Febrile Child Flashcards

Also look at Anki (Paeds in primary care)

1
Q

What are the infections that predispose a child to congenital abnormalities?

A

TORCH

T - toxoplasmosis

O - other .e.g HIV

R - Rubella

C - CMV

H - Herpes

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2
Q

What question can we ask if we want to QUICKLY screen for a child development (in history taking)

A

‘Compared to his/her peers/siblings, how do you think is he/she doing?’

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3
Q

What is the recommended feeding amount for a baby?

A

Aiming for 150-200 mls/kg per 24 hours

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4
Q

How much ml is 1 ounce (1 oz)?

A

1 oz = 30 ml

*as parents in the UK will usually give that amount when asked how much they baby feeds/ is there in the bottle

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5
Q

When is the appropriate time for weaning?

A

Weaning is roughly 6 - 9 months

*in practice it may be even at 4 months - if a child clearly want to try solids etc, no reason to stop them

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6
Q

Mesenteric Adenitis

  • characteristics of infection
  • type of pathogen likely to cause it
  • other symptoms
  • management
A
  • enlarged lymph nodes (mostly abdominal ones)
  • viral pathogen (possibly same viruses causing cold or flu)
  • other possible symptoms: fever, pain, feeling unwell, nausea and vomiting, cold-like symptoms, sore throat
  • Management: analgesia (paracetamol, ibuprofen), antibiotics (if other bacterial condition develops), surgical review (to role out appendicitis)
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7
Q

What is a paediatric equivalent to an adult neck stiffness (in meningitis)?

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8
Q

what is a possible diagnosis for these ‘red flag’ symptoms?

  • easy bruising
  • weight loss/ night sweats
  • rapid presentation
  • lymph nodes enlarged
A

Lymphoma/ Leukaemia

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9
Q

What are possible late complications of undetected UTI in children?

A
  • renal scarring
  • early onset hypertension *it is also a possible sign of a structural abnormality in renal system

If a febrile child and unsure diagnosis = always check for UTI (urinalysis)

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10
Q

What’s the typical age at which febrile seizures commonly occur?

What stage of the fever do they usually happen?

A
  • 6 months - 6 years
  • happen usually at the beginning of the fever
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11
Q

What meds can you give a child in order to relieve their fever?

A
  • Ibuprofen
  • Paracetamol
  • Calpol
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12
Q

Measles symptoms

A
  • fever
  • macular rash
  • conjunctivitis
  • coryza
  • Koplik spots (mouth)
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13
Q

Possible complication of Measles

A

encephalitis (during the onset of acute illness) -> death

  • blindness, deafness
  • bacterial pneumonia
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14
Q

Presentation of Scarlet fever

What pathogen is responsible for it?

A

Scarlet fever (due to group A Streptococcus)

  • rash
  • strawberry tongue
  • bacterial tonsillitis (exudate)
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15
Q

Possible complications of Scarlet fever

A
  • Rheumatic Fever
  • Glomerular Nephritis
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16
Q

Treatment of Scarlet Fever

A

Antibiotic: Penicillin V (oral) for 10 days

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17
Q

Slapped Cheek

  • pathogen causing it
  • symptoms
  • complications
A
  • Parvovirus B19
  • symptoms: fever, red cheeks/rash
  • complications: usually not dangerous, but dangerous in pregnancy (Hydrops Foetalis - foetal heart failure due to severe anaemia caused by destruction of RBCs)
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18
Q
  • What are the characteristics of a common rash in infants with viral illness?
  • Do we need to worry about that?
A
  • Characteristics: blanching and macular
  • If it’s blanching and a child is otherwise well, no need to worry
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19
Q

What are possible causes of non-blanching rash?

A
  • meningitis
  • vasculitis
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20
Q

Characteristics of a chickenpox rash

A
  • vesicular
  • different stages
  • fever and then rash
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21
Q

Treatment for impetigo

A

Topical: FuciBET

oral: Flucloxacillin

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22
Q

What’s a possible complication of pre-orbital cellulitis?

What is the best IV treatment option?

