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Phase 3a - Paediactrics > Infectious Diseases > Flashcards

Infectious Diseases Flashcards

1
Q

Kawasaki Disease

A

Mucocutaneous, lymph node syndrome - a systemic medium-sized vessels vasculitis

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2
Q

Who does Kawasaki Disease typically present in?

A

Typically affects young children under 5 years with no clear cause or trigger

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3
Q

Who is Kawasaki Disease more common in?

A

More common in boys, usually Japanese and Korean children + Afrocarribean children

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4
Q

Symptoms of Kawasaki Disease

A

Persistent high fever for more than 5 days - Child will be unwell and unhappy -Widespread erythematous maculopapular rash and desquamation on the palms
and soles
- Strawberry tongue
- Cracked lips
- Cervical lymphadenopathy
- Bilateral conjunctivitis

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5
Q

CRASH + BURN for Kawasaki Disease

A

Conjunctivitis, Rash, Adenopathy, Strawberry tongue, Hands (palmar erythema, swelling), fever (>5 days)

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6
Q

Ix for Kawasaki Disease

A

FBC + LFTs + ESR + Urinanalysis + Echo

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7
Q

What does FBC show for Kawasaki Disease

A

anaemia, leukocytosis and thrombocytosis

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8
Q

What do LFTs show for Kawasaki Disease

A

hypoalbuminemia

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9
Q

How is ESR effected in Kawasaki Disease

A

Raised

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10
Q

What does urinanalysis show in Kawasaki Disease

A

Raised WBC

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11
Q

Why is an Echo done for Kawasaki Disease

A

rule out major complication: coronary artery aneurysms

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12
Q

Acute phase of Kawasaki Disease

A

child will be unwell with fever, rash and lymphadenopathy - 1-2 weeks

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13
Q

Subacute phase of Kawasaki Disease

A
  • acute symptoms will settle but the arthralgia and risk of coronary artery aneurysms form - 2-4 weeks
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14
Q

Convalescent stage of Kawasaki Disease

A

remaining symptoms return back to normal and blood tests return to normal - 2-4 weeks

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15
Q

Management of Kawasaki Disease

A

High dose aspirin to reduce the risk of thrombosis - IV immunoglobulins - Public health should be informed

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16
Q

Complication of Kawasaki Disease

A

Coronary Artery Aneurysm

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17
Q

Measles

A

Despite significant vaccination, this is still a major cause of morbidity and death worldwide. - Initial exposure occurs through droplet spread and it is highly infectious during viral shedding

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18
Q

What causes measles?

A

RNA Paramyxovirus

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19
Q

Symptoms of Measles

A
  • Fever - Koplik spots (blue, white spots on the inside of the cheek) - Conjunctivitis - Coryza - Cough - Rash which spreads downwards from behind the ears to the whole of the body - maculopapular rash. ; Infectious from prodome till 4 days after rash starts.
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20
Q

Ix for Measles

A

IgM ab, raised LFTs, Measles RNA PCR on oral fluid specimen

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21
Q

Management of Measles

A
  • Supportive treatment depending on symptoms - Avoid school for at least 5 days after initial development of rash
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22
Q

How long does a child need to isolate with measles?

A

4 days after their symptoms resolve

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23
Q

Who should be notified with Measles cases

A

Notify Public Health

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24
Q

Complications of Measles

A

Otitis media (most common) - Pneumonia - Febrile convulsions - Encephalitis/Subacute sclerosing panencephalitis

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25
Q

Chickenpox

A

This is a common virus which is spread by respiratory droplets and is very infectious during viral shedding.

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26
Q

What causes Chicken pox?

A

Varicella Zoster Virus (VZV)

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27
Q

Symptoms of Chickenpox

A

Fever - Vesicular rash beginning on head and trunk which spreads to peripheries - Itching can lead to permanent scars/secondary infection

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28
Q

Managment of Chickenpox

A

Symptomatic treatment - Immunocompromised children/higher risk groups can be given aciclovir - Avoid school until lesions have crusted over (at least 5 days)

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29
Q

Complications of Chickenpox

A

Bacterial superinfection - Pneumonitis - DIC - Virus reactivation : Shingles

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30
Q

Rubella

A

A generally mild disease in childhood which occurs in winter and spring

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31
Q

What causes Rubella?

A

Togavirus , Rubella Virus

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32
Q

How long is the incubation period for Rubella?

A

Incubation period is 15-20 days

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33
Q

How is Rubella spread?

A

it is spread through respiratory contact.

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34
Q

Symptoms of Rubella

A

Symptoms start 2 weeks after exposure. Low grade fever - Maculopapular rash on the face which then spreads across the whole body.

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35
Q

Management of Rubella

A

No treatment necessary - Diagnosis should be confirmed serologically if there is any risk of exposure for non-immune pregnant women

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36
Q

How long should a child stay off school if they have Rubella?

A

5 days after the rash appears

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37
Q

Complications of Rubella

A

Arthritis - Encephalitis - Myocarditis

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38
Q

Congenital Rubella

A

•Foetal rubella syndrome can occur if a non-immune mother is infected in her 1st trimester of pregnancy → teratogenic, sensorineural deafness, congenital cataracts, CHD, cerebral palsy, microcephaly

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39
Q

What should you do if you suspect congenital rubella?

A

•If suspected: discuss with local health protection unit

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40
Q

Can you offer the MMR vaccine to preganant women?

A

NO !! Do NOT offer MMR vaccine to pregnant woman
offer non-immune mothers MMR vaccine in post-natal phase

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41
Q

Diphtheria

A
  • Infection which causes local disease with membrane formation affecting the nose, pharynx or larynx or systemic disease with myocarditis and neurological manifestations. Diphtheria is a bacterial infection caused by Corynebacterium diphtheriae, primarily affecting the respiratory system but can also involve the skin
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42
Q

Is Diphtheria common in the UK?

A

It has generally been eradicated in the UK.

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43
Q

True or False: Diphtheria is a common disease in children today.

A

False. Diphtheria is rare in countries with high vaccination rates.

