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Phase 3a > Paediatric infectious diseases > Flashcards

Paediatric infectious diseases Flashcards

1
Q

What is the clinical presentation of Kawasaki disease?

A

> 5 days of fever + 4 other features:

  • conjunctivitis
  • red mucous membranes
  • cervical lymphadenopathy
  • rash
  • red/sore/peeling hands and feet
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2
Q

What is the main complication of Kawasaki disease?

A

Coronary artery aneurysms (6 weeks)

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3
Q

What is the treatment for Kawasaki disease?

A

IV immunoglobulins

aspirin

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4
Q

What are the symptoms of measles?

A

fever, cough, coryza, enanthem (Koplik spots) on oral mucosa, maculopapular rash spreading head to toe

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5
Q

What is the difference between HSV1 and HSV2? What is the treatment for both?

A 
HSV1 = mainly transferred in saliva
HSV2 = mainly sex, cold sores

Tx = aciclovir

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6
Q

What are the possible complications of Herpes simplex virus?

A

Aseptic meningitis - mainly adolescence (sexually active), HSV2
Encephalitis
Neonatal infection
Eczema herpeticum - skin infection in eczema patient

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7
Q

What is the causative organism of chickenpox?

How is it spread?

A

Varicella Zoster virus

Respitatory droplets - median incubation = 14 days

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8
Q 
What infection follows the following rash cycle:
papules
vesicles
pustules
crusts
A

Chicken pox

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9
Q

What are the main complications of chickenpox?

A

Secondary bacterial infection
Encephalitis - within 1 week of rash –> ataxia + cerebellar
Purpura fulminans - necrosis of skin due to vasculitis
Stroke - due too either vasculitis or protein S deficiency
haemorrhagic chickenpox in malnourished or immunocompromised children

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10
Q

What is the management for chickenpox?

A

human varicella zoster immunoglobulin if high risk individuals come into contact with chickenpox
Aciclovir if severe

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11
Q

What is shingles?

A

Latent varicella zoster reactivating –> vesicles in distribution of dermatomes. Adults = nerve pain, children rarely get nerve pain.

Reinfection in childhood may indicate underlying immunue suppression

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12
Q

What is the causative organism of glandular fever?

what other condition is it associated with?

A

Epstein barr virus

Burkitt’s lymphoma

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13
Q

What is the presentation of a CMV infection?

A

mild/ subclinical symptoms in normal hosts
May present like mononucleosis but pharyngitis/lymphadenopathy less prominent than in EBV

Maternal CMV infection may cause congenital infection

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14
Q

What organism are organ recipients monitored for?

A

Cytomegalovirus

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15
Q

What infection is commonly known as slapped cheek syndrome? How is it spread?

A

Parvovirus B19

Respiratory secretions, vertical transmission + contaminated blood products

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16
Q

What are the range of presentations caused by parvovirus b19?

A
  1. asymptomatic
  2. erythema infectiosum - fever, malaise, myalgia –> slapped cheek after 1 week –> vesicopapular rash on body
  3. aplastic crisis - in children with chronic haemolytic anaemias (sickle cell)
  4. fetal disease - vertical transmission - causes hydrops
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17
Q

4 main types of poliovirus presentations:

A
  1. asymptomatic >90%
  2. minor illness - fever, headache, malaise, sore throat
  3. CNS involvement with aseptic meningitis
  4. paralytic polio - about 4 days after minor illness subsided
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18
Q

Name 2 types of enteroviruses?

How are they spread?

A

Coxsackie + polio

Faecal-oral - mostly in summer and autumn

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19
Q

what is the characteristic appearance of impetigo?
What is the causative organism?
What is the treatment?

A

Confluent honey coloured crusted lesions (starting with red macules which become vesicular and then rupture)

Staph Aureus

Tx = Topical antibiotics if mild, systemic antibiotics if severe - flucloxacilin or erythromycin

20
Q

What is the organism and presentation of scalded skin syndrome?

A

Fever + irritability + widespread redness –> red blistered skin after 24-48 hours. Heal without scarring.

Staph aureus

21
Q

Treatment of periorbital cellulitis?

A

IV abx

22
Q

What is thee presentation of toxic shock syndrome?

A

Release of staph/strep toxins at a point of infection (graze) –> systemic illness, high fever, diffuse macular rash, shock + other symptoms
1-2 weeks later = desquamation of hands and toes

Tx = ICU, surgical debridement, IV immunoogloblin

23
Q

What is the presentation of rubella?

A

prodrome of mild/no fever
rash (not itchy) starting on face then spreading (fades in 3-5 days)
lymphadenopathy

only management is vaccination

24
Q

What causes hand food and mouth disease?

A

Coxsackie A virus

25
Q

What is the presentation of HFM / coxsackie?

