Brainscape's Knowledge GenomeTM


Top Flashcards (Certified)
All Flashcards

Year 4 Paediatrics > Infectious Diseases > Flashcards

Infectious Diseases Flashcards

(200 cards)

Start Studying
1
Q

A Febrile Child is classed as a temperature over 38 degrees. How is temperature measured in Children?

A

<4 weeks - Electronic Thermometer in Axillary

4 weeks to 5 years - electronic thermometer in Axillary or tympanic thermometer

(Note: Axillary underestimates by 0.5 degrees)

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

What is your first thought if the Febrile Child is under 3 months?

A

Infection is likely bacterial as infants are relatively protected against viral infection in first few months due to passive immunity

Start sepsis screen and empirical antibiotics

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

What is in a Sepsis Screen?

A

Blood Culture
FBC
CRP
Urine Sample

Consider other investigations depending on PC

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

Give four red flags in a Febrile Child

A

Fever >38 (<3 months) or >39 (3 to 6 months)
Reduced level of consciousness
Bilious Vomiting
Severe Dehydration

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

How should you treat the severely unwell febrile child?

A

IV Abx (Broad Spectrum + Ampicillin if less than one month to cover for Listeria)

Antipyretics

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

Define Shock

A

Circulation is inadequate to meet metabolic demands of the tissue

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

Why are children more succeptible to shock?

A

Higher surface area to volume ratio

Higher Basal Metabolic Rate

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

How does early (compensated) shock present?

A

Tachypnoea and Tachycardia
Cold Peripheries
Sunken Eyes and Fontanelle
Decreased Urine Output

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

How does late (decompensated) shock present?

A 
Acidotic (Kussmaul breathing)
Bradycardia
Confusion
Absent UO
Hypotension
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

How is Shock managed?

A

Fluid rescucitation (0.9% NaCl 20ml/kg)

Trachea intubation
Inotropic support
Renal support

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

Scarlet Fever is infection with Group A Strep. How does it present?

A

Fine papular rash on flushed skin (sandpaper texture)

Associated sore throat, strawberry tongue, lymphadenopathy

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

How is Scarlet Fever managed?

A

Notify PHE

Penicillin V

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

Parvovirus is also known as Erythema Infectiosum. How does it present?

A

Slapped cheek rash appearance

3-7 days prodrome

Evanescent rash for weeks

Arthropathy

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

How is Parvovirus managed?

A

Supportive unless neonate (IVIG)

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

Roseola Infantum is infection with Human Herpes 6 Virus. How does it present?

A

Temperature for 3 days that improves with appearance of rash

Maculopapular rash

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

What causes Lyme Disease?

A

Tick Bites (Spirochaete Borrelia Burgdorfen)

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

Describe the rash associated with Lyme Disease

A

Erythema migrans

Painless, non pruritic, circular lesions often with central clearing (target)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

What is associated with Lyme Disease?

A

Localised - fever, headache, myalgia

Disseminated - Meningitis, Facial Nerve Palsy

Late - Large joint arthritis

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

How is Lyme disease investigated?

A

Localised - clinical diagnosis

Disseminated - ELISA

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

How is Lyme Disease managed?

A

<8 years Amoxicillin

> 8 years Doxycycline

For 2-3 weeks

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

Another cause of acute rash is Infectious Mononucleosis, how does this present?

A

Maculopapular rash (esp if treated with Amoxicillin)

Associated - flu like, exudate day pharyngitis, lymphadenopathy

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

Candidiasis is the most common opportunistic fungal infection. Who is most at risk?

A

Limited almost entirely to neonates

Children with primary/secondary immunodeficiency

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
23
Q

How does Candidiasis present in the different areas?

A 
Skin - ‘Diaper Dermatitis’, moist skin folds
Nails - Paronychia 
Mucous Membranes - Oral Candidiasis
Genitals - Thrush, Balanitis
Systemic if immunocompromised
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
24
Q

What can predispose children to Oral Candidiasis?

