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Paediatrics > Infectious Disease > Flashcards

Infectious Disease Flashcards

1
Q

Name 3 causes subtle convulsions in severe malaria

A
  • Hypoglycaemic
  • cerebral malaria
  • pyrexia
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2
Q

Which drug is used to treat severe malaria

A

Intravenous artesunate

Alternative: iv quinine

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3
Q

What causes Katayama’s disease?

A

Schistosoma japonicum

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4
Q

Which 3 parameters are used to classify pneumonia if little access to diagnostic technology?

A
  • Respiratory rate
  • chest indrawing
  • General danger signs
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5
Q

Treatment amebiasis?

A

Metronidazole

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6
Q

Treatment bilharzia?

A

Praziquantel

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7
Q

Treatment ascaris lumbricoidis?

A

Mebendazole

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8
Q

Treatment Candida albicans?

A

Amphotericin B

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9
Q

Which condition is associated with paediatric COVID 19?

A

PIMS: paediatric inflammatory multisystem syndrome

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10
Q

Which empirical antibiotic should be given for dysentery and why?

A

Iv ceftriaxone for 5 days

Most probably S Typhi, which is resistant to penicillins

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11
Q

Describe the stages and progression of syphilis (5)

A

Early syphilis: infections
- primary syphilis
→ incubation 17 - 28 days
→ chancre → 1 week → lymph nodes
- secondary syphilis
- early latent phase

Late syphilis: non-infections
- Late latent phase
- tertiary syphilis

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12
Q

Describe the symptoms and RPR title of early syphilis (9)

A

Primary
- Incubation 17-28 days ; RPR negative
- chancre: painless, may be multiple
- 1 week asymptomatic
- lymph nodes: painless, bilateral, if on cervix then no inguinal lymph nodes
- RPR 1:4

Secondary
- skin lesions eg condylomata lata
- RPR 1:8 and higher (peaks)

Early latent phase (about 1 year)
- asymptomatic
- RPR positive but starting to decrease

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13
Q

Describe the symptoms and RPR title of late syphilis (4)

A

Late latent phase (about 1 year)
- asymptomatic
- Rpr negative
- Tpha positive

Tertiary syphilis
- other systems affected eg CNS, CVS
- once positive the tpha test remains positive for life whether treated or not

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14
Q

Name 8 signs congenital syphilis

A
  • desquamative rash (red/blue spots or bruising esp on soles and palms )
  • jaundice
  • pallor
  • distended abdomen due to enlarged liver/spleen
  • low birth weight
  • respiratory distress
  • pale placenta
  • hypoglycaemia
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15
Q

Treatment asymptomatic newborn infant in mother with syphilis

A

Benzathine penicillin (pen G) 50 000 u/kg IM stat only if
- mom wasn’t treated
- mom received <3 doses benzathine Benzylpenicillin
- Mom delivers within 4 weeks of starting treatment

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16
Q

Treatment symptomatic newborn infant in mother with syphilis

A
  • refer
  • procaine penicillin. 50 000 u/kg IM daily 10 days, or benzyl penicillin G 50 000 u/kg/dose 12 hourly intravenously 10 days
  • erythromycin not reliable
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17
Q

Diagnosis strep pneumonia?

A

Cultures! NOT from nasopharynx

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18
Q

Treatment strep pneumonia URTI

A

Amoxil

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19
Q

Treatment strep pneumonia meningitis

A

3rd generation cephalosporin
Eg ceftriaxone

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20
Q

Clinical features and complications corynebacterium diphtheria (9)

A
  • sore throat, fever, toxaemia
  • white grey membrane in nose/oropharynx - attempt to remove → bleeding
  • Bull neck: cervical lymphadenopathy and periadenitis
  • myocarditis
  • neuritis: palatal and pharyngeal, ocular muscles, intercostal, peripheral nerves

Complications
- pneumonia
- thrombocytopenia, DIC
- renal failure
- airway obstruction

