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Year 5 - Paediatrics > Paeds INFECTION > Flashcards

Paeds INFECTION Flashcards

1
Q

Recall a long-term complication of mumps, rubella and polio

A

Mumps: infertile boys, deafness

Rubella: severe deformities to pregnancy

Polio: massive respiratory problems

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2
Q

In what age range does Kawasaki disease present?

A

6 months to 4 years: peak at 1 year

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3
Q

What is Kawasaki’s disease?

A

Systemic vasculitis

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4
Q

What is the main cause of mortality in KD?

A

Coronary aneurism

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5
Q

What are the signs and symptoms of Kawasaki disease?

A

CRASH + Burn
C: conjunctivitis
R: rash (polymorphous, begins at hands + feet)
A: Adenopathy
S: Strawberry tongue
H: hands + feet swollen

Burn (fever >5 days)

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6
Q

How is kawasaki disease diagnosed?

A

CLINICALLY
Do bloods + echo to guide management

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7
Q

How is kawasaki disease managed?

A

ADMISSION
IV Ig + high dose aspirin

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8
Q

By what vector is malaria spread?

A

Female anopheles mosquito

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9
Q

How fast is the onset of malaria after innoculation?

A

7-10 days

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10
Q

What are the signs and symptoms of malaria?

A

Cyclical fever with spikes
D+V
Jaundice
Anaemia
Thrombocytopaenia
Flu-like Sx

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11
Q

What are the appropriate investigations for malaria?

A

3 thick + thin blood films (thick = parasite, thin = species)
Malaria rapid antigen detection tests

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12
Q

What is used for anti-malarial prophylaxis?

A

Quinine

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13
Q

How should malaria be managed?

A

Arrange immediate admission
Notify PHE
Treatment is very variable
Non-falciparum: chloroquinine

Mild falciparum (not vomiting): ACT (Artemisinin Combination Therapy) + Atovaquone-proguanil

Severe/ complicated falciparum: IV Artesunate is 1st line

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14
Q

What is the route of transmission of typhoid?

A

Faeco-oral

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15
Q

What are the signs and symptoms of typhoid?

A

May be bradycardic
Cough
Malaise
Anorexia
Diarrhoea or constipation by 2nd week
Rose spots on trunk

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16
Q

How is typhoid diagnosed?

A

Blood culture is diagnostic

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17
Q

How should typhoid be managed?

A

1st line = IV ceftriaxone
2nd line = PO azithromycin

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18
Q

What is the vector of dengue virus?

A

Aedes aegyptii mosquito

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19
Q

Where is dengue usually imported from?

A

SE Asia + South Africa

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20
Q

What are the expected FBC abnormalities in Dengue?

A

Low WCC
Low platelets
Low Hb

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21
Q

What are the signs and symptoms of dengue?

A

Retro-orbital headache
Sunburn-like rash
High fever + myalgia
Hepatomegaly + abdo distention

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22
Q

What is dengue haemorrhagic fever?

A

Secondary infection by a different strain that causes severe capillary leakage –> hypotension + haemorrhagic manifestations
Due to partial host reponse augmenting severity of host infection

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23
Q

How should dengue haemorrhagic fever be managed?

A

Fluid resuscitation

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24
Q

What is the gold standard investigation for dengue diagnosis?

A

PCR viral antigen, serology IgM

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25
Q

What is the pathogen that causes mumps?

A

Mumps paramyxovirus

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26
Q

How is mumps transmitted?

A

Respiratory secretions

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27
Q

For how long is mumps infectious?

A

5 days before + 5 days after parotid swelling

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28
Q

What are the signs and symptoms of mumps?

A

Asymptomatic in 30%
Headache, fever + parotid swelling

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29
Q

Recall the 2 key investigations for mumps

A

Oral fluid IgM sample
Amylase in blood is raised

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30
Q

How should mumps be managed?

A

Notify HPU, isolate for 5 days from time of parotid swelling
Supportive care (rest, analgesia)
Safety net for complications

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31
Q

What are the possible complications of mumps?

A

Mumps orchitis (leading to infertility)
Viral meningitis (encephalitis)
Deafness (unilateral and transient)

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32
Q

How is measles transmitted?

A

Respiratory secretions

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33
Q

For how long is measles infectious?

A

4 days before + 4 days after rash

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34
Q

Recall the signs and symptoms of measles

A

Prodrome of high fever, irritability, conjunctivitis + febrile convulsions
Maculopapular rash (face/ neck –> hands/ feet)
Koplick spots (small white spots surrounded by red ring in mouth)
Cough
No lymphadenopathy

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35
Q

What investigations should be done in suspected measles?

A

1st line is measles serology (IgM/ IgG) from Oral fluid test (OFT)
2nd line is PCR of blood/ saliva

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36
Q

How should measles be managed?

A

Notify HPU
Isolate for 4 days following development of rash
Rest + supportive tx
Immunise close contacts
Safety net complications of encephalitis/ SSPE/ otitis media (most common), pneumonia

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37
Q

What is SSPE?

