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infectious diseases Flashcards

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1
Q

what are the essentials of a septic screen?

A
  • blood culture
  • FBC including differential WCC
  • CRP and ESR (acute phase reactants)
  • urine sample
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2
Q

which investigations can be done where appropriate as part of the septic screen?

A
  • CXR
  • LP
  • rapid antigen screen on blood/CSF/urine
  • meningococcal and pneumococcal PCR on blood/CSF
  • PCR for viruses in CSF (esp in herpes simplex and enteroviruses)
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3
Q

changes to CSF in bacterial meningitis?

A
  • cloudy, turbid
  • increased WBC (esp neutrophils)
  • increased protein
  • low glucose
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4
Q

typical features of meningitis?

A
  • headache
  • fever
  • neck stiffness
  • photophobia
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5
Q

a) describe the rash seen in meningococcal septicaemia

b) which organism causes this?

A

a) non-blanching petechial, purpuric rash with a necrotic centre
b) Neisseria meningitides

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6
Q

changes to CSF in viral meningitis?

A
  • clear
  • increased WBC (esp lymphocytes)
  • increased protein
  • normal glucose
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7
Q

which organism most commonly causes bacterial meningitis in:

a) newborns?
b) <6 year olds?
c) >6 year olds?

A

a) L. monocytogenes
b) N. meningitides
c) N. meningitides

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8
Q

causative organisms in viral meningitis? give 4

A
  • HSV 2
  • VZV
  • mumps
  • HIV
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9
Q

differentials for seizures in a febrile child?

A
  • febrile convulsions
  • meningitis
  • encephalitis
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10
Q

which extra investigations are done in tuberculous meningitis?

A
  • CXR
  • Mantoux test
  • sputum culture
  • early morning urine
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11
Q

signs of toxic shock syndrome?

A
  • fever >39C
  • hypotension
  • diffuse red macular rash
  • inflamed eye/mouth/genital mucosa
  • D+V
  • thrombocytopenia
  • altered consciousness
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12
Q

management of toxic shock syndrome?

A
  • immediate management of shock
  • surgically debride infected areas
  • ceftriaxone w/ clindamycin
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13
Q

what is impetigo?

A
  • localised, highly contagious skin infection

- more common where there’s a pre-existing skin condition like eczema

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14
Q

where do lesions normally present in impetigo?

A
  • face
  • neck
  • hands
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15
Q

describe the lesion in impetigo

A
  • red macules
  • become vesicular
  • then bullous (blisters)
  • when they burst they become honey-coloured and crusty
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16
Q

presentation of periorbital cellulitis?

A
  • fever
  • red, tender oedematous eyelid
  • unilateral
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17
Q

causative organism of periorbital cellulitis in unimmunised children?

A

H. influenzae B

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18
Q

treatment of periorbital cellulitis?

A

IV antibiotics

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19
Q

cause of scalded skin syndrome?

A

staphylococcal toxin that separates layers of epidermal skin

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20
Q

demographic of scalded skin syndrome?

A
  • infants

- young children

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21
Q

presentation of scalded skin syndrome?

A
  • fever
  • malaise
  • purulent, crusting local rash
  • starts around eyes, nose and mouth
  • spreads to rest of body
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22
Q

viral differentials of a maculopapular rash?

A
  • in <2 year olds, roseola infantum by HHV7
  • parvovirus (slapped cheek, 5-7yrs old)
  • enteroviral rash
  • measles, rubella (think unimmunised)
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23
Q

bacterial differentials of a maculopapular rash?

Study These Flashcards
A
  • group A streptococcus (scarlet fever)

- salmonella typhi (typhoid fever)

24
Q

non-infectious causes of a maculopapular rash?

Study These Flashcards
A
  • Kawasaki disease

- JIA

25
viral differentials of vesicular rash?
- VZV (chickenpox, shingles) - HSV - Coxsackie (hand, foot + mouth)
26
bacterial differentials of a vesicular rash?
- impetigo (staph or strep) | - scalded skin syndrome (staph toxin)
27
bacterial differentials of a petechial, purpuric rash?
- meningococcal septicaemia | - infective endocarditis
28
non-infectious differentials of a petechial, purpuric rash?
- post-URTI / post-chickenpox - Henoch-Schonlein purpura - thrombocytopenia - vasculitis - malaria (travel Hx)
29
where is HSV-1 more likely to present?
cold sores on lips and mouth
30
where is HSV-2 more likely to present?
genital sores
31
investigation for herpetic lesion near the eye?
- urgent ophthalmic assessment | - slit lamp examination of cornea
32
a) what are herpetic whitlows? | b) where can they be found?
a) painful, red, oedematous pustules | b) fingers
33
features of primary varicella infection?
- initial fever - vesicular rash - starts on head and trunk - spreads to peripheries - itchy - clears up within 10 days
34
complications of chickenpox? give 3
- secondary bacterial infection - encephalitis - purpura fulminans - pneumonia
35
what is purpura fulminans?
- a purpuric skin rash due to vasculitis of the skin vessels | - rare complication in chickenpox
36
management of primary varicella infection?
- conservative - paracetamol for pain relief - emollient to reduce itchiness
37
where does shingles present?
- dermatomal distribution of sensory nerves | - usually in thoracic region
38
what does recurrent / multidermal shingles suggest?
a T-cell defect (e.g. HIV)
39
causative agent in infectious mononucleosis?
Epstein-Barr virus
40
presentation of glandular fever?
- fever - malaise - tonsillitis / pharyngitis (severe!!! limits food intake) - lymphadenopathy less common: - petechiae on soft palate - hepatosplenomegaly - maculopapular rash - jaundice
41
how long do the symptoms of glandular fever persist?
1-3 months
42
treatment of glandular fever?
- corticosteroids if there is compromised breathing - penicillin if group A strep. found on tonsils - otherwise conservative
43
how is CMV transmitted?
- saliva - genital secretions - breastmilk
44
which condition is the presentation of CMV infection very similar to?
- infectious mononucleosis (glandular fever) - the lymphadenopathy is less severe here - most people get it subclinically
45
presentation of CMV infection in an immunocompromised host?
- retinitis - pneumonitis - bone marrow failure - encephalitis - hepatitis - oesophagitis - enterocolitis
46
treatment for severe CMV infection?
IV ganciclovir
47
how can HHV-6 and HHV-7 present?
roseola infantum: - high fever - malaise - then generalised macular rash
48
how does parvovirus B19 present in an infant?
- erythema infectiosum - "slapped cheek syndrome" - prodrome of fever, malaise, headache, myalgia - red rash on face later - maculopapular rash on trunk later
49
what is the most serious complication of a parvovirus B19 infection?
- aplastic anaemia | - affects kids with SCD, thalassaemia or malignancy
50
how does maternally transmitted parvovirus B19 infection present in a fetus?
- majority survive - fetal hydrops - death from severe anaemia
51
commonest causative organism in toxic shock syndrome?
S. aureus
52
how long is measles infectious for?
from prodrome (2 weeks) up to 4 days after start of rash
53
features of measles?
- irritable - conjunctivitis - fever - Koplik spots (white spots in mouth, come on before the rash does) - rash begins behind ears then spreads
54
investigations for measles?
IgM antibodies detectable within days of onset of rash
55
complications of measles?
- commonest is otitis media - deadliest is pneumonia - encephalitis (weeks later) - febrile convulsions

paediatrics (10 decks)

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