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Phase 3a Jemima > Paediatrics - infectious disease and ENT > Flashcards

Paediatrics - infectious disease and ENT Flashcards

1
Q

what are examples of inactivated vaccines

A

polio
flu vaccine
hepatitis A
rabies

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2
Q

what are examples of subunit and conjugate vaccines

A

pneumococcus
meningococcus
hepatitis B
pertussis
haemophilus influenza type B
HPV
shingles

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3
Q

what are examples of live attenuated vaccines

A

MMR
BCG
chicken pox
nasal influenza
rotavirus

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4
Q

what are examples of toxin vaccines

A

diphtheria
tetanus

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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)

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6
Q

what vaccines would a 12 week old receive

A

6 in 1
pneumococcal - 13 different serotypes
rotavirus

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7
Q

what vaccines would a 16 week old receive

A

6 in 1
meningococcal type B

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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

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9
Q

what vaccination will a child receive yearly between the ages of 2-8

A

influenza vaccine

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10
Q

what vaccine will a child receive at 3 years and 4 months

A

4 in 1 (diphtheria, tetanus, pertussis , polio)
MMR vaccine

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11
Q

what vaccine will a child receive between 12-13 years

A

the HPV vaccine - 2 doses given 6 to 24 months apart

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12
Q

what vaccines would a 14 year old receive

A

3 in 1 (tetanus, diphtheria, polio)
meningococcal groups A, C, W and Y

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13
Q

what is the current NHS HPV vaccine

A

Gardasil - protects against strains 6, 11, 16 and 18

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14
Q

what is kawasaki disease

A

systemic vasculitis which mainly affects infants and young children

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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

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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

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17
Q

what age does kawasaki disease normally present

A

6 months to 4 years old

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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

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19
Q

how is kawasaki disease diagnosed

A

no diagnostic test - diagnosis made on the clinical findings

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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

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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

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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

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23
Q

what are complications of kawasaki disease

A

coronary artery aneurysm
sudden death

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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

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25
Q

where does the rash in measles start

A

starts on the face

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26
Q

how long is someone with measles infectious for

A

4 days before and 4 days after the onset of the rash

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27
Q

how is measles diagnosed

A

clinical
blood film - leukopenia and lymphopenia
LFTs - raised transaminases
oral fluid test: measles RNA on oral fluid specimen confirms the diagnosis
serum serology

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28
Q

what is the management of measles

A

acute treatment: generally supportive but can include antibiotics for secondary bacterial infection
prevention: MMR
vitamin A

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29
Q

what are complications of measles

A

acute otitis media
lower respiratory tract infection
encephalitis
subcutaneous sclerosing panencephalitis

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30
Q

what is subcutaneous sclerosing panencephalitis

A

it is a rare and fatal neurological disease with progressive intellectual deterioration, ataxia and seizures about 7 years after measles infection

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31
Q

what age does chicken pox tend to occur between

A

1 and 6 years

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32
Q

when is the maximal transmission of chicken pox

A

between winter and spring

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33
Q

what are signs and symptoms of chicken pox

A

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

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34
Q

what is the infectious period for chicken pox

A

starts 2 days before the vesicles appear and end when the last vesicle crusts over

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35
Q

how is chicken pox diagnosed

A

clinical - characteristic rash
other: serology, electron microscopy of vesicle fluid

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36
Q

how is chicken pox managed

A

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)

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37
Q

what are complications of chicken pox

A

secondary bacterial infection with group A strep can lead to necrotising fasciitis or toxic shock
purpura fulminans
cerebrovascular stroke
encephalitis

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38
Q

what are the signs and symptoms of rubella

A

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

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39
Q

how is rubella diagnosed

A

serology - risk if non immune pregnant women is exposed
clinical features

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40
Q

what is the management of rubella

A

supportive treatment - paracetamol or ibuprofen
prevention: MMR vaccine

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41
Q

how is rubella spread

A

droplet infection or direct contact

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42
Q

how long are you infectious with rubella for

A

about a week before and a week after the rash appears

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43
Q

what are the symptoms of congenital rubella

A

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

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44
Q

what are the symptoms of diphtheria

A

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

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45
Q

what is cutaneous diphtheria

A

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

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46
Q

what is the cause of diphtheria

A

it is caused by the bacterium Corynebacterium diphtheriae which multiples on or near the surface of the throat or skin

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47
Q

how is diphtheria spread

A

airborne droplets
contaminated personal or household items

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48
Q

what are risk factors for developing diphtheria

A

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

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49
Q

what are complications of diphtheria

A

breathing problems
heart damage - myocarditis
nerve damage - caused by toxin leading to difficulty swallowing and weakness in the arms and legs

