fever Flashcards
(128 cards)
1
Q
meningitis causes in neonatal - 3 months?
A
GBS
e coli
listeria
2
Q
meningitis causes 1 month- 6 yrs
A
neisseria meningitidis
strep pneumoniae
h influenzae
3
Q
meningitis causes >6 yrs
A
neisseria meningitidis
strep pneumo
4
Q
Meningitis signs
A
positive Kernig’s sign (hip flexed knee bent -> pain felt on attempting to straighten leg)
headache
photophobia
neck stiffness
younger- non specific symptoms like crying, irritability, lethargy, bulging fontanelle (late sign)
5
Q
most common viral encephalitis
A
HSV type I
6
Q
meningitis complications
A
long term neuro impairment hearing loss (all should have audiological assessment promptly) local vasculitis local cerebral infarction hydrocephalus cerebral abscess
7
Q
Meningitis Ix
A
FBC, WCC, CRP Blood glucose Blood gas (for acidosis) coagulation screen U+Es LFTs Full septic screen. LP for CSF
8
Q
Encephalitis symptoms
A
fever
altered consciousness
seizures
9
Q
Encephalitis Mx
A
IV aciclovir
10
Q
Encephalitis
A
LP (PCR of CSF)
EEG and MRI/CT head - may show focal changes
11
Q
encephalitis complications/ prognosis
A
mortality rate is high 70%
most survivors have severe neurological sequelae
12
Q
impetigo
A
‘cornflakes’ stuck to skin
usually on face
can be vesicular/ pustular/ bullous
13
Q
most common cause of impetigo
A
staph aureus
in hot climates- strep pyogenes
14
Q
impetigo mx
A
oral fluclox if sever
topical abx sometimes effective in mild cases
avoid school until lesions dry
eradicate nasal carriage w nasal cream containing mupirocin
15
Q
impetigo ix
A
skin swab for MCS
16
Q
Impetigo complicatoins
A
post strep glomerulonephritis
staphylococcal scalded skin syndrome
17
Q
Staphylococcal scalded skin syndrome presentation
A
exotoxin-mediated epidermolysis secondary to staph aureus infection
Fever + malaise scalded appearance (widespread tender erythema and flaccid superficial blisters) Nikolsky sign (epidermis separates on gentle pressure)
18
Q
Staphylococcal scalded skin syndrome Mx
A
IV Anti staph Abx
analgesia
monitoring of fluid balance
Emollient ointments
ADMIT
19
Q
in chickpox hx always check
A
pregnant/ immunocompromised contacts
20
Q
Chickenpox rash?
A
vesicular.
21
Q
Chicken pox diagnosis
A
clinical based on characteristic rash, distribution and progression
Serology (VZV IgM)
22
Q
Chickenpox mx
A
school exclusion for 5 days after start of rash
symptomatic tx of fever and itching
calamine lotion
gloves to prevent scratching
if immunocomp or severe,
iV aciclovir
If contacted chickenpox-> VZIG
23
Q
chicken pox complications
A
bacterial superinfection with staph, group a strep -> may lead to toxic shock syndrome, necrotizing fasciitis
encephalitis
purpura fulminans -> can lead large areas of skin necrosis
Severe progressive disseminated disease in immunocomp patients -> haemorrhagic, pneumonitis, DIC
24
Q
roseola infantum which virus
A
HHV6
25
exanthem subitum which virus?
HHV6
26
Primary HHV6 infection complication
febrile convulsions
also
aseptic meningitis
encephalitis
hepatitis
27
Erythema infectiosum which virus?
Parvovirus B19
28
Slapped cheek syndrome
Parvovirus B19
29
Parvovirus B19 infects?
erythroblastoid red cell precursors in the BM
30
Parvovirus B19 complication?
Aplastic crisis
in children with SCA/ thalassaemia and in immunodeficient (malignancy) unable to produce antibody response to infection
31
Erythema infectiosum presentation
fever
malaise
headache
myalgia
slapped cheek rash
progressing to maculopapular lace-like rash on trunk and limbs
32
Maternal Parvovirus B19 infection may lead to?
fetal hydrops and death due to severe anaemia
33
Erythema infectiosum Ix
Must have FBC to exclude pancytopenia
34
Hand foot mouth disease which virus?
