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Phase 3a medicine > Paediatrics - Infectious diseases + Skin > Flashcards

Paediatrics - Infectious diseases + Skin Flashcards

1
Q

Name a bacterial cause of Impetigo

A

Staphylococcus aureus (the most common cause).
Streptococcus pyogenes
Meticillin-resistant Staphylococcus aureus (MRSA)

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2
Q

Non-bullous vs Bullous Impetigo

A

Non-Bullous: Asymptomatic/itchy, Lesions are thin walled vesicles or pustules (seldom seen on clinical examination as they rupture quickly) which release exudate forming a golden/brown crust, leaving mild erythema which then fades — healing occurs spontaneously without scarring within 2-3 weeks.
Bullous: Lesions are flaccid fluid filled vesicles and blisters (often diameter 1-2cm) which can persist for 2-3 days. Blisters rupture leaving flat yellow/brown crust. Healing usually occurs within 2-3 weeks without scarring

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3
Q

Name a cause of Urticaria (Hives)

A

Allergies, viral infection, pressure, friction, sweating, cold, heat, sunlight and water

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4
Q

What is the treatment for Hives?

A 
Often no treatment is necessary, as the rash commonly goes within 24-48 hours
Calamine lotion can help with itching
Avoid triggers
Antihistamines
Steroid tablets
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5
Q

Name a type of Angioedema

A

Allergic, Non-allergic drug reaction, Idiopathic, Hereditary, Acquired C1-INH deficiency (SLE)
(ACE-inhibitor induced Angioedema!)

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6
Q

How might Angioedema with weals and airway involvement be managed?

A

(similar to anaphylaxis)

adrenaline (epinephrine), antihistamines and steroids

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7
Q

Differences between Angioedema and Urticaria (Hives)

A

Angioedema:
Tissues involved - Subcutaneous and submucosal surfaces.
Organs affected - Skin and mucosa, particularly the eyelids, lips and oropharynx.
Duration - Transitory (between 24-96 hours).
Symptoms - Pruritus may or may not be present. Often accompanied by pain and tenderness.
Physical signs - Erythematous or skin-coloured swellings occurring below the surface of the skin.

Hives
Tissues involved - Epidermis and dermis.
Organs affected - Skin only.
Duration - Transitory (usually <24 hours).
Symptoms - Pruritus is usually present. Pain and tenderness are uncommon.
Physical signs - Erythematous patches and weals on the surface of the skin.

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8
Q

What is the cause of Pityriasis Versicolor and is it contagious?

A

Fungal (yeast-like germ - Malassezia) and Not contagious

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9
Q

Name 3 clinical features of Kawasaki disease?

A

Fever (lasting >5 days); Irritability; Erythema; Bilateral conjunctivitis; Rash; Inflammation of lips, mouth and/or tongue; Cervical lymphadenopathy

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10
Q

A common complication associated with Kawasaki disease?

A

Coronary artery aneurysm

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11
Q

What age range does Kawasaki disease usually affect?

A

6 month to 5year old

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12
Q

Name a type of percutaneous coronary intervention for coronary artery aneurysm

A

Balloon angioplasty; Cardiac stent; Ablation therapy; Intracoronary thrombolysis

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13
Q

Name 3 types of management of Kawasaki disease

A

High-dose Aspirin; IVIg therapy; Corticosteroid; Ant-TNF (Infliximab)

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14
Q

Most common cause of Scarlet Fever

A

Group A Strep (Streptococcus Pyogenes)

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15
Q

What kind of bacteria is Streptococcus Pyogenes?

A

Group A Beta-haemolytic Streptococcus

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16
Q

Name two symptoms/signs of Scarlet Fever

A

Red/White ‘strawberry’ tongue; Fever; Very red, sore throat; Scarlatiniform rash; Headache/Vomiting

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17
Q

Investigations of Scarlet Fever

A

Throat swab + culture; Rapid Antigen Test; Streptococcal antibody test; FBC (polymorphonuclear leukocytosis)

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18
Q

Management of Scarlet Fever (Abx, pain + ?)

A

Antibiotics (Penicillin/Azithromycin); Fluids; Pain relief (Ibuprofen/Parac)

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19
Q

What would a Red Risk febrile child <5 years look like?

A

pale/mottled; weak cry; grunting; RR>60bpm; not responding to social cues; Non-blanching rash; decreased skin turgor

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20
Q

What would an Amber Risk febrile child <5 years look like?

