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Probabiglity diagnosis

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Viral URTI infection incl. common cold, pharyngitis, tonsillitis

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Otitis media

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Acute bronchitis

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Roseola

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Gastroenteritis

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Post immunisation

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Serious disorders not to be missed

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Infection:

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  • Bacterial

  • Meningitis/encephalitis

  • Septicaemia/bacteraemia

  • Epiglottitis

  • Pneumonia

  • Oteomyelitis/septic arthritis

  • Tuberculosis

  • Orbital cellulitis

  • Abscess

  • Viral

  • Epstein—Barr mononucleosis

  • Exanthemata eg measles, varicella e.g. fifth disease, hand-foot-mouth disease

  • Bronchiolitis/croup

  • HIV/AIDS

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Cancer:

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  • Leukaemia/lymphoma

  • Neuroblastoma/sarcoma

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Other:

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  • Acute appendicitis

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Pitfalls (often missed)

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Tuberculosis

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Rheumatic fever

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Endocarditis

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Tropical infections e.g. malaria

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Atypical infections e.g. zoonoses

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Henoch Schonlein purpura

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Kawasaki disease (persistent fever)

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Heatstroke/hot car

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Masquerades checklist

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Drugs e.g. penicillin, antihistamines

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Urinary tract infection

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Is the patient trying to tell me something?

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?parental ?Munchaussen by proxy

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Key history

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Obtain detailed account from parents of the symptoms and circumstances, esp. associations such as vomiting, diarrhoea, sweating, cough, wheeze, headache, other pain, cognition, photophobia and urinary symptoms. Ask about immunisation (past and recent), infectious contacts, animal contact and travel. Past history: ?splenectomy.

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Key examination

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  • General features: appearance of the child, interaction and level of activity, colour, hydration, chest movement and vital signs including peripheral perfusion.

  • Examine skin looking for evidence of rashes, vesicles and purpura.

  • Examine the ears and throat.

  • Basic neurological signs, esp. neck stiffness and fontanelles.

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Key investigations (only if necessary)

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First line:

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  • FBE/ESR

  • urinalysis

  • MCU

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Consider:

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  • CXR

  • blood culture

  • lumbar puncture

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Diagnostic tips

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Fever is regarded as a temperature >38° (rectal or tympanic). Most fevers in children are caused by viruses and are self limiting. Distinguish between focal causes, e.g. tonsillitis, and no apparent focus when a more detailed history and examination is required. Be very mindful of septicaemia and endocarditis.

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