Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

Child Health > Infectious Diseases > Flashcards

Infectious Diseases Flashcards

1
Q

Examples of inactivated vaccines

Killed version of vaccine

A

Polio
Flu vaccine
HepA
Rabies

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

Subunit and conjugate vaccines
Contain parts of organism
Safer for immunocompromised patients
Examples:

A 
Pneumococcus 
Meningococcus
HepB
Pertussis 
Haemophilus influenza TYB
HPV
Shingles
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

Live attenuated vaccines
Contain a weakened version of the pathogen
Still capable of causing infection

A 
MMR
BCG: TB
Chickenpox: weakened varicella zoster
Nasal influenza 
Rotavirus
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

Toxin vaccines

A

Contain toxin produced by vaccine
Diphtheria
Tetanus

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

Vaccines given at birth

A

BCG if risk factors

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

Vaccines given at 2 months/ 8 weeks

A

6in1
Oral rotavirus vaccine
MenB

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

Vaccines given at 12 weeks/ 3 months

A

6 in 1
Pneumococcal (PCV)
Rotavirus

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

Vacccines given at 4 months/ 16weeks

A

6in1

MenB

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

Vaccines given at 1 year

A

Hib/MenC (2in1)
Pneumococcal
MMR
MenB

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

Vaccines given at 2-8

A

Flu vaccine

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

Vaccine given at 3-4years

A

4in1 pre-school booster

MMR

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

Vaccines given at 12-13year

A

HPV vaccination

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

Vaccines given at 13-18years

A

3in1 teenage booster

MenACWY

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

6in1 vaccine

A 
Diphtheria
Tetanus
Polio
HepB
Hib
Pertussis
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

4in1 preschool booster

A

Diphtheria
Tetanus
Whooping cough
Polio

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

3in1 teenage booster

A

Tetanus
Diphtheria
Polio

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

HPV vaccine and strains

A

Protects against 6, 11, 16 and 18
Strains 6 and 11 cause genital warts
Strains 16 and 18 cause cervical cancer

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

Cytokines in paediatric sepsis

A

Interleukins and TNF
Immune system activation, NO released, vasodilation
Increased vessel permeability, oedema, increased diffusion distance, decreased oxygenation
Anaerobic respiration, lactic acidosis
Coagulation system activation, DIC, thrombocytopenia, haemorrhages

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

Septic shock

A

Sepsis has lead to cardiovascular dysfunction
Organ hypoperfusion, decreased BP
Rise in lactate, anaerobic resp

Circulatory collapse and hypoperfusion of organs

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

Management of septic shock

A

IV fluids to improve blood pressure and tissue perfusion
Escalate children to HDICU
Inotropes stimulate CVS and improve blood pressure and tissue perfusion

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

Signs of sepsis

A 
Deranged physical observations
Prolonged CRT
Fever or hypothermia
Deranged behaviour 
Poor feeding
Inconsolable or high-pitched crying
Weak cry
Reduced consciousness 
Reduced body tone
Skin colour changes (cyanosis, mottled pale, ashen)
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
22
Q

Neonatal sepsis

A

Infection within 28 days of life

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
23
Q

Causes of neonatal sepsis

A

Group B streptococcus,early-onset
E.coli
Late-onset: staphylococcal epidermidis, pseudomonas aeruginosa, klebsiella, enterobacter, fungal species

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
24
Q

Risk factors for neonatal sepsis

A

Mother who has had a previous baby with GBS infection
Premature <37weeks
Low birth weight
Evidence of maternal chorioamnionitis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
25
Q

Neonatal sepsis presentation

A 
Respiratory distress
Tachycardia
Apnoea
Change in mental status/ lethargy
Jaundice
Seizures
Poor/reduced feeding
Abdominal distension 
Vomiting
Temperature, pre term hypothermia, term febrile
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
26
Q

Neonatal sepsis investigations

A 
Blood culture
FBC
CRP
Blood gases
Urine microscopy, culture and sensitivity 
Lumbar puncture
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
27
Q

Management of neonatal sepsis

A 
IV benzylpenicillin with gentamicin 
CRP measured 18-24hours after presentation 
Oxygenation
Fluid ad elctoyltres
Vasporessor support
Hypoglycaemia mx
Metabolic acidosis mx
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
28
Q

