infections/resp/allergy/derm Flashcards
croup AKA
laryngotracheobronchitis
Ix for croup
diagnosis is clinical
-FBC, CRP, U+E, viral PCR on throat swab
when to admit with croup
if mod/severe, <6 months, immunocompromised, poor response to Tx
Advice for parents at home with croup
symptoms should start to get better 48-72 hours, no abx needed (virus), keep child calm
if NEB adrenaline is given in croup - what do you need to do
monitor the child for 4 hours for rebound symptoms
discharge criteria for croup
no stridor at rest, normal colour, normal activity
what kind of bacteria is bordetella pertussis
gram negative bacillus
three phases of whooping cough
catarrhal - 1-2 weeks (prodrome)
paroxysmal - cough, inspiratory whoop, periods of apnoea
convalescent - lasts 3 months
Dx of whooping cough
PCR on nasopharyngeal swab!!!
-can do serology for pertussis IgG
how long does child need to be off school for with whooping cough
48 hrs after macrolides or for 21 days with no abx
apart from abx, what are other mx points for whooping cough
notifiable disease, pregnant mum needs vaccine, can take 3 months to resolve, abx prophylaxis for contacts
what is kartagener syndrome
type of PCD - situs inverses, recurrent sinusitis, bronchiectasis and sub fertility
IX for PCD (affect ciliary clearance in the lungs, paranasal sinus and middle ears
biopsy from bronchoscopy / nasal brush biopsy
+ look for consanguinity of the parents
apart from the sweat test, what other IX would you do for cystic fibrosis
sputum culture to see if colonised, genetic test, LFTs as can get obstruction due to thick pancreatic enzymes
what is tested for on the newborn heal prick test for CF
immunoreactive trypsinogen
what do people with CF become colonised with
staph aureus and pseudomonas (may start them on prophylactic Abx)
when can asthma subjective tests be done
before age 5
RF for asthma
genetic influence
LBW
prematurity
a saturation of what indicates a severe asthma attack IN CHILDREN
(<92%)
when does an asthma attack require admission
in pregnancy, previous near fatal, severe and not responding, life threatening
discharge criteria for asthma
PEFR >75%, inhaler technique checked, stable on discharge meds for 12-24 hours
what is uncontrolled asthma
any exacerbation which requires steroids, frequent regular symptoms (needing reliever 3 times a week/night time wakening more than 1 day a week)
what should you do if asthma is not controlled by a moderate dose MART + trials of a LTRA or LAMA
refer people to a specialist in asthma care when asthma is not controlled despite treatment with moderate-dose MART, and trials of an LTRA and a LAMA
RF for viral wheeze
maternal smoking, prematurity, male gender
causes of chronic cough in children
CF, PCD, asthma, aspiration (GORD), post nasal drip, TOF
what organisms colonise in bronchiectasis
Haemophilus influenza and pseudomonas aeruginosa
viral vs bacterial pneumonia in children
bacterial –> commonly affect the over 2s, have localised chest/neck/abdo pain due to pleuritic irritation, absence of rhinorrhoea or wheeze
viral –> under 2s, coryzal symptoms, lower temp, no localised pain
most common cause of pneumonia in children
strep pneumoniae
mx of pneumonia in children
1) amoxicillin
2) add a macrolide to cover atypical organisms
when does laryngomalacia peak
6-8 months
what would an FNE show of laryngomalacia
short aryepiglottic folds and omega shapped epiglottis
what causes laryngomalacia
the larynx cartilage is softer, meaning get a collapse of the supraglottic structures into the airway
Mx of laryngomalacia
should resolve by 18 months
-medical Mx –> feed thickener to stop aspiration and antirelfux meds to stop inflammation of the supra glottis
complications of laryngomalacia
life threatening airway obstruction, failure to thrive and failure to gain weight
sign of epiglottis on laternal neck xray
thumb sign
what is typical about the symptoms of epiglottis (dysphagia, dysphonia, drooling, dyspnoea)
acute onset!
complications of epiglottis
airway obstruction, meningitis, DNSI, pneumonia
pathophysiology of bronchiolitis
inflame of the bronchioles, excess mucous, causes increased airway resistance
RF of bronchiolitis
siblings that attend nursery, smoke exposure, chronic lung disease of prematurity, bottle fed
what Ix are done for bronchiolitis
pulse oximetry, nasopharyngeal aspirate or throat swab for RSV
when is a child with bronchiolitis admitted to hospital by 999
if apnoea, grunting, cyanosis, sats<92%, CHD
supportive MX for bronchiolitis in hospital
O2, NG feed, upper airway suctioning
when is discharge considered for bronchiolitis
when baby has adequate oral input, when they maintain sats >92% for > 4 hours
what can be used as prophylaxis for bronchiolitis
palivizumab
when should a baby recover from bronchiolitis
7-10 days
what causes roseolar infantum
HSV6 (maculopapular rash which occurs when fever has subsided, associated with febrile seizures)
when can child go back to school after scarlet fever
after 24 hours of abx
what strep species causes scarlet fever
group A Strep (progenies)
other names for fifth disease
slapped cheek, erythema infectious, parvovirus B19
complication of parvenus B19
aplastic crisis (can also cross the placenta, cause severe anaemia in the foetus and hydrops fetalis)
IX for measles
measles specific IgM or IgG
Mx for measles
if not vaccinated and presented in 72 hours –> can have MMR
how long do children with measles need to stay off school
4 days
virus causing hand foot and mouth
coxsackie A16
symptoms of rubella
posterior lymphadenopathy, fever then a rash which starts on the head and then spreads down the trunk
Ix for rubella
rubella specific IgM
if supportive measures of cradle cap (seborrhoea dermatitis) are not effective, what can be used?
