Infection

Question 1

What are the risk factors for group B strep?

Answer 1

Prematurity
PPROM
Sibling with previous GBS
Maternal pyrexia

Question 2

How is group B strep infection prevented?

Answer 2

Intrapartum IV benzylpenicillin

Question 3

What are the indications for intrapartum GBS treatment?

Answer 3

Preterm
+ swab during pregnancy
Previous sibling with GBS
Pyrexia in labour

Question 4

What is sepsis?

Answer 4

Life threatening organ dysfunction caused by dysregulated host response to infection

Question 5

What are the common causes of sepsis in neonates?

Answer 5

GBS= most common
E. coli
Listeria monocytogenes

Question 6

What are the common causes of sepsis in kids?

Answer 6

Strep. pneumoniae
Meningococci
Group A strep
Staph aureus

Question 7

What is the presentation of sepsis?

Answer 7

Fever or hypothermia
Mottled skin, cyanosis
Prolonged cap refill 
Chills/rigors 
Reduced LOC 
Reduced tone 
Diminished urine output 
Poor feeding, change in behaviour, inconsolable

Question 8

What is an urgent indication for sepsis treatment in <3 months?

Answer 8

Fever >38

Question 9

What is the management of sepsis?

Answer 9

ABC

Sepsis 6

Question 10

What is the sepsis 6?

Answer 10

Take 3, give 3
Blood cultures, urine output, serum lactate
Oxygen, IV fluids, IV antibiotics

Question 11

What is a complication of sepsis?

Answer 11

Septic shock

Question 12

What is septic shock?

Answer 12

Sepsis leading to CV dysfunction, resulting in hypotension and hypo perfusion

Question 13

What is the management of septic shock?

Answer 13

Sepsis 6

Bolus fluids

Question 14

What bacteria cause meningitis in neonates?

Answer 14

GBS

Listeria monocytogenes

Question 15

What bacteria cause meningitis in children?

Answer 15

N. meningitides

Strep. pneumonia

Question 16

What viruses cause meningitis?

Answer 16

HSV
VZV
ENterovirus

Question 17

What is the presentation of meningitis in babies?

Answer 17

Bulging fontanelles

Non specific- poor feeding, hypotonia, hypothermia

Question 18

What is the presentation of meningitis?

Answer 18

Classic triad- fever, neck stiffness, altered consciousness
Headache, photophobia
Vomiting
Non blanching rash

Question 19

What is non blanching rash a sign of?

Answer 19

Meningococcal septicaemia

Question 20

What are the indications for LP where meningitis is suspected?

Answer 20

<1 month with fever
1-3 months with fever and unwell
<1 year with unexplained fever and very unwell

Question 21

What is looked at in an LP?

Answer 21

Bacterial culture
Viral PCR 
Cell count
Protein
Glucose

Question 22

What investigations are done for suspected meningitis?

Answer 22

LP
Kernig’s and Brudzinski’s test
Blood cultures
Meningococcal PCR- if meningococcal disease suspected

Question 23

What are Kernig’s and Brudzinski’s?

Answer 23

tests for meningeal irritation
K= flex hip and knee to 90, straighten knee= pain
B= flex chin to chest, patient will flex hips and knees

Question 24

What is the management of suspected bacterial meningitis presenting in the community?

Answer 24

Stat IM/IV benzylpenicillin and transfer to hospital

Question 25

What is the management of bacterial meningitis in hospital in neonates?

Answer 25

Ampicillin and cefotaxime | Dexamethasone

Question 26

What is the management of bacterial meningitis in hospital > 1 month?

Answer 26

ceftriaxone/cefotaxime +/- vancomycin | Dexamethasone

Question 27

Why is dexamethasone given in bacterial meningitis?

Answer 27

Reduce frequency and severity of hearing loss and neurological damage

Question 28

What is the management of viral meningitis?

Answer 28

Supportive | Confirmed HSV or VZV= aciclovir

Question 29

What is the prognosis of bacterial vs viral meningitis?

Answer 29

``` Viral= generally less severe Bacterial= associated strongly with hearing loss ```

Question 30

What are some longterm complications of meningitis?

Answer 30

Hearing loss- bacterial Cerebral palsy Seizures and epilepsy Cognitive impairment and disability

Question 31

What are some causes of encephalitis?

Answer 31

Infection- viral, bacterial, fungal | Autoimmune

Question 32

What is the most common cause of encephalitis?

Answer 32

Viral

Question 33

What viruses commonly cause encephalitis?

Answer 33

HSV 2= neonates HSV 1= children VZV, CMV Measles, mumps and rubella in unvaccinated

Question 34

What is the presentation of encephalitis?

Answer 34

Altered consciousness and cognition Unusual behaviour Acute onset focal neurological symptoms and seizures Fever

Question 35

What investigations are done for encephalitis?

Answer 35

LP MRI Swabs HIV test

Question 36

What are the contraindications for an LP in encephalitis?

Answer 36

GCS <9 HAemodynamically unstable Active seizures

Question 37

What is the management of encephalitis?

Answer 37

IV acyclovir (ganciclovir for CMV) Supportive Repeat LP before stopping antivirals

Question 38

What are some long term complications of encephalitis?

Answer 38

Learning disability Headaches Seizures

Question 39

What is mumps?

Answer 39

Self limiting viral infection

Question 40

What is the presentation of mumps?

Answer 40

Flu like prodrome | Parotid swelling with associated pain

Question 41

What investigations are done for mumps?

Answer 41

PCR saliva and swab | Antiboddy test of blood or saliva

Question 42

What is the management of mumps?

Answer 42

Rest, fluids and analgesia | Notifibable disease

Question 43

What causes mono?

Answer 43

EBV

Question 44

What is the pathophysiology of mono?

Answer 44

Most people infected as children and have few symptoms | Recurs and causes more symptoms

Question 45

What is the presentation of mono/glandular fever?

Answer 45

Classic triad= lymphadenopathy, sore throat, fever Fatigue Intensely itchy maculopapular rash in response to amoxicillin Rare= splenomegaly and splenic rupture

Question 46

What investigations are done for mono?

Answer 46

Monospot test in 2nd week of illness

Question 47

What is the management of mono?

Answer 47

Supportive Avoid alcohol Avoid contact sports for 8 weeks due to risk of splenic rupture

Question 48

What are the complications of mono?

Answer 48

Associations with certain cancers and MS Splenic rupture Chronic fatigue

Question 49

How is vertical HIV transmission prevented?

Answer 49

NEVER breastfeed if mother HIV+ Antiretrovira to babies for first 4 weeks Delivery- normal vaginal if viral load <50, section if >400

Question 50

What are the indications for HIV testing of children?

Answer 50

HIV + parents Immunodeficiency Risk factors- e.g. needle stick injury, sexual abuse Concerning/recurrent infections e.g. encephalitis

Question 51

What HIV tests can be done?

Answer 51

Antibody screen | Viral load

Question 52

What is the management of HIV?

Answer 52

Antiretroviral therapy Normal vaccination- avoid/delay live vaccines if severely immunosuppressed Prophylactic co-trimoxazole if low CD4- prevent pneumocystis pneumonia