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Specialties > Paeds Written - Infections > Flashcards

Paeds Written - Infections Flashcards

1
Q

Red flag features in febrile child

A

Pale, mottled, ashen, blue skin, lips or tongue

No response to social cues
Appears ill to HCP
Does not wake or, if roused, does not stay awake
Weak, high pitched or continuous cry

Grunting
Moderate-severe chest indrawing (recessions)

Reduced skin turgor

Age <3 months + temp >38
Bacterial meningitis signs/Sx
HSV encephalitis signs/Sx

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2
Q

Key features of neonatal toxoplasmosis

A

Cerebral calcification
Chorioretinitis
Hydrocephalus

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3
Q

Key features of neonatal syphillis

A

Early:

  • snuffles, rhinitis
  • desquamative rash - palms, soles
  • splenomegaly

Late:

  • small teeth
  • Saber shins
  • sensorineural deafness
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4
Q

Key features of neonatal Rubella

A

Sensorineural deafness
Congenital cataracts
Congenital heart disease - PDA
Glaucoma

+ salt & pepper chorioretinitis

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5
Q

Key features of CMV neonatal infection

A

Growth retardation

Purpuric skin lesions (blueberry muffin rash?)

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6
Q

Vaccines at birth

A

BCG if risk factors:

  • TB in family in past 6 months
  • contact / travel to certain countries?
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7
Q

Vaccines at 6-8 weeks

A

DTaP = 6 in 1

  • diphtheria
  • tetanus
  • whooping cough
  • polio
  • HiB
  • Hep B

Oral rotavirus

Men B

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8
Q

Vaccines at 12 weeks

A

6 in 1

  • diphtheria
  • tetanus
  • whooping cough
  • polio
  • Hib
  • hepatitis B

Oral rotavirus

Pneumococcal conjugate vaccine (PCV)

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9
Q

Vaccines at 16 weeks

A

16 weeks = 6 (in 1) + 1 extra (Men B)

6 in 1: diphtheria, tetanus, whooping cough, polio, Hib and hepatitis B

Men B

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10
Q

Vaccines at 12-13 months

A

Hib/Men C

MMR

PCV

Men B

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11
Q

Vaccines from 2-8 years old

A

Annual influenza

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12
Q

Vaccines at 3-4 years

A

4 in 1 pre-school booster

  • diptheria
  • tetanus
  • whooping cough
  • polio

MMR

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13
Q

Vaccines in secondary school

A

12-13 years = HPV (strains 6, 8, 11, 16)

13-18 years

  • teenage 3 in 1 booster (diphtheria, tetanus, polio)
  • Men ACWY
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14
Q

How should vaccinations be scheduled in premature babies?

A

According to chronological age NOT corrected gestational age

Premature <28 weeks should have first set in hospital due to apnoea risk

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15
Q

Infective period for measles

A

From prodrome (4 days before rash) –> 4 days after

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16
Q

Key clinical features of measles infection

A

Prodrome: fever, conjunctivitis, irritability

Koplik spots - ‘grains of salt’ on buccal mucosa

Rash - starts behind ears, spread + becomes confluent, desquamates after 1 week

No lymphadenopathy

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17
Q

Non medical aspects of Measles management

A

Inform PHE - notifiable disease

4 days exclusion from rash onset

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18
Q

Important complications of measles

A

Encephalitis

  • 1-2 weeks after illness
  • headaches, irritability, seizures
  • coma, death (15%)

Subacute sclerosis panencephalitis

  • 5-10 years after illness
  • very rare
  • dementia + death from measles lying dormant in CNS
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19
Q

Most common complication of measles?

A

Otitis media

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20
Q

Infectious period of rubella

A

1 week BEFORe to 5 days after rash onset

21
Q

Clinical features of rubella

A

Prodrome: fever or asymptomatic

Pink maculopapular rash

  • face then whole body
  • Forchheimer spots in 20% (red spots on soft palate)

Lymphadenopathy

22
Q

Management of rubella infection

A

Notify PHE
Isolate for 4 days from rash onset

Supportive: fluid, analgesia, rest

Safety net for complications - haemorrhagic D/T thrombocytopenia

23
Q

Infectious period for Slapped Cheek / Parvovirus B19

A

10 days BEFORE –> 1 day AFTER rash onset

24
Q

Complications of Parvovirus B19

A

Foetal disease - maternal transmission –> hydrops fetalis (death due to severe anaemia)

Aplastic crisis - children with chronic haemolytic anaemia e.g. sickle cell OR immunodeficiency

25
Q

Key clinical features of parvovirus B19 infection

A

Asymptomatic / coryza period for 2-3 days

Latent 7-10 days

Erythema infectiosum = slapped check –> maculopapular lace-like rash (trunk + limbs) 1 week later

26
Q

Management principles for Parovirus B19 infection

A

Supportive: fluids, rest, analgesia

No need for school exclusion / avoiding pregnancy women - not really infectious once rash present

Safety net complications!

