This is the fourth approach to child fever. Have another crack and, as ever, beware the strawberry tongue …
Reviewed by: awaiting review
child fever 4
Stem 1 of 8
During the winter, a 12 year-old male presents to his GP with a sore throat. On examination, he has pharyngeal exudate and pharyngitis visibly. He has a tender anterior cervical lymphadenopathy and a high temperature. He is complaining of nausea associated with a headache.
Which criteria should be clinically used as a pre-testing aid to aetiology?
Stem 2 of 8The patient does not have Koplik spots on examination. For which condition is this pathognomic?
Stem 3 of 8Which point-of-care test is indicated next?
Culture throat swab for GAS
Culture throat swab for gonococcal
PCR for GAS
Rapid antigen test for GAS
Rapid antigen test for gonococcal
Stem 4 of 8What is the first line antimicrobial management for this patient (NICE, 2021)?
Stem 5 of 8Which of the following would be an acceptable threshold for the prescribing of antibiotics in sore throat? Select all which may apply.
Centor score 4
feverPAIN score 5
History of rheumatic fever
Rapid-antigen positive GAS
Throat culture positive GAS
Stem 6 of 8You wish to prescribe this patient some paracetamol. What is incorrect about this drug chart?
Route of administration
Max doses per day
Stem 7 of 8What is “fifth’s disease”?
Slapped cheek syndrome
Stem 8 of 8Which of the following features would suggest an acute sore throat was viral not bacterial?
7 years of age
Stem 1 of 4
Three days earlier, a 14 year-old female was tackled rather nastily whilst playing football on a muddy pitch. A stud hit her knee, with a puncture wound and some bleeding. Like a good player, she got back up as soon as the red card was issued to the offender. However, the next day she has a hot, swollen L knee joint at the site of the puncture wound with generalised reduction of functional movement. She presents to ED limping.
What is the most likely diagnosis at this point?
Stem 2 of 4Given the answer above, what is the next best step?
Joint aspirate for culture, crystals and cells
Joint washout in theatre
Per oral fluoroquinolone and metronidazole
Stem 3 of 4The tap reveals a neutrophilic leukocytosis, cellular debris, absence of crystals and cultures pending. Which empiric therapy is recommended?
Stem 4 of 4How can we monitor the response to treatment?
Check ESR/CRP every 24hr
Check weekly procalcitonin
Hepatorenal function every 24hr
Repeat joint aspiration and culture
Withdraw antibiotics periodically
Stem 1 of 5
A 3 year-old female presents to her GP with a high fever that has lasted the week. On examination she has a widespread rash (maculopapular) with some palmar skin peeling. Her tongue is bright red with large papillae present and her lips look dry. She has red eye and tender cervical lymphadenopathy bilaterally.
What is the best-matched differential?
Acute drug reaction
Stem 2 of 5What is the first line therapy?
Stem 3 of 5What type of conjunctivitis is this patient most likely to present with?
No conjunctivitis present
Stem 4 of 5Which of the following complications are linked to this differential classically?
Coronary artery aneurysm
Gaiter venous ulcer
Stem 5 of 5Which is the most useful inflammatory marker in this disease?