Paeds - Infectious disease Flashcards

Question

how is scalded skin syndrome managed?

Answer 1

IV anti-staphylococcal antibiotic, analgesia and monitoring fluid balance

Answer 2

gram negative bacterium bordetella pertussis

Answer 3

2-3 days of coryza precede the onset of: coughing bouts - usually worse at night and after feeding, may be ended by vomiting and associated central cyanosis insipiratory whoop - not always present - caused by force inspiration against a closed glottis infants may have spells of apnoea persistent coughing can cause subjconjunctival haemorrhages or even anoxia leading to syncope and seizure symptoms may last 10-14 weeks and is more severe in infants there is marked lymphocytosis

Answer 4

if a person has an acute cough for more than 14 days or more without another apparent cause and has one or more of the following features paroxysmal cough inspiratory whoop post-tussive vomiting undiagnosed apnoeic attacks in young infants

Answer 5

nasal swab culture to look for bordetella pertussis | PCR and serology are now increasinglt used

Answer 6

under 6 months if it suspected then admit them it is notifiable disease an oral macrolide - e.g. clarithromycin or azithromycin clarithromycin for infants less than 1 month azithromycin or clarithromycin for children aged 1 month or older and non-pregnant household contacts should be offered prophylaxis

Answer 7

subconjunctival haemorrhage pneumonia bronchiectasis seizures

Answer 8

catarrhal phase is the first stage (runny nose stage - typically lasts one to two week paroxysmal stage - duration is highly variable lasting from one to ten weeks, intense drawn out bouts of coughing during this phase. Attacks tend to be more frequent at night convalescent phase - the third stage - this can last for week to months and a chronic cough that becomes less paroxysmal (fewer sudden outbursts of coughing)

Answer 9

mycobacterium tuberculosis

Answer 10

a non-immune host is exposed to tuberculosis A small lung lesion known as a Ghon focus develops 3 weeks following initial infectoin The Ghon focus is composed of tubercle-laden macrophages. The combination of a Ghon focus and a hilar lymph node is known as a Ghon complex. In immunocompotent people this initially heals by fibrosis and calcification. Those who are immunocompromised may develop disseminated disease (miliary tuberculosis)

Answer 11

if the host becomes immunocompromised the initial infection may become reactivated Reactivation usually occurs in the apex of the lungs and may spread locally or to more distant sites causes of immunocompromise - HIV, immunosupressants, malnutrition

Answer 12

``` CNS - tuberculosis meningitis - the most serious complication vertabral bodies (potts disease) cervical lymph nodes - scrofluderma renal - WBC in urines addisons disease GI tract ```

Answer 13

Purified protein derivative intradermal skin test also know as tuberculin test mantoux test, TB test this test just shows that they have been exposed to TB not whether it is latent or active interferon gamma release assay positive results - do xray labs of sputum

Answer 14

isoniazid for 9 months

Answer 15

``` RIPE Rifampicin isoniazid pyrazinaminde ethambutol ```

Answer 16

group B streptococcus (usually acquired from the mother at birth) E.coli and other gram negative organisms listeria monocytogenes

Answer 17

``` Neisseria meningitidis (meningococcus) Streptococcus pneumoniae (pneumococcus) Haemophilus influenzae ```

Answer 18

``` Neisseria Meningitidis (meningococcus) Streptococcus pneumoniae (pneumococcus) ```

Answer 19

enterovirus EBV adenovirus mumps

Answer 20

``` headache temp cold hands and feet discolored skin (blotchy) poor feeding irritability hypotonia drowsiness ```

Answer 21

``` neck stiffness kernigs sign photophobia bulging fontanelle arched back siezure shock: increased HR, RR, cap refill and BP decrease ``` non blanching purpuric rash

Answer 22

``` Septic screen blood - coagulation screen, LFT, PCR, rap[id antigen test, blood gas Culture - throat swab, urine and stool TB - mantoux test, CXR LP ```

Answer 23

``` focal neurological sigs papiloedema significant bulding of the fontanelle DIC signs of cerebral herniation ```

Answer 24

antibiotics if less than 3 months - IV amoxacillin and cefotaxime if older than 3 months - IV cefotaxime Steroids - if less than 1 month and H.influenzae then guive dexamethosone Fluids Cerebral monitoring Public health notification prophylaxis of contacts with ciprofloxacin

Answer 25

cloudy low glucose high protein white cells 10-500 polymorphs

Answer 26

clear/clowdy CSF 60-80% of plasma glucose protein is normal/raised white cells 15-1000 lymphocytes