A

Sub-acute Sclerosing Panencephalitis
Seen 7 years after measles infection
Measles has been dormant in CNS
Signs + Sx = dementia + death

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38
Q

What type of virus causes rubella?

A

Togavirus

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39
Q

What is the infectious period of rubella?

A

1 week before to 5 days after rash onset

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40
Q

Recall the signs and symptoms of rubella

A

Prodrome of mild fever or sometimes asymptomatic
Pink maculopapular rash (face –> whole body) which fades pretty quickly
In 20% there are Forcheimer spots (red spots on soft palate)
Lymphadenopathy (none in measles)
No koplik spots or conjuntivitis

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41
Q

How should rubella be investigated?

A

Rubella serology (IgG and IgM) from oral fluid test
RT-PCR is 2nd line

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42
Q

How should rubella be managed?

A

Notify HPU, isolate for 4 days after development of rash
Supportive care
Safety net the complications (haemorrhagic complications due to thrombocytopaenia)

43
Q

Recall some other names for this roseola infantum

A

Fifth disease/ erythema infectiosum/ slapped cheek

44
Q

How is parvovirus B19 transmitted?

A

Respiratory secretions/ vertically

45
Q

Which cells does pB19 infect?

A

RBC precursors

46
Q

What is the infectious period of parvovirus?

A

10 days before to 1 day after rash develops

47
Q

Recall the signs and symptoms of parvovirus B19

A

1st: asymptomatic or coryzal illness for 2-3 days then latent for 7-10 days
2nd: most commonly, erythema infectiosum - ‘red slapped cheek’ rash on face
Progresses to maculopapular (‘lace like’) rash in trunk and limbs

48
Q

How should parvovirus B19 be investigated?

A

B19 serology (IgG and IgM) - similar to rubella
2nd line is RT-PCR

49
Q

How should pB19 be managed?

A

Supportive (virus, fluids, analgesia, rest)
No need to stay off school or avoid pregnant women (once rash develops it’s not really infectious)
Complications to safety net = anaemia, lethargy, pregnancy

50
Q

What is the infectious period of VZV?

A

48 hours before rash to last crusted over lesion

51
Q

What are the stages of the rash appearance in chickenpox?

A

Papule –> vesicle –> crust

52
Q

How should VZV be investigated?

A

Clinical dx

53
Q

How shoulod VZV be managed?

A

Supportive
No ibuprofen
Keep home from school

54
Q

What advice would you give to parents if their child has VZV?

A

Keep nails short

55
Q

When should you admit in VZV?

A

Pneumonia, encephalitis, dehydration

Secondary bacterial superinfection (sudden high fever, toxic shock, necrotising fasciitis)

Purpura fulminans: large necrotic loss of skin from cross-activation of anti-viral Abs

56
Q

What is the pathogen that causes hand, foot and mouth disease?

A

Usually coxsackie A16

Atypical: coxsackie A6

Severe: enterovirus 71

57
Q

What are the signs and symptoms of hand, foot and mouth disease?

A

Painful, itchy, vesicular lesions on hands, feet, mouth + buttocks
Mild systemic features: fever, sore throat, spots in mouth- develop into ulcers

58
Q

How should hand, foot and mouth disease be managed?

A

Supportive
Will clear in 7-10 days
Safety net for dehydration

59
Q

What pathogen causes roseola infantum?

A

HHV6

60
Q

What is another name for roseola infantum?

A

6th disease

61
Q

Describe the epidemiology of roseola infantum

A

Most children infected by age 2: it’s highly infectious for the whole period of disease

62
Q

What are the signs and symptoms of roseola infantum?

A

High fever + malaise for 3-4 days, followed by generalised macular rash (small pink spots) that goes neck- arms
Non-itchy

Febrile convulsions in 10-15%
Sore throat, lymphadenopathy, coryzal Sx, D+V
Nagayama spots (spots on the uvula + soft palate)

63
Q

How should roseola infantum be investigated?

A

HHV6/7 serology (IgG or IgM)
Measles + rubella serology: as have a similar presentation

64
Q

How should roseola infantum be managed?

A

Supportive
No need to stay off school
Safety net the complications: febrile convulsions

65
Q

How should children be investigated for HIV?

A

<18 months: PCR of virus at birth, on discharge, at 6w, 12w + 18 months
>18 months: antibody detection via ELISA

66
Q

How should childhood HIV be managed?

A

Cord clamped ASAP + bathed straight after birth

Zidovudine monotherapy for 2-4w (if low/med risk) or PEP combination 4w (if high risk)

Women not to breastfeed

Give all immunisations

67
Q

How does the aetiology of conjunctivitis differ between children and adults?

A

In adults is usually viral or allergic, in children is more likely to be bacterial

68
Q

What is the most likely cause of sticky eyes in a <48 hours neonate?

