Fever

Question 1

What are the five features of Kawasaki disease?

Answer 1

1. Cervical lymphadenopathy
2. Bilateral non-purulent conjunctival infection
3. Mucosal changes - cracked lips, strawberry tongue
4. Red rash
5. Peripheral skin changes - redness/oedema of hands and feet

Question 2

What are the features of bacterial meningitis?

Answer 2

Neck stiffness
Bulging fontanelle
Reducing consciousness
Convulsive status epilepticus

Question 3

What are the features of meningococcal disease?

Answer 3

Non blanching rash 
Lesions >2mm 
Ill looking child 
Neck stiffness
Cap refill >3 seconds

Question 4

What are the features of pneumonia?

Answer 4

Chest crackles
Tachypnoea 
Nasal flaring
Chest in drawing 
Cyanosis 
O2 sats <95%

Question 5

What are the features of UTI?

Answer 5

Vomiting 
Poor feeding 
Lethargy 
Irritability 
Abdominal pain or tenderness 
Urinary frequency or dysuria

Question 6

What are the features of septic arthritis?

Answer 6

Swelling of a limb or joint
Not using an extremity
Not weight bearing

Question 7

What is the paediatric sepsis six?

Answer 7

1. Give high flow oxygen
2. IV access and blood tests
3. Give antibiotics
4. Consider fluid resuscitation
5. Involve specialists early
6. Consider inotropic support

Question 8

What bloods are taken in sepsis?

Answer 8

Blood cultures
Blood glucose
Blood gas

Question 9

How are fluids given in sepsis?

Answer 9

20ml/kg isotonic fluid over 5-10 minutes

Examine for crepitations and hepatomegaly

Question 10

When is inotropic support given?

Answer 10

If normal physiological parameters not reached after 40ml/kg fluid
Adrenaline or dopamine

Question 11

Commonest pathogens for bacterial meningitis under 3 months?

Answer 11

Group b strep
E. coli
Listeria monocytogenes

Question 12

Commonest pathogens for bacterial meningitis 3 months - 5 years?

Answer 12

Neisseria meningitides
Strep pneumoniae
Haemophilus influenzae B

Question 13

Commonest pathogens for bacterial meningitis over 5 years?

Answer 13

Neisseria meningitides

Strep pneumoniae

Question 14

What are the commonest pathogens for viral meningitis?

Answer 14

Adenovirus
Coxsackie
Echovirus

Question 15

What should a fever system enquiry include?

Answer 15

CNS - bright lights, irritability
ENT - pulling at ears, swallowing
Resp - cough, breathing
Abdo - pain, blood, d&v
Urinary - smell, colour, pain
Joints - swelling, pain 
Other - rash, colour, food and drink

Question 16

What are the features of herpes simplex encephalitis?

Answer 16

Focal neurological signs
Focal seizures
Decreased level of consciousness

Question 17

What is on the traffic light system for identifying serious illness?

Answer 17

Colour
Activity 
Respiratory 
Circulation and hydration
Other

Question 18

‘Colour’ parameters on the traffic light system

Answer 18

Green - normal
Amber - pallor reported by parent
Red - pale, mottled, ashen, blue

Question 19

‘Activity’ parameters on the traffic light system

Answer 19

Green - normal
Amber - decreased, no smile
Red - no response to social cues, appears ill to health care professional, weak/high pitched cry

Question 20

‘Respiratory’ parameters on the traffic light system

Answer 20

Amber - nasal flaring, RR >50 (under a year) >40 (over a year), O2 sats <95%, crackles
Red - grunting, chest indrawing, RR >60

Question 21

‘Circulation’ parameters on the traffic light system

Answer 21

Green - normal, moist mucous membranes
Amber - tachycardia, dry mucous membranes, reduced urine output, poor feeding
Red - reduced skin turgor

Question 22

‘Other’ parameters on the traffic light system

Answer 22

Amber - fever for over 5 days, rigors, limb swelling, not using a limb
Red - non-blanching rash, bulging fontanelle, neck stiffness, seizures

Question 23

What is the first line for suspected meningitis in a hospital?

Answer 23

IV cefotaxime + amoxicillin - under 3 months

IV ceftotaxime - over 3 months

Question 24

What is the treatment for suspected meningococcal disease pre-hospital?

Answer 24

IV/IM benzylpenicillin

Question 25

When does the anterior fontanelle close?

Answer 25

18-24 months

Question 26

What should be done before an LP?

Answer 26

Blood glucose

Question 27

What are the CSF findings in bacterial meningitis?

Answer 27

``` Cloudy Increased opening pressure WBC elevated >100 Low glucose <40% serum Protein elevated >50mg/dl ```

Question 28

What are the CSF findings in viral meningitis?

Answer 28

``` Clear Normal or elevated opening WBC elevated 50-1000 Normal glucose Protein elevated >50mg/dl ```

Question 29

What are the CSF findings in tuberculosis meningitis?

Answer 29

``` Opaque, forms fibrin web Elevated opening WBC elevated 10-1000 Low glucose Protein elevated 1-5g/L ```

Question 30

When should corticosteroids be used in meningitis?

Answer 30

Dexamethasone 0.15mg/kg (max 10mg QD) for suspected or confirmed bacterial meningitis when CSF is suspicious DO NOT start if after 12 hours since antibiotics

Question 31

What landmarks can be used to identify the L4/5 disc space?

Answer 31

Draw a line between anterior superior iliac crests - L5 | Space is just above

Question 32

What are the contraindications for a lumbar puncture?

Answer 32

``` Child is unstable Signs of ICP Suspected intracranial mass Convulsions Bleeding disorder Infection at site of LP ```

Question 33

How is group b strep treated?

Answer 33

Under 3 months - 14 days cef | Over 3 months - 10 days cef

Question 34

How is listeria monocytogenes treated?

Answer 34

amoxicillin 21 days, gentamicin 7 days

Question 35

How is strep pneumoniae treated?

Answer 35

14 days cef

Question 36

What are acute complications of meningitis?

Answer 36

Seizures Raised ICP Coagulopahty Anaemia

Question 37

What are long-term complications of meningitis?

Answer 37

Hearing impairment Epilepsy Learning difficulties