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NP- Phase 3a Medicine > Paeds- Derm and Infectious Diseases > Flashcards

Paeds- Derm and Infectious Diseases Flashcards

1
Q

what is chicken pox?

A

highly infectious disease caused by the varicella zoster virus VZV

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2
Q

what does reactivation of the dormant VZV lead to?

A

reactivation of the dormant virus in the posterior root ganglia after a bout of chickenpox leads to herpes zoster (shingles)

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3
Q

explain briefly the pathophysiology of chicken pox

A
  • enters URT
  • 4-6 days later- viraemia, 11-21 days- skin lesions
  • infective from 4 days prior to rash until all leasions have scabbed
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4
Q

how does chicken pox present clinically?

A
  • temperature 38-39
  • headache, malaise, abdo pain
  • crops of vesicles appear- itchy- on head, neck and trunk
  • redness around lesion- bacterial superinfection
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5
Q

differential diagnosis of chicken pox

A
  • shingles
  • generalised herpes zoster/ simplex
  • dermatitis herpetiformis
  • impetigo
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6
Q

how is shingles differentiated from chicken pox?

A
  • shingles is confined to one dermatome

- occurs upon reactivation of virus in dorsal root ganglion

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7
Q

how is chicken pox diagnosed?

A
  • clinical

- fluorescent antibody tests- IgG/ IgM

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8
Q

complications of chicken pox

A
  • secondary bacterial infection of lesions
  • pneumonia
  • encephalitis
  • arthritis, nephritis, pancreatitis
  • disseminated haemorrhage chickenpox
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9
Q

how is chicken pox managed and treated?

A

management:

  • keep cool
  • trim nails (less harm fro scratching)
  • antihistamines and emollients
  • off school for 5 days

treatment:

  • Antivarecella-Zoster immunoglobulin and Acyclovir if severe
  • if bacterial superinfection- flucloxacillin
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10
Q

what are Exanthems?

A

Exanthems are eruptive skin rashes associated with a fever or other constitutional symptoms, associated with infectious diseases

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11
Q

which childhood exanthems are notifiable diseases?

A
  • measles
  • scarlet fever
  • rubella
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12
Q

what are the:

  • first disease
  • second disease
  • third disease
  • fifth disease

in childhood exanthems?

A

1st= measles
2nd= Scarlet fever
3rd= Rubella
5th- slapped cheek syndrome (erythrovirus)

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13
Q

explain the transmission of measles

A
  • acute viral infection
  • single stranded RNA morbillivirus
  • airborne via respiratory drops/ saliva
  • incubation of 7-12 days
  • infectivity lasts from prodrome until 4 days after rash disappears
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14
Q

how does measles present clinically?

A
  • rash for at least 3 days
  • fever (>40) presenting with at least one of:
    a non productive cough, corzya, conjunctivitis
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15
Q

describe the prodrome of measles

A

4C’S

Cough, coryza, conjunctivitis, cranky

Koplik’s spots on palate- small red spots with a white speck

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16
Q

describe the rash seen in measles

A
  • morbilliform
  • first on forehead, neck and behind ears
  • spreads to trunk and limbs in 3-4 days
  • fades after 3-4 days
  • leaves behind a brownish discolouration and fine desquamation
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17
Q

what 2 features may present alongside the rash in measles?

A

swelling of eyes

photophobia

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18
Q

differential diagnosis of measles

A

rubella

parovirus B19

enterovirus

scarlet fever

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19
Q

how is measles diagnosed?

A

Lab

  • IgM & IgG +ve
  • salivary swab/ serum sample for measles-specific immunoglobulin taken within 6 weeks on onset
  • RNA detection in swabs
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20
Q

how is uncomplicated measles treated and managed?

A

Notifiable disease !

parent must isolate

self limiting- tx is symptomatic- paracetamol, ibuprofen + fluids

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21
Q

what are some potential complications of measles?

A
  • ottitis media
  • croup/ tracheitis
  • pneumonia (most common cause of death in measles)
  • encephalitis (older)
  • subacute sclerosing panencephalitis
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22
Q

aetiology of scarlet fever

A

endotoxin mediated disease arising from a bacterial infection from a toxin-producing strain of strep pyogenes (group A haemolytic strep)

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23
Q

epidemiology of scarlet fever

A

2-10 years old commonly

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24
Q

how does scarlet fever present clinically?

