🤔 MEDIUM

The dreaded child with a fever, could it be a virus, could it be something more serious? Test yourself on this set of questions!

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Fever in a child

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Question 1

Stem 1, question 1 of 4

Nathan, a 10 month old male, is brought into the emergency department by his parents Craig and Raj. Nathan has a fever, unwell and is showing signs of respiratory distress

Which of the following is not a sign of respiratory distress?
A
Tracheal tug
B
Nasal flaring
C
Subcostal recessions
D
Retractions
E
Bradypnoea
Question 1 Explanation: 
Hopefully this is a nice start to the question set for you. There are a number of different signs of respiratory distress, they may be obvious or they may be more subtle so it is important to expose the child adequately. Bradypnoea is not a sign of respiratory distress, but tachypnoea is a key sign of respiratory distress
Question 2

Stem 1, question 2 of 4

On examination Nathan is in respiratory distress , a fever and has a dry cough. On auscultation, both a wheeze and crackles are heard. What is the most likely diagnosis?
A
Tonsillitis
B
Community acquired pneumonia
C
Influenza
D
Bronchiolitis
E
Otitis media
Question 2 Explanation: 
Nathan is presenting with the classical symptoms of bronchiolitis and is within the key age group of under 1 year old. Bronchiolitis is an acute viral infection of the lower respiratory tract and is a clinical diagnosis. Patient Info Professionals have a great resource on bronchiolitis: https://patient.info/doctor/bronchiolitis-pro
Question 3

Stem 1, question 3 of 4

What is the causative organism of 80% of cases of Bronchiolitis?
A
Adenoviruses
B
Coronaviruses
C
Rhinovirus
D
Respiratory syncytial virus
E
Herpes simplex virus
Question 3 Explanation: 
Upto 80% of cases of bronchiolitis are caused by respiratory syncytial virus, sadly this is a question you either know, or you don't! Adenoviruses, coronaviruses and rhinoviruses are common causes of tonsillitis
Question 4

Stem 1, question 4 of 4

Which of the following is not a risk factor for bronchiolitis?
A
Older siblings
B
Passive smoking
C
Low birth weight
D
Prematurity
E
Non-Black ethnicity
Question 4 Explanation: 
Non-Black ethnicity is a risk factor for urinary tract infections, not bronchiolitis. Passive smoking is a reversible risk factor here so it is important to encourage and support families to enable members to stop smoking, remember holistic care principles!
Question 5

Stem 2, question 1 of 5

Yasmin, a 8 year old female, presents to GP with her third episode of fever, urinary frequency, suprapubic pain, dysuria and vomiting in the last 6 months. She is accompanied by her Grandfather who is her guardian.

What is the most likely diagnosis?
A
Urinary tract infection
B
Pyelonephritis
C
Gastritis
D
Rotavirus
E
Pneumonia
Question 5 Explanation: 
This question is presenting the classical symptoms of a urinary tract infection. You might have through pyelonephritis as there is no costovertebral angle tenderness or flank pain it makes this diagnosis less likely. Urinary tract infections are the most common bacterial infection of childhood.
Question 6

Stem 2, question 2 of 5

The GP decides to investigate if Yasmin has a urinary tract abnormality resulting in an increased risk of urinary tract infections. What would be the most appropriate first investigation?  
A
Abdominal CT
B
Abdominal MRI scan
C
X-Ray of kidneys, ureters and bladder
D
Ultrasound of kidneys, ureters and bladder
E
Voiding cystourethrogram
Question 6 Explanation: 
Abnormal urinary tract anatomy can increase the risk of urinary tract infection and may account for the recurrent episodes Yasmin is having. Ultrasound is the most appropriate initial investigation: there is no radiation and is non-invasive. It can detect abnormal anatomy or a renal abscess if urine is clear but fever and pain persist. BMJ best practice has a great resources on UTIs in children
Question 7

Stem 2, question 3 of 5

9 months later Yasmin presents with a fever, otalgia and feeling unwell. Yasmin and her sister have recently both had a cold.

Given the most likely diagnosis, what examination findings are most likely?
A
Tachypnoea
B
Swollen tympanic membrane
C
Bibasal crackles
D
Petechial rash
E
Delayed capillary refill time
Question 7 Explanation: 
A bit of a trickier question this time around! The most likely diagnosis here is otitis media, following the recent upper respiratory tract infection. The causative organism can travel up the Pharyngotympanic/Eustachian/Auditory tube and enter the middle ear and result in otitis media, thus causing a swollen and bulging tympanic membrane
Question 8

Stem 2, question 4 of 5

Yasmin's Grandfather asks what treatment you can offer her, what is the most appropriate management for this condition?
A
Oral antibiotics
B
Admission to hospital
C
Analgesia and encourage oral fluid intake
D
Initiation of sepsis 6 pathway
E
Dexamethasone
Question 8 Explanation: 
This question tests your understanding of otitis media and the related management of the condition. Most otitis media cases are caused by viruses, especially given the history of a recent cold. There is no need in this case as Yasmin is systemically well for admission to hospital or antibiotics are not necessary in this case. Analgesia, encoring oral fluid intake and reassurance would be appropriate in this case
Question 9

Stem 2, question 5 of 5

Two days later Yasmin's Grandfather becomes worried and takes her to an Emergency Department as she her skin is mottled, cold to touch and she is difficult to wake, in addition to a fever. What is the most likely diagnosis now?
A
Meningitis
B
Sepsis
C
Pneumonia
D
Urinary tract infection
E
Tonsilitis
Question 9 Explanation: 
Hopefully this is ringing alarm bells in your head for sepsis! Remember that carer concern is not something that should be ignored in paediatrics! Often pale skin is cited as a key feature of sepsis but keep in mind not every person will appear as different skin tones may not become pale.
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