Paed strep + staph infections

Question 1

main differences between strep and staph tx

Answer 1

strep: NO RESISTANCE ISSUES - TX PENICILLIN
staph: RESISTANCE BIG ISSUE - Flucloxacillin

Question 2

scarlatina?

Answer 2

scarlet fever

group A beta haemolytic streptococci

Question 3

Scarlet fever PC - stages

Answer 3

2-4 incubation

malaise, VERY HIGH fever, tonsillitis, start exanthema (sand paper red rash)

strawberry tongue

recovery: squamation hands feet

Question 4

peak age for scarlet fever

Answer 4

between 2-10yo

Question 5

complications of scarlet fever

Answer 5

erysipelas, cellulitis, impetigo

TSS

rheumatic fever

GN

Question 6

scarlet fever tx

Answer 6

penicillin 10 days

Question 7

PC SSSS

Answer 7

staphylococcus aurea scalded skin syndrome - systemically unwell. fever, redness, fluid filled blisters, in skin folds

Question 8

Diagnosis of Kawasaki disease

Answer 8

fever for >5 days

4 of the 5:
1.	Bilateral conjunctival injection 
2.	Changes of mucous membranes
3.	Cervical lymphadenopathy 
4.	Polymorphous rash
DIFFERENTIATE FROM MENINGOCOCCAL RASH 
5.	Changes of the extremities 
Peripheral oedema 
Peripheral erythema
Periungual desquamation (under/around nails)

Question 9

pathophysiology of KD

Answer 9

idiopathic trigger

- self limiting vasculitis of medium sized arteries

Question 10

tx of KD

Answer 10

high dose immunoglobulin
aspirin

get better v quickly

Question 11

complication of KD

Answer 11

coronary artery disease - do an echo post infection

Question 12

Henoch Schonlein purpura PC

Answer 12

vasculitis rash on LL - like meningococcal but NO FEVER OR SYSTEMIC UPSET - self limiting

ass w prev viral illness

Question 13

varicella zoster virus infection

Answer 13

Primary infection - Varicella, (Chickenpox), systemically well - with individual spaced papules - new lesions stop after 7 days

only tx with aciclovir if immunocompromised

Question 14

characteristic of herpes simplex rash

Answer 14

vesicles are GROUPED TOGETHER

Question 15

aetiology:
VZV
HSZ 1
HSZ 2

Answer 15

VZV: kids <5yo + adults

HSZ 1: adults (oral)

HSZ 2: <5% (child abuse), adults - genitals

Question 16

herpes zoster reactivation (VZV)

Answer 16

shingles (adults) secondary infection

Question 17

hand-foot-mouth disease

Answer 17

causes: enteroviruses, coxsackie

children <10yo
summer/autumn

painful lesion

Question 18

recognising primary immunodeficiencies - 5 red flags (SPURR)

Answer 18

SEVERE
PERSISTENT 
UNUSUAL 
RECURRENT
RUNS IN THE FAMILY

Question 19

Antibody def

PC?

tests?

Answer 19

RECURRENT: URTI + LRTIs
strep pneumoniae, h. influenza

tests: IgA, IgM, IgG
then IgG subsets (IgG2)

Question 20

cellular immunodeficiencies

PC?

Tests?

Answer 20

UNUSUAL/oppurtunistic infections + faltering growth. Eg pneumocystis jirovecii

tests: immunophenotyping + WBC count

Question 21

innate immune disorders:

defects in phagocyte function

Answer 21

staph aureus + aspergillus

Question 22

innate immune disorders:

complement deficiencies

Answer 22

N. meningitidis

Question 23

Chronic Granulomatous disease

aetiology?

Answer 23

65% x linked

35% autosomal recessive

Question 24

Chronic Granulomatous disease

PC

Answer 24

life threatening recurrent severe bacterial and fungal infections

life time incidence of invasive aspergillosis 40%

main cause of death

peak <2yo

Question 25

Chronic Granulomatous disease

tx

Answer 25

stem cell therapy

Question 26

primary immunodeficiency can present similar to?

Answer 26

HIV - contracted via mother to child (rare now)

Question 27

PC - recurrent resp infection (6per yr) since 2yo - pneumonia
normal growth
4 a/bs each year

Answer 27

RECURRENT - points towards PID

S.pneumonia = Ab def

Question 28

PC: Meningococcal sepsis 13Mnth yo boy

Answer 28

SEVERE

N. meningitidis
= complement def

Question 29

PC: slow weight gain, dry cough, difficulty breathing

3 month girl

Answer 29

unusual organism

cellular immunodeficiency