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Zero to finals Paediatrics Marina > Paediatric Infectious Disease & Immunity > Flashcards

Paediatric Infectious Disease & Immunity Flashcards

1
Q

A mother brings her 11-month-old son to the emergency department because she is concerned about a rash he has developed. On further questioning, the mother describes that the rash started 2 days ago, initially behind the ears but has since spread.

Prior to developing the rash, the infant was generally unwell with a cough and a fever. He is currently up to date with vaccines but the mother knows that he is supposed to have some more soon though she has not booked an appointment for these yet.

On examination you note that he is irritable, has white spots in his mouth and his eyes appear inflamed.

Given the most likely diagnosis, which of the following would he be most at risk of developing?

A. Aplastic crisis

B. Arthritis of the small joints

C. Deafness

D. Orchitis

E. Otitis media

A

E. Otitis media: The most common complication of measles is otitis media

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2
Q

What are complications of measles?

A

otitis media: the most common complication
pneumonia: the most common cause of death
encephalitis: typically occurs 1-2 weeks following the onset of the illness)
subacute sclerosing panencephalitis: very rare, may present 5-10 years following the illness
febrile convulsions
keratoconjunctivitis, corneal ulceration
diarrhoea
increased incidence of appendicitis
myocarditis

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3
Q

What is Parvovirus B19 also known as?

A

Erythrovirus

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4
Q

what are common complications of mumps?

A

-orchitis - uncommon in pre-pubertal males but occurs in around 25-35% of post-pubertal males. Typically occurs four or five days after the start of parotitis
-hearing loss - usually unilateral and transient
-meningoencephalitis (aseptic CSF)
-pancreatitis

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5
Q

What is the most common cause of late onset sepsis (>72 hours after birth)?

A

Staphylococcus aureus

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6
Q

What is GBS also known as?

A

Streptococcus agalactiae

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7
Q

What are some main organisms causing late onset neonatal sepsis?

A

-Staphylococcus aureus (commonest)
-Staph epidermidis
-E. coli
-Pseudomonas
-Klebsiella

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8
Q

A 4 year old girl who recently started school is brought to her GP with a 24 hour history of feeling generally unwell, tiredness and headache. She has been eating and drinking but less than normal. Her mother states that she is usually happy and healthy but seems to have got gradually worse today. No one else in her class has been unwell. She has no past medical history and does not take any regular medications.

On examination the child looks unwell and appears quite withdrawn. Vital signs: pulse 100bpm, BP 110/70, respiratory rate 22/min, oxygen saturations 98%, temperature 38.5 degrees C. Systems examination is unremarkable. She has cold hands and feet and a non-blanching purpuric rash on her left upper thigh.

Her GP refers her to the nearest hospital. Which of the following treatments should her immediate family members receive? (class of Ab)

A. Meningococcal vaccine
B. Benzylpenicillin
C. Isoniazid
D. Ciprofloxacin
E. Paracetamol

A

D. Ciprofloxacin (fluoroquinolone; inhibits DNA synthesis)
-All household/close contacts should receive ciprofloxacin or rifampicin as prevention of spread of disease. A suitable alternative would be rifampicin (inhibits RNA synthesis)

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9
Q

What are some complications of parvovirus B19?

A

-Red cell aplasia (aplastic anaemia)
Parvovirus infection also reduces erythropoiesis.
This is not significant for most patients; however, in vulnerable groups like those with conditions like sickle cell anaemia and hereditary spherocytosis that rely on erythropoiesis, infection can precipitate a severe anaemia, causing an aplastic crisis

-Infection in the first half of pregnancy can also cause severe foetal anaemia that can precipitate hydrops foetalis and subsequent miscarriage

-Cardiomyopathy

-arthralgia (adults)

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10
Q

What are 3 other names for parvovirus B19?

A

-slapped cheek syndrome
-erythema infectiosum
-fifth disease

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11
Q

what are 2 other names for roseola infantum?

A

Sixth disease (HHV6)
exanthum subitem

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12
Q

How is measles diagnosed 3-14 days after onset of rash?

A

measles specific IgM and IgG serology (ELISA) is most sensitive 3-14 days after onset of the rash

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13
Q

How is measles diagnosed 1-3 days after rash onset?

A

measles RNA detection by PCR best for swabs taken 1-3 days after rash onset

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14
Q

What vaccine(s) happen at birth?

