Tutorial
Questions
The Dehydrated Child
CASE SCENARIO
An 11 month old male
infant is brought to casualty by his mother with a one day history of vomiting,
a two day history of watery stools and poor oral intake.
1. What
further historical information would you like to know?
2. What
are the clinical features of mild, moderate and severe dehydration?
Examination reveals a
lethargic, drowsy infant. Temperature of 38°C, Weight is 10kg
Pulse
is weak, rate of 160/min. Blood pressure 60/40
Capillary refill > 2
seconds, his eyes and anterior fontanelle are sunken and there is no salivary
pool.
3. Classify
the severity of this patient’s dehydration.
4. Calculate
the fluid deficit.
5. Does
this patient need oral or IV fluid therapy?
6. What
investigations would you do and why?
7. What
are the principles of rehydration therapy?
Child with a rash
A 4 year old child presents to your practice with a
two day history of fever, headache, vomiting and sore throat. Temperature recorded by mom was initially 101
degrees F responsive to paracetamol given every 4 hours. The following day the temperature increased
to 103 degrees F with the appearance of a fine papular
rash which started in the neck and armpits but
spread to the entire body after a few hours.
(1) What
is the likely diagnosis in this patient?
(2) What
is characteristic about the rash in the above scenario?
(3) How
does the timing of onset and nature of a rash assist you in arriving at a
diagnosis?
(4) What are the common clinical scenarios in paediatrics
where a rash is characteristic?
(5) Outline
options for treatment based on likely pathophysiology
Well Child Care
A teenage mother is visiting you for the first
time. She has recently moved to Kingston
with her 6 month old child. During your
first visit as you enquire about what her “son is currently doing”, she seems
unaware of what you are asking about.
1. Explain
to Mother the purpose of her Well baby visit and what all it should entail
2. Provide
explanations as to what is developmental
surveillance and its importance
3. Provide
age appropriate anticipatory guidance to mother.
Mrs Martin presents to you with her 24 month old
daughter whom she is concerned about as she is not yet “talking”. As you explore her history, outline important
aspects that need to be addressed in her history as well as possible diagnoses.
You are asked to address a group of parents at a
local kindergarten on temper tantrums.
What important points should you make?
“The Child with Cold, Cough and
Shortness of Breath ”
Instructions
to students:
Seek
out as many patients as you can who present to clinic, casualty or wards with
cold, cough with or without shortness of breath and answer the following
questions.
How does the clinical presentation
(symptoms and signs) of a child with cold and cough help in arriving at a
diagnosis?
How does the etiology of various
conditions with symptoms of cold and cough with or without shortness of breath
affect diagnosis investigation and treatment?
How does the pathophysiology and
prognosis of these conditions help to direct treatment?
Bring your cases, books/resource
materials to the tutorial.
Recommended Reading: See resources
on OurVLE
THE INFANT OR CHILD WITH FEVER
Objectives:
At the end
of the tutorial(s) the student should be able to:
1. Define fever
2. Describe the pathophysiology of
fever
3. Classify fever and explain the
significance according to the classification
4. Describe the aetiology of fever with
respect to pattern of fever and certain patient factors e.g. age group
5. Describe the complications of fever
6. Define febrile seizures
7. Decribe the pathophysiology of
febrile seizures
8. Describe the management of the
infant/ child with fever
The
following case scenarios have been developed to emphasise the above learning
points.
Case
scenario 1
A mother brings a 10-month-old
male infant to casualty, with a complaint that he has been having fever for the
past 5 days. The fever is intermittent and worse at night. She used a
thermometer at home and the highest temperature recorded was 39.8 0 C.
She tried sponging the infant with cold water, but he began shivering. His
appetite has been decreased and he is irritable.
a) How would you determine if
this child has fever (state methods and interpretation)?
b) How does the body produce
fever? (Be prepared to explain this process to parents and colleagues.)
c) What other causes of
elevated body temperature exist and how do they differ from true fever?
d) How can fever be classified?
What is the relevance of these classification systems?
e) What additional history do
you need to determine the cause of this infant’s problem? Give reasons for each
historical point.
f) What important examination
findings would lead you to a diagnosis?
g) What other historical data
should you elicit if the boy was less than one month old and older than 3 years
old?
h) What features in the
examination would support a diagnosis of meningitis? How do these features
change with age?
i)
What are the common causes of fever in children less than one month
old, 3-36 months old, older than 3 years old?
j)
What groups of children are considered high risk when they have fever?
k) What investigations would
you do? Do investigations vary with age? Explain why?
l)
What complications may occur with fever?
m) How is fever treated?
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