A
  • 2-4 days incubation
  • onset- sudden sore throat and fever, rash follows 12-24 hours later
  • scarlatiniform rash
  • strawberry tongue
  • circumoral pallor
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25
Q

describe the scarlatiniform rash seen in scarlet fever

A

appears first on chest, axilla and behind ears

affects trunk and legs later

red ‘pin prick’ blanching rash- sandpaper texture

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26
Q

describe the ‘strawberry tongue’ seen in scarlet fever

A

prominent red papillae seen through a ‘white fur’

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27
Q

describe the prodrome of scarlet fever

A
  • sore throat + tonsilitis
  • fever
  • headache
  • vomiting and abdo pain
  • myalgia
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28
Q

give 4 complications of scarlet fever

A
  • syndenhams chorea
  • otitis media
  • rheumatic fever
  • glomerulonephritis
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29
Q

how is scarlet fever diagnosed?

A

clinically

throat swab and culture

antigen detection kits

strep antibody tests

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30
Q

how is scarlet fever treated?

A

Pencillin/ azithromycin for 10 days

rest + fluids

ibuprofen and paracetamol

NOTIFIABLE DISEASE !

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31
Q

what virus causes rubella?

A

RNA virus- rubivirus togaviridae

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32
Q

how is rubella transmitted and what is its incubation period and infectivity window?

A
  • airborne droplets
  • incubation of 14-21 days
  • infectious for 5 days before and 5 day after rash

Lifelong immunity !

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33
Q

when is rubella a major complication?

A

maternal infection in early pregnancy

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34
Q

describe the prodrome of rubella

A

lethargy

low grade fever

headache

mild conjunctivitis

anorexia

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35
Q

describe the rash present in rubella

A

initially pink, discrete macular rash that coalesce starting behind the ears and face

spreads to entire body

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36
Q

in which lymph nodes is lymphadenopathy present in rubella?

A

suboccipital

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37
Q

differentials for rubella

A 
contact dermatitis
erythema multiforme 
drug allergy 
measles
scarlet fever 
Kawasaki
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38
Q

how is rubella diagnosed?

A
  • PCR

- FBC- low WBC with raised lymphocytes and thrombocytopenia

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39
Q

can rubella be treated?

A

No ! managed with antipyretics + vaccines

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40
Q

what are the complications of maternal rubella infection during early pregnancy?

A

weeks 1-4- eye anomaly

4-8- cardiac abnormalities

8-12- deafness

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41
Q

what is slapped cheek syndrome and how is it spread?

A
  • paravovirus B19
  • transmission via respiratory secretions
  • incubation- 4-20 days before rash develops
  • droplet spread
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42
Q

describe the prodrome of slapped cheek syndrome

A
  • starts around 1 week after symptom onset
  • mild
  • headache, rhinitis, sore throat, low-grade fever, malaise
  • nausea, diarrhoea, abdo pain, arthralgia
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43
Q

describe the presentation of slapped cheek syndrome after the initial prodrome

A
  • symptom free for 7-10 days
  • classic ‘slapped cheek’ rash then appears- malar erythema that SPARES the nose, perioral and periorbital regions
  • 1-4 days after facial rash- a new erythematous macular rash develops on limbs (non itchy)
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44
Q

describe the arthralgia seen in slapped cheek syndrome

A
  • symmetrical- hands, wrists, knees and ankles

- usually resolves in a few days

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45
Q

what is a serious complication of slapped cheek syndrome?

A

aplastic crisis

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46
Q

how is slapped cheek syndrome diagnosed?

A
  • B19 specific IgM
  • B19 specific IgG
  • PCR
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47
Q

if B19 specific IgM is present, what result is implied?

A

current/ recent infection with parvovirus B19 (slapped cheek)

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48
Q

if B19 specific IgG is present, what result is implied?

A

immunity/ past infection

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49
Q

what is impetigo and at what ages does it peak?

A

contagious superficial infection by staph aureus +/- strep pyogenes

2-5 years

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50
Q

how does impetigo present clinically?

A

well defined lesions that start around nose and face with honey/ golden coloured crusts on erythematous base

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51
Q

how is impetigo treated?

