cold peripheries, breathing difficulties
Haemorrhagic rash = >12 hrs into illness

54
Q

Late S+S of sepsis

A

Leaky vessels leads to poor perfusion so confusion, poor peripheral perfusion

55
Q

Complications of sepsis (early + late)

A

Complications = DIC, AKI, adrenal haemorrhage, circulatory collapse
Late complications = deafness, renal failure, scarring, amputations

Paediatrics (19 decks)

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