Paediatric ID

Question 1

Management of bacterial meningitis in a child <3 mnths

Answer 1

IV cefotaxime plus IV amoxicillin

Question 2

Management of bacterial meningitis in a child >3mnths

Answer 2

IV Ceftriaxone

Question 3

What is also given for management of bacterial meningitis in children >3mnths ?

Answer 3

• Dexamethasone 4x daily for 4 days

Question 4

What is the most common cause of encephalitis in children ?

Answer 4

• Viral : HSV-1 from cold sores
• In neonates : HSV-2 from genital herpes

Question 5

Give 6 features of encephalitis

Answer 5

• Altered consciousness
• Altered cognition
• Unusual behaviour
• Acute onset of focal neurological symptoms
• Acute onset of focal seizures
• Fever

Question 6

How is encephalitis investigated ?

Answer 6

• LP : sending CSF for viral PCR
• CT if LP CI

Question 7

How is encephalitis manged ?

Answer 7

• IV Aciclovir : covers HSV and VZV
• Ganciclovir covers CMV

Question 8

What causes infectious mononucleosis ?

Answer 8

• EBV

Question 9

How does IM present ?

Answer 9

TRIAD :

• Fever
• Sore throat
• Lymphadenopathy
• Fatigue
• Tonsillar enlargement
• Splenomegaly and in rare cases splenic rupture

Question 10

How does IM typically present in an exam ?

Answer 10

• Adolescent with a sore throat
• Develops itchy rash after taking amoxicilin

(IM causes intensely itchy maculopapular rash in response to amoxacillin or cefalosporins )

Question 11

What advice is givento someone with IM ?

Answer 11

• Avoid playing contact sports for 4 wks after having glandular fever to reduce the risk of splenic rupture

Question 12

How can IM be test for ?

Answer 12

• Monospot test : +ve result = presence of heterophile antibodies

Question 13

How does mumps present ?

Answer 13

• Prodromal flu like symptoms
• Parotid gland swelling (initially unilateral before becoming bilateral).

Question 14

4 complications of mumps

Answer 14

• Orchitis
• Pancreatitis
• Meningitis
• Encephalitis
• Sensorineural hearing loss

Question 15

How is mumps spread and how is it diagnosed ?

Answer 15

• Respiratory droplets
• PCR testing on viral swab

Question 16

What is the mode of delivery in a mother with HIV with a viral load <50 copies/ml

Answer 16

Normal vaginal delivery

Question 17

When is a CS considered in mothers with HIV ?

Answer 17

Viral load >50 copies /ml

Question 18

What is given to mothers with HIV during a CS if viral load is unknown or there are >10000 copes / ml

Answer 18

IV zidovudine

Question 19

When and what prophylactic treatment is given to a baby when the mother has HIV ?

Answer 19

• > Low risk babies, where mums viral load is < 50 copies per ml, should be given zidovudine for 4 weeks
• > High risk babies, where mums viral load is > 50 copies / ml, should be given zidovudine, lamivudine and nevirapine for 4 weeks

Question 20

When is breast feeding recommended in HIV +ve mother ?

Answer 20

Never

Question 21

When are babies to HIV positive parents test for HIV?

Answer 21

• > HIV viral load test at 3 mnths. If this is negative, the child has not contracted HIV during birth and will not develop HIV unless they have further exposure
• > HIV antibody test at 24 months. This is to assess whether they have contracted HIV since their 3 month viral load.

Question 22

what are the principles of medical care in a child with HIV ?

Answer 22

• ART
• Prophylactic co-trimoxazole (septrin) for children with low CD4 to protect against pneumocystis jirovecii pneumonia

Question 23

How is the risk of a baby contracting hepatitis B from a hep B +ve mother reduced ?

Answer 23

• Hepatitis B vaccine
• Hepatitis B immunoglobulin infusion
• Additional Hep B vaccine at 1 and 12 mnths

Question 24

When are babies to hepatitis C +ve mothers tested ?

Answer 24

18 mnths of age

Question 25

Features of measles

Answer 25

- Prodromal : conjunctivits, fever - Koplik spots of buccal mucosa before the rash : white spots - Rash : starts behind the ears before spreading

Question 26

Most common complication and most common cause of death following measles and complication that can occur 5-10 yrs later

Answer 26

- Complication : measles - Death : pneumonia - 5-10 yrs later : subacute sclerosing panencephalitis

Question 27

Threadworm treatment

Answer 27

- Oral mebendazole - Including all household contacts

Question 28

Chickenpox

Answer 28

- Fever initially - Itchy, rash starting on head/trunk before spreading. Initially macular then papular then vesicular - Systemic upset is usually mild

Question 29

Measles

Answer 29

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

Question 30

Mumps

Answer 30

- Fever, malaise, muscular pain - Parotitis ('earache', 'pain on eating'): unilateral initially then becomes bilateral in 70%

Question 31

Rubella

Answer 31

- Rash: pink maculopapular, initially on face before spreading to whole body, usually fades by the 3-5 day - Lymphadenopathy: suboccipital and postauricular

Question 32

Erythema infectosum

Answer 32

- Also known as fifth disease or 'slapped-cheek syndrome' - Caused by parvovirus B19 - Lethargy, fever, headache - 'Slapped-cheek' rash spreading to proximal arms and extensor surfaces

Question 33

Scarlett fever

Answer 33

- Reaction to erythrogenic toxins produced by Group A haemolytic streptococci - Fever, malaise, tonsillitis - 'Strawberry' tongue - Rash - fine punctate erythema sparing the area around the mouth (circumoral pallor)

Question 34

Hand, foot and mouth disease

Answer 34

- Caused by the coxsackie A16 virus - Mild systemic upset: sore throat, fever - Vesicles in the mouth and on the palms and soles of the feet