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50
Q

how is diphtheria diagnosed

A

clinical examination
culture and microscopy
tissue biopsy

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51
Q

what is the treatment of diphtheria

A

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

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52
Q

what is scalded skin syndrome

A

it is a rare, severe, superficial blistering skin disorder characterised by the detachment of the epidermis

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53
Q

what causes scalded skin syndrome

A

it is caused by exotoxin release from specific strains of staphylococcus aureus bacteria

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54
Q

what age group is scalded skin syndrome most common in

A

in children younger than 5, peak age being between 2-3 years old

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55
Q

why is scalded skin syndrome most common in children under 5

A

thought to be due to an immature:
immune system
renal clearance

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56
Q

what causes scalded skin syndrome

A

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

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57
Q

what are the clinical features of scalded skin syndrome

A

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

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58
Q

where does the rash in scalding skin syndrome start

A

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

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59
Q

where do you find the large fluid filled blisters in scalding skin syndrome

A

frequently found in areas of friction such as the axillae, groin and buttocks as well as the centre of the face and body orifices

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60
Q

what are complications of scalding skin syndrome

A

scarring
loss of bodily fluids and salts leading to dehydration and electrolyte imbalance
hypothermia
secondary infections
renal failure

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61
Q

how is scalding skin syndrome diagnosed

A

skin swabs
blood cultures
Tzanck smear
skin biopsy

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62
Q

what is the treatment for scalding skin syndrome

A

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

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63
Q

what bacteria causes pertussis

A

Bordetella pertussis

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64
Q

how is pertussis transmitted

A

via respiratory secretions generated by coughing or sneezing or via objects contaminated with respiratory secretions

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65
Q

what is the incubation period of pertussis

A

approximately 7-10 days

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66
Q

what are complications of pertussis

A

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

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67
Q

what are the three phases of whooping cough symptoms

A

catarrhal
paroxysmal
convalescent

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68
Q

what is the catarrhal phase of whooping cough

A

begins 7-10 days after exposure and lasts 1-2 weeks
rhinorrhoea
malaise
mild cough
sore throat
conjunctivitis

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69
Q

what is the paroxysmal phase of whooping cough

A

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

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70
Q

what is the convalescent phase of whooping cough

A

usually lasts 2-3 weeks
gradual improvement in cough frequency
paroxysms can recur

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71
Q

what is the most infectious phase of whooping cough

A

the catarrhal phase

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72
Q

how do you diagnose whooping cough

A

examination and clinical findings
laboratory tests: culture, PCR, serological testing or oral fluid testing

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73
Q

how is whooping cough managed

A

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

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74
Q

what are the different kinds of polio infection

A

abortive polio
nonparalytic polio
paralytic polio
post polio syndrome

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75
Q

what are symptoms of abortive polio

A

mild flu like illness that lasts 2-3 days
fever
headache
muscle aches
sore throat
stomach ache
loss of appetite
nausea
vomiting

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76
Q

what are symptoms of non paralytic polio

A

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

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77
Q

what is paralytic polio

A

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

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78
Q

what are symptoms of post polio syndrome

A

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

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79
Q

what is the cause of polio

A

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

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80
Q

how did vaccine derived poliovirus develop

A

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

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81
Q

how does polio spread

A

faeces
droplets by sneezing or coughing
contact of saliva
contaminated water

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82
Q

what are complications of polio

A

permanent paralysis
muscle shortening that causes deformed bones or joints
chronic pain
post polio syndrome

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83
Q

how is polio prevented

A

vaccine
the CDC recommends 4 doses of vaccine at 2 months, 4 months, between 6-18 months and between 4-6 years old

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84
Q

how is polio diagnosed

A

clinical symptoms
stool sample
throat swab during the first week of illness
lumbar puncture

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85
Q

how is polio treated

A

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

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86
Q

how is TB spread

A

respiratory route
close proximity to someone infected

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87
Q

what are the symptoms of TB

A

fever
anorexia and weight loss
tender lymph nodes
cough
haemoptosis
breathlessness
chest pain
joint pain
headache
chest pain
rash

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88
Q

what is the pathophysiology of TB

A

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

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89
Q

what is Extrapulmonary TB

A

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

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90
Q

what is miliary TB

A

this is disseminated TB where the bacteria spreads through the bloodstream and affects multiple organs throughout the body

