approach of a febrile child

Question 1

how do we measure fever inn children below the age of 4 week s?

Answer 1

electronic thermometer in axilla

Question 2

how is fever measures in children within the 4 weeks to 5 years range ?

Answer 2

electronic thermometer
chemical dot thermometer
infrared tympanic

Question 3

what is the causative organism inn occult bacteremia ?

Answer 3

stept pneumonia

Question 4

what is the presentation of meningococcemia ?

Answer 4

non blanching rash
signs of meningitis
DIC
use glass/tumbler test

Question 5

what is the presentation for kawasaki disease ?

Answer 5

fever more than 5 days 
bilateral conjunctival injection 
strawberry tongue 
red swollen mucous membranes 
desquamation of the fingers 
polymorphous rash

Question 6

what is a common complication of kawasaki disease ?

Answer 6

coronary artery aneurysm

Question 7

what is the treatment for kawasaki disease ?

Answer 7

aspirin

IVIG

Question 8

what is the differential diagnosis of strawberry tongue ?

Answer 8

scarlet fever

kawasaki disease

Question 9

what is the nature of the rash associated with chicken poc ?

Answer 9

vesicles and pustules
pleomorphic rash
central to peripheral

Question 10

what is the presentation of chicken pox?

Answer 10

fever but not high in grade

rash comes after the fever

Question 11

when is chickenpox infectious ?

Answer 11

1-2 days before the appearance of the rash up until the last crusty vesicle

Question 12

what is the presentation of measles ?

Answer 12

3Cs in prodrome 
very infectious very high grade fever, bad general condition 
descending rash 
koplik spots
rash appears at the end of the fever

Question 13

what is the presentation of scarlet fever ?

Answer 13

strep tonsilitis
strawberry tongue
sand paper rash

Question 14

what is the presentation of roseola infantum ?

Answer 14

baby measles
similar in presentation to measles but a good general condition
rash appears after fever ( low grade)

Question 15

what is slapped cheek disease ?

Answer 15

fifth disease / erythema infectiosum
cause by parvovirus B19
ages 4-10 years

Question 16

what is the presentation of erythema infectiosum ?

Answer 16

bright red lacy rash on the cheeks appears after the improvement of cold like symptoms

Question 17

what is the traffic light system ?

Answer 17

used to classify patients according to fever
green
amber
red

Question 18

what are the features of red stage in the traffic light system ?

Answer 18

chest indrawing 
grunting 
status epilepticus 
decreased skin turgor 
bile stained vomit 
RR more than 60
fever above 38 in 0-3 months old 
fever above 39 in 3-6 months old
weak, high pitched or continuous crying

Question 19

how is a rash described ?

Answer 19

SCALDA 
Size 
colour 
arrangement 
lesion morph 
distribution 
ask about hair and nails and check between the fingers

Question 20

what is the presentation of tonsillitis ?

Answer 20

fever chills 
headache 
abdominal pain 
GI disturbances 
exudate palatine petechiae

Question 21

what is the causative organism in tonsilitis ?

Answer 21

group a beta hemolytic strp
EBV
treat with penicillin

Question 22

when should a LP be considered in a feverish child ?

Answer 22

in all children under the red label

under one year of age if amber

Question 23

how often should children in red or amber be reassessed ?

Answer 23

reassess in 1-2 hours

Question 24

what are the investigations for a feverish child ?

Answer 24

WCC
CRP
Procalcitonin
chest x ray

Question 25

when should immediate parenteral AB be administered ?

Answer 25

shocked level
unrousable
showing signs of meningococcemia
reduced consciousness or seizures
all infants younger than 1 month
all infants between 1-3 who appear unwell
all 1-3 months who have a WCC less than 5000 or more than 15000

Question 26

what are the antipyretic interventions ?

Answer 26

tepid sponging
no over or under dressing
paracetamol and ibuprofen interchangeably
does not prevent febrile seizures