Acute severe Flashcards
A 3-year-old boy is brought to your After Hours surgery by his mother for evaluation. He has been unwell for 4 hours with diarrhoea and vomiting, fever and lethargy and has a non-blanching rash as shown.
WHICH ONE of the following options is the BEST management for this child?
Question 1Select one:
a.
Advise oral rehydration for 6 hours, then normal intake
b.
Arrange platelet count, clotting screen and dipstick urine
c.
Observe; seek paediatric assessment later if not improving
d.
Intramuscular ceftriaxone, oxygen and ambulance transfer
Intramuscular ceftriaxone, oxygen and ambulance transfer
The mother of a 5-year-old child asks you to see her. The child has a fever and has a rash over the abdomen and limbs consisting of dark reddish spots, 2-4 mm in diameter that don’t blanch (see illustration). According to mum, they started off as smaller pink lesions. There are no other signs.
Give IM Ceftriaxone, arrange urgent transfer to hospital
A 1 year old infant presents to you with a febrile illness, and you are concerned about the possibility of meningitis. All EXCEPT ONE of the following are commonly associated with meningitis at this age.
WHICH ONE is NOT commonly seen?
Question 3Select one:
a.
Lethargy
b.
Meningisim
c.
Vomiting
d.
Irritability
Meningism (neck stiffness)
A 2-year-old unimmunised child presents to your surgery with fever, lethargy, drooling and soft stridor of 2 hours duration. She was well in the morning before this. Which is the MOST APPROPRIATE next step?
Question 4Select one:
a.
Lateral neck-xray for retropharyngeal abscess
b.
Examine the throat to look for a quinsy
c.
Contact nearest ICU for urgent retrieval
d.
Secure immediate intravenous access
Contact nearest ICU for urgent retrieval
epiglottitis, needs intubation
A 6 month old infant presents with a fever, and you are assessing them for serious illness or sepsis. What physical sign of fluid loss or dehydration would be the earliest indication of serious illness or sepsis?
Question 5Select one:
a.
Capillary refill time >5 sec
b.
Dry mucous membranes
c.
Reduction in urine output
d.
Reduction in skin turgor
Capillary refill time >5 sec
others are just moderate
An 11-month-old child is seen in the paediatric assessment unit. This morning he woke at 8.00am with a fever, grizzling and refusing his bottle and breakfast. His parents put him back to bed as he was sleepy. At 10:00am they woke him and found a spot on his leg. His temperature is 39°C and his rash is spreading as shown in the picture below. His vaccinations are up to date according to the current New Zealand schedule.
From the options provided select the MOST LIKELY diagnosis.
Question 6Select one:
a.
Henoch-Schönlein purpura
b.
Meninogococcal septicaemia
c.
Meningococcal meningitis
d.
Idiopathic thrombocytopaenia
Meninogococcal septicaemia
You are asked to see a 9 month old baby girl with fever and irritability. A careful physical examination reveals acute otitis media, with a bulging, red eardrum on the right, but nothing else. You prescribe amoxicillin, plus paracetamol prn. for pain relief. Two day later the mother calls and says the child still has disturbed sleep and irritability. Your BEST OPTION at this point is to:
Question 7Select one:
a.
Recall the child for another careful, general clinical examination
b.
Prescribe a broader-spectrum antibiotic including clavulanate
c.
Advise giving the paracetamol four-hourly for better pain relief
d.
Recall the child to re-examine the ear, and perform tympanometry
Recall the child for another careful, general clinical examination
should have responded
A 10-day-old infant is brought to you for assessment of runny nose. The child is a little irritable but still feeding and his rectal temperature is 39°C. Physical examination reveals no other abnormalities. What is the optimum management plan for this child?
Question 8Select one:
a.
Arrange to reassess the child later that day in your surgery
b.
Arrange assessment that day in the paediatric department
c.
Give IM ceftriaxone; arrange ambulance transfer to hospital
d.
Advise paracetamol and fluids and review the child next day
Arrange assessment that day in the paediatric department
A girl, aged 2 years and 6 months who is unimmunized, is brought to see you with a history of fever and being unwell.
On examination the temperature is 39.5°C, the child is slightly irritable, and has decreased capillary refill time of 4 seconds. However,there is no rash, no meningism and no respiratory or abdominal signs.
A full blood count is performed and shows
haemoglobin 120 g/L
white blood cell count of 25 x 109/L, predominantly neutrophils
platelets of 200 x 109/l
CRP is 150
Blood cultures have been sent.
A bag urine shows 5 white cells and mixed organisms.
What is the MOST APPROPRIATE initial management of this girl?
Question 9Select one:
a.
Bladder puncture, then oral antibiotics
b.
Oral paracetamol, but recall on next day
c.
IV fluid bolus, followed by IV antibiotics
d.
Urgent paediatric surgical consultation
IV fluid bolus, followed by IV antibiotics
circulation (cap refill), likely sepsis
A 2-year-old boy is brought to the CAA with a 24-hour history of irritability, fever and vomiting. Examination reveals a sick looking child with a temperature of 40°C, and significant neck stiffness, sot that he cannot put his chin on his chest, or raise his leg.
WHICH ONE of the following is the CSF gram stain MOST LIKELY to show, if positive?
Question 10Select one:
a.
Motile bacilli
b.
Diplococci
c.
Amoebae
d.
Coccobacilli
Diplococci
Meningococci and pneumococci both gram +ve
