Infection and Immunity Flashcards
(114 cards)
1
Q
How is fever identified <4 weeks?
A
electronic thermometer in axilla
2
Q
How is fever identified 4 weeks to 5 years
A
electronic / chemical dot thermometer in axilla
OR infrared tympanic thermometer
3
Q
What is a fever in a child considered to be?
A
Body temp >37.5 degrees
4
Q
What are risk factors for infection?
A
ill close contacts lack of immunisation recent travel abroad contact with animal s immunodeficiency
5
Q
What are red flag features for a feverish child?
A
fever >38 if <3m, >39 if 3-6 months colour (pale, mottled, cyanosed) reduced consciousness neck stiffness bulging fontanelle status epilepticus focal Neuro signs seizures respiratory distress bile-stained vomit RASH
6
Q
How do you manage a febrile child?
A
If not seriously ill: discharge home with paracetamol/ibuprofen
Safety net parents + keep child away from school
If seriously ill: admit to paeds assessment unit, A&E, children ward
7
Q
What is most of the damage in meningitis caused by=
A
by the host response to infection (i.e. release of inflammatory mediators, recruitment of inflammatory cells, endothelial damage) which causes cerebral oedema, raised ICP, reduced blood flow
8
Q
what are causatrive organisms for meningitis in neonate -3months old
A
GBS
E coli
Listeria monocytogenes
9
Q
What are causative organisms in children 1m-6 yrs
A
NSH:
Neisseria meningitides
Strep pneumonia
Haemophilius influenzar
10
Q
What are causative organisms for BACTERIAL meningitis in children> 6 years
A
Neisseria meningitides
Strep pneumonia
11
Q
what investigations are appropriate for meningitis
A
Bloods - CRP, WCC, blood culture, coag
Rapid antigen test for meningitis organism
LP
12
Q
How do you manage bacterial meningitis ‘ at GP
A
IM benzylpenicillin single dose at GP
13
Q
What are complications of bacterial meningitis
A
hearing impairment vasculitis > CN palsies Cerebral infarction Subdural effusion Hydrocephalus
14
Q
What must you give to household contacts of meningococcal meningitis
A
ciprofloxacin (or rifampicin)
to eradicate nasopharyngeal carriage
15
Q
What is the most dangerous cause of viral encephalitis?
A
HSV
16
Q
How do you treat HSV encephalitis?
A
high dose IV acyclovir
17
Q
What causes toxic shock syndrome?
A
Toxin from S aureus
Group A strep
18
Q
What is presentation of TSS?
A
fever >39 degrees
hypotension
diffuse erythematous macular rash
19
Q
What does the toxin do in TSS
A
it acts as a SUPERANTIGEN causes organ dysfunction - mucositis - GI dysfunction - renal impairment - liver impairment - clotting abnormality
20
Q
what antibiotics fro you give for TSS=
A
Ceftriaxone
clindamycin
IVIG
21
Q
What toxin causes necrotising fascitis
A
Staph a
Group A strep
22
Q
What is management for necrotising fasciitis
A
surgical emergency
debride all infected tissue
IV fluids
empirical IV antibiotica
23
Q
what are sx of meningococcal septicaemia?
A
purpuric rash
non-blanching, irregular in size and colour, necrotic centre
24
Q
What is the most common cause of meningococcal septicaemia
A
group B meningococci
25
What is eczema herpeticum?
widespread vesicular rash resulting in secondary bacvgertial infection > septicaemia
26
What are herpetic whitlow
painful herpetic pustules on fingers, at site of broken ski
27
What is Kawasaki disease
a systemic vasculitis
28
what is the epidemiology of Kawasaki disease
more common in japanese children
6 m to 4 yrs
young infants are more severely affected
29
What are cardinal fts of Kawasaki
CRASH and burn
```
Conjunctivitis
Rash
Adenopathy
Strawberry tongue
Hand swelling / erythema / desquamation on hands and feet
```
Burn - fever difficult to control
30
WHAT ARE blood markers like in Kawasaki disease
high inflamm markers
| platelets rise in 2nd week
31
what occurs to coronary arteries in Kawasaki disease
Croronary arteries can be affected
- aneurysm
- myocardial ischaemia, sudden death
32
What is management of Kawasaki disease
IVIG
High dose aspirin
corticosteroids, infliximab, plasma exchange
"AEIO"
33
What are clinical fts of TB like in children
```
Very non speicfic
- prolonged fever
- malaise
- anorexia
.- WL
- lymph node swelling
```
34
What are ix for TB in children
```
Gastric washings on 3 consec mornings (as children swallow sputum
TB clture
PCR
tuberulin skin test
interferon gamma release assay
```
35
How do you manage TB in children
RIPE
Rifampicin + isoniazid 6 months
pyrazinamide + ethambutol first 2 months
36
How do you treat bacterial meningitis in hospital if <3m
IV amoxicillin + cefotaxime
37
How do you treat bacterial meningitis in hospital if >3m
IV ceftriaxone
38
How long do you give IV ceftriaxone based on the causative organism?
