GP - Feverish Child in the Community

Question 1

What is the Personal Child Health Record (PCHR)

more commonly known as?

Answer 1

The Red Book

• Has child’s health + developmental history
• Developmental milestones checklist by age
• Vaccination history

Question 2

What could be indicated by a parent failing to engage with a public health programme for their child e.g. vaccinations?

Answer 2

Possible neglect

Question 3

What signs can indicate increased work of breathing?

Answer 3

• Nasal flaring
• Treacheal tug
• Intercostal recession
• Tachypnoea
• Abdominal breathing
• Cyanosis

Question 4

What are the features of acute epiglottitis?

Answer 4

Used to be considered a disease of childhood but due to Hib vaccine, it is more common in adults

Features:

• Commonly age 2-4 yrs
• Child not vaccinated with HiB vaccine
• Rapid onset (hours)
• Pyrexia
• Stridor
• Dysphagia (due to throat pain)
• SoB
• Intense throat pain - prevents child speaking or swallowing
• Drooling of saliva (can occur due to airway obstruction)
• ‘Toxic’ appearance (especially children)
• Position: tripod position in which the child is sat immobile, upright, with hands on their knees and mouth open to improve airway

Question 5

What organism most commonly causes acute epiglottitis?

Answer 5

Haemophilus influenzae type B

(bacteria)

Question 6

Name some things that are ill-adivised in suspected acute epiglottitis?

Answer 6

The following can exacerbate the condition and cause further airway obstruction / death:

1. Lie the child down - further worsens / obstructs airway
2. Examine throat with spatula or palpation (too painful)
3. X-ray of chest or neck

Question 7

How is acute epiglottitis managed?

Answer 7

1. Urgent hospital admission - anaethetist, paediatrician and ENT surgeon contacted
2. Patent airway needs to be established e.g. naso-tracheal
3. Blood culture
4. IV Abx e.g. cefuroxime
5. Intubation can often be removed after ~24hrs and Abx given for 3-5 days

Question 8

What is Epiglottitis?

Answer 8

Epiglottitis is a rapidly progressive cellulitis of the epiglottis

Question 9

When is an immediate Abx prescribing approach considered for self-limiting RTIs in children / adults?

Answer 9

1. Children < 2-yrs with bacterial acute otitis media
2. Children with otorrhoea who have acute otitis media
3. Pts with acute sore throat / acute pharyngitis / acute tonsillitis when 3 or more on Centor criteria are present

Question 10

What are the Centor criteria?

Answer 10

A set of criteria used to identify the likelihood of a bacterial infection (due to Group A Strep) in pts with a sore throat (acute pharyngitis)

Use only in pts with recent onset (≤3 days) acute pharyngitis

Criteria:

1. Cough absent (+1)
2. Exudate or swollen tonsils (+1)
3. Tender/swollen anterior cervical lymph nodes (+1)
4. Temp > 38C (+1)
5. Age 3-14 (+1)
   
   • 15-44 = 0
   • > 45 = -1

Question 11

At what age are the Centor criteria valid?

(Centor criter are for for determining the risk of an acute sore throat being due to bacterial infection)

Answer 11

> 3-years old

Question 12

If a patient scores 3/4 on the Centor criteria what is the likelihood their sore throat is due to bacterial infection?

Answer 12

40-60%

Hence a course of Abx is considered

Question 13

If a patient has a Centor score of < 3 what is the liklihood of their acute sore throat being due to a virus?

Answer 13

~ 80%