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paeds > fever > Flashcards

fever Flashcards

1
Q

meningitis causes in neonatal - 3 months?

A

GBS
e coli
listeria

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2
Q

meningitis causes 1 month- 6 yrs

A

neisseria meningitidis
strep pneumoniae
h influenzae

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3
Q

meningitis causes >6 yrs

A

neisseria meningitidis

strep pneumo

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4
Q

Meningitis signs

A

positive Kernig’s sign (hip flexed knee bent -> pain felt on attempting to straighten leg)
headache
photophobia
neck stiffness
younger- non specific symptoms like crying, irritability, lethargy, bulging fontanelle (late sign)

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5
Q

most common viral encephalitis

A

HSV type I

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6
Q

meningitis complications

A 
long term neuro impairment
hearing loss (all should have audiological assessment promptly)
local vasculitis 
local cerebral infarction
hydrocephalus
cerebral abscess
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7
Q

Meningitis Ix

A 
FBC, WCC, CRP
Blood glucose
Blood gas (for acidosis)
coagulation screen
U+Es
LFTs
Full septic screen.
LP for CSF
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8
Q

Encephalitis symptoms

A

fever
altered consciousness
seizures

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9
Q

Encephalitis Mx

A

IV aciclovir

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10
Q

Encephalitis

A

LP (PCR of CSF)

EEG and MRI/CT head - may show focal changes

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11
Q

encephalitis complications/ prognosis

A

mortality rate is high 70%

most survivors have severe neurological sequelae

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12
Q

impetigo

A

‘cornflakes’ stuck to skin
usually on face
can be vesicular/ pustular/ bullous

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13
Q

most common cause of impetigo

A

staph aureus

in hot climates- strep pyogenes

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14
Q

impetigo mx

A

oral fluclox if sever
topical abx sometimes effective in mild cases
avoid school until lesions dry
eradicate nasal carriage w nasal cream containing mupirocin

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15
Q

impetigo ix

A

skin swab for MCS

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16
Q

Impetigo complicatoins

A

post strep glomerulonephritis

staphylococcal scalded skin syndrome

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17
Q

Staphylococcal scalded skin syndrome presentation

A

exotoxin-mediated epidermolysis secondary to staph aureus infection

Fever + malaise
scalded appearance (widespread tender erythema and flaccid superficial blisters)
Nikolsky sign (epidermis separates on gentle pressure)
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18
Q

Staphylococcal scalded skin syndrome Mx

A

IV Anti staph Abx
analgesia
monitoring of fluid balance
Emollient ointments

ADMIT

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19
Q

in chickpox hx always check

A

pregnant/ immunocompromised contacts

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20
Q

Chickenpox rash?

A

vesicular.

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21
Q

Chicken pox diagnosis

A

clinical based on characteristic rash, distribution and progression
Serology (VZV IgM)

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22
Q

Chickenpox mx

A

school exclusion for 5 days after start of rash
symptomatic tx of fever and itching
calamine lotion
gloves to prevent scratching

if immunocomp or severe,
iV aciclovir
If contacted chickenpox-> VZIG

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23
Q

chicken pox complications

A

bacterial superinfection with staph, group a strep -> may lead to toxic shock syndrome, necrotizing fasciitis

encephalitis

purpura fulminans -> can lead large areas of skin necrosis

Severe progressive disseminated disease in immunocomp patients -> haemorrhagic, pneumonitis, DIC

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24
Q

roseola infantum which virus

A

HHV6

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25
Q

exanthem subitum which virus?

A

HHV6

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26
Q

Primary HHV6 infection complication

A

febrile convulsions

also
aseptic meningitis
encephalitis
hepatitis

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27
Q

Erythema infectiosum which virus?

A

Parvovirus B19

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28
Q

Slapped cheek syndrome

A

Parvovirus B19

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29
Q

Parvovirus B19 infects?

A

erythroblastoid red cell precursors in the BM

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30
Q

Parvovirus B19 complication?

A

Aplastic crisis

in children with SCA/ thalassaemia and in immunodeficient (malignancy) unable to produce antibody response to infection

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31
Q

Erythema infectiosum presentation

A

fever
malaise
headache
myalgia

slapped cheek rash
progressing to maculopapular lace-like rash on trunk and limbs

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32
Q

Maternal Parvovirus B19 infection may lead to?

A

fetal hydrops and death due to severe anaemia

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33
Q

Erythema infectiosum Ix

A

Must have FBC to exclude pancytopenia

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34
Q

Hand foot mouth disease which virus?

A

Coxsackie A6 Virus

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35
Q

Hand foot mouth symptoms?

