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Year 4 Paediatrics > Infectious Diseases > Flashcards

Infectious Diseases Flashcards

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1
Q

A Febrile Child is classed as a temperature over 38 degrees. How is temperature measured in Children?

A

<4 weeks - Electronic Thermometer in Axillary

4 weeks to 5 years - electronic thermometer in Axillary or tympanic thermometer

(Note: Axillary underestimates by 0.5 degrees)

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2
Q

What is your first thought if the Febrile Child is under 3 months?

A

Infection is likely bacterial as infants are relatively protected against viral infection in first few months due to passive immunity

Start sepsis screen and empirical antibiotics

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3
Q

What is in a Sepsis Screen?

A

Blood Culture
FBC
CRP
Urine Sample

Consider other investigations depending on PC

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4
Q

Give four red flags in a Febrile Child

A

Fever >38 (<3 months) or >39 (3 to 6 months)
Reduced level of consciousness
Bilious Vomiting
Severe Dehydration

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5
Q

How should you treat the severely unwell febrile child?

A

IV Abx (Broad Spectrum + Ampicillin if less than one month to cover for Listeria)

Antipyretics

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6
Q

Define Shock

A

Circulation is inadequate to meet metabolic demands of the tissue

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7
Q

Why are children more succeptible to shock?

A

Higher surface area to volume ratio

Higher Basal Metabolic Rate

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8
Q

How does early (compensated) shock present?

A

Tachypnoea and Tachycardia
Cold Peripheries
Sunken Eyes and Fontanelle
Decreased Urine Output

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9
Q

How does late (decompensated) shock present?

A 
Acidotic (Kussmaul breathing)
Bradycardia
Confusion
Absent UO
Hypotension
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10
Q

How is Shock managed?

A

Fluid rescucitation (0.9% NaCl 20ml/kg)

Trachea intubation
Inotropic support
Renal support

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11
Q

Scarlet Fever is infection with Group A Strep. How does it present?

A

Fine papular rash on flushed skin (sandpaper texture)

Associated sore throat, strawberry tongue, lymphadenopathy

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12
Q

How is Scarlet Fever managed?

A

Notify PHE

Penicillin V

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13
Q

Parvovirus is also known as Erythema Infectiosum. How does it present?

A

Slapped cheek rash appearance

3-7 days prodrome

Evanescent rash for weeks

Arthropathy

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14
Q

How is Parvovirus managed?

A

Supportive unless neonate (IVIG)

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15
Q

Roseola Infantum is infection with Human Herpes 6 Virus. How does it present?

A

Temperature for 3 days that improves with appearance of rash

Maculopapular rash

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16
Q

What causes Lyme Disease?

A

Tick Bites (Spirochaete Borrelia Burgdorfen)

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17
Q

Describe the rash associated with Lyme Disease

A

Erythema migrans

Painless, non pruritic, circular lesions often with central clearing (target)

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18
Q

What is associated with Lyme Disease?

A

Localised - fever, headache, myalgia

Disseminated - Meningitis, Facial Nerve Palsy

Late - Large joint arthritis

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19
Q

How is Lyme disease investigated?

A

Localised - clinical diagnosis

Disseminated - ELISA

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20
Q

How is Lyme Disease managed?

A

<8 years Amoxicillin

> 8 years Doxycycline

For 2-3 weeks

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21
Q

Another cause of acute rash is Infectious Mononucleosis, how does this present?

A

Maculopapular rash (esp if treated with Amoxicillin)

Associated - flu like, exudate day pharyngitis, lymphadenopathy

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22
Q

Candidiasis is the most common opportunistic fungal infection. Who is most at risk?

A

Limited almost entirely to neonates

Children with primary/secondary immunodeficiency

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23
Q

How does Candidiasis present in the different areas?

A 
Skin - ‘Diaper Dermatitis’, moist skin folds
Nails - Paronychia 
Mucous Membranes - Oral Candidiasis
Genitals - Thrush, Balanitis
Systemic if immunocompromised
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24
Q

What can predispose children to Oral Candidiasis?

A

Inhaled Steroids

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25
Q

How is Candidiasis investigated?

A

Fungal Culture Swabs

Look for source

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26
Q

How is Candidiasis managed?