A

topical fusidic acid or oral flucloxacillin if severe

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52
Q

explain the science behind meningitis

A

micro-organisms reach the meninges either by direct extension from the ears, nasopharynx, cranial injury or congenital meningeal defect, or by bloodstream spread

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53
Q

bacterial causes of meningitis

A

Neiserria meningitides

streptococcus pneumoniae

haemophilus influenza

staph group B

listeria monocytogenes

e.coli

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54
Q

viral causes of meningitis

A 
enterovirus 
mumps 
herpes simplex
HIV
EBC
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55
Q

fungal causes of meningitis

A

cryptococcus neoformans

candida albicans

56
Q

risk factors of meningitis?

A
  • immunocompromised
  • spinal procedures
  • bacterial endocarditis
  • diabetes
  • alcoholism/ IV drug abuse
  • malignancy
  • renal and adrenal insufficiency
57
Q

what is the physiological difference between bacterial and viral meningitis?

A

bacterial- pia-arachnoid becomes congested with polymorphs- pus layer forms

viral- predominantly lymphocytic inflammatory CSF with no pus formation and no polymorphs

58
Q

what occurs first in meningitis, septic or meningeal signs?

A

septic signs !

59
Q

what are the septic signs of meningitis?

A
  • malaise, fever, temp, rigors, severe headache
  • increased pulse and RR, reduced BP
  • DIC
  • poor feeding
  • signs of shock
  • petechial non-blanching purpural rash
60
Q

what are the meningeal signs of meningitis?

A
  • +ve Kernigs sign
  • +ve Brudzinski’s sign
  • neck stiffness (rare)
  • photophobia
  • opisthotonus (arched back)
  • bulging fontanelle in infants
61
Q

what is Kernigs sign?

A

resistance to extending knee when hip is flexed

62
Q

what is Brudzinski’s sign?

A

neck flexion results in hip flexion

63
Q

what are the complications of meningitis and which one is most commonly seen?

A

SHAPeD

Sepsis
Hydrocephalus/ encephalitis
Abcess
Paralysis
Deafness (most common ! )
64
Q

how is meningitis diagnosed?

A
  • blood- lactate, fbc, glucose, coag
  • lumbar puncture
  • blood culture
  • throat swab
65
Q

when is a lumbar puncture contraindicated?

A

meningococcal disease !

66
Q

how is meningitis treated BEFORE the organism is known?

A
  • immediate- IV cefotaxime ! + supportive therapy (high flow O2, saline etc)
  • if <3 months= cefotaxime + amoxicillin
  • > 3 months- 18 years= ceftriaxone + dexamethasone
67
Q

what must a GP immediately give to a pt with suspected meningitis?

A

Benzylpenicllin (cefotaxime if allergic ! )

68
Q

causative organisms of meningitis- how are they treated?

Neisseria Meningitis

A

cefotaxime/ ceftriaxone/ benzylpenicllin

69
Q

causative organisms of meningitis- how are they treated?

Haemophilis influenzae

A

ceftriaxone

70
Q

causative organisms of meningitis- how are they treated?

strep pneumoniae

A

ceftriaxone/ benzylpenicllin

71
Q

causative organisms of meningitis- how are they treated?

E.coli

A

cefotaxime/ gentamicin

72
Q

causative organisms of meningitis- how are they treated?

Group B haemolytic strep

A

Benzylpenicllin IV

73
Q

causative organisms of meningitis- how are they treated?

listeria monocytogenes

A

IV ampicillin + gentamicin

74
Q

how is group B haemolytic strep passed to the infant?

A

via the mothers vagina

75
Q

what is given as prophylaxis from meningococcal meningitis?

A

rifampicin and ciprofloxacin

76
Q

how is viral meningitis treated?

A
  • supportive therapy- analgesia, anti-pyretic, hydration

- acyclovir

77
Q

give the differences in the:

  • appearance
  • glucose
  • protein
  • gram stain

between bacterial and viral meningitis

A

appearance:

  • bacterial- clear-turbid
  • viral- clear

glucose:

  • bacterial- low
  • viral- normal

protein:
- elevated in both

gram stain:

  • bacterial- organisms present
  • viral- normal
78
Q

what is Coxsackie’s disease?

A

hand, foot and mouth disease

viral illness commonly causing lesions involving the hands, feet and mouth

79
Q

aetiology of Coxsackie’s disease

A

Coxsackievirus A16

enterovirus 71

80
Q

how is Coxsackie’s disease transmitted and what is the incubation period?