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91
Q

what are risk factors for developing TB

A

close contact with an infected individual
ethnic minority groups
recent travel to high prevalence areas
extremes of age
homelessness
immunodeficiency

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92
Q

what are the clinical findings of someone with TB

A

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

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93
Q

what investigations are done in someone with suspected TB

A

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

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94
Q

how are TB samples analysed

A

with Ziehl-Neelson stain for acid-fast bacilli

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95
Q

what can be seen on a chest X ray in someone with TB

A

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

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96
Q

how is TB managed

A

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

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97
Q

how are asymptomatic children treated for TB

A

with rifampicin and isoniazid for 3 months as this will decrease the risk of reactivation later in life

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98
Q

who is the BCG vaccination offered to in the UK

A

high risk groups
- ethnic minorities
- TB in a family member in the previous 5 years
- local area has high prevalence

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99
Q

what are complications of TB

A

pleurisy
pleural effusions
empyema
pneumothorax
bronchiectasis
respiratory failure

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100
Q

what drugs used to treat TB do you get hepatitis as a side effect

A

rifampicin
isoniazid
pyrazinamide

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101
Q

what drug used to treat TB causes visual disturbance

A

ethambutol

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102
Q

what drug used to treat TB causes peripheral neuropathy

A

isoniazid

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103
Q

what drug used to treat TB causes red urine/tears

A

rifampicin

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104
Q

what is meningitis

A

it is inflammation of the meninges of the brain

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105
Q

what is the most common cause of meningitis

A

viral meningitis

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106
Q

what are causes of bacterial meningitis in neonates - 3 months

A

Group B streptococcus
Ecoli and other coliforms
listeria monocytogenes

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107
Q

what are causes of bacterial meningitis in 1 month-6 years

A

Neisseria meningitidis
streptococcus pneumoniae
haemophilus influenzae

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108
Q

what are causes of bacterial meningitis in >6 year olds

A

neisseria meningitidis
streptococcus pneumoniae

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109
Q

what are symptoms of meningitis

A

fever
headache
photophobia
lethargy
poor feeding or vomiting
irritability
hypotonia
drowsiness
loss of consciousness
seizures

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110
Q

what is seen on examination in someone with meningitis

A

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)

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111
Q

what investigations would you do in someone with suspected meningitis

A

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

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112
Q

what are contraindications to performing a lumbar puncture

A

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

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113
Q

what is Brudzinski sign

A

flexion of the neck with the child supine causes flexion of the knees and hips

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114
Q

what is Kernig sign

A

with the child laying supine with hips and knees flexed there is back pain on extension of the knee

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115
Q

what is the management of bacterial meningitis

A

antibiotics - cefotaxime or ceftriaxone
in children under 3 months give IV cefotaxime plus amoxicillin/ampicillin to cover listeria
supportive therapy

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116
Q

what are complications of meningitis

A

hearing loss
local vasculitis
local cerebral infarction
subdural effusion
hydrocephalus
cerebral abscess

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117
Q

what is aseptic meningitis

A

when CSF has whit cells on microscopy but the gram stain is negative and no bacteria are cultured

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118
Q

in primary care what do you do if someone is suspected of having bacterial meningitis

A

URGENT transfer to hospital
IM or IV benzylpenicillin

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119
Q

how are contacts of someone with bacterial meningitis treated

A

prophylactic antibiotics given within 24 hours: ciprofloxacin or rifampicin

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120
Q

what are causes of viral meningitis

A

enterovirus
EBV
adenovirus
mumps

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121
Q

how is viral meningitis diagnosed

A

PCR of CSF
culture of stool, urine
throat swab
serology

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122
Q

what is slapped cheek syndrome

A

it is infection with parvovirus, which causes a distinctive rash that develops across the face

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123
Q

what are symptoms of slapped cheek syndrome

A

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

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124
Q

how long will the rash in slapped cheek syndrome

A

will fade within a week or two
occasionally the body rash may come and go for a few weeks after the infection has passed

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125
Q

what can be done as management for slapped cheeked syndrome

A

rest
drink plenty of fluids
paracetamol or ibuprofen
emollient on itchy skin
antihistamines

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126
Q

how is slapped cheek syndrome spread

A

droplet infection
- inhaled droplets someones sneezed or coughed out or touching a contaminated surface