topical clotrimazole
in which population is Kawasaki more common
Asian
for Dx of Kawasaki, how many symptoms are needed
fever >39 for 5 days + 4/5 of the other symptoms
what do bloods of Kawasaki show
anaemia, leukocytosis and thrombocytosis, elevated LFT
how long is aspirin continued in Kawasaki
high dose in the acute phase and then low dose until a FU echo has been done to rule out a coronary artery aneurysm
how much is petechial vs purpura
<3mm vs >3mm
what is HSP
systemic IgA small vessel vasculitis
Mx of HSP
self limiting, monitor urinanalysis and BP
signs of HUS (thrombocytopenia, AKI, MAHA)
about 5 days after diarrhoea, reduced urine output, haematuria, abdo pain, confusion, bruising
MX of HUS
fluid rehydration, haemofiltration, steroids plasmapharesis, antihypertensives
Mx options for warts
1) leave them alone
2) cryotherapy
3) topical salicylic acid -
firstline tx for impetigo
1% hydrogen peroxide
-then fusidic acid
-stay off school / no sharing of towels or clothes, no picking or scratching
-flucloxacillin if more severe
MX for psoriasis
1) potent steroid and Vit D preparation applied at different times of day
2) if after 8 weeks no improvement try vit D twice a day (and stop steroid)
3) if no improvement after another8 weeks - then can use the steroid twice a day
4) then phototherapy UVB preferred
5) methotrexate
6) ciclosporin
7) biologics
although tonsillitis is normally caused by virus, what can cause it?
GAS (strep progenies) hence which is high score on fever pain needs 10 days of phenoxymethylpenicillin
Mx of oral candidiasis for babies
miconazole gel
what is ophthalmia neonatorum
conjunctivitis which occurs in the first 4 weeks of life (gonorrhoea - more acutely, lots of purulent discharge), (chalmydia presents a bit later)
what’s it called when HSV-1 causes cold sores / ulcers + redness in mouth
gingivostomatitis
what’s the incubation period for influenza
2 days
complicated signs of influenza
CNS symptoms, hypoxaemia, any signs or symptoms that require hospital admission
in children under 6 months, with flu, what are they prescribed
zanamivir (within 36 hours of symptom onset)
MOA of oseltamivir/zanamivir
neuraminidase inhibitor
vaccination of the flu in children
nasal spray from 2 - year 11 of secondary school (takes 2 weeks to work)
contraindications to the nasal flu vaccine
blocked nose, high fever, egg allergy, immunocompromised
lifecycle of malaria
protozoa gets injected as a sporozoite which travels to the liver, can lay dormant as a hypnozoite or can mature into a merozoite and leave. Merozoites become trophozoites in RBC
-the rings in RBC = TROPHOZOITES!!!!
signs of severe malaria
acidosis, hypoglycaemia, fever >39 degrees
what is the most common cause of periorbital cellulitis
ethmoidal sinusitis
Dx of orbital cellulitis
culture the purulent nasal discharge + need CT!
what abx do you use to treat orbital cellulitis
ceftriaxone
what is brudzinski sign
lie patient on their back, flex their neck and get spontaneous flexion of their knee
what are the LP results for TB
high lymphocytes, high protein - even though it is a bacteria not a virus
how do you Tx meningitis in < 3months
Iv amoxicillin + cefotaxime
do you have to retreat after giving mebendazole?
no only retreat after 2 weeks if infection reoccurs
give examples of warning signs which suggest a primary immunodeficiency
4 or more ear infections in one year, 2 or more serious sinus infections in one year or a recurrent deep skin or abscess infection
what is X linked agammaglobinaemia
absence of B cells –> get recurrent bacterial infections
Di George genetics
22q11 deletion
how might a neutrophil disorder present
chronic granulomatous disease
although Dx of mumps is clinical, how can diagnosis by confirmed
salivary IgM
apart from tampons, what else can cause toxic shock
post op infections, cellulite, HIV, burns
features of toxic shock syndrome
fever >38.9 degrees, hypotension, diffuse erythematous rash, desquamation of rash especially on palms, altered mental state
toxin causing toxic shock
staph aureus (TSST-1 superantigen)
Mx of toxic shock syndrome
-remove infection focus
-IV fluids
-IV antibiotics
-IVIG
most common cause of viral gastroenteritis
rota virus
which children are at risk of dehydration
-under 6 months
-children who pass >5 stools or vomit > twice in a 24 hour period
-children who stop breastfeeding in illness
compilation of rotavirus
toxic megacolon
symptoms of IGE mediated CPA
urticaria, itch, hoarseness
what is gold standard for allergy testing
oral food challenge
in a SPT, what do the sizes of the wheels indicate
not the severity of the allergy but instead the likelihood of having one
what is a type 2 hypersensitivity reaction
IgG / IgM mediated reaction against cell surface of the extracellular matrix antigen
what is a type 3 hypersensitivity reaction
IgG/IgM mediated –> soluble antigen gets bound to by antibodies forming immune complexes which then deposit out in tissues and cause damage
mneumonic for an allergy history
Exposure
Allergen
Timing
Environment
Reproducibility
Symptoms
causes for chronic urticaria (>6 weeks)
autoimmune, idiopathic, inducible
what investigations do you do for urticaria
LFTs, TFTs (autoimmune urticaria), CRP, FBC, allergy testing
