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Paeds > Lecture Day 1 Febrile > Flashcards

Lecture Day 1 Febrile Flashcards

1
Q

What is pyrexia?

A

> 38

High grade >38.5

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2
Q

What causes a puerperal rash?

A

Vascular necrosis

Adults: Vasculitis

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3
Q

How can you measure temp?

A

Axilla:

Ear thermometer

Oral thermometer: under tongue, vallecullar fossa

Rectal

Skin Temp: perfusion & core temperature

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4
Q

What temperature do cellular processes break down

A 
Heat stroke >42
Malignant hyperthermia (reaction to suxamethonium)
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5
Q

Why does fever matter

A
  • Sign of serious infection
  • Uncomfortable (give paracetamol-calpol, ibuprofen, cool clothing
  • Febrile seizures
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6
Q

Febrile convulsions

A

6 months-6 years

Typical

  • generalised tonic-clonic, < 5mins, associated with fever, rousable afterwards, no focality
  • one convulsion per fever
  • Any focality = worried

Often family Hx

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7
Q

How many will have a second febrile convulsion?

Is it associated with epilepsy?

A

1/3rd (1/3rd of those will have 3rd)

Only associated if repeated seizures

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8
Q

Signs of atypical febrile convulsions

A
  • Prolonged
  • Repeated
  • Focal
  • Difficult to rouse after
  • Older or younger children
  • (Not associated with high temp)
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9
Q

What are the differential diagnoses for typical/atypical febrile convulsions?

A
  • CNS infections (Meningitis & enchephalitis
  • Non febril seizure/epilepsy
    • Primary
    • Symptomatic (SOL)
  • (head injury)
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10
Q

Management of febrile convulsions

A
  • Admit for 1st episode
    • parental reassurance & education (leaflet)
    • observation only
  • advise parents what to do if further episode
    • safe position
    • call 999 if > 5 mins

Investigate if atypical

  • CNS infection
  • Epilepsy
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11
Q

Cause of pyrexia in children

A
  1. viral infection
  2. ENT
    Otitis media (mastoiditis)
    Rhinitis (sinusitis)
    tonsilitis (apiglottitis)
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12
Q

Bacterial cause of

A

Resp:
Pneumonia/empyema

Renal:
UTI/Pyelonephritis

CNS:
Meningitis/encephalitis

Blood:
Septicaemia

Bone
Osteomyelitis/septic arthritis

Malignancy

Rheumatological

Parasites
Malaria
D&V

Persistent fever
Kawasaki’s disease

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13
Q

What is Kawasaki Diseae

A

Self limiting acute vasculitis

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14
Q

How long does the fever last

A

> 5 days

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15
Q

4 clinical feature of what

A 
1. Changes in extremities 
     • desquamation
     • erythema, edema 
2. Bilateral conjunctivitis 
3. Rash
4. Cervical lymphadenopathy
5. Changes in lips/oropharynx
    • Cracked lips, red tongue

Irritable

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16
Q

Differentials

A

Scarlet fever

Measles

17
Q

What are the difference between purpura and petechia?

What are petechia

A

Petechia < 3mm

Micro bleeding

Think: thrombocytopenia

18
Q

Parents report baby ‘felt hot’

  • what questions do you ask
  • when would u take them seriously
A

Must determine if temp was taken, how it taken, is it a true pyrexia?
- if they are very young

19
Q

6 week, crying & irritable

What likely cause and what would you need to exclude

A

Probably viral BUT

meningitis
sepsis 
UTO
pneumonia
non-accidental injury
20
Q

What questions should you ask for an infective Hx

A
  • mental: irritable
  • urine output
  • feeding
Presenting complaint:
When was baby last well? 
Feeding pattern?
Cry (consolable, high-pitched)?
Vomiting?
Diarrhoea?
Cough?
Rash?
Is she herself?
21
Q

What questions for PMHx

A 
Birth history:
Vaccinations: 
Past medical history:
Family history:
Medications (antibiotics)
Social history:
Systems review:
22
Q

Examination

A 
General: Appearance irritable, mottled 
B: RR, Sats
C: HR, Cap refil, BP
D: Temp, Glucose 
E: Skin, ENT, abdo
CNS: fontanelle, neck stiffness, fundi, reflexes
23
Q 
Whats normal of the following 
Irritable
Mottled		
Cap refill - 4 secs
HR 180/min	
RR50/min	
Temp 38oC
BP 75/40 mmHg
A

RR & TEMP

24
Q

Do babies get neck stiffness in meningitis?

What age does this develop

A

No

>2 yrs

25
Q

Immediate management

A 
Call for help
ABCDE
- Give fluids (tachy &amp; prolonged cap refill)
- Start antibiotics
- Regular observations
26
Q

Investigations for infection

A 
Septic screen:
Blood cultures
Urine sample
Chest X-ray
Lumbar puncture

FBC, CRP, glucose, U&E

27
Q

Contraindications for LP

A

↑ ICP
Intracranial lesion

Relative: clotting or skin infection

28
Q

When to do LP

A

Immediate
After antibiotics
- PCR, WCC & glucose/protein still useful
After CT head

29
Q

Normal results for ↑ ICP

A

Summary of normal CSF results
Appearance Clear and colourless
Glucose >2.2mM/L (~70% blood glucose level)
Protein <0.4g/L - mainly albumin (up to 0.9g/L in neonates and elderly)
Cell count <4/mm3 lymphocytes, no polymorphonuclear neutrophils
IgG <15% of total CSF protein; no oligoclonal bands
Pressure 6-15cm H2O (patient’s head in line with sacrum), * with coughing
Some guidelines suggest that in traumatic taps you can allow 1 white blood cell for every 500 to 700 red blood cells

30
Q

Causes of meningitis in neonates

A 
(think birth canal)
Group B strep 
Escherichia coli
Listeria 
Viral
31
Q

Causes of infants and children

A 
Viral
H influenzae (vaccination)
S pneumoniae 
N meningitidis
TB
32
Q

Talk over CSF results in children (must record blood sugar when send off)

  • compare neutrophils between bacterial vs viral
  • Compare lymphocytes
A
  • bacterial 100-10,000, viral < 100

- bacterial < 100, viral 10-1000

33
Q

If you diagnose bacterial meningitis who must you inform

A

Public health (prophylaxis for contacts)

34
Q

Complications of meningitis in children

A
  • cerebral palsy in <2 yrs
  • deafness
  • epilepsy
  • coning & death
35
Q

Pyrexia + vomiting + abdominal pain

A
  • viral gastritis
  • UTI/pyelonephritis
  • Acute appendicitis
  • pneumonia (irritation of diaphragm)
  • tonsillitis
36
Q

How can urine infections present in children

A

dysuria, urgency, bed wetting

37
Q

Prolonged fever.. think

A

kawasaki

Paeds (20 decks)

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