Fever / Rashes Flashcards
(41 cards)
What are the ABCD signs of toxicity in a child?
Alertness/arousal/activity
Breathing difficulty
Colour (pale/mottled), Circulation (cool peripheries), Cry
Decreased fluid intake/urine output
What are the clinical features of Kawasaki disease?
Kawasaki = systemic vasculitis
Dx: 4/5 of CRASH plus five days of fever
C onjunctivitis (non exudative, bilateral)
R ash (polymorphus, not vesicular or bulla)
A denopathy (typically cervical and unilateral)
S trawberry tongue (red oral mucosa/lips)
H and (swelling or erythema or hands/feet progresses to desquamation when late)
and Burn… 5 days of daily fevers unresponsive to anti-pyretics or ABx
What is defined as fever in paeds?
> 38 if under 3 months and >38.5 in older infants and children
What are methods of measuring temperature and what is gold standard?
Gold standard is rectal
Axillary is recommended for routine clinical use
Tympanic is unreliable
Oral isn’t used for safety purposes
What investigations are performed for a septic screen?
FBC with differentiated WCC, acute phase proteins Blood culture Throat swab CXR if suspect respiratory illness Urine microscopy and culture LP
What is the most severe complication of Kawasaki disease?
Coronary artery vasculitis causing coronary aneurysm –> acute MI
What is the treatment for Kawasaki disease?
High dose aspirin (to prevent clots) and IVIG (reduces aneurisms from 20%-> 3%)
What are the 4 things to assess in a child with fever?
- Check fevers (>38)
- Check age - bring in if <3mo
- Signs of toxicity
- Look for site of infection
Describe what you would ask on history and what you would look for on examination in a child presenting with fever
History:
- Localising signs (e.g. neck stiffness, cough/coryzal, ENT, abdo pain, joint swelling, rash)
- Travel history
- Sick contacts
- IUTD
Examination
- ABCD signs of toxicity
- Well/unwell
- Localising signs
How will you investigate and manage a child <3mo presenting with fever?
Call for help
FBC, blood cultures, Urine/LP, CXR
Admit
IV Abx
What is a febrile seizure?
Convulsions, in a child between 6 months and 6 years of age, in the setting of an acute febrile illness, without previous afebrile seizures, significant prior neurological abnormality, and no CNS infection
What is the difference between simple and complex febrile seizures?
Simple - generalised TC seizures <15mins
Complex - focal features, last >15minutes, recur within same febrile illness, incomplete recovery at 1hr
How do you manage a febrile seizure?
Reassurance (remain calm, soft surface laying on side or back, do not restrain, do not put anything in mouth, if you can time and video)
** Call ambulance if lasts >5mins
Panadol doesn’t help, may help with symptoms of illness
How do you assess and investigate a febrile seizure?
Look for cause of seizure, ensure no previous afebrile seizures / progressive neurological conditions / signs of CNS infection
If simple - NO investigation
What is Henoch-Schonlein Purpura, what are the clinical features and how is it treated?
Systemic IgA-mediated autoimmune vasculitis
- Immune complexes deposit on small vessels
1. Rash: palpable purpura on buttocks and backs of legs
2. Colicky abdo pain - can be due to intussusception (bloody mucus diarrhoea)
3. Arthritis
4. Glomerulonephritis
Treatment: supportive, symptomatic, steroids, immunosuppressants
What causes meningitis? What does the rash look like? What are the associated features?
Neisseria meningitides
- Non-blanching petechial / purpuric rash
- Headache, nausea, neck stiffness, photophobia, vomiting and drowsiness
What are the clinical features of impetigo?
Red, raised, thin-walled vesicles & bullae which become pustular (honey-coloured crust)
- Occur commonly around mouth but can be anywhere
- Usually caused by staph and strep
What are the clinical features of measles? Complications? Treatment?
Prodromal coryzal symptoms (3-5 days before rash)
Diffuse maculopapular rash, starts behind the ears
Koplik spots inside mouth
TOXIC fevers (>40)
Not immunised
**Encephalitis
Supportive trt
What causes Chicken pox? What are the clinical features? Management?
Varicella zoster virus
- Rash begins as a few red spots or bumps (often mistaken for insect bites)
- Raised pink/red rash that forms vesicles –> then crust over
If see a spot, draw a circle around it –> if they change into blisters w/in 24 hours –> chicken pox
*Immunisation available >18mo
What causes ‘slapped cheek’ or 5th disease? What are the clinical features? Serious complication?
Parvovirus
Fever, runny nose, cough
Intensely red on cheek –> lacy/pimply rash spreads to limbs
**Aplastic crisis
What causes ‘Scarlet fever’? What are the clinical features? Treatment?
Group A strep infection
- Sore throat 1-2 days before fine, red, sandpaper rash -
- Starts of face spares the mouth and spreads to limbs
Treatment: penicillin or amoxycillin
What investigations are required for a diagnosis of HSP?
U/A: look for renal involvement (haematuria, proteinuria, casts)
EUC, serum IgA
Abdo ultrasound - may show intussusception
What are the clinical features of rubella? Complications? Treatment?
TOXIC fevers
Diffuse maculopapular rash that lasts 3 days
Congenital rubella syndrome (rubella in 1st trimester)
**Encephalitis
What is congenital rubella syndrome?
Rubella infection in 1st trimester causing infection in fetus
- deafness, congenital cataracts, blue purpura, hepatosplenomegaly, CHD, jaundice, growth and mental retardation
