Paediatrics - infectious disease and ENT Flashcards
1
Q
what are examples of inactivated vaccines
A
polio
flu vaccine
hepatitis A
rabies
2
Q
what are examples of subunit and conjugate vaccines
A
pneumococcus
meningococcus
hepatitis B
pertussis
haemophilus influenza type B
HPV
shingles
3
Q
what are examples of live attenuated vaccines
A
MMR
BCG
chicken pox
nasal influenza
rotavirus
4
Q
what are examples of toxin vaccines
A
diphtheria
tetanus
5
Q
what vaccines would a 8 week old receive
A
6 on 1 vaccine (diphtheria, tetanus, pertussis, polio, Hib and hepatitis B)
meningococcal type B
rotavirus (oral vaccine)
6
Q
what vaccines would a 12 week old receive
A
6 in 1
pneumococcal - 13 different serotypes
rotavirus
7
Q
what vaccines would a 16 week old receive
A
6 in 1
meningococcal type B
8
Q
what vaccinations would a 1 year old receive
A
2 in 1 (haemophilus influenza type B and meningococcal type C)
pneumococcal
MMR vaccine
meningococcal type B
9
Q
what vaccination will a child receive yearly between the ages of 2-8
A
influenza vaccine
10
Q
what vaccine will a child receive at 3 years and 4 months
A
4 in 1 (diphtheria, tetanus, pertussis , polio)
MMR vaccine
11
Q
what vaccine will a child receive between 12-13 years
A
the HPV vaccine - 2 doses given 6 to 24 months apart
12
Q
what vaccines would a 14 year old receive
A
3 in 1 (tetanus, diphtheria, polio)
meningococcal groups A, C, W and Y
13
Q
what is the current NHS HPV vaccine
A
Gardasil - protects against strains 6, 11, 16 and 18
14
Q
what is kawasaki disease
A
systemic vasculitis which mainly affects infants and young children
15
Q
what are infective causes of prolonged fever
A
localised infection
bacterial infections
deep abscesses
infective endocarditis
tuberculosis
non tuberculosis mycobacterial infections
viral infections
parasitic infections
16
Q
what are non infective causes of prolonged fever
A
systemic juvenile idiopathic arthritis
systemic lupus erythematosus
vasculitis
inflammatory bowel disease
sarcoidosis
malignancy
macrophage activation syndromes
drug fever
fabricated or induced illness
17
Q
what age does kawasaki disease normally present
A
6 months to 4 years old
18
Q
what is the cause of kawasaki disease
A
exact cause is unknown, although it is likely to be a result of immune hyperreactivity to a variety of triggers in a genetically susceptible host
19
Q
how is kawasaki disease diagnosed
A
no diagnostic test - diagnosis made on the clinical findings
20
Q
what are features of kawasaki disease
A
fever for over 5 days and four other features of:
- non purulent conjunctivitis
- red mucous membranes
- cervical lymphadenopathy
- rash
- red oedematous palms and soles or peeling of the fingers and toes
21
Q
how many children with kawasaki will have coronary artery involvement
A
in about 1/3 of children within the first 6 weeks of illness
22
Q
what is the treatment of Kawasaki disease
A
prompt treatment with intravenous immunoglobulins within the first 10 days
aspirin used to reduce the risk of thrombosis
echocardiogram at 6 weeks
children with giant coronary artery aneurysms may require long term warfarin therapy and close follow up
persistent inflammation and fever may require treatment with infliximab, steroids or ciclosporin
23
Q
what are complications of kawasaki disease
A
coronary artery aneurysm
sudden death
24
Q
what are clinical features of measles
A
fever
cough
runny nose
conjunctivitis
marked malaise
koplik spots - white spots on the buccal mucosa
maculopapular rash initially and then becomes blotchy and confluent
25
where does the rash in measles start
starts on the face
26
how long is someone with measles infectious for
4 days before and 4 days after the onset of the rash
27
how is measles diagnosed
clinical
blood film - leukopenia and lymphopenia
LFTs - raised transaminases
oral fluid test: measles RNA on oral fluid specimen confirms the diagnosis
serum serology
28
what is the management of measles
acute treatment: generally supportive but can include antibiotics for secondary bacterial infection
prevention: MMR
vitamin A
29
what are complications of measles
acute otitis media
lower respiratory tract infection
encephalitis
subcutaneous sclerosing panencephalitis
30
what is subcutaneous sclerosing panencephalitis
it is a rare and fatal neurological disease with progressive intellectual deterioration, ataxia and seizures about 7 years after measles infection
31
what age does chicken pox tend to occur between
1 and 6 years
32
when is the maximal transmission of chicken pox
between winter and spring
33
what are signs and symptoms of chicken pox
rash; usually starts on the head and trunk and then the rest of the body
lesions start as red macules and then progress through stages: papule, vesicle, pustule and crusting
headache
anorexia
signs of upper respiratory tract infection
fever
itching
34
what is the infectious period for chicken pox
starts 2 days before the vesicles appear and end when the last vesicle crusts over
35
how is chicken pox diagnosed
clinical - characteristic rash
other: serology, electron microscopy of vesicle fluid
36
how is chicken pox managed
symptoms: treat fever and itching
school exclusion: 5 days from the stark of skin eruption
antivirals can be used in severe vzv infection, encephalitis, pneumonia, babies and immunosuppressed patients
VZIG can be used as prophylaxis
immunisation (non currently part of vaccination schedule)
37
what are complications of chicken pox
secondary bacterial infection with group A strep can lead to necrotising fasciitis or toxic shock
purpura fulminans
cerebrovascular stroke
encephalitis
38
what are the signs and symptoms of rubella
prodrome: child may have mild illness with a low grade fever
maculopapular rash which starts on the face and then spreads to cover the whole body
suboccipital and post auricular lymphadenopathy
sore throat
runny nose
headache
joint pain
malaise
pink eye
39
how is rubella diagnosed
serology - risk if non immune pregnant women is exposed
clinical features
40
what is the management of rubella
supportive treatment - paracetamol or ibuprofen
prevention: MMR vaccine
41
how is rubella spread
droplet infection or direct contact
42
how long are you infectious with rubella for
about a week before and a week after the rash appears
43
what are the symptoms of congenital rubella
vision loss - cataracts and glaucoma
hearing loss
heart defects
neurological affects - microcephaly, inflammation, learning and behavioural difficulties
bone disease
thrombocytopenia, anaemia
thyroid disease
hepatosplenomegaly
type 1 diabetes
44
what are the symptoms of diphtheria
thick grey membrane covering the throat and tonsils
sore throat and hoarseness
swollen glands in the neck
difficulty breathing or rapid breathing
nasal discharge
fever and chills
tiredness
45
what is cutaneous diphtheria
it is a second type of diphtheria which affects the skin, causing pain, redness and swelling
may also present with ulcers covered by a grey membrane
46
what is the cause of diphtheria
it is caused by the bacterium Corynebacterium diphtheriae which multiples on or near the surface of the throat or skin
47
how is diphtheria spread
airborne droplets
contaminated personal or household items
48
what are risk factors for developing diphtheria
children and adults without up to date vaccines
people living in crowded or unsanitary conditions