A

BCG vaccine if risk factors present (eg family have it within past 6 months)

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15
Q

What vaccine(s) happen at 2 months?

A

6 in 1: diptheria, tetanus, whooping cough, polio, Hib, Hep B
-Men B
-oral rotavirus
(8 vaccines)

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16
Q

What vaccine(s) happen at 3 months?

A

6 in 1: diptheria, tetanus, whooping cough, polio, Hib, Hep B
-oral rotavirus
-PCV

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17
Q

What vaccine(s) happen at 4 months?

A

-6 in 1: diptheria, tetanus, whooping cough, polio, Hib, Hep B
-Men B

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18
Q

What vaccine(s) happen at 12-13months? (mnemonic)?

A

12-13=4 numbers= 4 vaccine groups
-Men B
-MMR
-Hib/Men C
-PCV

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19
Q

What vaccine(s) happen at 2-8 yrs?

A

annual flu vaccine

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20
Q

What vaccine(s) happen at 3-4 years?

A

-4 in 1 pre-school booster: whooping cough, polio, diptheria, tetanus
-MMR

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21
Q

What vaccine(s) happen at 12-13 years?

A

Gardasil HPV vaccine

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22
Q

What vaccine(s) happen at 13-18yrs?

A

-Men A, C W, Y
-“3 in 1” teenage booster: polio, diptheria, tetanus

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23
Q

When do the Men B vaccines happen?

A

-2months
-4months
-12-13months

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24
Q

When do the MMR vaccines happen?

A

-12-13months
-3-4 years

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25
Q

When do the PCV vaccines happen? (mnemonic)?

A

PCV: 3 letters: 3 months & 13 months
-3 months
-12-13months

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26
Q

When do the oral rotavirus vaccines happen?

A

-2months
-3months

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27
Q

when do the 6 in 1 vaccines happen (what are they)?

A

6 in 1: diptheria, tetanus, whooping cough, polio, Hib, Hep B
-at 2 months
-at 3 months
-at 4 months

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28
Q

An 8 year old girl is brought in by her mother having been unwell with a sore throat and runny nose for the past week. Her mother reports that for the past two nights she has been suffering from severe coughing fits which last up to a few minutes and is then gasping for breath. She has also vomited forcefully after a few of the coughing episodes. Her mother has noticed she appears very red in the face during the coughing fits. On further history taking her mother reveals that she has not received any vaccinations since birth as her mother was worried about the risk of developing autism.

Given the likely cause of her symptoms which investigation would provide be most likely to provide a definitive diagnosis?

A. Blood film

B. Direct fluorescent antibody test

C. Culture of organism on per-nasal swab

D. PCR

E. This would be the firstline investigation but is not the most sensitive. The sensitivity of the culture is dependent on the timing with swabs only swabs taken up to 3 weeks after onset usefulCulture of organism oral swab

A

D. PCR: PCR is the most sensitive investigation for the diagnosis of pertussis, with a sensitivity of 94% and a specificity of 97%. However, it should be noted a positive PCR result in the absence of cough is NOT diagnostic for whooping cough

Not C: culture; This would be the firstline investigation but is not the most sensitive. The sensitivity of the culture is dependent on the timing with swabs only swabs taken up to 3 weeks after onset useful

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29
Q

what are some features of congenital rubella (mnemonic)?

A

Congenital rubella syndrome (CCD): cataracts, cardiac defects (PDA), deafness
(hearing, seeing and heart)

  1. hearing impairment
  2. Congenital heart defects – in particular, branch pulmonary artery stenosis and patent ductus arteriosus
  3. Eye anomalies such as cataract(s), pigmentary retinopathy (salt and pepper type), chorioretinitis or congenital glaucoma
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30
Q

An 8 month old baby is brought into A&E by his mother. Over the last 24 hours he has been febrile and irritable and now he has developed a rash.

On examination there is widespread erythema and there are large fluid filled blisters across his body, many of which have ruptured. There are patches of desquamation and Nikolsky sign is positive. There is marked crusting and fissuring around his mouth, although his oral mucosa is unaffected.

The boy has no relevant past medical history and is up to date with his vaccinations.

Which of the following is the most likely diagnosis?