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21
Q

Management corynebacterium diphtheria (3)

A
  • Penicillin 10 days
  • Airway
  • Antitoxin
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22
Q

Classical Clinical features and stages Bordetella pertussis (5)

A
  • Whooping cough!
  • incubation 3 days
  • catarrhal stage 1-2 weeks
  • paroxysmal stage
  • Convalescent stage
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23
Q

More recent Clinical features Bordetella pertussis in infants <6 months (7)

A
  • Short catarrhal stage
  • gagging
  • gasping
  • apnoea
  • absence of whoop
  • Prolonged convalescence
  • sudden unexpected death

Complications: pneumonia, seizures, encephalopathy

Disease of infancy: no transplacental immunity

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24
Q

Management Bordetella pertussis (2)

A
  • Hospitalize, oxygen during spells
  • azithromycin/clarithromycin
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25
Q

Treatment salmonella enterica typhi ( 2)

A
  • ceftriaxone
  • ciprofloxacin
    (Resistance to ampicillin and chloramphenicol)
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26
Q

Name 8 clinical features congenital syphilis (treponema pallidum)

A
  • Skin: bullae, desquamation, red maculo- papules, condylomata
  • mucous membranes: fissures, scars, rhinitis
  • liver/spleen: hepatosplenomegaly, jaundice, hepatitis
  • haematological: anemia, leukaemoid reaction, thrombocytopenia, DIC
  • bones: metaphysitis, periostitis, diaphysitis
  • CNS: meningo encephalitis, convulsions, hydrocephalus
  • renal: nephrosis
  • other: sga , pneumonia alba, chorio-retinitis
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27
Q

Diagnosis syphilis (3)

A

Non-specific: vdrl, RPR
Specific: FTA IG M - may only become positive after 3 months

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28
Q

Treatment syphilis (treponema pallidum) with meningeal involvement

A

Pen G for 10 days

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29
Q

Define poliomyelitis

A

Any case Of acute flaccid paralysis including guillan barre that is not caused by injury in child < 15

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30
Q

Describe the 3 categories of rabies and treatment

A

Category 1: touching/feeding animal but skin intact (wound cleansing)
Category 2: minor scratches without bleeding; nibbling of uncovered skin (vaccine)
Category 3: bites /scratches that penetrate skin and draw blood; lick eyes / mouth, lick broken skin (vaccine and immunoglobulin)

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31
Q

Name 9 indications to defer art commencement

A
  • Tb symptoms - investigate and treat Tb first
  • diagnose drug sensitive Tb at non-neurological site
    → if CD4 < 50: initiate art within 2 weeks of starting Tb treatment, and symptoms improving, and Tb treatment tolerated
    → CD4 50 or more: initiate art 8 weeks after start Tb treatment
  • diagnose drug resistant Tb at non -neurological site: initiate art within 2 weeks of starting Tb treatment, and symptoms improving, and Tb treatment tolerated
  • diagnose drug sensitive or resistant Tb at neurological site: defer 4-8 weeks after start Tb treat
  • signs and symptoms meningitis: investigate
  • cryptococcal antigen positive in absence symptoms/signs meningitis: defer until first 2 weeks of fluconazole prophylaxis completed
  • confirmed cryptococcal meningitis: defer until 4-6 weeks of antifungal treatment completed
  • other acute illnesses eg pneumocystis jirovecii pneumonia or bacterial pneumonia: defer for 1-2 weeks after stunting treatment
  • clinical symptoms/signs liver disease: confirm using alt and bilirubin. alt > 120 with symptoms hepatitis, and or total serum bilirubin >40 significant. Investigate.
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32
Q

Baseline clinical evaluation with art commencement? (10)

