Q1.

When you might

consider a child to have a
fever? Briefly describe
pathophysiology of fever?
m `ormal temperature : 37°C - 38°C
m Always considered to be 37°C
m The normal rectal temperature is 0.5°C
higher; the axillary temperature is 0.5°C
lower
m Axillary temperature above 37.5°C are
considered abnormal
m Rectal temperature more than 38°C are
considered abnormal
 2xogenous
pyrogens Reach to anterior
(infections, Stimulate release of hypothalamus via
inflammatory endogenous arterial blood
process, pyrogens circulation
malignancy)

ncrease Liberating
thermoregulatory arachidonic acid
set point thus metabolized to
prostaglandins 2

Heat conservation Heat production

Q . What is the abnormal
movement described and
the complication which
can arise from such
events?
m Tonic-clonic seizures
m Consciousness and control of posture are
lost
m Followed by tonic stiffening and upward
deviation of the eye
Complication:
‡
f the activity everlasting longer that 0 minutes
= status epilepticus
‡ May lead to irreversible brain injury
m Cyanotic breath holding spells
m Breathing stops in expirations
involuntarily
m Occur in response to fear, confrontation,
traumatic event, being startled
Complication:
‡
njury due to fall as can be
accompanied by loss of consciousness.
‡ Do the seizure appear generalized, or focal? (to know the types
of febrile seizures)
‡ How long has she been having this fever?
‡ What cause the fever? (to ruled out if its due to viral or bacterial
infection)
‡Are they any associated symptoms? (to know if patient has pain,
headache)
‡ Do you have night sweats or loss of weight? (to ruled out TB)
‡ Do you take the temperature?
s it getting higher or lower?
‡Does the fever continuous or intermittent? (to ruled out typhoid,
malaria or TB)
‡
s the child has had any seizures before?
‡Besides her father, are they any of the family members have the
same problem? (to ruled out that genetic predisposition
contributes to the disease)
‡ Does your child experience any developmental delay?
‡ Has there been any exposure to drugs/alcohol during
pregnancy? ( some drugs may cause damage to the brain)
O
   
     

Headache Fever

`eck stiffness Drowsiness

Photophobia· Loss of consciousness

Fever Poor feeding

Vomiting
rritability

Lethargy

Bulging fontanelle
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 ‡ Abnormal movement
CAS2 ‡ Seizure

‡ Transient dysfunction of part or all of the brain.

D2F
`
T
O`
‡ Causing sudden and transitory phenomena of motor,
sensory, autonomic or physic nature

‡ Genetic or congenital malformation of the brain

‡ C`S infection
Causes ‡ Tumor
‡ Trauma
‡
diopathic
 Seizure

Generalise
Focal
d

Simple complex

Tonic-
Absence Clonic Myoclonic Tonic Atonic
clonic
Differential diagnosis
m Breath holding attack
m Syncope
m Cardiac arrhythmias
m Tumor
m Metabolic impairment
m Gastro-oesophageal reflux
Knowing by:
m Primarily detailed history taking of
character, from eyewitness (parents)
m Any factor that suggest the patient is
prone to fits the condition: i.e. family
history, or in fever.
m `eurological examination. (P2 and

nvestigation) i.e. 22G.
What have we know:
m Abnormal movement, suggesting
convulsion.
m Convulsion last for 45 minutes.
m Had vomiting just before it happened.
m Had past history not associated with
fever.
m `o remarkable birth history.
m `o concern about her development.
1. About the attack, detailed of what
happened. Before during and after.
. What have the baby been eating.
3. Associated symptoms
4. Family history
5. 2nvironment history
6. Ask more about vomitting.
m To rule out the types of seizures.
m Provisional diagnosis
· Tonic clonic epilepsy with complication
of status epilepticus

m Differential
diagnosis
· Pseudo-seizures
· Breath-holding spells
· Long QT syndrome
· Paroxysmal movement disorders
m FBC
· To rule out any infection or inflammation as secondary cause
m Blood glucose level
· To check the level of glucose as cause of seizures
m BUS2
· To check electrolyte imbalance (hypocalcaemia,
hyponatremia)
m 22G
· To measure electrical activity in the brain to indicate
epilepsy
m MR
@ CT scan
· To indicate progressive neurological disorder
m During an episode of seizure:
· Lie child in recovery position (head to side
and lower than trunk) ² to protect ABC
· Do not restraint seizure movement, but
protect the child from injuring themselves.

m
fpersists > 5 mins:

· Give anti-epileptic drug therapy ²
diazepam, phenytoin, phenobarbitone
m Ask parents to try and search for the
cause of seizures/epilepsy i.e.
photosensitivity, stress, and intervene the
cause
m Avoid sleep deprivation
m Better shower than bath
m
nform school, nursery or maids of
condition
m Ask parents or maids to learn and know
emergency treatment.