A

Inhaled Steroids

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
25
How is Candidiasis investigated?
Fungal Culture Swabs Look for source
26
How is Candidiasis managed?
Azoles for immunocompetent Amphiterecin for immunocompromised Prevention with infection control measures and prophylaxis with azoles to high risk groups
27
Define Cellulitis
Infection of the dermis and deep subcutaneous tissue with poorly demarcated borders (As opposed to Erysipelas which is more superficial with sharply demarcated borders)
28
Name four organisms commonly causing Cellulitis
Streptococcus Pyogenes Streptococcus Pneumoniae Staphylococcus Aureus MRSA
29
Give three red flags for Cellulitis
Fever Numbness/Tingling Immunocompromised
30
How would you investigate Cellulitis?
Skin and swab culture FBC CRP
31
How should Cellulitis be managed?
Supportive (rest, elevation, analgesia) Flucloxacillin Emollient
32
How can Conjunctivitis be classified?
Viral Bacterial Allergic Contact
33
Viral Conjunctivitis is highly contagious, give two examples of causative organisms
Adenovirus | Herpes Simplex
34
Bacterial Conjunctivitis is the most common form in children. Name four common causative organisms.
Haemophilia Influenza Staphylococcus Aureus Moraxella Catarrhalis Strep Pneumoniae
35
How does Bacterial Conjunctivitis present?
Bilateral red eye with irritation/grittiness/discomfort Mucopurlent discharge sticking lashes together Oedema of lids/conjunctiva
36
How does Viral Conjunctivitis present?
``` Bilateral red eye with irritation/grittiness/discomfort Sore Watery discharge History of URTI Preauricular lymphadenopathy ```
37
How does Allergic Conjunctivitis present?
Bilateral symptoms Itchy Watery discharge Oedema of eyelids
38
What signs of conjunctivitis can be seen OE?
``` Conjunctival oedema and dilated conjunctival vessels Conjunctival Follicles (white nodules on inferior eyelid) Conjunctival Papillae (Red dots of varying size on inferior eyelids - cobblestone) ```
39
How is Conjunctivitis investigated?
May just be a clinical diagnosis Swab if in doubt Fluorosceine 0.25% drops for corneal ulcer
40
How should Bacterial Conjunctivitis be managed?
Self limiting If persisting for >2 weeks then Chloramphenicol eye drops
41
How should Viral Conjunctivitis be managed?
Self resolving Wash hands frequently Use separate towels Consider topical steroids
42
How should Allergic Conjunctivitis be managed?
Remove allergen Cold Compress Antihistamines
43
What are Neonatal ‘Sticky Eyes’?
Common, beginning on day 3/4 of life Only require washing with Saline/Water
44
How should you manage a Neonatal red eye?
Treat as bacterial conjunctivitis and refer urgently to ophthalmologist
45
How should you manage a purulent eye within the first 48h of life?
Gram stain and culture discharge Treat with IV Cefotaxime (Risk of permanent loss of vision, likely Gonococcal)
46
How should you manage eye discharge occuring in first two weeks of life?
Immunoflourorescent staining Likely Chlamydia Treat with Azithromycin Eye Drops and Oral Erythromycin
47
Define Epiglottitis
Inflammation and swelling of epiglottis caused by infection Normally infection with HiB, but can be Staph Aureus or Staph Saprophyticus Can also be non infectious - thermal (steam), foreign bodies, trauma
48
Give 6 clinical features of Epiglottitis
``` Sore Throat Stridor Drooling Tripod Position Fever Muffled Voice ```
49
How is Epiglottitis investigated?
Don’t without sufficient airway management capabilities Lateral X-ray Neck - Thumbprint Fibre optic Laryngoscopy in operating theatre setting
50
How would you manage Epiglottitis ?
Don’t distress the patient Involve Senior Paediatrician and Anaesthetist Be prepared to intubate IV Ceftriaxone and Dexamethasone
51
What is the main complication of Epiglottitis?