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127
Q

what causes slapped cheek syndrome

A

Parvovirus B19

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128
Q

what is impetigo

A

common and highly contagious skin infection that causes sores and blisters

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129
Q

what are the two types of impetigo

A

non-bullous impetigo - most common
bullous impetigo

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130
Q

what are the symptoms of non bullous impetigo

A

begins with red sores normally around the nose and mouth, but other areas of the face and limbs can be affected as well
sores quickly burst leaving thick golden crusts
after crusts dry they leave a red mark that fade without scarring
sores arent painful but they can be itchy
high temperature (fever)
swollen glands

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131
Q

what are symptoms of bullous impetigo

A

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

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132
Q

what are the causes of impetigo

A

skin infected with bacteria
- staphylococcus aureus
- streptococcus pyogenes

133
Q

how long does it takes for impetigo symptoms to appear after initial infection

A

between 4-10 days after initial exposure

134
Q

how is impetigo treated

A

usually gets better without treatment in around 2-3
treatment recommended as it rescues length of illness and severity
antibiotics are prescribed - oral or topical
- topical mupirocin
- cephalosporins, clindamycin, sulfamethoxazole

135
Q

how long is impetigo infectious for

A

until the rash disappears
until the scabs fall off
until you’ve finished at least two days of antibiotics

136
Q

what are the complications of impetigo

A

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

137
Q

how is impetigo diagnosed

A

clinical diagnosis
may take a skin culture

138
Q

what is candidiasis

A

it is a fungal infection caused by an overgrowth of a type of of yeast that lives on your body

139
Q

what types of candidiasis exists

A

vaginal candidiasis
cutaneous candidiasis
oral candidiasis
candida granuloma
invasive candidiasis - systemic

140
Q

who does candidiasis most commonly affect

A

people with diabetes
pregnant people
babies and infants
people who wear dentures
immunocompromised people
catheter users

141
Q

what are the symptoms of candidiasis

A

discomfort
itching
irritation
redness of the skin with raised bumps
burning
vaginal discharge
white patches or sores in your mouth
swelling

142
Q

what can cause candidiasis

A

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

143
Q

how is candidiasis diagnosed

A

clinical diagnosis
may also do fungal swabs and culture

144
Q

how is candidiasis treated

A

antifungal medication - oral or topical

145
Q

what can cause candidiasis in a child

A

when skin is damaged
when warm or humid
when child is immunocompromised
use of antibiotics

146
Q

how is candidiasis treated in a child

A

topical antifungals
suppositories
mouthwash or lozenges
severe infection may need oral or IV meds

147
Q

what are risk factors for children to get candidiasis

A

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

148
Q

what is diaper rash

A

rash in diaper area caused by candidiasis infection

149
Q

what does diaper rash look like

A

small or bid red patches, may be entirely brightly red, or have raised edges or small bumps
pimples that ooze pus

150
Q

what is toxic shock syndrome

A

rare but life threatening complication of bacterial infection or colonisation chaacterised by high fever, rash, and shock

151
Q

what causes toxic shock syndrome

A

typically one of two types of bacteria
- staphylococcus aureus
- streptococcus pyogenes

152
Q

what are causes of staph.aureus toxic shock syndrome

A

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

153
Q

what are causes of strep. pyogenes toxic shock syndrome

A

in those who have recently had chickenpox, bacterial cellulitis or have recently given birth and have had surgery or have wounds

154
Q

what are signs/symptoms of staphylococcus toxic shock syndrome

A

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

155
Q

what are symptoms of streptococcal toxic shock syndrome

A

low blood pressure
decreased kidney function
bleeding issues
bruising
red, flat rash
decreased liver function
decreased urine output
difficulty breathing
sloughing of skin

156
Q

how is toxic shock syndrome diagnosed

A

blood cultures
blood tests
urine tests
wound cultures if needed
lumbar puncture

157
Q

how is toxic shock syndrome treated

A

IV antibiotics
IV fluids
dialysis
administration of blood products
supplemental oxygen or mechanical ventilation
deep surgical cleaning of infected wound

158
Q

what is scarlet fever

A

scarlet fever is a bacterial illness which causes a distinctive red rash

159
Q

what causes scarlet fever

A

streptococcus pyogenes bacteria - Group A

160
Q

what are the symptoms of scarlet fever

A

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

161
Q

how soon does the rash in scarlet fever develop after the initial symptoms

A

12-48 hours

162
Q

how long do symptoms of scarlet fever develop after initial infection

A

between 2-5 days

163
Q

how does scarlet fever spread

A

breathing in bacteria in airborne droplets from an infected person
touching the skin of a person
sharing contaminated towels, clothes or bed linin