A

fever
sore throat
oral ulcers
painful vesicular lesions on hands, feet, mouth and tongue

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36
Q

Kopliks spots

A

Measles

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37
Q

measles

A 
fever
cough, coryza, conjunctivitis
maculopapular rash spreads behind ears downwards onto trunk
generalised lymphadenopathy
anorexia
diarrhoea
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38
Q

measles ix

A

clinical diagnosis (kopliks spots)
blood film- leucopenia and lymphopenia
LFTs- raised transaminases
Serology- Measles IgM, measles RNA on PCR

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39
Q

Measles MX

A

public health notification!!

supportive - hydration and pain relief
immunocomp - give ribavarin
Vit A supplement may be given

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40
Q

Measles Complications

A 
Encephalitis
Pneumonia
Acute otitis media
Subacute sclerosing panencephalitis
Myocarditis, corneal ulceration, hepatitis
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41
Q

Swollen parotid glands

A

Mumps

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42
Q

Mumps

A 
myalgia
anorexia
headache
low grade fever
chills
ear pain due to parotitis - or pain on eating/ drinking
trismus (spasm of muscles of chewing)
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43
Q

Mumps Ix

A

examination of parotid duct - redness and swelling
Salivary PCR or Serology (mumps IgM)
FBC, WCC: increased amylase

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44
Q

Mumps complications

A 
viral meningitis
encephalitis
orchitis + epididymitis- may lead to infertility but rare
pancreatitis
myocarditis
arthritis
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45
Q

Rubella presentation

A

maculopap rash starting on face then spreading to whole body

*suboccipital and post-auricular lymphadenopathy

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46
Q

suboccipital and post-auricular lymphadenopathy

A

rubella

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47
Q

rubella hx check…?

A

pregnant women!

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48
Q

Kawasakis

A

CRASH and burn

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49
Q

Kawasakis Ix

A

Cardiac echo - visualize any aneurysms (coronary arteries most affected)
FBC, WCC, Pl, CRP, ESR
(high neutrophils, Pl, CRP/ ESR)

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50
Q

Kawasakis complications

A 
myocarditis 
pericarditis
aneurysms
MI
sudden death
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51
Q

Kawasakis Mx

A

IVIG one dose

High dose aspirin to reduce risk of aneurysms/ thrombosis

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52
Q

HIV in children Mx

A

Start ART
Prophylaxis for PCP and co-trimoxazole
Immunisations (avoid live vaccines)
MDT

53
Q

Malaria

A 
cyclical fever 
jaundice
anaemia
thrombocytopenia
diarrhoea 
vomiting
Cerebral malaria**
54
Q

Typhoid fever presentation

A 
worsening fever
headaches, cough, abdo pain
GI symptoms
rose spots on trunk
splenomegaly
55
Q

Typhoid fever diagnosis

A

Stool culture*, blood culture

Serology

56
Q

Typhoid fever tx

A

ceftriaxone

or azithromycin

57
Q

Scarlet fever what organism?

A

Group A strep (usually strep pyogenes)

58
Q

Scarlet fever presentation

A

strawberry tongue

rough sandpaper like rash that starts on torso

fever

tonsillitis

malaise

peeling of skin on palms/ soles

59
Q

scarlet fever ix

A

throat swab

60
Q

scarlet fever mx

A

abx (oral Penicillin for 10d)

can return to school 24 h after starting abx

61
Q

scarlet fever complications

A

otitis media
rheumatic fever
acute glomerulonephritis

62
Q

measuring temp in infants <4 wks

A

electronic thermometer in axilla

63
Q

measuring temp in children 4 wks - 5yrs

A

electronic thermometer in axilla

infra red tympanic thermometer

64
Q

Any child w fever ->

A

Use traffic light system

65
Q

Fever Ix

A

Obs: temp, HR, RR, CRT

66
Q

red light - high risk in fever <5

A 
pale/ ashen/ blue skin
no response to social cues, looks ill to healthcare professional
weak, high pitched or continuous cry
grunting RR>60
reduced skin turgor
***Age <3 months temp >38
non blanching rash
bulging fontanelle
status epilepticus
focal neuro signs
focal seizures
67
Q

Feverish illness mx

A

Immediate IV fluid bolus 20ml/kg 0.9% Nacl
immediate parenteral abx if shocked, unrousable, signs of meningococcal disease

Perform septic screen

68
Q

1st line abx in infants <3 months

A

third gen cephalosporin cefotaxime + abx against listeria (amoxicillin)

69
Q

if meningitis suspected in neonate, Mx?

A

IV amoxicillin and cefotaxime

70
Q

if +ve GBS + septic neonate, Mx?

A

IV Benzylpenicillin

OR

Gentamicin

71
Q

If listeria in a septic neonate, Mx?