Epiglottic Abscess | Treated the same as Epiglottitis
52
What are the different types of Influenza?
Influenza A - most commonly, characterised by haemagglutinin and neuraminidase Influenza B - Less severe Influenza C - akin to common cold
53
Paediatric Influenza can present atypically. How could it present in babies?
Apnoea Reduced tone Poor feeding BRUE
54
Paediatric Influenza can present atypically. How could it present in younger children?
``` Haematemesis Photophobia Chest Pain Apnoea Rigors ``` Drowsiness in 50% of under 4s
55
The management is mainly supportive for Influenza. State two important points.
Avoid Aspirin in <16y (Reyes Syndrome) If at risk then offer Oseltamivir
56
State three complications of Influenza
Bronchitis Secondary Bacterial Pneumonia Otitis Media
57
What is the route of infection with Herpes Simplex Virus?
Through mucous membranes/skin
58
What are the two types of Herpes Simplex Virus?
HSV1 - associated with lip and skin lesions | HSV2 - more commonly genital lesions
59
HSV infection is mostly asymptomatic, but can present as Gingivostomatitis, describe this.
Most common form in children Vesicular lesions on lips, gums, anterior tongue surface, hard palate Progresses to extensive painful bleeding and ulceration
60
Describe three skin manifestations of HSV
Cold Sores - Recurrent HSV lesions on gingival/lip lesions Eczema Herpeticum - Widespread vesicular lesions on eczematous skin, can get secondary bacterial Herpetic Whitlows - Painful erythematous oedematous white pustules on broken skin
61
Describe Disseminated HSV infection in immunocompetent
Cutaneous lesions may spread to involve distant sites (Oesophagitis, Proctitis) Can cause pneumonia
62
Describe Disseminated HSV infection in Neonates
More common in preterm, often through vaginal canal transmission Can cause encephalitis or localised lesions
63
HSV can be diagnosed with a swab, how should symptomatic patients be managed?
Acyclovir
64
State three subtypes of Malaria and describe the pathophysiology
Falciparum, Vivax, Ovale Spread by female anopheles mosquito, causing release of sporozoites into blood which travel to become merozoites in liver Reproduce in RBC every 48h causing Haemolytic Anaemia
65
How do Neonates with Malaria present?
If occurring within 7 days implies trans placental transmission Fever, Irritable, Refusing feeds, Anaemia, Jaundice
66
How do young children with malaria present?
Present the same as any febrile illness (so investigate if any recent travel to endemic area) Restless, Drowsy, Apathetic
67
Describe three possible investigations for Malaria
Blood Film LP (if Seizing) Dipstick for Plasmodium Falciparum
68
Describe the use of a blood film for the diagnosis of Malaria
3 samples sent over 3 days Thick and thin Giemsa staining destroys erythrocytes, showing parasites and leukocytes Ear Lobe/Finger prick/Big toe
69
If uncomplicated Malaria, how should it be managed?
1) Riamet 2) Malarine 3) Quinine Sulphate 4) Doxycycline
70
How is Severe (Falciparum)/Complicated Malaria managed?
1) Artesunate 2) Quinine Dihydrochloride Should be admitted as they can deteriorate quickly
71
Malaria can be prevented using mosquito spray/nets and antimalarials. State three antimalarials.
Malarone (daily 2d before, during and one week after) Mefloquine (once weekly 2w before, during and for four weeks after) Doxycycline
72
State three complications of Malaria
Seizures Reduced Consciousness DIC
73
Define Measles
Notifibable infection caused by single stranded RNA Morbillivirus One of the most contagious infectious diseases
74
How is Measles transmitted?
Transmission is air borne via respiratory droplets (but can remain on surfaces for two hours) Person is infectious from first onset of symptoms to four days after rash
75
Describe the prodromal phase of Measles
