Brainscape's Knowledge GenomeTM


Top Flashcards (Certified)
All Flashcards

Paediatrics > Infectious Diseases > Flashcards

Infectious Diseases Flashcards

(53 cards)

Start Studying
1
Q

What are the features of scarlet fever?

A

Occurs 24-48 hours after the sore throat

4Ss and 4Ps
S: Sore throat
S: Swollen tonsils
S: Strawberry tongue
S: Sandpaper rash
P: Perioral sparing
P: non-Painful
P: non-Pruritic
P: Peeling

>> Rash 24-48 hours after onset of fever/sore throat/strawberry tongue, occurring in the groin, axilla, neck and antecubital fossa
>> Generalized sandpaper rash with periorbital sparing within 24 hours
>> Look for Pastia’s lines (axillary rash)
>> Rash is nonpruritic and nonpainful, blanchable
>> Fades in 3-4 days
>> May be followed by desquamation

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

What is the specific management for Scarlet fever?

A

Penicillin for 10 days

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

What is the specific management for rheumatic fever?

A
  • Penicillin for 10 days
  • Prednisone if carditis is severe
  • Secondary prophylaxis with daily penicillin
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

What is the Jones criteria for diagnosing rheumatic fever?

A

2 major or 1 major + 2 minor PLUS evidence of preceding streptococcal infection
>> History of scarlet fever
>> Group A streptococcal pharyngitis culture
>> Positive rapid Ag detection test
>> Raised ASOT
>> Raised anti-DNA-ase B

Major criteria:

  • Migratory polyarthritis
  • Carditis/new heart murmur
  • Subcutaneous nodules
  • Erythema marginatum
  • Syndenham’s chorea

Minor criteria (PEACE)

  • PR interval prolonged
  • ESR raised
  • Arthralgias
  • CRP elevated
  • Elevated temperature (fever)
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

What are the common presenting features of rubella?

A

STAR complex

  • Sore throat
  • Arthritis
  • Rash

+ Low-grade fever and occipital nodes prodrome

Rash:

  • 1-4 days after start of symptoms
  • Starts on the face
  • Spreads to neck and trunk

>> Excellent prognosis in acquired disease
>> Irreversible defects in congenital rubella syndrome

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

What are the presenting features of EBV?

A

Peak incidence: 15-19 years

Infants and young children: asymptomatic/mild disease

Adolescents:
- 2-3 days prodrome of malaise and anorexia
- Classical triad of:
>> Fever
>> Generalized non-tender lymphadenopathy
>> Exudative pharyngitis/tonsilitis
- Hepatosplenomegaly
- Periorbital edema
- Rash: more common after inappropriate treatment with B-lactam antibiotics due to misdx of strep throat
- Any “-itis”

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

What are the investigations that will aid the diagnosis of EBV infection?

A
  • Monospot test
    >> 85% sensitive in adults
    >> 50% sensitive in children <4 years
  • EBV titres
  • CBC and differentials: anemia, thrombocytopenia
  • Blood smear: atypical lymphocytes and Downey cells
  • Throat culture to rule out strep throat
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

What are the complications of EBV infection?

A

Short-term:

  • Splenic rupture
  • Airway obstruction
  • Guillain-Barre syndrome/ADEM
  • Hemophagocytic lymphohistiocytosis

Long-term (can be short-term)

  • Burkitt’s lymphoma
  • Nasopharyngiocarcinoma (NPC)
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

What is the management for EBV infection?

A

SUPPORTIVE

  • Adequate rest
  • Hydration
  • Saline gargles and analgesics for sore throat

Acyclovir does NOT reduce duration of symptoms or result in earlier return to school or work.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

What are the possible causes for fever in children?

