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Infections/Fever Flashcards

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1
Q

What is the virus causing hand, foot and mouth disease?

A

Coxsakie A16

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2
Q

What are the clinical features of hand, foot and mouth disease

A
  • mild systemic upset: sore throat, fever
  • oral ulcers
  • vesicles on palms and soles of feet
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3
Q

Management of Hand, food and mouth disease

A

Symptomatic: analgesia and hydration

Reassure no link to disease in cattle

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4
Q

What are the exclusion rules for hand foot and mouth disease

A

None - keep off in unwell

Contact HPA if large outbreak

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5
Q

Contraindications to Lumbar Puncture

A 
focal neurological signs
papilloedema
significant bulging of the fontanelle
disseminated intravascular coagulation
signs of cerebral herniation
meningococcal septicaemia
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6
Q

Investigations for meningococcal septicaemia

A

Blood cultures

PCR for meningococcus

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7
Q

Meningitis antibiotics in children <3 months

A

IV amoxicillin + IV cefotaxime

aciclovir if worried about viral infection

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8
Q

Meningitis antibiotics

A

IV cefotaxime

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9
Q

What is Brudzinski sign

A

Lay on back, pull neck forward towards chest

If legs bend up/causes distress - positive

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10
Q

What is Kernigs sign

A

Lay down, extend hip and knee 90 degress passivly extend out if pain - positive

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11
Q

What subtle symptoms should you look for in infants

A

irritability
Abnormal/high pitch cry
lethargy
difficulty feeding

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12
Q

What is the managment of meningitis in paeds

A
  1. call senior help
  2. protect airway, high flow O2
  3. IV/IO access
  4. Bloods
  5. Anti-pyretics
  6. LP & Urine cultures
  7. Start Abx
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13
Q

Which bloods should be done if suspecting meningitis

A

lcatate
cultures
PCR for meningococcus

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14
Q

What antibiotics do you given in children >3month with meningitis

A
  • ceftriaxone

erythromycin if pen allergy

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15
Q

What antibiotics do you given in children <3month with meningitis

A
  • Ceftriaxone + amoxicillan (ampicillan)

- covers listeria

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16
Q

When and why do you give steroids with bacterial meningitis

A
  • give dexamethsone in confrimed/suspected if >3 monthd
  • With or W/I 4hrs of first ABX dose
  • decreases hearing loss
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17
Q

What pathogen causes hearing loss in meningitis

A

pneumococcal

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18
Q

What are the RF for bacterial meningitis

A 
Low family income
3-8 month and adolescents
asplenia
day care/crowded places
basal skull fracture
maternal infection/pyrexia at delivery
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19
Q

What would you see on LP in bacterial/pyogenic meningitis

A
  • turbid/cloudy appearance
  • hig neutrophils
  • low lymphocytes
  • Protein >1
  • glucose CSF:blood: low
    High opening pressure
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20
Q

What would you see on LP in viral meningitis

A
  • Clear appearance
  • <100 neutrophils
  • high lymphocytes
  • Protein 0.4-1
  • Glucose CSF:blood normal
  • normal/high opening pressure
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21
Q

What would you see on LP in TB meningitis

A
  • opaque appearance
  • neutrophils <100
  • high lympocytes
  • Very high protein
  • Glucose CSF:blood low
  • high opening pressure
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22
Q

