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Paediatrics > Infectious Diseases > Flashcards

Infectious Diseases Flashcards

1
Q

If a fever has lasted longer than 5 days what do you think of?

A

Kawasaki

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2
Q

If the febrile illness arises days before a rash what is viral cause?

A

VZV

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3
Q

History questions in sick child presentation?

A

How long
Chronology
Immunisations
Infected contacts
immunosuppression
Exposure - animals, travel, school, food/drink
Treatment already given - meningitis/penumonia

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4
Q

What temperature would be immediately high risk in a baby under 3 months and a child 3-6 months?

A

under 3 months = over 38

3-6 months = over 39

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5
Q

Child presenting with cough, conjunctivitis, coryzal rash on face and ears now around bottom, what are differentials?

A

Scarlet fever

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6
Q

Signs of scarlet fever?

A

sandpaper rash, strawberry red tongue, pastias lines

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7
Q

Symptoms of Meningitis in children?

A

Photophobia, neck stiffness, bulging fontanelle, rash, headache, seizures, sepsis, altered GCS

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8
Q

What investigations are needed into suspected meningitis?

A

Blood culture and LP

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9
Q

What does lumbar puncture look at for meningitis investigation?

A

Glucose, protein, WCC, microscopy, gram stain, molecular testing

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10
Q

How will CSF present in TB?

A

yellow with raised WCC, marked raise in protein and very low glucose

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11
Q

What sign is positive for meningitis?

A

Kernigs

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12
Q

8 causative organisms for meningitis?

A 
Neisseria meningitidis
Haemophillus influenza type b
Streptococcus pneumoniae
group B strep 
E.Coli
TB
Fungi
Parasites
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13
Q

Treatment for CNS infections?

A

3rd gen cef = cefotaxime or ceftriaxone

Steroids (HiB)

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14
Q

What follow up is needed in meningitis?

A

Audiology

clinical

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15
Q

What do steroids allow in meningitis treatment?

A

reduced hearing loss

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16
Q

Define encephalitis?

A

Inflammation of brain parenchyma

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17
Q

What 6 viral illnesses can then proceed to encephalitis?

A

CMV, enteroviruses, HSV, adenovirus, jap encephalitis, arboviruses

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18
Q

Why does HSV encephalitis have unique presentation and what is it?

A

Temporal region effected following tracking back from temporal lobe ganglion
Presents with haemorrhagic encephalitis

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19
Q

Treatment of HSV encephalitis?

A

Aciclovir

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20
Q

In encephalitis what investigations on CSF are looked at?

A

PCR
Serology - arboviruses, lyme disease
Examine - RBCs, protein, oligoclonal bands, pleocytosis

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21
Q

What is ADEM spectrum and when does it occur?

A

Acute demyelinating encephaliting spectrum in post infectious CNS

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22
Q

What 3 organisms most likely to cause post-infectious encephalitis?

A

HSV
VZV
Mycoplasma

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23
Q

6 common viral pathogens causing URTI?

A 
RSV
Rhinovirus
Adenovirus
Parainfluenza
Influenza
Coronavirus
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24
Q

Viral pathogens most likely to cause LRTI?

A 
RSV
parainfluenza
influenza
Adenovirus
Metapneumovirus
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25
Q

Bacterial pathogens most likely to cause LRTI?

A

mycoplasma
strep. pneumoniae
haemophillus
Staph aureus

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26
Q

Tests for moderate to severe pneumoniae?

A

Blood culture
Nasopharyngeal aspirate - PCR, FISH for virus
Sputum culture - bacterial
Pleural fluid

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27
Q

When is CXR indicated in pneumonia?

A

When it is very severe with complications or diagnostic doubt

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28
Q

Treatment of CAP? what is added if not effective?

A

Amoxicillin

Macrolide

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29
Q

What is Pertussis known as? Presents as?

A

Whooping cough
URTI, rhinorrhoea, cough with whoop, apnoea, vomiting, conjunctival haemorrhages
100 day cough

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30
Q

How is diagnosis of pertussis made?

A

Nasopharyngeal swab for PCR and culture

lymphocytosis

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31
Q

What drug class is given in pertussis to reduce transmissibility?

A

Macrolide - clarithromycin, azithromycin

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32
Q

What does the cocooning strategy of pertussis vaccination refer to?

A

Vaccinating whole household of newborn infant

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33
Q

Primary causative viral agent of gastroenteritis? 2 other viral causes?

A

Rotavirus
Adenovirus
Norovirus

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34
Q

5 main bacterial causes of gastroenteritis?

A 
Shigella
salmonella
e.coli
campylobacter
c. diff
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35
Q

Management of Gastroenteritis?

A

Supportive
Fluid and electrolyte replacement
Rotavirus vaccine

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36
Q

2 big MSK infections to be aware of?

A

Septic arthritis

Acute haemotogenous osteomyelitis

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37
Q

Septic arthritis symptoms?

