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3a > Paed:Infective > Flashcards

Paed:Infective Flashcards

1
Q

Risk factors for febrile child

A

Illness of other family members
Unimmunised
recent travel abroad
contact with animals

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2
Q

Red flag signs for febrile child

A

Fever >38 if below 3 months or Fever >39 if 3-6months
Colour: Pale/Mottled blue
Decreased LoC, neck stiffness, bulging fontanelle, seizures
Significant resp distress
Bile stained vomit
Severe dehydration/Shock

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3
Q

What is in a Septic Screen?

A
  • Urine Sample
  • Blood tests
  • Lumbar Puncture
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4
Q

What blood tests would you do in a septic screen?

A

Blood cultures, FBC (+WCC), CRP, Blood gas, U+E’s, Creatinine, Clotting screen

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5
Q

What other tests can be done in addition to septic screen?

A

CXR, other cultures (resp, wound, catheter ports)
Rapid antigen screen on blood/csf/ruine
PCR

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6
Q

Red flag sepsis criteria

A 
Hypotension
Resp rate >60
High blood lactate
CRT >5seconds
Oxygen req to maintain sats >92
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7
Q

What is septicaemia?

A

Bacteria proliferating in the bloodstream leading to septicaemia. The host response involves the release of infmallatory cytoines and activation of the endothelial cells, which may lead to septic shock.

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8
Q

Commonest cause of Septicaemia?

A

Neonates: Group B Strep, or G-ve organisms from BC
Children: Meningococcal infection
Pneumococcus is the commonest cause of bacteraemia.

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9
Q

Treatment of septicaemia

A
  • Antibiotics (?IV)
  • Fluids
  • Inotropic support
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10
Q

What is a complication of septicaemia?

A

Disseminated Intravascular Coagulation - Treat with FFP and platelet transfusions

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11
Q

What is meningitis?

A

Inflammation of the meninges. Confirmed by presence of inflammatory cells in the CSF

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12
Q

What type of Meningitis is more common?

A

Viral - although it is usually self limiting. Bacterial is more severe

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13
Q

Causative organisms of bacterial meningitis?

A

Neonatal: Group B Strep, E.Coli, Listeria Monocytogenes
1month-6years: Neisseria Meningitidis, Strep Pneumoniae, Haemophilus Influenzae
>6years: Neisseria meningitidis, Strep Pneumoniae

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14
Q

Presentation of meningitis

A

Non specific infection sx if under 18months.
Other: Fever, headache, purpuric rash, neck stiffness, bulging fontanelle, Opisthotonos, +Ve brudzinski/kernigs, reduced conscious level

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15
Q

What is brudzinskis sign?

A

Flexion of neck w/ child supine causes flexion of knees and hips

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16
Q

What is kernigs sign?

A

Child supine with knees and hips flexed, pain in back on extension of legs.

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17
Q

Diagnosis confirming investiagtion in meningitis?

A

LP

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18
Q

Investigations in meningitis

A

FBC, CRP, Coag Screen, U+E’s, LFTS, blood glucose
Cultures: blood, throat, urine, stool
Rapid antigen test

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19
Q

Lumbar puncture site

A

L3-L5

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20
Q

Contraindications to LP

A
  • Raised ICP (signs: papilloedema, fluctuating consciousness, high BP, reduced HR)
  • Infection over site of LP
  • DIC
  • Cardiorespiratory instability
  • Focal neurological signs
  • If it causes a delay in abx treatment
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21
Q

Risks of LP

A

Infection
Bleeding
Unsuccessful

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22
Q

CSF changes in bacterial meningitis

A

Appearance: Turbid
WBC: Increased polymorphs
Protein: Increased
Glucose: Decreased

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23
Q

CSF changes in viral menigitis

A

Appearance: Clear
WBC: Increased lymphocytes
Protein: Normal/increased
Glucose:Normal/decreased

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24
Q

CSF changes in TB meningitis

A

Appearance: Turbid/Clear/Viscous
WBC: Increased lymphocytes
Protein: Increased (more than bacterial)
Glucose: Decreased (less than bacterial)

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25
Q

Hospital management for bacterial meningitis

A

Ceftriaxone or Cefotaxime

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26
Q

What can be given as immediate management for bacterial meningitis?

A

IM Benzylpenicillin

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27
Q

Cerebral complications of meningitis

A
  • Hearing loss
  • Local vasculitis
  • Local cerebral infarction
  • subdural effusion
  • hydrocephalus
  • cerebral abcess
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28
Q

What is the cause of purpura?

A

Blood leaking and skin being necrotic.

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29
Q

How is meningitis spread?

A

Droplet spread

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30
Q

First line tx to reduce risk of disease in close contacts of meningitis

A

Ciprofloxacin: Single dose, no interaction with OC, readily available

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31
Q

Who shouldnt have Rifampicin?

A
  • People on OC pill
  • Renal/Hepatic impairment
  • Pregnant women
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32
Q

How is a close contact defined?