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44
Q

What are common symptoms of respiratory diphtheria in children?

A

Sore throat

Trouble breathing

Low fever

Husky voice

Stridor (a shrill sound caused when breathing in)

Enlarged lymph glands in the neck

Runny nose

Swelling of the roof of the mouth (palate

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45
Q

Which of the following is a common diagnostic method for diphtheria?

A) Blood culture

B) Throat culture

C) Chest X-ray

D) Skin biopsy

A

B) Throat culture

Explanation: A throat culture can confirm the presence of Corynebacterium diphtheriae.

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46
Q

What is the primary treatment for diphtheria in children?

A) Antiviral medication

B) Antibiotics and antitoxin

C) Antifungal medication

D) Surgery

A

B) Antibiotics and antitoxin

Explanation: Treatment includes antibiotics to eliminate the bacteria and antitoxin to neutralize the diphtheria toxin.

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47
Q

What are potential complications of diphtheria in children?

A

Damage to the heart, kidneys, and nervous system

Asphyxiation due to airway obstruction

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48
Q

True or False: Vaccination is the primary method of preventing diphtheria.

A

True. Vaccination is the most effective way to prevent diphtheria.

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49
Q

What is the typical mortality rate for diphtheria in children?

A) 1-2%

B) 5-10%

C) 15-20%

D) 25-30%

A

B) 5-10%

Explanation: The mortality rate for diphtheria is approximately 5-10%, but it can be higher in children under five years old.

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50
Q

How is diphtheria transmitted?

A) Airborne droplets

B) Direct contact with skin lesions

C) Both A and B

D) Contaminated food and water

A

C) Both A and B

Explanation: Diphtheria is transmitted through respiratory droplets and direct contact with skin lesions.

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51
Q

What is the recommended vaccination schedule for diphtheria in children?

A

DTaP vaccine at 2, 4, and 6 months

Booster doses at 15-18 months and 4-6 years

Td or Tdap booster every 10 years thereafter

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52
Q

Scaled Skin Syndrome is caused by ____

A

Caused by an exfoliative staphylococcal toxin which causes separation of the epidermal skin through the granular cell layers

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53
Q

Symptoms of Scaled Skin Syndrome

A
  • Fever - Malaise - Purulent, crusting, localised infection around eyes/nose/mouth with widespread erythema and tenderness - Areas of epidermis separate on gentle pressure (Nikolsky sign) leaving denuded areas of skin which then dry and heal without scarring
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54
Q

Management of Scaled Skin Syndrome

A

IV anti-staph antibiotics such as flucloxacillin - Analgesia - Fluid balance

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55
Q

What is Staphylococcal Scalded Skin Syndrome (SSSS)?

A

SSSS is a bacterial skin infection caused by Staphylococcus aureus, leading to redness, blistering, and peeling of the skin.

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56
Q

True or False: SSSS is most common in adults.

A

False. SSSS primarily affects infants and young children.

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57
Q

What are common symptoms of SSSS in children?

A

Fussiness (irritability)

Tiredness (malaise)

Fever

Redness of the skin

Fluid-filled blisters that break easily

Large sheets of the top layer of skin that peel away

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58
Q

Which of the following is a common diagnostic method for SSSS?

A) Skin biopsy

B) Blood culture

C) Throat culture

D) Urine analysis

A

A) Skin biopsy

Explanation: A skin biopsy can confirm the diagnosis of SSSS.

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59
Q

What is the primary treatment for SSSS in children?

A) Oral antibiotics

B) Intravenous antibiotics

C) Topical steroids

D) Antifungal medication

A

B) Intravenous antibiotics

Explanation: Treatment typically involves intravenous antibiotics to combat the Staphylococcus aureus infection.

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60
Q

What are potential complications of SSSS in children?

A

Dehydration

Shock

Secondary bacterial infections

Scarring

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61
Q

True or False: SSSS is always fatal in children.

A

False. With prompt treatment, the prognosis is generally good, and most children recover without scarring.

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62
Q

Which of the following is a preventive measure for SSSS?

A) Regular handwashing

B) Vaccination

C) Avoiding sun exposure

D) Using moisturizers

A

A) Regular handwashing

Explanation: Regular handwashing can help prevent the spread of Staphylococcus aureus, thereby reducing the risk of SSSS.

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63
Q

How is SSSS transmitted?

A) Airborne droplets

B) Direct contact with infected skin

C) Contaminated food

D) Insect bites

A

B) Direct contact with infected skin

Explanation: SSSS is transmitted through direct contact with infected skin or mucous membranes

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64
Q

Which condition should be considered in the differential diagnosis of SSSS?

A) Chickenpox

B) Impetigo

C) Measles

D) Eczema

A

B) Impetigo

Explanation: Impetigo is a superficial skin infection that can present with similar symptoms to SSSS

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65
Q

Whooping Cough

A

Bacterial URTI (bronchitis)

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66
Q

What causes Whooping Cough ?

A

Bordetella Pertussis - Gram -ve bacillus (highly contagious)

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67
Q

How long can Whooping Cough last for without treatment?

A

6-8 weeks

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68
Q

Incidence of Whooping Cough is reduced nowadays due to ___

A

Vaccination programme

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69
Q

When are the Whooping Cough Vaccines administered

A

: 2,3,4 months, booster at 3 years 4 months

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70
Q

What are the 2 phases of Whooping Cough

A

Catarrhal Phase: Lasts 1-2 weeks: coryzal symptoms - Paroxysmal Phase: Occurs week 3-6: characteristic ‘inspiratory whoop - Convalescent phase - downgrade of cough, may last up to 3 months

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71
Q

Symptoms of Whooping Cough

A

Cough worse at night - Spasmodic coughing episodes - can lead to vomiting - Low grade fever - Sore throat

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72
Q

Ix for Whooping Cough

A

Nasal-pharyngeal swab with pertussis - FBC - Antibody test

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73
Q

Tx for Whooping Cough

A

Macrolide e.g. Clarithromycin - Prophylactic Abx given to close contacts who are in higher risk health groups - Isolation for 21 days after symptom onset or 5 days after antibiotics

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74
Q

Complications of Whooping Cough

A

Seizures - Pneumonia - Bronchiectasis - Encephalopathy - Otitis Media

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75
Q

What is polio, and what causes it?

