Infectious Diseases

Question 1

What is Kawasaki disease?

Answer 1

A vasculitis predominantly seen in children

Question 2

What are features of Kawasaki disease?

Answer 2

High grade fever >5 days resistant to antipyretics
strawberry tongue
cervical lymphadenopathy
conjunctivitis
bright red cracked lips
red palms and soles which later peel

Question 3

What is the management of Kawasaki disease?

Answer 3

High dose aspirin, IVIg

Question 4

What investigation is used to look for a serious long term complication of Kawasaki disease?

Answer 4

Echocardiogram looking for coronary artery aneurysm

Question 5

What are clinical features of hand foot and mouth disease?

Answer 5

Sore throat, anorexia, cough and pyrexia. Oral ulcers followed later by vesicles on the palms and soles of the feet- can also occur on buttocks, face, legs and genitals

Question 6

Who normally gets hand foot and mouth?

Answer 6

Children under 10- commonly seen as outbreaks in nurseries

Question 7

What pathogens cause hand foot and mouth?

Answer 7

Intestinal viruses like coxsackie A16 and entrovirus 71

Question 8

What advice would you give for hand, foot and mouth disease?

Answer 8

Stay off school until feeling better and symptomatic treatment- hydration and analgesia

Question 9

What are characteristic features of measles?

Answer 9

Prodromal symptoms, koplik spots (small white spots on buccal mucosa), conjunctivitis and maculopapular rash starting behind the ears

Question 10

If a child not vaccinated against measles comes into contact with measles, would we give them the MMR vaccine?

Answer 10

Yes, as vaccine induced antibodies develop quicker than that following natural infection

Question 11

What complications can occur following measles?

Answer 11

Otitis media, pneumonia, encephalitis, subacute sclerosing panencephalitis (5-10 years after illness)

Question 12

Is measles notifiable?

Answer 12

Yes

Question 13

How does mumps present?

Answer 13

Prodromal phase, parotid swelling, fever, muscle aches, reduced appetite, headache, dry mouth

Question 14

What are some complications of mumps infection?

Answer 14

Pancreatitis, orchitis, meningitis, sensorineural hearing loss

Question 15

How can mumps be diagnosed?

Answer 15

PCR testing on saliva swab. Antibodies from blood or saliva

Question 16

Is mumps notifiable?

Answer 16

Yes

Question 17

What is the management of mumps?

Answer 17

Supportive treatment- rest, fluids and analgesia

Question 18

What is the most common cause of tonsillitis?

Answer 18

Viral infection
Most common bacterial cause is Group A strep (strep pyogenes)

Question 19

How will tonsillitis present?

Answer 19

Fever, sore throat and pain on swallowing

Question 20

What signs will be sign on examination with tonsillitis?

Answer 20

Enlarged, inflamed tonsils with or without exudate

Question 21

What features make a bacterial cause more likely for tonsillitis?

Answer 21

Fever over 38, pus on tonsils, absence of cough, tender anterior cervical lymphadenopathy, attend within 3 days of onset

Question 22

What is the censor criteria?

Answer 22

Scoring system used to help predict likelihood of bacterial tonsillitis, scored 1-4
A point for: fever over 38, tonsillar exudate, absence of cough and tender lymphadenopathy

Question 23

What is the FeverPAIN score?

Answer 23

Scoring system predicting likelihood of bacterial tonsillitis, one point for each:
- fever during last 24 hours
- pus on tonsils
- attended within 3 days of symptom onset
- severely inflamed tonsils
- no cough or coryza

Question 24

When considering centor and FeverPAIN score, when should ABx be given?

Answer 24

Centor = 3 or more
FeverPAIN = 4 or more

Question 25

What may prompt you to consider antibiotic in a child with tonsillitis other than centor and FeverPAIN scores?

Answer 25

if immunocompromised, at risk of more serious infections, significant co-morbidity or history of rheumatic fever

Question 26

What is the antibiotic of choice for tonsillitis?

Answer 26

Penicillin V (phenoxymethylpenicillin)

Question 27

What is one down side of the antibiotic given for tonsillitis in children?

Answer 27

The syrup tastes bad so many children are reluctant to take it

Question 28

What are complications of tonsillitis? ENT, systemic, kidneys+joints

Answer 28

Chronic tonsillitis, peritonsillar abscess, otitis media
Scarlet fever, rheumatic fever
Post-streptococcal glomerulonephritis and reactive arthritis

Question 29

What are additional symptoms to tonsillitis which may indicate a peritonsillar abscess?

Answer 29

Trismus (patient unable to open their mouth), change in voice, swelling and erythema in area beside tonsils

Question 30

How should a quinsy be managed?

Answer 30

Refer to ENT for incision and drainage with ABx before and after surgery

Question 31

what is the treatment for impetigo?

Answer 31

topical hydrogen peroxide or fusidic acid