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Children's Health > The Febrile Child > Flashcards

The Febrile Child Flashcards

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1
Q

What are the signs and symptoms of Kawasaki’s Disease?

A

Fever lasting over 5 days and 4/5 of the following signs;

  1. Cervical lymphadenopathy
  2. Bilateral non-purulent conjunctival infection
  3. Mucosal changes e.g. strawberry tongue/red cracked lips
  4. Red rash
  5. Peripheral skin changes e.g. redness, oedema and then peeling skin from the hands or feet from the tips downward
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1
Q

What are the signs and symptoms of Kawasaki’s Disease?

A

Fever lasting over 5 days and 4/5 of the following signs;

  1. Cervical lymphadenopathy
  2. Bilateral non-purulent conjunctival infection
  3. Mucosal changes e.g. strawberry tongue/red cracked lips
  4. Red rash
  5. Peripheral skin changes e.g. redness, oedema and then peeling skin from the hands or feet from the tips downward
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2
Q

When searching for the source of an infection how would you screen for; a CNS infection - what questions would you ask?

A
  1. Do bright lights seem to bother the child?
  2. Are they moving normally?
  3. Are they irritable or unsettled?
  4. Do you think they are in pain?
  5. Does their cry sound normal, or is it high pitched?
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3
Q

When searching for the source of an infection how would you screen for; an ENT infection - what questions would you ask?

A
  1. Have they been pulling at their ears?
  2. Have they been struggling to swallow?
  3. Have they got nasal discharge?
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4
Q

When searching for the source of an infection how would you screen for; a respiratory tract infection - what questions would you ask?

A
  1. Do they have a cough?
  2. Have they had noisy breathing?
  3. Are they struggling to breathe?
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5
Q

When searching for the source of an infection how would you screen for; an abdominal infection - what questions would you ask?

A
  1. Have they had any abdominal pains?
  2. Is their abdomen distended?
  3. Have they had a change in bowel habits - diarrhoea, constipation, blood or mucus?
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6
Q

When searching for the source of an infection how would you screen for; a UTI- what questions would you ask?

A
  1. Are they passing urine?
  2. Is their urine smelly or discoloured?
  3. Do they seem to be in pain when passing urine?
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7
Q

When searching for the source of an infection how would you screen for; generalised infective signs - what questions would you ask?

A
  1. Have you (as the parent) noticed any rash?
  2. Have you noticed a change in colour/complexion?
  3. How much have they eaten/drank in the last 24 hours?
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8
Q

When searching for the source of an infection how would you screen for; a joints or bone infection - what questions would you ask?

A
  1. Have you (as the parent) noticed any joint swelling, redness, pain or reduced movement?
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9
Q

List the NICE guidelines signs and symptoms (10) of serious illness in a child under 5.

A
  1. Pale/mottled/ashen/blue skin, lips or tongue
  2. No response to social cues
  3. Appears ill to a healthcare professional
  4. Does not wake or if they do rouse they do not stay awake
  5. Weak, high-pitched or continuous cry
  6. Grunting
  7. RR >60
  8. Moderate or severe chest indrawing
  9. Reduced skin turgor
  10. Bulging fontanelle
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10
Q

What temperature in a child under 3 months is very worrying?

A

Over 38°C

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11
Q

What temperature in a child 3-6 months is very worrying?

A

39°C

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12
Q

What 4 signs would lead you to be highly suspicious of meningococcal disease in a child with fever and a non-blanching rash?

A
  1. They look very ill
  2. Lesions are >2mm in diameter (purpura)
  3. CRT 3 seconds or more
  4. Neck stiffness
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13
Q

What 4 signs would make you highly suspicious of bacterial meningitis in a child with fever?

A
  1. Neck stiffness
  2. Bulging fontanelle
  3. Decreased level of consciousness
  4. Convulsive status epilepticus
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14
Q

How does an infant (younger than 1 year) present with bacterial meningitis?

A

They can present very non-specifically, this means they may not have any neck stiffness, bulging fontanelle or high-pitched cry.
They will always have a fever.

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15
Q

What 3 signs would make you highly suspicious of Herpes Simplex Encephalitis (HSE) in a child with a fever?

