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paeds > fever > Flashcards

fever Flashcards

1
Q

fever in under 5s - assessment

A

CAST your magic spell on the kid:

Consciousness
ABCDE and take obs + CRT
Sepsis?
Traffic light - CAR-CHO (colour, activity, resp, circulation, hydration, other symptoms)

BP = a late sign

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2
Q

red flags of fever in under 5s

A

Colour - skin / mouth
Activity - responding poorly or cry high, weak or continuous
Fontanelle bulging
Skin turgor reduced

CAFS

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3
Q

serious differentials for fever in under 5s

A 
Meningitis
UTI
Septic arthritis/osteomyelitis
Kawasaki
Sepsis

MUSKS

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4
Q

bacterial meningitis - presentation in <5s

A

bulging fontanelle
seizures
decreased LOC
neck stiff

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5
Q

pneumonia <5s - presentation + investigations

A

cyanosis + low sats
tachypnoea + work of breathing
crackles

obs
few tests are useful/required - CXR not routine in OP, bloods/cultures/sputum have little use

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6
Q

UTI <5s - presentation

A 
fever + lethargy
vomiting + poor feeding
irritability
abdo pain/tender
urinary frequency/pain
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7
Q

UTI in <5s - investigation

A

urinalysis (clean catch/collection pads/catheter/suprapubic aspirate) - leucocyte esterase + nitrites

± MC+S if serious

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8
Q

kawasaki in <5s - criteria

A

fever > 38 ° > 5d + 4 of:

cervical lymphadenopathy
red cracked lips, tongue, pharynx
peeling, oedematous, erythematous palms/soles
rash - polymorphous 
bilateral conjunctival injection

CRP-RB

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9
Q

fever in <5s - advice to + safety netting parents

A 
advice:
lots fluids/milk
stay off nursery
check in night
how to - examine dehydration + identify nb rash

safety net - return if:
concern / deterioration
fit or nb rash
fever >5d

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10
Q

UTI in <5s - management

A

admission:
admit as necessary (assess seriousness)
urgently admit if < 3mo

> 3mo:
oral cephalosporin - 3d lower, 7d upper

safety net:
return if ill after 1-2d

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11
Q

fever of unknown origin - things to ask about

A

Meningism - headache, photophobia, neck stiff, rash
Activity - cry + responsiveness
Joint pains

Skin - rash, bruising, bleeding
Airway - coughs, colds + SOB
Tummy - diarrhoea, vomiting, pain

MAJ (MAJor 3 red flags first)
SAT (they’re sat down cos ill)

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12
Q

HSP - presentation

A

often follows resp infection
± intussusception

palpable purpuric rash - buttocks + extensor surfaces
colicky abdo pain
haematuria + renal failure
inflamed joints
swollen testes
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13
Q

acute lymphocytic leukaemia - presentation

A

bone marrow failure:
anaemia - lethargy + pallor (incl mucous membranes)
neutropaenia - frequent / severe infections / sepsis
thrombocytopenia - bruising + petechiae

plus:
lymphadenopathy
hepatosplenomegaly
testicular swelling
bone pain - marrow infiltration
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14
Q

ITP - what is it? presentation?

A

immune thrombocytopaenia - immune-mediated reduction in platelet count

petechiae + purpura after a viral illness
± nosebleeds / other bleeding

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15
Q

measles - presentation

A

prodrome: irritable, conjunctivitis, fever
koplik spots
rash - ears to body

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16
Q

measles - investigations

A

IgM antibodies within a few days of rash onset

17
Q

measles - mgmt

A

inform PHE
supportive
may admit if immunosuppressed

18
Q

types of febrile convulsion

A

simple - <15m, generalised
complex - 15-30m, focal
status - >30m

19
Q 
febrile convulsion:
how parents should manage at home?
risk of happening again? 
when should you admit?
can they have vaccinations?
A 
advise parents:
start timer + film it
using rectal diazepam/buccal midazolam
999 if > 5 min
no evidence for antipyrexials

first/complex seizure - admit

1 in 3 risk of another
vaccinations as normal

20
Q

febrile convulsion - link to epilepsy

A

RFs - FH, complex seizure
2.5% risk if no RFs
50% if many RFs

21
Q

kawasaki - management

A

high dose aspirin
IV IgG
echo - screen for coronary artery aneurysms

22
Q

kawasaki - complications

A

coronary artery aneursyms

23
Q

HSP - management + prognosis?

A

supportive - NSAIDs + bed rest
monitor renal function
steroids if bad

1/3 relapse

24
Q

status epilepticus in kids - management

A

call senior

A - airway support if not patent
B - high flow O2
C - assess for shock, gain IV access?
D - buccal midazolam (disability = seizure) 
E - glucose, ?meningitis, ?ICP

2° - IV phenytoin

25
Q

how to treat raised ICP in kids?

A

mannitol

26
Q

status epilepticus in kids with fever - differentials

A

febrile convulsion
bacterial meningitis
meningoencephalitis (ie meningitis to brain)
poisoning

27
Q

HSP - investigation

A

3 blood:
BP
FBC
coagulation + platelets (normal)

3 renal:
renal function
protein:creatinine
urinalysis

HSP has 3 letters → 3 blood, 3 renal

28
Q

acute lymphoblastic leukaemia - investigation

A

immediate referral - few hours - to rule out ALL + meningococcus

FBC:
anaemia
thrombocytopenia
neutropaenia
WCC can be high, normal, low
if abnormal, do blood film

blood film - poss blast cells (may be limited to marrow)
bone marrow biopsy
clotting screen - other cause, DIC

liver + renal function before chemo

29
Q

ITP - investigations + outlook?

A

FBC - low platelets
rule out other causes eg clotting, meningococcal

self-limiting - usually 1-2wk but up to 6mo
only treat if symptoms bad - refer if so

30
Q

investigations in infants younger than 3 months with fever in hospital setting

A

obs
3 bloods - FBC, CRP, blood cultures
3 specifics - urinalysis, CXR (if resp signs o/e), stool culture (if diarrhoea)

31
Q

seizure in kids - differentials

A 
febrile convulsion
epilepsy / status
bacterial meningitis
haemolytic uraemic syndrome
herpes simplex encephalitis (focal)
32
Q

pneumonia in children - management

A

amoxicillin
antipyretics
admit if unwell/comorbidities

33
Q

red light traffic system for assessing fever - which components?

A 
Colour
Activity
Respiratory
Circulation + Hydration
Other symptoms

CAR-CHO

34
Q

traffic light assessment of fever: management of green, amber + red

A

green:
manage at home, supportive to condition, safety net

amber:
safety net or refer for paeds assessment

red:
immediate paeds

35
Q

unexplained petechiae or hepatosplenomegaly age 0-24 - investigation

A

refer for immediate specialist assessment for leukaemia + meningococcus

paeds (18 decks)

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