Child with a fever

Question 1

presentation of bacterial meningitis symptoms in <3 months

Answer 1

Question 2

presentation of bacterial meningitis symptoms in 3months - 3years

Answer 2

Question 3

presentation of meningitis symptoms in >3 years

Answer 3

Question 4

microscopy and culture of CSF should be performed in all cases except

Answer 4

coma or decerebrate/decorticate posturing
absent or non purposeful responses to pain
focal neurological signs or seizures
abnormal pupil size or reactions
irregular breathing
papilloedema
cardiovascular instability, bradycardia, hypertension

Question 5

treatment of bacterial meningitis

Answer 5

antibiotics and supportive care
- 3rd gen cephalosporin
- vancomycin if pneumococcal disease is likely
- penicillin/amoxicillin (<1m or immunosuppressed)
corticosteroids - give early if at all
cautious use of IV fluids
observation and treatment of complications - convulsions, haemodynamic compromise, cerebral oedema

Question 6

signs of bactrial meningitis <3 months

Answer 6

Question 7

signs of bacterial meningitis 3months - 3 years

Answer 7

Question 8

signs of bacterial meningitis >3 years

Answer 8

Question 9

pathogens causing bacterial meningitis <3 months

Answer 9

Question 10

pathogens causing bacteral meningitis 3months - 3 years

Answer 10

Question 11

pathogens causing bacterial meningitis >3 years

Answer 11

Question 12

complications of bacterial meningitis

Answer 12

death 2-5%
intellectual disability, spasticity, seizures, hydrocephalus, deafness 10-15%
learning and behavioural disorder 25-45%

Question 13

important investigations for pneumonia

Answer 13

plasma glucose
blood cultures
CXR
NP swabs/aspirate for respiratory virus
others that may be useful: sodium, creatinine, bicarbonate, WCC, neutrophils, CRP and/or procalcitonin

Question 14

bacteria causing lower resp tract infection

Answer 14

Question 15

viruses causing lower resp tract infection

Answer 15

Question 16

other agents causing lower resp tract infection

Answer 16

Question 17

broncholitis

Answer 17

most common viral LRTI in infants - a clinical diagnosis
pathophysiology is characterised by airway oedema, mucous production
usually secondary to RSV and hMPV
self resolving after 7-10 days
preterm and babies with underlying lung disease at greatest risk

Question 18

broncholitis severrity

Answer 18

Question 19

pneumonia presents with

Answer 19

cough and tachypnoea
can be due to viral or bacterial infection, viral is most common
clinical features and diagnostic tests are unreliable at distinguishing viral from bacterial
amoxycillin is appropriate treatment

Question 20

bacterial pneumonia is most frequently due to

Answer 20

S. pneumoniae in young children
M. pneumoniae in older children

Question 21

empyema

Answer 21

defined as the presence of pus in the pleural space (compared with parapneumonic effusion)
drainage is both diagnostic and therapeutic

Question 22

suggestive features of empyema

Answer 22

pneumonia wth pleural effusion
failure of pneumonia to improve within 48 hours with Rx

US or CT may be helpful to identify effusion

Question 23

empyema is most frequently due to

Answer 23

S. pneumoniae (or staphylococcus aureus)

Question 24

kawasaki’s disease

Answer 24

fever and 4 of 5 clinical features:
- bilateral non-purulent conjunctivitis
- oral mucosa changes: erythema, pharyngitis, strawberry tongue, dry cracked lips
- cervical lymphadenopathy (unilateral > bilateral)
- changes in extremitis: swelling of hands/feet, erythema of palms/soles, desquamation
- a generalised variable rash

Question 25

incomplete presentation of kawasaki disease

Answer 25

15-20% of children have an incomplete presentation - this is more common at the extremes of age

Question 26

community acquired sepsis pathogens

Answer 26

Question 27

hospital acquired sepsis pathogens

Answer 27

Question 28

other clinical features that may present with kawasaki's disease

Answer 28

inflammation and crusting of BCG site sterile pyuria aseptic meningitis hydrops of the gall bladder

Question 29

kawasakis disease prognosis

Answer 29

without treatment, fever lasts median of 11 days (may be weeks)

Question 30

what investigations are needed for kawasakis

Answer 30

WCC and platelet count CRP and ESR sodium, creatinine, albumin echcardiography is required as complications include coronary aneurysms

Question 31

what is kawasakis disease

Answer 31

uncommon but important non-infectious condition in young children most common between ages 1-4 more common in children of asain descent aneurysms develop in 20% if not treated

Question 32

treatment for kawasakis disease

Answer 32

anti-inflammatory therapy: IV immunoglobulin +/- low-dose aspirin 10-20% will require a second dose follow up: echocardiographic follow up - low dose aspirin until echocardiogram normal

Question 33

simple febrile convulsion

Answer 33

temp >38° C no evidence of CNS infection no evidence of metabolic derangement no history of afebrile seizures or neurological problem