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Phase 2 PEDs > Fever > Flashcards

Fever Flashcards

1
Q

Other disease processes ass/w fever besides infection?

A 
Rheum Dz
IBD
Kawasaki's
Poisoning
Malignancy
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2
Q

> 38 Celsius is what in F’?

A

> 100.4

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3
Q

Fever is diurnal - what times of the day?

A

Lower AM

Higher in PM

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4
Q

Will neonates have a febrile response?

A

Yes/No - fever may indicate serious infection!

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5
Q

<5yo will have what type of fever response?

A

Exaggerated (Up to 105)

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6
Q

Fever response decreases when?

A

> 5yo = high temps may indicate severe illness

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7
Q

Categories of fever?

A
  1. Fever of short duration
  2. Fever w/out focus
  3. Fever of unknown origin
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8
Q

Characteristics of Fever of short duration

A

Localized S/S

Dx - clinically

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9
Q

Characteristics of Fever w/out focus (source)

A

No localizing S/S or Source
MC <3yo
Cant Dx clinically

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10
Q

Characteristics of Fever of unknown origin

A

> 14d w/out source despite a work up
OR
1wk admit/eval

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11
Q

All febrile infants <4w age req what?

A

Admit for empirical Abx pending Cx

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12
Q

DDx of <3mo w/ fever

A 
MC - Viral
Bacteremia
Pneumonia
Meningitis
UTI
OM/septic arthritis
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13
Q

Fever for 3mo-3yrs are increased risk for what infectious pathogens?

A 
-- Polysaccharide capsule organisms
Strep Pneumo
H. Influenza
N. Meningitidis
Non-typhoidal Salmonella
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14
Q

Eyes - Alert vs Lethargic?

A

Alert - eyes shiny/bright and interactive

Lethargic - glassy eyes, stares vacantly

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15
Q

TXT fever w/

A

Remove clothes/blankets
Limit physical activity
Sponge baths w/ warm water
Antipyretics

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16
Q

Types of antipyretics used to TXT fever?

A

APAP (10-15mg/kg q4-6h)
Ibuprofen (10mg/kg q6h) - not before 6mo old
NO ASA (Reye’s syndrome)

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17
Q

Teething rarely ass/w temp higher than?

A

> 100.4 (not that high usually)

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18
Q

1st on Ddx to consider of Fever w/out source?

A

UTI or Pneumonia

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19
Q

W/U <1mo old w/ fever w/out source?

A 
Admit
- CBC, Bld Cx, UA/Cx
- LP csf
- CXR
ABX after labs drawn (Ampicillin/gentamycin)
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20
Q

W/U 1-36mo old and toxic appearing w/ fever w/out source?

A

Admit
- CBC, Bld Cx, UA/Cx
- LP csf (1-3mos OR 3-36mo and meningeal S/S)
- Stool Cx - (Diarrheal - WBC count)
- CXR - (if >102.1 + WBC >20k)
ABX after labs drawn (ceftriaxone or cefotaxime)

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21
Q

MC Dx of Fever of Unknown origin?

A

MC - Occult infections

  • Inflammatory disease
  • Malignancy
  • No Dx
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22
Q

W/U FUO >14 or >1wk admit?

A 
CBC w/ diff
ESR/CRP
LFTs
UA/Cx - Bld Cx - CSF/Cx
ANA - antinuclear antibody
RF - rheumatoid factor
C3, C4, CH50 complement - serum complement
CXR
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23
Q

MC infections causing FUO?

A

UTI’s
URI
Osteomyelitis
Occult abscesses

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24
Q

MC inflammatory diseases causing FUO?

A

JRA (MC)
SLE
Vasculitis

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25
Q

MC malignancies causing FUO?

A

Leukemia

Lymphoma

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26
Q

<5yo PEDs w/ SCA have increased risk for what? Why?

A

Bacteremia - impaired opsonization fx of spleen

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27
Q

Mgmt of SCA and severe illness w/ fever?

A

Admit if WBC <5 or >30k

Empiric Abx

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28
Q

Mgmt of SCA and fever outpt?

A

Blood Cx, Ceftriaxone

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29
Q

What conditions are MC w/ SCA? Organisms?

A

Osteomyelitis from Salmonella or S. Aureus

blood cx not always positive

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30
Q

Eval of FUO includes?

A

CBC, Bld Cx, UA/Cx, CMP, ESR
HIV, PPD
CXR

31
Q

High fever w/ rapid defervescence may indicate?

A

JRA, lymphoma, TB

32
Q

High fever w/ elevated baseline may indicate?

33
Q

High fever w/out fluctuations may indicate?

34
Q

Fever recurring over long periods of time may indicate?

A

CNS or metabolic cause

35
Q

FUO outpt mgmt?

