CLIPP 10: 6-month infant with fever

Question 1

Most common cause of fever without a source?

Answer 1

viral illness

Question 2

Children under what age do not demonstrate kernig’s or brudzinskis sign on PE despite having bacterial meningitis

Answer 2

Under 12 months

Question 3

Kernig’s sign in a baby < 12 months?

Answer 3

Kernig’s sign is resistance to extension of the knee

Question 4

What is Brudzinski’s sign?

Answer 4

Brudzinski’s sign is flexion of the hip and knee in response to flexion of the neck by the examine

Question 5

What are two criteria to warrant a CXR in a child looking for pneumonia?

Answer 5

Current guidelines recommend a chest X-ray if a child has respiratory findings and /or a WBC count > 20,000 cells x 100/μL

Question 6

Describe occult bacteremia

Answer 6

In contrast to sepsis , the term “occult bacteremia” is applied when there is a positive blood culture in a well-appearing child.

The distinction is made because most children with occult bacteremia will NOT develop a serious bacterial illness (SBI), whereas a child with sepsis represents a medical emergency

Question 7

Most common cause of bacterial meningitis in infants?

Answer 7

S. pneumoniae and N. meningitidis; remember, the conjugated pneumococcal vaccine protects against only 13 pneumococcal serotypes

Question 8

What are the usual presenting symptoms in Roseola (HHV6)?

Answer 8

A high fever is often the only symptom in the first few days of illness and typically lasts for 3 to 5 days