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Osha 3a > Paeds infectious > Flashcards

Paeds infectious Flashcards

1
Q

What is Kawasaki disease?

A
  • systemic, medium-sized vessel vasculitis
  • mucocutaenous lymph node syndrome
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2
Q

What is the epidemiology of Kawasaki disease?

A
  • affects young children, usually <5
  • more common in Asian: Japanese + Korean
  • more common in boys
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3
Q

What are the features of Kawasaki disease?

A
  • conjunctivitis
  • rash: widespread erythematous maculopapular
  • cervical lymphadenopathy
  • strawberry tongue
  • skin peeling on palms and soles
  • persistent high fever for >5 days
  • cracked lips
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4
Q

What investigations are done for Kawasaki disease?

A
  • FBC
  • LFTs: hypoalbuminaemia
  • inflammatory markers: ESR
  • urinalysis: raised wbc without infection
  • echocardiogram
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5
Q

Describe the acute phase of Kawasaki disease?

A
  • most unwell
  • fever
  • rash
  • lymphadenopathy
  • lasts 1-2 weeks
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6
Q

What is the subacute phase of Kawasaki disease?

A
  • desquamation
  • arthralgia
  • lasts 2-4 weeks
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7
Q

What is the convalescent stage of Kawasaki disease?

A
  • symptoms settle
  • normal bloods
  • lasts 2-4 weeks
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8
Q

What is the management of Kawasaki disease?

A
  • high dose aspirin for thrombosis
  • IVig for coronary artery aneurysms
  • close follow up with echocardiograms
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9
Q

What is meningitis?

A
  • inflammation of the meninges (lining of the brain and spinal cord)
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10
Q

What is meningococcal septicaemia?

A
  • meningococcus bacterial infection in the bloodstream
  • causes the non blanching rash
  • infection has caused disseminated intravascular coagulopathy (DIC) and subcutaneous haemorrhages
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11
Q

What is meningococcal meningitis?

A
  • bacteria infects the meninges and CSF
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12
Q

What are the bacterial causes of meningitis?

A
  • Neisseria meningitides
  • S. pneumoniae
  • neonates: GBS
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13
Q

How does bacteria causing meningitis enter the body?

A
  • extra cranial infection: nasal carriage, otitis media, sinusitis
  • via bloodstream: bacteraemic
  • neurosurgical complications: post op, infected shunts
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14
Q

What are the most common causes of viral meningitis?

A
  • HSV, enterovirus and VZV
  • CSF sample sent for PCR testing
  • treated with aciclovir
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15
Q

What are symptoms of meningitis?

A
  • fever
  • photophobia
  • neck stiffness
  • non-blanching petechial rash
  • vomiting
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16
Q

How does meningitis present in neonates?

A
  • non-specific signs
  • poor feeding
  • lethargy
  • bulging fontanelle
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17
Q

How is meningitis investigated?

A
  • lumbar puncture if
  • under 1 mo with fever
  • 1-3 mo with fever and unwell
  • <1 year and other features of serious illness
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18
Q

What special considerations should be made when treating meningitis?

A
  • allergy to penicillin: if anaphylaxis switch to chloramphenicol
  • recent travel: add vancomycin
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19
Q

What are contraindications for a lumbar puncture?

A
  • abnormal clotting (platelets/coagulation)
  • petechial rash
  • raised ICP
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20
Q

What is seen on LP for bacterial meningitis?

A
  • cloudy
  • high protein
  • low glucose
  • high neutrophils
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21
Q

What is seen on LP for viral meningitis?

A
  • clear
  • mildly raised or normal protein
  • normal glucose
  • high lymphocytes
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22
Q

What are differential diagnoses for meningitis?

A
  • subarachnoid haemorrhage
  • migraine
  • flu and sinusitis
  • malaria
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23
Q

What is the public health response to meningitis?

A
  • notify UK HSA
  • identify close contacts
  • PEP: ciprofloxacin or rifampicin for close contacts
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24
Q

What is Kernig’s test?

A
  • lie patient on back
  • flexing one hip and knee to 90 degrees and slowly straighten knee (keep the hip flexed)
  • spinal pain or resistance to movement in meningitis
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25
Q

What is Brudisinski’s test?

A
  • lie patient on back
  • gently lift head and neck and flex chin to chest
  • patient will involuntarily flex hips and knees
26
Q

What are the possible complications of meningitis?

A
  • hearing loss
  • cerebral palsy
  • seizures and epilepsy
  • cognitive impairment
  • disability
27
Q

What management is given for meningitis in primary care?

A
  • IV/IM benzylpenicillin if suspected meningitis AND non blanching rash
  • immediate hospital referral
28
Q

What antibiotics are given for meningitis in hospital?