A

Infection

  • CNS
  • Ears
  • Eyes
  • Upper and lower respiratory tracts
  • Lung parenchyma
  • Heart
  • GI system
  • Genitourinary systems: esp. UTI
  • Skin - Connective/soft tissue
  • Bones and joints
  • Sepsis

Inflammatory/Autoimmune causes

  • Kawasaki disease
  • SLE
  • JIA
  • IBD

Neoplastic

  • Leukemia
  • Lymphoma
  • Neuroblastoma

Iatrogenic

  • Dehydration
  • Drugs and toxins
  • Post-immunization
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

What are the questions to ask when evaluating a febrile child?

A
  1. Does this child really have a fever?
  2. How old is this child?
  3. Are there any risk factors for infections?
  4. How ill is this child?
  5. Is there any rash?
  6. Is there a focus of infection?
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

What is this lesion? What is the management?

A

Impetigo
- Honey-crust lesion with fluid exudation
- Common organisms
>> Streptococcus pyogenes
>> Staphylococcus aureus

Management

  • Avoid going to school
  • Topical antibiotics: fucidic acid or mupirocin cream
  • Systemic antibiotics if severe: cephalexin, erythromycin
  • Eradicate nasal carriage by nasal antibiotic creams
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

What is the diagnosis? What are the common organisms? What are the complications?

A

Periorbital cellulitis

Common organisms

  • Staphylococcus aureus
  • Streptococcus pyogenes
  • Hemophilus influenzae type B

Complications

  • Orbital cellulitis
  • Orbital abscess
  • Meningitis
  • Cavernous sinus thrombosis
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

What is the Centor criteria for Streptococcal A pharyngitis (for adults)?

A
  1. History of fever
  2. Tonsilar exudates
  3. Tender anterior cervical adenopathy
  4. Absence of cough

Age <15y: +1
Age >44y: -1

>> Score -1, 0, 1: antibiotics and throat culture not necessary
>> Score 2, 3: throat culture, and give antibiotics if throat culture positive
>> Score 4, 5: empirical antibiotics with follow-up throat culture

McIsaac Criteria: HOT LACE
HOT: fever >38C, Lymphadenopathy, Age (3-14 years), Cough absent, Exudative tonsils

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

What are the complications of Group A streptococcal pharyngitis?

A
  • *Preventable by Antibiotics**
  • AOM
  • Mastoiditis
  • Sinusitis
  • Cervical adenitis
  • Retropharyngeal/Peritonsillar abscess
  • Sepsis
  • *Immune-Mediated**
  • Scarlet fever
  • Acute rheumatic fever
  • Post-streptococcal glomerulonephritis
  • Reactive arthritis
  • PANDAS (pediatric autoimmune neuropsychiatric disorder associated with Group A streptococcus)
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

Which immune-mediated sequelae of strep throat is preventable by antibiotics?

A

Rheumatic fever is preventable if antibiotics (penicillin V x 10 days) are given within 9 days of symptom onset. Post-streptococcal glomerulonephritis is NOT preventable.

>> Rheumatic fever: post-strep throat
>> Post-streptococcal glomerulonephritis: post-strep throat and post-skin infection

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

What are the complications of rheumatic fever?

A
  • *Acute**
  • Myocarditis
  • Conduction system aberration
  • Valvulitis
  • Pericarditis
  • *Chronic**
  • Valvular heart disease (AR, MR)
  • Infectious endocarditis +/- thromboembolic phenomenon
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

When does post-streptococcal glomerulonephritis occur?

A

1-3 weeks following the initial skin/throat GAS infecton

>> Peak at 4-8 years
>> Males > Females

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

How can the diagnosis of post-streptococcal glomerulonephritis be confirmed?

A

History/Presentation
- Asymptomatic
- Microscopic or macroscopic hematuria
- Other signs of nephritic syndrome
>> Proteinuria (<50mg/kg/day)
>> Hematuria
>> Azotemia
>> RBC casts
>> Oliguria
>> Hypertension

  • *Investigations**
  • Elevated ASOT
  • Elevated anti-DNA-ase B levels
  • Low C3 complement
  • Confirm hematuria and proteinuria with urine dipstick
  • Confirm azotemia with RFT
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

What is the management for post-streptococcal glomerulonephritis?