anyone who travels to an area where diphtheria infections are more common
49
what are complications of diphtheria
breathing problems
heart damage - myocarditis
nerve damage - caused by toxin leading to difficulty swallowing and weakness in the arms and legs
50
how is diphtheria diagnosed
clinical examination
culture and microscopy
tissue biopsy
51
what is the treatment of diphtheria
treat first if you suspect before you know diagnosis
antibiotics - penicillin, erythromycin
antitoxin - to counteract diphtheria toxin
supportive therapy
to those exposed - prophylaxis and a booster vaccine
52
what is scalded skin syndrome
it is a rare, severe, superficial blistering skin disorder characterised by the detachment of the epidermis
53
what causes scalded skin syndrome
it is caused by exotoxin release from specific strains of staphylococcus aureus bacteria
54
what age group is scalded skin syndrome most common in
in children younger than 5, peak age being between 2-3 years old
55
why is scalded skin syndrome most common in children under 5
thought to be due to an immature:
immune system
renal clearance
56
what causes scalded skin syndrome
toxigenic staphylococcus aureus - releases exfoliative toxins A and B
these toxins bind to a specific desmosome present in the epidermis known as desmoglein-1 and breaks it down, leading to skin cells becoming loose and unstuck
57
what are the clinical features of scalded skin syndrome
starts with nonspecific symptoms in children: irritability, lethargy, fever
within 24-48 hours there is a painful widespread red rash on the skin followed by large, fragile fluid filled blister
58
where does the rash in scalding skin syndrome start
starts on the face and the flexural regions (groin, axilla, neck) and then spreads rapidly to other parts of the body including the arms, legs and trunk
59
where do you find the large fluid filled blisters in scalding skin syndrome
frequently found in areas of friction such as the axillae, groin and buttocks as well as the centre of the face and body orifices
60
what are complications of scalding skin syndrome
scarring
loss of bodily fluids and salts leading to dehydration and electrolyte imbalance
hypothermia
secondary infections
renal failure
61
how is scalding skin syndrome diagnosed
skin swabs
blood cultures
Tzanck smear
skin biopsy
62
what is the treatment for scalding skin syndrome
IV antibiotics: flucloxacillin
other options are ceftriaxone, clarithromycin, cealozin
for MRSA infection use vancomycin
pain relief
monitoring and maintaining fluid intake
skincare : gentle washing, emollients
63
what bacteria causes pertussis
Bordetella pertussis
64
how is pertussis transmitted
via respiratory secretions generated by coughing or sneezing or via objects contaminated with respiratory secretions
65
what is the incubation period of pertussis/whooping cough
approximately 7-10 days
66
what are complications of pertussis
apnoea
pneumonia
seizures
cerebral hypoxia
encephalopathy
otitis media
subconjunctival haemorrhage
epistaxis
ulceration of tongue and surrounding area
unilateral hearing loss (rare)
pneumothorax
umbilical and inguinal hernias
rib fracture
severe dehydration
malnutrition
67
what are the three phases of whooping cough symptoms
catarrhal
paroxysmal
convalescent
68
what is the catarrhal phase of whooping cough
begins 7-10 days after exposure and lasts 1-2 weeks
rhinorrhoea
malaise
mild cough
sore throat
conjunctivitis
69
what is the paroxysmal phase of whooping cough
lasts 1-6 weeks but can last up to 10
characterised by rapid violent and uncontrolled coughing fits
short expiratory burst followed by an inspiratory gasp (whoop)
occur frequently at night
may be triggered by external stimuli
associated with post-tussive vomiting
can cause cyanosis
70
what is the convalescent phase of whooping cough
usually lasts 2-3 weeks
gradual improvement in cough frequency
paroxysms can recur
71
what is the most infectious phase of whooping cough
the catarrhal phase
72
how do you diagnose whooping cough
examination and clinical findings
laboratory tests: culture, PCR, serological testing or oral fluid testing
73
how is whooping cough managed
need to notify public health england
if admission not necessary and onset of cough is within the last 14 days prescribe azithromycin or clarithromycin
if macrolides contraindicated prescribe co-trimoxazole
analgesia
adequate fluid intake
stay off from school until they have completed 48hrs of antibiotics
hospitalisation if there are significant breathing difficulties
74
what are the different kinds of polio infection
abortive polio
nonparalytic polio
paralytic polio
post polio syndrome
75
what are symptoms of abortive polio
mild flu like illness that lasts 2-3 days
fever
headache
muscle aches
sore throat
stomach ache
loss of appetite
nausea
vomiting
76
what are symptoms of non paralytic polio
more severe form
more severe flu like symptoms
neck pain and stiffness
aches and stiffness in the arms or legs
severe headache
decreased reflexes
muscle weakness
77
what is paralytic polio
begins more like non paralytic and then progresses:
intense pain
extreme sensitivity to touch
tingling or pricking sensations
muscle spasms or twitching
muscle weakness progressing to paralysis
can have paralysis in the breathing muscles
difficulty swallowing
78
what are symptoms of post polio syndrome
new signs or symptoms or progression which normally happens decades after having polio
- progressive muscle or joint weakness or pain
- fatigue
- muscle wasting
- breathing or swallowing issues
- sleep related breathing disorders
- lowered tolerance of cold temperatures
79
what is the cause of polio
caused by poliovirus which targets nerve cells mainly in the spinal cord and brain stem
naturally occurring poliovirus (wild type) has been eliminated in most countries, where as vaccine derived poliovirus is more widespread
80
how did vaccine derived poliovirus develop
due to communities or regions where not enough people are vaccinated, the weakened virus in the oral vaccine can spread, giving it a chance to mutate and behave like the wild type illness
81
how does polio spread
faeces
droplets by sneezing or coughing
contact of saliva
contaminated water
82
what are complications of polio
permanent paralysis
muscle shortening that causes deformed bones or joints
chronic pain
post polio syndrome
83
how is polio prevented
vaccine
the CDC recommends 4 doses of vaccine at 2 months, 4 months, between 6-18 months and between 4-6 years old
84
how is polio diagnosed
clinical symptoms
stool sample
throat swab during the first week of illness
lumbar puncture
85
how is polio treated
there is no cure for polio the focus is on supportive therapy
bed rest
analgesia
hot moist packs to control muscle pain and spasms
ventilation to help with breathing
physical therapy to prevent bone deformity and loss of muscle function
splints or other devices
86
how is TB spread
respiratory route
close proximity to someone infected
87
what are the symptoms of TB
fever
anorexia and weight loss
tender lymph nodes
cough
haemoptosis
breathlessness
chest pain
joint pain
headache
chest pain
rash
88
what is the pathophysiology of TB
after exposure the bacterium M.tuberculosis is engulphed by macrophages in the lung. most people will clear it at this point, but those who dont will have primary TB.