Answer 27

slapped cheek syndrome | Parvo virus B19

Answer 28

mild fever rose-red rash makes the cheeks appear bright red the rash may spread to the rest of the body but will spare the palms and soles. rash peaks after a week and then fades other presentations: - asymptomatic - pancytopaenia in immunocompromised patients aplastic crisis e.g sickle cell diseaase

Answer 29

most children recover and need no specific treatment

Answer 30

a superficial bacterial skin infection it may be a primary infection or a complication of an existing skin conditiomn such as eczema, scabies or insect bites. It is common in children in warm weather

Answer 31

staphylcoccus aureus or streptococcus pyogenes

Answer 32

anywhere on body but tend to occur on face, flexures and limbs not covered by clothing

Answer 33

golden, crusted skin lesions typically found around the moth

Answer 34

Non-bullous/ cruted impetigo tiny blisters that eventually burst and leave small wet patches of red skin that may weep fluid, gradually they crust over Bullous impetigo causes larger fluid containing blisters that look clear, then cloudy. they are more likely to stay longer without bursting Ecthyma - punched out ulcers with yellow crust and red edges

Answer 35

first line - topical fusidic acid | second line - topical retamulin

Answer 36

oral flucloxacillin or if allergic to penacillin - erythromycin children should be excluded from school until lesions are crusted and healed or 48 hours after commencing antibiotic treatment.

Answer 37

group A haemolytic streptococci | usually streptococcus pyogenes

Answer 38

2-6 years | peak incidence at 4 years

Answer 39

fever that typically lasts 24 to 48 hours malaise, headache, nausea/vomiting sore throat strawberry tongue rash - fine punctate erythema (pinhead) which generally appears first on the torso and spares the palms and soles the rash is often described as having a rough sandpaper texture desquamation occurs later in the course of the illness

Answer 40

throat swab

Answer 41

oral penicillin V for 10 days patients with penicillin allergy should be given azithromycin scarlet fever is a notifiable disease children can return to school 25 hours after starting antibiotics

Answer 42

otitis media rheumatic fever (usually 20 days after infection ) acute glomerularnephritis (typically 10 days after infections) invasive complications rare but are dangerous (bacteraemia , meningitis, necrotising fasciitis)

Answer 43

RBNA paramyxovirus

Answer 44

spread by droplets it is infective for 7 days before and 9 days after parotid swelling it has an incubation period of 14-21 days

Answer 45

fever malaise muscular pain parotitis (earache, pain on eating) unilateral initially then becomes bilateral in 70%

Answer 46

rest paracetamol for high fever and discomfort it is a notifiable disease

Answer 47

orchitis - uncommon in pre-pubertal males but occurs in 25-35% of post-pubertal males - typically occurs 4-5 days after parotitis hearing loss - usually unilateral and transient meningoencephalitis pancreatitis

Answer 48

toxin-producing staphylococcus aureus and group A streptococci

Answer 49

fever hypotension diffuse erythematous, macular rash can also cause organ dysfunction including: mucositis GI - vomiting/diarrhoea renal impairment liver impairment clotting abnormalities and thrombocytopenia CNS - altered consciousness

Answer 50

areas of infection should be surgically derided antibiotics - 3rd gen cephalosporin - ceftriaxone along side clindamycin IVIG to neutralise circulating toxin

Answer 51

direct invasion of the cerebrum by a neurotoxic virus (HSV) delayed brain swelling following a disordered neuroimmunological response to an antigen, usually a virus (post-infectious encephalopathy e.g. following chicken pox) a slow virus infection such as HIV infection or subacute sclerosing pan encephalitis following measles

Answer 52

high dose aciclovir

Answer 53

mother-to-child transmission - during pregnancy, and delivery or through breast feeding. children may also be infected by infected blood products, contaminated needle or through sexual abuse.

Answer 54

in children over 18 month, HIV is diagnosed by detecting antibodies to the virus. prior to 18 months - they will have the mothers antibodies which suggests exposure but not deffo infection before 18months diagnosis is by HIV DNA PCR

Answer 55

a proportion of HIV infected infants progress rapidly to symptomatic disease and onset of AIDs in the first year of life some children remain asymptomatic for months or years clinical presentation depends on degree of immunosuppression mild immunosupresion: lymphadenopathy or parotitis moderate - recurrent bacterial infection severe - pneumocystis jiroveci pneumonia (PCP), severe FTT, encephalopathy and malignancy, although this is rare in children

Answer 56

antiretroviral therapy prophylaxis against PCP with co-trimoxazole immunisation

Answer 57

most commonly coxsackie A16 and enterovirus 71

Answer 58

mild systemic upset - fever, sore throat oral ulcers followed later by vesicles on the palms and soles of feet

Answer 59

symptomatic treatment only | do not need to be excluded from school