A
  • Fluid and sodium restriction
  • Loop diuretics
    >> Edema
    >> Hypertension
  • Dialysis may be required
  • Penicillin V x 10 days if active GAS infection is present

95% children recover completely within 1-2 weeks

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

What is the definition of fever of known origin?

A

Daily or intermittent fevers for at least 2 consectuvei weeks of uncertain cause after careful history and physical and initial laboratory assessment

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
22
Q

How does one assess a child presenting with fever?

Study These Flashcards
A

History
- Characteristics of the fever
>> Duration
>> Height and pattern of fever
- Associated symptoms: headaches, dizziness, cough, SOB, HOV, rhinorrhea, wheezing/stridor, diarrhea, vomiting, change in stool character, oliguria, foul-smelling urine, change in urine colour and frequency, rash, unwilling to walk etc.
- TOCC: travel, cluster, contact
- Constitutional symptoms: feeding, irritability, ?playful, ?consolable, chills, rigor

  • *Physical Examination**
  • Toxic VS. Non-toxic
  • Alertness and consciousness
  • Vitals: temperature, BP, P, RR, SaO2, U/O — tachycardia, tachypnea, desaturation
  • Growth chart
  • Skin x Rash or foci of infection
  • Systematic review: HEENT, chest, CVS, abdomen, genitalia, neuro, lymph nodes

Investigations
- For young children: full septic workup
>> Blood for CBC, d/c, C/ST, ESR, CRP, RLFT
>> Urine for urinalysis, C/ST
>> Stool for C/ST, microscopy
>> Sputum for C/ST, virology
>> NPA for C/ST, virology
>> CXR

NB: Febrile neonates should be considered high risk regardless of clinical presentation and laboratory findings — septic until proven otherwise

23
Q

What is the disease? What is the causative organism?
Name the clinical features of the disease, the management and common complications.

Study These Flashcards
A

5th Disease/Erythema Infectiosum

  • Parvovirus B19
  • Incubation 4-14 days
  • Mode of transmission: respiratory secretions or infected blood
  • 7-10 days of flu-like illness and fever
  • Rash
    >> Onset 10-17 days after symptoms of flulike illness and fever
    >> May be warm, pruritic and non-painful
    >> Uniform, erythematous, maculopapular, “lacy” rash
    >> “Slapped cheeks” – bilateral cheecks with circumoral pallor
    >> May affect trunk and extremities
  • Glove-and-socks syndrome
  • STAR complex (Sore Throat, Arthritis, Rash)
  • Management is mainly supportive
  • Complications
    >> Aplastic crisis (as in post-viral EBV, HHV-6, HBV, HDV, HEV & HIV infections)
    >> Rash may reappear under sunlight or after exercise months later
24
Q

What is this disease? What is the causative organism? Name the clinical features.

Study These Flashcards
A

Hand, Foot and Mouth Disease

  • Coxsackie A (usually coxsackie A-16) virus
  • Incubation period: 3-5 days
  • Vesicles and pustules on an erythematous base in the hands, foots and mouth
  • Vesicles on the POSTERIOR ORAL CAVITY (pharynx, tongue)