A

pallour; not responding to social cues; no smile; nasal flaring; tachypnoea; O2 sat<95% in air; tachycardia; dry mucous membrane; temp>39C

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21
Q 
Name a feature of:
Chickenpox
Measles
Mumps
Rubella
Scarlet Fever
Hand, foot and mouth disease
A

Chickenpox - Fever initially; Itchy rash starting on head/trunk before spreading. Initially macular then papular then vesicular
Measles - Prodrome: irritable, conjunctivitis, fever; Koplik spots: white spots (‘grain of salt’) on buccal mucosa; Rash starts behind ears then to whole body, discrete maculopapular rash becoming blotchy & confluent
Mumps - Fever, malaise, muscular pain, Parotitis
Rubella - Rash: pink maculopapular, initially on face before spreading to whole body, usually fades by the 3-5 day, Lymphadenopathy
Scarlet Fever - Fever, malaise, tonsillitis; ‘Strawberry’ tongue; Rash - fine punctate erythema sparing the area around the mouth
Hand, foot and mouth disease - (coxsackie A16) Mild systemic upset: sore throat, fever; Vesicles in the mouth and on the palms and soles of the feet

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22
Q

Shingles is a painful rash caused by an infection of a nerve underneath the skin with what virus?

A

varicella-zoster virus

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23
Q

Name an antiviral medication used to treat Shingles

A

Aciclovir, Famciclovir, Valaciclovir

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24
Q

Name three types of medication used to treat shingles

A

Painkillers (Paracetamol); Antiviral (Aciclovir); Steroids (Prednisolone)

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25
Q

Hand, foot and mouth disease is caused by what virus?

A

Coxsackie A16 virus

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26
Q

Scarlet Fever is caused by reaction to erythrogenic toxins produced by what type of bacteria

A

Group A Streptococci

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27
Q

A ‘slapped cheek appearance’ in a 4-year-old boy with fever and malaise would be caused by what virus?

A

Parvovirus B19

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28
Q

Rubella might present with what type of rash?

A

Pink maculopapular, initially on face before spreading to whole body

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29
Q

Chickenpox is caused by what virus?

A

Varicella-zoster virus

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30
Q

Chickenpox might present with what type of rash/spots?

A

Small itchy spots/blisters

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31
Q

Name an investigation for Coxsackievirus infection (hand, foot and mouth)

A

Throat, vesicle or rectal swab; IgM with enzyme-linked immunosorbent assay (ELISA); PCR test

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32
Q

Name an investigation for Parvovirus B19 infection

A

B19 specific IgM + IgG testing; PCR test

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33
Q

Name an investigation for measles

A

Salivary swab; IgM test

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34
Q

Name 3 features of Measles

A

Koplik spots (inside of cheek); maculopapular (morbilliform) rash starts behind ears then to whole body; Fever; Cough; Coryza; Conjunctivitis

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35
Q

What does morbilliform mean when describing rash

A

Measles-like

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36
Q

Mumps is caused by what type of virus

A

Morbillivirus (Paramyxovirus)

37
Q

Meningococcal disease is caused by what bacterium?

A

Neisseria meningitidis

38
Q

What is the leading infectious cause of death in early childhood?

A

Meningococcal disease

39
Q

N. meningitides is usually found where/ in which mucous membranes in the human body?

A

In the mucous membrane of the nose and throat

40
Q

Most infections of meningococcal disease occur during what seasons?

A

winter and early spring

41
Q

Name 5 features of bacterial meningitis

A

Fever; Headache; Stiff neck/back rigidity; bulging fontanelle (in infants); photophobia; altered mental state; Non-blanching rash; Shock; Paresis; Seizures; Kernig’s sign; Brudzinski’s sign

42
Q

Bacterial meningitis is suspected due to a non-blanching rash. What antibiotic should be given whilst waiting for the ambulance?

A

Benzylpenicillin (alternative: Cefotaxime)

43
Q

Name 3 investigations for bacterial meningitis

A

Blood culture; FBC (+U&E,LFT,CRP,Renal); PCR test; aPTT; (disseminated IV coagulation.); Pharyngeal swab; LP; Aspirate for MC+S

44
Q

Kawasaki disease is classified by a fever which is present for 5 days or more along with 4 of the following features:

A 
Dry cracked lips
Bilateral conjunctivitis
Peeling of skin on fingers and toes
Cervical lymphadenopathy
Red rash over trunk
45
Q

Name 3 symptoms of meningitis in children

A

Neck stiffness; photophobia; drowsy/irritable; vomit; headache; bulging fontanelle, Kernig’s sign

46
Q

Name 3 symptoms of meningococcal septicaemia in children

A

red/purple non-blanching rash; cold hands and feet; tachypnoea

47
Q

What is indicated in Kawasaki disease, despite it usually being contraindicated in children

A

High-dose Aspirin

48
Q

What is the most common complication of measles?

