Infections

Front 1

A 3-year-old girl with a two day history of fever and malaise. Developed a pink maculopapular rash initially on the face before spreading. Suboccipital lymph nodes are also noted.

Diagnosis?

Back 1

Rubella

Front 2

A 4-year-old boy presents with fever and a sore throat. Examination reveals tonsillitis and a furred tongue with enlarged papillae. There is a blanching punctate rash sparing the face.

Diagnosis?

Back 2

Scarlet fever

Front 3

A 4-year-old boy presents with fever, malaise and a 'slapped-cheek' appearance.

Diagnosis?

Back 3

Parvovirus B19

Front 4

Features of chickenpox:

Back 4

1.) Fever initially

2.) Itchy, rash starting on head/trunk before spreading.
Initially macular then papular then vesicular.

3.) Systemic upset is usually mild

Front 5

Features of measles?

Back 5

1.) Prodrome: irritable, conjunctivitis, fever
2.) Koplik spots: white spots ('grain of salt') on buccal mucosa
3.) Rash: starts behind ears then to whole body, discrete maculopapular rash becoming blotchy & confluent

Front 6

Features of mumps?

Back 6

1.) Fever, malaise, muscular pain

2.) Parotitis ('earache', 'pain on eating'): unilateral initially then becomes bilateral in 70%

Front 7

Features of rubella?

Back 7

1.) Rash: pink maculopapular, initially on face before spreading to whole body, usually fades by the 3-5 day

2.) Lymphadenopathy: suboccipital and postauricular

Front 8

Features of erythema infectiosum?

(also known as fifth disease)

Back 8

'slapped-cheek syndrome'

1.) Caused by parvovirus B19

2.) Lethargy, fever, headache

3.) 'Slapped-cheek' rash spreading to proximal arms and extensor surfaces

Front 9

Features of scarlet fever?

Back 9

1.) Reaction to erythrogenic toxins produced by Group A haemolytic streptococci

2.) Fever, malaise, tonsillitis

3.) 'Strawberry' tongue

4.) Rash - fine punctate erythema sparing face

(pin-point dark red spots on erythematous base, course texture like sand-paper)

5.) Desquamination of fingers and toes happens later in the disease

Front 10

Features of hand, foot and mouth disease?

Back 10

1.) Caused by the coxsackie A16 virus

2.) Mild systemic upset: sore throat, fever

3.) Vesicles in the mouth and on the palms and soles of the feet

Front 11

Cause of scarlet fever?

Back 11

Scarlet fever is a reaction to erythrogenic toxins produced by Group A haemolytic streptococci

(usually Streptococcus pyogenes)

Front 12

Diagnosis and treatment for scarlet fever?

Back 12

Diagnosis: throat swab is taken, then immediately commence treatment.

Management: oral penicillin V

(if penicillin-allergic, give azithromycin)

It is a notifiable disease.

Children can return to school 24h after starting Abx.

Front 13

Complications of scarlet fever?

Back 13

- Most common: otitis media

- Rheumatic fever: typically occurs 20 days after infection

- Acute glomerulonephritis: typically occurs 10 days after infection

Front 14

Incubation period of scarlet fever?

Back 14

2 - 4 days

Front 15

Peak age incidence of scarlet fever?

Back 15

Most common age 2-6 years,

peak incidence age 4.

Front 16

14 month old boy, been off his food and irritable past few days.

Temp: 37.8 C

Most likely diagnosis?
(& causative organism)

Back 16

Hand, foot and mouth disease

Caused by the intestinal viruses of the Picornaviridae family, most commonly:

Coxsackie A16 and Enterovirus 71

Front 17

How does hand, foot and mouth disease present?

Back 17

Very contagious, outbreaks at nursery.

- Mild systemic upset: sore throat, fever

- Oral ulcers

- Followed later by vesicles on palms and soles of feet

Front 18

Management of hand, foot and mouth disease?

Back 18

It is a self-limiting condition.

Give advice about hydration & analgesia,

reassure no link to diseased cattle,

children do not need to be excluded from school*
*the HPA recommends they should stay home if feeling unwell, and that they should be contacted if large outbreak.

Front 19

A 6 year old child is brought in by his mother, who has changed her mind about the MMR and would now like him vaccinated.