Lasts 2-4 days Fever, cough, runny nose, mild conjunctivitis, diarrhoea Kopliks (small red spots with white spot on buccal mucosa)
76
Describe the characteristic rash of Measles
Morbilliform Initially on forehead and neck, then spreading to involve trunk and limbs Rash fades 3-4 days later in order of appearance, leaving discolouration behind
77
How is Measles investigated?
Salivary swab/serum sample for measles specific IgM within 6 months of onset RNA defection in salivary swabs
78
How is Measles managed?
Self limiting and supportive Notifiable disease PEP can be given within 72h of exposure
79
State two respiratory complications of Measles
Bronchopneumonia Giant Cell Pneumonitis
80
State two neurological complications of Measles
Acute demyelinating encephalitis (fluctuating consciousness progressing to coma) Subacute Sclerosing Panencephalitis (5-10 years later, results in rigidity and death)
81
Blindness is a complication of Measles, who is most at risk?
Vitamin A Deficiency
82
Define Meningitis
Inflammation of the brain and spinal cord, normally secondary to bacterial or viral infection
83
What is the difference between Meningococcal Meningitis and Meningococcal Septicaemia
Meningitis - Neisseria affects the meninges and CSF Septicaemia - when Neisseria is in the blood, characterised by ‘non blanching rash’ (indicative of DIC and a Subcut Haemorrhages)
84
What are the common organisms of Meningitis in Neonates and Children respectively?
Neonates - E.Coli, GBS, Listeria Children - Neisseria Meningitidis, Strep Pneumoniae
85
How would a Neonate with Meningitis typically present?
Hypotonia Poor Feeding Bulging Fontanelle
86
How would a child typically present with Meningitis?
``` Fever Neck Stiffness Headache Vomiting Seizures ```
87
How would you investigate Meningitis? Give four
Bloods (FBC, CRP, Clotting, U&Es) Blood Culture Lumbar Puncture ABG
88
What are the criteria for doing a LP (prior to antibiotics) in suspected Meningitis?
<1 month with fever 1-3 months with fever and unwell >1y with fever and other features
89
If the child with suspected Meningitis is over 2y, they may show positive Kernig’s and Brudzinski’s sign. What are these?
Kernig’s - Flex Hip and knee at 90 degrees then straighten knee while hip flexed (painful due to meningism) Brudzinski’s - Flex patients head and neck involuntarily which will cause involuntary flexion of knees and hips
90
How many white cells are expected in a normal CSF?
<5 lymphocytes
91
Describe the typical CSF composition in a Bacterial Meningitis
Cloudy High Protein Low Glucose High White Cells (Polymorphs)
92
Describe the typical CSF composition in a Viral Meningitis
``` Clear Normal/High Protein Normal/Low Glucose Increase White Cells Increased White Cells (Lymphocytes) ```
93
How would you immediately manage suspected Meningococcal Septicaemia in the community?
IV or IM Benzylpenicillin
94
Describe the antibiotics used in hospital for a Meningitis
<28d - Cefotaxime, Amoxicillin, Gentamicin 1-3m - Ceftriaxone and Amoxicillin >3m - Ceftriaxone (and Amoxicillin if Listeria suspected)
95
Steroids are given as an adjunct in Meningitis if the child is over 3 months. Why is this?
Reduces hearing loss and neurological damage
96
What do you do to manage Meningitis from a Public Health perspective?
Notify Public Health PEP for those who have had prolonged contact for >7 days (Single dose Ciprofloxacin)
97
When is an LP contraindicated in Meningitis?
Shock Convulsions Coagulation Abnormality Septicaemia
98
How would Viral Meningitis be treated?
General less severe so just supportive If HSV suspected then Aciclovir
99
One of the main differentials for Meningitis is Encephalitis. How would this present and how would you manage?
Altered consciousness, cognition and focal neurological symptoms Managed with empirical Acyclovir