A

Azoles for immunocompetent
Amphiterecin for immunocompromised

Prevention with infection control measures and prophylaxis with azoles to high risk groups

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27
Q

Define Cellulitis

A

Infection of the dermis and deep subcutaneous tissue with poorly demarcated borders

(As opposed to Erysipelas which is more superficial with sharply demarcated borders)

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28
Q

Name four organisms commonly causing Cellulitis

A

Streptococcus Pyogenes
Streptococcus Pneumoniae
Staphylococcus Aureus
MRSA

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29
Q

Give three red flags for Cellulitis

A

Fever
Numbness/Tingling
Immunocompromised

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30
Q

How would you investigate Cellulitis?

A

Skin and swab culture
FBC
CRP

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31
Q

How should Cellulitis be managed?

A

Supportive (rest, elevation, analgesia)
Flucloxacillin
Emollient

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32
Q

How can Conjunctivitis be classified?

A

Viral
Bacterial
Allergic
Contact

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33
Q

Viral Conjunctivitis is highly contagious, give two examples of causative organisms

A

Adenovirus

Herpes Simplex

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34
Q

Bacterial Conjunctivitis is the most common form in children. Name four common causative organisms.

A

Haemophilia Influenza
Staphylococcus Aureus
Moraxella Catarrhalis
Strep Pneumoniae

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35
Q

How does Bacterial Conjunctivitis present?

A

Bilateral red eye with irritation/grittiness/discomfort
Mucopurlent discharge sticking lashes together
Oedema of lids/conjunctiva

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36
Q

How does Viral Conjunctivitis present?

A 
Bilateral red eye with irritation/grittiness/discomfort
Sore
Watery discharge
History of URTI
Preauricular lymphadenopathy
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37
Q

How does Allergic Conjunctivitis present?

A

Bilateral symptoms
Itchy
Watery discharge
Oedema of eyelids

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38
Q

What signs of conjunctivitis can be seen OE?

A 
Conjunctival oedema and dilated conjunctival vessels
Conjunctival Follicles (white nodules on inferior eyelid)
Conjunctival Papillae (Red dots of varying size on inferior eyelids - cobblestone)
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39
Q

How is Conjunctivitis investigated?

A

May just be a clinical diagnosis

Swab if in doubt
Fluorosceine 0.25% drops for corneal ulcer

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40
Q

How should Bacterial Conjunctivitis be managed?

A

Self limiting

If persisting for >2 weeks then Chloramphenicol eye drops

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41
Q

How should Viral Conjunctivitis be managed?

A

Self resolving
Wash hands frequently
Use separate towels

Consider topical steroids

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42
Q

How should Allergic Conjunctivitis be managed?

A

Remove allergen
Cold Compress
Antihistamines

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43
Q

What are Neonatal ‘Sticky Eyes’?

A

Common, beginning on day 3/4 of life

Only require washing with Saline/Water

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44
Q

How should you manage a Neonatal red eye?

A

Treat as bacterial conjunctivitis and refer urgently to ophthalmologist

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45
Q

How should you manage a purulent eye within the first 48h of life?

A

Gram stain and culture discharge

Treat with IV Cefotaxime (Risk of permanent loss of vision, likely Gonococcal)

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46
Q

How should you manage eye discharge occuring in first two weeks of life?

A

Immunoflourorescent staining

Likely Chlamydia

Treat with Azithromycin Eye Drops and Oral Erythromycin

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47
Q

Define Epiglottitis

A

Inflammation and swelling of epiglottis caused by infection

Normally infection with HiB, but can be Staph Aureus or Staph Saprophyticus

Can also be non infectious - thermal (steam), foreign bodies, trauma

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48
Q

Give 6 clinical features of Epiglottitis

A 
Sore Throat
Stridor
Drooling
Tripod Position
Fever
Muffled Voice
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49
Q

How is Epiglottitis investigated?

A

Don’t without sufficient airway management capabilities

Lateral X-ray Neck - Thumbprint

Fibre optic Laryngoscopy in operating theatre setting

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50
Q

How would you manage Epiglottitis ?

A

Don’t distress the patient
Involve Senior Paediatrician and Anaesthetist

Be prepared to intubate

IV Ceftriaxone and Dexamethasone

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51
Q

What is the main complication of Epiglottitis?

A

Epiglottic Abscess

Treated the same as Epiglottitis

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52
Q

What are the different types of Influenza?

