pead infectious disease

Question 1

SIRS: 2+ of

Answer 1

temp >38 or <36
WCC >15 or <5
tachycardia >2SDs
tachypnoea >2SDs

Question 2

paed sepsis 6

Answer 2

• give high flow O2
• blood cultures, blood Glc, blood lactate
• IV broad spectrum antib
• fluid resus 20ml/kg isotonic fluid
• consider inotropic support - adrenaline
• involve senior clinicians/specialists early

Question 3

infants <3mo and sepeis

Answer 3

may have minimal symptoms/signs and non-specific presentation
deteriorate quickly

Question 4

infant sepsis risk factors

Answer 4

PROM 
maternal pyrexia 
maternal GBS
maternal STI 
prematurity

Question 5

sepsis Rx

Answer 5

airway 
breathing 
circulation: 20ml/kg fluid bolus
glc: 2ml/kg 10% dextrose 
antib

Question 6

sepsis antibiotic

Answer 6

3rd generation cephalosporin - ceftriaxone

add IV amoxicillin if <1mo

Question 7

sepsis investigations

Answer 7

blood: FBC, CRP, coag screen, blood gas, glucose
culure: blood, urine, CSF, stool
CXR

Question 8

sepsis organisms <1mo

Answer 8

group b strep
e.coli
listeria monocytogenes

Question 9

sepsis organisms older infants + kids

Answer 9

strep pneumoniae
neisseria meningitidis
group a strep
staph a

Question 10

meningitis features older children

Answer 10

headache
stiff neck 
photophobia
fever
nausea and vomiting 
reduced GCS
seizure
focal neurological deficits

Question 11

meningitis features younger children

Answer 11

fever or hypothermia
poor feeding 
lethargy, irritable
respiratory distress
apnoea
buldging fontanelle
vomiting

Question 12

meningitis clinical signs

Answer 12

nuchal rigidity
brudzinski’s sign
kernig’s sign

Question 13

brudinski’s sign

Answer 13

hip and knee flex on passive neck flexion

sign meningitis

Question 14

kernig’s sign

Answer 14

pain on passive knee extension

sign meningitis

Question 15

causes childhood meningitis

Answer 15

bacterial 4-18%
mostly viral - mainly enterovirus
fungal - neonates, immunocompromosed
unknown, aseptic

Question 16

bacterial meningitis organisms neonate <1mo

Answer 16

group b strep
e.coli
listeria monocytogenes

Question 17

bacterial meningitis organisms older infants + children

Answer 17

strep pneumoniae
neisseria meningitisis
Hib

Question 18

meningitis: Hib

Answer 18

small, non-motile
gram negative
coccobacillus

encapuslated - more serious infections
non-encapsulated - not bad

Question 19

invasive meningococcal disease long term sequalae

Answer 19

amputation
scarring
hearing loss
cognitive impairment/epilepsy

Question 20

strep pneumoniae

Answer 20

gram positive lancet-shaped diplococci

preceeding URTI to invasive infection

Question 21

pneomococcal meningitis neurological sequelae

Answer 21

hydrocephalus
neurodisability 
blindness
hearing loss
seizures

Question 22

meningitis Rx

Answer 22

airway 
breathing 
circulation: 20ml/kg fluid bolus, inotropes
glucose: 2ml/kg 10% dextrose
antibiotics

Question 23

meningitis antibiotics

Answer 23

3rd generation cephalosporin e.g. ceftriaxone

add IV amoxicillin if <1mo

Question 24

meningitis Ix

Answer 24

FBC, LFT, U+Es, CRP 
blood gas
Glc
blood culture
meningococcal/pneumococcal PCR

Question 25

signs of raised ICP

Answer 25

GCS <9
abnormal tone/posture
HTN 
bradycardia
pupillary defects
papilloedema

Question 26

meningitis duration of Rx: neisseria meningitidis

Answer 26

7 days

Question 27

meningitis duration of Rx: Hib

Answer 27

10 days

Question 28

meningitis duration of Rx: strep pneumoniae

Answer 28

14 days

Question 29

meningitis duration of Rx: group B strep

Answer 29

14+ days

Question 30

meningitis duration of Rx: listeria monocytogenes

Answer 30

21 days

Question 31

what cause the majority of soft tissue and skin infections

Answer 31

staph aureus

strep pyogenes

Question 32

staph aureus

Answer 32

gram positive cocci 
coagulase negaitive
colonise skin and mucosa
produce exotoxins and form superantigens
resistance is a problem - MRSA

Question 33

strep pyogenes

Answer 33

gram positive cocci 
B-haemolytic
oropharyngeal carriage 
produce exotoxins and form superantigens
resistance not usually problem

Question 34

staphylococcal scalded skin syndrome

Answer 34

usually <5yrs

toxin mediated - exfoliatoxin: damage to linkage proteins in superficial layers of dermis

Question 35

staphylococcal scalded skin syndrome features

Answer 35

initial bullous lesions then widespread desquemation
nikolsy’s sign
mild fever
purulent conjunctivitis

Question 36

staphylococcal scalded skin syndrome Rx

Answer 36

IV flucloxacillin

IV fluids

Question 37

scarlet fever - features

Answer 37

2-5 day incubation period
sandpaper rash 1-2 days after symptoms start 
fever, malaise, sore throat
strawberry tongue
desquamation

Question 38

scarlet fever Rx

Answer 38

inform public health - notifiable disease

phenoxymethylpenicillin 10days

Question 39

scarlet fever complications

Answer 39

abscess: retropharyngeal, peritonsilar
rheumatic fever
post-strep glomerulonephritis

Question 40

toxic shock syndrome

Answer 40

acute febrile illness caused by group A strep or staph a

rapid progression to shock and multi-organ failure

Question 41

toxic shock syndrome pathophys

Answer 41

superantigen causes intese T cell stimulation

• pro-inflam cytokine release
• excessive immune activation

Question 42

TSS features

Answer 42

fever
diffuse maculopapular rash
mucosal changes: non-purulent conjunctivitis, strawberry tongue, swollen lips
diarrhoea

shock + multi-organ failure: tachycardia, hypotension, renal impairment, reduced GSC

Question 43

TSS Rx

Answer 43

ABC 
fluid resuscitation +/- inotropes
cultures: blood, throat swabs, wounds
antib
IV Ig
avoid NSAIDs
surgical debridement

Question 44

TSS antibiotics

Answer 44

IV flucloxacillin and clindamycin