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Phase 3a Paeds > Infectious diseases > Flashcards

Infectious diseases Flashcards

1
Q

what is used to assess sepsis risk?

A

qSOFA
(Septic organ failure assessment)

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2
Q

what are the 3 criteria for qSOFA (sepsis risk assessment)?

A
  1. > 22 RR
  2. <15 GCS
  3. 100mmHg or less systolic
    at least 2 our of these 3 = RISK
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3
Q

How do we assess a sick child?

A

according to traffic light system

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4
Q

what sections are assess in the traffic light system?

A

CARChO
- Colour
- Activity
- RR
- Circulation / hydration
- Other

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5
Q

what is in the green section of the traffic light system?

A

Colour:
Normal colour

Activity:
-Responds normally to social cues
-Smiles/content
-stays awake or quickly awakens
-Strong normal crying/not crying

Resp rate normal

Circulation + Hydration:
-Normal eyes
-moist mucous membranes

Other:
-None of the amber or red Sx

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6
Q

what is in the amber section of the traffic light system?

A

Colour:
-Pallor - reported by parent/carer

Activity:
-Not responding normally to social cues
-No smile
-wakes only with prolonged stimulation
-decreased activity

Resp:
-nasal flaring
-Tachypnoea:
RR>50, 6-12 months
RR >40, >12 months
-Oxygen sats 95% or less on air
-crackles in chest

Circulation + hydration:
-Tachycardia:
>160bpm, <12 months
>150bpm, 12-24 months
>140bpm, 2-5y
-CRT 3+
-Dry mucous membranes
-Poor feeding in infants
-Reduced urine output

Other:
-age 3-6months + 39+*C
-Fever for 5+ days
-Rigors
-Swelling
-Non weight bearing limb/joint

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7
Q

what is in the red section of the traffic light system?

A

Colour:
-Pale/mottles/ashen/blue

Activity:
-No response to social cues
-Appears ill to a healthcare professional
-Does not wake or if roused doesn’t stay awake
-weak, high pitched cry

RR:
-Grunting
-Tachypnoea:
RR>60
-Moderate or severe chest indrawing

circulation + hydration:
-Reduced tissue turgor

Other:
-Age <3 months, temp 38+*C
-Non blanching rash
-Bulging fontanelle
-Neck stiffness
-Status epilepticus
-Seizures

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8
Q

what are the next steps for Low, moderate and severe risk in the traffic light system?

A

Low = safety net along

Moderate = + F2F assessment to judge admission or not

Severe = Urgent admission

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9
Q

what is Kawasaki disease?
ages it affects?
Ethnicity it affects?

A

Medium cell vasculitis

under 5y/o

Males, asian (Japanese + Korean) + afrocarribean

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10
Q

Sx of Kawasaki disease?

A

CRASH + BURN
-At least 4 out of 5 CRASH
Conjunctivitis (Bilateral)
Rash - maculopapular rash (widespread)
Adenopathy - anterior cervical LN
Strawberry tongue + mucosal involvement
Hands + feet - desquamation (skin peeling)

BURN, At least 5 days 39*C fever

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11
Q

What are the 3 phases of Kawasakis?

A

Acute phase (1-2 weeks) - fever, rash, LNadenopathy

Subacute phase (2-4 weeks) - Sx settle, desquamation + risk of coronary artery aneurysm

Convalescent stage (2-4 weeks) - remaining Sx settle + blood markers slowly normalise

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12
Q

Dx of Kawasaki?

A

Bloods = FBC (Low Hb, High WCC + Plt)
LFT = Low albumin, High AST/ALT
High ESR
Urinalysis = High WCC (no infection)
ECHO = CA pathology

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13
Q

Tx of Kawasaki?

A

IV IG (Sx improvement + lower CA aneurysm risk)

High dose aspirin (anti inflammatory + reduce thrombosis risk)

Do serial ECHO 2w onwards = 20% Px have coronary artery aneurysm as a complication

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14
Q

Why is aspirin usually CI?
what does it cause?

A

Reye syndrome
Neurohepatic Sx (brain + liver swelling) = encephalitis/AMS, Jaundice, seizures/LOC

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15
Q

What is VZV?
What 2 conditions does it cause?
in what age?

A

Vericella zoster virus (herpes virus)

Causes:
- Varicella (chicken pox)
-Herpes zoster (shingles)

> 5% children by 5

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16
Q

how is chicken pox spread?

A

Resp (airborne)
Direct contact

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17
Q

what are the Sx of chicken pox?
Prodrome?