A

Has had prolonged close contact with the case in a household type setting during the 7 days before onset of illness.
OR
People who have had transient close contact with the case only if they have been directly exposed to large particle droplets from resp tract of case around time of admission

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33
Q

Common causes of viral meningitis

A

Enteroviruses, EBV, adenoviruses, mumps

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34
Q

Viral mengitis confirmed by?

A

Culture/PCR of CSF, stool culture, serology

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35
Q

3 main symptoms of encephalitis?

A

Fever, altered consciousness, seizures

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36
Q

Commonest causes of encephalitis

A

Enterovirus, respiratoryviruses, HSV, VZV,

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37
Q

Treatment of encephalitis

A

Aciclovir

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38
Q

What causes Toxic Shock Syndrome?

A

Toxin producing Staph Aureus and Group A Strep

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39
Q

3 main symptoms of TSS

A

Fever >39
Hypotension
Diffuse erythematous macular rash

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40
Q

Treatment of TSS

A

Abx: Clindamycin + Flucloxacillin
Also: IV Immunoglobulin

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41
Q

What is Necrotising fasciitis/cellulitis?

A

Severe subcutaneous infection involving tissue from the skin down to the fascia and muscle. Leaves necrotic tissue at centre

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42
Q

Organism causing Necrotising Fasc?

A

Group A strep or S. Aureus

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43
Q

Treatment of Necrotising Fasciitis

A

Antibiotics (Benzypenicllin) and IV Ig and Surgical Debridement

44
Q

What causes Scalded Skin Syndrome?

A

Exfoliative staphylococcal toxin

45
Q

Symptoms of SSS?

A

Fever, malaise
Purulent, crusting, localised infection around eyes/noes/mouth
widespread erythema and skin tenderness

46
Q

What is Nikolsky’s sign?

A

Areas of the epidermis separate on gentle pressure. Seen in SSS

47
Q

Treatment of SSS

A

IV flucloxacillin

48
Q

Treatment of Herpes Simplex infections

A

Aciclovir

49
Q

Primary varicella zoster infection is better known as:

A

Chickenpox

50
Q

Clinical features of Chickenpox:

A

Vesicular rash, starting on head and trunk, 200-500 lesions and then moves to peripheries.
Papules>Vesicles>Pustules>Crusts.

51
Q

Complications of chickenpox

A

Secondary bacterial infection
Encephalitis
Purpura Fulminans

52
Q

Treatment of chickenpox

A

Normally self limiting.
If immunocompromised give IV Aciclovir.
If adolescent/adult give IV Valaciclovir.
Human varicella zoster IG may be given to at risk immunocompromised.

53
Q

What is shingles?

A

Reactivation of latent VZV causing a vesicular eruption in the dermatomal distribution of sensory nerves. Commonly thoracic.

54
Q

Symptoms of EBV infection

A

Fever, malaise, tonsillopharyngitis, lymphadenopathy.

On exam: petechiae on soft palate, splenomegaly, hepatomegaly, maculopapular rash, jaundice.

55
Q

Diagnosis of EBV

A
  • Atypical lymphocytes (large T cells on film)
  • positive monospot test (presence of heterophile antibodies)
  • Seroconverion with production of IgM and IgG to EBV antigens
56
Q

Treatment of EBV infection

A

Symptomatic or steroids if airway compromised.

57
Q

How is CMV transmitted?

A

Saliva, genital secretions, breastmilk, blood products

58
Q

Treatment of CMV

A

Ganciclovir of Foscarnet

59
Q

What can CMV cause in compromised pts

A

Retinitis, colitis, pneumonitis, enchephalitis, hepatitis, oesphagitis, bm failure

60
Q

What is Parvovirus b19 infection called?

A

Slapped cheek syndrome/ fitfth disease / eyrthema infectiosum

61
Q

How is Parvovirus B19 transmitted?

A

Resp secretions or MTCT

62
Q

What are clinical syndromes of Parvovirus B19?

A
  • Aysmptomatic
  • Erythema infectiosum
  • aplastic crisis
  • fetal disease
63
Q

How are enteroviruses transmitted?

A

Faeco-oral route

64
Q

How is measles spread?

A

Droplet spread. Caused by Rubeola virus

65
Q

Clinical features of measles?

A
  • Fever
  • rash - spreads downards from behind ears to whole of body
  • Kopliks spots - white spots on buccal mucosa, seen against bright red background
  • conjunctivitis and coryza
  • cough
66
Q

How to prevent measles?

A

IMMUNISATION U FOOLS (DR HR isnt happy)

67
Q

Complications of measles

A

Otitis media, croup, tracheits, pneumonia,
encephalitis, convulsions
diarrhoea

68
Q

How is mumps spread?

A

Spread by droplet infection. Attacks parotid gland

69
Q

Clinical features of mumps

A

Fever
Malaise
Parotitis
Earache

70
Q

What enzyme can be raised in mumps?

A

Amylase

71
Q

How is rubella spread?

A

Droplet spread

72
Q

Symptoms of rubella

A

Low grade fever
maculopapular rash
lymphadenopathy

73
Q

Complications of rubella

A

Arthritis
encephalitis
thrombocytopenia
myocarditis

74
Q

What is impetigo?