100
State 5 complications of Meningitis
``` Hearing Loss Cerebral Abscess Nerve Palsies Hydrocephalus Epilepsy ```
101
Mumps is a viral infection spread by respiratory droplet’s. How would it present?
Flu like prodrome Parotid Gland Swelling (either unilateral or bilateral, painful due to capsular distension inner ages by trigeminal)
102
How is Mumps investigated?
PCR of Saliva | Blood Mumps Specific IgM
103
How is Mumps managed?
Supportive only Notify public health Normal recovery in 2-4 weeks
104
State three complications of Mumps
Pancreatitis Orchitis (Testicular Pain and Swelling) Sensorineural Hearing Loss
105
Define Orbital Cellulitis
Potentially sight threatening and life threatening ophthalmic emergency due to infection of soft tissue behind orbital septum (usually from locally spreading infection)
106
What is Preseptal Cellulitis?
More common and less serious infection of anterior to orbital septum Common in young children
107
Describe the pathophysiology of Orbital Cellulitis
Extension of infection from periorbital structures (eg sinuses) Extension of Preseptal infection Direct Inoculation Haematogenous H.Influenza, S.Aureus, S.Pneumoniae, S.Pyogenes
108
How does Preseptal Orbital Cellulitis present?
Acute onset of swelling/warmth/redness/tenderness of eyelid | No orbital signs
109
How would Orbital Cellulitis present?
Anteriorly - Acute unilateral swelling of conjunctiva and lid (oedema, erythema, pain) Orbital - Muscle Opthalmoplegia, Proptosis, Pain on eye movement, Blurred vision Systemic - Fever, Malaise
110
Anyone with suspected Preseptal Cellulitis should be assumed to have Orbital until proven otherwise. How is it investigated?
FBC/CRP/Culture Nose Swab ENT and Opthalmology review CT of sinuses and orbit
111
How is Orbital Cellulitis managed?
IV Ceftriaxone | 4 hourly obs
112
Give two complications of Pre Septal and Orbital Cellulitis respectively
Preseptal - Orbital progression, Lid abscess Orbital - Vein Occlusion, Meningitis
113
There are many different subtypes of Otitis Media. Define Acute Otitis Media.
Inflammation of middle ear that can be bacterial or viral in origin
114
There are many different subtypes of Otitis Media. Define Acute Supparative Otitis Media.
Presence of pus in the middle ear
115
There are many different subtypes of Otitis Media. Define Otitis Media with Effusion.
Chronic inflammatory condition following slowly resolving acute otitis media Effusion behind intact Tympanic Membrane
116
There are many different subtypes of Otitis Media. Define Chronic Supparative Otitis Media.
Long standing middle ear infection with persistently perforated tympanic membrane
117
There are many different subtypes of Otitis Media. Define Mastoiditis.
Acute inflammation of the mastoid periosteum and air cells when infection from middle ear spreads
118
There are many different subtypes of Otitis Media. Define Cholesteatoma.
Retraction of Pars Flaccida and squamous proliferation in middle ear
119
Describe the pathophysiology of Otitis Media
Infective organisms reach middle ear via Nasopharynx In young children the angle between sustainable tube and pharynx is not acute so allows easy spread
120
Give two bacterial and two viral causes of Otitis Media
Bacterial - H.Influenza, S.Pneumoniae Viral - RSV, Rhinovirus
121
Name four risk factors for Otitis Media
Male Household smoking Nursery attendance Craniofacial abnormalities
122
Give four SYMPTOMS for Otitis Media
Pain (young children tug at ear) Malaise Poor Feeding Fever
123
How would the Tympanic Membrane appear in Otitis Media?
Red/Yellow/Cloudy Bulging Air fluid level behind
124
How would you investigate Otitis Media?
Normally a clinical diagnosis Culture discharge if chronic/recurrent/grommets CT/MRI if complications suspected
125