A
  • Recognise respiratory, neurological or abdominal danger signs (opportunistic infections) needing urgent care
  • nutritional assessment
  • screen for Tb
  • screen for meningitis: symptoms headache, confusion, visual disturbances, fever, neck stiff, coma.
  • Screen for depression, mental health issues, substance abuse (efv and DTG have neuropsychiatric side effects)
  • screen for major non-communicable chronic diseases (metformin and anti-epileptics interact with art)
  • screen for pregnancy and, plans to conceive
  • screen for STI
  • neurodevelopmental screen
  • WHO clinical stage
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33
Q

Baseline lab evaluation with art commencement? (8)

A
  • Confirm HIV result
  • CD4 count
  • if use TDF: creatinine and egFR
  • haemoglobin (azt cause anemia)
  • genexpert to diagnose Tb only if symptomatic
  • cryptococcal antigen test if Cd4 < 100 (if positive, do lp and give fluconazole )
  • Cervical cancer screening every 3 years
  • hbsag (caution TDF if positive - hepatitis flares)
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34
Q

When should cotrimoxazale be started and stopped in HIV positive infant <1 year old

A

All children should be on it irrespective on CD4 or clinical stage

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35
Q

When should cotrimoxazale be started and stopped in HIV positive child 1-5 years old (3)

A

Start:
- CD4 25% or less
- WHO stages 2-4

Stop:
- CD4 > 25% regardless of clinical stage

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36
Q

When should cotrimoxazale be started and stopped in HIV positive child < 5 years old with PJP

A

Start
After PJP treatment completed

Stop
Continue until 5 years old and stop only if CD4 criteria in older than 5 category are met

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37
Q

When should cotrimoxazale be started and stopped in HIV positive child >5 years old (3)

A

Start
- CD4 200 cells/ ul or less
- who stages 2-4

Stop
- CD4 > 200 regardless of clinical stage

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38
Q

Dolutegravir class?

A

Integrase inhibitor

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39
Q

Dolutegravir dose?

A

50 mg daily in children 20 kg or more and adolescents
If on concomitant Tb treatment, double dose to 50 mg 12 hourly

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40
Q

Name 5 side effects dolutegravir

A

Usually mild and self limiting

  • insomnia
  • headache
  • CNS effects: depression
  • gastrointestinal: increase serum creatinine
  • weight gain
  • neural tube defects: avoid preconception and first 6 weeks pregnancy
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41
Q

Benefits using DTG instead of EFV? (3)

A
  • High genetic barrier to resistance
  • no interaction with hormonal contraceptives
  • side effects mild and uncommon (efavirenz neuropsychiatric, )
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42
Q

Benefits using efavirenz instead of dolutegravir? (3)

A
  • safe in pregnancy
  • no significant interaction with Tb treatment (dtg interact with rifampin)
  • better for obese patients (dolutegravir: weight gain)
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43
Q

Name 4 drug interactions with dolutegravir

A
  • Rifampin: Decrease dolutegravir concentrations (double dose)
  • polyvalent cations - mg, fe, ca, al, zinc eg antacids, sucralfate, multivitamin, nutritional supplements: Decrease dolutegravir concentrations
  • anticonvulsants - carbamazepine, phenytoin, phenobarbital: Decrease dolutegravir concentrations
  • metformin: increase metformin levels
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44
Q

How should polyvalent cations be taken with dolutegravir (4)

A
  • Take calcium and DTG together with food (only decrease DTG on empty stomach)
  • take iron with DTG with food
  • calcium and Ir on must be taken at least 4 hours apart
  • magnesium/aliminium containing antacids should be taken minimum 2 hours after or 6 hours before DTG
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45
Q

Which anticonvulsants can be used with DTG (4)

A
  • Valproate
  • lamotrigine
  • Levetiracetam
  • topirimate

If carbamazepine must be used, double DTG to 50 mg 12 hourly

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46
Q

First line art in adolescents at least 35 kg and at least 10 years old

A

TLD
Tee (efavirenz, emtricitabine, tenofovir) if pregnant up to 6 weeks/ want to conceive soon