A

Otitis media

49
Q

what is the most common congenitally acquired infection in the developed world?

A

Cytomegalovirus (CMV)

50
Q

What is the appropriate treatment for Meningitis in children < 3 months?

A

IV Cefotaxime and IV Amoxycillin

51
Q

6 diagnostic criteria for Kawasaki’s and management?

A

Features

  • high-grade fever which lasts for > 5 days. Fever is characteristically resistant to antipyretics
  • conjunctival injection
  • bright red, cracked lips
  • strawberry tongue
  • cervical lymphadenopathy
  • red palms of the hands and the soles of the feet which later peel

Management

  • high-dose aspirin
  • intravenous immunoglobulin
  • echocardiogram (rather than angiography) is used as the initial screening test for coronary artery aneurysms
52
Q

Would you prescribe Mebendazole for the individual patient with Threadworm or prescribe for their household?

A

Household contacts of patients with threadworms should be treated even if they have no symptoms

53
Q

Seborrhoeic dermatitis is a common skin disorder seen in the first few weeks of life, affecting the scalp (‘Cradle cap’), nappy area, face and limb flexures. It is characterised by an erythematous rash with coarse yellow scales.

What is management for mild and severe cases?

A

mild-moderate: baby shampoo and baby oils

severe: mild topical steroids e.g. 1% hydrocortisone

54
Q

A 14-year-old boy has just returned from a holiday abroad.

His mum has noticed an itchy widespread rash on his back.

On examination, he has a large number of light brown macules and confluent patches affecting most of his back and chest. Examination is otherwise unremarkable.

What would be the most appropriate management in this case?

A

pityriasis versicolor, a common fungal skin infection

Treatment consists of topical antifungals - NICE recommends ketoconazole shampoo

55
Q

Management of Meningitis?

1, 2, 3, 4, 5

A
  1. Antibiotics
    < 3 months: IV amoxicillin (or ampicillin) + IV cefotaxime
    > 3 months: IV cefotaxime (or ceftriaxone)
  2. Steroids
    NICE advise against giving corticosteroids in children younger than 3 months
    dexamethsone should be considered if the lumbar puncture reveals any of the following:
    frankly purulent CSF
    CSF white blood cell count greater than 1000/microlitre
    raised CSF white blood cell count with protein concentration greater than 1 g/litre
    bacteria on Gram stain
  3. Fluids
    treat any shock, e.g. with colloid
  4. Cerebral monitoring
    mechanical ventilation if respiratory impairment
  5. Public health notification and antibiotic prophylaxis of contacts
    ciprofloxacin is now preferred over rifampicin
56
Q

What are some contraindications for lumbar puncture in a child with meningitis?

A
  • Any signs of raised ICP or meningococcal septicaemia
  • focal neurological signs
  • papilloedema
  • significant bulging of the fontanelle
  • disseminated intravascular coagulation
  • signs of cerebral herniation
57
Q

What should be considered in infants with vague signs such as poor feeding, grunting, lethargy?

A

Neonatal sepsis

  • Respiratory distress (85%)
  • Grunting
  • Nasal flaring
  • Use of accessory respiratory muscles
  • Tachypnoea
  • Tachycardia: common, but non-specific
  • Apnoea (40%)
  • Apparent change in mental status/lethargy
  • Jaundice (35%)
  • Seizures (35%): if cause of sepsis is meningitis
  • Poor/reduced feeding (30%)
  • Abdominal distention (20%)
  • Vomiting (25%)
58
Q

What does NICE recommend as a first-line regimen for suspected or confirmed neonatal sepsis?
(+ Other important factors to consider for management?)

A

intravenous benzylpenicillin with gentamicin

Other important management factors to consider include:

  • Maintaining adequate oxygenation status
  • Maintaining normal fluid and electrolyte status: severely ill neonates may require volume and/or vasopressor support. Body weight needs to be measured daily for accurate assessment of fluid status
  • Prevention and/or management of hypoglycaemia
  • Prevention and/or management of metabolic acidosis
59
Q

How long should a child with chickenpox be excluded from school?

A

until all the lesions are dry and have crusted over (usually about 5 days after the onset of the rash)

60
Q

Eczema management?

Name a thin and a thick cream?

