Paediatric infections Flashcards

1
Q

what is a serious complication of pertussis?

A

hypoxic encephalopathy

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2
Q

how might we treat pertussis?

A

Clarithromycin 7.5 mg/kg (for child > 1month) up to 500 mg po 12H for 7d
(No Clarithromycin syrup available at present)

Azithromycin 10 mg/kg (for infant < 1 month) daily for five days

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3
Q

how might we ix pertussis?

A

PCR/serology

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4
Q

what is the 100 day cough?

A

pertussis

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5
Q

what bugs can cause periorbital celluitis?

A

staphlococcus
streptococcus
HIB

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6
Q

what pathogen causes epiglottis?

A

HIB

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7
Q

what do you give for an unvaccinated child with periorbital celluitis?

A

flucloxacillin

+ ceftriaxone (for haemophillis!)

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8
Q

what are the complications of mumps?

A

orchitis

encephalitis

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9
Q

how do we ix bronchiolitis?

A

bronchiolitis is a clinical diagnosis really, but if you had to you could do a nasopharyngeal aspirate and PCR, ABG +/- CXR

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10
Q

who is at risk of bronchiolitis?

A

preterm babies, babies with chronic illnesses, babies with cardiorespiratory issues/insufficiency

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11
Q

what is the usual age for bronchiolitis?

A

less than 1 yr old

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12
Q

what alternative diagnosis would we consider for a 1-4 yr old patient with a ‘viral induced wheeze’?

A

asthma, but really > 4yrs is required for an asthma diagnosis

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13
Q

what are some signs of severe bronchiolitis in a child?

A
apneoic episodes
nasal flaring/tracheal tug/intercostal recession etc
cyanosis
lethargy
irritability
problems with feeding
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14
Q

what should we hear on auscultation for a child with bronchiolitis?

A

widespread crackles and wheeze
inspiratory fine crackles
prolonged expiratory time

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15
Q

what are some things we need to monitor/consider in a child who has been admitted to hospital with bronchiolitis?

A

Hospital admissions: monitor vitals + O2 sats,

consider NGT feeding, use suction as required

supplemental O2, close monitoring if requiring ICU care;

monitor FLUID STATUS; maintenance fluids

Ensure infection control procedures are followed.

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16
Q

what is the RSV immunoglobulin?

A

palivizumab, monoclonal antibody given IM

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17
Q

what are the main clinical indicators that croup is severe and the child requires hospitalisation?

A

stridor at rest and lethargy

18
Q

what antibiotic is best used for bacterial sinusitis?

A

augmentin

19
Q

how might we manage an empyema in a child?

A

drainage with chest drain

with either fibrinolytic agent (urokinase) or surgical decortication.

surgical decortication is preferred as urokinase can cause adhesions

20
Q

A young child presents with a fever. They are presumed to have an infection and given antibiotics. A maculopapular rash then appears 1 to 2 days after, and the child is thought to have a drug reaction. What is the most likely situation?

A

Roseola infection caused by herpes virus 6. Fever presents first and then rash appears later as fever goes down

21
Q

What are the complications of Kawasaki disease?

A

Coronary artery dilation or aneurysm formation

22
Q

Describe the management of Kawasaki’s disease

A

Administration of IVIG preferably within the first 10 days of illness and then aspirin once a day for at least 6 to 8 weeks plus or minus paracetamol

23
Q

what are the usual pathogens and clinical cause of haemolytic uraemic syndrome?

A

Usually bloody diarrhoea and afebrile; child does not look that unwell.

  • commonly associated with big outbreaks in uncooked meat
  • caused by shiga toxin producing e.coli
24
Q

what are the pathogens that cause toxic shock syndrome?

A

streptoccocus pyogenes/ staph aureus

25
Q

tell me about the signs/symptoms of kawasaki’s with management/ix

A

Conjunctivitis
Oedema
Lymphadenopathy
Dry cracked lips, desquamation

Strawberry tongue
Ongoing fever (> 5 days)
Rash
Erythema

Aspirin
Echocardiogram
IVIG/infliximab
O (anti-streptolysin O)
Up to date vaccinations (influenza/VZV) --> risk of Reye's with aspirin
26
Q

when does post streptococcal glomerulonephritis present post strep throat?