A

Influenza A - most commonly, characterised by haemagglutinin and neuraminidase

Influenza B - Less severe

Influenza C - akin to common cold

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53
Q

Paediatric Influenza can present atypically. How could it present in babies?

A

Apnoea
Reduced tone
Poor feeding
BRUE

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54
Q

Paediatric Influenza can present atypically. How could it present in younger children?

A 
Haematemesis
Photophobia
Chest Pain
Apnoea
Rigors

Drowsiness in 50% of under 4s

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55
Q

The management is mainly supportive for Influenza. State two important points.

A

Avoid Aspirin in <16y (Reyes Syndrome)

If at risk then offer Oseltamivir

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56
Q

State three complications of Influenza

A

Bronchitis
Secondary Bacterial Pneumonia
Otitis Media

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57
Q

What is the route of infection with Herpes Simplex Virus?

A

Through mucous membranes/skin

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58
Q

What are the two types of Herpes Simplex Virus?

A

HSV1 - associated with lip and skin lesions

HSV2 - more commonly genital lesions

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59
Q

HSV infection is mostly asymptomatic, but can present as Gingivostomatitis, describe this.

A

Most common form in children

Vesicular lesions on lips, gums, anterior tongue surface, hard palate

Progresses to extensive painful bleeding and ulceration

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60
Q

Describe three skin manifestations of HSV

A

Cold Sores - Recurrent HSV lesions on gingival/lip lesions

Eczema Herpeticum - Widespread vesicular lesions on eczematous skin, can get secondary bacterial

Herpetic Whitlows - Painful erythematous oedematous white pustules on broken skin

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61
Q

Describe Disseminated HSV infection in immunocompetent

A

Cutaneous lesions may spread to involve distant sites (Oesophagitis, Proctitis)

Can cause pneumonia

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62
Q

Describe Disseminated HSV infection in Neonates

A

More common in preterm, often through vaginal canal transmission

Can cause encephalitis or localised lesions

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63
Q

HSV can be diagnosed with a swab, how should symptomatic patients be managed?

A

Acyclovir

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64
Q

State three subtypes of Malaria and describe the pathophysiology

A

Falciparum, Vivax, Ovale

Spread by female anopheles mosquito, causing release of sporozoites into blood which travel to become merozoites in liver

Reproduce in RBC every 48h causing Haemolytic Anaemia

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65
Q

How do Neonates with Malaria present?

A

If occurring within 7 days implies trans placental transmission

Fever, Irritable, Refusing feeds, Anaemia, Jaundice

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66
Q

How do young children with malaria present?

A

Present the same as any febrile illness (so investigate if any recent travel to endemic area)
Restless, Drowsy, Apathetic

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67
Q

Describe three possible investigations for Malaria

A

Blood Film
LP (if Seizing)
Dipstick for Plasmodium Falciparum

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68
Q

Describe the use of a blood film for the diagnosis of Malaria

A

3 samples sent over 3 days

Thick and thin

Giemsa staining destroys erythrocytes, showing parasites and leukocytes

Ear Lobe/Finger prick/Big toe

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69
Q

If uncomplicated Malaria, how should it be managed?

A

1) Riamet
2) Malarine
3) Quinine Sulphate
4) Doxycycline

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70
Q

How is Severe (Falciparum)/Complicated Malaria managed?

A

1) Artesunate
2) Quinine Dihydrochloride

Should be admitted as they can deteriorate quickly

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71
Q

Malaria can be prevented using mosquito spray/nets and antimalarials. State three antimalarials.

A

Malarone (daily 2d before, during and one week after)
Mefloquine (once weekly 2w before, during and for four weeks after)
Doxycycline

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72
Q

State three complications of Malaria

A

Seizures
Reduced Consciousness
DIC

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73
Q

Define Measles

A

Notifibable infection caused by single stranded RNA Morbillivirus
One of the most contagious infectious diseases

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74
Q

How is Measles transmitted?

A

Transmission is air borne via respiratory droplets (but can remain on surfaces for two hours)
Person is infectious from first onset of symptoms to four days after rash

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75
Q

Describe the prodromal phase of Measles

A

Lasts 2-4 days

Fever, cough, runny nose, mild conjunctivitis, diarrhoea
Kopliks (small red spots with white spot on buccal mucosa)

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76
Q

Describe the characteristic rash of Measles

A

Morbilliform

Initially on forehead and neck, then spreading to involve trunk and limbs

Rash fades 3-4 days later in order of appearance, leaving discolouration behind

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77
Q

How is Measles investigated?