A. Bullous pemphigoid

B. Toxic epidermal necrolysis

C. Kawasaki disease

D. Staphylococcal scalded skin syndrome

E. Pemphigus vulgaris

A

D. Staphylococcal scalded skin syndrome

The age of this patient, the de-squamation, the positive Nikolsky sign and the sparing of the oral mucosa points towards staphylococcal scalded skin syndrome (SSSS)

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31
Q

diffuse rose-pink macular rash with surrounding pale halos. His temperature is 40.0 degrees + seizure

A

HHV6

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32
Q

when would you avoid the use of corticosteroids in suspected meningitis?

A

If child <3months

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33
Q

what are common meningitis organisms at Neonatal-3 months

A

Group B streptococcus , E.coli , Listeria monocytogenes

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34
Q

what are common meningitis organisms at 1 month-6 years

A

Neisseria meningitidis , Streptococcus pneumoniae , Haemophilus influenzae

35
Q

What Abs would be given >3months meningitis:

A

IV ceftriaxone

36
Q

GP medication for meningitis

A

IM benzylpenicillin
-Cefotaxime as an alternative if penicillin allergic

37
Q

what Abs would be given <3months meningitis:

A

IV ampicillin/amoxicillin (listeria coverage) +cefotaxime (as ceftriaxone causes biliary stasis)

38
Q

supportive therapy for bacterial meningitis:

A
  1. Analgesia and antipyretics
    2.Oxygen: reservoir rebreathing mask, unless intubation required
  2. Anticonvulsant therapy if needed
  3. IV fluids: 0.9%NaCl+5% dextrose
    5.Vasopressors if hypotensive despite fluid resuscitation
39
Q

what are common meningitis organisms at >6 years

A

Neisseria meningitidis , Streptococcus pneumoniae

40
Q

An 18-year-old primigravida is booked for induction at 38 weeks due to intrauterine growth restriction. After a short labour, a baby girl is delivered by vaginal delivery. The baby has a low birth weight. On examination, she is noted to have microcephaly, moderate hepatosplenomegaly and a petechial rash. Shortly after admission to the neonatal intensive care unit, she has a seizure.

The mother was well throughout pregnancy, has no past medical history, takes no medications and has had all of her vaccinations.

What infection has the baby likely been exposed to in-utero?

A. Cytomegalovirus

B. Herpes Simplex

C. Parvovirus B19

D. Rubella

E. Varicella Zoster

A

A. Cytomegalovirus

Congenital CMV manifests with hearing loss, low birth weight, petechial rash, microcephaly and seizures

41
Q

Congenital CMV mnemonic:

A

-Low birth weight
-Purpuric skin lesions
-Sensorineural deafness
-Microcephaly

Other features:
-Visual impairment
-Learning disability
-Encephalitis/seizures
-Pneumonitis
-Hepatosplenomegaly
-Anaemia
-Jaundice
Cerebral palsy

42
Q

Congenital rubella features (mnemonic):

A

(CCD): cataracts, cardiac defects (eg PDA), deafness

43
Q

congenital toxoplasmosis features (mnemonic):

A

Pentad of Cs:
1. chorioretinitis,
2. intracranial calcifications, 3. hydrocephalus,
4. convulsions
5. cerebral palsy

44
Q

When should exclusion happen?
A 6-year-old boy presents with a 3-day history of fever, mild coryzal symptoms, rash and cervical lymphadenopathy. He has an erythematous, maculopapular rash on his face and neck that has started spreading down his body. He has not received any routine childhood immunisations

A

5 days from onset of rash is correct. The most likely diagnosis is rubella based on his clinical presentation of fever, mild coryza, a characteristic rash and lymphadenopathy. In addition, due to his vaccination status, he is at higher risk of rubella. Rubella requires exclusion from school for 5 days from the onset of the rash.

45
Q

When should exclusion happen? An 8-year-old girl presents with a 2-day history of fever, lethargy and a sore throat. Over the last few hours, she has developed a pinpoint, sandpaper-like blanching rash that initially appeared on her trunk before spreading to the rest of the body. The area around her mouth is noted to be spared. Her pharynx is inflamed with petechiae noted on the hard and soft palate. Cervical lymphadenopathy is palpable.

A

24 hours after commencing antibiotics

The most likely diagnosis is scarlet fever given the history of acute fever and sore throat before the development of a characteristic rash (with circumoral pallor), cervical lymphadenopathy and ‘Forchheimer spots’. A ‘strawberry tongue’ may also be seen on clinical examination. Scarlet fever results from a reaction to toxins produced by group A haemolytic streptococci. It is highly contagious and requires exclusion from school for 24 hours after commencing antibiotics (first-line phenoxymethylpenicillin if not penicillin allergic).