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47
Q

First line art in neonates (birth - 4 weeks) weighing at least 2,5 kg

A

Azt + 3TC+ NvP
LAN

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48
Q

First line art in infants and children (more than 4 weeks age and 42 weeks or more gestational age ) weighing at least 3 kg

A

ABC + 3TC+ lpv/r
All

49
Q

First line art in children <10 years or weighing 20-35 kg

A

ABC + 3TC + dtG
Lad

Transition from lpv/r in infanthood to dtg requires vl < 50 in last 6 months

50
Q

First line art in children > 10 years and weighing >35 kg

A

TLD

Transition from childhood art requires vl < 50 in last 6 months. Make sure renal function is fine

51
Q

Name 3 art drugs that interact with rifampin and how to manage

A
  • Nevirapine ( taken by neonates, seek expert advice)
  • LPV /r ( taken by infants and children < 20kg): double dose tablets or give additional ritonavor solution or powder.
  • DTG: double dose

Continue boosting art until 2 weeks after stopping rifampicin

52
Q

Routine vl monitoring for patients on art? (3)

A
  • 6 months after starting art
  • if suppressed (<50) repeat at 12 months (otherwise in 3 months)
  • 12 monthly therafter
53
Q

Routine Cd4 monitoring for patients on art? (3)

A
  • Month 12 on art
  • every 6 months until meet criteria to discontinue CPT
  • stop if vl < 1000
  • if > 1000, every 6 months
54
Q

Management of raised viral load in children on art? (4)

A

Do thorough assessment of cause: ABCDe (adherence, bugs, in correct dose, drug interaction, rEsistance ) implement interventions to resuppress vl including enhanced adherence support and repeat after 3 months
- 50 - 999 → continue enhanced adherence support and repeat in 6 months
- 1000 or more
→ on NNRTI ( efv/ nvp) based regimen: consider switching to second line if confirmed virological failure (1000 or more on 2 consecutive occasions and adherence issues addressed )
→ on insti (dtg) or pi based regimen: consider second line confirmed virological failure (vl 1000 or more on at least 3 occasions over the last 2 years; or 1000 or more with signs of immunological or clinical failure ie declining CD4 and / or opportunistic infections )

55
Q

Name side effect abacavir

A

Hypersensitivity (fever, rash, git, resp) in first 6 weeks
Symptoms typically worsen in hours immediately after dose
If occurs, stop permanently.

56
Q

Name side effect lamivudine

A

Generally well tolerated. Rarely pure red cell aplasia causing anaemia

57
Q

Name contraindication zidovudine

A

Anaemia (hb < 8): cause bone marrow suppression

58
Q

Name 3 indications second line art

A
  • Virological failure
  • immunological failure
  • clinical progression (opportunistic infections)
59
Q

Treatment tonsillitis and pharyngitis? Why?

A
  • Amoxycillin 25 mg/ kg twice daily for 10 days
    Scared of rheumatic fever.
60
Q

Name 2 causes purulent otorrhoea

A
  • Otitis externa
  • otitis media with perforation or drainage through tympanostomy (grommet)
61
Q

Name 2 causes otorrhoea with clear fluid

A
  • Serous middle ear effusion
  • CSF leak
62
Q

Why do younger children get otitis media?

A

Eustacian tube short, smaller calibre, more horizontal.
Immunologically naïve and immature

63
Q

Why / how do children get otitis media? (2)

A
  • Viral URTI > 90%
  • colonization nasopharynx with pathogens
64
Q

Name 6 usual causes (organisms) otitis media

A

Viruses
- Rsv
- Rhinovirus
- influenza

Bacteria
- strep pneumonia
- non typable haemophilus influenza
- moraxella catarrhalis

65
Q

Name 3 diagnostic criteria for acute otitis media

A
  • acute onset
  • signs middle ear effusion: bulging tympanic membrane, limited or absent mobility tm, air fluid level behind Tm, otorrhoea
  • signs and symptoms middle ear inflammation: distinct erythema of TM (NB in crying children this is normal), distinct otalgia (clearly preferable to ear, interfere with normal activity or sleep)
66
Q