A

Salivary swab/serum sample for measles specific IgM within 6 months of onset

RNA defection in salivary swabs

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78
Q

How is Measles managed?

A

Self limiting and supportive

Notifiable disease

PEP can be given within 72h of exposure

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79
Q

State two respiratory complications of Measles

A

Bronchopneumonia

Giant Cell Pneumonitis

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80
Q

State two neurological complications of Measles

A

Acute demyelinating encephalitis (fluctuating consciousness progressing to coma)

Subacute Sclerosing Panencephalitis (5-10 years later, results in rigidity and death)

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81
Q

Blindness is a complication of Measles, who is most at risk?

A

Vitamin A Deficiency

82
Q

Define Meningitis

A

Inflammation of the brain and spinal cord, normally secondary to bacterial or viral infection

83
Q

What is the difference between Meningococcal Meningitis and Meningococcal Septicaemia

A

Meningitis - Neisseria affects the meninges and CSF

Septicaemia - when Neisseria is in the blood, characterised by ‘non blanching rash’ (indicative of DIC and a Subcut Haemorrhages)

84
Q

What are the common organisms of Meningitis in Neonates and Children respectively?

A

Neonates - E.Coli, GBS, Listeria

Children - Neisseria Meningitidis, Strep Pneumoniae

85
Q

How would a Neonate with Meningitis typically present?

A

Hypotonia
Poor Feeding
Bulging Fontanelle

86
Q

How would a child typically present with Meningitis?

A 
Fever
Neck Stiffness
Headache
Vomiting
Seizures
87
Q

How would you investigate Meningitis? Give four

A

Bloods (FBC, CRP, Clotting, U&Es)
Blood Culture
Lumbar Puncture
ABG

88
Q

What are the criteria for doing a LP (prior to antibiotics) in suspected Meningitis?

A

<1 month with fever
1-3 months with fever and unwell
>1y with fever and other features

89
Q

If the child with suspected Meningitis is over 2y, they may show positive Kernig’s and Brudzinski’s sign. What are these?

A

Kernig’s - Flex Hip and knee at 90 degrees then straighten knee while hip flexed (painful due to meningism)

Brudzinski’s - Flex patients head and neck involuntarily which will cause involuntary flexion of knees and hips

90
Q

How many white cells are expected in a normal CSF?

A

<5 lymphocytes

91
Q

Describe the typical CSF composition in a Bacterial Meningitis

A

Cloudy
High Protein
Low Glucose
High White Cells (Polymorphs)

92
Q

Describe the typical CSF composition in a Viral Meningitis

A 
Clear
Normal/High Protein
Normal/Low Glucose
Increase White Cells
Increased White Cells (Lymphocytes)
93
Q

How would you immediately manage suspected Meningococcal Septicaemia in the community?

A

IV or IM Benzylpenicillin

94
Q

Describe the antibiotics used in hospital for a Meningitis

A

<28d - Cefotaxime, Amoxicillin, Gentamicin

1-3m - Ceftriaxone and Amoxicillin

> 3m - Ceftriaxone (and Amoxicillin if Listeria suspected)

95
Q

Steroids are given as an adjunct in Meningitis if the child is over 3 months. Why is this?

A

Reduces hearing loss and neurological damage

96
Q

What do you do to manage Meningitis from a Public Health perspective?

A

Notify Public Health

PEP for those who have had prolonged contact for >7 days (Single dose Ciprofloxacin)

97
Q

When is an LP contraindicated in Meningitis?

A

Shock
Convulsions
Coagulation Abnormality
Septicaemia

98
Q

How would Viral Meningitis be treated?

A

General less severe so just supportive

If HSV suspected then Aciclovir

99
Q

One of the main differentials for Meningitis is Encephalitis. How would this present and how would you manage?

A

Altered consciousness, cognition and focal neurological symptoms

Managed with empirical Acyclovir

100
Q

State 5 complications of Meningitis

A 
Hearing Loss
Cerebral Abscess
Nerve Palsies
Hydrocephalus
Epilepsy
101
Q

Mumps is a viral infection spread by respiratory droplet’s. How would it present?