A

Polio, or poliomyelitis, is an infectious disease caused by the poliovirus, which is a member of the enterovirus group.

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76
Q

How is the poliovirus transmitted?

A

It is transmitted via the fecal-oral route or through respiratory droplets from infected individuals.

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77
Q

What are the three main serotypes of poliovirus?

A

Types 1, 2, and 3.

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78
Q

What are the clinical stages of polio infection?

A

Asymptomatic infection
Abortive poliomyelitis (minor illness)
Non-paralytic poliomyelitis (aseptic meningitis)
Paralytic poliomyelitis

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79
Q

What is the hallmark feature of paralytic poliomyelitis?

A

Acute onset of asymmetric flaccid paralysis without sensory loss.

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80
Q

Which part of the nervous system does poliovirus primarily affect?

A

The anterior horn cells of the spinal cord and brainstem motor nuclei.

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81
Q

Poliovirus primarily spreads through the - route.

A

Fecal-oral

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82
Q

The __________ vaccine is an inactivated polio vaccine administered by injection.

A

Salk

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83
Q

The __________ vaccine is a live attenuated oral polio vaccine.

A

Sabin

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84
Q

Paralytic poliomyelitis is characterized by __________ paralysis without sensory involvement.

A

Flaccid

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85
Q

The eradication of polio requires maintaining __________% immunization coverage globally.

A

95

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86
Q

Which vaccine is used in the global polio eradication program?
A. BCG vaccine
B. Oral polio vaccine (OPV)
C. DTaP vaccine
D. Rotavirus vaccine

A

B. Oral polio vaccine (OPV)

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87
Q

What is the most common outcome of poliovirus infection?
A. Paralytic disease
B. Non-paralytic aseptic meningitis
C. Asymptomatic infection
D. Abortive poliomyelitis

A

C. Asymptomatic infection

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88
Q

Which serotype of poliovirus is most frequently associated with outbreaks?
A. Type 1
B. Type 2
C. Type 3
D. All types equally

A

A. Type 1

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89
Q

Scenario: A 6-year-old child presents with fever, headache, stiff neck, and muscle weakness. The child has not been fully immunized against polio.
Q: What is the likely diagnosis, and how would you confirm it?

A

Likely diagnosis: Poliomyelitis (non-paralytic or paralytic). Confirmation: Stool or throat swab for poliovirus PCR and serology.

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90
Q

Scenario: A patient who recovered from polio 20 years ago presents with new muscle weakness and fatigue.
Q: What is the likely diagnosis, and how is it managed?

A

Likely diagnosis: Post-polio syndrome. Management: Supportive care, physical therapy, and symptom management.

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91
Q

Place these steps in the progression of poliovirus infection in the correct order:
A. Infection of the oropharynx and gastrointestinal tract
B. Viremia
C. Spread to the central nervous system
D. Destruction of anterior horn cells

A

A → B → C → D

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92
Q

Abortive poliomyelitis

A

Mild febrile illness with no CNS involvement

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93
Q

Non-paralytic poliomyelitis

A

Aseptic meningitis with headache and stiff neck

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94
Q

Paralytic poliomyelitis

A

Acute flaccid paralysis with asymmetric motor involvement

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95
Q

Post-polio syndrome

A

Late-onset muscle weakness in previously affected individuals

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96
Q

What are the pros and cons of using the oral polio vaccine (OPV)?

A

Pros:

Provides intestinal immunity
Easy to administer
Effective in halting community transmission
Cons:

Risk of vaccine-derived poliovirus (VDPV)
Requires careful cold chain storage

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97
Q

Why is polio considered a good candidate for eradication, and what challenges remain?

A

Reasons for eradication feasibility:

No animal reservoirs
Effective vaccines available
Clear clinical diagnosis in paralytic cases
Challenges:

Vaccine-derived poliovirus (VDPV) in poorly immunized areas
Political and logistical barriers in endemic regions

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98
Q

Describe how the introduction of the global polio eradication initiative has impacted poliovirus cases worldwide.

A

Since the initiative began in 1988, global cases of polio have decreased by over 99%, with endemic transmission confined to a few regions.

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99
Q

Is Tuberculosis common ?

A

TB had a real decline however there is increased incidence in patients with HIV infection and the emergency of drug resistant strains

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100
Q

How is Tuberculosis spread?

A

It is spread through respiratory droplets.

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101
Q

Tuberculosis Infection

A

TB infection is latent TB and is more likely to progress to TB disease in infants and young children however children will generally not be infectious compared to adults

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102
Q

Symptoms of TB in children

A

Asymptomatic children will have minimal signs of infection as a local inflammatory reaction limits the progression of the disease however it remains latent and so a Mantoux test may become positive.

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103
Q

How does TB spread throughout the body?

A

If the local infection response fails, it can spread through the lymphatic system causing fever, anorexia and weight loss, cough and chest x-ray changes such as hilar lymphadenopathy. There may be enlargement of the peribronchial lymph nodes which can cause consolidation, bronchial obstruction and pleural effusions.
- There may also be other organ involvement including the gut, skin and superficial lymph nodes.

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104
Q

What happens in the dormant stage of TB?

A

A dormant stage occurs and this can be reactivated and present as post-primary TB where the infection can be local or spread across systems including bones, joints, kidneys and CNS (can lead to TB meningitis)

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105
Q

Ix for TB

A

Given the difficulty in obtaining sputum samples, gastric washings on 3 consecutive mornings can be obtained to culture acid-fast bacilli through an NG tube. - Mantoux tests can be performed however this can be positive due to past vaccination rather than infection. - IGRA is a new blood test which is used to assess the response of T cells to antigens found in TB but not the BCG vaccine.

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106
Q

Tx for Tuberculosis

A

Rifampicin, Isoniazid, Pyrazinamide, Ethambutol therapy initially and then reduced to just Rifampicin and Isoniazid after 2 months. This whole therapy normally lasts around 6 months.