A

Gonorrohoea

69
Q

What is the most likely cause of sticky eyes in a neonate in first 1-2w?

A

Chlamydia - often co-presents with pneumonia

70
Q

How should neonatal gonorrhoeal infection be investigated and treated?

A

Ix: Gram stain and culture

Mx: 3rd gen cephalosporin (e.g. ceftriaxone)

71
Q

How should neonatal chlamydia infection be investigated and treated?

A

Ix: immunofluorescent staining

Mx: oral erythromycin

72
Q

For how long should a child be excluded from school if they have scarlet fever?

A

24 hours after antibiotics

73
Q

For how long should a child be excluded from school if they have whooping cough?

A

48 hours after Abx

74
Q

For how long should a child be excluded from school if they have measles?

A

4 days from onset of rash

75
Q

For how long should a child be excluded from school if they have rubella?

A

4 days from onset of rash

76
Q

For how long should a child be excluded from school if they have chickenpox?

A

Until all lesions crusted over

77
Q

For how long should a child be excluded from school if they have impetigo?

A

Until all lesions crusted over

78
Q

For how long should a child be excluded from school if they have mumps?

A

5 days from onset of swollen glands

79
Q

For how long should a child be excluded from school if they have influenza?

A

Until recovered

80
Q

What infections are children with DiGeorge syndrome particularly at risk of and why?

A

Candidiasis
No thymus –> no T cells

81
Q

Give 2 causes of evanescent salmon pink rash

A

Listeriosis (neonate)
Juvenile idiopathic arthritis

82
Q

Recall 3 conditions that cause rigors in children?

A

Pyelonephritis
Influenza
Malaria

83
Q

What is the triad of features seen in Rubella syndrome?

A

Cataracts
Deafness
Cardiac abnormalities

84
Q

What abnormalities would be seen in a baby who is born to a mother with syphillis?

A

Saddle nose
Rhinitis
Deafness
Jaundice
Hepatosplenomegaly

85
Q

Which babies are at highest risk of developing NEC?

A

Premature or LBW

86
Q

What is the aetiology of NEC?

A

Mostly unknown but thought to be a combination of poor blood flow and infection

87
Q

What are the early signs of NEC?

A

Bilious vomiting (green)
Feeding intolerance

88
Q

What will be seen on AXR in NEC?

A

Gas cysts

89
Q

What are the appropriate investigations to do in NEC?

A

AXR
Blood cultures

90
Q

What are the criteria used to decide management of NEC?

A

Bell’s staging

91
Q

Recall the elements of NEC management

A
  1. Bowel rest: stop oral feed + switch to parenteral nutrition
  2. Broad-spectrum Abx (eg Tazocin): duration depends on stage
  3. Laparotomy (if perforation is seen on AXR)
92
Q

What is the most common causative agent of meningitis in children?

A

Neisseria meningitides

93
Q

When is the meningococcal C vaccine given?

A

Routinely given at 12 months and at 14 years as part of the MenACWY vaccine

94
Q

When is the meningococcal B vaccine given?

A

At 8 and 16 weeks, followed by a booster at 1 year

95
Q

What is the most common causative strain of meningococcus?

A

Group B - accounts for 60% of meningococcal disease, the other 40% is accounted for by Group A

96
Q

What causative agents of meningitis are seen in neonates?

A

Group B strep
E. coli
Listeria
Pneumococcus
Staph aureus

97
Q

What causative agents of meningitis are seen in babies > 1 month?

A

Meningococcus
Pneumococcus
Haemophilus influenzae B (used to be more common before vaccination programme)

98
Q

How may meningitis present in babies/children?

A

Classical triad of meningism (headache, neck stiffness and photophobia) is less common in children and not seen in babies.

Instead they may present with non-specific and vague symptoms.

99
Q

What are the 3 reliable ways to measure temperature in children?

A

Axillary electronic
Axillary chemical dot
Tympanic infra red

DON’T use anything else

100
Q

What risk factors/signs in the history suggest potential need for admission for a febrile illness?

A

Aged 3-6m
Temp > 39
Fever for more than 5 days
Rigors - sign of bacterial infection
Swelling of limb or joint
Non-weight bearing limb or joint

101
Q

What are the common causative agents of fever in infants < 1 month?

A

Listeria
Group B strep
E. coli

102
Q

What are the typical antibiotics used for fever in infants < 1 month?

A

Cefotaxime and amoxicillin

103
Q

How do you collect a urine sample in a child that is not toilet trained?

A

Wait with bottle (clean catch)
Catheter aspirate
Suprapubic aspirate (US-guided)

Never rely on cotton wool in nappy or sterile bag as these can be contaminated with skin flora.

104
Q

What is the immediate management of sepsis in children?

A

If shocked:
- 20ml/kg 0.9% saline bolus (may also be 10ml/kg given recent research)
- Reassess need for further boluses
- Immediate IV antibiotics

Year 5 - Paediatrics (15 decks)

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