A

Flu like prodrome

Parotid Gland Swelling (either unilateral or bilateral, painful due to capsular distension inner ages by trigeminal)

102
Q

How is Mumps investigated?

A

PCR of Saliva

Blood Mumps Specific IgM

103
Q

How is Mumps managed?

A

Supportive only
Notify public health
Normal recovery in 2-4 weeks

104
Q

State three complications of Mumps

A

Pancreatitis
Orchitis (Testicular Pain and Swelling)
Sensorineural Hearing Loss

105
Q

Define Orbital Cellulitis

A

Potentially sight threatening and life threatening ophthalmic emergency due to infection of soft tissue behind orbital septum (usually from locally spreading infection)

106
Q

What is Preseptal Cellulitis?

A

More common and less serious infection of anterior to orbital septum
Common in young children

107
Q

Describe the pathophysiology of Orbital Cellulitis

A

Extension of infection from periorbital structures (eg sinuses)

Extension of Preseptal infection

Direct Inoculation

Haematogenous

H.Influenza, S.Aureus, S.Pneumoniae, S.Pyogenes

108
Q

How does Preseptal Orbital Cellulitis present?

A

Acute onset of swelling/warmth/redness/tenderness of eyelid

No orbital signs

109
Q

How would Orbital Cellulitis present?

A

Anteriorly - Acute unilateral swelling of conjunctiva and lid (oedema, erythema, pain)

Orbital - Muscle Opthalmoplegia, Proptosis, Pain on eye movement, Blurred vision

Systemic - Fever, Malaise

110
Q

Anyone with suspected Preseptal Cellulitis should be assumed to have Orbital until proven otherwise. How is it investigated?

A

FBC/CRP/Culture
Nose Swab
ENT and Opthalmology review
CT of sinuses and orbit

111
Q

How is Orbital Cellulitis managed?

A

IV Ceftriaxone

4 hourly obs

112
Q

Give two complications of Pre Septal and Orbital Cellulitis respectively

A

Preseptal - Orbital progression, Lid abscess

Orbital - Vein Occlusion, Meningitis

113
Q

There are many different subtypes of Otitis Media. Define Acute Otitis Media.

A

Inflammation of middle ear that can be bacterial or viral in origin

114
Q

There are many different subtypes of Otitis Media. Define Acute Supparative Otitis Media.

A

Presence of pus in the middle ear

115
Q

There are many different subtypes of Otitis Media. Define Otitis Media with Effusion.

A

Chronic inflammatory condition following slowly resolving acute otitis media
Effusion behind intact Tympanic Membrane

116
Q

There are many different subtypes of Otitis Media. Define Chronic Supparative Otitis Media.

A

Long standing middle ear infection with persistently perforated tympanic membrane

117
Q

There are many different subtypes of Otitis Media. Define Mastoiditis.

A

Acute inflammation of the mastoid periosteum and air cells when infection from middle ear spreads

118
Q

There are many different subtypes of Otitis Media. Define Cholesteatoma.

A

Retraction of Pars Flaccida and squamous proliferation in middle ear

119
Q

Describe the pathophysiology of Otitis Media

A

Infective organisms reach middle ear via Nasopharynx

In young children the angle between sustainable tube and pharynx is not acute so allows easy spread

120
Q

Give two bacterial and two viral causes of Otitis Media

A

Bacterial - H.Influenza, S.Pneumoniae

Viral - RSV, Rhinovirus

121
Q

Name four risk factors for Otitis Media

A

Male
Household smoking
Nursery attendance
Craniofacial abnormalities

122
Q

Give four SYMPTOMS for Otitis Media

A

Pain (young children tug at ear)
Malaise
Poor Feeding
Fever

123
Q

How would the Tympanic Membrane appear in Otitis Media?

A

Red/Yellow/Cloudy

Bulging

Air fluid level behind

124
Q

How would you investigate Otitis Media?

A

Normally a clinical diagnosis

Culture discharge if chronic/recurrent/grommets

CT/MRI if complications suspected

125
Q

Describe the use of antibiotics in Otitis Media

A

Aim not to and explain why

Can give delayed (‘if not improving in 4 days’)

Give if systemically unwell/at risk of complications/not improving after four days

5 days Amoxicillin

126
Q

Give three complications of Otitis Media

A

Chronic Supparative Otitis Media
Mastoiditis
Meningitis

127
Q

Rubella (AKA German Measles) is an RNA airborne virus. How does it present?