A

Contagious 4 days before - exanthema (rash) - 5 days after (incubation period = 3 weeks)

Prodrome =
Fever (1st Sx), Itch, general fatigue, malaise

Macular - papular - vesicular - crusting (widespread erythematous raised vesicular fluid filled lesions) - start at trunk or face to whole body in 2-5 days

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18
Q

when is chicken pox no longer infectious?

A

When the rash has crusted

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19
Q

Dx of chicken pox?

A

Clinical

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20
Q

Tx of chicken pox?

A

Self limiting, supportive
Acyclovir if severe (immunocompromised)
Itchy = calamine lotion

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21
Q

How long is school exclusion in chicken pox?

A

5 days post exanthem (crusted over)

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22
Q

Complications of shingles?

A

Dormant VZV, reactivates in immunocompromised, dermatomal scarring

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23
Q

what is a main complication of VZV and what does it cause?

A

Ramsey hunt
Encephalitis, Foetal varicella (cutaneous scars, limb defect, eyes/CNS abnormalities), pneumonia

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24
Q

what should NOT be given in VZV and why?

A

DO NOT GIVE NSAIDS in VZV - can precipitate necrotising fasciitis

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25
Q

Is measles notifiable to PHE?

A

Yes

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26
Q

What is Measles caused by?
How is it spread?
Contagious?
Incubation period?

A

Morbillivirus (RNA Paramyxoviridae)
Spreads via resp droplets
Very contagious
10-14 day incubation

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27
Q

Sx of measles?

A

Prodromal (3-5days)
Cough
Coryza
Conjunctivitis
(+ 10% diarrhoea)

Then exanthem
(macular papular face + trunk rash)

Buccal koplik spots
(Pathagnomic white buccal mucosa spots)

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28
Q

Dx of measles?

A

Clinical
IgM/G

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29
Q

Tx of measles?
School exclusion?
when is it no longer contagious?

A

School exclusion 4 days after rash (not contagious)

Notify PHE

MMR vaccine <72hrs

Contact management

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30
Q

What are the MC complications of measles?

A

Otitis media!!!!!
Encephalitis, SPSE, Febrile convulsions

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31
Q

what is the MC cause of death in measles?

A

Pneumonia

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32
Q

In measles, where does exanthem affect?
what also affects the child 1 week later?

A

Exanthem = behind ears to trunk + body

Desquamation on palms + soles = 1 week later

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33
Q

what is mumps caused by?
what does it affect?
how is it spread?
what ages are usually affected?
what time of year?

A

RNA Pymyxovirus
Salivary + parotid glands
Resp droplets + direct contact spread
15-20y
Winter, spring

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34
Q

is mumps notifiable to PHE?

A

Yes

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35
Q

Sx of mumps?

A

Fever, malaise, muscular pain,
Parotitis (parotid gland swelling) - U/L initially B/L in 70%

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36
Q

Incubation period of mumps?

A

12-25 days

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37
Q

Dx of mumps?

A

PCR on saliva swab

Blood/saliva serology = mumps viral Abs

ECG changes (15%) = ST-T depression, T inversion, PR prolongation

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38
Q

Tx of Mumps?
School exclusion?
Prophylaxis?

A

Supportive (Rest and analgesia)
Notify PHE
School exclusion 5 days after parotitis
Prophylaxis = MMR

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39
Q

Complication of Mumps?

A

Orchitis (1/3 Px)
Meningitis
Pancreatitis

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40
Q

What is rubella caused by?
how is it spread?
what is it also called?
is it a severe or mild disease?
when does it usually occur?

A

Togavirus
Resp droplets
‘German measles’
Mild disease
Winter + spring

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41
Q

is Rubella notifiable to PHE?

A

Yes

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42
Q

Sx of rubella?

A

Prodrome:
Low grade fever, sore throat, Coryza

Then
-Exanthem (macular papular rash), –Arthralgia
-Forsccheimer spots (small, red spots on the soft palate, occasionally preceding a rash)
-LNadenopathy 2 weeks after exanthem (post auricular, suboccular)

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43
Q

Dx of rubella?

A

IgG titre

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44
Q

Tx of rubella?
School exclusion time?

A

Supportive
4 days after exanthem , go back to school
Notify PHE

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45
Q

Complications of rubella?

A

1/3 = Cytokine release syndrome
(SNHL + B/L cataract + PDA + BM rash)
Encephalitis

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46
Q

Is hand foot and mouth notifiable to PHE?

A

No

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47
Q

What is hand foot and mouth caused by?
ages affected?