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107
Q

How do you change TB tx after puberty

A

After puberty, pyridoxine is given weekly to minimise the peripheral neuropathy side effects of isoniazid

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108
Q

Why is contact tracing essential for TB?

A

Contact tracing is essential as children often pick up the infection from adults

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109
Q

HIV prevalence in children + main route of transmission

A

Affecting over 2 million children a year, the main route of transmission is mother-children transmission during pregnancy, at delivery or through breast feeding.

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110
Q

Ix for HIV in children > 18 months

A

In children over 18 months, presence of antibodies is diagnostic.

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111
Q

Ix for HIV in children < 18 months

A

In those under 18 months, a HIV DNA PCR is needed as antibodies may be present from merely exposure not active infection.

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112
Q

Presentation of HIV in children

A

A proportion of HIV infected infants progress rapidly to symptomatic disease and AIDS in the first year of life however most children will remain asymptomatic for several years.

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113
Q

HIV presentation in children with mild immunosuppression

A

may present with lymphadenopathy, those with moderate may have recurrent bacterial infections, chronic diarrhoea and lymphocytic interstitial pneumonitis.

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114
Q

Severe AIDS diagnosis can be indicated with ____

A

pneumocystis jirovecii pneumonia, severe faltering growth and encephalopathy.

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115
Q

Tx for HIV

A

Antiretroviral therapy, Immunisations, MDT approach, Regular follow up including weight, development and clinical signs of disease.

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116
Q
  • Antiretroviral therapy should be started in all infants and some older children depending on _____
A

clinical status, HIV load and CD4 count

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117
Q

Why are immunisations important for HIV treatment?

A

Immunisations are important due to the higher risk of other infections

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118
Q

Mothers who test positive for HIV, should be on _____ to reduce viral load at time of delivery.

A

Antiretroviral drugs

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119
Q

Mothers who have HIV should also avoid ___

A

They should also avoid breastfeeding and active management of labour and delivery to prevent prolonged rupture of membranes

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120
Q

If breastfeeding cannot be avoided (in women who have HIV) then what should be given to both the mother + the baby?

A

Antiretroviral drugs

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121
Q

Meningitis

A

Inflammation of the meninges which are the lining of the brain and the spinal cord

122
Q

Which bacteria cause Meningitis

A

Neisseria meningitidis is a gram negative diplococcus bacteria which occur in pairs

123
Q

What is meningococcal meningitis?

A

Meningococcal meningitis is when the bacteria is infecting the meninges and the CSF

124
Q

Most common bacterial causes of meningitis

A

Most common cause is Neisseria Meningitidis and Streptococcus pneumoniae

125
Q

Most common cause of Bacterial Meningitis in neonates

A

, the most common cause is Group B Strep which is contracted during birth from GBS bacteria that live in the mothers vagina

126
Q

Symptoms of Meningitis

A

Fever, neck stiffness, vomiting, headache, photophobia, altered consciousness and seizures. Neonates and babies can have non specific symptoms such as hypotonia, poor feeding, lethargy, hypothermia and a bulging fontanelle.

127
Q

Kernig’s test

A

Lay patient on back and flex one hip and knee then straighten the knee whilst keeping the hip flexed, this will product pain/resistance in meningitis

128
Q

Brudzinski’s test

A

Lay the patient on their back and lift their head and neck off the bed and flex chin to the chest, this will cause involuntary flexion of hips and knees.

129
Q

All children under 1 month with a fever, 1-3 months with a fever and unwell and under 1 year with unexplained fever and other signs of serious illness should have _____

A

a LP

130
Q

Community Management of Meningitis

A

Stat injection of benzylpenicillin and then transfer to hospital

131
Q

Hospital Management of Meningitis

A

blood culture and LP should be performed before antibiotics are started and a meningococcal PCR should be sent

132
Q

Tx for Meningitis for children under 3 months

A

IV Cefotaxime plus IV Amoxicillin, above 3 months - IV Ceftriaxone. Dexamethasone is sometimes used

133
Q

Who should be informed with a new case of Meningitis?

A
  • Public health should be informed
134
Q

What is given as post exposure prophylaxis for Meningitis?

A
  • A single dose of ciprofloxacin should be given as post exposure prophylaxis.
135
Q

Viral Meningitis is most commonly caused by ____

A

Most common causes are HSV, enterovirus and VZV

136
Q

Ix for viral Meningitis

A

Sample of CSF should be sent for viral PCR

137
Q

Tx for viral Meningitis

A

Only supportive treatment is needed, sometimes aciclovir can be used

138
Q

Cerebrospinal Fluid in Bacterial Meningitis: Appearance

A

Cloudy

139
Q

Cerebrospinal Fluid in Viral Meningitis: Appearance

A

Clear

140
Q

Cerebrospinal Fluid in Bacterial Meningitis: Protein

A

High

141
Q

Cerebrospinal Fluid in Viral Meningitis: Protein

A

Mildly raised or normal

142
Q

Cerebrospinal Fluid in Bacterial Meningitis: Glucose

A

Low

143
Q

Cerebrospinal Fluid in Viral Meningitis: Glucose

A

Normal

144
Q

Cerebrospinal Fluid in Bacterial Meningitis: White Cell Count

A

High (neutrophils)

145
Q

Cerebrospinal Fluid in Viral Meningitis: White Cell Count

A

High (lymphocytes)

146
Q

Cerebrospinal Fluid in Bacterial Meningitis: Culture

A

Bacteria

147
Q

Cerebrospinal Fluid in Viral Meningitis: Culture

A

Negative

148
Q

What’s the difference between Meningitis and Menigococcal Septicaemia?

A

Meningitis : invasion of meninges. Septicaemia : when the infection spreads to the rest of the body

149
Q

Encephalitis

A

Inflammation of the brain which can be either infectious or non-infections (this is usually autoimmune)

150
Q

Most common cause of Encephalitis

A

The most common cause is viral however bacterial and fungal are also possible.