A

Prodrome (low fever, mild conjunctivitis, rhinorrhoea)

Pink discrete macules that coalesce, spreading cephalocaudally

Forcheimers Sign (Petichiae on soft palate)

128
Q

How would you investigate suspected Rubella?

A

PCR

FBC (increased lymphocytes, low platelets)

129
Q

How would you manage Rubella?

A

No specific treatment
NSAIDs (Not Aspirin - Reyes)

Keep child away from school for 4d from rash onset

130
Q

Describe the different subtypes of Otitis Externa (inflammation of ear canal)

A 
Acute (<3 weeks)
Chronic (>3 weeks)
Localised (infection of follicle/boil)
Diffuse
Malignant (Osteomyelitis of Temporal and Mastoid Bone)
131
Q

Describe the aetiology of Otitis Externa

A

Bacterial - Pseudomonas Auerginosa, Staph Aureus (secondary to blockage of canal, absence of wax, trauma)

Fungus

132
Q

Name three risk factors for Otitis Externa

A

Hot and Humid
Swimming
Eczema

133
Q

How would Otitis Externa present?

A 
Pain
Itching
Discharge
Hearing Loss
Preauricular Lymphadenopathy
134
Q

What advice would you give a patient with Otitis Externa?

A

Avoid getting ear wet
Remove discharge using cotton wool (not bud)
Remove hearing aids and earrings
Take simple pain relief

135
Q

How would you manage Otitis Externa medically?

A

topical antibiotic and steroid
Lymphadenopathy - Oral Flucloxacillin

Chronic - Acetic Acid and Corticosteroids

If not resolving then swab

136
Q

Give three complications of Otitis Externa

A

Abscess
Ear Canal Stenosis
Perforated Ear Drum

137
Q

Describe the pathophysiology of Mastoiditis

A

Infection causes a breakdown of fine trabecular in mastoid air cells and allows collection of pus

The build up of pus causes local bone necrosis and subperiosteal abscess (behind pinna, superior to pinna, or over squamous temporal)

138
Q

How would Mastoiditis present?

A

Otalgia
Pyrexia
Tenderness behind pinna (MacEwans Triangle)
Pinna may be pushed forward

On a background of acute or recurring Otitis Media

139
Q

If Mastoiditis is advanced, how could it present?

A

Abducens/Facial/Opthalmic Nerve Palsy

140
Q

Investigations for Mastoiditis shouldn’t delay treatment. What should you do?

A

CT head and mastoid with contrast

Will show coalescing air cells, opaque mastoid and middle ear

141
Q

How is Mastoiditis managed?

A

Initial IV Abx (Co-Amoxiclav or Ceftriaxone)

Oral Abx for 14d

Surgery if not improving after 48h of IV, or if complications

142
Q

Define Tonsillitis

A

Inflammation of palatine tonsils (concentrated lymphoid tissue) as a result of bacterial/viral infection

Can occur with other areas of inflammation (tonsulopharyngitis, adenotonsillitis)

143
Q

Describe the pathophysiology of Tonsillitis

A

Tonsils are naturally at their largest between 4-8y

Majority of infections are viral (Adenovirus, EBV) but can be bacterial (S.Pyogenes)

144
Q

How does Tonsillitis present?

A

Symptoms normally for 5-7 days (if longer consider glandular fever)

Odynophagia, Fever, Halitosis, Red Inflamed Tonsils

145
Q

What is the Centor Criteria?

A

1) Tonsilar Exudate
2) Lymphadenopathy
3) Fever or Hx of fever
4) Absence of cough

> /=3 means that bacterial is likely

146
Q

What is the FeverPAIN Score?

A

1) Fever in past 24h
2) Purulence
3) Attend Rapidly (within 3d)
4) Inflamed Tonsils
5) No Cough/Coryza

1 - Abx not indicated
2 to 3- Consider delayed
4 to 5 - Abx indicated

147
Q

How is Tonsillar Size graded?

A 
0 - not visible beyond anterior pillar
1 - occupy >25% oropharynx
2 - occupy 25-50% oropharynx
3 - occupy 25-75% oropharynx 
4 - tonsils meet in midline
148
Q

Give three differentials for tonsillitis

A

Quinsy
Glandular Fever
Epiglottitis

149
Q

What medication should be used for Tonsillitis?

