Fever in Infants and Children — MCQs
Simple febrile seizure is defined as
Treatment of simple febrile convulsion is based on
Fever occurs due to which of the following mechanisms?
Management of typical febrile seizures includes all except:
A 10 week old child comes for vaccination, with previous history of inconsolable cry & fever after getting vaccinated at 6 weeks. What should be done next?
How do antipyretic medications help in reducing fever?
A neonate who is febrile, presents with features of encephalitis. On examination, the baby is found to have vesicular skin lesions. Most probable causative organism is:
Fever stops and rash begins is diagnostic of-
A 5-year-old presents with high fever, strawberry tongue, bilateral cervical lymphadenopathy, and a fine sandpaper-like rash that blanches on pressure. What is the diagnosis?
Exanthema subitum is caused by -
Fever in Infants and Children Indian Medical PG Practice Questions and MCQs
Question 1: Simple febrile seizure is defined as
- A. All of the options
- B. Seizure lasts < 15 min
- C. Focal seizure
- D. Generalized seizure <15 min, within 24 hours of fever onset, in a child 6mo-5yr (Correct Answer)
Explanation: ***Generalized seizure <15 min, within 24 hours of fever onset, in a child 6mo-5yr*** - A **simple febrile seizure** is characterized by a **generalized tonic-clonic appearance**, lasting less than 15 minutes, and occurring within 24 hours of the onset of fever. - It typically affects children between the ages of **6 months and 5 years** who do not have a history of afebrile seizures or other neurological conditions. *All of the options* - This option is incorrect because simple febrile seizures must meet **specific criteria** regarding duration, number of episodes, and seizure type to be classified as simple. - While some individual components might be correct, the definition requires a **combination of specific features**, not a general 'all of the options' approach. *Seizure lasts < 15 min* - While a duration of less than 15 minutes is a **necessary criterion** for a simple febrile seizure, it is not sufficient on its own. - Other factors such as the type of seizure (generalized), the number of seizures (single in 24 hours), and the child's age are also crucial for the definition. *Focal seizure* - A **focal seizure**, characterized by originating in a specific area of the brain and often manifesting with localized symptoms, is a hallmark of a **complex febrile seizure**, not a simple one. - Simple febrile seizures are by definition **generalized**, meaning they affect both sides of the brain from the outset.
Question 2: Treatment of simple febrile convulsion is based on
- A. Control of fever (Correct Answer)
- B. Rectal diazepam
- C. CSF finding
- D. Blood reports
Explanation: ***Control of fever*** - Among the given options, **control of fever** is the most appropriate answer as it represents the **immediate supportive care** for a child with a simple febrile seizure. - Management includes using antipyretics like **paracetamol** or **ibuprofen** to reduce fever and improve comfort. - **Important note:** While fever control is good supportive care, evidence shows that antipyretics do **NOT prevent recurrence** of febrile seizures. The actual cornerstone of management is **reassurance and parental education**. - According to AAP guidelines, simple febrile seizures are benign, self-limited events that require no specific anticonvulsant treatment. *Rectal diazepam* - **Rectal diazepam** is used for **acute termination** of prolonged seizures (>5 minutes) or as rescue therapy for recurrent episodes. - It is NOT indicated for routine management of simple febrile seizures, which typically last <15 minutes and resolve spontaneously. - May be prescribed for home use in select cases with recurrent seizures. *CSF finding* - **CSF analysis** is a **diagnostic procedure**, not a treatment basis. - It is indicated only when there is clinical suspicion of meningitis or meningoencephalitis (e.g., altered sensorium, meningeal signs, complex seizure features). - NOT routinely required for simple febrile seizures in well-appearing children. *Blood reports* - **Blood investigations** are diagnostic, not treatment-guiding for simple febrile seizures. - They may be considered to identify the source of fever or rule out electrolyte abnormalities, but are not the basis of seizure management itself. - Simple febrile seizures do not require routine laboratory workup.