>> Management: supportive
>> Main complication: dehydration

25
This is measles. Describe the clinical features of the disease, and the mode of transmission.
Measles: Morbillivirus ## Footnote - Incubation: 8-13 days - Transmission: Airborne - **3Cs Prodrome**: **C**ough, **C**oryza, **C**onjunctivitis - **Koplik** spots 1-2 days before rash onset - **Rash**: \>\> Erythematous maculopapular rash that starts from the face down \>\> _Spares the palms and soles_ - Desquamation Definitive diagnosis - Positive serology for measles **IgM**
26
What is the management for measles?
**Symptomatic treatment for the patient** ## Footnote - Notify Department of Health - Respiratory isolation For close contacts: - Unimmunized \>\> Measles vaccine _within 72 hours of exposure_ \>\> IgG _within 6 days of exposure_
27
What are the complications of measles?
* *_Secondary Bacterial Infections_** - AOM - Sinusitis - Pneumonia - Encephalitis * *_Other rare complications_** - **Subacute sclerosing panencephalitis** - Myocarditis - Pericarditis - Glomerulonephritis - Stevens-Johnson Syndrome - Thrombocytopenia
28
This is roseola infantum. What is the causative organism? What are the clinical features and possible complications?
HHV-6 ## Footnote - High-grade fever - Rash \>\> Eppears once fever subsides \>\> Blanchable, pink, maculopapular rash \>\> Starts at neck and trunk; spreads to face and extremities (starts from middle!) - Irritability - Poor feeding - Lymphadenopathy - Erythematous TM and pharynx - Nagayama sign (see picture) * *_Complications_** - CNS: febrile seizures, aspetic meningitis - Thrombocytopenia - Post-viral aplastic anemia
29
What are the possible complications of varicella infection/chickenpox?
* *_Skin_** - Bacterial superinfection (esp. Streptococcus pyogenes \>\> Scarlet fever) - Necrotizing fasciitiis * *_CNS_** - Acute encephalitis - Cerebellar ataxia **_Systemic_** - Hepatitis - DIC - Congenital varicella syndrome \>\> Mental retardation/intellectual disability, microcephaly, hydrocephalus \>\> **Chorioretinitis**, cataract \>\> Cutnaeous scarring \>\> **Limb aplasia** \>\> Soft tissue calcification
30
What is the diagnosis? Describe the clinical appearance and the management plan.
Diaper Dermatitis: Irritant Contact Dermatitis ## Footnote - Shiny red macules with **NO FLEXURAL INVOLVEMENT** \>\> sparing of skin folds - Management \>\> **Eliminate direct skin contact** with urine and feces \>\> Allow periods of **rest without a diaper** \>\> **Frequent diaper changes** \>\> **Topical barriers** :: Perolatum :: Zinc oxide :: Paste \>\> Short-term low-potency topical corticosteroids in severe cases
31
What is the diagnosis? Describe the clinical features and management.
Diaper dermatitis: Candidal dermatitis ## Footnote - Erythematous _macerated_ papules/plaques with **SHARP MARGINS**, scaling and **SATELLITE LESIONS** - Involves the intertriginous areas, i.e. **involves skin folds** - Management \>\> Examine for coexisting oral thrush \>\> Topical antifungal agents: **NYSTATIN**
32
What is the diagnosis? Describe the lesion and possible management plan.
Infantile seborrheic dermatitis ## Footnote - Yellow, greasy macules/plaques on erythema with scaling - **Cradle cap**: yellow or white greasy scales on the forehead/face - Starts from 2-3 weeks of life and usually clears in a few weeks - Usually never occur - Can occur in adults - Management \>\> Usually self-limiting \>\> Short-term topical low-potency corticosteroids
33
What is the diagnosis? Describe the lesion and other common clinical features.
Atopic dermatitis ## Footnote - Erythematous papules with **crusting**, **oozing**, **excoriation** and **lichenification** - Location \>\> _Facial and extensor involvement_ during infancy \>\> _Flexural involvement_ in late childhood \>\> **Usually spares the diaper area** - Chronic relapsing course with a personal or family history of atopy \>\> Atopic dermatitis \>\> Allergic rhinitis \>\> Asthma - Prone to impetigo and are at risk for generalized cutaneous infection of HSV