A

URTI
mouth/tongue ulcers after 1-2 days
then red blistering / itchy spots around mouth, hands and feet

Mx = supportive, resolves after 1 week-10 days, highly contagious

26
Q

What are the symptoms of scarlet fever?

A

first = flu like Sx - fever, sore throat, lymphadenopathy

red rash = face chest and armpits, feels like sandpaper, flushed cheeks, white coating on tongue

27
Q

What is the causative organism in scarlet fever?

A

group A haemolytic streptococcus

28
Q

What is the treatment in scarlet fever?

A

IV penicillin 10 days

29
Q

What type of candida is common in neonates?

A

Oral thrush - pseudomembranous candidiasis

caused by candida albicans

30
Q

What is the treatment for oral candida?

A

first line = miconozole oral gel for children >4 months

second line = nystatin suspension if miconozole is unsuitable (do not use in neonates)

31
Q

What are the causative organisms of meningitis in:

  1. neonates <3 months
  2. 1 month- 6 years
  3. > 6 years
A
  1. group B streep, E.coli, listeria monocytogenes
  2. Neisseria meningitidis, strep pneumoniae, Haemophilus influenzae
  3. Neirsseria meningitidis + strep pneumoniae
32
Q

What is the key extra feature in neonates with meningitis?

A

bulging fontanelle and arched back

33
Q

When is a lumbar puncture recommended?

A

<1 month and fever
1-3 months fever and unwell
<1 year with unexplained fever and other featurees of serious illness

34
Q

What two special tests can check for meningitis?

A

Kernig’s test - lie patient on back, flex hip and knee to 90, straighten knee but keep hip flexed –> causes pain or resistance if meningitis

Brudzinski’s test - lie patient on back and lift head, positive test = knees will come to chest

35
Q

What is the management for meningitis

A

IM benpen in communicty
LP in hospital (but do not delay antibiotics)

Abx:
<3 months = cefotaxime + amoxicillin
>3 months = ceftriaxone

Contact prophylaxis = rifampicin
steroids
inform PHE

36
Q

What are the pathological causes of encephalitis?

A

direct invasian of cerebrum by neurotoxic virus
delayed brain swelling following immune response to a virus (eg. after chickenpox)
slow virus infection eg. HIV

37
Q

What is the key difference between meningitis and encephalopathy?

A

Initially hard to tell - commence treatment for both initially

Encephalopathy may present insidiously and can include a behaviour change

38
Q

What is the presentation of encephalitis?

what are the most common causative organisms?

A

fever, altered consciousness, seizures

enteroviruses, respiratory viruses and herpes viruses
(HSV very rare cause but long term consequences so always give aciclovir to cover this possibility)

39
Q

What are the symptoms of primary TB?

What is the test?

A

prolonged fever, malaise, cough, anorexia, weight loss + CXR changes

50% infants and 90% of older children are asymptomatic at primary infection

Mantoux test - positive test suggests active infection

40
Q

What might the presentation be for post-primary TB (reactivation)

A

local or miliary TB (bones, joints, kidneys, pericardium, CNS)

Infants + young children - CNS infection most likely causing tuberous meningitis

41
Q

What is tuberous meningitis?

A

Insidious onset meningitis caused by contact with tuberculosis.
Meningism may be minimal
Dx = most will have a positive mantoux test, acid-fast bacilli identified with Ziehl-Nielsen / auramine staining . early morning urine samples

42
Q

What is the treatment for TB?

A 
RIPE for 2 months
Rifampicin
Isoniazid
Pyrazinamide
Ethambutol

Contact tracing

43
Q

What type of organism is HIV?

A

RNA retrovirus (HIV1 is the most common, HIV2 is uncommon outside West African countries)

44
Q

How can vertical transmission of HIV be prevented?

A

mode of delivery according to viral load of mother:

  • normal vaginal if <50
  • C section if >50
  • IV zidovudine if unknown viral load or >10000

Prophylaxis treatment for babies:

  • low risk (<50) = 4 weeks of zidovudine
  • high risk (>50) = 4 weeks zidovudine, lamivudine and nevirapine
45
Q

What are the options for HIV testing in children?

A

HIV antibody screen - standard test but can give false positives if HIV +ve mum
HIV viral load - no risk of false positive but may be ‘undetectable’ if on antiretroviral therapy

46
Q

How is paediatric HIV managed?

A

ART
Vaccines - may delay live vaccines if severe
Prophylactic co-trimoxazole (Septrin) if low CD4 count (protect against pneumoncystis jiroveci)
Tx of opportunistic infection
MDT

47
Q

How does dipteria present?

A

Recent foreign travel
similar to bacterial tonsilitis but thick grey membrane at back of throat
can cause heart failure, paralysis, death
tx = penicillin

Phase 3a (13 decks)

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