164
Q

who is affected by scarlet fever

A

mostly in children under 10

165
Q

how is scarlet fever treated

A

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

166
Q

how long should a child stay away from school/nursery with scarlet fever

A

at least 24 hours after starting antibiotic treatment

167
Q

what are complications of scarlet fever

A

ear infection
throat abscess
sinusitis
pneumonia
bacteraemia
septic arthritis
meningitis
necrotizing fasciitis
streptococcal toxic shock syndrome

168
Q

what is coxsackie disease

A

otherwise known as hand foot and mouth disease, it is a milk, contagious viral infection common in young children

169
Q

what are symptoms of hand foot and mouth disease

A

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

170
Q

how long is the period from initial infection to the time symptoms appear in hand foot and mouth disease

A

3 to 6 days

171
Q

how soon after the fever begins do the sores develop in hand foot and mouth disease

A

one or two days after the fever begins the painful sores will develop

172
Q

what are the causes of hand foot and mouth disease

A

infection with coxsackievirus 16

173
Q

how does coxsackievirus infection spread

A

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

174
Q

when is someone most contagious with hand foot and mouth disease

A

in the first week of having the disease

175
Q

what are risk factors for developing hand foot and mouth disease

A

age - mostly affects children ages 5-7
those immunosuppressed

176
Q

what are complications of hand foot and mouth

A

dehydration
viral meningitis
encephalitis

177
Q

how is hand foot and mouth diagnosed

A

clinical diagnosis
throat swab or stool specimen

178
Q

how is hand foot and mouth treated

A

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

179
Q

how can you prevent vertical transmission of HIV

A

use of antenatal, perinatal or postnatal antiretroviral drugs
avoid labour and birth canal contact by elective caesarean section
avoidance of breastfeeding

180
Q

what are he clinical features of HIV in children

A

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

181
Q

what are AIDs defining illnesses in a HIV positive child

A

lymphocytic interstitial pneumonitis
PCP
infection
candida oesophagitis

182
Q

how is HIV diagnosed in children

A

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

183
Q

how is HIV treated in children

A

prophylaxis against PCP - co-trimoxazole
avoidance of live oral polio vaccine and HCG
antiretroviral therapy
social, psychological and family support

184
Q

how is HIV transmitted

A

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

185
Q

when would a woman with HIV have a normal vaginal delivery

A

if her viral load is below 50 copies/ml

186
Q

when would a woman with HIV have a caesarean section

A

considered in patients with over 50 copies/ml and in al women with over 400 copies /ml

187
Q

when is IV zidovudine given in birth where the woman is HIV positive

A

given during caesarean when the viral load is unknown or if there are over 10,000 copies/ml

188
Q

what prophylaxis treatment is given for babies born of mothers who have HIV

A

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

189
Q

when do you test children for HIV with HIV positive patents

A

HIV viral load test at 3 months
HIV antibody test at 24 months

190
Q

what will the paediatric HIV MDT be involved in

A

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

191
Q

what is encephalitis

A

inflammation of the brain as a result of infective or non infective causes

192
Q

what is the most common cause of encephalitis

A

with a virus - HSV is the most common.
other causes include; VZV, CMV, EBV, enterovirus, adenovirus, influenza virus

193
Q

how does encephalitis present

A

altered consciousness
altered cognition
unusual behaviour
acute onset of focal neurological symptoms
acute onset of focal seizures
fever

194
Q

how is encephalitis diagnosed

A

LP - CSF for viral PCR
Ct scan if LP is contraindicated
MRI scan
EEG recording
swabs - viral and vesicle
HIV testing

195
Q

what are contraindications to a lumbar puncture

A

GCS below 9
haemodynamically unstable
active seizures
post ictal

196
Q

what is the management of encephalitis

A

IV antiviral medications
- aciclovir for HSV and VZV
- ganciclovir for CMV
repeat LP
follow up, support and rehabilitation

197
Q

what are complications of encephalitis

A

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

198
Q

what are signs of sepsis in children

A

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)

199
Q

what are the NICE guidelines that cover assessment of a child under 5 with a fever

A

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

200
Q

what is the immediate management of a child with sepsis

A

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

201
Q

what additional investigations may be performed if sepsis in a child is suspected

A

Chest X ray
abdominal and pelvic ultrasound
lumbar puncture
meningococcal PCR
serum cortisol if adrenal crisis suspected

202
Q

what is septic shock

A

when sepsis leads to cardiovascular dysfunction
- arterial blood pressure falls resulting in hypo-perfusion and leads to anaerobic respiration