Treatment acute otitis media? Which age groups do you treat? (4)

A

< 6 months
- antibacterial whether sure of diagnosis or not

6 months - 2 years
- certain diagnosis: antibacterial
- uncertain: antibacterial if severe ( moderate - severe otalgia or fever 39 or more), observation if not (mild otalgia and fever <39 in previous 24 hours)

> / = 2 years
- Certain : antibacterial if severe, observation if not
- uncertain: observe (follow up)

Treat with amoxicillin 80 - 90 mg/kg/day

67
Q

Name 3 bacterial causes sinusitis

A
  • s pneumonia
  • M catarrhalis
  • H influenza
68
Q

Name 5 predisposing factors to acute bacterial sinusitis

A
  • Viral URTI (bacterial superinfection)
  • day care
  • allergic rhinitis
  • anatomic obstruction
  • irritants: smoke
69
Q

Name 4 symptoms and 3 signs acute bacterial sinusitis

A

Symptoms
- Discharge
- nasal obstruction
- cough
- fever

Signs,
- discharge nasal/posterior pharynx
- sinus tenderness (rare in children)
- periorbital swelling

70
Q

Treatment acute bacterial sinusitis (2)

A
  • Amoxicillin with or without clavulanate 90 mg/kg/day at least 10 days
    (If hospitalised, 3rd generation cephalosporin)
  • adjunctive: saline irrigation
71
Q

WHO classification and treatment pneumonia in children 2 months - 5 years with cough and or difficulty breathing (3)

A
  • cough and cold: no pneumonia (home care)
  • fast breathing and/or chest indrawing = pneumonia (oral amoxicillin clavulanic acid, home care, follow up)
  • General danger sign = severe pneumonia/disease (give first dose antibiotic, refer for injectable antibiotic and supportive therapy oxygen, blood transfusion, hydration, airway obstruction, temp control )
72
Q

Name 3 “constitutional” symptoms measles

A
  • Koplik spots
  • descending erythematous maculopapular rash starting on face → trunk → limbs, later staining and desquamation
  • barking seal cough (croup)
73
Q

Name 10 complications measles!

A

Pulmonary

  • Mostly pneumonia: bacterial superinfection or viral (measles, adenovirus, herpes); later bronchiolitis obliterans or bronchiectasis
  • laryngotracheobronchitis

General

  • immune suppression

Neurological

  • Acute encephalitis
  • encephalopathy
  • sspe

Abdomen

  • diarrhoea

Head and neck

  • corneal ulceration!
  • herpes simplex gingivostomatitis
  • otitis media
74
Q

What disease does parvovirus B19 cause?

A

Erythema infectiosum /slapped cheek disease

Erythematous rash

75
Q

Name 3 populations in which parvovirus B19 is important to consider

A
  • Haemolytic anaemia: can cause aplastic crisis
  • HIV: chronic anaemia
  • foetus: severe anemia and hydrops
76
Q

What disease does HHV 6 cause?

A

Roseola infantum or undifferentiated febrile illness without rash

Erythematous rash

77
Q

Name characteristic features roseola infantum

A
  • Fever 3-7 days
  • around day 3-4, characteristic erythematous rash
    Also enlarged lymph nodes
78
Q

What causes German measles

A

Virus!
Rubella.
( erythematous rash)

79
Q

Cause hand foot and mouth disease?

A

Enteroviruses: coxsackie A 16, ev 71

80
Q

Classical triad tick bite fever? Cause of disease?

A
  • Fever
  • eschar
  • erythematons rash

Cause: boutonneuse fever-like TBF (r conorii), African TBF (r. Africae)

81
Q

Differential diagnosis erythematous maculopopular rashes? (7)

A

Bacterial
- measles! (Spread downwards)
- Lyme disease (borrelia burgdorferi)
- tick bite fever (rickettsia)

Viral
- Parvovirus B 19
- HHV6! (And 7) - roseola infantum
- German measles (rubella)
- Enterovirus eg coxsackie,! ( hand foot and mouth)

82
Q

Differential diagnosis vesicular and blistering rashes? (3)

A

Viral
- Varicella (chicken pox)!
- herpes simplex!