Sepsis risk assessment

A

Colour: cyanosis, mottled pale or ashen
Activity
Respiratory
Circulation and hydration

All infants <3months with a temperature of >38 need to be treated urgently for sepsis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
29
Q

Immediate management of sepsis

A

Give oxygen: if evidence of shock or saturations <94%
IV access
FBC, UE, CRP, clotting screen (INR), blood gas (lactate and acidosis)
Blood cultures
Urine dipstick
Antibiotics within 1 hr of presentation, continue for 5-7days
IV fluids: 20ml/kg IV if lactate >2mmol/L or if there is shock

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
30
Q

When do you stop ax in sepsis

A

Low suspicion of bacterial infection
Patient is well
Blood cultures and 2 CRP results are negative at 48hours

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
31
Q

Chickenpox features

A

Fever initially
Itchy rash starting on head/trunk before spreading
Macular, papular then vesicular
Systemic upset usually mild

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
32
Q

Measles

A

Prodromal: irritable, conjunctivitis, fever
Koplik spots
Rash behind ears then to whole body
Discrete maculopapular rash, then blotchy and confluent

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
33
Q

Mumps

A

Fever, malaise, muscular pain

Parotitis, unilateral then bilateral

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
34
Q

Rubella

A

Pink maculopapular rash, initially on face before spreading to whole body
Usually fades by 3-5 days
Subocciptal and post auricular lymphadenopathy

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
35
Q

Erythema infectiosum

A 
Fifth disease
Slapped cheek syndrome
Parvovirus B19
Lethargy, fever, headache
Slapped cheek rash spreading to proximal arms and extensor surfaces
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
36
Q

Scarlet fever

A

Reaction to erythrogenic toxins produced by GroupA haemolytic streptococci
Fever, malaise, tonsilitis
Strawberry tongue
Circumoral pallor

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
37
Q

Hand, foot and mouth disease

A

Coxsackie A16 virus
Mild systemic upset: sore throat, fever
Vesicles in mouth and on the palms and soles of feet

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
38
Q

Meningitis organisms

Neonatal to 3 months

A

Group B streptococcus: from mum
E,coli
Listeria monocytogenes

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
39
Q

Meningitis organisms

1month-6years

A

Neisseria meningitidis
Streptococcus pneumoniae
Haemophilius influenza

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
40
Q

Meningitis organisms >6months

A

Neisseria meningitidis

Streptococcus pneumoniae

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
41
Q

Presentation of meningitis

A 
Fever
Neck stiffness
Vomiting
Headache
Photophobia 
Altered consciousness 
Seizures
Hypotonia, poor feeding, lethargy, hypothermia, bulging fontanelle
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
42
Q

Lumbar puncture indications in meningitis

A

<1 month and fever
1-3months with fever and unwell
<1 year with unexplained fever

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
43
Q

Contraindications to lumbar puncture

A 
RICP signs
Focal neurological signs
Significant bulging of fontanelle
Papilloedema
DIC
Signs of cerebral herniation

Take blood cultures and PCR instead

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
44
Q

Special tests for meningeal irritation

A

Kernigs test

Brudzinskis test

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
45
Q

Kernigs test

A 
For meningeal irritation 
Lie patient on back 
Flex hip and knee to 90
Straighten knee
Spinal pain/resistant to movement
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
46
Q

Brudzinski’s test

A

Lie patient on back
Use hands to lift their hand and neck off bed
Flex chin to their chest
Positive test: flex hip and knees

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
47
Q

Management of meningitis

A 
Lumbar puncture for CSF
Blood culture 
Meningococcal PCR
Fluids to treat shock
Cerebral monitoring 
Notifiable disease, antibiotic prophylaxis of contacts, ciprofloxacin
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
48
Q

Antibiotics in meningitis

A

<3 months: IV amoxicillin + IV cefotaxime
>3 months: IV ceftriaxone

Add vancomycin if risk of penicillin resistant pneumococcal infection

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
49
Q

Steroids in meningitis

A

No corticosteroids if <3 months

Dexamethasone if lumbar puncture suggests bacterial meningitis, 4x daily for 4 days