A
  • faecal-oral route

- 5-7 days

81
Q

describe the prodrome of Coxsackie’s disease

A
  • low-grade fever
  • malaise
  • loss of appetite
  • sore mouth/ throat
  • cough
  • abdo pain
82
Q

how do the mouth lesions present in Coxsackie’s disease?

A
  • buccal mucosa, tongue + hard palate
  • initially macular lesions that progress to vesicles and then erode
  • yellow ulcers surrounded by red haloes
83
Q

how do skin lesions present in Coxsackie’s disease?

A
  • palm, soles and between fingers and toes

- erythematous macules that progress to grey vesicles with an erythematous base

84
Q

differential diagnosis of Coxsackie’s disease

A
  • herpangina
  • herpes simplex
  • chickenpox
  • Kawasaki disease
85
Q

how is Coxsackie’s disease diagnosed?

A
  • clinical
  • swab lesions
  • PCR
86
Q

how is Coxsackie’s disease managed and treated?

A
  • symptomatic !

fluid intake, soft diet, paracetamol

can use lidocaine oral gel if mouth is painful

stay off school if feeling unwell

87
Q

causes of encephalitis in infants

A

infective !

HSV, mumps, varicella zoster, rabies, parvovirus, influenza, TB, toxoplasmosis, malaria

immunocompromised

88
Q

clinical signs of encephalitis

A

flu-like prodrome

reduced consciousness

‘odd’ behaviour

vomiting

fits/ seizures

raised temp

meningism

89
Q

how is encephalitis investigated?

A

CSF, MC&S, PCR, bloods, stool (enteroviruses), urine

90
Q

which causative organism of encephalitis is most treatable and how is this managed?

A

herpes simplex encephalitis- acyclovir

91
Q

when should TB be suspected?

A
  • overseas contact
  • HIV +ve
  • odd CXR
92
Q

how does TB present clinically?

A

anorexia

low fever

failure to thrive

malaise

possible cough

93
Q

describe the tuberculin test

A

hypersensitivity test to tuberculin when applied to skin via an injection

94
Q

how does TB present on a CXR?

A

consolidation and cavities

Miliary spots (fine white dots)- rare, but grave

95
Q

how is TB managed?

A

6-month supervised plan of isoniazid + rifampicin + pyrazinamide

96
Q

how much does the transmission rate of HIV increase by if the mother breastfeeds?

A

50%

97
Q

how is HIV diagnosed in infants?

A

test at birth, 3 and 6 months:

  • HIV viral PCR
  • P24 antigen
  • specific IgA
  • monitor CD4 counts= help stage HIV
98
Q

give some symptoms which, if present, could indicate HIV

A
  • PUO, lymphadenopathy, hepatosplenomegaly, parotid enlargement
  • persistent diarrhoea
  • shingles
  • reduced platelets
  • failure to thrive, recurrent infections that are slow to clear, finger clubbing
99
Q

when should a non-vertical HIV seroconversion illness be suspected in an infant?

A
  • temp, fatigue rash, pharyngitis, oral ulcers, headache
  • lymphadenopathy
  • meningism, peripheral neuropathy
  • thrush, WL, neight sweats
100
Q

what is the prognosis for HIV infection in infants?

A

by 3 years only, those with early opportunistic infection- 50% died

101
Q

describe HAART

A

Highly Active Anti-Retroviral therapy

  • PENTA regimen
  • used in pt’s with AIDS defining conditions/ CD4 <15%
102
Q

what are the side effects of HAART?

A
  • raised lipids and glucose

- reduced bone metabolism

103
Q

how is toxic shock syndrome caused?

A

toxin-producing Staph. Aureus/ group A strep

104
Q

what is toxic shock syndrome characterised by?

A

fever >39’c

hypotension

diffuse erythematous, macular rash

105
Q

what is the main consequence of toxin release?

A

organ dysfunction- vomiting, diarrhoea, organ impairment, altered consciousness etc

106
Q

how is toxic shock syndrome managed?

A

ceftriaxone + clindamycin

surgically debride infected areas

107
Q

what is vaccinated against at the 8 week mark?

A
  • diptheria, tetanus, pertussis, polio, HiB, Hep B (6- in - 1)
  • pneumococcal
  • meningitis B
  • rotavirus
  • gastroenteritis
108
Q

what vaccines are given at 12 weeks?

A

6-in-1

rotavirus

109
Q

what vaccines are given at 16 weeks?

A

6-in-1

pneumococcal

meningitis B

110
Q

what vaccines are given at 1 year?