Bacterial
-Impetigo (staph, strep)

83
Q

Treatment chickenpox?

A

(Varicella virus)
- healthy 12 years or less: none
- Immuno competent children 13 or older; or secondary cases in household contacts: oral antiviral therapy

84
Q

Name 5 clinical features herpes simplex

A
  • GingiVostomatitis: fever, salivation, refusal to eat; vesicles → rupture → shallow ulcers with red margin; 4-9 days
  • meningo-encephalitis
  • conjunctivitis
  • Recurrent disease: fever blisters
  • Disseminated disease: immunocompromised
85
Q

Differential diagnosis petechial/ purpuric rashes

A

Bacterial
- meningococcus!
- gonococcus

86
Q

Clinical features meningococcal disease? (5)

A

Variable! Ranges asymptomatic transient bacteraemia to deadly fulminant sepsis

Early: signs URTI, fever, headache, lethargy, vomiting, myalgia, joint pain

Typical:
- Urti
- fever
- haemorrhagic rash and purport
- circulatory collapse, shock

87
Q

Treatment purpuric rash?

A

Always suspect meningococcus so treat for that.

  • ceftriaxone/cefotaxime/ penicillin (if allergy: chloramphenicol
88
Q

Chemoprophylaxis meningococcal meningitis?

A

Rifampicin to household contacts only

89
Q

Name 7 important differentials for CNs infections

A

Virus
- enterovirus
- mumps
- HSV

Bacteria
- meningococcal meningitis
- N meningitides
- s pneumonia
- h influenza type B

Tb

90
Q

Name 2 indications for routine steroids in Paeds infections

A
  • Tb meningitis
  • present deafness in H influenza B infection
91
Q

Name 4 clinical features staph aureus

A
  • Skin: impetigo, boils
  • bones: osteomyelitis, septic arthritis
  • resp: pneumonia, tracheitis
  • cardio: endocarditis
92
Q

Name 4 complications mumps

A
  • Pancreatitis
  • orchitis!
  • meningitis
  • sensorineural hearing loss
93
Q

Simple vs complicated UTI?

A

Simple: lower tract only (cystitis, urethritis), few symptoms and signs
Complicated: upper tract, systemic symptoms and signs

94
Q

Diagnosis UTI? (2)

A
  • Urinalysis: bacterieria and/or pyuria
  • culture: at least 50 000 CFu /ml, uropathogen
95
Q

Indication for ultrasound in children with UTI?

A

All pre-pubertal children with documented culture proven UTI
(Not if previous normal ultrasound)

96
Q

Treatment UTI (3)

A

Empiric amoxicillin - clavulanic acid
Adjust when cultures back

Complicated and older than 3 months: oral antibiotics 7-10 days, or Iv 2-4 days followed by oral 10 days

Hospitalize and iv if: younger than 3 months, urosepsis, children vomiting or can’t tolerate oral medication, immune compromised, no response to oral therapy

97
Q

CSF results bacteria? (6)

A

Protein slightly elevated
Glucose very low
Chloride normal
Polymorphs abundant
Lymphocytes slightly increased
Red blood cells none

98
Q

Most likely cause acute meningitis at 8 months

A

Strep pneumonia

99
Q

CSf results of viral eg herpes encephalitis

A

Seizures, fever, irritable
Glucose normal
Neutrophils none
Red blood cells very high

100
Q

Name 7 steps in diagnosing Tb

A
  • History
  • clinical exam
  • Tst
  • Igra (interferon gamma release assays)
  • genexpert
  • culture and sensitivity (gold standard)
  • Cxr
101
Q

Treatment uncomplicated Tb <8 years old?

