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JUST4MED clinical cases > Paeds- Febrile Seizures + Sudden Infant death > Flashcards

Paeds- Febrile Seizures + Sudden Infant death Flashcards

1
Q

1 in how many children will have a febrile seizure?

a) 1/25
b) 1/5
c) 1/75
d) 1/50

A

a) 1/25

Febrile Seizures are relatively common, occurring in 1 in every 25 children

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2
Q

How long does a febrile seizure last on average?

a) 15s
b) 30s
c) 90s
d) 300s

A

c) 90s

Febrile seizures are seizures that occur with a fever. They usually last approx 90 seconds

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3
Q

After how long does a febrile seizure become a medical emergency?

a) 2 minutes
b) 5 minutes
c) 10 minutes
d) 15 minutes

A

d) 15 minutes

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4
Q

What is a ‘Febrile seizure?

A

• Febrile seizures are seizures that occur with a fever

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5
Q

‘Febrile seizure usually occur in…

A

children under 5 years old

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6
Q

Fevers may be caused by any infection including….

A

g URTI,

pneumonia,

gastroenteritis,

ear infections

or meningitis.

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7
Q

Why are children more prone to seizures?

A

• Children in general have lower ‘seizure thresholds’ than adults making them more prone to seizures.

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8
Q

in the early stages of illness when there is a rapid rise in body temperature could lead to….

A

febrile convulsion

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9
Q

Symptoms of febrile convulsion

A
  • High temperature (>38 degrees Celsius)
  • Body stiffening
  • Sharp jerking movements of arms and legs
  • Arched back
  • Eyes rolled back
  • Child unresponsive during seizure
  • Breathing can become irregular
  • Incontinence (fecal or urinary)
  • Often post-ictal drowsiness
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10
Q

What to look out for in a history presenting with fever

A
  • May be no prior history of illness.
  • Child may be systemically unwell before seizure, with increased temperature, Increased RR, vomiting, out of character.
  • Seizure could also occur before anyone realizes child is unwell.
  • After having one febrile seizure, 1/3 children go on to have another one.
  • 1/15 children will go on to have three or more febrile seizures

. • May run in families.

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11
Q

Ix for febrile convulsion

A

Diagnosis is clinical

• Tests may be required to identify source of fever

. Investigations to consider:

  • Lumbar puncture
  • Rule out meningitis
  • Viral studies
  • Blood culture
  • Bacteremia?
  • EEG
  • Brain MRI
  • Consider in child with abnormal development, history or neurological examination.
  • FBC
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12
Q

Differential Diagnosis for febrile seizure?

A
  • Bacterial meningitis
  • Viral meningitis
  • Viral encephalitis
  • Epileptic seizure
  • Hot water epilepsy : Focal seizure after bathing in hot water.
  • Breath-holding spells : Afebrile infant with apneic attack and short generalised episodes of jerking after crying spell
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13
Q

What examinations would you for suspected febrile seizure?

A
  • Dermatology examination
  • Respiratory examination
  • Ear examination
  • Gastrointestinal examination

Rule out meningitis • E.g. lack of nuchal rigidity and focal neurological abnormalities

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14
Q

After one febrile seizure, how many children go on to have another?

a) 1/3
b) 1/5
c) 1/10
d) 1/15

A

a) 1/3

A surprisingly large number of children will then go on to have another febrile seizure in the future

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15
Q

Most important differential diagnosis to rule out? febrile seizure

a) Epilepsy
b) Viral meningitis
c) Bacterial meningitis
d) Hot water epileps

A

c) Bacterial meningitis

Bacterial meningitis can cause many long term complications in children

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16
Q

What temperature is needed to diagnose a febrile seizure?

a) 37.5 Degrees Celsius
b) 39 Degrees Celsius
c) 38.5 Degrees Celsius
d) 38 Degrees Celsius

A

d) 38 Degrees Celsius

Other symptoms include body stiffening, sharp jerking movements, arched back and eyes rolling back.

17
Q

Which of these is a risk factor for SIDS?

a) Prone sleeping position
b) Being breastfed
c) Using a dummy
d) Sleeping in the parental bedroom

A

a) Prone sleeping position

18
Q

What needs to be ruled out before SIDS can be diagnosed?

a) Accidental suffocation
b) Non-accidental death (abuse/trauma)
c) Respiratory infection
d) All of the above

A

d) All of the above

19
Q

What is the prevalence of SIDS in the UK?

a) 1 death per 1,000
b) 0.6 per 1,000
c) 0.1 per 1,000
d) 0.3 per 1,000

A

d) 0.3 per 1,000

20
Q

Sudden Infant Death Syndrome’ is also known as?

A

cot death

21
Q

What is ‘Sudden Infant Death Syndrome’

A

Defined as ”The sudden death of an infant under 1 year, which remains unexplained after thorough case investigation including autopsy, examination of scene and review of history”

22
Q

Sudden Infant Death Syndrome’ is of the leading cause of

A

post-neonatal infant death

23
Q

WHat is Triple-Risk Hypothesis

A

The triple-risk hypothesis explains SIDS by three factors converging to result in infant death.

24
Q

What are the three factors in Triple-Risk Hypothesis SIDS

A
  • A vulnerable infant - prematurity, low birth weight
  • In a critical period during homeostatic control development
  • An exogenous stressor – smoke exposure, sleep, over-heating
25
Q

What does BRUEs stand for?

A

Brief resolved unexplained events

26
Q

SIDS risk factors?

A
  • Sleeping position – Prone or side sleeping
  • Sleeping surface - soft
  • Sleeping arrangements
  • Smoke exposure
  • Not being breastfed
  • Prematurity
27
Q

Signs of a BRUE

A
  • Cyanosis
  • Breathing difficulties
  • Abnormal limb movements
28
Q

BRUE

Hx questions to ask?

A
  • Did the infant have a foreign body ingestion?
  • Does the infant have a history of apnoea?
  • What was the time and amount of last meal?
  • Was the baby asleep or awake?
  • How did the baby seem before BRUE?
  • What was the child’s position?
  • Did the infant change colour?
29
Q

Investigations for SIDS

A
  • Blood culture – evaluation for bacterial, viral and fungal pathogens
  • CSF culture – as above
  • Urine culture – as above
  • Serum chemistry – results negative for other metabolic causes
  • Photographic record – negative for bruising, haemorrhages or other skin findings
  • Skeletal survey – negative for bone injuries
30
Q

Differential Diagnosis for SIDS

A

• Accidental suffocation – sign of entrapment between two surfaces, accidental strangulation or suffocation against bedding

• Non-accidental trauma or abusive injury – bruising in unusual places, rib fractures, spiral fractures of long bones and retinal haemorrhages

• Respiratory syncytial virus – can be tested for by nasal swab. Upper respiratory symptoms of cough and nasal congestion.

• Pertussis – as above

31
Q

Tx for SIDS

A

• Carer follow-up and grief counselling

32
Q

Which of these is a risk factor for SIDS?

a) Prone sleeping position
b) Being breastfed
c) Using a dummy
d) Sleeping in the parental bedroom

A

a) Prone sleeping position

33
Q
A

JUST4MED clinical cases (15 decks)

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