Coxsackie A6 Virus
35
Hand foot mouth symptoms?
fever
sore throat
oral ulcers
painful vesicular lesions on hands, feet, mouth and tongue
36
Kopliks spots
Measles
37
measles
```
fever
cough, coryza, conjunctivitis
maculopapular rash spreads behind ears downwards onto trunk
generalised lymphadenopathy
anorexia
diarrhoea
```
38
measles ix
clinical diagnosis (kopliks spots)
blood film- leucopenia and lymphopenia
LFTs- raised transaminases
Serology- Measles IgM, measles RNA on PCR
39
Measles MX
public health notification!!
supportive - hydration and pain relief
immunocomp - give ribavarin
Vit A supplement may be given
40
Measles Complications
```
Encephalitis
Pneumonia
Acute otitis media
Subacute sclerosing panencephalitis
Myocarditis, corneal ulceration, hepatitis
```
41
Swollen parotid glands
Mumps
42
Mumps
```
myalgia
anorexia
headache
low grade fever
chills
ear pain due to parotitis - or pain on eating/ drinking
trismus (spasm of muscles of chewing)
```
43
Mumps Ix
examination of parotid duct - redness and swelling
Salivary PCR or Serology (mumps IgM)
FBC, WCC: increased amylase
44
Mumps complications
```
viral meningitis
encephalitis
orchitis + epididymitis- may lead to infertility but rare
pancreatitis
myocarditis
arthritis
```
45
Rubella presentation
maculopap rash starting on face then spreading to whole body
| *suboccipital and post-auricular lymphadenopathy
46
suboccipital and post-auricular lymphadenopathy
rubella
47
rubella hx check...?
pregnant women!
48
Kawasakis
CRASH and burn
49
Kawasakis Ix
Cardiac echo - visualize any aneurysms (coronary arteries most affected)
FBC, WCC, Pl, CRP, ESR
(high neutrophils, Pl, CRP/ ESR)
50
Kawasakis complications
```
myocarditis
pericarditis
aneurysms
MI
sudden death
```
51
Kawasakis Mx
IVIG one dose
| High dose aspirin to reduce risk of aneurysms/ thrombosis
52
HIV in children Mx
Start ART
Prophylaxis for PCP and co-trimoxazole
Immunisations (avoid live vaccines)
MDT
53
Malaria
```
cyclical fever
jaundice
anaemia
thrombocytopenia
diarrhoea
vomiting
Cerebral malaria**
```
54
Typhoid fever presentation
```
worsening fever
headaches, cough, abdo pain
GI symptoms
rose spots on trunk
splenomegaly
```
55
Typhoid fever diagnosis
Stool culture*, blood culture
| Serology
56
Typhoid fever tx
ceftriaxone
| or azithromycin
57
Scarlet fever what organism?
Group A strep (usually strep pyogenes)
58
Scarlet fever presentation
strawberry tongue
rough sandpaper like rash that starts on torso
fever
tonsillitis
malaise
peeling of skin on palms/ soles
59
scarlet fever ix
throat swab
60
scarlet fever mx
abx (oral Penicillin for 10d)
| can return to school 24 h after starting abx
61
scarlet fever complications
otitis media
rheumatic fever
acute glomerulonephritis
62
measuring temp in infants <4 wks
electronic thermometer in axilla
63
measuring temp in children 4 wks - 5yrs
electronic thermometer in axilla
infra red tympanic thermometer
64
Any child w fever ->
Use traffic light system
65
Fever Ix
Obs: temp, HR, RR, CRT
66
red light - high risk in fever <5
```
pale/ ashen/ blue skin
no response to social cues, looks ill to healthcare professional
weak, high pitched or continuous cry
grunting RR>60
reduced skin turgor
***Age <3 months temp >38
non blanching rash
bulging fontanelle
status epilepticus
focal neuro signs
focal seizures
```
67
Feverish illness mx
Immediate IV fluid bolus 20ml/kg 0.9% Nacl
immediate parenteral abx if shocked, unrousable, signs of meningococcal disease
Perform septic screen
68
1st line abx in infants <3 months
third gen cephalosporin cefotaxime + abx against listeria (amoxicillin)
69
if meningitis suspected in neonate, Mx?
IV amoxicillin and cefotaxime
70
if +ve GBS + septic neonate, Mx?
IV Benzylpenicillin
OR
Gentamicin
71
If listeria in a septic neonate, Mx?