A
  • Rifampicin
  • isoniazid (with pyridoxine to prevent peripheral neuropathy )
  • Pyrazinamide
102
Q

Treatment Tb meningitis?

A
  • Rifampicin
  • isoniazid
  • pyrazinamide
  • Ethionamide!
  • prednisone
103
Q

Name 9 clinical features of severe falciparum malaria according to WHO

A

At least 1
- Impaired consciousness
- Prostration (can’t sit/stand/ walk without assisstance)
- multiple convulsions: >2 in 24 hours
- acidotic breathing, respiratory distress
- Acute pulmonary oedema, ARDS
- Circulatory collapse or shock
- anuria
- jaundice
- abnormal bleeding

104
Q

Name 7 lab and other features of severe falciparum malaria according to WHO

A
  • Hypoglycaemia
  • metabolic acidosis
  • Severe normocytic anaemia (hb < 7 or Hct < 20%)
  • hyperparasitaemic
  • hyperlactataemia
  • Renal impair (creatinine > 265)
  • Pulmonary oedema - radiological
105
Q

Treatment uncomplicated malaria caused by P falciparum/Malariae / Knowlesi?

A
  • Antemether- lumefantrine (coartem)
    If unavailable: oral quinine plus doxycycline/ clindamycin
106
Q

Treatment uncomplicated malaria caused by P ovale/vivax or mixed infections falciparum plus ovale/vivax?

A
  • Artemether lumefantrine
  • followed by primaquine
107
Q

Treatment severe malaria?

A
  • iv artesunate (if not available, quinine)
  • Once able to tolerate oral treatment, follow with artemether lumefantrine (coartem)
108
Q

Name 7 contraindications lumbar puncture

A
  • Decreased level of conciousness (glascow<13)
  • signs/ raised intra-cranial pressure
  • focal deficit eg unequal pupils
  • too sick - haemodynamically unstable/ respiratory compromise
  • septicaemia with petechia/ purpura
  • Low platelets or DIC
  • local skin infection
109
Q

Normal CSF findings? (3)

A
  • White cells: o neutrophils, 0-6 lymphocytes
  • Protein: 0,15 - 0,45 g/l
  • glucose: 3,6 - 5,6 mmoI/l
110
Q

Tb meningitis CSF findings? (3)

A
  • White cells: predominantly lymphocytes (other bacteria neutrophils)
  • protein extremely high
  • glucose very low
111
Q

Cause false negative Mantoux test in child with TB? (10)

A
  • Malnutrition
  • HIV
  • severe viral infections eg measles, chickenpox
  • cancer
  • immunosuppressive drugs eg steroids
  • severe disseminated Tb
  • Cutaneous energy
  • recent Tb within 8-10 weeks; very old Tb many years
  • very young < 6 months
  • recent live virus vaccination eg measles, vzv
  • incorrect method TST admin, incorrect interpretation
112
Q

Cause false positive Mantoux test in child without TB? (3)

A
  • Injected subcutaneous in right arm (area of previous BCG vaccination)
  • infection with non-tb mycobacteria
  • incorrect test admin, incorrect interpretation
113
Q

Malaria prophylaxis child ? (2)

A
  • chloroquine
  • proguanil
114
Q

Positive Mantoux test in HIV positive/ malnourished / severe illness

A

5 mm or more

115
Q

Positive Mantoux test in healthy?

A

10 mm or more
Only measure induration, not erythema

116
Q

Common cause pyrexia of unknown origin in developing countries?

A

Typhoid fever

117
Q

Complication varicella?

A

Cerebellar ataxia

118
Q

Define lymphocytic interstitial pneumonitis

A

Rare, infiltration alveolar interstitia and air spaces with small lymphocytes and plasma cells.
Most common cause pulmonary disease after pjp in HIV positive children or EBV.
Autoimmune or indirect viral etiology.

Paediatrics (15 decks)

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