A

Coxsackie A16 virus
<5y/o

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48
Q

Sx of hand foot and mouth?

A

Mild URTI (upper resp tract infect)
1-2 days = small mouth ulcers
Blistering red painful vesicular lesions +/- itchy on hands, feet, mouth, tongue + buttocks

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49
Q

Dx of hand foot and mouth?

A

Clinical

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50
Q

Tx of hand foot and mouth?
exclusion from school?

A

Supportive, fluids, PRN analgesia
No exclusion from school

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51
Q

what is slapped cheek also called?

A

Erythema infectiosum
5th disease

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52
Q

cause of slapped cheek syndrome?
transmission?
what time of year?

A

Parovirus B19
Resp secretions, vertical transmission, transfusions
Spring

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53
Q

Sx of slapped cheek syndrome?

A

1 week preceding = Fever, malaise, headache, myalgia
2-5 days = rose red rash on both cheeks - progresses to macular papular rash on trunk and limbs

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54
Q

Tx of slapped cheek syndrome?

A

supportive

55
Q

what can parvovirus B19 precipitate if baby has preexisting haemolytic anemia?

A

Aplastic crisis
Foetal hydrops fetalis

56
Q

What is roseola caused by?

A

HHV - 6 (+ HHV-7)

57
Q

Sx of roseola?
age affected?

A

2-3y/o with high grade fever (>40^C) then lace like rash (NOT ITCHY) on arms, legs + trunk

Cold, dissapears for a few days then rash

58
Q

Tx of roseola?

A

Supportive

59
Q

Complication of roseola?

A

febrile convulsion

60
Q

In a febrile convulsion in roseola, what would you do if:
Drowsy >2hrs?
Simple?
complex?

A

Drowsy >2hr = refer

simple = 1st seizure <5m

Complex = >5m or multiple

61
Q

Is scarlet fever notifiable to PHE?

A

Yes

62
Q

What is Scarlett fever caused by?
what can it cause?

A

Reaction to strep pyogenes toxin (exotoxin B, C, F)
Pharyngitis (tonsillitis, strawberry tongue, forchheimer spots - red spots on soft palate)

63
Q

Peak ages of scarlet fever?
how is it spread?

A

2-6y/o (<10y/o)
peak age 4y/o

Spread via inhalation of resp droplets, direct contact with nose/throat discharge

64
Q

Sx of scarlet fever?

A

Fever (24-48hrs)
Sandpaper red/pink rash from trunk outwards,
strawberry tongue,
cervical LNadenopathy,
exudative tonsils

65
Q

Dx of scarlet fever?

A

Throat swab (but start Abx)
ASOT

66
Q

Tx of scarlet fever?
school exclusion time?

A

PO Penoxymethylpenicillin 10 days
school exclusion until 24hr post Abx

67
Q

Complications of scarlet fever?

A

quinsy
otitis media
post strep glomerulonephritis
Rheumatic fever

68
Q

S.aureus + S.pyogenes cause which 4 diseases?

A

Impetigo
Cellulitis
Necrotising fascitis
Staph scolded skin syndrome (SSSS)

69
Q

What is impetigo?
caused by?
how is it spread?
age?
where can it be caught?

A

Superficial bacterial skin infection
s.aureus + s.pyogenes - direct contact with Px
<10y at daycare
warm weather

70
Q

what is the main symptom in impetigo?
when is it not infectious?
school exclusion?

A

Honey crusted perioral lesions
When dry = non infectious
crusted over or 2 days after Abx

71
Q

what are the 2 types of impetigo and which is MC and LC?
Describe each and Sx?

A

Bullous (LC):
More severe, always s.aureus

Non bullous (MC):
Around nose/mouth, exudate dries, golden crust (no systemic Sx)

72
Q

Dx of impetigo?

A

Swabs of vesicles +/- exudate post Abx rash

73
Q

Tx of impetigo?

A
  1. 1% hydrogen peroxide cream
  2. topical fusidic acid
  3. PO Flucoxicillin
74
Q

what is CI in impetigo?

A

Clarythromycin

75
Q

what is cellulitis?
caused by?

A

SC + Dermal group A strep infection
LL calf

76
Q

Sx of cellulitis?

A

Shiny erythematous oedematous poorly defined

77
Q

what is the severity classification used in cellulitis?

A

Eron classification 1-4

78
Q

Dx of cellulitis?

A

R/O DVT
(bloods, D-dimer)

79
Q

Tx of cellulitis?