A

HiB and meningitis C

pneumococcal

MMR

Meningitis B

111
Q

what vaccine is given each year between 2-8 years?

A

influenza

112
Q

what vaccines are given pre-school (around 3 years and 4 months)?

A

diptheria, tetanus, pertussis and polio (4 in 1)

MMR

113
Q

what vaccine is given to girls aged 12-13?

A

HPV- 2 dose given 6-12 months apart

114
Q

what vaccine is given at age 14 (and which vaccine is specific to men)?

A

tetanus, diptheria, polio (3 in 1)

Men- ACWY

115
Q

describe the epidemiology of eczema in children

A

present in 15-20% of children

presents before 6 months, clears in around 50% by 5 years and 75% by 10 years

116
Q

how does eczema present in:
- infants

  • younger children
  • older children
A

infants- face and trunk

younger- extensor surfaces

older- typical distribution- flexor surfaces and creases of face and neck

117
Q

how is eczema managed?

A
  • identify and avoid irritants
  • emolients- in ratio with topical steroids of 10:1
  • severe- we wraps and oral ciclosporin may be used
118
Q

what is eczema herpeticum, and how is it managed?

A

severe primary infection of the skin seen more commonly in kids with atopic eczema

common infective organism- HSV

life threatening ! manage with Acyclovir

119
Q

what is Stevens-Johnson Syndrome?

A

severe bullous form or erythema multiforme- also involving mucous membranes

120
Q

how does Stevens-Johnson Syndrome initally present?

A

Vague upper respiratory tract symptoms 2-3 weeks after starting a drug, a rash will then present 2 days after

121
Q

describe the clinical presentation of Stevens-Johnson Syndrome

A

Painful erythematous macules- evolve to form target lesions

severe mucosal ulceration (typically on 2 surfaces- e.g. conjunctiva, oral cavity, urethra, labia)

122
Q

what drugs can cause Stevens-Johnson Syndrome?

A
  • Sulfonamides
  • anti-epileptics
  • penicllins
  • NSAIDs
123
Q

how is Stevens-Johnson Syndrome managed clinically?

A
  • ophthalmological assessment
  • supportive therapy- protect skin
  • avoid steroids- increases infection risk

do not debride skin !!

124
Q

how does urticaria present clinically?

A

hives/ flesh coloured wheals or redness

resulting from local vasodilation and increased permeability of capillaries/ venules

itchy !

125
Q

how does urticaria result into angioedema?

A

involvement of deeper tissues produces swelling- usually around lips and eyes

126
Q

what are the 3 classes of utricaria and angioedema?

A
  • acute
  • chronic idiopathic
  • physical urticarias
127
Q

describe acute urticaria and angioedema

A
  • resolves in 6 weeks
  • triggers- infection, food allergy, drug reaction
  • viral infection- last days
  • allergen- lasts hours
128
Q

describe chronic idiopathic urticaria and angioedema

A

intermittent for >6 weeks, usually non-allergic in origin

129
Q

causes of physical urticarias

A

cold, delayed pressure, heat contact, solar

130
Q

how are urticaria and angioedema managed?

A

2nd generation, non-sedating antihistamines

131
Q

what is given in refractory cases of urticaria and angioedema?

A

omalizumab

132
Q

what is anaphylaxis?

A

severe, life-threatening hypersensitivity

133
Q

causes of anaphylaxis in children

A

85%- food allergy

IgE mediated reactions

insect stings, drugs, latex, exercise, inhalant allergens

134
Q

how is anaphylaxis diagnosed?

A

Airway- swelling, hoarseness, stridor

Breathing- tachypnoea, wheeze, cyanosis SpO2 <92%

Circulation- Urticaria/ angioedema

135
Q

how is anaphylaxis managed?

A

ABCDE

  • establish airway
  • high flow O2
  • IV fluid- crystalloid
  • early administration of adrenaline IM/ IV
  • chlopheniramine- antihstamine
  • hydrocortisone
  • salbutamol if wheeze

monitor pulse oximetry, ECG, BP

136
Q

What are the TORCH infections?

A 
Toxoplasmosis 
Other (syphillis, varicella-zoster, parvovirus B19)
Rubella
Cytomegalovirus
Herpes
137
Q

In HIV, what is vertical transmission?

A

term used to describe mother to child transmission

NP- Phase 3a Medicine (22 decks)

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