151
Q

Most common type of Encephalitis

A

The most common type is herpes simplex 1 from cold sores in children and herpes simplex 2 in neonates from genital herpes contracted during birth.

152
Q

Name some other causes of Encephalitis

A

Other causes include VZV associated with chickenpox, EPV, enterovirus, adenvirus and influenza.

153
Q

Symptoms of Encephalitis

A
  • Altered consciousness - Altered cognition - Unusual behaviour - Acute onset of focal neurological symptoms - Acute onset of focal seizures - Fever
154
Q

Ix for Encephalitis

A

LP, CT, MRI, HIV

155
Q

Why is a lumbar puncture done in Encephalitis

A

to send CSF fluid for PCR testing

156
Q

What do you do if LP in contraindicated in Encephalitis

A

CT scan

157
Q

Contraindications for LP

A

active seizures, hemodynamically unstable

158
Q

Why is an MRI done in Encephalitis

A

after the LP for visualisation

159
Q

___ testing is also recommended in all patients with encephalitis

A

HIV testing is also recommended in all patients with encephalitis

160
Q

Managment of Encephalitis caused by Herpes/ VZV

A

Aciclovir to treat Herpes and VZV

161
Q

Management of Encephalitis caused by CMV

A

Ganciclovir to treat Cytomegalovirus

162
Q

Management of Encephalitis also involved repeated LP - why?

A

Repeat LP are needed to ensure successful treatment before antivirals are stopped

163
Q

Complications of Encephalitis

A
  • Lasting fatigue - Change in personality/mood/memory/cognition - Headaches and chronic pain - Sensory disturbance - Seizures
164
Q

Hand, Foot and Mouth Disease is caused by___

A

Coxackie Virus

165
Q

Symptoms of Hand, Foot and Mouth Disease

A

URT symptoms first 1-2 days, Mouth ulcers, including on the tongue, then blistering spots on the body mainly hands and feet, mainly in children under 10

166
Q

Dx of Hand, Foot and Mouth Disease

A

Based on clinical findings

167
Q

Management of Hand, Foot and Mouth Disease

A

-supportive with analgesia and fluid intake. Avoid sharing towels etc

168
Q

How long does Hand, Foot and Mouth Disease last?

A

~ 10 days

169
Q

Roseola Infantum

A

known as the ‘3 day fever’

170
Q

Roseola Infantum affects ____

A

children < 2 y/o

171
Q

What causes Roseola Infantum?

A

HHV-6

172
Q

Symptoms of Roseola Infantum

A

Rose coloured rash, starts from trunk, spreads peripherally. Nagayama spots : enathem on uvula and soft palate.May have febrile convulsions prior to rash.

173
Q

Tx for Roseola Infantum

A

Self - resolving withing 2-5 days, Supportive Tx

174
Q

What is molluscum contagiosum?

A

Molluscum contagiosum is a common, self-limiting viral skin infection caused by the molluscum contagiosum virus (MCV), a member of the poxvirus family.

175
Q

How is molluscum contagiosum transmitted?

A

It is transmitted through direct skin-to-skin contact, shared items such as towels, and autoinoculation (spreading the virus by scratching).

176
Q

What are the characteristic features of molluscum contagiosum lesions?

A

Small, firm, dome-shaped, pearly papules with a central dimple or umbilication.

177
Q

In which age group is molluscum contagiosum most commonly seen?

A

It is most common in children, particularly those aged 1–10 years.

178
Q

What is the typical duration of molluscum contagiosum?

A

It typically resolves spontaneously within 6–12 months, though it may persist for up to 2 years.

179
Q

Molluscum contagiosum is caused by a __________ virus.

A

Pox

180
Q

Molluscum contagiosum lesions typically have a central __________ or __________.

A

Dimple; umbilication

181
Q

The condition is self-limiting and usually resolves within __________ to __________ months.

A

6; 12

182
Q

Molluscum contagiosum spreads through __________ contact or shared __________.

A

Direct; items

183
Q

What is the most common mode of transmission for molluscum contagiosum?
A. Airborne droplets
B. Fecal-oral route
C. Direct skin-to-skin contact
D. Bloodborne transmission

A

C. Direct skin-to-skin contact

184
Q

Which feature is characteristic of molluscum contagiosum lesions?
A. Scaling and redness
B. Dome-shaped papules with central umbilication
C. Vesicular rash with crusting
D. Hyperpigmented macules

A

B. Dome-shaped papules with central umbilication

185
Q

What is the first-line management for uncomplicated molluscum contagiosum?
A. Topical antibiotics
B. Observation and reassurance
C. Surgical excision
D. Oral antivirals

A

B. Observation and reassurance

186
Q

Scenario: A 6-year-old child presents with multiple small, pearly, dome-shaped lesions on their torso and arms. The lesions have a central dimple, and the child reports no pain or itching.
Q: What is the likely diagnosis, and how should it be managed?

A

Likely diagnosis: Molluscum contagiosum. Management: Reassurance and observation, as the condition is self-limiting.

187
Q

Scenario: A 9-year-old child with atopic dermatitis develops molluscum contagiosum. The lesions appear to be increasing in number, and the child is scratching them.
Q: What complications might occur, and how can they be prevented?

A

Complications: Secondary bacterial infection or widespread lesions. Prevention: Minimize scratching, maintain good hygiene, and manage underlying eczema.

188
Q

Arrange the steps in the pathophysiology of molluscum contagiosum in order:
A. Viral entry via micro-abrasions in the skin
B. Formation of dome-shaped papules with central umbilication
C. Resolution as the immune system clears the infection
D. Replication of the molluscum contagiosum virus in keratinocytes

A

A , D, B, C

189
Q

What are the pros and cons of treating molluscum contagiosum versus observing it?

A

Pros of treatment:

Can speed up lesion resolution
Reduces risk of autoinoculation or transmission to others
Cons of treatment:

Most cases resolve spontaneously
Treatments can cause discomfort or scarring
Increased cost and unnecessary intervention

190
Q

Why might molluscum contagiosum persist longer in immunocompromised individuals, and how should it be managed in these cases?