The lung lesion plus the lymph node affected will constitute the Ghon (primary) complex.
in most people this will lead to asymptomatic latent TB. This can reactivate.
some people will develop primary progressive or extrapulmonary TB
89
what is Extrapulmonary TB
this is TB in an organ other than the lungs and it can affect almost any organ
- genitourinary: sterile pyuria, pyelonephritis
- CNS: meningitis
- GI: peritonitis
- Cardiac: pericarditis
- lymphatics: lymphadenitis
- spinal vertebrae: Potts disease
90
what is miliary TB
this is disseminated TB where the bacteria spreads through the bloodstream and affects multiple organs throughout the body
91
what are risk factors for developing TB
close contact with an infected individual
ethnic minority groups
recent travel to high prevalence areas
extremes of age
homelessness
immunodeficiency
92
what are the clinical findings of someone with TB
sputum pots with purulent or blood stained sputum
enlarged and tender lymph nodes
crackles or bronchial breathing over consolidation
dullness to percussion and decreased fremitus over pleural effusions
93
what investigations are done in someone with suspected TB
Urine dip
ECG
bloods: inflammatory markers, renal and liver profile
viral screen
sputum microscopy: culture and sensitivities
bronchoscopy with lavage
mantoux and interferon gamma release assay to diagnose latent TB
94
how are TB samples analysed
with Ziehl-Neelson stain for acid-fast bacilli
95
what can be seen on a chest X ray in someone with TB
lobar or patchy consolidation
linear or nodular opacities
Miliary TB = small, uniformly distributed nodules
cavitating lesions
tuberculoma = caseating
calcified tuberculoma (ghon focus) or lymph nodes
lymphadenopathy
pleural effusion
96
how is TB managed
need to notify public health england
triple or quadruple therapy; RIPE
- rifampicin
- isoniazid
- pyrazinamide
- ethambutol
which is then decreased to rifampicin and isoniazid after 2 months
the treatment for uncomplicated or lymph node TB is 6 months
longer treatment is required for disseminated TB
97
how are asymptomatic children treated for TB
with rifampicin and isoniazid for 3 months as this will decrease the risk of reactivation later in life
98
who is the BCG vaccination offered to in the UK
high risk groups
- ethnic minorities
- TB in a family member in the previous 5 years
- local area has high prevalence
99
what are complications of TB
pleurisy
pleural effusions
empyema
pneumothorax
bronchiectasis
respiratory failure
100
what drugs used to treat TB do you get hepatitis as a side effect
rifampicin
isoniazid
pyrazinamide
101
what drug used to treat TB causes visual disturbance
ethambutol
102
what drug used to treat TB causes peripheral neuropathy
isoniazid
103
what drug used to treat TB causes red urine/tears
rifampicin
104
what is meningitis
it is inflammation of the meninges of the brain
105
what is the most common cause of meningitis
viral meningitis
106
what are causes of bacterial meningitis in neonates - 3 months
Group B streptococcus
Ecoli and other coliforms
listeria monocytogenes
107
what are causes of bacterial meningitis in 3 month-6 years
Neisseria meningitidis
streptococcus pneumoniae
haemophilus influenzae
108
what are causes of bacterial meningitis in >6 year olds
neisseria meningitidis
streptococcus pneumoniae
109
what are symptoms of meningitis
fever
headache
photophobia
lethargy
poor feeding or vomiting
irritability
hypotonia
drowsiness
loss of consciousness
seizures
110
what is seen on examination in someone with meningitis
fever
purpuric rash (meningococcal disease)
neck stiffness
bulging fontanelle
arching of back
positive brudzinski/kernig signs
signs of shock
focal neurological signs
altered conciousness levels
pappiloedema (rare)
111
what investigations would you do in someone with suspected meningitis
full blood count
blood glucose and gas
coagulation screen
U+E
culture of blood
rapid antigen testing
lumbar puncture
PCR
chest X ray and Mantoux test if TB suspected
112
what are contraindications to performing a lumbar puncture
cardiorespiratory instability
focal neurological signs
signs of raised ICP
coagulopathy
thrombocytopenia
local infection at the site of LP
if it causes undue delay in starting antibiotics
113
what is Brudzinski sign
flexion of the neck with the child supine causes flexion of the knees and hips
114
what is Kernig sign
with the child laying supine with hips and knees flexed there is back pain on extension of the knee
115
what is the management of bacterial meningitis
antibiotics - cefotaxime or ceftriaxone
in children under 3 months give IV cefotaxime plus amoxicillin/ampicillin to cover listeria
supportive therapy
116
what are complications of meningitis
hearing loss
local vasculitis
local cerebral infarction
subdural effusion
hydrocephalus
cerebral abscess
117
what is aseptic meningitis
when CSF has whit cells on microscopy but the gram stain is negative and no bacteria are cultured
118
in primary care what do you do if someone is suspected of having bacterial meningitis
URGENT transfer to hospital
IM or IV benzylpenicillin
119
how are contacts of someone with bacterial meningitis treated
prophylactic antibiotics given within 24 hours: ciprofloxacin or rifampicin
120
what are causes of viral meningitis
enterovirus
EBV
adenovirus
mumps
121
how is viral meningitis diagnosed
PCR of CSF
culture of stool, urine
throat swab
serology
122
what is slapped cheek syndrome
it is infection with parvovirus, which causes a distinctive rash that develops across the face
123
what are symptoms of slapped cheek syndrome
can be asymptomatic
fever
upset stomach
headache
runny nose
several days after the early symptoms, a bright red rash may appear on the childs face across the cheeks
after a few days a light pink rash may appear on the chest, stomach, arms and thighs. This may be raised, lace like and itchy
124
how long will the rash in slapped cheek syndrome
will fade within a week or two
occasionally the body rash may come and go for a few weeks after the infection has passed
125
what can be done as management for slapped cheeked syndrome
rest
drink plenty of fluids
paracetamol or ibuprofen
emollient on itchy skin
antihistamines
children can return to school once the rash has formed
126
what patients are at risk of complications with slapped cheek syndrome
immunocompromised patients
pregnant women
patients with haematological conditions: sickle cell, thalassaemia, hereditary spherocytosis, haemolytic anaemia
127
what are the complications of slapped cheek syndrome
Aplastic anaemia
Encephalitis or meningitis
Pregnancy complications including fetal death
Rarely hepatitis, myocarditis or nephritis
128
how is slapped cheek syndrome spread
droplet infection
- inhaled droplets someones sneezed or coughed out or touching a contaminated surface
129
what causes slapped cheek syndrome
Parvovirus B19
130
what is impetigo
common and highly contagious skin infection that causes sores and blisters
131
what are the two types of impetigo
non-bullous impetigo - most common
bullous impetigo
132
what are the symptoms of non bullous impetigo
begins with red sores normally around the nose and mouth, but other areas of the face and limbs can be affected as well
exudate from the lesions dries to form a thick golden crust
after crusts dry they leave a red mark that fade without scarring
sores arent painful but they can be itchy
swollen glands
133
what are symptoms of bullous impetigo
fluid filled blisters which usually occur on the central part of the body between the waist and neck, or arms or legs
blisters may spread quickly before bursting after several days to leave a yellow crust
