Paeds 2017 Flashcards
Most common vasculitis in children?
HSP
4 years old Rash develops around neck and then spreads to limbs and trunk Also has a sore throat.. Diagnosis? Organism type? Natural history and features
Scarlet fever
Group A b-haemolytic strep (strep pyogenes)
Prodromal
-Vomiting, sore throat, headache, abdo pain, fever
-> Rash develops after 24-48hrs
Enlarged tonsils
Strawberry tongue
Haemorrhagic spots on palate
Scarlett fever Ix? Mx? Complications ?
Ix
Throat swab and culture
Rapid antigen test
FBC
Mx Isolation Penicillin for 10 days Rest, fluids Notifiable disease
Complications
Rheumatic fever!
Post strep glomerulonephritis
What is scalded skin syndrome? Who affected? Features? Mx?
Staphylococcus toxin
Affects young children
Fever, malaise
Crusting local infection around eyes and mouth
Erythema / peeling
Mx
Admit
IV flucloxacilin
Topical fusidic acid
A newborn who was delivered at 32 weeks after a PROM develops a high fever and floppiness. He has not been feeding and appears to be in respiratory distress. The baby is inconsolable.
Likely organism?
Strep. Agalactiae - meningitis
Group B strep
Bacterial meningitis CSF Appearance? Polymorphonuclear cell ratio? Lymphocyte? Protein? Glucose?
Appearance Yellowish, turbid
Polymorphonuclear cell ratio - Markedly increased
Lymphocyte? - Normal / slightly increased
Protein? - Markedly increased
Glucose? - Decreased
Viral meningitis CSF Appearance? Polymorphonuclear cell ratio? Lymphocyte? Protein? Glucose?
Appearance - clear
Polymorphonuclear cell ratio? - Slightly increased / normal
Lymphocyte? - Markedly increased
Protein? - Slightly increased / normal
Glucose? - Normal
TB meningitis CSF Appearance? Polymorphonuclear cell ratio? Lymphocyte? Protein? Glucose?
Appearance? - Yellowish and viscous
Polymorphonuclear cell ratio? - Slightly increased or normal
Lymphocyte? - Markedly increased
Protein? - increased
Glucose? - Decreased
Fungal meningitis CSF Appearance? Polymorphonuclear cell ratio? Lymphocyte? Protein? Glucose?
Appearance? - Yellowish and viscous
Polymorphonuclear cell ratio? - Slightly increased / normal
Lymphocyte? - Markedly increased
Protein? - Slightly increased / normal
Glucose? - Normal / decreased
When are mothers screened for group B strep? What happens if they are positive?
What are the risk of infection?
What can it cause in newborn?
3rd trimester - vaginal and anal swabs
-> intrapartum antibiotic prophylaxis
Risks
Preterm labour
PROM >18hrs
Intrapartum fever
Newborn
Sepsis
Meningitis
Stillbirth
Causes of meningitis
Neonate
1-6yrs
>6yrs
N - Group B strep, E. coli, listeria monocytogenes
1-6 - N meningitides, S pneumonia, H influenza
Over 6 - N meningitides, S pneumonia
3 stages of whooping cough?
- Catarrhal Phase- cold like symptoms, lasts 1 week.
- Paroxysmal phase- spasmodic cough, lasts 3-6 weeks.
- Convalescent phase- symptoms decrease for several months.
A 9 year old girl is brought to the GP by her mother.
She has developed a redness in both her cheeks which will not go away.
She was unwell with a week off school a week ago with a sore throat and fever, but has been well in herself ever since.
Organism?
What should pregnant women who in contact of a case do?
Parvovirus B19
Seek medical advice
A 3 year old comes in with Stridor. You make a quick clinical diagnosis of Croup. The child is very distressed and sats are at 92%. You give the child oxygen, but what are you going to give to treat the child?
The child is too distressed to take oral medication.
What scoring system can be used for croup?
Nebulised Budesonide and adrenaline
Modified Wesley scoring system for croup
Score of 1-17
>6 = severe croup
Abx in epiglottis?
IV ceftriaxone
Call anaesthetist to secure airway
Cause of mumps?
Complications?
Paramyxovirus
Orchitis - 25% of post pubertal men Meningitis Encephalitis Pancreatitis Deafness (rare) Spontaneous abortion of pregnancy
Congenital vs non congenital presentation of rubella?
Congenital - Cataracts, deafness, cardiac defects
Non congenital - macular rash beginning behind ears and spreading to the trunk
Ix and Mx in rubella
Ix
Serology / PCR
FBC - low WCC
Mx
Keep from school until 4 days after rash clears
Sx management
A 3m old boy who has Cystic fibrosis is approaching November. He needs to be immunised to prevent more serious complications from common infections in children his age at this time.
What vaccine should he receive? What illness is this to protect from ?
Palivizumab - RSV
Bronchiolitis
When would you admit with bronchiolitis
Poor feeding <50% as this is inadequate to maintain hydration
Lethargy Apnea RR>70 Severe chest wall recession Cyanosis Nasal flaring or grunting Sats <94% Uncertainty regarding diagnosis
Which virus causes measles ?
Lab diagnosis? Given to close contacts?
Paramyxovirus
IgM for measles in saliva
Post exposure prophylaxis
A baby presents with a gold crusty plaque on his hand.
It began with small vesicles after he had a small graze here.
His axillary lymph nodes are enlarged.
What is this condition?
Usual cause?
RF?
Impetigo
Staph aureus / strep pyogenes
Eczema
Poor hygiene
Minor trauma
2 types of presentation of impetigo ?
Non bullous
1 - Erythermatous Macules
2 - Vesicles / pustules
3 - Honey crusted plaque
Bullous
Occur on face, trunk, extremities, perineum
-Associated with eczema
Systemic malaise
A 1 year old boy develops a rash which begins with papules, then becomes vesicular then pustular then crusty.
1 week later he then has a regression of development, and no longer is attempting to stand and walk. He is drowsy, irritable and no longer orientating to the same stimuli he used to.
What has occurred?
Encephalitis - Varicella zoster