A

Flucoxacillin
MRSA = Vancomycin/gentamycin

80
Q

what is necrotising fascitis?
caused by?
RF?

A

Invasive group A transdermal total infection
RF = immunocompromised, skin condition, SGLT-2 use

81
Q

Sx of necrotising fascitis?

A

Pain disproportionate to appearance
(then >24hr = gangrene, high fever|)

82
Q

Tx of necrotising fascitis?

A

surgical debridement
IV Flucloxacillin

83
Q

what is staph scalded skin syndrome?
caused by?
MC?
RF?

A

<1y/o desquamating rash due to epidemolytic toxins

Can be MC = S.Aureus or Invasive Group A strep

Immunocompromised, CKD

84
Q

Sx of staph scalded skin syndrome?

A

Nikolsky +ve - (rubbing = skin peels off)
Erytheroderma (+90%)
No mucosal involvement
Systemic Sx

85
Q

Dx and Tx of staph scalded skin syndrome?

A

GS = skin biopsy

ABCDE in hosp, IV Fluid + Abx (flucloxacillin)

86
Q

what is Steven Johnson syndrome / toxic epidermal necrolysis?
what is the difference?

A

T4 hypersensitivity
(SJS<10% skin, TEN >10% ~30%)

87
Q

RF for Steven Johnson syndrome / toxic epidermal necrolysis?
Causes?

A

Drugs MC
Lamotrigine!!!
Carbamezapine (anti epileptics)
Allopurinol
Beta lactam
NSAIDs

Other = EBV, malignancy, HIV

88
Q

Sx of Steven Johnson syndrome / toxic epidermal necrolysis?

A

Erythroderma
Nikolsky +ve, 2+ mucosal surfaces - mouth, pharynx, urethra, rectum, vagina, eyes
Targeted lesions

89
Q

Dx of Steven Johnson syndrome / toxic epidermal necrolysis?

A

GS = skin biopsy
Blood = Low RBC, low WCC, low platelet, High IgE
LFTs

90
Q

what score is used in Steven Johnson syndrome / toxic epidermal necrolysis and what does it assess?

A

Scorten 7 = evaluates morality in SJS/TEN

91
Q

Tx of Steven Johnson syndrome / toxic epidermal necrolysis?

A

Supportive
Admit + IV fluid
Analgesia
eye care (daily opthamology review)

92
Q

What is toxic shock syndrome?
caused by?

A

Invasive group A strep (s.pyogenes)
Staph aureus

93
Q

who does toxic shock syndrome affect?
scenario?

A

Teen girls with prolonged tampon use / menstrual cup (up to 50y)
Exposed wound infection, contraceptive diaphragm, post birth

94
Q

Sx of toxic shock syndrome?

A

Fever 39^c+
Hypotension <90mmHg systolic
Diffuse erythematous rash
Desquamation of palms + soles

95
Q

Dx of toxic shock syndrome?

A

Bloods, swabs, BP, ECG, Urine dip

96
Q

Tx of toxic shock syndrome?

A

ITU; ABCDE, Remove tampon (if still in)
Advice = use pads
Sepsis 6 = including fluclox, IV fluids, Abx

97
Q

toxic shock syndrome:
Involvement of 3+ organ systems (damaged), what Sx do you get?

A

AKS
Deranged LFT
Clotting changes

98
Q

what are the 2 types of HSV?

A

1 AND 2

99
Q

HSV 1
affects where?
Sx?

A

affects HEAD
(oral ulcers + encephalitis)

100
Q

HSV 2
Affects where?
Sx?

A

affects Genetalia
(genital ulcers)

101
Q

Complication of HSV?

A

eczema herpeticum - superimposed HSV on eczematous skin

102
Q

what is erythema multiforme?

A

Rash (target lesion)

103
Q

What is TB?
Caused by?
Spread how?
where?

A

T4 hypersensitivity infection by mycobacterium tuberculosis
(acid fast bacillus) - ziehl Neilson stain

Spread via saliva drops

Africa + asia (India + china)

104
Q

What is the pathology of TB?

A

1^ Ghon focus (granuloma, upper RHL)

1^ Ghon complex (+ LN)

Millary (systemic) or latent (Asx - immune system encapsulates bacteria)

105
Q

Sx of TB?
Resp and systemic?

A

Resp = haemoptysis, weight loss, night sweats, fever, sputum

Systemic = meningitis, scrofulous (skin + LN infection), spondylitis, Addisons

106
Q

Dx of latent TB?

A

Mantoux skin test

107
Q

Dx for active TB?