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
50
Q

Causes of viral meningitis

A

Herpes simplex virus
Enterovirus
Varicella zoster virus

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
51
Q

Management of viral meningitis

A

Aciclovir

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
52
Q

Meningitis CSF appearance

A

Cloudy in bacterial

Clear in viral

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
53
Q

Meningitis CSF protein

A

0.2-0.4g/l: normal
>1.5g/L: bacterial
Mildly raised or normal: viral

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
54
Q

Meningitis CSF glucose

A

Normal: 0.6-0.8
Viral: 0.6-0.8
Bacterial: <0.5

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
55
Q

Meningitis CSF WCC

A

Normal <5
Bacterial >1000 and neutrophils
Viral >1000 and lymphocytes

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
56
Q

Complications of meningits

A

Hearing loss
Seizures and epilepsy
Cognitive impairment and learning disability
Memory loss
Cerebral palsy: limb weakness or spasticity

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
57
Q

Causes of encephalitis

A

HSV-1 cold sores in children

HSV-2 genital warts in neonates (from birth)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
58
Q

Encephalitis presentation

A 
Altered consciousness 
Altered cognition
Unusual behaviour 
Acute onset of focal neurological symptoms 
Acute onset of focal seizures
Fever
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
59
Q

Diagnosis of encephalitis

A 
Lumbar puncture
CT scan
MRI scan 
EEG recording
Swabs: throat and vesicle 
HIV testing
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
60
Q

Management of encephalitis

A

IV aciclovir: herpes simplex virus, varicella zoster virus
IV gancliclovir: cytomegalovirus

Repeat lumbar puncture

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
61
Q

Complications of encephalitis

A 
Lasting fatigue, prolonged recovery
Change to personality or mood
Changes to memory and cognition
Learning disability
Headaches
Chronic pain 
Movement disorders
Sensory disturbance 
Seizures
Hormonal imbalance
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
62
Q

Infectious mononucleosis

A

Glandular fever
EBD, human herpesvirus 4
Rash after amoxicillin

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
63
Q

Features of infectious mononucleosis

A

Sore throat
Lymphadenopathy: anterior and posterior triangles
Pyrexia

Fatigue
Tonsillar enlargement, snoring
Splenomegaly: splenic ruptures 
Malaise, anorexia, headache
Palatal petechiae
Hepatitis, transient rise in ALT
Lymphocytosis 
Haemolytic anaemia

Symptoms resolve after 2-4sweek

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
64
Q

Diagnosis of infectious mononucleosis

A

Heterophil antibody test: Monospot (horses) or Paul-Bunnell test (sheep)
In 2nd week
Viral capsid antigen for EBV antibodies

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
65
Q

Monospot test infectious mononucleosis

A

Introduces patients blood to RBC from horses

Heterophile antibodies will give a positive result

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
66
Q

Management and prognosis infectious mononucleosis

A

Acute illness lasts 2-3weeks, fatigue for several months once infection is disabled
Avoid alcohol
Rest during early stages
Avoid playing contact sports for 8 weeks after having glandular fever to reduce risk of splenic rupture

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
67
Q

Complications of infectious mononucleosis

A 
Splenic rupture
Glomerulonephritis
Haemolytic anaemia
Thrombocytopenia
Chronic fatigue 
Gillian-Barre syndrome 
Encephalitis

Associated with Burkitts lymphoma

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
68
Q

Mumps

A 
RNA paramyxovirus
Respiratory droplets
Incubation 14-21days
Self-limiting, lasts 1 week 
Supportive management
69
Q

Presentation of mumps

A 
Fever
Malaise, muscular pain
Parotitis: unilateral then bilateral, with associated pain 
Lethargy
Dry mouth 
Reduced appetite
Headache
70
Q

Complications of mumps

A

Abdominal pain: pancreatitis
Testicular pain and swelling: orchitis
Confusion, neck stiffness and headache (meningitis or encephalitis)
Sensorineural hearing loss: unilateral and transient

71
Q

Management of mumps

A

PCR test on saliva swab to diagnose
Test saliva for antibodies
Supportive management
Notifiable disease

72
Q

Epiglottitis

A

Inflammation and swelling of epiglottitis
Caused by infection
Haemophilus influenza TYB
Streptococcus pneumoniae