46
Q

When should exclusion occur?
A 5-year-old girl presents with a 2-day history of fever, reduced appetite, abdominal discomfort and a sore mouth. She has scattered ulcerative lesions in her mouth and an erythematous maculopapular rash on the sides of her fingers, dorsum of her hands and margins of her heels.

A

No exclusion. The most likely diagnosis is hand, foot and mouth given the characteristic nature of her rash. It is typically self-limiting, does not require exclusion from school and is managed conservatively with analgesia and encouraging oral fluid intake. It is most commonly caused by the Coxsackie A16 virus.

47
Q

When should exclusion for whooping cough happen?

A

2 days after commencing antibiotics (or 21 days from onset of symptoms if no antibiotics)

48
Q

When should exclusion for measles happen?

A

4 days from onset of rash

49
Q

When should exclusion for chickenpox happen?

A

after all lesions crusted over

50
Q

When should exclusion for impetigo happen?

A

Until lesions are crusted and healed, or 48 hours after commencing antibiotic treatment

51
Q

When should exclusion from mumps occur?

A

5 days from onset of rash

52
Q

When should exclusion from rubella occur?

A

5 days from onset of swollen glands

53
Q

When should exclusion from scabies occur?

A

until treated (permethrin 5% is first-line
malathion 0.5% is second-line, malathion also used for headlice)

54
Q

When should exclusion from influenza occur?

A

until recovered

55
Q

what organism causes threadworms?

A

Enterobius vermicularis (threadworms)

56
Q

treatment for threadworms:

A

-CKS recommend a combination of 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

57
Q

Impetigo common organisms:

A

Group A Streptococcus or staphylococcus aureus

58
Q

clinical features of impetigo

A
  1. It classically presents as a pruritic rash with discrete patches that have a golden crusting
  2. Patients may also be febrile
  3. It commonly occurs in infants and school-age children
59
Q

Management of impetigo:

A

-In most circumstances it can be managed in primary care with topical treatments such as fusidic acid. Oral flucloxacillin may also help.
-It is highly infectious. Patients should not share towels and should not attend school or work until they have completed 48 hours of antibiotic treatment.

60
Q

what is the most common intrauterine infection?

A

CMV (cytomegalovirus)

61
Q

CMV symptoms (mnemonic)

A

-seizures
-hepatosplenomegaly
-learning difficulties

62
Q

Common causes of meningitis in neonates:

A

Gp B Strep, E Coli, Listeria, Pneumococcus, Staph aureus.

63
Q

Common causes of meningitis in babies >1month & children:

A

Meningococcus, Pneumococcus and Haemophilus influenzae B (Haemophilus, a coccobacilli, was previously more common until it was included in the childhood vaccination programme; it now much less commonly seen).

64
Q

what is the most common cause of meningitis in children:

A

Neisseria meningitides is the most common cause of meningitis in children.

5% of survivors have neurological sequelae (not all of them) and there is a 10% mortality

65
Q

when is Meningococcal Gp C vaccine routinely given?

A

at 12 months of age and at 14 years, as part of the MenACWY vaccine.

66
Q

when is Men Gp B vaccine usually given?

A

at 8 and 16 weeks, followed by a booster at 1 year

67
Q

what meningitis vaccine is given to travellers?

A

. Gp A strains are seen in other parts of the world and a Gp A+C travel vaccine is available.

68
Q

sepsis vs shock definitions:

A

Severe sepsis develops when the infection causes organ damage. Sepsis= a life-threatening reaction to an infection

Septic shock is the most severe form in which the infection causes low blood pressure, resulting in damage to multiple organs.

69
Q

What Abs would be given >3months meningitis:

A

IV ceftriaxone

70
Q

what antibiotic would be added for recent foreign travel if meningitis suspected?

A

Vancomycin

71
Q

when should dexamethasone be given in the context of meningitis:

A

Dexamethasone may be given if
>3 months old and presents with these in CSF analysis:
o Frankly purulent CSF
o CSF WBC>1000/μL
oRaised CSF WBC+protein concentration>1g/L
o Bacteria on Gram stain

steroids should not be used in meningococcal septicaemia

72
Q

Infection with which virus in the first 20 weeks of pregnancy causes hydrops fetalis?

