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Paedriatrics > Infectious diseases > Flashcards

Infectious diseases Flashcards

1
Q

What is sepsis?

A

SIRS + suspected/proven infection

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2
Q

What is SIRS?

A 
Systemic inflammatory response syndrome:
Fever/hypothermia
Tachycardia
Tachypnoea
Leucocytosis or leucocytopenia
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3
Q

What is severe sepsis?

A 
SEPSIS + multi-organ failure
>2 of:
- Respiratory failure
- Renal failure
- Neurologic failure
- Haematological failure
- Liver failure
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4
Q

What is ARDS?

A

Acute respiratory distress syndrome - inflammatory response of the lungs

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5
Q

Which sex des sepsis occur in more?

A

Male

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6
Q

What are the responsible pathogens of sepsis in neonates?

A

Group B streptococci
E.coli
Listeria monocytogenes

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7
Q

What are the responsible pathogens of sepsis in children?

A

Strep pneumoniae
Meningococci
Group A strep
Staph aureus

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8
Q

What are symptoms of paediatric sepsis?

A 
Fever/hypothermia
Cold hands/feet
Mottled skin
Prolonged cap refill time
Chills/rigors
Limb pain
Vomiting/diarrhoea
Muscle weakness
Muscle/joint aches
Skin rash
Reduced urine output
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9
Q

What is probably the best sign of sepsis?

A

Tachycardia

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10
Q

What is the treatment for sepsis?

A

ABC
DEFG - don’t ever forget glucose
Antibiotics with broad-spectrum and CSF penetration
Cephalosporins

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11
Q

What blood investigations would you do for sepsis and the likely results?

A

FBC - leucocytosis, thrombocytopenia
CRP - elevated
Coag factors - deranged clotting due to DIC
U&Es, LFTs - renal and hepatic dysfunction
Blood gas - metabolic acidosis, raised lactate
Glucose - hypoglycaemia
Culture

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12
Q

What CSF investigations would you do for sepsis and what are the likely results?

A

Cell count & culture - increased WCC

Protein & glucose - increased protein level, low glucose

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13
Q

What other investigations would you do for sepsis?

A 
Blood
CSF
Urine culture
Skin biopsy culture
Imaging: CT/MRI head
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14
Q

What are the responsible pathogens of meningitis in neonates?

A

Group B strep
E.coli
Listeria monocytogenes

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15
Q

What are the responsible pathogens of meningitis in children?

A

Strep pneumoniae
Meningococci
Haemophilus influenza

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16
Q

What are the symptoms of meningitis in children?

A 
Nuchal rigidity
Headaches, photophobia
Diminished consciousness
Focal neurological abnormalities
Seizures
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17
Q

What are the symptoms of meningitis in neonates?

A 
Lethargy, irritability
Bulging fontanelle
Seizures
High temp
Sleepy
Breathing fast/difficulty breathing
Shivering
Vomiting/refusing to feed
Blotchy skin
Stiff body with jerky movements
Cold hands/feet
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18
Q

What is the treatment of meningitis?

A

Chemoprophylaxis

Steroids

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19
Q

Where does strep pneumoniae colonize?

A

Upper airways

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20
Q

What is the transmission of strep pneumoniae?

A

Droplets

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21
Q

What are signs of pnuemococcal meningitis?

A

Brain damage
Hearing loss
Hydrocephalus

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22
Q

Is strep pneumoniae gram neg or pos?

A

Gram positive

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23
Q

Is haemophilus influenza type B gram pos or neg?

A

Gram negative

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24
Q

What can haemophilus influenza type B cause?

A

Bacteraemia
Meningitis
Pneumonia
Epiglottitis

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25
Q

What are long term complications for survivors of meningitis?

A

Amputation
Skin scarring
Cognitive impairment/epilepsy/hearing loss

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26
Q

What are vaccine preventable diseases?

A

Meningococcal disease

Haemophilus influenzae B Pneumococcal disease

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27
Q

What are the first signs of scarlet fever after 2-4 days?

A

Malaise
Fever
Flu-like symptoms
Pharyngitis

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28
Q

If progressive strep infection what is the next sign after flu-like symptoms?

A

Rash

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29
Q

What happens to the tongue in scarlet fever

A

Strawberry tongue

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30
Q

What can happen to hands and fingers in scarlet fever?

A

Peeling

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31
Q

What time of year is scarlet fever most common?

A

Winter

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32
Q

When can Group A strep cause complicated presentations?

A

Immunosuppressed

Chickenpox

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33
Q

What is the treatment for scarlet fever?

A

Penicillin 10 days

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34
Q

What are some complications of scarlet fever?

A 
Impetigo
Necrotising fasciitis
Erysipelas
Rheumatic fever
Glomerulonephritis
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35
Q

What infections can staph aureus cause?

A 
Impetigo
Cellulitis
Infected eczema
Ulceration
Staph scalded skin syndrome
Toxic shock syndrome
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36
Q

Is streptococci gram positive or gram negative?

A

Gram positive

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37
Q

What is streptococci treated with?

A

Penicillin

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38
Q

Does streptococci have resistance issues?

A

Not usually

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39
Q

Is staphylococci gram positive or gram negative?

A

Gram positive

40
Q

What is staphylococci treated with?

A

Flucloxacillin

41
Q

Does staphylococci have resistance issues?

A

Yes - resistance big issue e.g. MRSA

42
Q

What is impetigo caused by usually?

A

S. Pyogenes

S. Aureus

43
Q

How does impetigo present?

A

‘Golden’ sores and blisters

No systemic symptoms

44
Q

What is SSSS usually caused by?

45
Q

How does SSSS usually present?

A

Fever
Widespread redness
Fluid-filled blisters - rupture easily, especially in skin folds

46
Q

What is TSS usually caused by?