73
Q

Pathophysiology of epiglottitis

A

Haemophilus influenza and streptococcus pneumoniae infection
Can also be due to non-infectious cases: trauma, thermal/chemical damage
Inflammation starts on lingual surface
Spreads to aryepiglottic folds, arytenoids, supraglottic larynx

Vocal cords swelling restricted by epithelium, increased pressure in small area, airway obstruction

74
Q

Epiglottitis in children airway obstruction more likely

A

Epiglottis is more floppy, broader, longer and angled more obliquely to trachea
Larger tones and anteriorly-angled vocal cords mean children find it more difficult to move air past partial obstruction

75
Q

Risk factors for epiglottitis

A

Not receiving HiB vaccine
Male gender
Immunosuppression

76
Q

4Ds of epiglottitis

A

Dyspnea
Dysphagia
Drooling
Dysphonia

77
Q

Clinical features epiglottitis

A 
Sore throat and stridor
Drooling
Tripod position
High fever
Difficulty or painful swallowing
Muffled voice
Scared and quiet child
Septic and unwell appearance

Symptom duration<12hours
No cough typically

78
Q

DD epiglottitis

A 
Croup
Inhaled foreign body
Retropharyngeal abscess
Tonsilitis 
Peritonsillar abscess
Diphtheria
79
Q

Investigations epiglottitis

A 
Secure airways 
Intubation equipment ready
Throaty swabs 
Blood tests: FBC, cultures, CRP
Lateral neck XRAY: thumb print signs, thickened aryepiglottic folds, increased opacity of larynx and vocal cord
80
Q

Management of epiglottitis

A

Secure airway: Escalate to anaesthetist and ENT registrar
Oxygen
Nebulised adrenaline to reduce oedema
IV antibiotics: 3rd generation cephalosporin (cefotaxime, ceftriaxone), oral co-amoxicillin once well
IV steroids (dexamethasone)
IV infusion

81
Q

Complications of epiglottitis

A 
Mediastinitis: if spreads to retropharyngeal space
Deep neck space infection
Pneumonia
Meningitis
Sepsis/ Bacteraemia
82
Q

Glandular fever epidemiology

A

Age 1-6

Age 18-22

83
Q

Tonsilitis

A 
Inflammation of palatine tonsils
Viral infection
Concentration of lymphoid tissue within oropharynx 
Tonsillopharyngitis 
Adenotonsilitis
84
Q

Causes of bacterial tonsilitis

A

Group A streptococcus (pyogenes)
Penicillin V (phenoxymethylpenicillin)
Streptococcus pneumoniae

Also:
H. influenza
Morazella catarrhalis
Staphylococcus aureus

85
Q

Causes of viral tonsilitis

A

Adenovirus
EBV
Group A strep (strep. Pyogenes)

86
Q

Risk factors for tonsilitis

A

Smoking

Second hand smoke

87
Q

Waldeyer’s tonsillar ring

A 
Ring of lymphoid tissue in pharynx
Adenoids
Tubular
Lingual
Palatine
Infected and enlarged in tonsilitis
88
Q

Tonsilitis history

A 
Symptoms last 5-7 days, if linger could be glandular fever
Odynophagia
Fever
Reduced oral intake
Halitosis
New onset snoring
Shortness of breath
89
Q

Tonsilitis examination

A

Red inflamed tonsils
White exudate spots on tonsils
Cervical lymphadenopathy
Examine eats to visualise tympanic membranes

90
Q

Centor criteria

Estimate probability that tonsilitis is due to bacterial infection

A 
>3
Fever >38
Tonsillar exudates
Absence of cough 
Tender anterior cervical lymph nodes (lymphadenopathy)
91
Q

FeverPAIN criteria

Probability of bacterial tonsilitis

A 
>4
Fever: during previous 24hours
Purulence (pus on tonsils)
Attended within 3 days of the onset of symptoms
Inflamed tonsils (severely inflamed)
No cough or Coryza
92
Q

Streptococcal score card
Specific to Group A streptococci
Tonsilitis

A 
5-15years
Season
Fever
Cervical lymphadenopathy
Pharyngeal erythema, oedema or exudate 
No viral URTI symptoms
93
Q