A

Reason for persistence: Reduced immune response to the virus allows lesions to persist or multiply.
Management: Consider active treatment such as cryotherapy, curettage, or topical agents, and address underlying immunosuppression.

191
Q

Provide an example of a situation where molluscum contagiosum may spread rapidly in a community.

A

In swimming pools, where shared towels and close skin contact can facilitate transmission among children.

192
Q

Slapped Cheek Syndrome/ Fifth Disease is caused by

A

Parvovirus B19 causes erythema infectiosum/slapped cheek syndrome

193
Q

When are Slapped Cheek Syndrome/ Fifth Disease outbreaks common?

A

Outbreaks are common during the spring months and transmission is via respiratory secretions from infected patients/mother to foetus.

194
Q

What does Slapped Cheek Syndrome/ Fifth Disease infect?

A

It infects the erythroblastosis red cell precursors in the bone marrow

195
Q

Symptoms of Slapped Cheek Syndrome/ Fifth Disease

A

Asymptomatic infection

196
Q

Erythema Infectiosum : Slapped Cheek Syndrome/ Fifth Disease

A
  • the most common illness with fever, headache and myalgia followed by a characteristic rash on the face which progresses to maculopapular rash on the trunk and limbs
197
Q

Aplastic Crisis : Slapped Cheek Syndrome/ Fifth Disease

A

occurs in children with haemolytic anaemia where there is an increased rate of red cell turnover and immunodeficiency

198
Q

Foetal disease : Slapped Cheek Syndrome/ Fifth Disease

A

Foetal disease where transmission can lead to foetal death due to severe anaemia.

199
Q

Managment of Slapped Cheek Syndrome/ Fifth Disease

A

Supportive therapy

200
Q

Complications of Slapped Cheek Disease

A

In someone who has haemolytic anaemia (e.g. SCD), infection can trigger an aplastic crisis, pancytopenia. In pregnant women, infection can cause hydrops fetalis in baby.

201
Q

Impetigo

A

A superficial bacterial skin infection usually caused by the staphylococcus aureus bacteria

202
Q

What causes Impetigo?

A

Staphylococcus aureus or Strep Pyogenes

203
Q

What is characteristic of Impetigo ?

A

A ‘golden crust’ is characteristic for this

204
Q

Where does Non-Bullous Impetigo occur?

A

This typically occurs around the nose or mouth and the exudate from the lesions dries to form a golden crust

205
Q

Are there any symptoms of Non-Bullous Impetigo?

A

The children will have no systemic symptoms and will not be unwell

206
Q

What is the Treatment of local Non-Bullous Impetigo?

A

This can be treated with topical fusidic acid or antiseptic cream if it is localised.

207
Q

What is the treatment of widespread Non-Bullous Impetigo?

A

For widespread, oral flucloxacillin is used

208
Q

What should patients with Non-Bullous Impetigo avoid doing?

A

Patients should avoid touching or scratching the lesions

209
Q

What is Bullous Impetigo caused by?

A
  • This is always caused by S.aureus which produce toxins that break down the proteins that hold skin cells together causing 1-2 cm fluid filled vesicles to form on the skin which then burst and form the golden crust.
210
Q

Are there symptoms with Bullous Impetigo?

A

This is much more common in neonates and children under 2 and patients will have systemic symptoms such as fever and malaise

211
Q

How do you diagnose Bullous Impetigo?

A

Swabs of the vesicles can confirm diagnosis

212
Q

How do you treat Bullous Impetigo?

A

flucloxacillin.

213
Q

Complications of Impetigo?

A
  • Sepsis - Scarring - Post strep glomerulonephritis - Scarlet fever - Staphylococcal scalded skin syndrome
214
Q

What is candida in paediatrics?

A

Candida is a fungal infection caused by Candida species, most commonly Candida albicans. It can affect the skin, mucous membranes, and other areas of the body.

215
Q

What are common presentations of candida infections in paediatrics?

A

Common presentations include oral thrush, diaper dermatitis (candida nappy rash), and systemic candidiasis in immunocompromised children.

216
Q

What factors predispose children to candida infections?

A

Factors include prolonged antibiotic use, immunosuppression, use of corticosteroids, poor hygiene, and chronic illnesses like diabetes.

217
Q

How does oral thrush typically present in children?

A

Oral thrush presents as white, creamy plaques on the tongue, inner cheeks, and sometimes the gums, which can be wiped off, leaving a red, raw surface.

218
Q

How is candida diaper dermatitis differentiated from other types of diaper rash?

A

It typically presents with beefy red plaques, satellite lesions, and involvement of skin folds, which are less common in other types of diaper rash.

219
Q

Candida infections are most commonly caused by __________.

A

Candida albicans

220
Q

Oral thrush presents as __________, __________ plaques on the mucous membranes.

A

White; creamy

221
Q

Candida nappy rash often involves __________ and is characterized by __________ lesions.

A

Skin folds; satellite

222
Q

Prolonged use of __________ is a risk factor for candida infections in children.

A

Antibiotics

223
Q

Which of the following is a common presentation of candida infections in children?
A. Erythema nodosum
B. Oral thrush
C. Scaly plaques on the scalp
D. Impetigo

A

B. Oral thrush

224
Q

What is a hallmark feature of candida diaper dermatitis?
A. Absence of skin fold involvement
B. Beefy red plaques with satellite lesions
C. Linear excoriations
D. Scaly rash on the palms

A

B. Beefy red plaques with satellite lesions

225
Q

Which medication is most commonly used to treat oral thrush in children?
A. Amoxicillin
B. Fluconazole
C. Nystatin
D. Clotrimazole

A

C. Nystatin

226
Q

T/F: Candida infections are always confined to the skin and mucous membranes.

A
227
Q

T/F: Satellite lesions are a characteristic feature of candida diaper dermatitis.

A

t

228
Q

T/F: Oral thrush is more common in children who are breastfed.

A
229
Q

Scenario: A 2-month-old infant presents with a persistent diaper rash despite regular diaper changes and use of barrier creams. The rash involves the skin folds and has small red spots around it.
Q: What is the likely diagnosis, and how should it be treated?

