CASE 25 - Child With Fever

Question 1

Do you think that I did the right thing by coming here and telling you about my child’s fever?

Is my child going to be okay?

Answer 1

You certainly did the right thing by coming in today. Maria may have an infection that is causing her fever, so we need to examine her here in the office and then decide whether shee needs any tests and/or tx.

Question 2

Specific Qs:

Answer 2

1. Difficulty swallowing.
2. Rash.
3. Shaking (seizures).
4. How has the child looked (lethargic, irritated, playful, etc)?
5. Ill contacts + DC + Ill contacts in DC + Immunizations + Last checkup + Birth history + Developmental + Eating + sleeping.

Question 3

DDx:

Answer 3

1. Acute otitis media.
2. Meningitis.
3. Scarlet fever.
4. 5th disease or other viral exanthem.
5. VZV.
6. Neonatal sepsis.
7. Pneumonia.
8. Pyelonephritis.
9. URI.
10. Gastroenteritis.

Question 4

Workup:

3x4

Answer 4

1. Pneumatic otoscopy.
2. LP—CSF analysis.
3. CBC with differential, blood culture, UA, and urine culture.
4. Throat culture.
5. PLTs, PT/PTT, D-dimer, fibrin split products, fibrinogen.
6. Electrolytes.
7. CXR.
8. Tympanocentesis culture.
9. Viral panel.
10. Stool culture.
11. Tympanometry.
12. Skin lesions scrapings.