blisters may be painful
skin surrounding may be itchy
fever
swollen glands
134
what are the causes of impetigo
skin infected with bacteria
- staphylococcus aureus
- streptococcus pyogenes
135
how long does it takes for impetigo symptoms to appear after initial infection
between 4-10 days after initial exposure
136
how is impetigo treated
usually gets better without treatment in around 2-3 weeks
Non bullous - Topical fusidic acid/antiseptic cream (hydrogen peroxide 1% cream). can use oral flucloxacillin if its more severe
Bullous - antibiotics usually flucloxacillin
137
how long is impetigo infectious for
until the rash disappears
until the scabs fall off
until you've finished at least two days of antibiotics
children should be kept off school during the infection
138
what are the complications of impetigo
complications are rare
can cause glomerulonephritis
rash spreading to deeper skin layers
bacterial infection spreading to other parts of your body
permanent skin damage or scarring
bullous impetigo can lead to staphylococcus scalded skin syndrome
139
what advice should be given to avoid spreading impetigo
not touching or scratching the lesions
hand hygiene
avoid sharing face towels and cutlery
off school until all lesions have healed or they have been treated with antibiotics for at least 48 hours
140
how is impetigo diagnosed
clinical diagnosis
may take a skin culture
141
what is candidiasis
it is a fungal infection caused by an overgrowth of a type of of yeast that lives on your body
142
what types of candidiasis exists
vaginal candidiasis
cutaneous candidiasis
oral candidiasis
candida granuloma
invasive candidiasis - systemic
143
who does candidiasis most commonly affect
people with diabetes
pregnant people
babies and infants
people who wear dentures
immunocompromised people
catheter users
144
what are the symptoms of candidiasis
discomfort
itching
irritation
redness of the skin with raised bumps
burning
vaginal discharge
white patches or sores in your mouth
swelling
145
what are risk factors for development of candidiasis
taking antibiotics, steroids, oral contraceptives, medicines that cause dry mouth
feeling stresses
eating a diet high in refined carbs, yeast or sugar
uncontrolled diabetes
HIV
cancer
immunocompromised
pregnancy/hormonal changes
146
how is candidiasis diagnosed
clinical diagnosis
may also do fungal swabs and culture - charcoal swab
can test vaginal pH in women - will be lower than 4.5
147
how is candidiasis treated
antifungal medication - oral or topical
clotrimazole (cream)
fluconazole (oral)
148
what can cause candidiasis in a child
when skin is damaged
when warm or humid
when child is immunocompromised
use of antibiotics
149
how is candidiasis treated in a child
topical antifungals - miconazole gel or nystatin
suppositories
mouthwash or lozenges
severe infection may need oral or IV meds
150
what are risk factors for children to get candidiasis
age - born premature or low birth weight
getting it during birth due to infected mother
breastfeeding with untreated yeast infection
using human milk from a pump that hasnt been properly sterilised
sucking on a pacifier/bottle too often and too long
using an inhaler without rinsing beforehand
recent history of antibiotic use
immunosuppressed
151
what is nappy rash
Nappy rash is contact dermatitis in the nappy area. It is usually caused by friction between the skin and nappy and contact with urine and faeces in a dirty nappy
152
what does diaper rash look like
sore, red, inflamed skin in the nappy area
individual patches on exposure areas of skin
tends to spare skin creases
few red papules
itchy
distressed infant
153
what are risk factors for nappy rash
Delayed changing of nappies
Irritant soap products and vigorous cleaning
Certain types of nappies (poorly absorbent ones)
Diarrhoea
Oral antibiotics predispose to candida infection
Pre-term infants
154
what are signs that would point to candidal infection rather than nappy rash
Rash extending into the skin folds
Larger red macules
Well demarcated scaly border
Circular pattern to the rash spreading outwards, similar to ringworm
Satellite lesions, which are small similar patches of rash or pustules near the main rash
155
how do you treat nappy rash
Switching to highly absorbent nappies (disposable gel matrix nappies)
Change the nappy and clean the skin as soon as possible after wetting or soiling
Use water or gentle alcohol free products for cleaning the nappy area
Ensure the nappy area is dry before replacing the nappy
Maximise time not wearing a nappy
infection with candida will need antifungal cream - clomtrimazole or miconazole
156
what are complications of nappy rash
Candida infection
Cellulitis
Jacquet’s erosive diaper dermatitis
Perianal pseudoverrucous papules and nodules
157
what is toxic shock syndrome
rare but life threatening complication of bacterial infection or colonisation chaacterised by high fever, rash, and shock
158
what causes toxic shock syndrome
typically one of two types of bacteria
- staphylococcus aureus
- streptococcus pyogenes
159
what are causes of staph.aureus toxic shock syndrome
occur after a tampon is left in too long
may occur from another infection such as pneumonia, sinusitis, osteomyelitis
may occur in the setting of a skin or soft tissue infection
160
what are causes of strep. pyogenes toxic shock syndrome
in those who have recently had chickenpox, bacterial cellulitis or have recently given birth and have had surgery or have wounds
161
what are signs/symptoms of staphylococcus toxic shock syndrome
high fever
chills
malaise
headache
fatigue
red flat rash that covers most areas of the body
low blood pressure
vomiting
diarrhoea
muscle pain
increased blood flow to mouth, eyes and vagina making them appear red
decreased urine output
decreased liver function
bruising
confusion
sloughing of the skin
162
what are symptoms of streptococcal toxic shock syndrome
low blood pressure
decreased kidney function
bleeding issues
bruising
red, flat rash
decreased liver function
decreased urine output
difficulty breathing
sloughing of skin
163
how is toxic shock syndrome diagnosed
blood cultures
blood tests
urine tests
wound cultures if needed
lumbar puncture
164
how is toxic shock syndrome treated
IV antibiotics
IV fluids
dialysis
administration of blood products
supplemental oxygen or mechanical ventilation
deep surgical cleaning of infected wound
165
what is scarlet fever
scarlet fever is a bacterial illness which causes a distinctive red rash
166
what causes scarlet fever
streptococcus pyogenes bacteria - Group A
167
what are the symptoms of scarlet fever
usually follows a sore throat or skin infection like impetigo
rash - red blotches at first which turns into a fine pink red rash that feels like sandpaper to touch and looks like a sunburn
itchy
rash usually starts of the chest and the stomach but soon spreads to other parts of the body like ears, neck, elbows, inner thighs, groin
rash doesnt usually spread to the face, however the cheeks become flushed
swollen neck glands
loss of appetitie
vomiting or nausea
white coating of the tongue which peels leaving it red and swollen (strawberry tongue)
malaise
168
how soon does the rash in scarlet fever develop after the initial symptoms
12-48 hours
169
how long do symptoms of scarlet fever develop after initial infection
between 2-5 days
170
how does scarlet fever spread
breathing in bacteria in airborne droplets from an infected person
touching the skin of a person
sharing contaminated towels, clothes or bed linin
171
what age is scarlet fever most common in
mostly in children under 10
172
how is scarlet fever treated