Describe the use of antibiotics in Otitis Media
Aim not to and explain why Can give delayed (‘if not improving in 4 days’) Give if systemically unwell/at risk of complications/not improving after four days 5 days Amoxicillin
126
Give three complications of Otitis Media
Chronic Supparative Otitis Media Mastoiditis Meningitis
127
Rubella (AKA German Measles) is an RNA airborne virus. How does it present?
Prodrome (low fever, mild conjunctivitis, rhinorrhoea) Pink discrete macules that coalesce, spreading cephalocaudally Forcheimers Sign (Petichiae on soft palate)
128
How would you investigate suspected Rubella?
PCR | FBC (increased lymphocytes, low platelets)
129
How would you manage Rubella?
No specific treatment NSAIDs (Not Aspirin - Reyes) Keep child away from school for 4d from rash onset
130
Describe the different subtypes of Otitis Externa (inflammation of ear canal)
``` Acute (<3 weeks) Chronic (>3 weeks) Localised (infection of follicle/boil) Diffuse Malignant (Osteomyelitis of Temporal and Mastoid Bone) ```
131
Describe the aetiology of Otitis Externa
Bacterial - Pseudomonas Auerginosa, Staph Aureus (secondary to blockage of canal, absence of wax, trauma) Fungus
132
Name three risk factors for Otitis Externa
Hot and Humid Swimming Eczema
133
How would Otitis Externa present?
``` Pain Itching Discharge Hearing Loss Preauricular Lymphadenopathy ```
134
What advice would you give a patient with Otitis Externa?
Avoid getting ear wet Remove discharge using cotton wool (not bud) Remove hearing aids and earrings Take simple pain relief
135
How would you manage Otitis Externa medically?
topical antibiotic and steroid Lymphadenopathy - Oral Flucloxacillin Chronic - Acetic Acid and Corticosteroids If not resolving then swab
136
Give three complications of Otitis Externa
Abscess Ear Canal Stenosis Perforated Ear Drum
137
Describe the pathophysiology of Mastoiditis
Infection causes a breakdown of fine trabecular in mastoid air cells and allows collection of pus The build up of pus causes local bone necrosis and subperiosteal abscess (behind pinna, superior to pinna, or over squamous temporal)
138
How would Mastoiditis present?
Otalgia Pyrexia Tenderness behind pinna (MacEwans Triangle) Pinna may be pushed forward On a background of acute or recurring Otitis Media
139
If Mastoiditis is advanced, how could it present?
Abducens/Facial/Opthalmic Nerve Palsy
140
Investigations for Mastoiditis shouldn’t delay treatment. What should you do?
CT head and mastoid with contrast Will show coalescing air cells, opaque mastoid and middle ear
141
How is Mastoiditis managed?
Initial IV Abx (Co-Amoxiclav or Ceftriaxone) Oral Abx for 14d Surgery if not improving after 48h of IV, or if complications
142
Define Tonsillitis
Inflammation of palatine tonsils (concentrated lymphoid tissue) as a result of bacterial/viral infection Can occur with other areas of inflammation (tonsulopharyngitis, adenotonsillitis)
143
Describe the pathophysiology of Tonsillitis
Tonsils are naturally at their largest between 4-8y | Majority of infections are viral (Adenovirus, EBV) but can be bacterial (S.Pyogenes)
144
How does Tonsillitis present?
Symptoms normally for 5-7 days (if longer consider glandular fever) Odynophagia, Fever, Halitosis, Red Inflamed Tonsils
145
What is the Centor Criteria?
1) Tonsilar Exudate 2) Lymphadenopathy 3) Fever or Hx of fever 4) Absence of cough >/=3 means that bacterial is likely
146
What is the FeverPAIN Score?
1) Fever in past 24h 2) Purulence 3) Attend Rapidly (within 3d) 4) Inflamed Tonsils 5) No Cough/Coryza 1 - Abx not indicated 2 to 3- Consider delayed 4 to 5 - Abx indicated
147
How is Tonsillar Size graded?
``` 0 - not visible beyond anterior pillar 1 - occupy >25% oropharynx 2 - occupy 25-50% oropharynx 3 - occupy 25-75% oropharynx 4 - tonsils meet in midline ```
