Feverish Child

Question 1

What are the behavioural high-risk criteria for a child <5 years with suspected sepsis?

Answer 1

No response to social cues; appears ill; does not wake or stay awake; weak high-pitched/continuous cry

Question 2

What are the behavioural moderate-risk criteria for a child <5 years with suspected sepsis?

Answer 2

Not responding normally to social cues; no smile; wakes only with prolonged stimulation; decreased activity; parent concerned child is behaving differently to usual

Question 3

What are the respiratory high-risk criteria for a child <5 years with suspected sepsis?

Answer 3

Grunting; apnoea; O2 sats <90% in air
<1 yr: resp rate 60 or more
1-2 yrs: 50 or more
3-4 yrs: 40 or more

Question 4

What are the respiratory moderate-risk criteria for a child <5 years with suspected sepsis?

Answer 4

O2 sats <92% on air, nasal flaring
<1 year: 50-59 breathspm
1-2 yrs: 40-49 bpm
3-4 yrs: 35-39 bpm

Question 5

What are the circulation/hydration high-risk criteria for a child <5 years with suspected sepsis?

Answer 5

Bradycardia (<60 bpm)
Tachycardia:
<1yr: >160bpm
1-2 yrs: >150bpm
3-4 yrs: >140bpm

Question 6

What are the circulation/hydration medium-risk criteria for a child <5 years with suspected sepsis?

Answer 6

Cap refill 3 or more seconds
Reduced urine output
<1yr:150-159bpm
1-2yrs: 140-149bpm
3-4yrs: 130-139bpm

Question 7

What are the skin high- and medium-risk criteria for a child <5 years with suspected sepsis?

Answer 7

High: Mottled/ashen appearance, cyanosis of skin/lips/tongue, non-blanching rash

Medium: Pallor of skin, lips, or tongue

Question 8

What are the temperature high-risk criteria for a child <5 years with suspected sepsis?

Answer 8

Less than 36degrees or >38degrees for those under 3 months.

A temperature of 39 or more is moderate risk for 3-6 month year olds

Question 9

What are the behavioural high-risk criteria for children aged 5-11 years with suspected sepsis?

Answer 9

Altered behaviour/mental state, appears ill to a healthcare professional, does not wake or if roused does not stay awake

Question 10

What are the respiratory high-risk criteria for children aged 5-11 years with suspected sepsis?

Answer 10

O2 sats <90%
5 yrs: 29+ breaths
6-7 yrs: 27+ breaths
8-11 yrs: 25+ breaths

Question 11

What are the circulation and hydration high-risk criteria for children aged 5-11 years with suspected sepsis?

Answer 11

Heart rate <60 bpm
5 yrs: 130+ bpm
6-7 yrs: 120+ bpm
8-11 yrs: 115+ bpm

Question 12

What are the skin high-risk criteria for children aged 5-11 years with suspected sepsis?

Answer 12

Mottled/ashen, cyanosis of skin, lips or tongue, non-blanching rash

Question 13

What are the behavioural high-risk criteria for people aged 12+ with suspected sepsis?

Answer 13

Objective evidence of new altered mental state

Question 14

What are the respiratory high-risk criteria for people aged 12+ with suspected sepsis?

Answer 14

Raised RR 25+ breathspm

New need for O2 to maintain sats >92%

Question 15

What are the BP high-risk criteria for people aged 12+ with suspected sepsis?

Answer 15

Systolic BP 90 or less

Question 16

What are the circulation and hydration high-risk criteria for people aged 12+ with suspected sepsis?

Answer 16

HR 130+

Not passed urine in previous 18 hours

Question 17

What are the skin high-risk criteria for people aged 12+ with suspected sepsis?

Answer 17

Mottled/ashen, cyanosis of skin, lips or tongue, non-blanching rash

Question 18

What are the symptoms/signs of meningococcal disease in conjunction with fever?

Answer 18

Non-blanching rash, particularly with 1+ of: ill-looking, lesions larger than 2mm diameter (purpura), cap refill >/= 3secs, neck stiffness

Question 19

What are the symptoms/signs of bacterial meningitis in conjunction with fever?

Answer 19

Neck stiffness, bulging fontanelle, decreased level of consciousness, convulsive status epilepticus

Question 20

What are the symptoms/signs of herpes simplex encephalitis in conjunction with fever?

Answer 20

Focal neurological signs, focal seizures, decreased level of consciousness

Question 21

What are the symptoms/signs of penumonia in conjunction with fever?

Answer 21

Tachypnoea (>60 breathspm age 0-5 months, >50 breathspm age 6-12 months, >40 breathspm age >12 months), chest crackles, nasal flaring, chest indrawing, cyanosis, O2 sats <96%

Question 22

What are the symptoms/signs of UTI in conjunction with fever?

Answer 22

Vomiting, poor feeding, lethargy, irritability, abdo pain/tenderness, urinary frequency or dysuria

Question 23

What are the symptoms/signs of septic arthritis in conjunction with fever?

Answer 23

Swelling of a limb/joint, not using an extremity, non-weight bearing

Question 24

What are the symptoms/signs of Kawasaki disease in conjunction with fever?

Answer 24

Fever >5 days and 4+ of: bilateral conjunctival injection, change in mucus membranes, change in the extremities, polymorphous rash, cervical lymphadenopathy

Question 25

What features suggest epiglottitis?

Answer 25

2-4 years old: short hx of fever, irritability, dyspnoea, dysphonia and dysphagia, pooling of oral secretions, drooling of saliva.
Adult: sore throat is the most prominent symptom

Question 26

Why is it important to consider epiglottitis before examining a patient’s throat?

Answer 26

Potential to cause abrupt and complete airway obstruction

Question 27

Are most cases of tonsillitis viral or bacterial?

Answer 27

Viral

Question 28

What are the Centor criteria used for?

Answer 28

To predict bacterial infection in people with acute sore throat

Question 29

What are the four Centor criteria?

Answer 29

1. Presence of tonsillar exudate
2. Presence of tender anterior cervical lymphadenopathy or lymphadenitis
3. History of fever
4. Absence of cough

3 or 4 of these means high chance it is bacterial; 1 or 2 means high chance it is viral