DD tonsilitis

A 
Quinsy or peritonsillar abscess
Pharyngitis
Glandular fever
Tonsillar malignancy
Epiglottitis
94
Q

Investigations tonsilitis

A

Throat swabs limited value
FBC
LFT, glandular fever
U&E: dehydration/AKI

95
Q

Initial management of tonsilitis

A 
Check for respiratory compromise
Rehydrate
Analgesia 
Steroids 
Antibiotics: benzylpenicillin IV, oral penicillin V if able to swallow 7-10days
96
Q

Complications of tonsilitis

A 
Chronic tonsilitis
Peritonsillar abscess, quinsy
Otitis media
Scarlet fever
Rheumatic fever
Post-streptococcal glomerulonephritis
Post-streptococcal reactive arthritis
97
Q

Post-streptococcal glomerulonephritis

A

Hypertension
Haematuria
Oedema

98
Q

Rheumatic fever post-streptococcal

A

Prolonged fever
Anaemia
Arthritis
Pancarditis

99
Q

Peritonsillar abscess

A

Quinsy
Collection of pus in peritonsillar space that surrounds palatine tonsils
Deep neck space abscess
Complications of tonsilitis

100
Q

Pathophysiology peritonsillar abscess

A

Tonsil between anterior tonsillar pillar (glossopalatine muscle) and posterior tonsillar pillar (pharyngopalatine muscles)
Pus collects in space between tonsillar capsule and superior pharyngeal muscles

101
Q

Causative organisms peritonsillar abscess

A

30-39years: Group A Streptococcus (Strep pyogenes)

15-24years: fusobacterium necrophorum

102
Q

Risk factors peritonsillar abscess

A

Recurrent tonsilitis
Partially treated tonsilitis
Smokers

103
Q

Peritonsillar abscess presentation

A 
Sore throat
Painful swallowing/ drooling
Trismus: muscle spasms preventing jaw opening to full extent
Hot potato voice: pharyngeal swelling 
Halitosis
Fever
Neck pain
Referred ear pain
Swollen tender lymph nodes 
Fatigue and irritability: dehydration
104
Q

Peritonsillar abscess examination

A

Unilateral tonsillar inflammation
Deviation of uvula away from affected side
Restricted opening of jaw
Fullness/ fluctuant swelling superior to the tonsil/ in posterior soft palpate pushing the tonsil infero-medially

105
Q

Peritonsillar abscess examination

A

Unilateral tonsillar inflammation
Deviation of uvula away from affected side
Restricted opening of jaw
Fullness/fluctuant swelling superior to tonsil/ in posterior soft palate pushing the tonsil inferomedially

106
Q

DD peritonsillar abscess

A

Tonsilitis
Peritonsillar cellulitis
Parapharyngeal/ retropharyngeal abscess
Epiglottitis

107
Q

Investigations for peritonsillar abscess

A

FBC, elevated neutrophil
U&E
CRP
Glandular fever

CT to see if infection is spread into parapharyngeal or retropharyngeal space

108
Q

Management peritonsillar abscess

A 
Aspiration or incision and drainage
Antibiotics: co-amoxicillin or benzylpenicillin and metronidazole.
IV rehydration
Steroid therapy: dexamethasone
Needle aspiration
109
Q

Tonsillectomy indications

A

7 or more in 1 year
5 per year for 2 years
3 per year for 3 years

Recurrent tonsillar abscesses (2 episodes)
Enlarged tonsils causing difficult breathing, swallowing or snoring

110
Q

Complications of tonsillectomy

A 
Pain, sore throat
Damage to teeth
Infection
Post-tonsillectomy bleeding
Risks of general anaesthetic
111
Q

Post-tonsillectomy bleeding management

A

Call ENT registrar
IV access, send bloods including FBC, clotting screen, group and save, crossmatch
Keep child calm and give adequate analgesia
Sit child up and encourage to spit out blood rather than swallowing
IV fluids for maintenance and resuscitation as required

Hydrogen peroxide gargle
Adrenalin soaked swab applied topically

112
Q

Otitis media

A

Middle ear infection
Bacteria enter through Eustachian tube
Viral URTI
Short,straight wide Eustachian tube in children