148
Give three differentials for tonsillitis
Quinsy Glandular Fever Epiglottitis
149
What medication should be used for Tonsillitis?
10 days Pen V (or Clarithromycin) If unable to swallow consider IV Benzylpenicillin Paracetamol/Ibuprofen/Topical Benzydramine spray
150
When should you consider a tonsillectomy in a child?
>7 episodes in a year >5 episodes each year for 2 years >3 episodes each year for 3 years
151
Give three complications of Tonsillitis
Peritonsillar Abscess Retropharyngeal Abscess Post Strep Glomerulonephritis
152
Peritonsillar Abscesses are collections of pus in peritonsillar space. Describe the pathophysiology.
Palatine tonsils sit between tonsillar pillars and within a thin capsule Pus collects between capsule and superior pharyngeal constrictors
153
How do Peritonsillar Abscesses present?
``` Severe sore throat (worse unilaterally) Drooling Trismus ‘Hot Potato Voice’ Unilateral uvular deviation ```
154
How should Peritonsillar Abscesses be investigated?
FBC/CRP/Glandular Fever Screen CT is suspecting retropharyngeal abscess
155
How are Peritonsillar Abscesses managed?
Aspiration and drainage Co- Amoxiclav/Benzylpenicillin + Metronidazole IV rehydration
156
What is Toxic Shock Syndrome?
S.Aureus and Group A Strep release toxins which act as superantigens causing fever/hypotension/diffuse rash
157
Toxic Shock Syndrome causes dysfunction of all organ systems to varying degrees. Describe some management options
ICU Support Debridement of infection areas IV Ceftriaxone and Clindamycin IVIG to neutralise toxin
158
What can occur 1-2 weeks after Toxic Shock Syndrome?
Desquamation of palms/soles/fingers/toes
159
Describe the pathophysiology of Tuberculosis in children
Latent TB is more likely to progress to active TB in infants and young children Children normally acquire TB from infected adults in same household Children normally aren’t infectious as they are paucibacillary
160
How does symptomatic TB present?
Fever, Anorexia, Weight Loss, Cough, Pleural Effusions
161
How does a Post Primary TB present?
Can be localised or disseminated Infants and young children are more prone to tuberculous meningitis
162
Diagnosis of TB is difficult is in children ad they swallow sputum until age of around 8. What can be done as an alternative?
Gastric washings via NG on three separate mornings and then ZN stain
163
What is the Mantoux test?
Can be positive due to previousBCG Intradermal injection of purified protein derivative Induration >5mm is TB positive
164
What is the IGRA Test?
Assess response to TB proteins via blood sample Not affected by vaccination status Done in conjunction with Mantoux in under 5s
165
How is latent TB treated?
3 months Rifampicin and Isoniazid Or 6 months Isoniazid
166
How is Active TB managed?
2 months Rifampicin/Isoniazid/Pyrazinamide/Ethambutol Followed by 4 months Rifampicin and Isoniazid Pyridoxine required in older children
167
When should you give prophylactic Isoniazid?
If less than 2 years and significant contact with a sputum positive If Mantoux and IGRA are negative at 6 weeks it can be discontinued
168
What is encompassed in the term ‘URTI’?
Common Cold Sore Throat (Pharyngitis, Tonsillitis) Acute Otitis Media Sinusitis
169
Define Viral Exanthem
A rash accompanied by systemic symptoms such as fever/headache/malaise. Due to organism’s toxins, damage by organism itself or by immune response
170
Give three Viral Exanthems starting on the face
Measles Rubella Erythema Infectiosum
171
Give two Viral Exanthems starting on the trunk
Roseola | Scarlet Fever
172
Give a papulovesicular Viral Exanthem
Chickenpox
173
What is Gianotti Crosti Syndrome?
Normally caused by EBV Discrete non pruritic monomorphic papules lasting 2-8 weeks Seen over face/buttocks/extensor surfaces
174