most cases clear up without treatment however treatment reduces the length of time, speeds up recovery and lowers risk of complications
- 10 day course of antibiotics often penicillin or amoxicillin. if allergic use erythromycin
173
how long should a child stay away from school/nursery with scarlet fever
at least 24 hours after starting antibiotic treatment
174
what are complications of scarlet fever
ear infection
throat abscess
sinusitis
pneumonia
bacteraemia
septic arthritis
meningitis
necrotizing fasciitis
streptococcal toxic shock syndrome
175
what is coxsackie disease
otherwise known as hand foot and mouth disease, it is a milk, contagious viral infection common in young children
176
what are symptoms of hand foot and mouth disease
fever
sore throat
feeling sick
painful, blister like lesions on the tongue, gums and inside of the cheeks
rash on the palms, soles and sometimes buttocks
the rash is not itchy but sometimes blisters
rash may appear red, white, gray or tiny bumps
fussiness in infants and toddlers
LOA
177
how long is the period from initial infection to the time symptoms appear in hand foot and mouth disease
3 to 6 days
178
how soon after the fever begins do the sores develop in hand foot and mouth disease
one or two days after the fever begins the painful sores will develop
179
what are the causes of hand foot and mouth disease
infection with coxsackievirus 16
180
how does coxsackievirus infection spread
spends by person to person contact with an infected persons:
nose secretion or throat discharge
saliva
fluid from blisters
stools
respiratory droplets with coughing or sneezing
181
when is someone most contagious with hand foot and mouth disease
in the first week of having the disease
182
what are risk factors for developing hand foot and mouth disease
age - mostly affects children ages 5-7
those immunosuppressed
183
what are complications of hand foot and mouth
dehydration
viral meningitis
encephalitis
184
how is hand foot and mouth diagnosed
clinical diagnosis
throat swab or stool specimen
185
how is hand foot and mouth treated
no specific treatment, symptoms usually clear up in 7 to 10 days
topical oral anaesthetic may help relieve mouth sores
over the counter pain medications such a acetaminophen or ibuprofen may help relieve discomfort
186
how can you prevent vertical transmission of HIV
use of antenatal, perinatal or postnatal antiretroviral drugs
avoid labour and birth canal contact by elective caesarean section
avoidance of breastfeeding
187
what are he clinical features of HIV in children
dormant infection lasts a short period and has few to no features
chronic diarrhoea
failure to thrive
delayed development
cerebral palsy
recurrent bacterial and viral infection
lymphadenopathy and hepatosplenomegaly
opportunistic infections: pneumocystitis canirii, candida, herps, varacella
respiratory distress
188
what are AIDs defining illnesses in a HIV positive child
lymphocytic interstitial pneumonitis
PCP
infection
candida oesophagitis
189
how is HIV diagnosed in children
specific antibody response (anti-HIV antibodies): infants infected perinatally have an immune response by 4-6 months of age
virus or its components in blood: PCR
190
how is HIV treated in children
prophylaxis against PCP - co-trimoxazole
avoidance of live oral polio vaccine and HCG
antiretroviral therapy
social, psychological and family support
191
how is HIV transmitted
unprotected anal, vaginal or oral sexual activity
mother to child at any stage of pregnancy, birth or breastfeeding
mucous membranes, blood or open wound exposure
192
when would a woman with HIV have a normal vaginal delivery
if her viral load is below 50 copies/ml
193
when would a woman with HIV have a caesarean section
considered in patients with over 50 copies/ml and in al women with over 400 copies /ml
194
when is IV zidovudine given in birth where the woman is HIV positive
given during caesarean when the viral load is unknown or if there are over 10,000 copies/ml
195
what prophylaxis treatment is given for babies born of mothers who have HIV
dependent on the viral load:
low risk: where mums have less than 50 copies/ml should be given zidovudine for 4 weeks
high risk: when mums viral load is over 50 copies/ml should be given zidovudine, lamivudine and nevirapine for 4 weeks
196
when do you test children for HIV with HIV positive patents
HIV viral load test at 3 months
HIV antibody test at 24 months
197
what will the paediatric HIV MDT be involved in
Regular follow up to monitor growth and development
Dietician input for nutritional support when required
Parental education about the condition
Disclosing the diagnosis to the child is often delayed until they are mature enough
Psychological support
Specific sex education in relation to HIV when appropriate
198
what is encephalitis
inflammation of the brain as a result of infective or non infective causes
199
what is the most common cause of encephalitis
with a virus - HSV is the most common.
other causes include; VZV, CMV, EBV, enterovirus, adenovirus, influenza virus
200
how does encephalitis present
altered consciousness
altered cognition
unusual behaviour
acute onset of focal neurological symptoms
acute onset of focal seizures
fever
201
how is encephalitis diagnosed
LP - CSF for viral PCR
Ct scan if LP is contraindicated
MRI scan
EEG recording
swabs - viral and vesicle
HIV testing
202
what are contraindications to a lumbar puncture
GCS below 9
haemodynamically unstable
active seizures
post ictal
203
what is the management of encephalitis
IV antiviral medications
- aciclovir for HSV and VZV
- ganciclovir for CMV
repeat LP
follow up, support and rehabilitation
204
what are complications of encephalitis
Lasting fatigue and prolonged recovery
Change in personality or mood
Changes to memory and cognition
Learning disability
Headaches
Chronic pain
Movement disorders
Sensory disturbance
Seizures
Hormonal imbalance
205
what are signs of sepsis in children
Deranged physical observations
Prolonged capillary refill time (CRT)
Fever or hypothermia
Deranged behaviour
Poor feeding
Inconsolable or high pitched crying
High pitched or weak cry
Reduced consciousness
Reduced body tone (floppy)
Skin colour changes (cyanosis, mottled pale or ashen)
206
what are the NICE guidelines that cover assessment of a child under 5 with a fever
Colour: normal vs cyanosis, mottled pale or ashen
activity: active, happy vs abnormal responses, drowsy or inconsolable cry
respiratory: normal vs distress, tachypnoea or grunting
circulation and hydration: normal vs tachycardia, dry membranes or poor skin turgor
other: fever for over 5 days, non blanching rash, seizures, high temp for over 6 months
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what is the immediate management of a child with sepsis
ABCDE
Give O2
IV access
bloods - FBC, U+E, CRP, clotting
blood cultures
urine dipstick
antibiotics - within 1 hour of presentation
IV fluids - 20ml/kg IV bolus of normal saline if lactate is above 2mmol/l
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what additional investigations may be performed if sepsis in a child is suspected
Chest X ray
abdominal and pelvic ultrasound
lumbar puncture
meningococcal PCR
serum cortisol if adrenal crisis suspected
209
what is septic shock
when sepsis leads to cardiovascular dysfunction
- arterial blood pressure falls resulting in hypo-perfusion and leads to anaerobic respiration
210
what is the pathophysiology of sepsis
causative pathogens are recognised by macrophages, lymphocytes and mast cells. these release cytokines which lead to release of chemicals such as nitrous oxide which causes vasodilation.