113
Q

Bacteria in otitis media

A

Streptococcus pneumoniae most common

Also:
Haemophilus influenzae 
Moraxella catarrhalis
Staphylococcus aureus 
RSV
Rhinovirus
114
Q

Risk factors for acute otitis media

A 
Age
Gender
Passive smoking
Bottle feeding
Craniofacial abnormalities

Recurrent AOM seen more commonly with use of pacifiers
Fed supine, first episode occurred <6months
More common in winter season

115
Q

Clinical features of otitis media

A

Ear pain, reduced hearing
Pain, malaise, fever, coryzal symptoms lasting a few days
Feeling generally unwell
Tug at ears or cradle ear that hurts

Vestibular system: balance issues, vertigo, discharge when tympanic membrane perforated

Fever, vomiting, irritability, lethargy, poor feeding

116
Q

Examination otitis media

A

Otoscope:
Tympanic membrane erythematous and bulging
Tear and discharge

Conductive hearing loss
Cervical lymphadenopathy

Test and document function of facial nerve
Intracranial complications

117
Q

DD acute otitis media

A

Chronic suppurative otitis media
Otitis media with effusion
Otitis externa

118
Q

Management of otitis media

A

Assessment and admission in infants <3 months or with a temperature of >38
Or 3-6 months with a temperature >39
Symptoms resolve in <3 days

Grommets

119
Q

Indications for antibiotics in otitis media

A 
Amoxicillin 5 days
Systemically unwell children not requiring admission
Known risk factors for complications
Unwell for >4days
Discharge with ear
<2s with bilateral infections
120
Q

Complications of otitis media

A 
Otitis media with effusion
Mastoiditis
Perforated eardrum
Hearing loss
Recurrent infection
Abscess
121
Q

Mastoiditis from otitis media

A 
Boggy, erythematous swelling behind ear
Pushes pinna forward
IV AX
CT head if no improvement
High risk of intracranial spread and meningitis
122
Q

Otitis media with effusion

A

Eustachian tube dysfunction
Build up of fluid in middle ear
Loss of hearing

123
Q

Risk factors glue ear

A 
Bottle fed
Paternal smoking
Atopy
Genetic disorders: mucociliary disorders(CF, primary ciliary dyskinesia)
Craniofacial disorders (Downs syndrome)
124
Q

Glue ear presentation

A

Reduction of hearing in that ear
Sensation of pressure, popping or crackling noises
Vertigo

Otoscopy:
Dull tympanic membrane
No light reflex
Bubble seen behind TM
Visible fluid level
125
Q

Investigations glue ear

A

Pure tone audiometry
Tympanometry
Conductive hearing loss and reduced membrane compliance

126
Q

Management of glue ear

A

Resolve within 3 months

No resolution after 3 months:
Non-surgical: hearing aid insertion
Surgical: myringotomy and grommet insertion

Persistent disease:
Adenoidectomy

127
Q

Peri-orbital cellulitis epidemiology

A

0-15years
More common in males
Bi-modal seasonal variation late winter/early spring
Sinus related infections

128
Q

Peri-orbital cellulitis pathophysiology

A

Pre-septal cellulitis
Post-septal cellulitis
Paranasal sinuses: ethmoidal sinuses most common cause, frontal sinuses, sphenoidal sinuses, maxillary sinuses

129
Q

Why does peri-orbital cellulitis occur more in children

A

Neonates haven’t yet formed their frontal sinuses
Thinner and dehiscent bone surface of lamina papyracea
Increased diploic venous supply in comparison with adulthood
Incomplete immunologic development in age group

Mild periorbital cellulitis-> sight-threatening orbital abscess

130
Q

Causes of peri-orbital cellulitis

A 
Sinuses infection spread
Dacrocystitis
Dental infecton
Endophthalmitis
Trauma
Foreign bodies
Insect bites
Skin infections (impetigo)
Eyelid lesions (chalazia, hordeola)
Eyelid and oral procedures

Haemophilus influenza TYB

131
Q

Clinical features of pre-septal cellulitis

A 
Eyelid oedema
Erythema of upper eyelid
Abscence of orbital signs
Normal vision
Absence of proptosis
Full ocular motility without pain on movement