A

Pre-orbital cellulitis -> it can progress to orbital cellulitis (affect vision)

*hospital admission is required

Treatment option: IV cephalosporins

*possible treatment with Vancomycin, Clindamycin, or Doxycycline due to resistance

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23
Q

‘hand, foot and mouth disease’

    • what type of pathogen causes it
    • does the child need to be isolated?
  • what’s treatment?
A
  • viral illness
  • it is common in the nurseries - child does not need to be isolated although disease is contagious
  • child is usually well

No need for treatment, possible use anaelgesia if painful; should resolve on its own in a week time

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24
Q

Do we give Ibuprofen in chickenpox?

A

NO - no NSAIDs as that will increase the risk of Necrotising Fascitis

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25
Q

What do we need o to remember about the vaccination schedule (roughly)

A
  • lots of vaccines in 2, 3, 4th months of life
  • then when 1 year old
  • then yearly vaccine (flu)
  • 12-13 girls HPV vaccine
  • 14 years ACWY
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26
Q

What are signs of dehydration?

A
  • sunken eyes
  • sunken fontanelle (in infants)
  • dry mucous membranes (look at the tongue)
  • mottled skin/cold extremities
  • skin turgor
  • prolonged cap refill
  • increased HR, poor pulse volume
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27
Q

Where would you manage the child based on ‘Traffic light’ system?

  • green
  • amber
  • red
A
  • green - manage at home
  • amber - safety netting (careful planning); possible paeds admission unit
  • red - admission to hospital
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28
Q

Why do we worry about a baby that is <3 months old and have a fever of 38C or above?

A

This age group is likely to show no focal/ localised signs, therefore even a serious illness may not manifest itself clearly

29
Q

Investigations used in An Infection Screen

A
  • FBC
  • blood cultures
  • urine culture
  • CXR
  • stool MC&S if diarrhoea
  • LP (especially if unwell and <3 months old with raised WCC
  • U&E
  • ABG
  • glucose
30
Q

Spot diagnosis: what is this?

A

Measles

Notes:

Measles -> viral infection

Symptoms:

  • Fever, rash (starts head- body), red maculo-papular (red-brown)
  • 3C’s (cough, coryza and conjunctivitis)
  • Non purulent conjunctivitis
  • Pathognomonic sign: Koplik spots (prodromic viral enanthem of measles manifesting two to three days before the measles rash itself.
  • Incubation 10 days prior to rash
  • MMR live vaccine 13m and prior to school

Complications: encephalitis, pneumonia, hepatitis- disability deafness, blindness

31
Q

Spot diagnosis: what is this?

A

Scarlet fever

Notes:

  • Children (<10)
  • Streptococcal infection (most strep A)

Symptoms:

  • fever, sore throat, rash (toxins)
  • Strawberry tongue (or white strawberry tongue is coated usually earlier in illness)
  • Rash- like sandpaper to touch

Management: Penicillin V 10 days

* Notifiable

Complications: OM, pneumonia, meningitis Later (immune complexes)- RF, GN

32
Q

Spot diagnosis: what is this?

A

Parvovirus B19 / Slapped cheek

Notes:

  • Usually mild illness
  • Age 3-15

Symptoms:

  • Rash: bright red to cheeks and can spread to body
  • May have non-specific illness

NB - caution if:

  • harm to pregnant women (if not had previously- check serum if exposure esp <20 weeks)

Lifelong immunity if infected before

  • immunocompromised (possible serious illness) and flare-ups in Sickle-Cell
33
Q

Spot diagnosis: what is this?

A

Eczema Herpeticum

Notes:

  • HSV1 (cold sores)
  • affect pts with underlying inflammatory skin conditions- atopic eczema (when eczema comes to contact with HSV)
  • Commonly face and neck (but can be widespread and potentially serious)

Symptoms: rash (sore and itchy), fever, systemic upset and Lymph nodes

*Rash: vesicular/blistering- on normal or inflamed skin)

Treatment: antivirals ASAP - may need admission for IVs

Advice to avoid immunosupressed: very young/old etc (not contagious to those with normal immunity)

34
Q

What is this?

A

Roseola

35
Q

What is this?

Treatment

A

Kawasaki Disease (may lead to coronary arteries aneurysm)

Investigation to do: ECHO

Treatment: Aspirin (in that case we do not bother about Reye) an immunoglobulin

36
Q

Criteria for diagnosis of Kawasaki disease

A
37
Q

What’s that?