these cytokines also cause the endothelial lining to become more permeable and fluid to lead into the extracellular space
activation of the coagulation system leads to fibrin deposition causing organ composition and consumption of platelets and clotting factors.
this leads to thrombocytopaenia and haemorrhage
211
what virus causes infectious mononucleosis
EBV
212
how is EBV transmitted
spread by saliva of the infected individuals - kissing, sharing cups, toothbrushes, and other equipment that transmits saliva
213
how long can people be infected with EBV before the illness begins
can be infectious for several weeks before the illness begins and is secreted in their saliva
214
what are features of infectious mononucleosis
Fever
Sore throat
Fatigue
Lymphadenopathy (swollen lymph nodes)
Tonsillar enlargement
Splenomegaly and in rare cases splenic rupture
215
what antibodies are produces in infectious mononucleosis
heterophile antibodies - takes up to 6 weeks for these antibodies to be produced
216
how can you test for heterophile antibodies
monospot test: introduces patients blood to RBC from horses, and if the antibodies are present they will react with the horses blood and give a positive result
Paul-bunnell test: similar to monospot but uses red blood cells from sheep
217
what specific antibody tests are there for infectious mononucleosis
possible to test for EVB antibodies due to them targeting the viral capsid antigen
- IgM: early and suggests acute infection
- IgG: persists and suggests immunity
218
how is infectious mononucleosis managed
self limiting, lasts around 2-3 weeks
avoid alcohol
avoid contact sports due to risk of splenic rupture
219
what are complications of infectious mononucleosis
Splenic rupture
Glomerulonephritis
Haemolytic anaemia
Thrombocytopenia
Chronic fatigue
EBV infection is associated with certain cancers, notable Burkitt’s lymphoma.
220
how is mumps spread
respiratory droplets
221
what is the incubation period of mumps
14-25 days
222
how does mumps present
prodrome: initial period of flu like symptoms
Fever
Muscle aches
Lethargy
Reduced appetite
Headache
Dry mouth
then a few days later there is parotid gland swelling either uni or bilateral with associated pain
abdominal pain (pancreatitis)
testicular pain (orchitis)
confusion, neck stiffness, headache (meningitis or encephalitis)
223
how is mumps diagnosed
PCR testing of saliva swab
blood or saliva tested for antibodies
clinical diagnosis
224
how is mumps managed
need to notify public health with any suspected and confirmed cases
supportive management: rest, fluid and analgesia
225
what are the complications of mumps
Pancreatitis
Orchitis
Meningitis
Sensorineural hearing loss
226
what type of virus is Hep B
DNA virus
227
how is hepatitis B transmitted
contact with blood or bodily fluids
- sexual intercourse
- sharing needles
- contaminated products such as toothbrushes or contact between minor cuts or abrasions
- vertical transmission
228
what is the risk of developing chronic hepatitis B after exposure in children
90% for neonates
30% for children under 5
under 10% for adolescents
229
what are the symptoms of hepatitis B in children
most are asymptomatic
less that 5% will develop liver cirrhosis
less than 0.05% will develop hepatocellular carcinoma (risk increases when they enter adulthood)
230
what viral markers are there for hepatitis B
surface antigen - active infection
E antigen - marker of viral replication
core antigen - implies past or current infection
surface antibody - implies vaccination or past or current infection
hepatitis B virus DNA - direct count of viral load
231
what does HBsAb demonstrate
demonstrates an immune response, however it is given in the vaccine and so it may simply indicate they have been vaccinated
232
how can HBcAb distinguish between acute, chronic and past infection
can measure IgM and IgG versions
- IgM implies active infection, with a higher titre indicating acute infection
- IgG indicates past infection
233
which children are important to test for hepatitis B
Children of hepatitis B positive mums (screen at 12 months of age or any time after that)
Migrants from endemic areas
Close contacts of patients with hepatitis B
234
how do you reduce the risk of a baby contracting Hepatitis B if their mother is positive for hepatitis B
at birth (within 24 hours) neonates with hepatitis B positive mothers should be given hepatitis B vaccine and immunoglobulin infusion
infants are given additional hepatitis B vaccine at 1 and 12 months
they are tested for HBsAg at 1 year
235
can mothers positive with Hep B breastfeed
as Hep B can be found in breastmilk the advice is that it is safe for them to breast feed if their babies are properly vaccinated
236
what is the hepatitis B vaccination
it is an injection of the hepatitis B surface antigen and requires 3 doses at different intervals
237
how are children with chronic hepatitis B managed
usually asymptomatic and dont require treatment
will need regular specialist follow up to assess their ALT, HBeAg, HBV DNA, physical examination and liver ultrasound
where there is evidence of hepatitis or cirrhosis then treat with antivirals
238
what type of virus is Hep C
RNA virus
239
how is Hep C spread
via blood and bodily fluids
240
how common is vertical transmission in hep C
Hepatitis C is passed from infected mothers to their babies about 5 – 15% of the time. Hepatitis C antivirals are not recommended in pregnancy and there are no additional measures that are known to reduce the risk of transmission.
241
how is hepatitis C tested for
Hepatitis C antibody is the screening test
Hepatitis C RNA testing is used to confirm the diagnosis of hepatitis C, calculate viral load and identify the genotype
242
what is the management of hepatitis C in children
babies to hepatitis c positive mothers are tested at 18 months
breastfeeding is not found to spread the virus
children often clear the virus spontaneously
infected children will require regular specialist follow up to monitor liver function and viral load
medical treatment is considered in children over 3
243
what treatment is given to children with hepatitis C
pegylated interferon and ribavirin
244
what is otitis media
it is an infection in the middle ear
245
what is the middle ear
it is the space that sits between the tympanic membrane and the inner ear - where the cochlea, vestibular apparatus and nerves are found
246
how can bacteria enter the middle ear
enters from the back of the throat through the eustachian tube
247
what is a bacterial infection of the middle ear often preceeded by
a viral upper respiratory tract infection
248
what bacteria most commonly cause otitis media
streptococcus pneumoniae.