A

Joint swelling
Fever
limitation of movement

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38
Q

Most common pathogens causing septic arthritis?

A 
S. aureus
Group A strep
Hib
Pneumococcus
Kingella Kingae
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39
Q

Symptoms of acute haematogenous osteomyelitis?

A

pain
fever
swelling

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40
Q

Organisms most likely to cause acute haematogenous osteomyelitis?

A 
Staph aureus
Group A strep
Hib
Pneumococcus
Kingella Kingae
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41
Q

Treatment of MSK infection?

A

Flucloxicillin (more broad spec in younger)

42
Q

What is it important to clarify in a history of GI upset?

A

Travel history

43
Q

Travellers diarrhoea may need short course of what 2 antibiotics?

A

Ciprofloxacin

Azithromycin

44
Q

Most common 4 agents of travellers diarrhoea?

A

Shigella
E.Coli
Salmonella
Parasites

45
Q

Malaria symptoms in children, test and what test looks for?

A

Fever, rigors, headache
Antigen test for malaria
Looks at viral load and species of plasmodium

46
Q

Increasing symptoms of typhoid fever in first 3 weeks?

Treatment with what 2 drugs?

A 
Fever
GI pain
Rash - rose spots
2nd week - gastro perforation
3rd week - encephalopathy
broad spec ceph and azithromycin
47
Q

What is the infection known as break down fever? symtpoms?

A

Dengue fever, high temp and severe bone pain

48
Q

2 illnesses you can get from ticks?

A

Typhus

Lyme disease

49
Q

At 2 months old, what 3 injections are given? What oral drug?

A

1 - diptheria, polio, tetanus, pertussis
2 - penumococcus
3 - Hib
Oral - rotavirus

50
Q

At 3 months old what 2 injections are given? what oral drug?

A

1 - (second) diptheria, tetanus, polio, pertussis
2 - Men C
Oral - rotavirus

51
Q

At 4 months old what 3 injections are given?

A
  1. (third) tetanus, polio, diptheria, pertussis
  2. (second) Hib
  3. (second) Pneumococcus
52
Q

At age 1 what 3 vaccines do you receive?

A
  1. MMR
  2. Pneumococcus
  3. Hib and Men C
53
Q

At age 3 what 2 vaccines do you get?

A
  1. MMR

2. (fourth) tetanus, polio, pertussis, diptheria

54
Q

Girls age 12/13 get what vaccine

A

HPV

55
Q

If a mother is identified as having hep B, what is the child vaccination management plan?

A 
Birth ( potentially Ig too)
1 month
2 months
1 year
5 years
56
Q

Who is the BCG vaccine given to and what does it protect against?

A 
TB
Children in high risk areas
Parents from high risk countries
Travel
Recent contact
57
Q

What should you ask about in a CNS infection history?

A 
Travel
Work
Sex
Contacts
Epidemics
Animal contacts
Vaccinations
58
Q

Clinical features of meningitis?

A 
Headache
Photophobia
Decreased consiousness 
Bulging fontanelle
Vomiting
Fever
Positive Kernigs sign
Rash
Lethargy
Irritable 
High pitched cry in babies
Poor feeding
59
Q

Comment on the lymphocytes, neutrophils, glucose, protein, gram and ziehl neelson in CSF of pyogenic, viral, TB infections?

A 
Pyogenic = normal, very raised, very low, high, positive, negative
Viral = raised, normal, normal, raised, negative, negative
TB = raised, normal, low, very high, negative, positive
60
Q

Which bacterial agent of meningitis initially invades intracellularly and which invades intercellularly

A

Neisseria meningitis is intracellularly

Haemophillus influenzae is intercellularly

61
Q

How are meningitis agents able to invade the CNS undetected?

A

Evade the complement system and therefore no Ig are produced allowing unimpeded growth

62
Q

What 3 components of bacterial cell walls are released in meningitis ?

A

IL 1
IL6
TNF

63
Q

3 most common pathogenic causes of meningitis in infants?

A

Group B strep
E. Coli
Listeria monocytogenes

64
Q

3 most common pathogenic causes of meningitis in toddlers?

A

N. meningitidis
Hib
Strep. pneumoniae

65
Q

What is neisseria meningitidis sensitive to? type of bacteria? How is it grown and identified?

A

penicillin
Gram negative diplococci
Sugar fermentation of maltose and glucose

66
Q

Haemophillus influenzae sensitive?
Grown on what?
Type of bacteria?

A

Beta lactamase positive meaning usually penicillin resistant
Grown on chocolate agar with factor X and V
Gram negative rod

67
Q

2 drugs used to treat children with meningitis?

A

Ampicillin and cefotaxime

68
Q

1 drug used to treat toddlers and adults with meningitis?

A

Ceftriaxone

69
Q

When is dexmethasone used before treating meningitis?