Hand Foot and Mouth Disease is a self limiting disease normally caused by Coxsackie Virus. How does it present?
Brief 12-36 hour prodrome Painful ulcers on hard palate, tongue, buccal mucosa Tongue may become red and oedematous Erythematous macules with central grey vesicles on hands and feet (normally sides of fingers and for sum)
175
Viral causes of GE include Rotavirus, Noravirus and Adenovirus. What is the most common cause?
Norovirus Rotarix vaccine given at 8-12 weeks
176
What’s the most common cause of bacterial GE in children?
Campylobacter Can cause bloody diarrhoea Consumption of undercooked meat and underpasteurised milk
177
Other than Gastrienteritis, what can VTEC cause?
Haemorrhagic Colitis | Haemolytic Uraemic Syndrome
178
Who is at greatest risk of dehydration with Gastroentetitis?
Children under 6 months >5 diarrhoeal stools in 24 hours >2 vomits in 24 hours Children who have stopped breast feeding due to GE
179
GE is normally a clinical diagnosis. When should you send stools for microscopy?
Suspected septicaemia Blood/Mucous in stools Immunocompromised child
180
How should you manage dehydration in GE?
Give IV if shock is suspected/any red flag symptoms/persistent vomit Oral 50ml/kg over 4h to replace deficit plus maintenance If refusing oral feed - NG
181
What advice should you give parents after GE?
Avoid fruit juice and carbonated water Don’t attend school for 48h since last episode Child shouldn’t swim for two weeks
182
State three complications of GE
Haemolytic Uraemic Syndrome Reactive Arthritis Secondary Lactose Intolerance
183
Why can a HIV antibody test come back positive if <18 months?
Due to maternal antibodies that have crossed placenta
184
When should you test children for HIV? Give four examples
Babies to HIV parents When immunodeficiency suspected Young sexually active people Needle stick/IVDU
185
If a child is born to HIV positive parents, when should they be screened?
Viral load test at 3m (shows whether HIV contracted at birth) Anti body test at 24m (see if they’ve contracted it since - eg via breast feeding)
186
How is HIV managed in children?
Antiretrovirals Normal childhood vaccines Prophylactic Co-Trimoxazole Treatment of opportunistic infections
187
When should you test children for Hep B?
Hep B positive mothers Migrants from endemic areas Close contacts
188
How should a child born to a Hep B positive mother be managed?
Within 24h - Hep B Vaccine and Hep B IVIG Additional vaccines at 1 and 12 months (alongside normal schedule) Tested for HbSag at 1 year
189
Can Hep B positive mothers breast feed?
Yes as long as child is fully vaccinated
190
How should children born to Hep C positive mothers be managed?
Antibody Tested at 18 months Children often clear virus spontaneously Mothers can breast feed as long as nipples aren’t cracked
191
How should chronic Hep C in children be managed?
Consider Peg Interferon in over 3s Treatment is more effective in adults so normally delayed
192
What vaccines contain egg?
Live Influenza Yellow Fever Rabies
193
Name 5 live vaccines
``` MMR BCG Chickenpox Nasal Influenza Rotavirus ```
194
What vaccinations are given at 8 weeks?
Diphtheria/Tetanus/Pertussis/Polio/HiB/Hep B Men B Rotavirus
195
What vaccinations are given at 12 weeks?
Diphtheria/Tetanus/Pertussis/Polio/HiB/Hep B Pneumococcal Rotavirus
196
What vaccinations are given at 16 weeks?
Diphtheria/Tetanus/Pertussis/Polio/HiB/Hep B | Men B
197
When is the MMR vaccine given?
3 years 4 months
198
When is the Men ACWY vaccine given?
14 years
199
Describe the paediatric sepsis six
``` O2 Bloods IV Abx Fluids Escalation Consider Inotropic Support ```
200
What is the Paediatric Maintenance fluid of choice?
0.9% Sodium Chloride + 5% Dextrose

Year 4 Paediatrics (15 decks)

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