A
  • < 3mo: cefotaxime + amoxicillin
  • > 3mo: ceftriaxone
29
Q

What is the post-exposure prophylaxis for meningitis?

A
  • single dose of ciprofloxacin
30
Q

What is the definition of encephalitis?

A
  • inflammation of the brain
31
Q
A
32
Q

What are the causes of encephalitis?

A
  • usually viral
  • HSV 1 in children
  • HSV2 in neonates
  • VZV
  • CMV
  • EBV
33
Q

How does encephalitis present?

A
  • altered consciousness and cognition
  • unusual behaviour
  • acute onset of focal neurological symptoms
  • acute onset focal seizures
  • fever
34
Q

What are the investigations for encephalitis?

A
  • LP: lymphocytic CSF and viral PCR
  • CT/MRI
35
Q

What are the contraindications to LP in encephalitis?

A
  • GCS <9
  • haemodynamically unstable
  • active seizures or post-ictal
36
Q

What is the management of encephalitis?

A
  • aciclovir if HSV or VZV
  • ganciclovir if CMV
  • supportive
37
Q

What are complications of encephalitis?

A
  • lasting fatigue
  • changes in personality or mood
  • changes to memory or cognition
  • headaches
  • seizures
38
Q

What is impetigo?

A
  • superficial bacterial skin infection
  • usually caused by S. aureus
  • contagious
39
Q

What causes impetigo?

A
  • bacteria entering via a break in the skin
  • healthy
  • or related to eczema or dermatitis
40
Q

What is the epidemiology of impetigo?

A
  • mainly affects infants and school children
  • bullous: neonates and children <2
41
Q

What is non-bullous impetigo?

A
  • occurs around nose or mouth
  • exudate dries to form golden crust
  • no systemic symptoms
42
Q

How is non-bullous impetigo treated?

A
  • topical fusidic acid
  • oral flucloxacillin if serious
43
Q

What measures should be taken to stop the spread of impetigo?

A
  • don’t touch or scratch lesions
  • hand hygiene
  • don’t share face towels
  • off school until lesions healed or treated with Abx for 48hrs
44
Q

What is bullous impetigo and what causes it?

A
  • always caused by S. aureus
  • bacteria produce epidermolytic toxins breaking down proteins that hold together skin cells
45
Q

How does bullous impetigo present?

A
  • 1-2cm fluid filled vesicles
  • grow in size and burst forming golden crust
  • heal without scarring
  • painful and itchy
46
Q

How does a severe form of bullous impetigo present and what is it called?

A
  • feverish
  • unwell
  • widespread lesions: staphylococcus scalded skin syndrome
47
Q

How is bullous impetigo investigated and treated?

A
  • swabs for bacteria and Abx sensitivities
  • oral flucloxacillin, IV if unwell
48
Q

What are the complications of impetigo?

A
  • cellulitis
  • sepsis
  • post strep glomerulonephritis
  • scalded skin syndrome
  • scarlet fever
49
Q

What is staphylococcus scalded skin syndrome?

A
  • condition caused by type of S. aureus producing epidermolytic toxins
  • usually affects children <5
50
Q

How does SSSS present?

A
  • generalised patches of erythema
  • skin looks thin and wrinkled
  • followed by bullae which burst
  • appearance of burn/scald
51
Q

What is Nikolsky sign?

A
  • gentle rubbing of skin causes it to peel
  • positive in SSSS
52
Q

What are systemic symptoms of SSSS?

A
  • fever
  • irritability
  • lethargy
  • dehydration
53
Q

How is SSSS managed?

A
  • IV Abx
  • fluid and electrolyte balance
  • avoid dehydration
54
Q

What causes chickenpox?

A
  • varicella zoster virus
  • infected once then develop immunity
55
Q

How does chickenpox present?

A
  • widespread erythematous rash
  • raised and vesicular
  • blistering lesions
  • starts on trunk/face and spreads outwards
  • lesions then scab over
56
Q

What are the systemic symptoms of chickenpox?

A
  • fever
  • itch
  • fatigue
  • malaise
57
Q

How infectious is chickenpox?

A
  • spreads through direct contact with lesions
  • infected droplets
  • symptomatic from 10 days-3 weeks after
  • stop when lesions have crusted over
58
Q

What are complications of chickenpox?

A
  • bacterial superinfection
  • dehydration
  • conjunctival lesions
  • pneumonia
  • encephalitis
  • shingles or Ramsay Hunt syndrome
59
Q

How is chickenpox managed?

A
  • Aciclovir in immunocompromised
  • calamine lotion and chlorphenamine for itching
  • keep off school until lesions crust
60
Q
A

Osha 3a (15 decks)

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