PARA 3008 - PAIN AND FEVER

Question 1

If a child feels hot, what’s the chance they actually have a fever?

Answer 1

~50% chance. Feeling centrally warm is more predictive than peripheral heat.

Question 2

Why do febrile children often feel cold early in the fever process?

Answer 2

Peripheral vasoconstriction conserves heat centrally during the rise to the new set point.

Question 3

Besides infection, what other diseases can cause fever?

Answer 3

Autoimmune diseases, Lymphoproliferative diseases (e.g., leukemia, lymphoma), Other cancers.

Question 4

Why is it important to identify fever cause rather than treat the fever itself?

Answer 4

Because fever is a symptom; treatment should target the underlying pathology (infection, etc.).

Question 5

Which age group is most at risk of serious bacterial infection?

Answer 5

Infants under 3 months.

Question 6

What signs suggest serious infection in a febrile child?

Answer 6

Toxic appearance, lethargy, non-responsiveness, poor feeding, signs of sepsis.

Question 7

What is the peak effect time for oral analgesia in children?

Answer 7

30 minutes.

Question 8

What are the benefits and limitations of IN fentanyl?

Answer 8

Pros: Fast onset (5 min), peaks at 15, non-invasive. Cons: Dose limited, not as deep sedation as IV.

Question 9

What are key ketamine effects useful for paediatric pain care?

Answer 9

Catatonia, amnesia, analgesia, hallucinations, BP/HR support.

Question 10

What are the side effects of ketamine?

Answer 10

Emergence reaction, hypersecretions, altered consciousness.

Question 11

What’s a unique side effect of morphine administration?

Answer 11

Local histamine release causing itching/redness near injection site.

Question 12

What is the primary role of midazolam in pain management?

Answer 12

Sedation and amnesia (not analgesia).

Question 13

What is the paradoxical effect of midazolam?

Answer 13

Agitation in some children due to GABA pathway suppression.

Question 14

What is the initial step for managing wounds in paediatrics?

Answer 14

Direct pressure for 10 minutes to stop bleeding.

Question 15

What is the best burn cover after cooling?

Answer 15

Cling film or non-stick dressing (post 20-min cooling).

Question 16

When is a burn likely to need a skin graft?

Answer 16

Deep dermal or full-thickness burns.

Question 17

Why should splints immobilize the limb in the most comfortable position?

Answer 17

Reduces movement and additional pain while avoiding further injury.

Question 18

What condition must be ruled out in a vomiting child with green vomit?

Answer 18

Bowel obstruction (until proven otherwise).

Question 19

What symptoms indicate bowel obstruction in children?

Answer 19

Bile-stained vomit, colicky pain, no flatus/stooling, distension, ↓ bowel sounds.

Question 20

What is necrotising enterocolitis and how might it present?

Answer 20

Inflammatory gut condition in infants – silent abdomen, signs of sepsis.

Question 21

What behavioural cues may indicate pain in a non-verbal child?

Answer 21

Agitation, not settling, abnormal crying, avoiding movement of a limb.

Question 22

What are common physiological responses to severe pain?

Answer 22

Tachycardia, tachypnoea, pallor, diaphoresis — OR vagal response (bradycardia).

Question 23

What is considered a fever in paediatric patients?

Answer 23

Core temperature >38°C. In neonates or immunocompromised: >37.5°C is high; <36°C is concerning.

Question 24

Does teething cause fever?

Answer 24

No, teething is not a clinical feature of fever.

Question 25

What is the gold standard for measuring body temperature?

Answer 25

Rectal. Axillary is accepted practice. Expect ~1°C variation across body sites.

Question 26

What are signs that a child may be developing a fever?

Answer 26

Cool peripheries, warm core, shivering, feeling cold, behavioural changes.

Question 27

What triggers the hypothalamus to raise the body’s set point temperature during fever?

Answer 27

Endogenous and exogenous pyrogens (e.g., cytokines from WBCs or microbial toxins).

Question 28

How does the body generate heat during a fever?

Answer 28

Vasoconstriction, piloerection, shivering, behavioural adaptations (e.g., rugging up).

Question 29

How does the body dissipate heat after fever peaks?

Answer 29

Vasodilation, sweating, behavioural changes like removing clothes.

Question 30

What’s the main difference between fever and hyperthermia?

Answer 30

Fever: regulated ↑ in hypothalamic set point; Hyperthermia: unregulated ↑ from external or internal causes.

Question 31

Can fever exceed 41°C?

Answer 31

Rarely. Hyperthermia can exceed 41°C and be life-threatening.

Question 32

What are the 'Big 4' serious bacterial infections in febrile children?

Answer 32

Sepsis, UTI, Pneumonia, Meningitis.

Question 33

When should you suspect occult bacteraemia?

Answer 33

Fever with no identifiable source in a well-appearing child.

Question 34

How should you manage fever?

Answer 34

Focus on underlying cause, not just temperature. Use antipyretics only symptomatically.

Question 35

What investigations are appropriate if no clear fever source?

Answer 35

CXR, urine, blood cultures, lumbar puncture.

Question 36

How is pain defined?

Answer 36

Unpleasant sensory/emotional experience from actual or potential tissue damage.

Question 37

Why is paediatric pain often undertreated?

Answer 37

Hesitation to administer analgesia due to fear of side effects or misjudging severity.

Question 38

What is the FLACC scale and when is it used?

Answer 38

Face, Legs, Activity, Cry, Consolability. For ages 1 month – 7 years.

Question 39

How do you assess pain in children with developmental delays?

Answer 39

Use the R-FLACC scale and consult family.

Question 40

What physiological signs suggest pain in a child?

Answer 40

Tachycardia, tachypnoea, pallor, diaphoresis.

Question 41

What behavioural signs suggest pain in children?

Answer 41

Painful cry, agitation, favouring a limb, not settling.

Question 42

What does bile-stained vomit in a child suggest?

Answer 42

Bowel obstruction until proven otherwise.

Question 43

What are common signs of bowel obstruction?

Answer 43

Vomiting, colicky pain, no stooling, abdominal distension, decreased bowel sounds.

Question 44

What is the best early pain relief in children?

Answer 44

IN Fentanyl – rapid, non-invasive, effective within 10–15 mins.

Question 45

What are non-pharmacological pain relief strategies?

Answer 45

Distraction, cooling (burns), RICE (MSK injury), dressing, splinting.

Question 46

Compare fentanyl and methoxyflurane in children.

Answer 46

Fentanyl: Fast, strong, IN dose 1.5 mcg/kg. Methoxy: Inhaled, short duration, causes dissociation, less effective long-term.

Question 47

What’s ketamine used for in pain management?

Answer 47

Dissociative anaesthetic (IM 2–4 mg/kg or IV 1–2 mg/kg), good for severe pain + sedation.

Question 48

What is midazolam’s role in paediatric pain care?

Answer 48

Sedative/amnesic. No analgesia. Watch for paradoxical agitation.

Question 49

How long should burns be cooled?

Answer 49

20 minutes under running water.

Question 50

How should limb fractures be managed pre-hospital?

Answer 50

Splint in most comfortable position, analgesia, immobility.

Question 51

What type of pain is associated with deep dermal or full-thickness burns?

Answer 51

Deep dermal – painful, may require grafting. Full-thickness – numb or pins & needles.