A

10 days Pen V (or Clarithromycin)

If unable to swallow consider IV Benzylpenicillin

Paracetamol/Ibuprofen/Topical Benzydramine spray

150
Q

When should you consider a tonsillectomy in a child?

A

> 7 episodes in a year
5 episodes each year for 2 years
3 episodes each year for 3 years

151
Q

Give three complications of Tonsillitis

A

Peritonsillar Abscess
Retropharyngeal Abscess
Post Strep Glomerulonephritis

152
Q

Peritonsillar Abscesses are collections of pus in peritonsillar space. Describe the pathophysiology.

A

Palatine tonsils sit between tonsillar pillars and within a thin capsule

Pus collects between capsule and superior pharyngeal constrictors

153
Q

How do Peritonsillar Abscesses present?

A 
Severe sore throat (worse unilaterally)
Drooling
Trismus
‘Hot Potato Voice’
Unilateral uvular deviation
154
Q

How should Peritonsillar Abscesses be investigated?

A

FBC/CRP/Glandular Fever Screen

CT is suspecting retropharyngeal abscess

155
Q

How are Peritonsillar Abscesses managed?

A

Aspiration and drainage

Co- Amoxiclav/Benzylpenicillin + Metronidazole

IV rehydration

156
Q

What is Toxic Shock Syndrome?

A

S.Aureus and Group A Strep release toxins which act as superantigens causing fever/hypotension/diffuse rash

157
Q

Toxic Shock Syndrome causes dysfunction of all organ systems to varying degrees. Describe some management options

A

ICU Support
Debridement of infection areas
IV Ceftriaxone and Clindamycin
IVIG to neutralise toxin

158
Q

What can occur 1-2 weeks after Toxic Shock Syndrome?

A

Desquamation of palms/soles/fingers/toes

159
Q

Describe the pathophysiology of Tuberculosis in children

A

Latent TB is more likely to progress to active TB in infants and young children

Children normally acquire TB from infected adults in same household

Children normally aren’t infectious as they are paucibacillary

160
Q

How does symptomatic TB present?

A

Fever, Anorexia, Weight Loss, Cough, Pleural Effusions

161
Q

How does a Post Primary TB present?

A

Can be localised or disseminated

Infants and young children are more prone to tuberculous meningitis

162
Q

Diagnosis of TB is difficult is in children ad they swallow sputum until age of around 8. What can be done as an alternative?

A

Gastric washings via NG on three separate mornings and then ZN stain

163
Q

What is the Mantoux test?

A

Can be positive due to previousBCG

Intradermal injection of purified protein derivative

Induration >5mm is TB positive

164
Q

What is the IGRA Test?

A

Assess response to TB proteins via blood sample
Not affected by vaccination status

Done in conjunction with Mantoux in under 5s

165
Q

How is latent TB treated?

A

3 months Rifampicin and Isoniazid
Or
6 months Isoniazid

166
Q

How is Active TB managed?

A

2 months Rifampicin/Isoniazid/Pyrazinamide/Ethambutol
Followed by 4 months Rifampicin and Isoniazid

Pyridoxine required in older children

167
Q

When should you give prophylactic Isoniazid?

A

If less than 2 years and significant contact with a sputum positive

If Mantoux and IGRA are negative at 6 weeks it can be discontinued

168
Q

What is encompassed in the term ‘URTI’?

A

Common Cold
Sore Throat (Pharyngitis, Tonsillitis)
Acute Otitis Media
Sinusitis

169
Q

Define Viral Exanthem

A

A rash accompanied by systemic symptoms such as fever/headache/malaise. Due to organism’s toxins, damage by organism itself or by immune response

170
Q

Give three Viral Exanthems starting on the face

A

Measles
Rubella
Erythema Infectiosum

171
Q

Give two Viral Exanthems starting on the trunk

A

Roseola

Scarlet Fever

172
Q

Give a papulovesicular Viral Exanthem

A

Chickenpox

173
Q

What is Gianotti Crosti Syndrome?

A

Normally caused by EBV

Discrete non pruritic monomorphic papules lasting 2-8 weeks

Seen over face/buttocks/extensor surfaces

174
Q

Hand Foot and Mouth Disease is a self limiting disease normally caused by Coxsackie Virus. How does it present?