Amoxicillin + Gentamicin
72
Brudzinski's sign (forced flexion of neck -> reflex flexion of the hip)
Meningitis
73
Non blanching rash
Meningococcal septicaemia
74
Fever + vomiting in infant DDx
```
Meningitis
UTI
Pneumonia
Sepsis
could be anything!
```
75
non blanching rash 1st line mx in GP
IM/ IV BenPen immediately
Send directly to hospital
76
non blanching rash / petechial rash 1st line mx in hospital
IV ceftriaxone
77
Meningococcal septicaemia Ix
```
FBC, WCC, CRP, coagulation screen
Blood culture
Whole blood PCR for N meningitides
Blood Glucose
Venous blood gas
CT scan to detect alternative intracranial pathology if reduced/ fluctuating LOC, or focal neuro signs
***LP
```
78
Bacterial meningitis Mx (>3mths) in hosp
IV ceftriaxone
79
Suspected Bacterial Meningitis Mx (<3mths) in hosp
IV cefotaxime + amoxicillin
80
why not use ceftriaxone in <3 months?
biliary sludging -> may exacerbate hyperbilirubinaemia
81
if confirmed gram - bacterial meningitis in child <3 mths, mx?
IV cefotaxime for at least 21 days
82
Full Mx in bacterial meningitis
IV abx
dexamethasone
respiratory support - O2 15L rebreathing mask
IV fluids 0.9% saline with 5% dextrose
Monitor fluids and urine output
monitor electrolytes and glucose regularly
Correct any metabolic disturbances e.g. coagulopathy (FFP, cryoprecipitate)
83
Meningococcal septicaemia 1st link mx for shock
IV resuscitation fluid bolus of 20ml/kg 0.9% NaCl over 5-10 min
reassess and if persists, 2nd bolus
84
Following bacterial meningitis, what follow up is needed?
audiological assessment within 4 wks
off cochlear implants if severe deafness
discuss any morbidities w paediatrician at follow up
if recurrent- test for complement deficiency
85
recommended method for acquiring Urine sample
clean catch urine
86
under 3mths, UTI Ix?
Urine sample for urgent MCS
87
3 months - 3yrs. UTI ix?
Urine dip first and send urine for culture
88
3mths - 3yrs Leucocyte + Nitrites +?
UTI! start abx
89
3mths - 3yrs. Leucocyte - Nitrites +?
send for urine culture but start Abx in meantime!
90
3mths - 3yrs. Leucocyte + Nitrites -?
May not be UTI. send for urine culture.
don't start abx unless good clinical evidence of UTI
91
3mths - 3yrs. Leucocytes - Nitrites -?
No UTI
92
Risk factors for UTI?
```
poor urine flow
hx suggesting previous UTI
recurrent fever of uncertain origin
antenatally diagnosed renal abnormality
FHx renal disease of VUR
```
93
>3 months with upper UTI mx?
oral antibiotics for 7-10 days. (ceftriaxone or co-amoxiclav)
or IV ceftriaxone for 2-4 days then oral for total 10d
94
>3 months with lower UTI mx?
trimethoprim, nitrofurantoin
oral abx for 3 days
95
<6 months with UTI further IX?
all should have renal USS.
if simple-> outpatient USS in 6 weeks.
if abnormal-> MCUG
96
if recurrent UTI/ atypical UTI further Ix?
Renal USS - to identify structural abnormalities
DMSA scan - to detect renal parenchymal defects
Assessed by paediatric specialist
97
advice to prevent UTI recurrence?
drink adequate math
ready access to clean toilets
should not delay voiding
address dysfunctional elimination syndromes and constipation
consider prophylactic abx in infants w recurrent UTI
98
If neonate in close contact with TB person? Mx?
Assess for active TB.
Start isoniazid (with pyridoxine)
refer to TB specialist
99
child w latent TB Mx?
involve TB specialist
3 months of Isoniazid (with B6) and rifampicin
OR
6 months of isoniazid (with B6) alone
offer testing for HIV, Hep B, Hep C before starting treatment for latent TB
100
child with active TB Mx?
TB specialist referral
2 months of RIPE
then 4 mths of Isoniazid (+B6) + Rifampicin
101
child w active TB of the CNS Mx?
