Paediatric infectious disease

Question 1

At birth immunisation

Answer 1

BCG if risk factors (see below) - At birth the BCG vaccine should be given if the baby is deemed at risk of tuberculosis (e.g. Tuberculosis in the family in the past 6 months).

Question 2

2 months immunisation

Answer 2

‘6-1 vaccine’ (diphtheria, tetanus, whooping cough, polio, Hib and hepatitis B)
Oral rotavirus vaccine
Men B

Question 3

3 months immunisation

Answer 3

‘6-1 vaccine’ (diphtheria, tetanus, whooping cough, polio, Hib and hepatitis B)
Oral rotavirus vaccine
PCV

Question 4

4 months immunisation

Answer 4

‘6-1 vaccine’ (diphtheria, tetanus, whooping cough, polio, Hib and hepatitis B)
Men B

Question 5

12-13m immunsations

Answer 5

Hib/Men C
MMR
PCV
Men B

Question 6

2- 8 years annual vaccination

Answer 6

Flu vaccine annually

Question 7

3-4 years vaccination

Answer 7

‘4-in-1 pre-school booster’ (diphtheria, tetanus, whooping cough and polio)
MMR

Question 8

12-13 years vaccination

Answer 8

HPV vaccination

Question 9

13-18 years vaccination

Answer 9

‘3-in-1 teenage booster’ (tetanus, diphtheria and polio)
Men ACWY

Question 10

IM benzypenicillin dose for Meningitis <1 year

Answer 10

300mg

Question 11

IM benzypenicillin dose for Meningitis 1-10 years

Answer 11

600mg

Question 12

IM benzypenicillin dose for Meningitis >10 years

Answer 12

1200mg

Question 13

Scarlet fever causative agent

Answer 13

Group A haemolytic strep

Question 14

Scarlet fever epi

Answer 14

children aged 2-6 peak incidence at 4 years

Question 15

scarlet fever spread

Answer 15

resp route

Question 16

scarlet fever presentation

Answer 16

Fever: typically for 23 to 48 hours
Malaise, headache, nausea/vomiting
Sore throat
‘strawberry tongue’
Rash

Question 17

Scarlet fever rash type/pattern

Answer 17

• fine punctate erythema (‘pinhead’) which generally appears first on the torso and spares the palms and soles
• children often have a flushed appearance with circumoral pallor. The rash is often more obvious in the flexures
• it is often described as having arough ‘sandpaper’ texture
desquamination occurs later in the course of the illness, particularly around the fingers and toes

Question 18

Scarlet fever diagnosis

Answer 18

a throat swab is normally taken but antibiotic treatment should be commenced immediately, rather than waiting for the results

Question 19

Scarlet fever management

Answer 19

• oral penicillin V for 10 days
• patients who have apenicillin allergy should be given azithromycin
• children can return to school 24 hours after commencing antibiotics
scarlet fever is anotifiable disease

Question 20

Scarlet fever complications

Answer 20

• otitis media: the most common complication
• rheumatic fever: typically occurs 20 days after infection
• acuteglomerulonephritis: typically occurs 10 days after infection
invasive complications (e.g. bacteraemia, meningitis, necrotizing fasciitis) are rare but may present acutely with life-threatening illness

Question 21

Roseola infantum definition

Answer 21

Roseola infantum (also known as exanthem subitum, occasionally sixth disease)

Question 22

roseola infantum cause

Answer 22

HHV6

Question 23

roseola infantum incubation period

Answer 23

5-15 days

Question 24

Roseola infantum target age range

Answer 24

6 months to 2 years

Question 25

Roseola infantum features

Answer 25

• high fever: lasting a few days, followed later by a • maculopapular rash • Nagayama spots: papular enanthem on the uvula and soft palate • febrile convulsions occur in around 10-15% • diarrhoea and cough are also commonly seen

Question 26

roseola infantum complications

Answer 26

• Aseptic meningitis • Hepatitis Febrile convulsions 10-15% of cases

Question 27

roseola infantum school exclusion ?

Answer 27

Not needed

Question 28

NICE traffic light - Categories

Answer 28

Colour, activity, respiratory Circulation and hydration, Other

Question 29

NICE traffic light Colour normal features

Answer 29

Normal colour

Question 30

NICE traffic light colour: Amber findings

Answer 30

Pallor reported by parent/carer

Question 31

NICE traffic light colour: Red flag

Answer 31

• Pale/mottled/ashen/blue

Question 32

NICE traffic light: Activity Green findings

Answer 32

• Responds normally to social cues • Content/smiles • Stays awake or awakens quickly • Strong normal cry/not crying

Question 33

NICE traffic light: Activity Amber findings

Answer 33

normally to social cues • Content/smiles • Stays awake or awakens quickly • Strong normal cry/not crying • Not responding normally to social cues • No smile • Wakes only with prolonged stimulation • Decreased activity

Question 34

NICE traffic light: Red findings

Answer 34

• No response to social cues • Appears ill to a healthcare professional • Does not wake or if roused does not stay awake • Weak, high-pitched or continuous cry

Question 35

NICE traffic light: respiratory amber findings

Answer 35

• Nasal flaring • Tachypnoea: respiratory rate >50 breaths/minute, age 6-12 months; >40 breaths/minute, age >12 months • Oxygen saturation <=95% in air • Crackles in the chest

Question 36

NICE traffic light: respiratory Red findings

Answer 36

• Grunting • Tachypnoea: respiratory rate >60 breaths/minute • Moderate or severe chest indrawing

Question 37

NICE traffic light Circulation and hydration Green

Answer 37

• Normal skin and eyes • Moist mucous membranes

Question 38

NICE traffic light Circulation and hydration Amber findings

Answer 38

• Tachycardia: >160 beats/minute, age <12 months >150 beats/minute, age 12-24 months >140 beats/minute, age 2-5 years • Capillary refill time >=3 seconds • Dry mucous membranes • Poor feeding in infants • Reduced urine output

Question 39

NICE traffic light Circulation and hydration Red findings

Answer 39

reduced skin turgor

Question 40

NICE traffic light other amber findings

Answer 40

• Age 3-6 months, temperature >=39ºC • Fever for >=5 days • Rigors • Swelling of a limb or joint • Non-weight bearing limb/not using an extremity

Question 41

NICE traffic light other Red findings

Answer 41

• Age <3 months, temperature >=38°C • Non-blanching rash • Bulging fontanelle • Neck stiffness • Status epilepticus • Focal neurological signs • Focal seizures

Question 42

NICE traffic light patient in green category - management

Answer 42

Child can be managed at home with appropriate care advice, including when to seek further help

Question 43

NICE traffic light patient in Amber category

Answer 43

provide parents with a safety net or refer to a paediatric specialist for further assessment a safety net includes verbal or written information on warning symptoms and how further healthcare can be accessed, a follow-up appointment, liaison with other healthcare professionals, e.g. out-of-hours providers, for further follow-up

Question 44

NICE traffic light patient in Red group

Answer 44

refer urgently to a paediatric specialist