A

Before beta lactam antibiotics to treat cerebral oedema

For Hib as reduces changes of deafness

70
Q

What are the 2 protein carriers for Hib vaccine?

A

tetanus, diptheria

71
Q

Which strain of neisseria meningitidis has a vaccine and which doesnt?

A

Strain B doesnt, strain C does

72
Q

If someone in the house had Hib what are the rest prophylactically treated with?

A

Rifampicin

73
Q

If someone has neisseria meningitidis what 2 things are the rest of the household treated with prophylactically

A

Rifampicin or ciprofloxacin

74
Q

What viral cause of meningitis is most common? other agents

A 
Enterovirus 80%
CMV
VZV
HSV
Adenovirus
Japanese encephalitis
HIV
Mumps
75
Q

Different presentations of viral meningitis?

A 
URTI
Conjunctivitis
pharyngitsis
pneumonia
myopericarditis
gastroenteritis
Neuro
76
Q

Other causes of meningitis besides bacterial and viral

A 
Fungi
TB
Helminths
Protozoa
Mycoplasma
Brucella
Syphillis
77
Q

How many months after initial infection does TB meningitis present?

A

3-6 months

78
Q

50% of TB meningitis is what type?

A

miliary

79
Q

Symptoms of TB meningitis?

A 
Drowsy
Headache
Neck stiffness
Photophobia
Irritable
Personality changes
decreased consiousness
cranial nerve involvement
80
Q

How do you diagnose TB meningitis?

A

positive tuberculin test (man 2 test), gastric washings

81
Q

What is the 4 fold treatment of TB meningitis?

A 
Rifampicin
Isoniazid
Pyrazinamide 
Aminoglycoside/ethambutol
all for 2 months
Continue rifampicin and isoniazid up to 9-12 months
82
Q

2 forms of meningitis most prevalent in the immunocompromised?

A

Listeria monocytogenes

Crytococcus (yeast)

83
Q

Most common viral cause of encephalitis? % get long term complications?

A

HSV 1
50%
Fever, headache, decreased consciousness, confusion, dysphasia

84
Q

non-viral causes of encephalitis?

A 
Neisseria meningitis 
listeria monocytogenes
Scrup typhus
Leptospirosis
Melioidosis
Malaria
TB
Borrelia
Brucella
85
Q

Before youve got samples back for encephalitis what do you start?

A

high dose aciclovir and antibiotics

86
Q

What investigations are done into encephalitis?

A 
Throat sample
Stool sample
CSF
Neuroimaging 
EEG
87
Q

What can develop immediately after infection by measles?

A

Post-infection encephalitis

88
Q

What can develop 1-6 months after infection with measles? prognosis?

A

measles inclusion body encephalitis

Fatal

89
Q

What can develop years after a measles infection? prognosis?

A

Subacute sclerosing panencephalitis

Fatal

90
Q

Progressive multifocal encephalopathy occurs in the immunosuppressed due to what virus?

A

JC virus

91
Q

Symptoms of a brain abscess?

A 
Fatigue
stupor
Seizures
Headache
confusion
ataxia
sensory or motor impairments focal to the lesion
Nausea 
Vomiting
Papilloedema
92
Q

3 different ways in which brain abscess’ can develop?

A

Contiguous suppurative focus
trauma
haematogenous spread

93
Q

What is an example of contiguous suppurative spread that causes a brain abscess?

A

Otitis media

94
Q

Most common organisms that are involved in brain abscess development?

A 
Staph aureus
Strep - aerobic and anaerobic 
Bacteroides
Prevotella
Fusobacterium
Enterobacteriaceae 
Pseudomonas
95
Q

When treating a brain abscess blindly what 3 medications do you use?

A

Penicillin G and 3rd gen cephalosporin (ceftriaxone, cephalosporin)
Metronidazole to cover anything penicillin resistant

96
Q

After brain surgery or trauma what bacteria is suspected to cause a brain abscess? 2 medications that cover this?

A

Staphlococcus aureus

Vancomycin and nafcillin

97
Q

If pseudomonas aeruginosa is suspected as a causative agent for brain abscess what 2 medications are used to treat?

A

cefepime or ceftazidime

98
Q

If a HIV patient develops a brain abscess, what infection are you worried about?

A

Toxoplasmosis

99
Q

What are prion diseases also known as?

A

Transmissible spongiform encephalopathies

100
Q

Sporadic CJD symptoms? diagnosed how?

A

Ataxia, myoclonus, dementia

14-3-3 protein in CSF

101
Q

Familial form of transmissible spongiform encephalopathy? inheritance pattern?

A

Familial TSE

Autosomal dominant

102
Q

Variant CJD is also known as what? Presentation? 2 proteins in CSF?

A

Bovine Spongiform Encephalopathy
Psychiatric symptoms
Proteins - 14-3-3 and Tau

Paediatrics (20 decks)

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