A

localised, highly contagious, staphylococcal and/or streptococcal skin infection

75
Q

Main route of transmission of HIV in paeds?

A

MTCT

  • Intrauterine - in pregnancy
  • intrapartum - at delivery
  • postpartum - breastfeeding
76
Q

Diagnosis of HIV

A

> 18months: HIV detected by antibodies to the virus
<18months: - Born to infected mothers –> will have transplacental maternal IgG HIV antibodies
- HIV DNA PCR is most sensitive

77
Q

Clinical features of HIV

A

Mild immunosupression: Lymphadenopathy, parotitis
Moderate immunosuppresiion: recurrent bacterial infections, candidiasis, chronic diarrhoea
Severe: opportunistic infections eg. Pneumocystis jiroveci pneumonia, severe FtT

78
Q

Treatment of HIV

A

Antiretroviral therapy

Prophylaxis against Pneumocystis jiroveci pnia –> co-trimaxole

79
Q

How to reduce vertical transmission?

A
  • Use of ART in mother
  • Birth via C section
  • Avoid breastfeeding
  • Avoid prolonged rupture of membranes
80
Q

What causes Scarlet Fever?

A

Exotoxin released from Strep Pyogenes

81
Q

Signs of scarlet fever?

A

Red prinprick blanching rash (chest, axilla, behind ears) , facial flushing w/ circumoral pallor, strawberry tongue.
Develops after initial sore throat and fever.

82
Q

Treatment of scarlet fever?

A

Phenoxymethylpenicillin

83
Q

What is Kawasaki disease?

A

Systemic vasculitis that can lead to coronary artery aneurysms and myocardial infection.

84
Q

Diagnostic criteria for Kawasaki disease?

A

Fever >38.5 >5days and 4outof5 of:

  • Non-purulent bilateral conjunctivitis
  • Red mucous membranes (dry cracked lips, strawberry tognue)
  • Cervical lymphadenopathy
  • Polymorphous rash
  • Extremities changes (red, oedemaotus, peeling palms)
85
Q

What test results would you see in Kawa Disease?

A 
Anaemia
Increased WCC 
Increased CRP
Increased ESR
Icnreased liver enzymes
Urine: mononuclear WBC w/o bacteria
Increased platelets
Note: You would perfrom an echo to check for cardiac changes.
86
Q

Management of Kawasaki disease?

A

High dose IV Ig

Aspirin

87
Q

Complications of treatment of KD with Aspirin?

A

Reyes Syndrome (hepatic encephalitis)

88
Q

Complications of treament of KD with IV IG

A

Steven Johnson syndrome

89
Q

What are some predisposing factors for Candida albicans infection?

A
  • moist body folds
  • treatment with broad-spec abx
  • immunosuprresion
  • diabetes mellitus
90
Q

What are the variants of candida?

A
  • cutaneous candidiasis: well demarcated macular erythema, slight scaling and small outline ‘satellite’ lesions, worse in body folds
  • chronic paronychia
  • chronic mucocutaenous granulomatous candidiasis (secondary to congenital immunodeficiency disorder)
91
Q

Ix of candida

A

Skin scrapings for microscopy and culture

92
Q

Tx of candida

A

oral or topical anti-candida drugs (e.g. nystatin, fluconazole)

93
Q

What is candida?

A

Fungal skin infection

94
Q

What is a coxsackie virus?

A

RNA virus that can cause hand, foot and mouth disease. Usually self-limiting

95
Q

What is Diptheria?

A

This is an acute upper respiratory tract infection, but sometimes it infects the skin. Caused by Corynebacterium diphtheriae.

96
Q

Polio? Tell me about it

A

Poliomyelitis (polio) is caused by infection with the poliovirus, an enterovirus. The virus may invade lymphatic tissue and spread into the bloodstream. It can be neurotropic, destroying motor neurons, particularly in the anterior horn of the spinal cord and brain stem. This causes flaccid paralysis which may be spinal or bulbar.

97
Q

What is protected against in the 6in1 vaccine?

A

Diphtheria, Tetanus, Pertussis, Polio, Hib disease, hepatitis B

98
Q

When is the 6in1 given?

A

8, 12 and 16 weeks

99
Q

When is pneumococcal (PCV) vaccine given?

A

8 and 16 weeks

100
Q

WHen is Meningococcal group B vaccine given?

A

8 weeks, 16 weeks and one year.

101
Q

When is rotavirus vaccine?

A

8 and 12 weeks

102
Q

When is Hib and Men C vaccine?

A

1 year old

103
Q

MMR vaccine when?

A

1 year old

3years 4 months

104
Q

Preschool/4in1 booster?

A

Diphteria, tetanis, pertussis, polio. 3years4months.

105
Q

HPV vaccine when?

A

12-13yr olds

106
Q

Teenage booster?

A

Tetanus, diphtheria and polio. teenage.

107
Q

When give MenACWY?

A

4 types of meningococcal disease. teenage

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