Random assortment

Question 1

Name and describe the 4 most common periodic fever syndromes.

• symptoms
• timing of fever
• inheritance

Answer 1

PFAPA- Periodic fever, aphthous stomatitis, pharyngitis and cervical adenitis. Fever occurs ever 2-8/52 and lasts 4/7. Random inheritance.

Familial Mediterranean Fever- Painful pleuritis, peritonitis, oligoarthritis, foot and ankle rash. Fever comes irregularly and lasts 2/7. AR inheritance.

Hyper IgD syndrome- abdo pain, splenomegaly & cervical adenopathy. Fever comes irregularly and lasts 4-6/7. AR inheritance.

TNF receptor associated periodic syndrome (TRAPS)- abdo pain, pleuritis, rash, myalgias, orbital oedema. Fever irregular and lasts 1-3/52. AR inheritance

Question 2

How does influenza cause death in children? (2 most common mechanisms)

Answer 2

1) Exacerbation of underlying medical condition

2) secondary bacterial infection (usually MRSA)

Question 3

What is the classical presentation of EBV? (5)

Answer 3

Fever
Pharyngitis
Lymphadenopathy
Splenomegaly
Petichiae on palate

Question 4

What are the haem changes associated with EBV? (4)

Answer 4

Thrombocytopaenia
Haemolytic anaemia
Atypical lymphocytes >10%
Mononuclear cells >50%

Question 5

What are the complications of EBV? (5)

Answer 5

Meningitis/ encephalitis
Myocarditis
Myelitis/ GBS
Splenic rupture
Immunocomp: Burkitt lymphoma, nasopharyngeal carcinoma, lymphoprolif disease

Question 6

In symptomatic CMV, what is the main clinical difference to presentation of EBV?

Answer 6

Exudative pharyngitis not prominent in EBV

Both have lymphocytosis with atypical lymphocytes

Question 7

Causes for blood in LP (3)

Answer 7

Bloody tap (traumatic rupture of small venous plexuses surrounding subarach space)
Subarach haemorrhage
HSV

Question 8

How do you differentiate bacterial, viral and fungal/ TB meningitis based on WCC, polymorphonuclear neuts, glucose & protein in CSF?

Answer 8

WCC: >500 in B, 80% in B, 4 in V
Protein: >100 in B&F, <100 in V

Question 9

Most common cause of bacterial meningitis in neonate? (3)

Answer 9

GBS
E.coli
Listeria

(Can also get S.pneum, enteronbacteriaciea & CONS)

Question 10

Most common cause of bacterial meningitis in 1-3/12 olds? (4)

Answer 10

GBS
E.coli
Listeria
N.meningitidis

(ie same as neonate, but also Neiserria)

Question 11

Most common cause of bacterial meningitis in children aged 3/12 to 5yo? (3)

Answer 11

N.meningitidis
S.pneumo
H.inf

Question 12

Most common cause of bacterial meningitis in children >5yo

Answer 12

S.pneum

N.meningitidis

Question 13

What is the role of dexamethasone in meningitis?

Answer 13

CNS pathology and resultant sequelae largely due to inflamm effect in meningitis.

Reduced incidence of hearing loss if dex given in H.INFLUENZAE meningitis.

Dex NOT proven to be effective in children if meningitis caused by other pathogen.

Dex most effective if given >15mins prior to 1st dose of abx

Question 14

Meningitis caused by which bacteria has the worst long-term outcome?

Answer 14

S.pneum has higher mortality and morbidity than N.meningit & H.inf