Other common causes include:
Haemophilus influenzae
Moraxella catarrhalis
Staphylococcus aureus
249
how does otitis media present
ear pain
reduced hearing in the affecting ear and general symptoms of upper airway infection such as fever, cough, coryzal symptoms, sore throat, and generally feeling unwell.
balance issues and vertigo
discharge if tympanic membrane is perforated
250
what will a tympanic membrane look like in otitis media
bulging
red
inflamed
if perforated will see discharge in the ear canal and a hole in the tympanic membrane
251
how is otitis media managed
most cases will resolve without antibiotics - most cases will resolve within 3 days but can last up to a week
can give immediate antibiotics in patients with significant co-morbidities, are systemically unwell or immunocompromised
give delayed prescription if symptoms havent improved or worsen after 3 days
252
what is the treatment used for otitis media
amoxicillin for 5 days
alternatives are erythromycin and clarithromycin
253
what are complications of otitis media
Otitis medial with effusion
Hearing loss (usually temporary)
Perforated eardrum
Recurrent infection
Mastoiditis (rare)
Abscess (rare)
254
what is glue ear
otitis media with effusion, where the middle ear becomes full of fluid causing a loss of hearing in the ear
255
what causes glue ear
when the eustachian tube becomes blocked, there is a build up of secretions in the middle ear which normally drains, causing loss of hearing
256
what is the main symptom of glue ear
loss of hearing in the affected ear
257
what is the main complication of glue ear
otitis media - infection
258
what will otoscopy show in someone with glue ear
dull tympanic membrane with air bubbles or a visible fluid level
can look normal
259
what is the management of glue ear
refer to audiometry to help establish a diagnosis and the extend of the hearing loss
treat conservatively and normally resolves within 3 months
children with co morbidities affecting the ear structure may require hearing aids or grommets
260
what are grommets
tiny tubes which are inserted into the tympanic membrane by an ENT surgeon
this allows fluid from the middle ear to drain through the tympanic membrane to the ear canal
261
how are grommets removed
they usually fall out within a year, and only 1 in 3 patients require further grommets to be inserted for persistent glue ear
262
what are congenital causes of hearing loss
maternal rubella or CMV infection during pregnancy
genetic deafness - recessive/dominant
associated syndromes such as Downs
263
what are perinatal causes of hearing loss
prematurity
hypoxia during or after birth
264
what are causes of hearing loss after birth
jaundice
meningitis and encephalitis
otitis media or glue ear
chemotherapy
265
how is hearing of newborns tested in the UK
the newborn hearing screening programme tests hearing in all neonates
- can identify congenital hearing problems early
266
what are signs in children that they may have issues with their hearing
Ignoring calls or sounds
Frustration or bad behaviour
Poor speech and language development
Poor school performance
267
what is audiometry
it is audio testing in children under 3, looking for a basic response to sound
older children can be tested properly with headphones and specific tones and volumes
268
what are the results of audiometry recorded on
on an audiogram which can help identify and differentiate between conductive and sensorineural hearing loss
269
what are audiograms
these are charts that document the volume at which patients can hear different tones
- frequency on the X axis
- volume is plotted on the Y axis
270
what are normal readings on audiograms
when someone has normal hearing all readings will between 0 and 20 dB at the top of the chart
271
what is sensorineural hearing loss
Sensorineural hearing loss, or SNHL, happens after inner ear damage. Problems with the nerve pathways from your inner ear to your brain can also cause SNHL. Soft sounds may be hard to hear. Even louder sounds may be unclear or may sound muffled. This is the most common type of permanent hearing loss.
272
what will sensorineural hearing loss look like on an audiogram
both air and bone conduction readings will be more than 20 dB, plotted below the 20 dB line on the chart. This may affect only one side, one side more than the other or both sides equally.
273
what is conductive hearing loss
when sounds are unable to pass from your outer ear to your inner ear, often because of a blockage such as earwax, glue ear or a build-up of fluid from an ear infection, perforated ear drum or disorder of the hearing bones
- sound can travel through bones but not through air.
274
what will conductive hearing loss look like on an audiogram
bone conduction readings will be normal (between 0 and 20 dB), however air conduction readings will be greater than 20 dB, plotted below the 20 dB line on the chart.
275
what will mixed hearing loss look like on an audiogram
both air and bone conduction readings will be more than 20 dB, however there will be a difference of more than 15 dB between the two (bone conduction > air conduction).
276
how is hearing loss managed
MDT approach
Speech and language therapy
Educational psychology
ENT specialist
Hearing aids for children who retain some hearing
Sign language
specialist schools
277
what is the most common cause of bacterial tonsillitis
group A streptococcus
278
what are other bacterial causes of tonsillitis
Haemophilus influenzae
Morazella catarrhalis
Staphylococcus aureus
279
what is Waldeyer's tonsillar ring
in the pharynx there is a ring of lymphoid tissue, there are six areas of lymphoid tissue making up the adenoid, tubal tonsils, palatine tonsils and lingual tonsil.