A

S. Pyogenes

S. Aureus

47
Q

How does TSS present?

A

Widespread redness, desquamation, multi-organ involvement

48
Q

What is Kawasaki disease?

A

Self-limited vasculitis of medium-sized arteries

49
Q

What is the leading cause of acquired heart disease in developed world?

A

Kawasaki disease

50
Q

What are the signs/symptoms of Kawasaki disease?

A

Fever for 5 days plus:

  • bilateral conjunctival injection
  • cracked lips/strawberry tongue
  • cervical lymphadenopathy >1.5cm
  • polymorphus rash
  • changes of the extremities
51
Q

What is the diagnostic test for Kawasaki disease?

A

None - exclude differentials

Throat swab/microbiology

52
Q

What is the main acquired heart disease caused by Kawasaki disease?

A

Coronary aneurysm

53
Q

What is the aim of Kawasaki disease treatment?

A

Aim to prevent complications

54
Q

What is the treatment of Kawasaki disease?

A 
Immunoglobulins
Aspirin
Steroids
Immunosuppressive agents
Cardiology assessment
55
Q

What are examples of persistant fever and rashes?

A

Henoch-Schonlein purpura

Vasculitis

56
Q

What are three categories of rash?

A

Erthematous maculopapulous
Vesiculobullous
Petechial and purpuric

57
Q

What viruses may present with an erythematous maculopapulous rash?

A 
Measles
Rubella
Enterovirus
Cytomegalovirus
Human herpesvirus 6
Human herpesvirus 7
Parvovirus B19
Epstein-Barr virus
58
Q

How does a erythematous maculopapulous rash appear?

A

Red, patchy rash, often raised

59
Q

What viruses may present with a vesticulobullous rash?

A

VZV
Herpes simplex virus
Enterovirus

60
Q

How does a vesiculobullous rash appear?

A

Small vesicles, fluid/pus filled, or bullous

61
Q

What viruses may present with a petechial or purpuric rash?

A

Rubella (congential)
Cytomegalovirus (congenital)
Enterovirus

62
Q

What are the types of VZV infections?

A

Primary infection: varicella, chickenpox

Recurrent infection: zoster

63
Q

What is the incubation period for VZV infections?

A

14 (10-21) days

64
Q

What are the clinical signs of chickenpox?

A 
Mild malaise
Fever
Generally not unwell
Itchy
Exanthema
65
Q

What is the natural history of exanthema in chickenpox?

A

Papules -> vesicles -> pustules -> crustae -> scarring ‘cropping’

66
Q

What are the complications of chickenpox?

A

Secondary strep/staph infections of skin
Meingoencephalitis
Cerebellitis
Arthritis

67
Q

What is the therapy for chickenpox?

A

None

Aciclovir if immunosuppressed

68
Q

When is a VZV infection more fatal?

A

<1yr

T-cell deficiencies

69
Q

What are the warning signs of a more fatal VZV infection?

A

High fever
New lesions >day 10
Inflammed lesions
General malaise

70
Q

What are signs of HSV infection?

A

Herpes stomatitis

Whitlow’s on fingertips

71
Q

Which type of herpes is HSV 1?

72
Q

Which type of herpes is HSV 2?

73
Q

What is the primary symptom of HSV 1?

A

Stomatitis - recurrent cold sores

74
Q

What are serious complications of HSV?

A

Keratoconjunctivitis
Encephalitis
Systemic neonatal infections

75
Q

What is the therapy for HSV infections?

A

Self-limiting

Aciclovir

76
Q

How can HSV infections be spread to neonates?

A

Birth canal/direct contact

77
Q

Why are HSV infections serious in neonates?

A

Not great immune system, disseminates

78
Q

What disseminated infections can HSV cause in neonates?

A

Sepsis
Meningoencephalitis
Hepatitis
Skin/eye/mouth (SEM) disease

79
Q

What is the treatment for neonates with HSV infection?

80
Q

What is the usual cause of hand-foot-mouth disease?

A

Enteroviruses

81
Q

What age group is most susceptible to hand-foot-mouth disease?

82
Q

When is hand-foot-mouth disease most prevalent?

A

Summer and early autumn

83
Q

What is the incubation period for hand-foot-mouth disease?

84
Q

What is clinical presentation of hand-foot-mouth disease?

A

Exanthema

Painful lesions

85
Q

What type of bacteria is usually responsible for scarlet fever?

A

Group A strep (GAS)

86
Q

What are primary immunodeficiencies caused by?

A

Missing or improper function of body’s immune system//single genetic defects

87
Q

What is more common: primary or secondary immunodeficiencies?

A

Secondary immunodeficiencies

88
Q

What is the most common cause of secondary immunodeficiency?

A

Prolonged steroid use

89
Q

What are warning signs that it could be a primary immunodeficiency?

A 
Serious
Persistent
Unusual
Recurrent
FH
90
Q

What investigations should you do if you suspect a primary immunodeficiency?

A 
FBC
Immunoglobulins
HIV test
Functional antibodies
Lymphocyte subsets
NBT - Nitroblue tetrazolium blood test
Complement
91
Q

What does the Nitroblue tetrazolium blood test check for?

A

Screen for Chronic Granulomatous Disease (CGD)

92
Q

What are different causes of immunodeficiency?

A

Antibody deficiencies
Cellular immunodeficiencies
Innate immune disorders

93
Q

What is transmission for most paediatric HIV cases?

A

Vertical transmission

94
Q

What is the main risk factor for vertical transmission of HIV?

A

High viral load

95
Q

What is the treatment postnatally for HIV?

A

Mother - ART

Baby - prophylaxis until further testing, no breastfeeding

96
Q

What is the treatment for children with HIV?

Paedriatrics (19 decks)

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