Question 3: Fever occurs due to which of the following mechanisms?
- A. Endorphin
- B. Enkephalin
- C. Histamine
- D. IL-1 (Correct Answer)
Explanation: ***IL1*** - Interleukin-1 (IL-1) is a **proinflammatory cytokine** that plays a key role in the immune response and is a primary mediator of fever [1]. - It stimulates the **hypothalamus** to increase body temperature set-point, thus inducing fever. *Enkephalin* - Enkephalins are **opioid peptides** involved in pain modulation, not in the fever response. - They primarily act in the **central nervous system** and do not directly influence thermoregulation. *Endorphin* - Endorphins, like enkephalins, are also **opioid peptides** related to pain relief and mood regulation, with no significant role in fever induction. - Their main function is to provide **analgesic** effects rather than influencing body temperature. *Histamine* - Histamine is predominantly involved in **allergic responses** and inflammation but is not a direct mediator of fever. - It causes **vasodilation** and increases vascular permeability, but does not raise the body temperature set-point like IL-1 does. **References:** [1] Kumar V, Abbas AK, et al.. Robbins and Cotran Pathologic Basis of Disease. 9th ed. Inflammation and Repair, pp. 110-111.
Question 4: Management of typical febrile seizures includes all except:
- A. Intermittent diazepam
- B. Sponging
- C. Paracetamol or ibuprofen
- D. Prophylactic phenobarbitone (Correct Answer)
Explanation: ***Prophylactic phenobarbitone*** - **Continuous prophylactic anticonvulsant therapy** with phenobarbitone is **definitively NOT recommended** for typical (simple) febrile seizures - The risks of chronic anticonvulsant use—including **sedation, cognitive impairment, and behavioral problems**—significantly outweigh any potential benefits - Evidence shows prophylactic phenobarbital does **not prevent future epilepsy** and has insufficient benefit in preventing recurrent febrile seizures - This is the **correct answer** as it is explicitly excluded from management guidelines *Intermittent diazepam* - While **not routinely recommended** for typical febrile seizures, intermittent rectal or buccal diazepam may be discussed as a *potential option* for specific situations (frequent recurrences, parental anxiety, prolonged seizures) - It serves as **rescue medication** to abort an ongoing seizure rather than daily prophylaxis - Its role in typical febrile seizure management is controversial and limited, but it may be mentioned in comprehensive management discussions *Sponging* - **Tepid sponging** is a supportive physical cooling measure used in fever management - While it does not prevent febrile seizures, it is part of general **symptomatic care** for fever reduction - Typically used alongside antipyretics to help lower body temperature and improve comfort *Paracetamol or ibuprofen* - **Antipyretics** are standard management for fever control and improving the child's comfort - While they do **not reliably prevent** febrile seizures from occurring, they are essential for **symptomatic fever management** - Recommended as first-line treatment for fever in children with febrile seizures
Question 5: A 10 week old child comes for vaccination, with previous history of inconsolable cry & fever after getting vaccinated at 6 weeks. What should be done next?
- A. Give DT (Correct Answer)
- B. Defer for 1 month
- C. Administer antibiotics
- D. Give DPT vaccination
Explanation: ***Correct Option: Give DT*** - **Inconsolable crying** (typically defined as crying ≥3 hours) following pertussis-containing vaccine is classified as a **precaution** for subsequent doses per IAP, CDC, and WHO guidelines - When a **precaution** exists, the pertussis component should be **withheld** from future doses - **DT vaccine** (diphtheria-tetanus without pertussis) ensures continued protection against diphtheria and tetanus while avoiding repeat exposure to the pertussis antigen that likely caused the reaction - This represents appropriate **risk-benefit assessment** in immunization practice *Incorrect: Give DPT vaccination* - Continuing DPT after inconsolable crying ignores established AEFI (Adverse Events Following Immunization) guidelines - While fever alone is not a contraindication, **inconsolable crying is a recognized precaution** that warrants modification of the vaccination schedule - Repeating the same vaccine risks recurrence of the adverse event *Incorrect: Defer for 1 month* - Simply deferring without changing the vaccine type doesn't address the underlying issue - The child would still receive the pertussis component later, risking another adverse reaction - Unnecessary delay in protection against diphtheria and tetanus when DT is available *Incorrect: Administer antibiotics* - **Post-vaccination fever and crying** are inflammatory responses to vaccine antigens, not bacterial infections - Antibiotics have no role in managing vaccine-related reactions - This approach doesn't address the need for continued immunization protection
Question 6: How do antipyretic medications help in reducing fever?