34
Delineate the typical management plan for eczema.
Affects 10-20% of children ## Footnote * *_Non-medical Treatment_** - Non-soap cleansers and moisturizing soaps - Fragrance-free and dye-free laundry detergent - Food/Allergen avoidance - Traditional Chinese Medicine **_Enhance barrier function of the skin_** - Regular application of moisturizers - **Emollients** \>\> Fragrance-free and dye-free \>\> To hydrate skin \>\> To reduce pruritis \>\> Twice daily application is recommended even in the absence of symptoms \>\> Apply especially after swimming or bathing \>\> E.g. petrolium jelly, cetaphil cream **_Anti-inflammatory therapy_** - **Topical steroids** \>\> Intermittent use to treat active, inflamed, palpable plaques \>\> Discontinue once the areas are smooth \>\> Side effects :: Skin atrophy :: Purpura :: Striae :: Steroid acne :: Glaucoma when used around the eyes - **Topical immunomodulators** \>\> Calcineurin inhibitors: Tacrolimus, pimecrolimus \>\> Side effects: skin burning, transient irritation \>\> NOT indicated in children younger than 2 years \>\> Pros over topical steroids :: No skin atrophy :: Safe for face and neck :: Rapid sustained effect in controlling pruritis - Systemic immunomodulators \>\> Cyclosporin, azathioprine, tacrolimus and mycophenolate mofetil - Phototherapy - _Antihistamines for pruritis_ - Treat concomittant Staphylococcus infection: ?cloxacillin PO x 10 day**_s_**
35
What is the diagnosis? What is the management plan?
**Eczema Herpeticum** (Eczema + herpes infection) \>\> THIS IS PAINFUL ## Footnote - Admission - Consult ophthalmologist - Systemic antivirals (?acyclovir)
36
What is the diagnosis? Describe the lesion and management plan.
Molluscum Contagiosum ## Footnote - Caused by poxviruses - Spread by direct skin-to-skin contact - Smooth, skin-coloured, 2-6mm, **DOMED** papules with **CENTRAL UMBILICATION** - Predilection for skin folds (axillae and groin) \>\> Warts tend to have a more jagged surface \>\> Herpes simplex lesions are fluid-filled vesicles \>\> Milia tend to be whiter in colour and more concentrated on hte face Management - Cantharidin (off-label but effective - extract from blister beetle) - Cryotherapy - Laser therapy - Imiquimod 5% cream
37
What is the diagnosis? Describe the lesion and provide a typical management plan.
Tinea (corporis) ## Footnote - Round erythematous plaques with **CENTRAL CLEARING** and a **SCALY BORDER** Management - Topical anti-fungal for skin (usually 1-6 weeks) \>\> Terbinafine 1% cream \>\> Clotrimazole 1% cream \>\> Luliconazole 1% cream - Systemic anti-fungal for nails/head (onychomycosis or tinea capitis) \>\> Terbinafine \>\> Itraconazole \>\> Griseofulvin: reserved for severe cases - Tinea pedis \>\> Avoid humidity \>\> Anti-fungal for at least 3 weeks
38
What is this lesion? Describe the clinical features and a possible management plan.
Scabies | (Sarcoptes scabies var. hominis) ## Footnote - **HIGHLY CONTAGIOUS AND PRURITIC** - Polymorphic lesions in **web spaces/folds** - Diagnosis: clinical, skin scraping Management - **Permethrin** 5% cream for patient AND FAMILY \>\> 2 applications, 1 week apart \>\> Apply below the neck in older children and adults \>\> Apply to the _whole body_ for toddlers and infants - Other insecticides \>\> Lindane \>\> Sulphur \>\> Benzyl benzoate
39
What are the side effects of topical steroids?
- Skin atrophy - Purpura - Striae - Steroid acne - Glaucoma if used around the eye
40
What is the diagnosis? Describe the lesion and the common associations.
**Erythema multiforme** ## Footnote - **TARGET** (classically bull's-eye) lesions with _damaged skin_ in the **CENTRAL ZONE** - **All lesions appear _within 72 hours_** - **Fixed** by at least **_7 days_** - Severe forms: Stevens-Johnson Syndrome (toxic epidermal necrolysis) * *_Common associations_** - Virus: **HSV**, Orf virus - Bacteria: **Mycoplasma** - Parasite: Histioplasma - Drugs: NSAIDs, carbamazepine (1502), other anticonvulsants, allopurinol (5801), sulfonamides and penicillins
41