A

Likely diagnosis: Candida diaper dermatitis. Treatment: Topical antifungal agents like clotrimazole or miconazole.

230
Q

Scenario: A 6-year-old child undergoing chemotherapy develops fever and signs of systemic infection. Blood cultures grow Candida species.
Q: What is the diagnosis, and what is the appropriate management?

A

Diagnosis: Systemic candidiasis. Management: Systemic antifungal therapy with agents like fluconazole or amphotericin B, depending on the severity.

231
Q

Arrange the following steps in the pathophysiology of candida infection:
A. Disruption of normal microbiota
B. Candida overgrowth
C. Breach of epithelial barrier
D. Localized or systemic infection develops

A

A → B → C → D

232
Q

Oral thrush

A

White, creamy plaques in the mouth

233
Q

Candida diaper dermatitis

A

Beefy red rash with satellite lesions

234
Q

Systemic candidiasis

A

Fever, sepsis-like symptoms, and positive blood cultures

235
Q

What are the pros and cons of topical versus systemic antifungal treatment for candida infections in paediatrics?

A

Pros of topical treatment:

Targeted action
Fewer systemic side effects
Cons of topical treatment:

Ineffective for systemic infections
Requires frequent application
Pros of systemic treatment:

Effective for systemic and widespread infections
Can treat multiple sites simultaneously
Cons of systemic treatment:

Risk of systemic side effects
Potential for drug interactions

236
Q

Why is it important to distinguish between candida diaper dermatitis and irritant diaper dermatitis?

A

Candida diaper dermatitis requires antifungal treatment, while irritant diaper dermatitis is managed with barrier creams and improved hygiene. Misdiagnosis may delay appropriate treatment, worsening symptoms.

237
Q

Give an example of a clinical situation where a candida infection might occur in an otherwise healthy child.

A

A breastfed infant develops oral thrush after a course of antibiotics, which disrupted the normal oral flora.

238
Q

Toxic Shock Syndrome is caused by

A

Toxin producing Staphylococcus aureus and group A streptococci

239
Q

Symptoms of Toxic Shock Syndrome

A

Diffuse erythematous, macular rash

240
Q

Signs of Toxic Shock Syndrome

A

Characterised by fever > 39 - Hypotension

241
Q

Causes of organ dysfunction in Toxic Shock Syndrome

A
  1. Mucositis: Conjunctivae, oral mucosa, genital mucosa 2. Gastrointestinal: Vomiting/Diarrhoea 3. Renal impairment 4. Liver impairment 5. Clotting abnormalities and thrombocytopenia
242
Q

Managment of Toxic Shock Syndrome

A
  • Intensive care support is needed to manage the shock and areas of infection should be debrided - Antibiotics such as ceftriaxone with clindamycin are used to stop toxin production - After 1-2 weeks, there is desquamation of the palms, soles, fingers and toes. - There is a risk of recurrent skin and soft tissue infections
243
Q

Scarlet Fever

A
  • An infectious disease caused by toxin producing strains of the bacterium Streptococcus pyogenes.
244
Q

Transmission of Scarlet Fever

A
  • It is highly contagious and is transmitted through infected saliva or mucus with aerosol transmission or direct contact.
245
Q

Scarlet Fever is common in those between ____

A

2-8 years of age

246
Q

What is the cause of Scarlet Fever?

A

Group A Streptococcus usually strep pyogenes

247
Q

Risk Factors of Scarlet Fever

A
  • Neonates - Immunocompromised
  • Concurrent chickenpox or influenza
248
Q

Symptoms of Scarlet Fever

A

Initial sore throat, fever, headache, fatigue and nausea/vomiting - Pinpoint, sandpaper like blanching rash initially on the trunk then spreads to the rest of the body and flexures.

249
Q

Signs of Scarlet Fever

A

Strawberry tongue - Cervical lymphadenopathy

250
Q

Management of Scarlet Fever

A

Oral antibiotics such as benzylpenicillin for 10 days (or phenoxymethylpenicillin)

251
Q

How long does the child need to be kept off school if they have Scarlet Fever?

A

until 24hrs after the Abx

252
Q

Who needs to be notified with cases of Scarlet Fever

A

Public Health

253
Q

Complications of Scarlet Fever

A

Otitis Media + Rheumatic Fever

254
Q

What is Coxsackie’s disease?

A

Coxsackie’s disease is a viral infection caused by Coxsackie viruses, part of the enterovirus group. It commonly affects children and causes a range of illnesses, including hand, foot, and mouth disease (HFMD) and herpangina.

255
Q

What are the common types of Coxsackie viruses, and what conditions do they cause?

A

The two common types are:
• Coxsackie A: Causes hand, foot, and mouth disease and herpangina.
• Coxsackie B: Causes pleurodynia, myocarditis, and pericarditis.

256
Q

How is Coxsackie’s disease transmitted?

A

: It is transmitted through respiratory droplets, fecal-oral contact, or contact with contaminated surfaces.

257
Q

What are the characteristic symptoms of hand, foot, and mouth disease?

A

Symptoms include fever, painful oral ulcers, and a vesicular rash on the hands, feet, and sometimes the buttocks.

258
Q

What is herpangina, and how does it present?

A

Herpangina is a condition caused by Coxsackie A viruses, characterized by high fever, sore throat, and vesicles or ulcers in the oropharynx.

259
Q

Coxsackie’s disease is caused by viruses from the __________ group.

A

Enterovirus

260
Q

Hand, foot, and mouth disease is most commonly caused by Coxsackie __________ virus.

A

A

261
Q

Coxsackie virus spreads via the __________ and __________ routes.

A

Respiratory droplet; fecal-oral

262
Q

Herpangina presents with __________ and vesicular lesions in the __________.