A
73
Q

what are absolute contraindications to primary immunisations?

A
  1. Severe allergic reaction (anaphylaxis) to a previous dose of the vaccine or a vaccine component
  2. Known severe immunodeficiency (e.g. congenital immunodeficiency, HIV infection with severe immune suppression, malignancy with chemotherapy, transplantation with immunosuppressive therapy)
  3. Current moderate to severe acute illness with or without fever, until the illness has resolved.
74
Q

contraindications to MMR vaccine:

A
  1. Immunosuppression
  2. Neomycin allergy (aminoglycoside antibiotic)
  3. Other live vaccine <4w prior
  4. IVIG <3months prior
  5. Avoid pregnancy 1 month following vaccination
75
Q

6 in 1 vaccine mnemonic:

A

o Parents Polio
o Will Whooping cough (Pertussis)
o Immunise Influenzae (HiB)
o Toddlers Tetanus
o Because B (Hepatitis)
o Death Diphtheria

76
Q

Which four are most likely differential diagnoses?

A
  1. Pyelonephritis
  2. Sepsis
  3. Pneumonia (can present in babies even if chest is clear)
  4. Meningitis

A 6-month-old coming with high fever indicates a high probability of sepsis. In such babies, the focus of sepsis may be difficult to identify. In our baby, the high fever cannot be explained by just the diarrhoea and the diarrhoea is not severe enough to cause the tachypnoea and tachycardia, exclusing gastroenteritis as a differential. The foul smelling urine gives a clue, and meningitis is a serious infection that can present in babies without any localizing signs.

77
Q

A 6-year-old child was briefly admitted two weeks ago to an open paediatric ward with an undiagnosed rash. His 1-year-old brother is now in paediatric ED and has been diagnosed with measles by the paediatric registrar who has now gone off to attend to an emergency. What do you do? (3 options)

Advise that it is fine for the patient to be in an open 6 bed area

Ensure the patient is being managed in a side-room with respiratory precautions

Ensure the patient is being managed in a side-room with gloves and aprons

Ensure the patient is being managed in a negative-pressure room

Inform the local Health Protection Consultant by phone even if out of hours

Notify the Health Protection Consultant in office hours/through a notification form

Inform the hospital infection control team

A
  1. Ensure the patient is being managed in a side-room with respiratory precautions
  2. Inform the local Health Protection Consultant by phone even if out of hours
  3. Inform the hospital infection control team
78
Q

what is kawasaki disease also known as?

A

IgA vasculitis
-mucocutaneous lymph node syndrome.

79
Q
A

Gamma globulin (vs penicillin) as 5 days of fever suggests Kawasaki (no recent unwell contacts as well so points against scarlet fever)

80
Q

what’s the definition of fever?

A

A fever is usually when your body temperature is 37.8°C or higher

81
Q

A 3 year old girl is seen at GP with a pruritic rash covering her body, including her scalp, face and limbs (pictured). It developed 3 days ago. Her dad is also concerned that his other child, who a four year boy, will also catch this. He has sent his son to stay with his mother in the meanwhile. At present his son is asymptomatic. He asks how long about if he needs to wait to see if his son will get the rash.

A

Given the most likely diagnosis, what is the most appropriate response for the GP to give when advising about the incubation period concerning the son?

A. Up to 14 days

B. It is non-contagious

C. Up to 21 days

D. Up to 3 days

E. Up to 7 days

82
Q

A 3 year old girl is seen at GP with a pruritic rash covering her body, including her scalp, face and limbs (pictured). It developed 3 days ago. Her dad is also concerned that his other child, who a four year boy, will also catch this. He has sent his son to stay with his mother in the meanwhile. At present his son is asymptomatic. He asks how long about if he needs to wait to see if his son will get the rash.

Given the most likely diagnosis, what is the most appropriate response for the GP to give when advising about the incubation period concerning the son?

A. Up to 14 days

B. It is non-contagious

C. Up to 21 days

D. Up to 3 days

E. Up to 7 days

A

C. Up to 21 days

The incubation period for chickenpox is up to 21 days

83
Q

Conservative management of chickenpox (advice):

A

Management of chickenpox is conservative as the condition is self-limiting.

Simple measures include
1. keeping fingernails short
2. wearing long sleeved clothing to prevent scratching
3. use of oatmeal baths to reduce itching.

Zero to finals Paediatrics Marina (18 decks)

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