A
  1. Focal neurological signs
  2. Focal seizures
  3. Decreased level of consciousness
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16
Q

What 6 signs would make you highly suspicious of pneumonia in a child with a fever?

A
  1. Tachypnoea (RR >60 in 0-5 months; RR >50 in 6-12 months; RR>40 in 12months
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17
Q

What infection should you always consider in a child presenting with a fever who is under 3 months old?

A

UTI

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18
Q

What 6 signs would make you highly suspicious of UTI in a child over 3 months with a fever?

A
  1. Vomiting
  2. Poor feeding
  3. Lethargy
  4. Irritability
  5. Abdominal pains/tenderness
  6. Urinary frequency or dysuria
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19
Q

What 3 signs would make you highly suspicious of septic arthritis/osteomyelitis in a child with a fever?

A
  1. Swelling of a limb or joint
  2. Not using an extremity
  3. Non-weight bearing
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20
Q

What investigations should be carried out in infants under the age of 3 months with a fever?

A
  1. FBC
  2. Blood culture
  3. CRP
  4. Urine dip (only for UTI)
  5. CXR (only for resp signs)
  6. Stool culture (only if diarrhoea is present)
21
Q

When should you perform a lumbar puncture in a child with fever?

A
  1. Infants <1 month
  2. All infants aged 1-3 months who appear unwell
  3. Infants aged 1-3 months with a WBC <5 × 109/litre or >15 × 109/litre
22
Q

What investigations should be performed on a child with a fever of unknown origin who present with 1< ‘red’ features?

A
  1. FBC
  2. Blood cultures
  3. CRP
  4. Urine testing (when considering UTI)
23
Q

When a child presents with ‘RED’ sepsis scoring, what are the first steps you are going to take?

A
  1. Inform a senior colleague
  2. Perform a rapid ABCDE assessment of the child
  3. Prescribe some paracetamol to help with pain and keep the child comfortable
24
Q

When does the anterior fontanelle usually close?

A

18-24 months

25
Q

What is Kernig’s sign positive?

A

Severe stiffness of the hamstrings that can be elicited from straightening the leg when the hip is flexed at 90 degrees

26
Q

What is Brudzinski’s sign positive?

A

Involuntary raising of the knees or hips in flexion on passive flexion of the neck

27
Q

What percentage of meningitis cases are viral?

A

70%

28
Q

List 5 (out of 13) clinical features of meningitis in neonates?

A
  1. Poor feeding
  2. Lethargy
  3. Irritability
  4. Apnoea
  5. Listlessness
  6. Fever
  7. Hypothermia
  8. Seizures
  9. Jaundice
  10. Pallor
  11. Bulging fontanelle
  12. High-pitched cry
  13. Floppiness
29
Q

List 5 (out of 11) clinical features of meningitis in infants?

A
  1. Fever
  2. Lethargy
  3. Nausea/vomiting
  4. Bulging fontanelle
  5. Neck stiffness
  6. Altered alertness
  7. Opisthotonus
  8. Irritability
  9. Poor appetite
  10. Seizures
  11. Hypothermia
30
Q

List 5 (out of 10) clinical features of meningitis in older children?

A
  1. Fever
  2. Headache
  3. Nausea/vomiting
  4. Neck stiffness
  5. Photophobia
  6. Altered alterness
  7. Seizures
  8. Poor appetite
  9. Opisthotonus (spasm of muscles causing backward arching of the head, neck and spine)
  10. Hypothermia
31
Q

What are the steps you take when faced with a child you are highly suspicious has meningitis as an FY1/FY2?

A
  1. Call for senior help immediately
  2. Give high-flow oxygen if it is tolerated - even if they are saturated well with oxygen as the oxygen demand in sepsis increases
  3. Obtain IV access - take bloods (FBC, Blood gas, Lactate, Biochem, CRP, blood culture, U&E, LFT, glucose, clotting)
  4. LP needed, if they are clinically stable, perform this before administration of Abx
  5. Px antipyretics
  6. Obtain a urine sample - catch a clean sample, catheter sample or even a suprapubic aspiration sample in a severely unwell child
  7. If bacterial meningitis is suspected, start empirical Abx
32
Q

What tests would be requested on a CSF sample of a child with suspected meningitis?