- A. They reduce sweating
- B. They constrict blood vessels
- C. They directly cool the body
- D. They inhibit prostaglandin synthesis (Correct Answer)
Explanation: ***They inhibit prostaglandin synthesis.*** - Fever is mediated by **prostaglandins**, specifically **PGE2**, which are released in response to pyrogens and act on the **hypothalamus** to raise the body's set point. - Antipyretics like **NSAIDs** (e.g., ibuprofen, aspirin) and **acetaminophen** (paracetamol) primarily work by inhibiting the enzyme **cyclooxygenase (COX)**, thereby reducing the production of these fever-inducing prostaglandins. *They reduce sweating* - Reducing sweating would impair the body's natural cooling mechanism and **exacerbate fever**, not reduce it. - Sweating is a **thermoregulatory response** to actively cool the body when its temperature set point is lowered. *They constrict blood vessels* - **Vasoconstriction** reduces heat loss from the skin and is a process the body uses **to conserve heat** or **raise body temperature**, which would worsen fever. - Antipyretics promote **vasodilation** as part of the body's heat loss mechanisms once the hypothalamic set point is reset. *They directly cool the body* - Antipyretics act **pharmacologically** to modulate internal physiological processes, not by physically or directly cooling the body. - Direct cooling methods like cold compresses or sponging are **external interventions**, distinct from the action of antipyretic medications.
Question 7: A neonate who is febrile, presents with features of encephalitis. On examination, the baby is found to have vesicular skin lesions. Most probable causative organism is:
- A. Meningococci
- B. Streptococci
- C. HSV I
- D. HSV II (Correct Answer)
Explanation: ***HSV II*** - **Herpes simplex virus type 2 (HSV-2)** is the most common cause of **neonatal herpes**, presenting with neurological manifestations like encephalitis and characteristic vesicular skin lesions. - Transmission usually occurs during **vaginal delivery** from a mother with genital herpes, leading to widespread infection in the neonate. *Meningococci* - While *Neisseria meningitidis* can cause **meningitis** and **septicemia** in neonates, it does not typically produce vesicular skin lesions. - Its infections are more commonly associated with a **petechial or purpuric rash**, not vesicles. *Streptococci* - **Group B Streptococcus (GBS)** is a leading cause of **neonatal sepsis and meningitis**, but it does not cause vesicular skin lesions. - GBS typically presents with non-specific signs of sepsis or meningitis in neonates. *HSV I* - Although **herpes simplex virus type 1 (HSV-1)** can cause neonatal herpes, **HSV-2 remains the predominant cause** of vertically transmitted neonatal infection with encephalitis and disseminated disease. - HSV-1 is more commonly associated with **oral herpes (cold sores)** in older children and adults, though its incidence in neonatal infection is increasing.