A

Brief 12-36 hour prodrome

Painful ulcers on hard palate, tongue, buccal mucosa

Tongue may become red and oedematous

Erythematous macules with central grey vesicles on hands and feet (normally sides of fingers and for sum)

175
Q

Viral causes of GE include Rotavirus, Noravirus and Adenovirus. What is the most common cause?

A

Norovirus

Rotarix vaccine given at 8-12 weeks

176
Q

What’s the most common cause of bacterial GE in children?

A

Campylobacter

Can cause bloody diarrhoea
Consumption of undercooked meat and underpasteurised milk

177
Q

Other than Gastrienteritis, what can VTEC cause?

A

Haemorrhagic Colitis

Haemolytic Uraemic Syndrome

178
Q

Who is at greatest risk of dehydration with Gastroentetitis?

A

Children under 6 months
>5 diarrhoeal stools in 24 hours
>2 vomits in 24 hours
Children who have stopped breast feeding due to GE

179
Q

GE is normally a clinical diagnosis. When should you send stools for microscopy?

A

Suspected septicaemia
Blood/Mucous in stools
Immunocompromised child

180
Q

How should you manage dehydration in GE?

A

Give IV if shock is suspected/any red flag symptoms/persistent vomit

Oral 50ml/kg over 4h to replace deficit plus maintenance

If refusing oral feed - NG

181
Q

What advice should you give parents after GE?

A

Avoid fruit juice and carbonated water
Don’t attend school for 48h since last episode
Child shouldn’t swim for two weeks

182
Q

State three complications of GE

A

Haemolytic Uraemic Syndrome
Reactive Arthritis
Secondary Lactose Intolerance

183
Q

Why can a HIV antibody test come back positive if <18 months?

A

Due to maternal antibodies that have crossed placenta

184
Q

When should you test children for HIV? Give four examples

A

Babies to HIV parents
When immunodeficiency suspected
Young sexually active people
Needle stick/IVDU

185
Q

If a child is born to HIV positive parents, when should they be screened?

A

Viral load test at 3m (shows whether HIV contracted at birth)

Anti body test at 24m (see if they’ve contracted it since - eg via breast feeding)

186
Q

How is HIV managed in children?

A

Antiretrovirals
Normal childhood vaccines
Prophylactic Co-Trimoxazole
Treatment of opportunistic infections

187
Q

When should you test children for Hep B?

A

Hep B positive mothers
Migrants from endemic areas
Close contacts

188
Q

How should a child born to a Hep B positive mother be managed?

A

Within 24h - Hep B Vaccine and Hep B IVIG

Additional vaccines at 1 and 12 months (alongside normal schedule)

Tested for HbSag at 1 year

189
Q

Can Hep B positive mothers breast feed?

A

Yes as long as child is fully vaccinated

190
Q

How should children born to Hep C positive mothers be managed?

A

Antibody Tested at 18 months

Children often clear virus spontaneously

Mothers can breast feed as long as nipples aren’t cracked

191
Q

How should chronic Hep C in children be managed?

A

Consider Peg Interferon in over 3s

Treatment is more effective in adults so normally delayed

192
Q

What vaccines contain egg?

A

Live Influenza
Yellow Fever
Rabies

193
Q

Name 5 live vaccines

A 
MMR
BCG
Chickenpox
Nasal Influenza
Rotavirus
194
Q

What vaccinations are given at 8 weeks?

A

Diphtheria/Tetanus/Pertussis/Polio/HiB/Hep B
Men B
Rotavirus

195
Q

What vaccinations are given at 12 weeks?

A

Diphtheria/Tetanus/Pertussis/Polio/HiB/Hep B
Pneumococcal
Rotavirus

196
Q

What vaccinations are given at 16 weeks?

A

Diphtheria/Tetanus/Pertussis/Polio/HiB/Hep B

Men B

197
Q

When is the MMR vaccine given?

A

3 years 4 months

198
Q

When is the Men ACWY vaccine given?

A

14 years

199
Q

Describe the paediatric sepsis six

A 
O2
Bloods
IV Abx
Fluids
Escalation
Consider Inotropic Support
200
Q

What is the Paediatric Maintenance fluid of choice?

A

0.9% Sodium Chloride + 5% Dextrose

Year 4 Paediatrics (15 decks)

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