infection

Question 1

kawasakis disease presentation (My HEART)

Answer 1

mucosal involvement - dry lips, strawberry swollen tongue
hand and feet with oedmea
eyes - non purulunt bilateral conjunctivitis
andenopathy - cervical, unilateral
rash - truncal and pleomorphic (maculopapular)
temperature - non remittting fever at least 5 days

Question 2

kawasakis disease what is it

Answer 2

idiopathic systemic vasculitis

causes coronary aneurysms - echocardiogram

Question 3

kawasakis disease management

Answer 3

aspirin (beware reyes syndrome)
IV immunoglobulin (reduces fever and myocardial inflammation)

Question 4

measles (notifiable disease) presentation (4cs) and rash

Answer 4

prodrome - cough, coryza, conjunctivitis, cranky
rash - first behind ears, forehead, spreads to involve trunk and limbs
also grey/white spots in mouth

Question 5

measles (notifiable disease) complications

Answer 5

otitis media - most common
pneumonia - most common cause of death
subacute sclerosing panencephalitis - chronic complication, develops 7-13yrs after measles with changes in behaviour, dementia, death

Question 6

measles (notifiable disease) management

Answer 6

nutrition

vitamin A in developing world

Question 7

scarlet fever (notifiable disease) presentation

Answer 7

sore throat and fever
rash on chest, axilla or behind ears
red ‘pin prick’ blanching rash, facial flushing and strawberry tongue

Question 8

scarlet fever (notifiable disease) management

Answer 8

penicillin or clarithromycin

Question 9

scarlet fever (notifiable disease) complications

Answer 9

sydenhams chorea (involuntary jerking movements)

Question 10

scarlet fever (notifiable disease) cause

Answer 10

endotoxin from strep pyognes (group A haemolytic)

Question 11

rubella (notifiable disease) presentation

Answer 11

macular rash

suboccipital lymphadenopathy

Question 12

rubella (notifiable disease) complications

Answer 12

small joint arthritis
infection during fetal development causes:
week 1-4 eye anomaly 
week 4-8 cardiac abnormality
week 8-12 deafness

Question 13

rubella (notifiable disease) managment

Answer 13

RNA virus - vaccine

Question 14

chicken pox cause and presentation

Answer 14

varicella zoster virus

itchy vesicles

Question 15

chicken pox management

Answer 15

calamine lotion

flucloxacillin if bacterial superinfection

Question 16

chicken pox DD

Answer 16

shingles

Question 17

shingles presentation

Answer 17

reactivation of vzv in posterior root ganglia

confined to one dermatone

Question 18

diphtheria presentation

Answer 18

tonsilits
may cause polyneuritis
dysphagia, muffled voice, upper airway obstruction

Question 19

diphtheria treatment

Answer 19

anti-toxin and erythromycin

Question 20

pertussis (whooping cough) (notifiable disease)

Answer 20

bordetella pertussis (gram -ve coccobacillus)

Question 21

diphetheria cause

Answer 21

toxin from corynebacterium diphtheriae

Question 22

pertussis signs

Answer 22

apnoea

barking cough - worse at night

Question 23

pertussis management

Answer 23

macrolides - azithromycin/clarithromycin

Question 24

TB signs and symptoms

Answer 24

suspect with overseas travel
weight loss
low fever
malaise
cough

Question 25

TB diagnosis

Answer 25

tuberculin hypersensitivity (mantoux test) culture and ziehl neelson acid fast stain CXR - consolidation, miliary spots

Question 26

TB management RIPE +SE

Answer 26

rifampicin - 6 months Nausea; thrombocytopenia; vomiting isoniazid - 6 months hepatitis pyrazinamide - 2 months hepatitis ethambutol - 2 months Hyperuricaemia; nerve disorders; visual impairment

Question 27

HIV diagnosis

Answer 27

CD4 count <200 = AIDS (CD4 count useful for staging) HIV viral PCR p24 antigen

Question 28

HIV considerations

Answer 28

``` children should always be bottle fed if mother +ve (risk of vertical transmission) consider in children with: pyrexia of unknown origin hepatosplenomegaly persistant diarrhoea ```

Question 29

HIV management

Answer 29

``` highly active antiretroviral therapy ccr5 antagonists nucleotide and non nucleotide reverse transcriptase inhibitors integrase strand transfer inhibitors protease inhibitors ```

Question 30

meningitis aetiology 3 children 3 neonates

Answer 30

children: neisseria meningitis, haemophilus influenza, strep pneumoniae neonates: group B haemolytic step (via mothers vagina), e.coli, listeria

Question 31

meningitis presentation (septic and meningeal signs)

Answer 31

``` septic signs: increased temp, pulse and RR decreased BP abnormal cry / skin colour cold extremities ``` meningeal signs: neck stiffness kernings sign photophobia

Question 32

``` bacterial meningitis diagnosis opening pressure WBCs appearence glucose protein ```

Answer 32

``` elevated polymorphs - neutrophils turbid low elevated ```

Question 33

``` viral meningitis diagnosis opening pressure WBCs appearence glucose protein ```

Answer 33

``` normal lymphocytes clear normal elevated ```

Question 34

meningitis management

Answer 34

IV cefotaxime STAT, then cultures/CSF in community - benzylpenicilin contact tracing - close contacts have Ciprofloxacin one dose or Rifampicin BD 2 days if viral - acyclovir

Question 35

encephalitis signs

Answer 35

flu like prodrome behaviour changes vomiting fits

Question 36

encephalitis causes

Answer 36

Herpes simplex virus also mumps, varicella zoster

Question 37

encephalitis management

Answer 37

HSV - aciclovir

Question 38

slapped cheek syndrome (erythrovirus) cause

Answer 38

parovirus B19 (respiratory droplets spread)

Question 39

slapped cheek syndrome (erythrovirus) presentation

Answer 39

``` malar erythema (slapped cheek rash), spreads to limbs (mainly extensor surfaces) may cause aplastic crisis ```

Question 40

slapped cheek syndrome (erythrovirus) diagnosis

Answer 40

B19 IgM - current / recent infection | B19 IgG - immunity

Question 41

slapped cheek syndrome (erythrovirus) complications

Answer 41

growth restriction hydrops fetal death in pregnancy

Question 42

impetigo cause

Answer 42

staph aureus +/- strep pyogenes

Question 43

impetigo management

Answer 43

fusidic acid and oral flucloxacilin

Question 44

toxic shock syndrome cause

Answer 44

s.aureus + group a step (rare)

Question 45

toxic shock syndrome signs

Answer 45

fever, hypotension, malar rash

Question 46

toxic shock syndrome management

Answer 46

ITU | ceftriaxone + clindamycin

Question 47

coxsackies disease presentation

Answer 47

mildly unwell | vesicles on palms, soles and mouth

Question 48

``` red flags for serious illness colour activity respiratory circualtion other ```

Answer 48

``` pale no response grunting, RR>60 reduced turgor non blanching rash, bludging fontanelle, seizures, neck stiff <3months old ```

Question 49

``` orange flags for serious illness colour activity respiratory circulation and hydration other ```

Answer 49

``` pallor not responding normally to social ques nasal flaring RR>50 tachycardia, CRT>3, dry mucus membranes prolonged fever, 3-6 months, rigors ```

Question 50

TORCH infections - teratogenic

Answer 50

most common perinatal infections toxoplasmosis other - syphilis (can cause miscarriage. benzylpenicilin), varicella zoster, parovirus B19 rubella CMV - most common, growth retardation (IUGR) may develop hearing, visual and mental impairment herpes simplex - blindness, low IQ