Neisseria 7 days
Strep p 14 days
Haemophilius influenza 10 days
39
What other drug can you give if CSF in meningitis is very concerning ?
Add IV dexamethasone
40
When must you NEVER give IV dexa in meningitis
If meninogococcal septicaemia
41
What is the most common form of primary HSV in children
Gingivostomatitis
42
How does gingivostomatitis present
vesicular lesions on lips, gums, tongue, palate
Progresses to extensive painful ulceration and bleeding
with high fever
43
What are the causative organisms for hand foot and mouth disease
viral (cocksackie A16, enterovirus 71)
44
Who is hand foot and mouth disease common in
children under age of 5
45
what are symptoms of hand foot and mouth disease
low grade fever, malaise
sore throat, N&V, anorexia, irritability
RASH - moth sores (yellow ulcer with red halo on buccal mucosa)
- erythematous macule (flat, discoloured) that progress to grey vesicles ON HAND, FOOT
46
How do you manage hand foot and mouth disease
analgesia (self limiting)
| no need to exclude from school
47
Explain spread of chicken pox
HIGHLY infectious
spreads via respiratory route
can be caought from someone with shingles
48
Explain when the infectious period is in chicken pox
-4 to 5 days around rash
49
What are symptoms of chicken pox
200 lesions start on head and trunk
progressing to peripheries
lesions appear as crops of papule, vesicles, with surrounding erythema
itching and scratching
results in permanent depigmented scar
50
How do you manage chicken pox
Supportive
- calamine lotion
- school exclusion until 5 days from rash onset
51
What are major complications of chicken pox
Secondary bacterial infections (staph/Group A strep) > TSS/necrotising fascitis
Encephalitis (good prognosis)
Purpura fulminant
52
What symptoms is chicken pox encephalitis associated with
VZV associated cerebellitis
53
What is purpora fulminans
disseminated haemorrhage chicken pox
| causes loss of large areas of skin by necrosis
54
What viruses cause roseola infantum
HHV6, HHV7
55
What are symptoms of roseola infantum?
high fever, malaise, generalised macular rash
56
What does human parvovirus B19 cause in derm children (give all names for it=)
Erythema infectious
Fifth disease
Slapped cheek syndrome
57
How is P B19 transmitted
via respiratory secretions / vertical transmission / infected blood products
58
What is the presentation of erythema infectiosum
fever, malaise, headache, myalgia > red cheeks, peri oral pallor (SLAPPED CHEEK)> progresses to lace like rash on trunk, limbs
59
What is the pathological organism causing measles
Morbillivirus (pox)
60
How is measles transmitted
(via resiratory tract - droplet spread)
61
What are the symptoms of measles
```
fever, cough, coryza
maculopapular rash (from head to body), may desquamate in second week
Koplik spots (white spots on mouth)
```
62
How do you manage measles
Notify HPT
Conservative management
Stay away from school for 4 days after rash develops
63
How do mumps spread
Through respiratory droplepts
64
What are symptoms of mumps
incubation period 2 weeks
fever, malaise, parotitis
PAROTITIS - unilateral, then becomes bilateral
Also have earache and pain when eating / drinking
65
How do you manage mumps
Notify HPU
Self limiting
66
How do you diagnose mumps
oral swab
67
What are appropriate investigations for suspected Kawasaki
FBC, U&E, LFT, CRP, ESR
urine MC&S
Troponin
Echo, ECG
68
What are blood results of Kawasakiu
RAISED ALT, platelets, WCC, albumin
69
What are negative effects of Kawasaki on vascular system
Aneurysm > rupture, pericardial effusion
Thrombosis > MI > sudden death!!!!