Can he be vaccinated now, and if so, with what, and when?

Back 19

Give MMR with repeat dose in 3 months.

The Green Book recommends leaving 3 months between doses to maximise response (a period of 1 month is appropriate if child aged >10, or in a younger child if urgent situation e.g. school outbreak)

Front 20

What does the MMR vaccine protect against, and when is it given?

Back 20

Measles

Mumps

Rubella

12-15 months and 3-4 years

Front 21

Contraindications to the MMR vaccine?

Back 21

Severe immunosuppression

Allergy to neomycin

Child has had another live vaccine within 4 weeks

Pregnancy should be avoided for at least 4wks

Immunoglobulin therapy within past 3 months (there may be no immune response to measles vaccine if antibodies are present)

Front 22

Adverse effects of MMR vaccine?

Back 22

Malaise, fever & rash may occur after 1st dose

Typically occurs after 5-10 days, lasts around 2-3 days

Front 23

At 12-13 months, what vaccines are given?

Back 23

Hib/Men C + MMR + PCV

Front 24

At 2 months, what vaccines are given?

Back 24

DTaP/IPV/Hib + PCV

Oral rotavirus vaccine

Front 25

At 3 months, what vaccines are given?

Back 25

DTaP/IPV/Hib + Men C

Oral rotavirus vaccine

Front 26

At 4 months, what vaccines are given?

Back 26

DTaP/IPV/Hib + PCV

Front 27

When is the Flu vaccine (annual) given?

Back 27

2 -3 years

Front 28

What vaccines are given at 3-4 years?

Back 28

MMR + DTaP/IPV

Front 29

When is the HPV vaccine given to girls?

Back 29

12-13 years

Front 30

What vaccine is given age 13-18?

Back 30

DT/IPV + MenC

Front 31

Are any vaccines given at birth?

Back 31

BCG / hepatitis B vaccine if risk factors*

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).

Hepatitis B vaccine should be given at birth if the mother is HBsAg +ve.

Front 32

What is roseola infantum?

Back 32

(also known as exanthem subitum, occasionally sixth disease)

Common in 6 month to 2 year olds, caused by human herpes virus 6 (HHV6).

High fever: lasting a few days, followed by a maculo-papular rash.

Febrile convulsions occur in around 10-15%

Diarrhoea and cough are also commonly seen

(HHV6 can also cause aseptic meningitis and hepatitis)

Front 33

A 2-month-old baby girl is admitted to hospital with suspected meningitis. In addition to IV Cefotaxime, what antibiotic should be given intravenously?

Back 33

Amoxicillin

Meningitis in children < 3 months: give IV amoxicillin in addition to cefotaxime to cover for Listeria.

>3 months? Just IV cefotaxime

Front 34

Contra-indication to lumbar puncture?

Back 34

Focal neurological signs

Papilloedema

Significant bulging of the fontanelle

Disseminated intravascular coagulation

Signs of cerebral herniation

Cariovascular instability (risk of cardiac arrest)

Front 35

In hand, foot and mouth disease, what is the classical presentation?

Back 35

Mild systemic upset: sore throat, fever. Oral ulcers followed later by vesicles on the palms and soles of the feet.

Caused most commonly by coxsackie A16 and enterovirus 71

Front 36

Which vaccines are live, attenuated vaccines?

(these could therefore pose risk to immunocompromised patients)

Back 36

BCG

MMR (measles, mumps, rubella)

Oral polio

Yellow fever

Oral typhoid

Intranasal influenza

Front 37

For the DTP vaccine specifically, if a child has this it is contraindicated and the vaccine should be deferred...

Back 37

In children with an evolving or unstable neurological condition (e.g. seizure disorder currently being investigated)

Front 38

General situation where a vaccine should be delayed?

Back 38

Febrile illness / intercurrent infection

Front 39

Suspected meningococcal septicaemia in a <1yo in the community. Dose of what?

Back 39

300mg IM benpen

Front 40

When are febrile seizures typically seen?

Do antipyretics reduce incidence?

Back 40

Between 6 months and 5 years of age. Affects 3% of population. Usually occur in viral infection as temperature rises quickly.

No evidence that antipyretics reduced febrile seizures.