A
  1. Chest xray (bilateral hilar infiltrates, RUL consolidation, pleural effusion)

GS. Sputum MC + S

108
Q

Tx of TB?

A

RIPE

109
Q

What does RIPE stand for?
how long is each given for?
SE of each?

A

Rifampicin
6m, Red secretion

Isoniazid
6m, peripheral neuropathy (give pyridoxine)

Pyrazinamide
2m, hepatitis, gout

Ethambutol
2m, optic neuritis

110
Q

What prophylaxis can be given for TB?
when?

A

Bacillus calmette - guerin vaccine, if at risk at birth

111
Q

is TB and polio notifiable to Public Health England?

A

yes

112
Q

Polio
ASx in how many Px?
spread?
1% causes?
Complication?

A

ASx in 70-90%

Feco-oral spread

1% = anterior horn disease = flaccid paralysis

Comp = bulbar palsy

113
Q

Dx of polio?
Tx?
Prophylaxis?

A

Dx = viral swab, IgG

Tx = Supportive

Prophylaxis = IPV (3 in 1, 4 in 1, 6 in 1)

114
Q

What is diptheria caused by?
Spread?
mainly affects where?

A

Corynebacterium diptheriae (bacteria), only when infected by bacteriophage - produce diphtheria toxin

Resp spread

mainly affects nose + throat

115
Q

Sx of diphtheria?

A

Fever
Pseudomembrane (grey) on tonsils / throat
Bullneck
Swollen glands (LN) in neck
Pseudomembranous croup

116
Q

Dx of diphtheria?

A

+ve ELEK test (toxin isolated) + grows on Loeffler Meoia

117
Q

Tx of diphtheria?
prophylaxis?

A

DAT (antitoxin)
PO azithromycin

DTaP vaccine

118
Q

what are 2 complications of diphtheria?

A

neuritis + myocarditis

119
Q

What is scabies?
transmission?

A

T4 hypersensitivity vs sarcoptes scabiei protein - skin to skin transmission

120
Q

Sx of scabies?

A

Longitudinal burrows therefore severe itch (between finger webs, worse at night + in warmth)

121
Q

what is the itchy rash in scabies caused by?

A

10-15 mites

122
Q

Dx of scabies?

A

Ink burrow test +ve

123
Q

Tx of scabies?

A

Permethrin cream + hygiene advice to all household 6+ months

124
Q

Complication of scabies?
Tx?

A

Crusted norweigen scabies (1000+ mites)
Tx = Inpatient + ivermectin

Nodular scabies = penile + groin

125
Q

What is Henloch Schonlein purpura?

A

IgA mediated small cell vasculitis = inflammation = affecting skin + joints + GI tract + kidneys

126
Q

Age of getting Henloch Schonlein purpura?
M or F?
Peaks when?
post?

A

<10y/o
M>F
Peaks during winter months
Post URTI or gastroenteritis

127
Q

Sx of Henloch Schonlein purpura?

A

Purpura (100%): Legs to buttocks

Joint pain (75%) = knees / ankles

Abdo pain (50%)

Renal (50%) = IgA nephritis, H/Puria

128
Q

Dx of Henloch Schonlein purpura?

A

Exclude Ddx of non blanching rash:
FBC / Blood film (sepsis/leukemia)
Renal profile
Albumin (nephrotic)
CRP
Urine dip
BP

Monitor urine dip for renal involvement (+ BP for htn)

129
Q

Tx of Henloch Schonlein purpura?
prognosis?

A

Supportive - analgesia for arthralgia
Good, self limiting

130
Q

Complications of Henloch Schonlein purpura?

A

Renal (20-55%) = Glomerulonephritis, nephrotic syndrome

GI (50-75%) = Bowel infarction, intussusseption, GI haem, bowel perf

131
Q

What is molluscum contagiosum due to?
Sx?
Tx?

A

POX virus
Fleshy umbilical papule occurring in crops
Sx = raised itchy ring, erythamtous rash
Self limiting

132
Q

What is ringworm caused by?
Sx?
Tx?

A

Fungi Trichophyton (tines corporis)
Raised itchy ring shaped erythematous rash
Tx = ketonazole shampoo

133
Q

what is Lyme disease caused by?
spread how?
Sx? early and late
Tx?

A

Borelia (-ve spirochete)
Spread by ticks
Early = Bulls eye (erythema migrans)
Late = Neuroborreliosis + joint involvement
Tx = PO doxycycline

Phase 3a Paeds (14 decks)

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