280
which tonsils are typically affected in tonsillitis
the palatine tonsils, these are the tonsils either side at the back of the throat
281
what are features of tonsillitis
fever
sore throat
painful swallowing
poor oral intake
headache
vomiting
282
what will examination of the throat reveal in tonsillitis
red inflamed and enlarged tonsils with or without exudates
283
what is the centor criteria
it is used to eliminate the probability that tonsilitis is due to bacterial infection and will benefit from antibiotics
284
what score would give a higher probability that tonsillitis is caused by bacteria
a score of 3 or more gives a 40-60% probability of bacterial tonsillitis
285
what features are looked at in the centor criteria
Fever over 38ºC
Tonsillar exudates
Absence of cough
Tender anterior cervical lymph nodes (lymphadenopathy)
each one present is given one point
286
what is the FeverPAIN score
it is an alternative score to the Centor criteria, and a score of 2 gives a 34-40% probability, and a score of 4-5 gives a 62-65% chance its caused by bacterial tonsillitis
287
what factors are looked at in the FeverPAIN score
Fever during previous 24 hours
P – Purulence (pus on tonsils)
A – Attended within 3 days of the onset of symptoms
I – Inflamed tonsils (severely inflamed)
N – No cough or coryza
288
what is the management of tonsilitis
need to calculate centor or feverPAIN score
safety net advice
simple analgesia - paracetamol or ibuprofen
antibiotics if indicated (can be immediate or delayed) - Penicillin V for a 10 day course. clarithromycin if there is a penicillin allergy
289
what are complications of tonsillitis
Chronic tonsillitis
Peritonsillar abscess, also known as quinsy
Otitis media if the infection spreads to the inner ear
Scarlet fever
Rheumatic fever
Post-streptococcal glomerulonephritis
Post-streptococcal reactive arthritis
290
what is Quinsy
it is the common name for a peritonsillar abscess
291
what causes quinsy
when there is a bacterial infection with trapped pus, forming an abscess in the region of the tonsils
292
how does quinsy present
sore throat
painful swallowing
fever
neck pain
referred ear pain
swollen tender lymph nodes
trismus - unable to open mouth
change in voice due to pharyngeal swelling
swelling and erythema in the tonsillar area
293
what are the common bacteria that causes quinsy
streptococcus pyogenes (group A)
staphylococcus aureus
haemophilus influenzae
294
what is the management of quincy
patients should be referred into hospital for incision and drainage of the abscess
antibiotics are required = co-amoxiclav
steroids (dexamethasone) to settle inflammation and aid recovery (not always)
295
what is a tonsillectomy
it is the name for the surgical removal of the tonsils
296
what are indications for a tonsillectomy
7 or more episodes of tonsillitis in 1 year
5 episodes per year for two years
3 episodes per year for three years
recurrent tonsillar abscesses (2 episodes)
enlarged tonsils causing issues with breathing, swallowing or snoring
297
what are complications of a tonsillectomy
pain - sore throat can last 2 weeks
damage to teeth
infection
post-tonsillectomy bleeding
risks of general anaesthetic
298
what is post tonsillectomy bleeding
it is the main significant complication
significant bleeding can occur in up to 5% of patients and it requires urgent management
bleeding can be severe and in rare cases life threatening due to aspiration of blood
299
how long after a tonsillectomy can post tonsillectomy bleeding occur
can happen up to two weeks after the operation
300
what is the management for post tonsillectomy bleeding
call ENT registrar
get IV access and send bloods: FBC, clotting screen, group and save, crossmatch
give adequate analgesia
encourage to spit blood rather than swallowing
nil by mouth
IV fluids for maintenance and resuscitation as required
301
prior to going back into theater what two options are there for stopping less severe bleeds in post tonsillectomy bleeding
hydrogen peroxide gargle
adrenaline soaked swab applied topically
302
where do nosebleeds originate form
the Kiesselbachs plexus which is also known as little area. this is an area of nasal mucosa of the front of the nasal cavity which contains a lot of blood vessels
303
what causes a nosebleed
then the mucosa in the Kiesselbachs plexus gets disrupted and the blood vessels are exposed, then the nose becomes prone to bleeding
304
what can initiate a nosebleed
nose picking
colds
vigorous nose blowing
trauma
changes in weather
305
what does bleeding from both nostrils indicate
may indicate bleeding posteriorly in the nose
306
what is the management of nosebleeds
will usually resolve without medical assistance
recurrent and significant nosebleeds might require investigations to look for underlying disease such as thrombocytopenia or clotting disorders
307
what advice would you give parents on how to manage nosebleeds
Sit up and tilt the head forwards. Tilting the head backwards is not advised as blood will flow towards the airway.
Squeeze the soft part of the nostrils together for 10 – 15 minutes
Spit any blood in the mouth out rather than swallowing
308
when may patients require hospital admission for a nosebleed
when the bleeding doesnt stop after 10-15 minutes
if the bleeding is severe
if the bleeding is from both nostrils
if the patient becomes unstable
309
what are the treatment options for a nosebleed in hospital
nasal packing using nasal tampons or inflatable packs
nasal cautery using a silver nitrate stick
310
after treating a nosebleed what can be prescribed to help with recovery
consider prescribing naseptin (chlorhexidine and neomycin) four times a day for ten days,
helps reduce crusting, inflammation and infection
311
when is Naseptin contraindicated
in peanut or soya allergy
312
what is tongue tie
also known as ankyloglossia, it is when the baby is born with a short and tight lingual frenulum, the attachment of the tongue to the floor of the mouth
313
how does tongue tie present
it normally presents with difficulty feeding (particularly breastfeeding)
also can be picked up on newborn baby check
314
what is the management of tongue tie
can be monitored in mild cases
when it affects feeding babies may benefit from frenotomy which is when a trained person cuts the tongue tie
this is normally done without anaesthetic
315
what are the complications of frenotomy
very rare - excessive bleeding, scar formation, infection
316
what is a cystic hygroma
it is a malformation of the lymphatic system that results in a cyst filled with lymphatic fluid
317
what is the most common location for a cystic hygroma
typically in the posterior triangle of the neck, on the left hand side
can also present in the armpit
318
what are the features of a cystic hygroma
they can be very large
are soft
are non tender
transilluminate
319
what are complications of a cystic hygroma
depending on the location and size they can interfere with swallowing, feeding or breathing
they can become infected
there can be haemorrhage into the cyst
320
what is the management of a cystic hygroma
depends on size, location and complications
watch and wait
aspiration
surgical removal
sclerotherapy
321
what is thyroglossal cyst
this is when part of the thyroglossal duct persists giving rise to a fluid filled cyst
322
what is the pathophysiology of a thyroglossal cyst
during fetal development the thyroid gland starts at the base of the tongue.
from there is gradually travels down the neck to its final position, in front of the trachea
it leaves a track behind called the thyroglossal duct which then disappears.
when part of this duct persists it can give rise to a thyroglossal cyst
323
what is the key differential diagnosis of a thyroglossal cyst
ectopic thyroid tisue
324
what is the main complication of a thyroglossal cyst
infection of the cyst
325
what are the key features of a thyroglossal cyst
Thyroglossal cysts usually occur in the midline of the neck. They are:
Mobile
Non-tender
Soft
Fluctuant
they move up and down with movement of the tongue
326
how are thyroglossal cysts diagnosed
clinical diagnosis
ultrasound and CT scan can confirm the diagnosis
327
how are thyroglossal cysts managed
usually surgically removed to provide diagnosis and prevent infections
can reoccur after surgery unless the full thyroglossal duct is removed
328
what is a branchial cysts
it is a congenital abnormality arising when the second brachial cleft ails to properly form during fetal development
this leaves a space surrounded by epithelial tissue in the lateral aspect of the neck which can fill up with fluid
329
what do brachial cysts present as
round, soft, cystic swelling between the angle of the jaw and the sternocleidomastoid muscle in the anterior triangle of the neck
330
when do brachial cysts most commonly present
tend to present after the age of 10 years, most commonly in young adulthood when the cyst becomes noticeable or infected.
331
what is the difference between sinuses and fistulas
sinuses are blind ending pouches
fistulas are an abnormal connection between two epithelial surfaces
332
what is a brachial cleft sines
this is when a brachial cysts is connected via a tract to the outer skin surface. There will be a small hole visible in the skin beside the cyst and there may be some noticeable discharge from the sinus
333
what is a brachial pouch sinus
this is when the brachial cyst is connected via a tract to the oropharynx
334
what is a brachial fistula
this is when there is a tract connecting the oropharynx to the outer skin surface via the brachial cyst
335
what is the management of a brachial cyst
where it is not causing any functional or cosmetic issues conservative management may be appropriate
where recurrent infections are occurring, there is diagnostic doubt, or it is causing other functional or cosmetic issues then surgical excision may be appropriate
336
