Tutorial #30: Febrile Seizures

Question 1

What are the 3 criteria of simple febrile seizures?

What is an important caveat ?

Answer 1

1. Generalized onset
2. lasts less than 15 minutes
3. Not recurrent within 24 hours

Caveat: That the seizures are not due to any other pathology that accounts for the seizure (epilepsy, CNS infection, or metabolic cause).

Therefore complex febrile sezirues are anything outside of this criteria

Question 2

What is the typical age range of a patient that has simple febrile seziures?

Answer 2

6 months - 5 years

Question 3

What are the three criteria of “Fever without a source (FWS)”

Answer 3

1. There is a true fever (Temp > 38 celsius)
2. There isnt an obvious diagnosis*
3. It is relatively acute

*The phrase “without a source” in this context implies that despite a thorough history and physical exam, the source of the fever has not been found, ie. there are no signs and symptoms of anything obvious

Question 4

In young children who have a core temperature >= 39 degrees celsius, what is the most likely etiology?

Answer 4

Infectious

Question 5

What is the most reliable method to get a core temperature?

Answer 5

Rectal temperature measurement.

Question 6

In the Pediatric Assessment Triangle, the components of “Appearance” can be memorized by the mnemonic “TICLS” (Tickles)

Answer 6

T: Tone
I: Interactiveness
C: Consolability
L: Look/Gaze
S: Speech/cry

THESE ARE NORMAL FEATURES FOUND IN THE DIAGRAM

Question 7

What are the 3 categories of the Pediatric Assessment Triangle?

Answer 7

1. Appearance
2. Work of Breathing
3. Circulation of Skin

Question 8

What are the abnormal characteristics you should assess in the “Work of Breathing” component of the Pediatric Assessment Triangle? (x4)

Answer 8

1. Abnormal airway sounds
2. Abnormal positioning
3. Retractions
4. Nasal Flaring

Question 9

What are the abnormal characteristics you should assess in the “Circulation to skin” component of the Pediatric Assessment Triangle? (x3)

Answer 9

1. Pallor
2. Mottling
3. Cyanosis

Question 10

What vaccines are included for a child to be “immunization complete”

Can be remembered by “3-2-1”

Answer 10

3 Strep Pneumoniae vaccines (occur no earlier than 6 months of age)

2 Haemophilus influenzae type b Vaccines

All scheduled booster vaccines

3,2,1 where 1 = all scheduled booster vaccines.

Question 11

In a child who has fever without a source, urine testing with urinalysis and culture should be done for which 4 patient categories?

Answer 11

1. Females < 24 months old
2. uncircumsized males < 12 months old
3. circumsised males < 6 months old
4. recurrent UTI, urogenital abnormality, or symptoms of UTI

Question 12

What are positive predictors for meningitis?

Answer 12

Toxic appearance.
Not immunized.
Neonates.
Abrupt onset of fever.
Headache, photophobia, confusion, lethargy, irritability. Nuchal rigidity.
Rash (meningococcus).
30% present with seizures. Exposure to a person with meningitis.
WBC >20.

Question 13

What test can you do to rule out meningitis?

Answer 13

Lumbar puncture to obtain CSF
Imaging DOES NOT diagnose meningitis.

Question 14

What are the positive predictors of bacteremia? (x5)

Answer 14

1. Immunocompromised
2. non-vaccinated
3. Age < 36 months (especially if < 3 months)
4. worsening clinical course
5. WBC > 20

Question 15

What are positive predictors for Acute Otitis Media?

Answer 15

HISTORY: ear pain, ear tugging/rubbing, difficulty sleeping, previous AOM, recent URTI
EXAM: tympanic membrane that is bulging (very sensitive and specific finding), red, decreased mobility with pneumatic otoscopy

This is the most common bacterial cause of fever in kids 3-36 months old

Question 16

What kind of rash would you see in a child with meningitis?

Answer 16

Petechial/purpuric