Paeds Infectious Diseases + Immunology + Haematology

Question 1

what is the most common cause of bacterial meningitis in children?

Answer 1

neisseria meningitidis and strep pneumoniae
(in neonates - group B strep)

Question 2

presenation of meningitis in children?

Answer 2

• fever
• neck stiffness
• vomiting
• headache
• photophobia
• altered consiousness
• seizures
• non blanching rash (if meningicoccal septiceamia)

Question 3

signs of meningitis in neonates an babies?

Answer 3

• hypotonia
• poor feeding
• lethargy
• hypothermia
• bulging fontanelle

Question 4

Ix for meningitis?

Answer 4

kernigs and brudzinkis test - check for meningeal irritation

blood culture + lumbar puncture

Question 5

Mx of meningitis?

Answer 5

community (give STAT IM benzylpenicillin and go straight to hosp)

under 3 months: cefotaxime + amoxicillin
above 3 months: ceftrixone

+ steroids (dexamethasone) to prevent neuro damage and hearing loss

Question 6

name the conditions that are a result of hypersensitivity reactions?

Answer 6

• asthma
• atopic eczema
• allergic rhinitis
• hayfever
• food allergies
• animal allergies

Question 7

what are the 3 main ways to test for allergies?

Answer 7

• skin prick testing
• RAST testing (blood testing for IgE)
• food challenge testing

Question 8

what medications can be used to treat allergic reactions?

Answer 8

antihistamines
steroids (oral prednis, topical or IV hydrocort)
IM adrenaline in anaphylaxis

Question 9

Mx of having an allergy

Answer 9

• avoidance
• regular hoovering, changing sheets (if dust mites)
• staying in doors when pollen count high)
• prophylactic antihistamines when contact is inevitable
• if at risk of anaphylactic reactions then give epipen

Question 10

presentation of anaphylaxis?

Answer 10

• urticaria
• itching
• angio-oedema, with swelling around lips and eyes
• abdo pain
• SOB
• wheeze
• swelling of larynx (stridor)
• tachy
• lightheadness
• collapse

Question 11

Mx of anaphylaxis?

Answer 11

A-E!!!
- IM adrenaline (repeat after 5 mins if required)
- antihistamines
- steroids (IV hydrocort)

Question 12

what type of hypersensitivity reaction is allergic rhinitis?

Answer 12

IgE mediated type 1 hypersensitivity reaction

Question 13

typical features of allergic rhinitis?

Answer 13

• runny, blocked and itchy nose
• sneezing
• itchy, red and swollen eyes

Question 14

Mx of allergic rhinitis?

Answer 14

• avoid trigger, hoovering, changing pillows etc
• oral antihistamines (cetirizine, chlorphenamine)
• nasal corticosteroid sprays (fluticasone)
• nasal antihistamines

Question 15

how to tell between cows milk intolerance and cows milk protein allergy?

Answer 15

cows milk intolerance presents with the GI symptoms (bloating, diarrhoea etc) but no allergy symptoms (rash, angio-oedema, sneezing etc)

children with cows milk intolerance will be able to tolerate it, but just not very well. children with cows milk allergy will no be able to tolerate it at all

children with cows milk intolerance will grow out of it by age 2-3

Question 16

presenation of a child with cows milk protein allergy?

Answer 16

usually present when child is being weaned off breast milk to formula milk

GI symptoms: bloating, abdo pain, diarrhoea, vomiting

allergic symptoms: urticarial rash, angio-oedema, wheeze, sneezing, watery eyes, eczema

Question 17

how is cows milk protein allergy diagnosed?

Answer 17

full Hx and examination
skin prick testing

Question 18

Mx of children with cows milk protein allergy?

Answer 18

avoid cows milk
(if breast feeding, then mother avoid dairy products)
hydrolysed formulas designed for cows milk allergy can be used
most children will outgrow the allergy by age 3

Question 19

what are the types of leukaemia in children?

Answer 19

ALL (most common)
AML (next most common)
CML

Question 20

why do you get pancytopenia in leukaemia?

Answer 20

leukaemia = genetic mutation leading to XS production of abnormal WBC which leads to supression of other cells

Question 21

what is pancytopenia characterised by?

Answer 21

• low RBC (anaemia)
• low WBC (leukopenia)
• low platelets (thrombocytopenia)

Question 22

risk factors for leukaemia?

Answer 22

• radiation exposure (e.g. abdo XR in pregnancy)
• downs syndrome
• kleinfelters dynrome
• noonan syndrome
• fanconis anaemia

Question 23

peak age for ALL ?

Answer 23

2-5 yo

Question 24

presentation of a child with leukaemia?

Answer 24

• persistent fatigue
• unexplained fever
• failure to thrive
• night sweats
• weight loss
• pallor (anaemia)
• petechiae + abnormal bruising
• unexplained bleeding
• abdo pain
• generalised lymphadenopathy
• unexplained or persistent bone or joint pain
• hepatosplenomegaly

Question 25

if leukaemia is suspected in a child, what Ix must be done?

Answer 25

FBC within 48 hrs !! - shows pancytopenia
blood film can show blasts cells
bone marrow biopsy
lymph node biopsy

staging tests: CXR, CT, LP, genetic analysis & immunophenotyping of abnormal cells

Question 26

Mx of leukaemia?

Answer 26

chemo (main tx)
other:
radio
bone marrow transplant
surgery

Question 27

chemotherapy complications in children?

Answer 27

failure to treat leukaemia
stunted growth + development
immunodeficiency and infections
neurotoxicity
infertility
secondary malignancy
cardiotoxicity