What kills in Stevens-Johnson syndrome?
Dehydration and infections ## Footnote Morbidity: - Ocular sequalae - Scarring of skin - Esophageal stricture
42
What is the diagnosis? Name the clinical features/diagnostic criteria and the possible management plan.
Stevens-Johnson Syndrome ## Footnote - **Variable skin rash** and **at least _2 mucosal lesions_** - Usually preceded by a respiratory prodrome - Mucosal lesions include: \>\> Purulent **conjunctivitis** \>\> Hemorrhagic erosions or necrosis over **lips**, **peri-anus** and **urethral opening** Associations - Drugs: NSAIDS, sulfonamides, penicillins, tetracyclines, anticonvulsants etc. - Infections: HSV, Mycoplasma, Orf virus, EBV, TB, histioplasmosis etc. \>\> Usually milder erythema multiforme (VS. drugs -- SJS) Management - Hospitalization: burns unit or PICU where standard burn protocols are followed - Fluid replacement - Nutritional support - Increased environmental temperature (28-30C) - Regular culture of skin, blood and urine for infection - Ophthalmology follow-up regularly - Treat with _acyclovir_ if HSV suspected
43
What is the diagnosis? What is the management?
Urticaria ## Footnote - Can be very florid but usually **_disappears within 24 hours_** - Skin is normal-looking after the rash recedes - Second most common type of drug reaction - Results from a release of histamine from mast cells in the dermis Management - Antihistmaines - IV hydrocortisone for any accompanying angioedema - **IM adrenaline** \>\> 1:1000 = 1mg/mL \>\> Adrenaline 0.05-0.5mL
44
Describe fixed drug eruptions.
_Sharply demarcated_ erythematous oval patches on the skin or mucous membranes that **reoccurs in the SAME location** upon subsequent exposure to the drug -- **FIXED LOCATION** -- and thus the name "fixed drug eruptions" ## Footnote Common drugs - Antimicrobials: tetracycline, sulfonamides - Anti-inflammatories - Barbiturates - Phenophthalein
45
What are the common drug reactions?
1. Exanthematous eruptions 2. Urticaria 3. Fixed Drug Eruptions 4. Erythema multiforme \>\> Stevens-Johnson Syndrome \>\> Toxic Epidermal Necrolysis
46
What is the diagnosis? How would you manage this patient?
Meningococcemia ## Footnote * *_Investigations_** - Blood culture - Blood: CBC, clotting, RLFT, ESR, CRP - CSF culture - Skin lesion culture - Urinalysis and C/ST * *_Treatment_** - Resuscitation - Fluids - Antibiotics
47
What are the differential diagnosis of a rash following a viral infection?
- Idiothrombocytopenic purpura - Henoch-Scholein Purpura (HSP) --- see picture \>\> Vasculitis with RBC extravasation \>\> Usually benign and self-limiting **\>\> Palpable purpura on buttocks and legs \>\> Abdominal pain \>\> Athralgia \>\> Fever** **\>\> Transient microscopic hematuria**
48
How does one manage a case of diphtheria?
1. Throat swab and culture to confirm 2. Treatment is **based on clinical suspicion** \>\> **Diphtheria antitoxin** \>\> Penicillin G or erythromycin to halt further toxin production and prevent carrier
49
What are the possible complications of diphtheria?
5-10% mortality ## Footnote - Airway obstruction - Recurrent nerve palsy - Diphtheritic peripheral neuritis - Diphtheritic myocarditis
50
In whom does pertussis have the greatest incidence?
Children \<1year (not fully immunized) Adolescents (waning immunity)
51
What are the common causative organisms of preorbital and orbital cellulitis?
* *- Staphylococcus aureus - Streptococcus pyogenes - Streptococcus pneumoniae - Moraxella catarrhalis** - Hemophilus influenzae type B
52
**ORBITAL CELLULITIS IS AN OCULAR AND MEDICAL EMERGENCY.**
53
What are the cardinal signs of orbital involvement?
1. Decreased visual acuity 2. Ophthalmoplegia/diplopia 3. Pain with extraocular eye movement 4. Googly eyes

Paediatrics (16 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2025 Bold Learning Solutions. Terms and Conditions