Fever

Question 1

Cry of a distressed child

Answer 1

High pitched cry

Question 2

Clothing sign of a sick child

Answer 2

Does not protest to undressing

Normal baby response is to resist undressing

Question 3

Theory for developing a temperature

Answer 3

Immune enzymes work better at higher temp

Fever is not bad for you, the cause of the fever is

Question 4

Definition of a fever

Answer 4

> 38 degrees C

Question 5

Physiological causes of fever

Answer 5

Endogenous pyrogens:

• IL-1
• TNF

Question 6

Methods of measuring temperature

Answer 6

Tympanic
Axillary
Occasionally rectally

Question 7

Prolonged rupture of membranes

Answer 7

Water breaks but labour does not start yet
Baby no longer in sterile amniotic fluid
Increased infection risk

Question 8

Urine dip in > 2 year olds

Answer 8

Nitrites most useful

Then leukocytes

Question 9

Urine dip in < 2 year olds

Answer 9

Negative nitrites does not rule out UTI

Incontinent so urine isn’t stored long enough for nitrites to build up

Question 10

Paediatric septic screen

Answer 10

FBC, WBC, PLT, CRP
Blood cultures
Urine dip
LP
CXR

Question 11

Hierarchy of urine collection quality

Answer 11

1) Suprapubic aspiration
2) Residual catheter
3) Clean catch
4) Sterile Newcastle pad
5) Bag specimen - only useful if result is sterile

Question 12

Method to promote neonate urination

Answer 12

Swab abdomen with cold saline soaked gauze

Question 13

Blood test priorities

Answer 13

1) Culture

2) Glucose / Gas

Question 14

Most common causes of infection in neonates

Answer 14

1) UTI
2) RTI
3) Meningitis
4) Septicaemia
5) GI
6) Otitis media

Question 15

Febrile convulsions

Answer 15

Convulsions due to infection outside of CNS
Typically don’t increase epilepsy risk
Can be familial

Question 16

Febrile convulsion characteristics

Answer 16

Generalised
< 15 mins
Self resolving

Question 17

Mx of febrile convulsions

Answer 17

Treat fever and source
Asses risk of recurrence / epilepsy
Counsel parents

Question 18

Atypical febrile convulsions

Answer 18

Prolonged
Focal
Increase risk of epilepsy / brain injury

Question 19

Risk of febrile convulsion recurrence

Answer 19

1/3 of children

Question 20

Otitis media organisms

Answer 20

Step pneumoniae
Moraxella catarrhalis
GAS

Question 21

Mx of otitis media

Answer 21

Antipyretics

Analgesics

Question 22

Possibel complications of otitis media

Answer 22

Mastoiditis

Recurrence

Question 23

Non infectious causes of fever

Answer 23

Kawasaki disease
Rheumatological disease: JIA
Malignancy: lymphoma, leukaemia

Question 24

Kawasaki disease

Answer 24

Small and medium vessel vasculitis
Mimics streptococcal throat infection
Can cause coronary artery aneurysms - ECG + Echo
Treat urgently

Question 25

Kawasaki disease criteria

Answer 25

Fever > 38 for 5 days + 3 out of 5 of: - Rash - Lymphadenopathy - Red tongue and lips - Peripheral swellings/peeling - Non purulent conjunctivitis

Question 26

Mx of Kawasaki disease

Answer 26

High dose aspirin Immunoglobulin +/- Steroids

Question 27

Use of aspirin in children

Answer 27

Never use aspirin in children except for Kawasaki disease | Aspirin has risk of causing Reyes syndrome

Question 28

Reyes syndrome

Answer 28

Hepatic encephalopathy | Can be caused by aspirin in children

Question 29

Febrile convulsion age group

Answer 29

6mo to 6yo

Question 30

Kawasaki main complication

Answer 30

Coronary aneurysm : ECG ECHO

Question 31

Mumps

Answer 31

Fever Malaise Parotits Muscle pain