What are the common meningitis pathogens in neonates 0-3 months

A

Group B streptococcus
E. Coli
Listerial monocytogenes

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23
Q

What are the common meningitis pathogens in infants 3mo-5yrs

A

Nisseria meningitide
Streptococcus pneumoniae
Haemophillus influenza B

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24
Q

What are the common meningitis pathogens in children >5yrs

A

Niserria meningitide

Streptococcus pneumoniae

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25
What is group B streptocccus
gram positive coccus chains
26
What is E.coli
Gram negative rod
27
What is listeria monocytogenes
gram positive rod
28
What is Nisseria meningitide
gram negative cocci
29
What is streptococcus pneumoniae
Gram positive cocci
30
What is haemophilus influenzae B
Gram negative diplococci
31
What are the acute complications of meningitis
``` seizures raised ICP coagulatophy metabolic disturbances anaemia coma death ```
32
What are the long term complications of meningitis
``` hearing impairment psychosocial problems epilepsy dev/learning difficulties neurological impairments ```
33
What must you remember to do on discharging a child with bacterial meningitis
audiology assessment 4w after discharge - 4% hearing loss
34
What constitutes a simple febrile seizure
<15 mins generalised seizure No recurrence within 24 hours Complete recovery in one hour
35
What constitures a complex febrile sezire
15-30 mins Focal seizure Multiple episodes within 24 hours
36
What constitutes febrile status epilepticus
>30 mins
37
What are the clinical features of a febrile seizure
usually occur early in a viral infection as the temperature rises rapidly seizures are usually brief, lasting less than 5 minutes are most commonly tonic-clonic
38
Typical age for febrile seizure
- 6 months and 5 years | - 3% of children
39
What is the management of a febrile seizure
children who have had a first seizure OR any features of a complex seizure should be admitted to paediatrics
40
What is the prognosis & advice for parents of a febrile seizure
- further febrile convulsion = 1 in 3 - if recurrences, try teaching parents how to use rectal diazepam or buccal midazolam. - Parents should be advised to phone for an ambulance if the seizure lasts > 5 minutes - regular antipyretics have not been shown to reduce the chance of a febrile seizure occurring
41
What are risk factors for urther febrile seizures
- age of onset < 18 months - fever < 39ºC - shorter duration of fever before seizure - family history of febrile convulsions
42
Do febrile seizures mean they're going to have epilepsy?
risk factors for developing epilepsy - family history of epilepsy - having complex febrile seizures - background of neurodevelopmental disorder - children with no risk factors have 2.5% risk of developing epilepsy - if children have all 3 features the risk of developing epilepsy is much higher (e.g. 50%)
43
What are the key features of Kawasaki's disease
Fever for >5 days and 4 of below - Dry cracked lips - Bilateral conjunctivitis - Peeling of skin on fingers and toes - Cervical lymphadenopathy - Red rash over trunk
44
How do you diagnose Kawasakis
- clinical diagnosis, no specific test
45
What is the management of Kawasaki's Disease
- high-dose aspirin - intravenous immunoglobulin (reduces coronary art. aneurysm) - echo: coronary artery aneurysms
46
Why is aspirin usually contraindicated in paediatrics
- Kawasaki disease is one of the few indications | - risk of Reye's syndrome
47
What is the main complications of Kawasaki's disease
coronary artery aneurysm
48
Investigations for Kawasaki disease
- ESR/CRP - LFTs: bilirubin raised & AST FBC: increased platelets
49
What is the pathogen involved in Scarlet fever
Exotoxins from strep. pyogenes
50
What are the symtoms fo scarlet fever
- Sore throat - Fever - Sand paper rash devs on chest, axilla, behind ears 12-24 hours after sore throat - Swollen glands - Facial flushing - Strawberry tongue - Desquamation of digits post infection
51
Management of scarlet fever
- Penicillin V for 10 days | - Clarithromycin if pen allergic
52
most common cause of paraneumonic empyema
streptococcus pneumoniae
53
What is a rare complication of sinusitis
subdural empyema - Do an MRI! | streptococcus anginosa - Group H strep
54
hand foot and mouth disease
coxsackie virus
55
Key features of measles
high fever wide spread maculopapular rash conjunctivitis
56
Key features of rubella
widespread blanching rash that starts on the face fever suboccipital and posterior cervical chain lymphadenopathy
57
Which live bactrial vaccine is currently in use in the UK
BCG
58
Which live viral vaccines are used in the UK
``` MMR rotavirus influenza oral polio varicella]yellow fever ```
59
Which vaccines are contraindicated in a patient with HIV and low CD4 count
BCG | yellow fever
60
What is passive anti-body protection
Provide IgG antibodies to protect against infection | Immediate but short lived protection (4w)
61
Which conditions call for passive antibody protection
- human tetnus immunoglobulin - zoster immunoglobulin if immunosurpressed - human immnoglobulin - measles - Palivizumab (synagis) - RSV - HEP B immunoglobulin
62
Who is eligible for palivizumab (synagis)
- ex premature with chronic lung disease - other resp conditions who are in O2 - haemodynamically significant CHD - SCID (severe immmune deficiency) -
63
What is giardia intestinalis
- protozoal parasite - endemic in areas with poor sanitation - food and water outbreak - 1-4YO - cystic fibrosis and IgA deficiency at higher risk
64
What is the presentation of giardia intestinalis
- can be asymptomatic - acute diarrhoeal disease - chronic diarrhoea and malabsorption
65
what findings are in keeping of giardia intestinalis on histoligy
partial villous atrophy in small bowel (similar to coeliacs)
66
What is the diagnosis of giardia intestinalis
stool sample showing cysts | duodenal aspirate at small bowel biopsy
67
What is the management of giardia intestinalias
good hydration + nutrition | oral metronidazole
68
What is the management of c.difficile toxin positive
- metronidazole if mild | - vancomycin if severe/recurrent episodes
69
Which allergies preven children having the MMR
- neomycin + kanamycin
70
Key features of IgA immunodeficiency
recurrently URTI + LRTI recurrent otitis media association with atopic and autoimmune conditions
71
Key features of severe combined immunodeficiency (SCID)
- Ok first few months - 3-4 months persistent diarrhoea and faltering growth - oral candidiasis - atypical infections
72
what do you often see on sereum immunoglobulins in a patient with HIV
High IgG Low IgA Low IgM
73
organism for typhoid fever
salmonella typhi
74
Features of typhoid fever
``` high fever abdo pain headache thrombocytopaenia leucopaenia Raised ALT bradycardia ```
75
Clinical findinds of leptospirosis
- jaundice w 2 | - leucopaenia and thrombocytopaenia in early ifection
76
Key features of DIC
thrombocytopaenia prolonged PT Prolonged APTT low fibrinogen

Paediatrics (21 decks)

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