Front 41

Prognosis after a febrile seizure?

Back 41

1/3 will have another.

If single seizure + no focal signs + <30mins = 1% chance of developing epilepsy.

If all of these features, risk >50%. (this applies to <1% of all children with febrile seizures)

Front 42

Which organisms like to colonise CF patients?

Back 42

Staphylococcus aureus

Pseudomonas aeruginosa

Burkholderia cepacia

Aspergillus

Front 43

Emergency treatment of croup?

(oxygen + inhaled ............. )

Back 43

Oxygen + nebulised adrenaline

(oral dexamethasone should also be given if the child can tolerate it)

Front 44

A 15-year-old girl presents with a palpable purpuric rash over her lower limbs accompanied by polyarthralgia following a recent sore throat. What is the most likely diagnosis?

Back 44

Henoch-Schonlein purpura

IgA-mediated small vessel vasculitis

Front 45

Features of Henoch-Schonlein purpura?

Back 45

Palpable purpuric rash (with localized oedema) over buttocks and extensor surfaces of arms and legs.

Abdominal pain. Polyarthritis

Features of IgA nephropathy may occur e.g. haematuria, renal failure

Front 46

Management and prognosis for Henoch-Schonlein purpura?

Back 46

Analgesia for arthralgia. Treatment of nephropathy is generally supportive. There is inconsistent evidence for the use of steroids and immunosuppressants.

Self-limiting, esp if no renal involvement.

Excellent prognosis. 1/3 have relapse.

Front 47

When can a child with whooping cough return to school?

Back 47

5 days after Abx commence

Front 48

When can a child with Roseola return to school?

Back 48

No school exclusion

Front 49

When can a child with diarrhoea and vomiting return to school?

Back 49

48 hours after symptoms settle

Front 50

A 9-year-old boy who has recently arrived from India presents with fever. On examination a grey coating is seen surrounding the tonsils and there is extensive cervical lymphadenopathy.

What is the most likely diagnosis?

Back 50

Diptheria

Presents: recent visitors to Eastern Europe / Russia / Asia

sore throat with a 'diphtheric membrane' on tonsils caused by necrotic mucosal cells.

Bulky cervical lymphadenopathy.

Neuritis e.g. cranial nerves

Heart block

Front 51

Lesser known complications of CF?

Back 51

short stature

diabetes mellitus

delayed puberty

rectal prolapse (due to bulky stools)

nasal polyps

male infertility, female subfertility

Front 52

Complications of chicken pox?

Back 52

Commonly: secondary bacterial infection of the lesions

Rarely: pneumonia; encephalitis (cerebellar involvement may be seen); disseminated haemorrhagic chickenpox;

arthritis, nephritis and pancreatitis may very rarely be seen

Front 53

Should children with chicken pox be excluded from school?

Back 53

Yes. For 5 days from start of skin eruption.

Front 54

Management of chicken pox?

Back 54

Supportive. Trim nails, keep cool.

Calamine lotion.

If immunocompromised or neonate is exposed, should receive varicella zoster immunoglobulin (VZIG). If chicken pox then develops, consider IV Aciclovir.

Front 55

Chicken pox is highly infective. When are the children infective? Incubation period?

Back 55

4 days before rash until 5 days after appearance of rash.

(previously thought it was until lesions scab over, but this has now been replaced by 5 days after rash appearing)

Incubation period 10-21 days.

Front 56

Suspected meningococcal septicaemia in a <1yo in the community. Dose of what?

Back 56

300mg IM benpen

Front 57

Suspected meningococcal septicaemia in a 1-10yo in the community. Dose of what?

Back 57

600mg benpen IM

Front 58

Suspected meningococcal septicaemia in a >10yo in the community. Dose of what?

Back 58

1200mg ben pen IM

Front 59

Characteristic features of congenital cytomegalovirus infection?

Back 59

Growth retardation

Purpuric skin lesions

Front 60

Characteristic features of congenital Rubella infection?

Back 60

Sensorineural deafness

Congenital cataracts

Congenital heart disease (e.g. patent ductus arteriosus)

Glaucoma

Front 61

Characteristic features of congenital Toxoplasmosis infection?

Back 61

Cerebral calcification

Chorioretinitis

Hydrocephalus