Impedance to drainage through ethmoid vessels:
Erythema may spread to upper cheek and brow area
Hx of acute sinusitis or URTI
Hyperaemia of nasal mucosa
Occasional purulent discharge from ipsilateral osteomeatal complex and sphenoethmoidal recess

132
Q

Clinical features of orbital cellulitis

A 
Proptosis
Opthalmoplegia
Decreased visual acuity
Loss of red colour vision- first sign of optic neuropathy
Chemosis
Painful diplopia
133
Q

Chandler classification

A 
TY1: pre-septal cellulitis
TY2: post septal, orbital cellulitis
TY3: sub periosteal abscess
TY4: intra-orbital abscess 
TY5: cavernous sinus thrombosis
134
Q

TY1: pre-septal cellulitis

A

Cellulitis confined to eyelid

Anterior to superior orbital septum: inflammation does not spread beyond orbital septum

135
Q

TY2: post-septal, orbital cellulitis

A

Inflammation extends into orbital tissue
No abscess formation
Cellulitis involving the orbit-a disuse infiltration of orbital tissues with inflammatory cells
Eyelids may be swollen and there may be conjunctival chemosis with variable degree of proptosis and visual loss

136
Q

TY3: subperiosteal abscess

A

Abscess forms deep to periosteum of the orbit
Purulent material collects periorbitally and in the bony walls of the orbit
Pronounced eyelid oedema, conjunctival chemosis, and tenderness along the affected orbital rim with variable degree of motility, proptosis and visual acuity changes

137
Q

TY4: intra-orbital abscess

A

Collection of pus inside or outside muscle cone
Progressive and untreated orbital cellulitis
Proptosis, conjunctival chemosis, decreased ocular motility, and visual loss may be severe

138
Q

TY4: cavernous sinus thrombosis

A

Bilateral marked eye oedema
Involvement of CN3, 5, 6
Associated generalised sepsis, nausea, vomiting and signs of altered mentation

Orbital apex syndrome: proptosis, eyelid oedema, optic neuritis, opthalmoplegia, neuralgia of opthalmic division of CN5
Caused by sinus disease aroun optic foramen and superior orbital fissure

139
Q

Examination peri-orbital cellulitis

Investigations

A

Vitals
Dentition
Anterior rhinoscopy: appearance of the nasal mucosa in general and middle meatus area
Discharge should be swapped and sent for culture
Opthalmic assessment
Neurological examination
Inflammatory markers to check response to treatment
CT: extension of disease into orbit

140
Q

DD peri-orbital cellulitis

A 
Vesicles of herpes zoster opthalmicus 
Erythematous irritation of contact dermatitis
Hordeolum or stye
Chalazion 
Dacrocystitis
Blepharitis 
Raised, dry plaques of atopic dermatitis
141
Q

Management of pre-septal cellulitis

A

Outpatient

Broad spectrum oral ax

142
Q

Management of orbital cellulitis

A 
Hospital admission
IV ax 
Nasal decongestants
Steroid nasal drops
Nasal douching 
IV fluids
Analgesia
Optic nerve monitoring

Intracranial complications: urgent drainage

143
Q

Optic complication of peri-orbital cellulitis

A

Loss of vision: from papilloedema or neuritis, mechanical pressure, compression of arteries, necrosis of optic nerve
Asymmetrical eyelid opening
Impaired ocular motility
Eyelid inflammation

144
Q

Neurological complications of peri-orbital cellulitis

A

Encephalomeningitis
Cavernous sinus thrombosis
Sepsis
Intracranial abscess formation: fever, altered mental status

145
Q

Staphylococcal toxic shock syndrome

A

Severe systemic reaction to staphylococcal exotoxins

TSST-1 superantigen txin

146
Q

Staphylococcal toxic shock syndrome

Centres for disease control and prevention diagnosirtc criteria

A 
Fever: temperature >38.9
Hypotension: systolic blood pressure <90
Diffuse erythematous rash
Desquamation of rash, especially of the palms and soles
Involvement of >3 organ systems
147
Q

Presentation of staphylocccal toxic shock syndrome

A 
GI: D/V
Mucous membrane erythema 
Renal failure
Hepatitis
Thrombocytopenia
CNS involvement
148
Q