203
Q

what is the pathophysiology of sepsis

A

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

204
Q

what virus causes infectious mononucleosis

A

EBV

205
Q

how is EBV transmitted

A

spread by saliva of the infected individuals - kissing, sharing cups, toothbrushes, and other equipment that transmits saliva

206
Q

how long can people be infected with EBV before the illness begins

A

can be infectious for several weeks before the illness begins and is secreted in their saliva

207
Q

what are features of infectious mononucleosis

A

Fever
Sore throat
Fatigue
Lymphadenopathy (swollen lymph nodes)
Tonsillar enlargement
Splenomegaly and in rare cases splenic rupture

208
Q

what antibodies are produces in infectious mononucleosis

A

heterophile antibodies - takes up to 6 weeks for these antibodies to be produced

209
Q

how can you test for heterophile antibodies

A

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

210
Q

what specific antibody tests are there for infectious mononucleosis

A

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

211
Q

how is infectious mononucleosis managed

A

self limiting, lasts around 2-3 weeks
avoid alcohol
avoid contact sports due to risk of splenic rupture

212
Q

what are complications of infectious mononucleosis

A

Splenic rupture
Glomerulonephritis
Haemolytic anaemia
Thrombocytopenia
Chronic fatigue
EBV infection is associated with certain cancers, notable Burkitt’s lymphoma.

213
Q

how is mumps spread

A

respiratory droplets

214
Q

what is the incubation period of mumps

A

14-25 days

215
Q

how does mumps present

A

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)

216
Q

how is mumps diagnosed

A

PCR testing of saliva swab
blood or saliva tested for antibodies
clinical diagnosis

217
Q

how is mumps managed

A

need to notify public health with any suspected and confirmed cases
supportive management: rest, fluid and analgesia

218
Q

what are the complications of mumps

A

Pancreatitis
Orchitis
Meningitis
Sensorineural hearing loss

219
Q

what type of virus is Hep B

A

DNA virus

220
Q

how is hepatitis B transmitted

A

contact with blood or bodily fluids
- sexual intercourse
- sharing needles
- contaminated products such as toothbrushes or contact between minor cuts or abrasions
- vertical transmission

221
Q

what is the risk of developing chronic hepatitis B after exposure in children

A

90% for neonates
30% for children under 5
under 10% for adolescents

222
Q

what are the symptoms of hepatitis B in children

A

most are asymptomatic
less that 5% will develop liver cirrhosis
less than 0.05% will develop hepatocellular carcinoma (risk increases when they enter adulthood)

223
Q

what viral markers are there for hepatitis B

A

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

224
Q

what does HBsAb demonstrate

A

demonstrates an immune response, however it is given in the vaccine and so it may simply indicate they have been vaccinated

225
Q

how can HBcAb distinguish between acute, chronic and past infection

A

can measure IgM and IgG versions
- IgM implies active infection, with a higher titre indicating acute infection
- IgG indicates past infection

226
Q

which children are important to test for hepatitis B

A

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

227
Q

how do you reduce the risk of a baby contracting Hepatitis B if their mother is positive for hepatitis B

A

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

228
Q

can mothers positive with Hep B breastfeed

A

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

229
Q

what is the hepatitis B vaccination

A

it is an injection of the hepatitis B surface antigen and requires 3 doses at different intervals

230
Q

how are children with chronic hepatitis B managed

A

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

231
Q

what type of virus is Hep C

A

RNA virus

232
Q

how is Hep C spread

A

via blood and bodily fluids

233
Q

how common is vertical transmission in hep C

A

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.

234
Q

how is hepatitis C tested for

A

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

235
Q

what is the management of hepatitis C in children

A

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

236
Q

what treatment is given to children with hepatitis C

A

pegylated interferon and ribavirin

237
Q

what is otitis media

A

it is an infection in the middle ear

238
Q

what is the middle ear

A

it is the space that sits between the tympanic membrane and the inner ear - where the cochlea, vestibular apparatus and nerves are found

239
Q

how can bacteria enter the middle ear

A

enters from the back of the throat through the eustachian tube

240
Q

what is a bacterial infection of the middle ear often preceeded by

A

a viral upper respiratory tract infection

241
Q

what bacteria most commonly cause otitis media

A

streptococcus pneumoniae.

