Febrile Child

Question 1

Define pyrexia

Answer 1

≤38 degrees

Question 2

Temp of ≥38 degrees in a child <3 months?

Answer 2

RED FLAG

Question 3

How is temp in paeds routinely measured in hopsital?

Answer 3

Axillary electronic thermometer

Question 4

Temp of ≥39 degrees in a child 3-6 months?

Answer 4

Amber flag

Question 5

When is a rectal temperature indicated?

Answer 5

In cases of hypothermia

Question 6

Features of an atypical febrile seizure (3)

Answer 6

Any 1 of:

1) Lasts >15 mins

2) Focal features (?CNS infection)

3) 2 within 24 hours, or within same febrile illness

Question 7

What are 3 risks in a febrile convulsion of going on to develop epilepsy?

Answer 7

1) Atypical febrile seizure

2) Abnormal neurology/neurodevelopment prior to event

3) FH in 1st degree relative of epilepsy

Question 8

Can febrile convulsions be prevented? (e.g. with use of antipyretics)?

Answer 8

NO

Question 9

How long does a typical febrile seizure last?

Answer 9

<15 mins

Question 10

Give some causes of pyrexia in children

Answer 10

1) Viral URTI

2) LRTI/pnuemonia (viral or bacterial)

3) Otitis media

4) Viral gastroenteritis

5) Tonsillitis

6) UTI/pyelonephritis

7) Osteomyelitis

8) Unknown (PUO)

9) Meningitis

10) Kawasaki’s

11) Others - malignancy, rheumatological

Question 11

What is a key red flag under ‘circulation and hydration’ assessment?

Answer 11

Reduced skin turgor

Question 12

What is Kawasaki’s disease?

Answer 12

An acute vasculitic syndrome of unknown aetiology.

Question 13

What is the key complication of Kawasaki disease?

Answer 13

Risk of coronary artery aneurysms

Question 14

Diagnostic criteria for Kawasaki disease?

Answer 14

1) Fever (at least 5 days in duration)

Presence of at least 4 of:

2) Bilateral conjunctivitis

3) Rash

4) Changes in extremities (hands/feet):
- desquamation
- erythema
- oedema

5) Cervical lymphadenopathy

6) Changes in lips/oropharynx:
- cracked lips, red tongue

Question 15

Define size of:

a) petechiae

b) purpura

c) ecchymosis

Answer 15

a) up to 2mm

b) 2mm to 10mm

c) >10mm

Question 16

Mx of Kawasaki disease?

Answer 16

1) High dose aspirin

2) IV immunoglobulin

Question 17

How is a diagnosis of Kawasaki disease made?

Answer 17

Kawasaki disease is a clinical diagnosis as there is no specific diagnostic test.

Question 18

Some red flag signs in children:

Answer 18

• Pale/mottled/ashen/blue
• No response to socialcues
• Appears ill
  *Does not wake
• Weak, high-pitched or continuous cry
• Grunting
• Tachypnoea
• Recessions
• Reduced skin turgor
• Temp ≥ 38 °C if 0-2m
• Non-blanching rash
• Neck stiffness
• Bulging fontanelle
• Focal seizures or signs
• Status epilepticus