A

Henoch Schonlein Purpura (HSP)

  • an IgA mediated small vessel vasculitis
  • usually seen in children following infection

Features

  • palpable purpuric rash (with localized oedema) over buttocks and extensor surfaces of arms and legs
  • abdominal pain
  • polyarthritis
  • features of IgA nephropathy may occur e.g. haematuria, renal failure

Tetrad: Rash, abdominal pain, arthralgia, nephritis (+/- diarrhoea, rectal bleeding, haematuria)

Treatment

  • analgesia for arthralgia
  • treatment of nephropathy is generally supportive. There is inconsistent evidence for the use of steroids and immunosuppressants

Prognosis

  • usually excellent, HSP is a self-limiting condition, especially in children without renal involvement
  • around 1/3rd of patients have a relapse
38
Q

What’s that?

A

Hand Mouth and Foot disease

Notes:

  • Viral (enterovirus:- coxsackievirus, enterovirus 71- rare complication is encephalitis)

Symptoms:

Non-specific symptoms- coryzal, cough, anorexia, fever Mouth ulcers Rash- papules and vesicles

  • Contagious while unwell

Management: Conservative management

39
Q

What’s that?

A

Chicken Pox/ Varicella-Zoster virus

40
Q

What’s that?

A

Mumps

Pathogen: RNA paramyxovirus

Clinical features

  • fever
  • malaise, muscular pain
  • parotitis (‘earache’, ‘pain on eating’): unilateral initially then becomes bilateral in 70%

Management

  • rest
  • paracetamol for high fever/discomfort
  • notifiable disease

Complications

  • orchitis - uncommon in pre-pubertal males but occurs in around 25-35% of post-pubertal males. Typically occurs four or five days after the start of parotitis
  • hearing loss - usually unilateral and transient
  • meningoencephalitis
  • pancreatitis
41
Q

What’s that?

A

Impetigo and bullous impetigo

42
Q

What is that?

A

Pre-orbital cellulitis

Notes

  • usually children <5 (5-10) (but can affect any age) *in young children the orbital septum not fully developed)
  • Infection/inflammation of soft tissues superficial to orbital septum
  • orbital function remains in tact

Cause__: Can come from superficial site- insect bite, folliculitis, trauma, can spread from any URTI infection

! in children can be caused by sinusitis

IMPORTANT can rapidly progress to orbital cellulitis involves deeper tissues within orbit- fat and muscles and thus orbital dysfunction= requires urgent admission/imaging/surgical assessment

Complications: abscess, Cavernous Sinus Thrombosis, Intracranial abscess, loss of vision, death

Symptoms: redness and swelling around eye, warmth and tenderness +/- malaise, irritability and fever (caution with fever- think orbital as differential) (less common: pain or visual disturbance).

43
Q

What’s that?

A

Meningococcal disease

44
Q

What’s that?

A

Meningococcal septicaemia

  • a very late sign of a disease

*child is very sick

45
Q
A
46
Q

ABCDE in a sick child

What to look for in A?

A

Airway – Is it obstructed?eg secretions, foreign body, stridor

47
Q

ABCDE in a sick child

What to look for in B?

A

B – Breathing – Is the child struggling to breathe?
Assess respiratory rate, look for recession/accessory muscle use, check oxygen saturation, auscultate the chest

48
Q

ABCDE in a sick child

What to look for in C?

A

C – Circulation – Is there evidence of poor circulation?
Assess colour skin, heart rate, capillary refill time (on sternum and fingers/toes), blood pressure, warm or cold hands/feet?

49
Q

ABCDE in a sick child

What does D mean? What do we assess?

A

D – Disability – What is the child’s neurological state?
Assess pupil response to light, limb tone and movement, AVPU score/GCS, temperature, glucose, urinalysis

50
Q

ABCDE in a sick child

What does E mean? What do we assess?

A

E – Exposure – Have you exposed the child and examined top-to-toe?
Rashes – viral rash, infectious disease rash, non-blanching rash (septicaemia?)

Any evidence of injury/trauma

51
Q

What signs to look for in an abdominal examination of an unwell child?

