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Paediatrics > Fever > Flashcards

Fever Flashcards

1
Q

What are the five features of Kawasaki disease?

A
  1. Cervical lymphadenopathy
  2. Bilateral non-purulent conjunctival infection
  3. Mucosal changes - cracked lips, strawberry tongue
  4. Red rash
  5. Peripheral skin changes - redness/oedema of hands and feet
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2
Q

What are the features of bacterial meningitis?

A

Neck stiffness
Bulging fontanelle
Reducing consciousness
Convulsive status epilepticus

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3
Q

What are the features of meningococcal disease?

A 
Non blanching rash 
Lesions >2mm 
Ill looking child 
Neck stiffness
Cap refill >3 seconds
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4
Q

What are the features of pneumonia?

A 
Chest crackles
Tachypnoea 
Nasal flaring
Chest in drawing 
Cyanosis 
O2 sats <95%
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5
Q

What are the features of UTI?

A 
Vomiting 
Poor feeding 
Lethargy 
Irritability 
Abdominal pain or tenderness 
Urinary frequency or dysuria
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6
Q

What are the features of septic arthritis?

A

Swelling of a limb or joint
Not using an extremity
Not weight bearing

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7
Q

What is the paediatric sepsis six?

A
  1. Give high flow oxygen
  2. IV access and blood tests
  3. Give antibiotics
  4. Consider fluid resuscitation
  5. Involve specialists early
  6. Consider inotropic support
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8
Q

What bloods are taken in sepsis?

A

Blood cultures
Blood glucose
Blood gas

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9
Q

How are fluids given in sepsis?

A

20ml/kg isotonic fluid over 5-10 minutes

Examine for crepitations and hepatomegaly

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10
Q

When is inotropic support given?

A

If normal physiological parameters not reached after 40ml/kg fluid
Adrenaline or dopamine

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11
Q

Commonest pathogens for bacterial meningitis under 3 months?

A

Group b strep
E. coli
Listeria monocytogenes

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12
Q

Commonest pathogens for bacterial meningitis 3 months - 5 years?

A

Neisseria meningitides
Strep pneumoniae
Haemophilus influenzae B

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13
Q

Commonest pathogens for bacterial meningitis over 5 years?

A

Neisseria meningitides

Strep pneumoniae

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14
Q

What are the commonest pathogens for viral meningitis?

A

Adenovirus
Coxsackie
Echovirus

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15
Q

What should a fever system enquiry include?

A 
CNS - bright lights, irritability
ENT - pulling at ears, swallowing
Resp - cough, breathing
Abdo - pain, blood, d&amp;v
Urinary - smell, colour, pain
Joints - swelling, pain 
Other - rash, colour, food and drink
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16
Q

What are the features of herpes simplex encephalitis?

A

Focal neurological signs
Focal seizures
Decreased level of consciousness

17
Q

What is on the traffic light system for identifying serious illness?

A 
Colour
Activity 
Respiratory 
Circulation and hydration
Other
18
Q

‘Colour’ parameters on the traffic light system

A

Green - normal
Amber - pallor reported by parent
Red - pale, mottled, ashen, blue

19
Q

‘Activity’ parameters on the traffic light system

A

Green - normal
Amber - decreased, no smile
Red - no response to social cues, appears ill to health care professional, weak/high pitched cry

20
Q

‘Respiratory’ parameters on the traffic light system

A

Amber - nasal flaring, RR >50 (under a year) >40 (over a year), O2 sats <95%, crackles
Red - grunting, chest indrawing, RR >60

21
Q

‘Circulation’ parameters on the traffic light system

A

Green - normal, moist mucous membranes
Amber - tachycardia, dry mucous membranes, reduced urine output, poor feeding
Red - reduced skin turgor

22
Q

‘Other’ parameters on the traffic light system

A

Amber - fever for over 5 days, rigors, limb swelling, not using a limb
Red - non-blanching rash, bulging fontanelle, neck stiffness, seizures

23
Q

What is the first line for suspected meningitis in a hospital?

A

IV cefotaxime + amoxicillin - under 3 months

IV ceftotaxime - over 3 months

24
Q

What is the treatment for suspected meningococcal disease pre-hospital?

A

IV/IM benzylpenicillin

25
Q

When does the anterior fontanelle close?

A

18-24 months

26
Q

What should be done before an LP?

A

Blood glucose

27
Q

What are the CSF findings in bacterial meningitis?

A 
Cloudy
Increased opening pressure
WBC elevated >100
Low glucose <40% serum
Protein elevated >50mg/dl
28
Q

What are the CSF findings in viral meningitis?

A 
Clear 
Normal or elevated opening
WBC elevated 50-1000
Normal glucose 
Protein elevated >50mg/dl
29
Q

What are the CSF findings in tuberculosis meningitis?

A 
Opaque, forms fibrin web
Elevated opening 
WBC elevated 10-1000
Low glucose
Protein elevated 1-5g/L
30
Q

When should corticosteroids be used in meningitis?

A

Dexamethasone 0.15mg/kg (max 10mg QD) for suspected or confirmed bacterial meningitis when CSF is suspicious
DO NOT start if after 12 hours since antibiotics

31
Q

What landmarks can be used to identify the L4/5 disc space?

A

Draw a line between anterior superior iliac crests - L5

Space is just above

32
Q

What are the contraindications for a lumbar puncture?

A 
Child is unstable 
Signs of ICP 
Suspected intracranial mass
Convulsions 
Bleeding disorder 
Infection at site of LP
33
Q

How is group b strep treated?

A

Under 3 months - 14 days cef

Over 3 months - 10 days cef

34
Q

How is listeria monocytogenes treated?

A

amoxicillin 21 days, gentamicin 7 days

35
Q

How is strep pneumoniae treated?

A

14 days cef

36
Q

What are acute complications of meningitis?

A

Seizures
Raised ICP
Coagulopahty
Anaemia

37
Q

What are long-term complications of meningitis?

A

Hearing impairment
Epilepsy
Learning difficulties

Paediatrics (8 decks)

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