A

7-14 days post strep throat infection

27
Q

what are the clinical presentation of post strep GN and how might we ix this?

A

clinical presentation= acute fluid overload (e.g. oedema, HT), raised creatinine/oliguria, haematuria

ix= low C3, high anti-streptolysin O titre, red casts in urine, raised UEC and normocytic normochromic mild anaemia

no renal biopsy is usually indicated

28
Q

you diagnose a child with epididymo-orchitis. What do you do next in terms of ix and why?

A

you would do a renal tract ultrasound and cysteurethrography. Epididyorchitis is often associated with urinary tract abnormalities.

29
Q

what do we mean by ‘scarlet fever’

A

strep pyogenes (group a) infection causing tonsilitis/pharyngitis and toxin mediated diffuse erythematous exantham

30
Q

what is the clinical presentation of quinsey abscess?

A
Severe sore throat (often unilateral)
“Hot “ potato voice
Difficulty swallowing saliva (pooling/drooling)
Trismus
Neck swelling
Referred ear pain
31
Q

how might we manage quinsey abscess?

A

Antibiotics:
• Benzylpenicillin 60 mg/kg(max 2 g) IV 6 hourly
• Metronidazole 15mg/kg (max 500 mg)
IV stat then 7.5 mg/kg IV 8 hourly

Refer to ENT for surgical drainage

32
Q

what is the clinical presentation of EBV mononucleosis?

A
Fever
Protracted illness
Cervical lymphadenopathy
Fatigue and malaise
Variable hepatosplenomegaly
Amoxycillin-induced rash
33
Q

what is your immediate management of epiglottis?

A

Maintain position of comfort with parents present
Defer invasive examinations/ procedures (IV) or imaging (lateral neck x-ray) in patients with severe respiratory distress due to risk of precipitating respiratory arrest

Early PICU/anaesthetic review

Antibiotics: Ceftriaxone 50 mg/kg (max 2 g) IV 12 hourly

airway support!

34
Q

what is your management of retropharyngeal abscess?

A

Lateral neck x-ray initially: A normal x-ray does not exclude the diagnosis. CT with IV contrast is the imaging modality of choice. This should be performed in a setting where advanced airway management is able to be performed.

Antibiotics: Timentin 50 mg/kg (max 3 g) IV 6 hourly

Refer to ENT for surgical drainage

35
Q

what is the treatment of encephalitis according to RCH?

A

Aciclovir 20 mg/kg iv 8H (age <3m )

500 mg/m2 iv 8H (age 3m-12y)

10 mg/kg iv 8H (age >12y)

36
Q

what is the treatment of meningitis less than 2 months old?

A

cefoxtamine + benzylpenicillin

37
Q

what is the treatment of orbital cellulitis according to RCH?

A

Flucloxacillin 50 mg/kg (2 g) iv 6H and

Ceftriaxone 50 mg/kg/dose (2g) iv 12H

38
Q

what is the treatment of UTIs in children?

A

If sick or less than 6months old
Benzylpenicillin 60 mg/kg (2 g) iv 6H and
Gent 7.5 (6 if >10y) mg/kg (360 mg) iv daily

If well or greater than 6months old
Trimethoprim 4 mg/kg (150 mg) tablets po 12H or
if syrup necessary then Co-trimoxazole
(8/40 mg per mL) 0.5 mL/kg (20 mL) po 12H

39
Q

according to RCH guidelines what antibiotics do we use for mild moderate severe pneumonia?

A

mild- amoxicillin
moderate- benzylpenicillin
severe- flucloxacillin

40
Q

what is the antibiotic regimen for OM/septic arthritis in children?

A

Flucloxacillin 50 mg/kg (2 g) iv 4-6H

add Cefotaxime 50 mg/kg (2 g) iv 6-8H if less than 5yrs or not HIB immunised

41
Q

what is your next line of action if you suspect orbital cellulitis in a child?

A

a CT scan to identify those with a subperiosteal abscess

42
Q

what are the clinical features of orbital cellulitis

A

(proptosis), limited eye movement (ophthalmoplegia), pain on eye movement, or loss of vision