27
Q

Timeline of roseola infantum

A

High fever + malaise for several days

THEN maculopapular rash (as fever wanes)

  • can be up to 1-2 weeks later
  • lasts 1-2 days
28
Q

Specific derm feature seen in Roseola infantum?

A

Nagayama spots - erythematous papular enanthem on uvula + soft palate

29
Q

Management for Roseola infantum

A

Supportive: fluids, analgesia, rest

No school exclusion needed

Safety net - febrile convulsions advice

30
Q

Mumps infectious period

A

5 days BEOFRE –> 5 days AFTER parotid swelling

31
Q

Investigations for Mumps

A

Serology (IgM) from Oral fluid test sample

Amylase - raised in blood

32
Q

Complications of mumps

A

Orchitis –> infertility (very rare)
Viral meningitis / encephalitis (very rare)
Deafness - unilateral, transient

33
Q

Complications of Chickenpox

A

Secondary bacterial infection

  • range from single infected lesion –> small area of cellulitis –> invasive Group A strep infection
  • AVOID NSAIDs - increase risk of necrotising fasciitis

Purpura fulminans / Disseminated haemorrhagic chickenpox

  • cross reactive Abs
  • inhibit the anti-coagulation protein C and S
  • clotting + purpuric skin rash
34
Q

When to treat chickenpox?

A

Adolescent/adult with chickenpox = oral acyclovir 800mg 5x/day for 7 days

Immunocompromised or neonate

  • disease = IV acyclovir
  • exposure = VZ Ig

Encephalitis = IV acyclovir

35
Q

Advice RE school exclusion in Hand, foot & mouth disease

A

No exclusion required
BUT advised to keep off school until they feel better

Contact PHE if large outbreak suspected

36
Q

Causative organisms of Hand, Foot & Mouth disease

A

Coxsackie A16 - most common
Enterovirus 71 - severe
Coxsackie A6 - atypical

37
Q

Causative Organism in Scarlet Fever

A

Streptococcus pyogenes (Group A strep)

38
Q

Key clinical features of scarlet fever

A

‘Sandpaper’ rash

Pastia’s lines - rash in prominent skin creases

White tongue –> desquamated Strawberry tongue

39
Q

Management of Scarlet fever

A

1st line = Phenoxymethylpenicillin
2nd line = azithromycin

Notify PHE
Exclusion from nursery/school for 24 hours from starting Abx

40
Q

Testing for HIV in infant

A

<18 months - viral PCR
- cannot use serology as have maternal anti-HIV IgG from mother

> 18 months = serology - Ab detection using ELISA

41
Q

When is HIV PCR measured in at-risk infant?

A

At birth
On discharge
6 weeks (2 weeks after stopping prophylaxis)
12 weeks (8 weeks after stopping prophylaxis)
18 months

42
Q

HIV prophylaxis options for neonate?

A

Low-medium risk = Zidovudine monotherapy 2-4 weeks

High risk = PEP (2 NRTI + 1 Integrase inhibitor) 4 weeks

43
Q

High risk features for recurrence of febrile convulsion

A

Age of onset <18 months
Fever <39
Shorter duration of fever before seizure
Family Hx

44
Q

Features of simple febrile convulsion

A

<15 mins
Generalised
No recurrence within 24 hours
Complete recovery within 1 hour

45
Q

Typical age for febrile convulsion

A

6 months –> 5 years

46
Q

Criteria for admission after febrile convulsion

A 
First febrile convulsion
<18 months old
Features of complex seizure
Diagnostic uncertainty
Currently taking Abx
47
Q

Advice for parents RE: febrile convulsions

A

Call ambulance if >5 mins seizing (or >10 mins after giving meds)

During seizure:

  • protect from injury
  • do not restrain

After: check ABC + put in recovery position

Regular antipyretics do NOT prevent future seizure

Recurrent seizures - can be trained to give medication e.g. buccal midazolam, rectal diazepam

48
Q

Threadworm symptoms

A

Asymptomatic - 90%
Perianal itching (especially at night)
+/- vulval Sx

49
Q

Management of threadworm

A

<6 months = consult ID + hygiene advice for 6 weeks

> 6 months = mebendazole (Obex) single dose for ALL OF HOUSEHOLD

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