Infections in childhood

Question 1

Kawasaki disease

Answer 1

childhood febrile vasculitis affecting the small to medium sized arteries

most common in children <5 years old

• sudden onset fever (prolonged = 5 days)
• do not resolve despite abs therapy
• nonexudative conjunctivitis (bilateral)
• change in lips, oral mucosal cavities
• polymorphous rash
• lymphadenopathy
• mucositis
• cardiovascular manifestations (coronary artery aneurysm)

in second stage of the disease there is desquamation of the digits, thrombocytosis and coronary anerusym

Question 2

treatment of Kawasaki disease

Answer 2

IVIG
aspirin
monitor CVS function
Echo

Question 3

Coxsackie infection

Answer 3

group of RNA viruses
transmitted via faecal-oral route and resp route

can be asymptomatic / aseptic meningitis, encephalitis, myopericarditis, acute haemorrhage conjunctivitis or hand, foot and mouth disease

Question 4

measels

Answer 4

paramyxovirus
10 day incubation period
2-4 days of prodromal symptoms
fever, coryza, conjunctivitis
rash on face, defending to trunk and extremtieis
erythematous and maculopapular and lateral confluent
blue-grey spots on buccal mucosa (Koplik spots)

tend to resolve in a week

Question 5

Scarlet Fever

Answer 5

group A haemolytic streptococci (gram +ve coccus)
exudative pharyngitis or tonsillitis
fever
erythematous rash
children 1-10

high fever, sore throat, myalgia, headache, malaise
rash in 12-48hrs (neck to trunk and extremities)
tachycardia
anterior cervical lymphadenoapthy
*characteristic strawberry tongue with white coating through the papillae protrude

• rash: blanching, 12-72hr after fever appears fine, red, begins on face and neck then decends to body
• enlarged tonsils with exudates
  tx: penicillin abx

Question 6

Tonsillitis

Answer 6

tonsillar exudate
tender anterior cervical lymphadenopathy/lymphadenitis
history of fever (>38’C)
absence of cough

give phenoxymethylpenicillin

streptococcus:
fever, purulence, attend rapidly (3 days of symptoms) inflamed tonsils, no cough or coryza

IV abs if breathing difficulty, clinical dehydration, peritonsillar abscess, sign of marked systemic illness

Question 7

Intussuception

Answer 7

Paediatric emergency
bowel segment invaginated into the neighbouring part of the bowel (bowel telescoping) which causes obstruction

triad of symptoms:
vomiting
abdominal pain
passing blood and mucus per retum
leathery
palpable abdominal mass in right hypochondirium

intermittent- draw legs to chest in an attack
non billows vomiting
stool is mixture of mucus, blood, much, currant jelly.

ix: USS
5 months to 3 years

Question 8

colic

Answer 8

evenings
excessive high pitch crying
peaks at 6 weeks
GORD, over feeding, incomplete burping post feeds, food allergy

Question 9

food intolerance

Answer 9

diarrhoea
vomiting
wheezing
pruritis
rash

Question 10

pylori stenosis

Answer 10

hypertrophy of the pyloric muscle leading to gastric outlet obstruction
first few weeks of life
projectile non billows vomiting
palpable mass and visible peristalsis
not associated with diarrhoea

Question 11

Hirschsprung’s disease

Answer 11

constipation and diarrhoea associated with abdominal distention in an infant who has failed to pass meconium in the first 48 hours of life

absent ganglion cells in the myenteric plexus of the rectum which results in absent motility.

can process to complete intestinal obstruction. only liquid stool can pass the blockadge

can develop enterocolits- abdominal pain, fever, bloody diarrhoea.

diagnose with rectal biopsy to visualise the absence of ganglion cells in the rectum

Question 12

scarlet fever diagnosis

Answer 12

elevated antistreptolysin O titre in the blood

notifiable disease

treatment: phenoxymethylpenicillin (pen V) QDS for 10 days.