Fever

Question 1

What is the standard urine collection method?

Answer 1

Catheter

Question 2

If these 3 findings are present on UA then you presume an UTI

Answer 2

• Positive nitrites on urine dip
• leukocyte esterase on urine dip
• > 5-10WBC/hpf on urine microscopy

Question 3

Hypothermia (<36C) in a newborn may be a sign of what?

Answer 3

sepsis

Question 4

If a newborn presents to the ER with a temp >38C what do you do?

Answer 4

• full work up

- admit on broad-spectrum IV antibiotics for at least 48 hrs

Question 5

What are the 3 gram positive pathogens that can cause UTI in peds?

Answer 5

• Enterococcus
• Staph A
• GBS (newborns)

Question 6

If glucose accounts for what % of serum should you be concerned for bacterial meningitis?

Answer 6

<40% of serum

Question 7

On urine culture what growth density threshold is positive for an UTI for the following:

percutaneous
cath
clean catch

Answer 7

• percutaneous = >1000
• cath = >10000
• clean catch = >100,000

Question 8

What is the goal in imaging for UTI?

Answer 8

identify treatable anatomic abnormalities and decrease long-term risk

Question 9

If a child-bearing mother is positive for Group B strep (GBS) what is the treatment?

Answer 9

2 doses of penicillin peri-natal

Question 10

Atypical lymphocytes may be seen in what virus?

Answer 10

EBV infection (infections mononucleosis)

Question 11

What are the 3 gram negative pathogens that can cause UTI in peds?

Answer 11

• E. coli (most common)
• Klebsiella (more in young infants)
• Proteus (more in males)

Question 12

A 3mo-3yr old should be considered for further work up if he presents with a fever that is how high?

Answer 12

> 39C (102F)

Question 13

What are the 3 common causes of serious bacterial infections in 0-3 month old? (* the most common)

Answer 13

Group B strep*
E-coli
Listeria

Question 14

If you obtain a CXR for suspected pneumonia but it comes back negative, what is one important fact to note?

Answer 14

E/o of pneumonia may be delayed by 12-24hr

Question 15

What is the most common pathogen causing bacterial infection in 1-3 month old?

Answer 15

H-flu (HIB)

*vaccinated against this at 2 mths

Question 16

What is the trend in normal range for WBC and Hct in the following age ranges:

Newborn
1mo-2yr
2yr-10yr

*Platelets are the same as adults

Answer 16

WBC and Hct are extremely high in newborns and then begin to normalize at 1mo-2yr

-Newborn
WBC = 9-30
Hct = 42-65

• 1mo-2yr
  WBC = 5-13
  Hct = 30-41

-2yr-10yr
WBC = 4-12
Hct = 33-43

Question 17

What are the trend in normal ranges for PMN, band cells, lymphocytes in the following age ranges:

Newborn
1mo-2yr
2yr-10yr

Answer 17

PMNs and band cells are extremely high in newborns.
Between 1mo-2yr lymphocytes become more prominent.
Between 2yr-10yr values begin to normalize to adult values.

-Newborn
PMN = 50-80%
Band cells = <3.5%
Lymph = 20-40%

-1mo-2yr
PMN = 20-50%
Band cells = <1%
Lymph = 40-75%

-2yr-10yr
PMN = 40-60%
Band cells = <1%
Lymph = 30-50%

Question 18

What is normal CSF blood count in the following ages:

newborn
1-3 month old
3-6 month old

Answer 18

newborn = 30
1-3 month = 10
3-6 month = 5

Question 19

What are the 4 risk factor categories for an UTI?

Answer 19

Girls < 2yr
Boys < 1yr uncirc
Boys < 6mo circ
Fever > 2d

Question 20

What is the protocol depending on the rapid dip test results?

Answer 20

positive = treat, send cx
negative = send cx, follow

Question 21

If a school age boy presents with a fever, vomiting, abdominal pain with secondary nocturnal diuresis what do you suspect?

Answer 21

UTI

Question 22

Lymphocyte count may be high in what classic infection?

Answer 22

whooping cough (pertussis infection)

Question 23

What are the 3 most common pathogens causing bacterial infections in 3-36 month old?

Answer 23

• Strep Pneumo
• Neisseria
• Staph A