Paediatric Infections

Question 1

define meningococcal infection

Answer 1

an infection due to Neisseria meningitidis - a gram -ve intracellular diplococcus

Question 2

transmission of meningococci

Answer 2

respiratory droplets spread between humans

Question 3

clinical features of Neisseria meningitidis

Answer 3

rapidly developing purpuric rash 
lethargy
headache 
fever +/- rigors
vomiting

Question 4

additional features of Neisseria meningitidis infection

Answer 4

septicaemia 
hypovolaemic shock (cold peripheries, poor cap refill, tachycardia and ⬇️ urine output)

Question 5

what is Waterhouse-Friderichsen Syndrome?

Answer 5

a mixture of septicaemia and meningitis with massive adrenal haemorrhage and septic shock

Question 6

investigations of meningococcal disease

Answer 6

blood cultures
CSF culture
PCR testing

Question 7

management of meningococcal disease

Answer 7

IM or IV benzylpenicillin
cefotaxime +/- amoxicillin
ICU admission

Question 8

additional management of meningococcal disease

Answer 8

contacting household members and close contacts to provide prophylaxis rifampicin

Question 9

contraindications for lumbar puncture

Answer 9

raised ICP
focal neurological signs
fluctuating consciousness

Question 10

define sepsis

Answer 10

a clinical syndrome presenting with complications of the bodys response to infections

Question 11

clinical presentation of sepsis in children

Answer 11

lethargy
reduced social interactions
pale or mottled skin
altered conscious level
decreased urine output 
poor feeding 
rash

Question 12

signs of sepsis in children

Answer 12

⬆️ respiratory rate + effort
bradycardia or tachycardia
fever
signs of dehydration

Question 13

red flag symptoms in children with suspected sepsis

Answer 13

non-rousable child
bradycardia or tachycardia 
bradypnoea or tachypnoea 
mottled skin
cyanosis 
non-blanching rash

Question 14

risk factors of paediatric sepsis

Answer 14

age > 1yr
impaired immune function
recent surgery (< 6wks)
breaching of skin
presence of indwelling catheter/line

Question 15

first line investigations for paediatric sepsis

Answer 15

bloods (FBC, CRP + U+Es)
blood cultures 
creatinine 
clotting screen 
blood gas (VBG)

Question 16

additional investigations for paediatric sepsis

Answer 16

urinalysis
CXR
abdomen and pelvis imaging
lumbar puncture

Question 17

management of paediatric sepsis

Answer 17

ABCD approach
broad spectrum antibiotics (e.g. cefotaxime)

if child < 1yr: add amoxicillin

Question 18

what blood test is most specific to bacterial sepsis?

Answer 18

procalcitonin - shows specific inflammatory markers

Question 19

indications for ICU admission in paediatric sepsis

Answer 19

high lactate

highly abnormal physical observations

Question 20

define neonatal sepsis

Answer 20

early onset of sepsis occurring < 72hrs post-birth or late onset which occurs > 72hrs post-birth

Question 21

common organisms in early onset sepsis

Answer 21

group B strep
toxoplasma
rubella

Question 22

common organisms in late onset sepsis

Answer 22

staph aureus
e.coli
pseudomonas
staph epidermis

Question 23

investigations of neonatal sepsis

Answer 23

bloods (FBC, CRP and culture)
CXR
lumbar puncture

Question 24

management of GBS in neonates

Answer 24

IV penicillin and gentamicin

fluids

Question 25

management of group B infection of a pregnant woman

Answer 25

IV benzylpenicillin