Paeds infection

Question 1

Management threadworms

Answer 1

• anthelmintic with hygiene measures for all members of the household

mebendazole is used first-line for children > 6 months old. A single dose is given unless infestation persists

Question 2

TB pathogen and histology

Answer 2

mycobacteria - acid fast bacilli

resistant to gram stain

stain with Zeil Neelson –> red/pink

Question 3

Drugs for TB

Answer 3

RIPE

Rifampicin
Isonizad
Pyrazinamide
Ethanbutol

Question 4

Side effects rifamicin

Answer 4

R
Red/oragne urine
Hepatitis

Question 5

Side effects Isonizid

Answer 5

Hepatitis
Neuropathy

Question 6

Side effects pyrazinamide

Answer 6

hepatitis
Arthralgia / gout
rash

Question 7

Side effects ethanbutol

Answer 7

optic neuritis

Question 8

Complications of mumps

Answer 8

Pancreatitis
Orchitis
Meningitis
Sensorineural hearing loss

Question 9

How good is MMR at protecting against mumps

Answer 9

80% effective

Question 10

Diagnosis mumps

Answer 10

PCR testing on a saliva swab.

oral fluid sample (salivary IgM)

Question 11

Along with treating patient for mumps, what else do you need to do?

Answer 11

Notify Public health england

Question 12

incubation period and presentation mumps

Answer 12

14 – 25 days

prodrome general illness
unilateral or bilateral parotid gland swelling

May also have:
Abdominal pain (pancreatitis)
Testicular pain and swelling (orchitis)
Confusion, neck stiffness and headache (meningitis or encephalitis)

Question 13

Screening for Hep B

Answer 13

HBcAb (for previous infection/vacciantion)

and HBsAg (for active infection)

Question 14

Management of neonates born to mothers with Hep B

Answer 14

Give at birth:
Hepatitis B vaccine
Hepatitis B immunoglobulin infusion

Infants are given an additional hepatitis B vaccine at 1 and 12 months of age.

They will also receive the hepatitis B vaccine as part of the normal 6 in 1 vaccine given to all infants aged 8, 12 and 16 weeks.

They are tested for the HBsAg at 1 year to see if they have contracted hepatitis B.

Question 15

Breastfeeding and Hep B

Answer 15

Safe to breastfeed provided their babies are properly vaccinated

Question 16

Hep B type of virus and spread

Answer 16

DNA virus. It is transmitted by direct contact with blood or bodily fluids.

Question 17

Testing for Hep C

Answer 17

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

Question 18

Management babies born to mothers with hep C

Answer 18

tested at 18 months of age using the hepatitis C antibody test

can breastfeed

Question 19

Presentation infectious mononucelosis

Answer 19

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

Question 20

Testing for EBV

Answer 20

heterophile antibodies 6 weeks after

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.

100% specific but only 7-0% sensitive

It is possible to test for specific EBV antibodies. These antibodies target something called viral capsid antigen (VCA):

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

Question 21

Complications EBV

Answer 21

Splenic rupture
Glomerulonephritis
Haemolytic anaemia
Thrombocytopenia
Chronic fatigue

EBV infection is associated with certain cancers, notable Burkitt’s lymphoma (a type of non-hodgkins lymphoma)

Question 22

how to reduce chance of splenic rupture ebv

Answer 22

Advise against contact sports and heavy lifting for 1 month to minimise risk of splenic rupture

Question 23

presentations mumps

Answer 23

1) Parotitis: The parotid glands are almost always affected, usually bilaterally (though can be unilateral). Swelling can be severe enough to prevent the mouth from being opened and usually lasts 3-4 days. Prior to parotitis, there may be flu-like symptoms such as headache, malaise and myalgia.

2) Orchitis: Epididymo-orchitis is the second most common extra-salivary symptom of Mumps, which presents as severely painful swelling of one or both testicles and/or backache. It usually develops 4-5 days after onset of parotitis. 7% of post-pubertal females get oophoritis, with rare cases of infertility and premature menopause as a result.

3) Aseptic meningitis: A relatively common complication in 4-25% of cases. Usually mild and self-limiting

4) Encephalitis: Rare complication presenting as headache, vomiting, seizures, unconsciousness.

5) Deafness: A rare cause of acute or insidious sensorineural hearing loss (usually unilateral) in children.

6) Other: Pancreatitis, nephritis, arthritis, thyroiditis, pericarditis.

Question 24

parotitis

Answer 24

parotitis (‘earache’, ‘pain on eating’)