A
  1. Microscopy and Gram stain
  2. Culture and sensitivity
  3. Protein
  4. Glucose (ensure you take a blood glucose before so you can calculate a CSF:BM ratio)
  5. Virology
  6. PCR for virology, pneumococcus and meningococcus
33
Q

What Antibiotic should be given to a child over 3 months old with a high clinical suspicion of meningitis?

A

IV Ceftriaxone - 80mg/kg OD dose

34
Q

What Antibiotic should be given to an infant under 3 months old with a high clinical suspicion of meningitis?

A

IV Cefotaxime with an IV penicillin (amoxicillin) for Listeria cover

35
Q

What are the most common bacteria causing bacterial meningitis in neonates - 3months?

A
  1. Group B Streptococcus
  2. Escherichia Coli
  3. Listeria Monocytogenes
36
Q

What are the most common bacteria causing bacterial meningitis in 3 months - 5 years?

A
  1. Niesseria Meningitides
  2. Streptococcus pneumoniae
  3. Haemophilus Influenza B
37
Q

What are the most common bacteria causing bacterial meningitis in children over 5 years?

A
  1. Niesseria Meningitides

2. Streptococcus Pneumoniae

38
Q

85% of viral meningitis is caused by enteroviruses; give 2 examples of enteroviruses.

A
  1. Coxsackie

2. Echovirus

39
Q

List 3 out of 6 risk factors for bacterial meningitis.

A
  1. Attendance at day care/crowded environments
  2. Asplenia
  3. Basal skull fracture
  4. Children with facial cellulitis, periorbital cellulitis, sinusitis, septic arthritis
  5. Maternal infection and pyrexia at the time of delivery
  6. Low family income
40
Q

What antibiotic would you add to the treatment regime of bacterial meningitis if they have travelled abroad recently (within the last 3 months)?

A

Vancomycin

41
Q

Do we give children corticosteroids with bacterial meningitis?

A

Yes we do

42
Q

What prescription for corticosteroids would you give a child with bacterial meningitis?

A

Dexamethasone 0.15mg/kg (max dose of 10mg) QDS for 4 days

43
Q

Define sepsis

A

Life-threatening organ dysfunction due to a dysregulated host immune response to infection.

44
Q

List 6 of 12 risk factors for development of high risk sepsis in childhood.

A
  1. Sickle cell disease
  2. Chronic Steroid dependency
  3. Neonatal
  4. CHD
  5. Burns patient
  6. Presence of a central line
  7. Malignancy or bone marrow transplant or impaired immune function
  8. Neutropenia
  9. Asplenia
  10. Complex urogenital anatomy or repair
  11. Severe neurological impairment
  12. Technology dependent (e.g. long term ventilated patients)
45
Q

Where do we aim to collect CSF from in an LP?

A

In the L4/L5 intervertebral space

46
Q

How do we find the correct space on the back for an LP? Which landmarks do we use?

A
  1. Identify the anterior superior iliac crest (ASIC)
  2. Draw an imaginary line between the ASIC’s
  3. The midpoint of the line is the L5 vertabrae, just above this is space we need for LP
47
Q

List the reasons when a LP would be inappropriate.

A
  1. Child is too unstable
  2. Symptoms/signs of raised ICP
  3. Suspected IC mass
  4. After convulsing
  5. Extensive or spreading purpuric rash
  6. Bleeding disorder
  7. Local infection at site of LP
48
Q

List 3 out of 7 acute complications of meningitis.

A
  1. Seizures
  2. Raised ICP
  3. Metabolic disturbance
  4. Coagulopathy
  5. Anaemia
  6. Coma
  7. Death
49
Q

List 3 out of 5 of the long-term complications of meningitis.

A
  1. Hearing impairment
  2. Psychosocial problems
  3. Epilepsy
  4. Developmental/learning difficulties
  5. Neurological impairment
50
Q

What are the triad of features in Nephrotic Syndrome?

A
  1. Oedema/swelling
  2. Low serum albumin <25mmol/l
  3. Proteinuria >200mg/mmol

Children's Health (14 decks)

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