A

Tummy – Is this soft? Distended? Tender? What are the bowel sounds like? Any masses?Any hernias?(In boys, never forget to examine the testis - testicular torsion = surgical emergency)

52
Q
A
53
Q

What antipyretics would you use in a child ?

A

Antipyretics if a child is distressed:

o Paracetamol

o Ibuprofen

*Do not use both antipyretics together routinely (change agents if one isn’t working)

54
Q

Should you use Ice or cold bath in a child with a fever?

A

Do not use cold water baths or ice (shivering can increase basal body temperature)

55
Q

Safety netting advice for a child with a fever

A

Safety Netting: When to seek further advice

  • Seizure
  • Non-blanching rash
  • Parents/carer feel child is worsening
  • Fever >5 days
56
Q

What medications and when give to a child with a seizure?

A
  • rectal diazepam repeated once after 5 minutes if the seizure has not stopped
  • or one dose of buccal midazolam
57
Q

When to do ‘infection screen’ on a child with a fever?

A

The following children will require an infection screen in hospital:

  • All children < 3 months old with fever
  • Fever without apparent source and red or amber criteria on NICE Traffic Light System
  • Any child with red criteria on NICE Traffic Light System
58
Q

What investigations does ‘Infection Screen’ consist of?

A
  • FBC
  • Blood Cultures
  • CRP
  • Urine Culture
  • CXR
  • Stool MC&S if diarrhoea
  • Lumbar puncture (especially in unwell <3month old who are unwell with raised WCC)
  • U&E
  • ABG
59
Q
A
60
Q

Orbital Cellulitis

  • symptoms
A

Symptoms: Ptosis, orbital pain (can be severe-compartment syndrome), visual disturbance/loss, proptosis, chemosis, fever, headache, systemic symptoms, ( uncommon: vomiting, altered consciousness consider meningeal involvement)

61
Q

Orbital Cellulitis

  • investigations
  • management
A

Investigations: FBC, swab, Ct sinus/orbits or MRI, LP

Management: Po co-amoxiclav, IV cephalosporin (plus flucloxacillin and or metronidzole – covering for staph and anaerobes).

Alternatives (if Penicillin allergy): include clinadmycin and quinolone

62
Q

When is LP contraindicated in a picture of meningitis?

A

LP contraindicated in the face of widespread purpura, severe coagulopathy and cardiovascular shock

63
Q

What are contraindications to giving a vaccine?

A

Confirmed anaphylaxis to a previous dose (or a vaccine with the same antigen) or to a component of the vaccine (eg neomycin, streptomycin, polymyxin B in some vaccines)

Influenza and yellow fever: confirmed anaphylaxis to egg

64
Q

Who should not receive a live vaccine?

A
  • pregnant women
  • immunocompromised
  • timing frame with receiving another life vaccine
65
Q

Croup

  • pathogen
  • symptoms
  • management
A

Pathogen: Para-influenza virus (RSV next common)

Symptoms: barking cough, stridor, hoarse voice

Management:

A. Symptomatic: Paracetamol, Ibuprofen, fluids

B. Steroids (single, oral dose) e.g. Dexamethasone

66
Q

Viral URTI

  • pathogen (common)
  • symptoms
  • management
A

Pathogen: Rhinovirus

Symptoms: cough (green sputum), sneezing, sore throat, hoarse voice

Management:

Symptomatic - Ibuprofen, Paracetamol ,fluids

* use CENTOR criteria to assess for the need of antibiotic treatment

67
Q

UTI

  • pathogen
  • symptoms/investigation finding
  • management
A

Pathogen: E.Coli

Investigations: Nitrites + Leucocyte on urinalysis

Symptoms: abdominal pain, hematuria, burning pain on passing urine

Management:

A. Send the sample - Clean catch urine sample or MSU

B. Antibiotics

68
Q

Tonsillitis

  • pathogen
  • presentaiton
  • management
A

Pathogen: Group A beta-haemolytic streptococcus

* often viral

Presentation: Exudates (bacterial), tender cervical lymphadenopathy, sore throat, absence of a cough

*use CENTOR criteria to assess if bacterial and if Abx needed

Management:

symptoms relief by Ibuprofen or Paracetamol; Abx depends on if bacterial or not

69
Q
A