A
  • Emollients are the first-line during both acute flares and remissions of the condition.
    (Thin creams - E45, Diprobase cream, Oilatum cream, Aveeno cream, Cetraben cream, Epaderm cream)
    (Thick emollients - Hydromol ointment, Diprobase ointment, Cetraben ointment)
  • The use of topical steroids should be considered for red, inflamed skin. The lowest potency and amount of topical corticosteroid necessary to control symptoms should be prescribed, depending on the severity of the flare.
  • Mild: Hydrocortisone 0.5%, 1% and 2.5%
  • Moderate: Eumovate (clobetasone butyrate 0.05%)
  • Potent: Betnovate (betamethasone 0.1%)
  • Very potent: Dermovate (clobetasol propionate 0.05%)
  • If there is persistent, severe itch, or urticaria, a one-month trial of a non-sedating antihistamine should be considered.
  • If itching is severe and affecting sleep, a short course of a sedating antihistamine should be considered (if appropriate).
  • If there is severe, extensive eczema, a short course of oral corticosteroids should be considered.
  • If eczema is weeping, crusted, or there are pustules, with fever or malaise, secondary bacterial infection should be considered, and antibiotic treatment should be prescribed.
61
Q

Where is atopic dermatitis most commonly found?

A

Flexor surfaces, face and neck

62
Q

What are some environmental triggers of eczema?

A

changes in temperature, certain dietary products, washing powders, cleaning products and emotional events or stresses

63
Q

What is the most common infective organism in relapses of Eczema + treatment?

A

Staph. Aureus

Tx - Flucloxacillin

64
Q

Eczema herpeticum is a viral skin infection in patients with eczema caused by what?

A

herpes simplex virus (HSV) or varicella zoster virus (VZV)

65
Q

Eczema herpeticum presentation + management

A

Presentation
A typical presentation is a patient who suffers with eczema that has developed a widespread, painful, vesicular rash with systemic symptoms such as fever, lethargy, irritability and reduced oral intake. There will usually be lymphadenopathy (swollen lymph nodes).

The Rash
The rash is usually widespread and can affect any area of the body. It is erythematous, painful and sometimes itchy, with vesicles containing pus. The vesicles appear as lots of individual spots containing fluid. After they burst, they leave small punched-out ulcers with a red base.

Management
Viral swabs of the vesicles can be used to confirm the diagnosis, although treatment is usually started based on the clinical appearance.

Treatment is with aciclovir. A mild or moderate case may be treated with oral aciclovir, whereas more severe cases may require IV aciclovir.

66
Q

Name a cause of Stevens-Johnson Syndrome

A

Medications

  • Anti-epileptics
  • Antibiotics
  • Allopurinol
  • NSAIDs

Infections

  • Herpes simplex
  • Mycoplasma pneumonia
  • Cytomegalovirus
  • HIV
67
Q

Stevens-Johnson syndrome (SJS) and toxic epidermal necrolysis (TEN) are medical emergencies and patients should be admitted to a suitable dermatology or burns unit for treatment.

What are some treatment options?

A

Treatment options include steroids, immunoglobulins and immunosuppressant medications

68
Q

Name a complication of Stevens-Johnson Syndrome

A
  • Secondary infection: The breaks in the skin can lead to secondary bacterial infection, cellulitis and sepsis.
    • Permanent skin damage: Skin involvement can lead to scarring and damage to skin, hair, nails, lungs and genitals.
  • Visual complications: Depending on the severity, eye involvement can range from sore eyes to severe scarring and blindness.
69
Q

Name some typical clinical features of Allergic Rhinitis

A
  • Typical symptoms - sneezing, nasal itching, discharge (rhinorrhoea), and congestion.
  • Possible associated allergic conjunctivitis, asthma, or eczema.
  • Occur following exposure to a known causative allergen
70
Q

Treatment options for Allergic Rhinitis?

A

Initial management of allergic rhinitis should include advice on:

  • Sources of information and support.
  • Possible use of nasal irrigation with saline.
  • Allergen avoidance techniques if there is a specific identified causative allergen.
  • The use of an as-needed intranasal antihistamine or non-sedating oral antihistamine or intranasal chromone.
  • The use of a regular intranasal corticosteroid during periods of allergen exposure
  • Arranging review after 2–4 weeks if symptoms persist, as management may need to be stepped up.