RIPE for 2 months
then 10 months of Isoniazid (B6) + rifampicin
TB specialist referral
+ adjunctive dexamethasone and prednisolone gradually withdrawn over 4-8 wks
102
Symptoms of clinical dehydration
unwell/ deteriorating
altered responsiveness (lethargic, irritable)
decreased UO
103
Symptoms of clinical shock
decreased LOC
pale / mottled skin
cold extremities
104
Signs of clinical shock:
```
weak peripheral pulses
prolonged cap refill
hypotension
tachycardia
tachypnoea
```
105
Signs of clinical dehydration
```
sunken eyes
dry mucous membranes
tachycardia tachypnoea
reduced skin turgor
normal peripheral pulses
normal cap refill
normal BP
```
106
Red flags to identify children at risk of progression to shock
```
unwell/ deteriorating
lethargic/ irritable
sunken eyes
tachycardia
tachypnoea
reduced skin turgor
```
107
if child is clinically dehydrated, mx?
rehydration with 1st line oral rehydration solution
50ml/kg of rehydration + maintenance vol over 4h period
Continue breastfeeding as well
108
Clinical dehydration Ix?
U+Es (Na, K, Urea, Cr)
blood glucose
Venous blood gas - acid base status
Full clinical assessment for symptoms and signs of dehydration
suspect HyperNa dehydration if jittery movements, increased muscle tone, hyperreflexia, convulsions, drowsiness or coma
109
jittery movements, increased muscle tone, hyperreflexia, convulsions, drowsiness or coma
what type of dehydration?
HyperNa dehydration
110
high fever lasting a few days followed by (and resolving at the time) maculopapular rash starting on the trunk. Febrile convulsions seen in 10-15%.
roseola infantum
exanthem subitum
complications: aseptic meningitis, hepatitis
111
best initial ix for SUFE
AP and frog leg Xray
112
tx for kawasakis
infusion of IG on the day of diagnosis.
| high dose aspirin at anti-inflammatory doses followed by low-dose aspirin at anti-thrombotic doses.
113
what are risk factors for development of coronary artery aneurysms in Kawasaki's?
prolonged fever >16 days, male sex, age < 1 yr, cardiomegaly, raised inflammatory markers and raised platelets.
114
strep pneumo meningitis?
IV ceftriaxone and IV dexamethasone
115
ix for TB in child?
tuberculin skin test (IGRA), sputum collection for MCS, FBC, CRP, U+Es, LFTs.
CXR.
116
Mx for TB in child?
RIPE + pyridoxine to reduce risk of isoniazid causing peripheral neuropathy.
117
intense itching in a child? + burrows, papules, vesicles and pustules.
scabies
thread-like, linear burrows, typically in the finger webs and wrists are pathognomonic but often v difficult to see.
118
Dx of scabies
definitive diagnosis involves removal of the mite from the burrow and examination under the microscope. - difficult
119
tx of scabies
permethrin.
tx all household contacts.
+ topical abx may be needed for secondary bacterial infections.
oral antihistamines and topical steroids (1% hydrocortisone) may be needed to help tx the itching.
all clothing/ bed linen needs to be laundered at high temps to remove eggs and mites.
can take 4-6 wks for itching to resolve.
if lesions still present and persistent itching-> consider reinfection and repeating treatment.
120
fever followed by rash?
roseola infantum
121
when to refer for developmental skills?
can't smile by 10 wks.
doesn't sit unsupported by 12months.
can't walk by 18 months.
122
A 3 month old boy is suspected of having hypospadias. At which of the following locations is the urethral opening most frequently located in boys suffering from the condition?
on the distal ventral surface of the penis
123
non motor problems of cerebral palsy include?
```
learning difficulties (60%)
epilepsy (30%)
squints (30%)
hearing impairment (20%)
```
124
what does a prolonged jaundice screen involve?
```
conjugated and unconjugated bilirubin: the most important test as a raised conjugated bilirubin could indicate biliary atresia which requires urgent surgical intervention.
direct antiglobulin test (Coombs' test).
TFTs,
FBC and blood film,
urine for MC&S and reducing sugars,
U&Es and LFTs
```
125
what disorders exhibit genetic anticipation?
Huntingtons disease
| and myotonic dystrophy
126
major risk factors of sudden infant death syndrome
putting baby prone, parental smoking, prematurity, bed sharing, hyperthermia or head covering
127
other risk factors of sudden infant death syndrome
male sex, multiple births, social classes IV and V, maternal drug use, increased incidences in winter
128
protective factors for Sudden infant death syndrome
breastfeeding, room sharing, use of pacifiers
