Febrile child

Question 1

what are the most common organisms

Answer 1

E.coli, S. Aureus

Question 2

what is the immunisation schedule

Answer 2

birth - hep B 
2,4,6mo - hep B, DTPa, Hib, Pneumococcal, Rotavirus 
12mo - Hib, Menc, MMR
18mo - MMR, DTPA
4yo - DTPA

Question 3

what are some signs of an unwell child

Answer 3

lethargic, poor interaction, inconsolable, tachycardia, tachypnoea, cyanosis, poor peripheral perfusion

Question 4

when should a child always be admitted for IV Abs

Answer 4

<1mo

Question 5

what are the components of a septic screen

Answer 5

• FBC
• BC
• Urine MCS
• CXR
• LP

Question 6

when should you admit a child

Answer 6

<1mo
unwell
septic shock
high risk

Question 7

what are some red flags

Answer 7

T >38 (1-3mo) >39 (3-6mo)
pale, mottled
neurologic signs 
resp distress
bile stained vomit 
dehydration/shock

Question 8

what are the dc requirements
<1m0
1-3mo
>3mo

Answer 8

<1mo - ADMIT 
1-3mo
- well child 
- normal ix 
r/v by senior reg/boss
- folluw up available within 12hrs
>3mo
- well child 
- follow up arranged

Question 9

what is the difference between early onset and late onset sepsis

Answer 9

early onset

• within 48 hrs of life
• from vaginal flora infecting amniotic fluid then infant lungs
• often GBS
• present with pneumonia and septicaemia
• Ix: septic screen
• Mx: emperical ABx

late onset

• after 4hrs of life
• from environment
• most often coagulase negative staph
• meningitis
• IX septic screen

Question 10

what are the common bacterial and viral causes of meningitis

Answer 10

bacterial:
<3mo e.coli, GBS
3mo-6yrs: neiserria meningitides, s pneumonia, Hif
bacterial can cause severe conseuqneces

viral
responsible for 2/3
- enterococcus, adenovirus, EBV
- less severe, often full recovery

Question 11

when does a child need further ix for a UTI

Answer 11

USS KUB when aytpical UTI, not responsive to abx within 48hrs, male <3mo, or older child with recurrent utis

Question 12

why is uti important in children

Answer 12

up to half the time they represent and underlying srtuctural abnormality

Question 13

what is kawasaki disease

Answer 13

vasculitits

commonly <5yrs

Question 14

how is kawasaki diagnosed, investigated and treated

Answer 14

5 days fever + 4/5

• polymorphous rash
• bilateral non purulent conjucntival injection
• mucous membrane changes (red lips, strawberry tongue)
• peripheral changes (palmar erythema, oedema)
• cervical LN

IX

• ASOT
• Anti DNAse B
• Echo
• Plt (thrombocytosis in 2nd wk)

RX
IV IG
Aspirin

Question 15

what is the risk of giving a child aspirirn

Answer 15

reyes syndrome if <12y