Other common causes include:
Haemophilus influenzae
Moraxella catarrhalis
Staphylococcus aureus

242
Q

how does otitis media present

A

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

243
Q

what will a tympanic membrane look like in otitis media

A

bulging
red
inflamed
if perforated will see discharge in the ear canal and a hole in the tympanic membrane

244
Q

how is otitis media managed

A

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

245
Q

what is the treatment used for otitis media

A

amoxicillin for 5 days
alternatives are erythromycin and clarithromycin

246
Q

what are complications of otitis media

A

Otitis medial with effusion
Hearing loss (usually temporary)
Perforated eardrum
Recurrent infection
Mastoiditis (rare)
Abscess (rare)

247
Q

what is glue ear

A

otitis media with effusion, where the middle ear becomes full of fluid causing a loss of hearing in the ear

248
Q

what causes glue ear

A

when the eustachian tube becomes blocked, there is a build up of secretions in the middle ear which normally drains, causing loss of hearing

249
Q

what is the main symptom of glue ear

A

loss of hearing in the affected ear

250
Q

what is the main complication of glue ear

A

otitis media - infection

251
Q

what will otoscopy show in someone with glue ear

A

dull tympanic membrane with air bubbles or a visible fluid level
can look normal

252
Q

what is the management of glue ear

A

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

253
Q

what are grommets

A

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

254
Q

how are grommets removed

A

they usually fall out within a year, and only 1 in 3 patients require further grommets to be inserted for persistent glue ear

255
Q

what are congenital causes of hearing loss

A

maternal rubella or CMV infection during pregnancy
genetic deafness - recessive/dominant
associated syndromes such as Downs

256
Q

what are perinatal causes of hearing loss

A

prematurity
hypoxia during or after birth

257
Q

what are causes of hearing loss after birth

A

jaundice
meningitis and encephalitis
otitis media or glue ear
chemotherapy

258
Q

how is hearing of newborns tested in the UK

A

the newborn hearing screening programme tests hearing in all neonates
- can identify congenital hearing problems early

259
Q

what are signs in children that they may have issues with their hearing

A

Ignoring calls or sounds
Frustration or bad behaviour
Poor speech and language development
Poor school performance

260
Q

what is audiometry

A

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

261
Q

what are the results of audiometry recorded on

A

on an audiogram which can help identify and differentiate between conductive and sensorineural hearing loss

262
Q

what are audiograms

A

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

263
Q

what are normal readings on audiograms

A

when someone has normal hearing all readings will between 0 and 20 dB at the top of the chart

264
Q

what is sensorineural hearing loss

A

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.

265
Q

what will sensorineural hearing loss look like on an audiogram

A

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.

266
Q

what is conductive hearing loss

A

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.

267
Q

what will conductive hearing loss look like on an audiogram

A

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.

268
Q

what will mixed hearing loss look like on an audiogram

A

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).

269
Q

how is hearing loss managed

A

MDT approach
Speech and language therapy
Educational psychology
ENT specialist
Hearing aids for children who retain some hearing
Sign language
specialist schools

270
Q

what is the most common cause of bacterial tonsillitis

A

group A streptococcus

271
Q

what are other bacterial causes of tonsillitis

A

Haemophilus influenzae
Morazella catarrhalis
Staphylococcus aureus

272
Q

what is Waldeyer’s tonsillar ring

A

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.

273
Q

which tonsils are typically affected in tonsillitis

A

the palatine tonsils, these are the tonsils either side at the back of the throat

274
Q

what are features of tonsillitis

A

fever
sore throat
painful swallowing
poor oral intake
headache
vomiting

275
Q

what will examination of the throat reveal in tonsillitis

A

red inflamed and enlarged tonsils with or without exudates

276
Q

what is the centor criteria

A

it is used to eliminate the probability that tonsilitis is due to bacterial infection and will benefit from antibiotics

277
Q

what score would give a higher probability that tonsillitis is caused by bacteria

A

a score of 3 or more gives a 40-60% probability of bacterial tonsillitis

278
Q

what features are looked at in the centor criteria

A

Fever over 38ºC
Tonsillar exudates
Absence of cough
Tender anterior cervical lymph nodes (lymphadenopathy)
each one present is given one point

279
Q

what is the FeverPAIN score

A

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

280
Q

what factors are looked at in the FeverPAIN score

A

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

281
Q

what is the management of tonsilitis

A

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

282
Q

what are complications of tonsillitis

A

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

283
Q

what is Quinsy

A

it is the common name for a peritonsillar abscess

284
Q

what causes quinsy

A

when there is a bacterial infection with trapped pus, forming an abscess in the region of the tonsils

285
Q

how does quinsy present

A

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

286
Q

what are the common bacteria that causes quinsy

A

streptococcus pyogenes (group A)
staphylococcus aureus
haemophilus influenzae

287
Q

what is the management of quincy

A

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)