A

Amoxicillin + Gentamicin

72
Q

Brudzinski’s sign (forced flexion of neck -> reflex flexion of the hip)

A

Meningitis

73
Q

Non blanching rash

A

Meningococcal septicaemia

74
Q

Fever + vomiting in infant DDx

A 
Meningitis
UTI
Pneumonia
Sepsis
could be anything!
75
Q

non blanching rash 1st line mx in GP

A

IM/ IV BenPen immediately

Send directly to hospital

76
Q

non blanching rash / petechial rash 1st line mx in hospital

A

IV ceftriaxone

77
Q

Meningococcal septicaemia Ix

A 
FBC, WCC, CRP, coagulation screen
Blood culture
Whole blood PCR for N meningitides 
Blood Glucose
Venous blood gas
CT scan to detect alternative intracranial pathology if reduced/ fluctuating LOC, or focal neuro signs
***LP
78
Q

Bacterial meningitis Mx (>3mths) in hosp

A

IV ceftriaxone

79
Q

Suspected Bacterial Meningitis Mx (<3mths) in hosp

A

IV cefotaxime + amoxicillin

80
Q

why not use ceftriaxone in <3 months?

A

biliary sludging -> may exacerbate hyperbilirubinaemia

81
Q

if confirmed gram - bacterial meningitis in child <3 mths, mx?

A

IV cefotaxime for at least 21 days

82
Q

Full Mx in bacterial meningitis

A

IV abx
dexamethasone
respiratory support - O2 15L rebreathing mask
IV fluids 0.9% saline with 5% dextrose
Monitor fluids and urine output
monitor electrolytes and glucose regularly
Correct any metabolic disturbances e.g. coagulopathy (FFP, cryoprecipitate)

83
Q

Meningococcal septicaemia 1st link mx for shock

A

IV resuscitation fluid bolus of 20ml/kg 0.9% NaCl over 5-10 min
reassess and if persists, 2nd bolus

84
Q

Following bacterial meningitis, what follow up is needed?

A

audiological assessment within 4 wks
off cochlear implants if severe deafness
discuss any morbidities w paediatrician at follow up

if recurrent- test for complement deficiency

85
Q

recommended method for acquiring Urine sample

A

clean catch urine

86
Q

under 3mths, UTI Ix?

A

Urine sample for urgent MCS

87
Q

3 months - 3yrs. UTI ix?

A

Urine dip first and send urine for culture

88
Q

3mths - 3yrs Leucocyte + Nitrites +?

A

UTI! start abx

89
Q

3mths - 3yrs. Leucocyte - Nitrites +?

A

send for urine culture but start Abx in meantime!

90
Q

3mths - 3yrs. Leucocyte + Nitrites -?

A

May not be UTI. send for urine culture.

don’t start abx unless good clinical evidence of UTI

91
Q

3mths - 3yrs. Leucocytes - Nitrites -?

A

No UTI

92
Q

Risk factors for UTI?

A 
poor urine flow
hx suggesting previous UTI
recurrent fever of uncertain origin
antenatally diagnosed renal abnormality
FHx renal disease of VUR
93
Q

> 3 months with upper UTI mx?

A

oral antibiotics for 7-10 days. (ceftriaxone or co-amoxiclav)

or IV ceftriaxone for 2-4 days then oral for total 10d

94
Q

> 3 months with lower UTI mx?

A

trimethoprim, nitrofurantoin

oral abx for 3 days

95
Q

<6 months with UTI further IX?

A

all should have renal USS.
if simple-> outpatient USS in 6 weeks.
if abnormal-> MCUG

96
Q

if recurrent UTI/ atypical UTI further Ix?

A

Renal USS - to identify structural abnormalities
DMSA scan - to detect renal parenchymal defects

Assessed by paediatric specialist

97
Q

advice to prevent UTI recurrence?

A

drink adequate math

ready access to clean toilets

should not delay voiding

address dysfunctional elimination syndromes and constipation

consider prophylactic abx in infants w recurrent UTI

98
Q

If neonate in close contact with TB person? Mx?

A

Assess for active TB.
Start isoniazid (with pyridoxine)
refer to TB specialist

99
Q

child w latent TB Mx?

A

involve TB specialist
3 months of Isoniazid (with B6) and rifampicin

OR

6 months of isoniazid (with B6) alone

offer testing for HIV, Hep B, Hep C before starting treatment for latent TB

100
Q

child with active TB Mx?

A

TB specialist referral
2 months of RIPE
then 4 mths of Isoniazid (+B6) + Rifampicin

101
Q

child w active TB of the CNS Mx?

A

RIPE for 2 months
then 10 months of Isoniazid (B6) + rifampicin
TB specialist referral

+ adjunctive dexamethasone and prednisolone gradually withdrawn over 4-8 wks

102
Q

Symptoms of clinical dehydration

A

unwell/ deteriorating
altered responsiveness (lethargic, irritable)
decreased UO

103
Q

Symptoms of clinical shock

A

decreased LOC
pale / mottled skin
cold extremities

104
Q

Signs of clinical shock:

A 
weak peripheral pulses 
prolonged cap refill
hypotension
tachycardia
tachypnoea
105
Q

Signs of clinical dehydration

A 
sunken eyes
dry mucous membranes
tachycardia tachypnoea
reduced skin turgor
normal peripheral pulses 
normal cap refill
normal BP
106
Q

Red flags to identify children at risk of progression to shock

A 
unwell/ deteriorating
lethargic/ irritable
sunken eyes
tachycardia
tachypnoea
reduced skin turgor
107
Q

if child is clinically dehydrated, mx?

A

rehydration with 1st line oral rehydration solution
50ml/kg of rehydration + maintenance vol over 4h period
Continue breastfeeding as well

108
Q

Clinical dehydration Ix?

A

U+Es (Na, K, Urea, Cr)
blood glucose
Venous blood gas - acid base status
Full clinical assessment for symptoms and signs of dehydration
suspect HyperNa dehydration if jittery movements, increased muscle tone, hyperreflexia, convulsions, drowsiness or coma

109
Q

jittery movements, increased muscle tone, hyperreflexia, convulsions, drowsiness or coma
what type of dehydration?

A

HyperNa dehydration

110
Q

high fever lasting a few days followed by (and resolving at the time) maculopapular rash starting on the trunk. Febrile convulsions seen in 10-15%.

A

roseola infantum
exanthem subitum

complications: aseptic meningitis, hepatitis

111
Q

best initial ix for SUFE

A

AP and frog leg Xray

112
Q

tx for kawasakis

A

infusion of IG on the day of diagnosis.

high dose aspirin at anti-inflammatory doses followed by low-dose aspirin at anti-thrombotic doses.

113
Q

what are risk factors for development of coronary artery aneurysms in Kawasaki’s?

A

prolonged fever >16 days, male sex, age < 1 yr, cardiomegaly, raised inflammatory markers and raised platelets.

114
Q

strep pneumo meningitis?

A

IV ceftriaxone and IV dexamethasone

115
Q

ix for TB in child?

A

tuberculin skin test (IGRA), sputum collection for MCS, FBC, CRP, U+Es, LFTs.
CXR.

116
Q

Mx for TB in child?

A

RIPE + pyridoxine to reduce risk of isoniazid causing peripheral neuropathy.

117
Q

intense itching in a child? + burrows, papules, vesicles and pustules.

A

scabies

thread-like, linear burrows, typically in the finger webs and wrists are pathognomonic but often v difficult to see.

118
Q

Dx of scabies

A

definitive diagnosis involves removal of the mite from the burrow and examination under the microscope. - difficult

119
Q

tx of scabies

A

permethrin.
tx all household contacts.
+ topical abx may be needed for secondary bacterial infections.
oral antihistamines and topical steroids (1% hydrocortisone) may be needed to help tx the itching.
all clothing/ bed linen needs to be laundered at high temps to remove eggs and mites.
can take 4-6 wks for itching to resolve.

if lesions still present and persistent itching-> consider reinfection and repeating treatment.

120
Q

fever followed by rash?

A

roseola infantum

121
Q

when to refer for developmental skills?

A

can’t smile by 10 wks.
doesn’t sit unsupported by 12months.
can’t walk by 18 months.

122
Q

A 3 month old boy is suspected of having hypospadias. At which of the following locations is the urethral opening most frequently located in boys suffering from the condition?

A

on the distal ventral surface of the penis

123
Q

non motor problems of cerebral palsy include?

A 
learning difficulties (60%)
epilepsy (30%)
squints (30%)
hearing impairment (20%)
124
Q

what does a prolonged jaundice screen involve?

A 
conjugated and unconjugated bilirubin: the most important test as a raised conjugated bilirubin could indicate biliary atresia which requires urgent surgical intervention.
direct antiglobulin test (Coombs' test).
TFTs,
FBC and blood film,
urine for MC&amp;S and reducing sugars,
U&amp;Es and LFTs
125
Q

what disorders exhibit genetic anticipation?

A

Huntingtons disease

and myotonic dystrophy

126
Q

major risk factors of sudden infant death syndrome

A

putting baby prone, parental smoking, prematurity, bed sharing, hyperthermia or head covering

127
Q

other risk factors of sudden infant death syndrome

A

male sex, multiple births, social classes IV and V, maternal drug use, increased incidences in winter

128
Q

protective factors for Sudden infant death syndrome

A

breastfeeding, room sharing, use of pacifiers

paeds (12 decks)

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