Question 8: Fever stops and rash begins is diagnostic of-
- A. Fifth disease
- B. Toxic shock syndrome
- C. Measles
- D. Roseola infantum (Correct Answer)
Explanation: ***Roseola infantum*** - This condition is characterized by a **high fever** that typically lasts for 3-5 days, followed by its abrupt resolution and the subsequent appearance of a **maculopapular rash**. - The rash usually starts on the **trunk** and spreads outward, often appearing just as the child's fever breaks, a key diagnostic feature. *Fifth disease* - Characterized by a distinctive **"slapped cheek" rash** on the face, followed by a lacy rash on the trunk and extremities. - The rash typically appears after mild prodromal symptoms, but the onset of rash is not directly linked to the resolution of a high fever. *Toxic shock syndrome* - This severe illness is marked by a **sudden high fever**, diffuse **erythematous rash**, hypotension, and multi-organ involvement. - The fever and rash typically occur concurrently, and the rash does not appear after the fever breaks. *Measles* - Measles is characterized by a prodromal phase of **fever**, cough, coryza, and conjunctivitis, followed by the appearance of **Koplik spots**. - The characteristic **maculopapular rash** typically appears 3-5 days after the onset of fever, while the fever is still present or peaking, not after its resolution.
Question 9: A 5-year-old presents with high fever, strawberry tongue, bilateral cervical lymphadenopathy, and a fine sandpaper-like rash that blanches on pressure. What is the diagnosis?
- A. Measles
- B. Scarlet fever (Correct Answer)
- C. Kawasaki disease
- D. Strep throat
Explanation: ***Scarlet fever*** - The combination of **high fever**, **strawberry tongue**, **bilateral cervical lymphadenopathy**, and a **fine sandpaper-like rash that blanches on pressure** is pathognomonic for scarlet fever. - Scarlet fever is caused by **Group A Streptococcus** (Streptococcus pyogenes) producing erythrogenic toxin. - The rash typically spares the perioral area (circumoral pallor) and desquamates after 1-2 weeks. *Measles* - While measles causes high fever, it presents with a **maculopapular rash** (not sandpaper-like), **Koplik spots** on buccal mucosa, and the **three Cs: cough, coryza, and conjunctivitis**. - The strawberry tongue and blanching sandpaper rash are not features of measles. *Kawasaki disease* - Kawasaki disease presents with **prolonged fever (≥5 days)**, **bilateral non-exudative conjunctivitis**, **strawberry tongue**, **polymorphous rash**, **extremity changes** (erythema/edema of hands/feet, later desquamation), and **unilateral cervical lymphadenopathy >1.5 cm**. - The **sandpaper-like blanching rash** is characteristic of scarlet fever, not Kawasaki disease, which has a polymorphous (variable) rash. - Kawasaki disease lacks the pharyngeal exudate and specific rash pattern seen in scarlet fever. *Strep throat* - **Strep throat** (streptococcal pharyngitis) is the underlying pharyngeal infection that can progress to scarlet fever when the streptococcal strain produces erythrogenic toxin. - Strep throat alone presents with **sore throat**, **fever**, **pharyngeal exudate**, and **tender cervical lymphadenopathy**, but does **not** produce the characteristic **strawberry tongue** and **sandpaper rash** that define scarlet fever. - The question describes scarlet fever specifically, not just uncomplicated strep throat.
Question 10: Exanthema subitum is caused by -
- A. HIV
- B. HCV
- C. HPV
- D. HHV (Correct Answer)
Explanation: ***HHV*** - **Exanthema subitum**, also known as **roseola infantum**, is most commonly caused by **Human Herpesvirus 6 (HHV-6)** and sometimes **Human Herpesvirus 7 (HHV-7)**. - It is characterized by high fever followed by a **maculopapular rash** once the fever subsides. *HIV* - **Human Immunodeficiency Virus (HIV)** causes **Acquired Immunodeficiency Syndrome (AIDS)**, leading to a weakened immune system. - While HIV can cause various skin manifestations, **exanthema subitum** is not one of its primary or characteristic presentations. *HCV* - **Hepatitis C Virus (HCV)** primarily causes **hepatitis**, infecting the liver and potentially leading to chronic liver disease. - HCV is not known to cause **exanthema subitum** or similar childhood exanthems. *HPV* - **Human Papillomavirus (HPV)** is responsible for **warts** and certain **cancers**, particularly cervical cancer. - HPV does not cause **exanthema subitum**; its manifestations are typically localized to skin and mucous membranes as proliferative lesions.
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