A

High fever; oropharynx

263
Q

Which of the following conditions is caused by Coxsackie B virus?
A. Hand, foot, and mouth disease
B. Herpangina
C. Pleurodynia
D. Scarlet fever

A

C. Pleurodynia

264
Q

The rash in hand, foot, and mouth disease primarily involves:
A. Palms, soles, and oral mucosa
B. Face, neck, and chest
C. Scalp and back
D. Trunk and extremities

A

A. Palms, soles, and oral mucosa

265
Q

How is Coxsackie’s disease most commonly diagnosed?
A. Clinical examination
B. Blood culture
C. Chest X-ray
D. Skin biopsy

A

A. Clinical examination

266
Q

T/F: Hand, foot, and mouth disease is highly contagious.

A

t

267
Q

T/F: Coxsackie B viruses are a common cause of myocarditis in children.

A

t

268
Q

T/F: Antibiotics are the first-line treatment for Coxsackie’s disease.

A
269
Q

Scenario: A 3-year-old presents with a fever, painful ulcers in the mouth, and a vesicular rash on the hands and feet. The mother reports a recent outbreak of similar symptoms at the daycare.
Q: What is the likely diagnosis, and how should it be managed?

A

Likely diagnosis: Hand, foot, and mouth disease. Management: Supportive care with hydration, pain relief using paracetamol or ibuprofen, and monitoring for complications like dehydration.

270
Q

Scenario: A 5-year-old child has fever, chest pain, and difficulty breathing. The physician suspects myocarditis.
Q: Which Coxsackie virus is most likely responsible, and what investigations should be done?

A

Likely virus: Coxsackie B. Investigations: ECG, echocardiogram, and viral serology.

271
Q

Arrange the progression of symptoms in hand, foot, and mouth disease:
A. Fever
B. Painful oral ulcers
C. Vesicular rash on palms and soles
D. Resolution of symptoms

A

A → B → C → D

272
Q

What are the pros and cons of diagnosing Coxsackie’s disease clinically versus using laboratory investigations?

A

Clinical diagnosis:
• Pros: Quick, non-invasive, and cost-effective.
• Cons: May miss atypical presentations or differentiate poorly from similar conditions.

Laboratory investigations:
• Pros: Confirms diagnosis, especially in severe cases like myocarditis.
• Cons: Time-consuming and expensive.

273
Q

Why is hydration particularly important in children with hand, foot, and mouth disease?

A

Painful oral ulcers may lead to reduced oral intake, increasing the risk of dehydration. Maintaining hydration prevents complications and supports recovery.

274
Q

Give an example of a scenario where a child with Coxsackie’s disease might require hospitalization.

A

A child with hand, foot, and mouth disease develops dehydration due to refusal to drink fluids because of painful oral ulcers or a child with myocarditis caused by Coxsackie B virus presents with severe chest pain and cardiac dysfunction

275
Q

What is primary immunodeficiency (PI)?

A

PI refers to a group of more than 450 rare, chronic conditions where part of the body’s immune system is missing or does not function properly.

276
Q

True or False: Primary immunodeficiencies are always present at birth.

A

True. PI often has a genetic cause and is present at birth, though symptoms may not appear until later.

277
Q

PI often has a ________ cause and runs in ________.

A

genetic; families

278
Q

Name the six broad categories of primary immunodeficiency disorders.

A
  1. B cell (antibody) deficiencies
  2. T cell deficiencies
  3. Combination B and T cell deficiencies
  4. Defective phagocytes
  5. Complement deficiencies
  6. Unknown (idiopathic)
279
Q

True or False: Primary immunodeficiency disorders are rare but can present at any age.

A

t

280
Q

In the UK, the estimated prevalence of primary immunodeficiency disorders is approximately ________ per 100,000 individuals.

A

5

281
Q

List common signs and symptoms of primary immunodeficiency in children.

A

Recurrent infections (e.g., otitis media, pneumonia)

Poor growth or failure to thrive
Chronic diarrhea
Autoimmune manifestations
Unusual or severe infections

282
Q

Children with primary immunodeficiency often present with ________ infections and may have a history of ________ to thrive.

A

recurrent; failure

283
Q

True or False: Persistent oral thrush in a child can be an indicator of primary immunodeficiency.

A

True

284
Q

What initial investigations are recommended when suspecting primary immunodeficiency in a child?

A

Full blood count with differential

Serum immunoglobulin levels
Lymphocyte subsets
Specific antibody responses

285
Q

A family history of ________ immunodeficiency is a significant risk factor for the condition in children.

A

primary

286
Q

What are common treatment approaches for primary immunodeficiency disorders in children?

A

Prompt treatment of infections

Immunoglobulin replacement therapy
Prophylactic antibiotics
Hematopoietic stem cell transplantation in severe cases

287
Q

Immunoglobulin replacement therapy is indicated for children with significant ________ deficiencies.

A

antibody

288
Q

True or False: Live vaccines are contraindicated in children with severe T-cell deficiencies.

A

True

289
Q

List potential complications associated with primary immunodeficiency in children.

A

Chronic lung disease

Autoimmune disorders
Increased risk of malignancy
Growth retardation

290
Q

Children with primary immunodeficiency are at increased risk of developing ________ disorders and certain types of ________.

A

autoimmune; cancer

291
Q

True or False: With appropriate treatment, many children with primary immunodeficiency can lead relatively normal lives.

A

True

292
Q

Early diagnosis and ________ management are crucial for improving outcomes in children with primary immunodeficiency.

A

appropriate

293
Q

Mumps is caused by __

A

mumps virus

294
Q

How is Mumps spread?

A

Respiratory droplets

295
Q

Symptoms of Mumps

A

flu-like prodrome, followed by parotid swelling. can have muscle aches, reduced appetite, dry mouth

296
Q

Ix for Mumps

A

: PCR testing on saliva swab

297
Q

Management for Mumps

A

supportive: rest, fluids and analgesia

298
Q

Isolation advice for Mumps

A

self - isolate for 5 days

299
Q

Who should be notified for Mumps

A

Public Health

300
Q

How long does Mumps last?

A

-self-limiting, lasts around 1 week

301
Q

Complications of Mumps

A

Mengitis and orchitis are rare (otitis media most common Cx) but serious

Phase 3a - Paediactrics (17 decks)

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