Regurgitation
70
What causes Lyme disease
Borrelia burgdorferi
HARD TICKS
71
What are clinical features of lime disease
Erythema migrant - erythematous macule that enlarges to form a painless red expanding lesion
Fever, headache, malaise
Myalgia, arthlagia
Lymphadenopathy
72
What are late features of Lyme disease
Neuro (encephalitis, neuropathy)
Cardiac (myocarditis)
Joint (arthritis - 50% of patients)
73
How do you diagnose Lyme disease
Clinical
| ELISA if without erythema migricans > immunoblot
74
How do you manage Lyme disease
Doxycycline
75
What vaccine can you give at birth
BCG if AT RIsk
76
What are key times for vaccines
2m
3m
4m
12m
3y 4m
13yo
18yo
77
What vaccine do you give at 2 m
6 in 1
Rotavirus
Men B
78
What vaccine do you give at 3 m
6 in 1
Rotavirus
Pneumococcus (PCV)
79
What vaccine do you give at 4m
6 in 1
Men B
80
What vaccine do you give at 12 m
Hib, Men C
MMR
Booster: pneumococcus, men B
81
What vaccine do you give at 3 y 4m
Booster: DTPP
| MMR 2nd dose
82
What vaccine do you give at 13years
HPV
Booster: DTP
83
What vaccine do you give at 18years
Men ACWY
| To freshers and all 17/18 yo
84
What is the 6 in 1
DTPPHH
```
Diphteria
Tetanus
Pertussis
Polio
Hep B
Hib
```
85
When do you give 6 in 1 vaccines
2m
3m
4m
86
When do you give 6 in 1 boosters
3 years 4 months DTPP (diphtheria, tetanus, Polio, Pertusssis)
13 years: DTP (diphtheria, tetanus, pertussis9
87
When do you give MMR
1 year
| 3y 4 m
88
what should you add to treatment plan for meningitis in child who has travelled recently
vancomycin
89
when should you add dexamethasone to meningitis tx
if >3m AND CSF analysis shows following:
- purulent CSF
- WBC >1000
- raised CSF WBC and protein conc >1g/L
- bacteria on gram stain
90
what should you organise as discharge and follow up in child who has meningitis
review by paediatrician 4-6 weeks post discharge
| formal audiological assessment
91
what should YOU NOT FORGET to do as holistic tx when a child has meningitis
treat contacts (anyone who had close contact with ptient over past 7 days) with CIPROFLOXACIN
92
what are key components of traffic light system
```
CARCO
Colour
Activity
Resp
Circulation and Hydration
Other
```
93
what colour places child in RED traffic light system
pale, mottled, ashen, blue
94
what activity level places child in RED traffic light system
no response to socia
95
what resp places child in RED traffic light
grunting
tachypnoea RR >60
moderate/severe chest intrawing
96
what hydration status places child in RED traffic light
reduced skin turgor
97
what other features place child in RED traffic light
```
age <3m &temp >38
non-blanching rash
bulging fontanelle
neck stiffness
status epilepticus
focal neuro signs
focal seizures
```
98
what colour places child in YELLOW traffiuc light
pallor reported by parent
99
what activity level places child in AMBER. traffic light
not responding normally to social cues
no smile
wakes only on prolonged stimulation
decreased activity
100
what resp features place child in AMBER traffic light
nasal flaring
tachpynoea (RR>50 if 6-12m, RR>40 if >12m(
ox sat <95
chest crackles
101
what circ/hydration place child in amber traffic light
```
tachycardia (>160 if <12m, >150 if 12-24m, >140 if 2-5yo)
CRT >3
dry mucous membranes
poor feeding
redu ed urine output
```
102
what other features place child in amber traffic light
```
3-6m, temp >39
fever for >5 days
rigors
limb swellinng
non weight bearing limbv
```
103
how should you manage child in red traffic light
```
refer urgently to paeds specialisy
FBC, CRP, blood culture
urine dip + MC&S
CXR, LP, serum electrolytes, blood gas
Consider starting empirical antibiotics
```
104
how do you manage roseola infantum (HSV6/7)
partacetamol or ibuprofen for pain relief
| should self resolve
105
how do you treat baby with HIV + motgher
ZIDOVUDINE for 6 weeks
106
How do you manage non-bullous neonatal impetigo (non-MRSA vs MRSA)
nonMRSA: erythromycin 7 days || MRSA: vancomycin 7 days
HYGENE: 2x daily wash with soap and water
107
How do you manage impetigo in infants/children
```
fusidic acid (topical)
oral fluclox / clindamycin
```
108
how do you prevent impetigo recurrence
intranasal mupirocin
109
HOW DO YOU MANAGE staphylococcal scalded skin syndrome
hospital admission
IV fluclox
analgesia
emollient for pruritus and tendnerness
110
how do you manage suspected typhoid
ceftriaxone +/-azithromycin
111
how do you manage known typhoid
ciprofloxacin days 7
112
what are complications of measles
Neuro: encephalitis, subacute sclerosing panencephalitis
Resp: pneumonia, otitis media
Other: myocarditis, diarrhoea
113
What are complications of mumps
- hearing loss
- meningitis, encephalitis
- orchitis
114
What are complications of rubella
arthritis, encephalitis, thrombocytopoenia, myocarditis
