CLIPP 10 Flashcards
adverse rxn w rotavirus vaccine
happens typically within first several days and most commonly with the first dose of it
-is a live virus vaccine, can cause fever
MMR and varicella adverse rxns
are live virus vaccines and can cause fever in some infants 7-10d after administration
FWS vs FUO
FWS - complete hx and Pex done and no identified source of fever
FUO - fever >38.3 (101) for at least 2 weeks with failure to reach dx after 1 week of eval
sepsis dx
typically requires +BC? card 6 case 10
occult bacteremia
applied to child with bacteremia who looks well or is a little fussy (compared to toxic or ill appearing child with bacteremia is more likely to be septic)
SBI - and most common cause
serious bacterial illness - kids with occult bacteremia will likely not get this while kids with sepsis are a medical emergency.
-most common cause is a UTI
organisms responsible for a lot of the occult bacteremia we see, if we see it
strep pneumo, hib, NM, salmonella enteritidis
a wbc count of <15000
excellent at ruling out bacteremia
will most young children presenting w/ fever w/o focus be bactremic?
no - thus empiric tx not always indicated
kernigs and brudzinski signs
kernig - flex at hip and knee, then extend at knee: positive result of pain w/ ext of knee
brudzinski - positive result is flexion of hip and knee in response to flexion of neck by examiner
*note that most kids under 1 yo will not demo a kerning or brudzinski sign even if they do have bacterial meningitis i.e. the absence of meningismus cannooottt rule meningitis out. but if theo do demo a + or both + sign, then do LP
one of the things on ddx of bulging fontanelle
meningitis
paroxsymal criyng is __ and could indicate __
for example, crying when picked up, meningitis
opisthotonos
hyperextension (severe) , almost in bridge form. In severe cases of meningitis, increased extensor tone of neck and spine leads to hyperextension of the entire spine or “opisthotonos.”
nuchal rigidity
involuntary reisstance to neck flexion
UTI presentation
commonly presents as fever and no focus on physical examination and a relatively unremarkable review of systems.
Fussiness and lack of appetite are common associated symptoms.
UTI gender and age RF
females =39 (102.2) or more than 24 h of FWS
in what case is a cxr in an immunized kid w/o resp sx indicated
if WBC>=20,000 x 10^3
how could young infants in sepsis present
hypothermia rather than fever
most common cause of bacterial meningitis in kids is
SP, NM (conjug pneumococcal vaccine only projects against 13 serotypes)
common culprit in viral meningitis and sx
enterovirus
in kids, presents w/ fever and can also have diarrhea, rash, or URI sx
roseola - age, virus type, sx, tx
Common viral illness in children under 2 years of age.
Caused by human herpes virus 6 (HHV-6).
A high fever is often the only symptom in the first few days of illness and typically lasts for 3 to 5 days.
Some patients develop a rash as the fever resolves; the rash can persist from 1 to 4 days.
Appropriate management for a child with roseola is to reassure the family that no other therapy is indicated
occult bacteremia vs sepsis
by definition, it may be found in a child with high fever with no other symptoms and no source of infection on physical examination who appears well (as opposed to children with sepsis who also have bacteria in their blood).
