Download What you should be able to do

What you should be able to do
Stimulus questions in relation to outcomes
Competence in Clinical Skills
What devices are used in hospital or in the home?
What are the differences between core and
peripheral temperature recordings?
Be familiar with appropriate devices for checking
temperature in infants and children of various
ages.
Be able to take a full paediatric history for a child
with fever and rash.
Perform a complete general examination
Be able to describe common childhood rashes.
Competence in practical procedures
Be aware of the way in which venous blood is
taken from a young child.
Be aware of the different ways of obtaining urine
samples from infants and young children.
Observe a lumbar puncture
Know how to take swabs and nasopharyngeal
aspirate.
Competence in Patient Investigation
Know the appropriate investigations for a febrile
child.
Competence to manage a patient
Initial emergency care in hospital and general
practice.
Be aware of protocols for managing meningitis and
Are there any features in the history that give
cause for concern? What symptoms do the
parents report in this illness? Enquire about the
rash; when was it first noticed? How has it
progressed over time? Did the rash appear after
the temperature subsided? Has the child any
underlying chronic illness? Is there a past history
of recurrent, severe or unusual infections? Does
the child have known congenital heart disease or a
murmur? Has the child been in contact with a
known contagious disease? Is there any history of
foreign travel? Are the child’s immunisations up to
date?
Consider the general appearance of the child. Are
they well or unwell? Is there any evidence of
shock? (What are the important features of shock
in a young child?)
Examine the rash. Describe the nature of the rash
(macular, papular, vesicular, purpura or petechial.)
Consider the distribution of the rash. Check
mucous membranes.
Check
for
lymphadenopathy
and
hepatosplenomegaly.
Is it appropriate to use a local anaesthetic cream,
or would this create an undesirable time delay in
investigation and treatment? What is meant by
distraction therapy?
What are the problems in collecting urine from
children and infants? What are the advantages
and disadvantages of the various methods of
collection?
What are the contra-indications to performing a
lumbar puncture? What investigations will you
request on the CSF sample? What information
can be obtained from an LP if it is performed after
antibiotic administration?
What are the components of a septic screen?
When would you perform a full septic screen?
What other investigations may be indicated in a
child with fever and rash?
What other
investigations may be considered in a child with a
history of frequent, severe or unusual infections?
What emergency resuscitation may a child with
meningococcal sepsis require? Where is the most
appropriate place for your patient to be cared for?
What measures are used for temperature control
in children? Why is this important in the young
meningococcal septicaemia.
child?
Consider infectivity of your patient
Is this child infectious? Is isolation required? What
special precautions should be taken?
Be aware of long-term complications/ morbidity
associated with meningitis.
What follow-up investigation would you arrange
after a child has had meningitis?
Competence to offer advice in health promotion and
disease prevention
What should a GP do if he suspects a child has
meningitis/ meningococcal septicaemia?
Be aware of initial management in the community.
What routine childhood immunisations are given and
what is the timing of these? What are the contraindications
and
relative
contra-indications
to
immunisations?
Be aware of the immunisation schedule for children.
Know what concerns
immunisations.
parents
may
have
about
What links have been made between immunisations and
other childhood illness? What role has the media played
in this? What evidence is there for these associations?
What advice does the Chief Medical Officer give about
immunisations?
Be aware of “Notifiable diseases”
Be aware of chemo-prophylaxis.
Be aware of the teratogenicity of viral infections.
Which diseases are notifiable? To whom must these
diseases be reported? Why are such notifications
important? What may happen following notification?
Which diseases require prophylaxis of contacts? What
medicine may be used for prophylaxis?
What
constitutes a “contact”?
Who should arrange
prophylaxis? What is the purpose of prophylaxis? What
are the side effects of the commonly used prophylactic
agent?
Competence in communication
Demonstrate
concerns.
appreciation of
listening to
parental
Consider the approach to parents of a child with a
potentially life-threatening infection.
Understand the importance of communication with
colleagues in other specialties to optimise the
management of your patient.
Competence to retrieve and handle information
Be aware of local outbreaks of infection.
Which of the viral infections may have teratogenic
effects? What problems can they cause to the foetus?
What stage of pregnancy do they have greatest effect?
Parents may be anxious about the possibility of
meningitis in their child.
Consider how you would counsel parents who are
unsure whether to immunise their child.
Understand the importance of keeping parents fully
informed and up-to-date with the changing clinical
situation. Allow the parents to be with their child as
much as possible. Be aware of common responses to
such stressful situations. These may include anger and
aggression, blame, guilt and even denial.
Colleagues in microbiology and pharmacy may offer
invaluable advice for rational antibiotic prescribing based
on local knowledge of infections and sensitivities. Your
patient may require paediatric intensive care and this
may involve an inter-hospital transfer.
Local public health consultant may produce a monthly
newsletter to update colleagues of local outbreaks of
infection. Consider direct contact for more up-to-date
information.
Understanding the social, basic and clinical sciences
Anatomy, physiology and biochemistry of CSF
circulation.
Pathophysiology of fever.
What causes fever? What adaptive changes are there
in response to fever?
Microbiology of meningitis in the young.
Epidemiology
exanthems.
and
clinical
features
How is CSF produced? How does it circulate? What
complication may occur secondary to meningitis? What
are the normal values in CSF? What is the Syndrome of
inappropriate ADH secretion? When may it occur? How
would you manage this?
of
childhood
Pathophysiology of shock
What are the commonest bacterial pathogens in a)
neonates and b) young children? How will this influence
your choice of antibiotics? How has the epidemiology of
childhood infections changed with introduction of new
immunisations?
What are the common childhood exanthems? Be aware
of their different features in terms of type of rash,
distribution, relationship between rash and fever.
Consider other features that may help diagnosis
(occipital lymphadenopathy, Koplik’s spots). What are
the incubation periods for the common childhood viral
illnesses, the duration of infectivity and their associated
complications?
Appropriate attitudes, ethical understanding and legal
responsibilities
Be aware of notifiable diseases
What is shock? What types of shock are there? How is
shock mediated?
What legal responsibilities do you have in certain
infections?
Be aware of local protocols/guidelines for managing
meningococcal sepsis.
Be aware of protocols for management of
meningococcal septicaemia. Consider when children
can be managed in local paediatric units or when they
should be transferred to a paediatric intensive care unit.
Be able to combine clinical findings with known patterns
of infectious disease and appreciate how to deal with
diagnostic uncertainty.
How do you differentiate a viral rash from
meningococcal septicaemia? Appreciate how clinical
findings may evolve.
How you should present yourself professionally
Stimulus questions in relation to outcomes
What does each member of the multi-professional team
contribute to managing patients with fever and rash?
Clinical decision making
Role of the doctor
Be aware of the different professions that should be
involved the management of children with fever and
rash.
Personal development
Be aware of the knowledge and skills you should
possess in relation to the management of fever and rash
as a graduate
Consider the opportunities that you will have to broaden
you knowledge and skills relating to this core clinical
task
Consider what are the core knowledge and skills for you
at present, how might this change depending on your
chosen postgraduate field?
Outside of Child health, where else might you meet or
learn about viral exanthems and meningococcal
disease?