A

No Abx until cause identified

Fever diary - no antipyretics

36
Q

When does in-utero infant receive maternal antibodies

A

Third trimester (pre-term infants don’t receive all mom’s antibodies)

37
Q

SIRS stands for?

A

Systemic inflammatory response syndrome

38
Q

SIRS criteria?

A

2 or more

  • TEMP - (<96.8 or >100.4)
  • TACHYPNEA
  • HR - (>90bpm or >2 SD for age)
  • WBC - (<4k or >12k or bands >10%)
39
Q

Sepsis is defined as?

A

SIRS due to infection

40
Q

Severe sepsis is defined as?

A

1 or more end organ compromise

41
Q

Septic Shock is defined as?

A

Severe infection > HOTN and inadequate organ perfusion.

42
Q

Meningitis is defined as?

A

Inflammation of meninges by pathogen

43
Q

Aseptic meningitis refers to what?

A

Viral meningitis

44
Q

Meningitis after surgery or head trauma is most likely due to what organism?

A

Staphylococcal

45
Q

Partially treated meningitis refers to?

A

Abx TXT prior to CSF LP - Negative Cx but findings of infection.

46
Q

Viral meningitis is commonly caused by?

A

Enteroviruses and parechoviruses

- HSV, EBV, CMV, HIV, Mumps virus (unvaccinated)

47
Q

Pathogens that cause rapid onset meningitis?

A

S. Pneumo or N. Meningitides

48
Q

Presentations of meningitis

A

URI is common
Meningeal inflammation symptoms
Fever

49
Q

Meningeal inflammation symptoms are?

A 
May not be present w/ young infants
HA-photophobia
Irritable
N/V
Nuchal rigidity
Lethargy
50
Q

> 12mo old w/ meningitis PE tests used to ID?

A

Kernig sign

Brudzinski sign

51
Q

Meningitis causes what type of focal neurologic signs?

A

Shock, Seizures, coma
Increased ICP
Arthralgia/myalgia

52
Q

Blood/skin manifestations ass/w meningitis?

A

Petechial or purpuric lesions

53
Q

Meningeal - ICP manifestations?

A

HA, diplopia, vomiting

Bulging fontanelle

54
Q

Meningeal - ICP w/ brain herniation manifestations?

A 
Ptosis
6th nerve palsy
anisocoria
bradycardia
HTN
Apnea
55
Q

CNS abscess are Dx via?

56
Q

TXT of meningitis due to N. meningitidis and H. Influenzae?

A

Cefotaxime OR ceftriaxone

57
Q

Infants <2mo add what antibiotic for listeria monocytogenes

A

Ampicillin
+
Cefotaxime OR ceftriaxone

58
Q

Txt duration of N. meningitidis?

59
Q

Txt duration of H. Influenzae?

60
Q

Txt duration of S. pneumonia?

61
Q

H. Influenzae meningitis TXT?

A

Cefotaxime OR ceftriaxone

Initiate Dexamethasone w/ 1st dose Abx

62
Q

Newborn (0-28d) TXT for meningitis

A

Cefotaxime OR ceftriaxone + ampicillin +- gentamicin
(ALT - Ampicilin + gentamicin)
(ALT - Ampicillin + Ceftazidime)

63
Q

Infant and toddler (1mo-4yo) TXT for meningitis

A

Cefotaxime OR ceftriaxone + vancomycin (ALT rifampin)

64
Q

Children/adolescents/adults 5-13yo) TXT for meningitis

A

Cefotaxime OR ceftriaxone + vancomycin

ALT - Cefepime OR ceftazidime

65
Q

Complications to PVT w/ meningitidis?

A 
Hearing loss
Shock/arrythmia
DIC - SIADH
Increased ICP/ Cerebral edema
Seizure/coma
66
Q

Before disposition of PEDs w/ meningitidis you must obtain?

A

Hearing evaluation and at follow up appointment

67
Q

Meningitidis ass/w subdural effusions are correlated to what organisms?

A

S. Pneumo and H. Influenzae

68
Q

When should you drainage of subdural effusions only occur if?

A

Increased ICP present or Focal neuro S/S

69
Q

Encephalitis is defined as?

A

Inflammed brain parenchyma leading to cerebral dysfx

70
Q

MC organisms ass/w encephalitis?

A

Viruses - HSV, Arbovirus, Enteroviruses

71
Q

Encephalitis presents as?

A

Prodrome (Sore throat, fever, HA, Abd complaints > then lethargy, behavior change, neuro deficits)
Seizures
Maculopapular rash

72
Q

Complications during Encephalitis?

A

Coma
Transverse myelitis
Anterior horn cell disease
Peripheral NP

73
Q

Complications after Encephalitis recovery?

A 
Paresis or spasticity
Cognitive impairment
Weakness
Ataxia
Recurrent seizures

Phase 2 PEDs (23 decks)

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