288
Q

what is a tonsillectomy

A

it is the name for the surgical removal of the tonsils

289
Q

what are indications for a tonsillectomy

A

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

290
Q

what are complications of a tonsillectomy

A

pain - sore throat can last 2 weeks
damage to teeth
infection
post-tonsillectomy bleeding
risks of general anaesthetic

291
Q

what is post tonsillectomy bleeding

A

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

292
Q

how long after a tonsillectomy can post tonsillectomy bleeding occur

A

can happen up to two weeks after the operation

293
Q

what is the management for post tonsillectomy bleeding

A

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

294
Q

prior to going back into theater what two options are there for stopping less severe bleeds in post tonsillectomy bleeding

A

hydrogen peroxide gargle
adrenaline soaked swab applied topically

295
Q

where do nosebleeds originate form

A

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

296
Q

what causes a nosebleed

A

then the mucosa in the Kiesselbachs plexus gets disrupted and the blood vessels are exposed, then the nose becomes prone to bleeding

297
Q

what can initiate a nosebleed

A

nose picking
colds
vigorous nose blowing
trauma
changes in weather

298
Q

what does bleeding from both nostrils indicate

A

may indicate bleeding posteriorly in the nose

299
Q

what is the management of nosebleeds

A

will usually resolve without medical assistance
recurrent and significant nosebleeds might require investigations to look for underlying disease such as thrombocytopenia or clotting disorders

300
Q

what advice would you give parents on how to manage nosebleeds

A

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

301
Q

when may patients require hospital admission for a nosebleed

A

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

302
Q

what are the treatment options for a nosebleed in hospital

A

nasal packing using nasal tampons or inflatable packs
nasal cautery using a silver nitrate stick

303
Q

after treating a nosebleed what can be prescribed to help with recovery

A

consider prescribing naseptin (chlorhexidine and neomycin) four times a day for ten days,
helps reduce crusting, inflammation and infection

304
Q

when is Naseptin contraindicated

A

in peanut or soya allergy

305
Q

what is tongue tie

A

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

306
Q

how does tongue tie present

A

it normally presents with difficulty feeding (particularly breastfeeding)
also can be picked up on newborn baby check

307
Q

what is the management of tongue tie

A

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

308
Q

what are the complications of frenotomy

A

very rare - excessive bleeding, scar formation, infection

309
Q

what is a cystic hygroma

A

it is a malformation of the lymphatic system that results in a cyst filled with lymphatic fluid

310
Q

what is the most common location for a cystic hygroma

A

typically in the posterior triangle of the neck, on the left hand side
can also present in the armpit

311
Q

what are the features of a cystic hygroma

A

they can be very large
are soft
are non tender
transilluminate

312
Q

what are complications of a cystic hygroma

A

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

313
Q

what is the management of a cystic hygroma

A

depends on size, location and complications
watch and wait
aspiration
surgical removal
sclerotherapy

314
Q

what is thyroglossal cyst

A

this is when part of the thyroglossal duct persists giving rise to a fluid filled cyst

315
Q

what is the pathophysiology of a thyroglossal cyst

A

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

316
Q

what is the key differential diagnosis of a thyroglossal cyst

A

ectopic thyroid tisue

317
Q

what is the main complication of a thyroglossal cyst

A

infection of the cyst

318
Q

what are the key features of a thyroglossal cyst

A

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

319
Q

how are thyroglossal cysts diagnosed

A

clinical diagnosis
ultrasound and CT scan can confirm the diagnosis

320
Q

how are thyroglossal cysts managed

A

usually surgically removed to provide diagnosis and prevent infections
can reoccur after surgery unless the full thyroglossal duct is removed

321
Q

what is a branchial cysts

A

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

322
Q

what do brachial cysts present as

A

round, soft, cystic swelling between the angle of the jaw and the sternocleidomastoid muscle in the anterior triangle of the neck

323
Q

when do brachial cysts most commonly present

A

tend to present after the age of 10 years, most commonly in young adulthood when the cyst becomes noticeable or infected.

324
Q

what is the difference between sinuses and fistulas

A

sinuses are blind ending pouches
fistulas are an abnormal connection between two epithelial surfaces

325
Q

what is a brachial cleft sines

A

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

326
Q

what is a brachial pouch sinus

A

this is when the brachial cyst is connected via a tract to the oropharynx

327
Q

what is a brachial fistula

A

this is when there is a tract connecting the oropharynx to the outer skin surface via the brachial cyst

328
Q

what is the management of a brachial cyst

A

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

329
Q
A

Phase 3a Jemima (16 decks)

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