Management of staphylococcal toxic shock syndrome

A

Removal of infection focus, tampon
IV fluids
IV ax

149
Q

Candidiasis

A

Balanitis
Oral thrush
Vaginal discharge: cottage cheese discharge, vulvitis, itch
Onychomycosis
Black hairy tongue
Candida dermatitis (napkin rash), satellite lesions, involves flexure

150
Q

Features of bacterial conjunctivitis

A

Purulent discharge

Eyes stuck together in morning

151
Q

Features of viral conjunctivitis

A

Serous discharge
Recent URTI
Preauricular lymph nodes

152
Q

Management of infective conjunctivitis

A

Self-limiting in 1-2sweeks
Topical Ax therapy, chloramphenicol drops
Topical fusidic acid for pregnant women

153
Q

Kawasaki disease

A 
Mucocutaneous lymph node syndrome
Medium sized vasculitis 
<5s affected 
More common in boys and Asian children 
Complication: coronary artery aneurysm
154
Q

Features of Kawasaki disease

A 
High-grade fever >5 days
Conjunctival injection
Bright red, cracked lips
Strawberry tongue
Cervical lymphadenopathy
Red palms of hand and soles of feet, desquamation 
Fever resistant to antipyretic
Widespread erythematous maculopapular rash
155
Q

Investigations Kawasaki disease

A

FBC: anaemia, leukocytosis, thrombocytosis
LFT: hypoalbuminaemia, elevated liver enzymes
Inflammatory markers raised
Urinalysis: raised WCC without infection
ECHO: coronary artery pathology

156
Q

Disease course Kawasaki disease

A

Acute phase: fever, rash, lymphadenopathy 1-2weeks
Subacute phrase: desquamation and arthralgia, risk of coronary artery aneurysms forming, 2-4weeks
Convalescent stage: settle, 2-4weeks

157
Q

Management of Kawasaki disease

A

High dose aspirin to reduce thrombosis risk
IVIG to reduce risk of coronary artery aneurysm
Follow up with ECHO

158
Q

Congenital rubella syndrome

A

8-10 weeks risk of damage to fetus is high
Caused by togavirus
If contracted during pregnancy
Incubation 14-21days

159
Q

Features of congenital rubella syndrome

A 
Sensorineural deafness
Congenital cataracts
Congenital heart disease
Growth retardation
Hepatosplenomegaly
Purpurin skin lesions
Salt and pepper chorioretinitis
Micropthalmia 
Cerebral palsy
160
Q

Diagnosis of congenital rubella syndrome

A

Health protection unit

IgM antibodies raised n women recently exposed to virus

161
Q

Management of congenital rubella syndrome

A

Discuss with local health protection unit

Offer non-immune mom MMR vaccine post-natally

162
Q

Rubella features

A

Milder erythematous macular rash
Starts on face and spreads to body
Rash lasts 3 days
Associated with mild fever, joint pain, sore throat
Lymphadenopathy behind ear and at back of neck

163
Q

Management of rubella

A

Supportive
Notifiable disease
Stay off school 5 days after rash first appearance
Children should avoid pregnant women

164
Q

Complications of rubella

A 
Thrombocytopenia
Encephalitis
Arthritis
Myocarditis 
Congenital rubella syndrome: deafness, blindness, congenital heart disease
165
Q

Measles

A

RNA paramyxovirus
Spread by droplets
Infective from prodromal until 4 days after rash starts
Incubation 10-14datys

166
Q

Features of measles

A

Prodrome: irritable, conjunctivitis, fever
Koplik spots
Rash behind ears then to whole body, discrete maculopapular rash becoming blotchy and confluent
Diarrhoea in 10% of patients

167
Q

Investigations for measles

A

IGM antibodies few days after rash appears

168
Q

Management of measles

A

Mainly supportive, self resolves after 7-10 days of symptoms
Admission may be considered in immunosuppressed or pregnant patients
Notifiable disease-> inform public health

169
Q

Complications of measles

A 
Pneumonia
Otitis media
Encephalitis
Subacute sclerosing pan encephalitis, may present 5-10years following illness
Febrile convulsions
Keratoconjunctivitis, corneal ulceration 
Diarrhoea
Increased incidence of appendicitis
Myocarditis 
Dehydration
Meningitis
Vision loss 
Death

Child Health (20 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions