Fever / Rashes Flashcards
What are the ABCD signs of toxicity in a child?
Alertness/arousal/activity
Breathing difficulty
Colour (pale/mottled), Circulation (cool peripheries), Cry
Decreased fluid intake/urine output
What are the clinical features of Kawasaki disease?
Kawasaki = systemic vasculitis
Dx: 4/5 of CRASH plus five days of fever
C onjunctivitis (non exudative, bilateral)
R ash (polymorphus, not vesicular or bulla)
A denopathy (typically cervical and unilateral)
S trawberry tongue (red oral mucosa/lips)
H and (swelling or erythema or hands/feet progresses to desquamation when late)
and Burn… 5 days of daily fevers unresponsive to anti-pyretics or ABx
What is defined as fever in paeds?
> 38 if under 3 months and >38.5 in older infants and children
What are methods of measuring temperature and what is gold standard?
Gold standard is rectal
Axillary is recommended for routine clinical use
Tympanic is unreliable
Oral isn’t used for safety purposes
What investigations are performed for a septic screen?
FBC with differentiated WCC, acute phase proteins Blood culture Throat swab CXR if suspect respiratory illness Urine microscopy and culture LP
What is the most severe complication of Kawasaki disease?
Coronary artery vasculitis causing coronary aneurysm –> acute MI
What is the treatment for Kawasaki disease?
High dose aspirin (to prevent clots) and IVIG (reduces aneurisms from 20%-> 3%)
What are the 4 things to assess in a child with fever?
- Check fevers (>38)
- Check age - bring in if <3mo
- Signs of toxicity
- Look for site of infection
Describe what you would ask on history and what you would look for on examination in a child presenting with fever
History:
- Localising signs (e.g. neck stiffness, cough/coryzal, ENT, abdo pain, joint swelling, rash)
- Travel history
- Sick contacts
- IUTD
Examination
- ABCD signs of toxicity
- Well/unwell
- Localising signs
How will you investigate and manage a child <3mo presenting with fever?
Call for help
FBC, blood cultures, Urine/LP, CXR
Admit
IV Abx
What is a febrile seizure?
Convulsions, in a child between 6 months and 6 years of age, in the setting of an acute febrile illness, without previous afebrile seizures, significant prior neurological abnormality, and no CNS infection
What is the difference between simple and complex febrile seizures?
Simple - generalised TC seizures <15mins
Complex - focal features, last >15minutes, recur within same febrile illness, incomplete recovery at 1hr
How do you manage a febrile seizure?
Reassurance (remain calm, soft surface laying on side or back, do not restrain, do not put anything in mouth, if you can time and video)
** Call ambulance if lasts >5mins
Panadol doesn’t help, may help with symptoms of illness
How do you assess and investigate a febrile seizure?
Look for cause of seizure, ensure no previous afebrile seizures / progressive neurological conditions / signs of CNS infection
If simple - NO investigation
What is Henoch-Schonlein Purpura, what are the clinical features and how is it treated?
Systemic IgA-mediated autoimmune vasculitis
- Immune complexes deposit on small vessels
1. Rash: palpable purpura on buttocks and backs of legs
2. Colicky abdo pain - can be due to intussusception (bloody mucus diarrhoea)
3. Arthritis
4. Glomerulonephritis
Treatment: supportive, symptomatic, steroids, immunosuppressants
What causes meningitis? What does the rash look like? What are the associated features?
Neisseria meningitides
- Non-blanching petechial / purpuric rash
- Headache, nausea, neck stiffness, photophobia, vomiting and drowsiness
What are the clinical features of impetigo?
Red, raised, thin-walled vesicles & bullae which become pustular (honey-coloured crust)
- Occur commonly around mouth but can be anywhere
- Usually caused by staph and strep
What are the clinical features of measles? Complications? Treatment?
Prodromal coryzal symptoms (3-5 days before rash)
Diffuse maculopapular rash, starts behind the ears
Koplik spots inside mouth
TOXIC fevers (>40)
Not immunised
**Encephalitis
Supportive trt
What causes Chicken pox? What are the clinical features? Management?
Varicella zoster virus
- Rash begins as a few red spots or bumps (often mistaken for insect bites)
- Raised pink/red rash that forms vesicles –> then crust over
If see a spot, draw a circle around it –> if they change into blisters w/in 24 hours –> chicken pox
*Immunisation available >18mo
What causes ‘slapped cheek’ or 5th disease? What are the clinical features? Serious complication?
Parvovirus
Fever, runny nose, cough
Intensely red on cheek –> lacy/pimply rash spreads to limbs
**Aplastic crisis
What causes ‘Scarlet fever’? What are the clinical features? Treatment?
Group A strep infection
- Sore throat 1-2 days before fine, red, sandpaper rash -
- Starts of face spares the mouth and spreads to limbs
Treatment: penicillin or amoxycillin
What investigations are required for a diagnosis of HSP?
U/A: look for renal involvement (haematuria, proteinuria, casts)
EUC, serum IgA
Abdo ultrasound - may show intussusception
What are the clinical features of rubella? Complications? Treatment?
TOXIC fevers
Diffuse maculopapular rash that lasts 3 days
Congenital rubella syndrome (rubella in 1st trimester)
**Encephalitis
What is congenital rubella syndrome?
Rubella infection in 1st trimester causing infection in fetus
- deafness, congenital cataracts, blue purpura, hepatosplenomegaly, CHD, jaundice, growth and mental retardation
What causes roseola infantum and what are the clinical features?
Caused by herpes virus 6
Fever –> subsides –> rash (maculopapular)
What causes hand-foot-mouth disease? What are the clinical features? Complications?
Enteroviruses - Coxsackie virus
High fever that goes away then comes back
Severe mouth pain or sore throat, copious drooling, refusal to eat or drink
Small, red or white spots and blisters can, but not always, often appear on the hands or feet
What organisms cause ringworm?
Several different fungus organisms that all belong to a group called Dermatophytes
- Treated with oral and topical anti fungal preparations
What is Stevens-Johnson syndrome?
Unclear immunological response to infection / drugs –> characterised by detachment of epidermis from the papillary dermis at the epidermal-dermal junction, manifesting as a maculopapular rash and bullae
- Erosions/ulcerations causing painful, blistery lesions at mucous membranes especially on mouth, throat, eyelids
and genital region
What is the definition of anaphylaxis?
Severe hypersensitivity reaction that manifests with respiratory difficulty (wheeze, upper airway swelling) and/or CV symptoms (shock, hypotension)
Explain the pathophysiology of anaphylaxis
- Rapid degranulation of mast cells and basophils
- Systemic release of inflammatory mediators, capillary leak, mucosal oedema, smooth muscle contraction
What are the features to look for with an anaphylactic reaction?
○ Mucosal involvement - hives, pruritis, flushing, swelling of lips/tongue/uvula
○ Respiratory compromise (dyspnoea, stridoe, wheeze, hypoxia)
○ CV compromise (hypotension, tachycardia, syncope)
○ GI involvement (crampy abdo pain, diarrhoea, vomiting)
What is the IM dose of adrenaline for anaphylaxis?
1:1000 IM
What does the ear look like during otitis media?
EXAMINE THE EARS in any febrile toddler ○ Red eardrum ○ Loss of light reflex ○ Ear drum may have bulging/perforation ○ Purulent discharge
What is the most common cause of otitis media?
Viral - RSV
What is a complication of otitis media? How is it managed?
Otitis media with effusion (OME)
- Common in children prone to recurrent URTI
- Middle ear fluid persists (an effusion)
- Conductive hearing loss
- Increased susceptibility to infection
- Grommet - surgical drainage of middle ear
○ Ventilates middle ear
What is the most common cause of nappy rash? How is it treated?
Candida albicans
Antifungal creams
What are some common causes of nappy rash?
- Excess skin hydration
- Skin trauma, due to friction between the nappy and skin
- Other irritants such as ammonia produced from
urine, diarrhoea, soap and detergent residue, powders, creams and nappy wipes
How does atopic dermatitis present?
Eczema
- Dry, red, extremely itchy patches on the extensor surfaces in younger children and flexor surface in older children
- Skin becomes lichenfied (dry and thickened from constant scratching and rubbing)
What is the treatment for atopic dermatitis?
- Reduction of exposure to trigger factors (where possible)
- Regular emollients (moisturisers)
- Intermittent topical steroids
What are the different methods for testing for allergy?
- Skin prick testing on forearm or back: If you are allergic to the tested allergen, a small itchy lump (wheal) surrounded by a red flare will appear within 15-20 mins
- Don’t take antihistamines in the week before this - Blood tests for allergen-specific IgE
- Patch testing for contact dermatitis
- Oral allergen challenge
What is the paediatric dose of cefotaxime / cetriaxone? Ben pen?
Cefotaxime or Ceftriaxone: 50 mg/kg up to 2g IV/ IM
Benzylpenicillin: 60 mg/kg up to 3g IV/ IM