Management of refractory allergic rhinitis should include offering:

  • Possible add-on treatments, such as an intranasal decongestant, intranasal anticholinergic, combination intranasal antihistamine and corticosteroid, or leukotriene receptor antagonist, depending on the nature of symptoms, the person’s age, and personal preferences.
  • A short course of oral corticosteroid for severe, uncontrolled symptoms that are significantly affecting quality of life.
71
Q

Type 1 hypersensitivity reaction:

  1. ) Allergen reacts with specific IgE antibodies on which cells? (2 types)
  2. ) triggering rapid release of what chemical?
A

1.) Mast cells and Basophils
2.) Histamine
(causing capillary leakage, mucosal oedema and ultimately shock and asphyxia)

72
Q

Staphylococcal scalded skin syndrome (SSSS) usually affects children of what age?

A

Under 5 years old

73
Q

What type of medication should be used to treat cardiovascular dysfunction in Septic Shock?

A

Inotropes (eg. Noradrenalin)

74
Q

What types of Polio vaccine are available and when are the 5 doses administered?

A
  1. ) Live attenuated vaccine virus in oral polio vaccine (OPV)
  2. ) Inactivated: the Salk vaccine given by injection.
  • Three doses at 2, 3 and 4 months
  • Fourth dose at 3-5 years
  • Fifth dose at 13-18 years
75
Q

What testing should be offered to diagnose Latent TB in people who are either household contacts or close work or school contacts (aged 5 years and older) of all patients diagnosed with active TB?
(+ what is a second-line test in case of BCG causing positive result?)

A

Mantoux testing

Second-line - Interferon gamma testing

76
Q

What kind of virus is HIV?

A

RNA retrovirus

77
Q

What prophylactic treatment might be administered to prevent HIV transmission during birth?
(VERTICAL transmission)

A
  • Low risk babies, where mums viral load is < 50 copies per ml, should be given zidovudine for 4 weeks
  • High risk babies, where mums viral load is > 50 copies / ml, should be given zidovudine, lamivudine and nevirapine for 4 weeks
78
Q

What are two options for testing for HIV?

A
  • HIV antibody screen: this tests whether the immune system has created antibodies due to exposure to the HIV virus. It can take up to 3 months for antibodies to develop after exposure to the virus.
  • HIV viral load: this tests directly for viruses in the blood. This will never be falsely positive, but may come back as “undetectable” in patients on antiretroviral therapy.
79
Q

Name treatment options for HIV

A
  • Antiretroviral therapy (ART) to suppress the HIV infection
  • Normal childhood vaccines, avoiding or delaying live vaccines if severely immunosuppressed.
  • Prophylactic co-trimoxazole (Septrin) for children with low CD4 counts, to protect against pneumocystis jirovecii pneumonia (PCP)
  • Treatment of opportunistic infections
80
Q

Infectious mononucleosis (IM) is a condition caused by infection with what virus?

A

Epstein Barr virus (EBV).

81
Q

An adolescent with a sore throat develops an itchy maculopapular rash after taking amoxicillin.

What is the most likely diagnosis?

A

Mononucleosis (IM) causes an intensely itchy maculopapular rash in response to amoxicillin or cefalosporins.

82
Q

Name some features of Infectious mononucleosis (IM)

A
  • Fever
  • Sore throat
  • Fatigue
  • Lymphadenopathy (swollen lymph nodes)
  • Tonsillar enlargement
  • Splenomegaly and in rare cases splenic rupture
83
Q

In infectious mononucleosis, heterophile antibodies are produced, which are multipurpose and not specific to the EBV antigens. It takes up to 6 weeks for these antibodies to be produced.

What 2 tests can be used to detect heterophiles antibodies?

A
  • Monospot test: this introduces the patient’s blood to red blood cells from horses. Heterophile antibodies (if present) will react to the horse red blood cells and give a positive result.
  • Paul-Bunnell test: this is similar to the monospot test but uses red blood cells from sheep.
84
Q

Which Ig rises early and suggests acute infection of IM and which Ig antibody persists after the condition and suggests immunity?

A
  • The IgM antibody rises early and suggests acute infection
  • The IgG antibody persists after the condition and suggests immunity

These antibodies target something called viral capsid antigen (VCA)

85
Q

Where in the body is the most common disease manifestation of CMV found?

A

Gastrointestinal disease

86
Q

Patients with CMV disease should receive what antiviral?

A
  • Intravenous ganciclovir or oral valganciclovir until the resolution of symptoms and for a minimum of 14 days.
  • Foscarnet and cidofovir are second-line therapeutic options
87
Q

What is the most common manifestation of CMV disease in patients who are HIV-positive?
(+ how might this present?)

A

Retinitis

It presents with decreased visual acuity, floaters and loss of visual fields on one side

88
Q

Roseola infantum is caused by what virus?

A

human herpes virus 6

Phase 3a medicine (24 decks)

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