Final Exam Old Material Flashcards
How is a fever defined?
T > 100.4 (38)
Define Fever without focus/fever without source
acute febrile illness of less than 1 week duration in children under 24 months of age in which fever etiology is not apparent after careful H&P
Define fever of unknown origin
Temperature greater than 38 (101) or greater on several occasions of more than 2-3 weeks duration with failure to reach a dx despite 1 week of intense investigation
How would you work up a fever in an infant aged:
29-60 days
61-90 days
90 days +
- Infants 29-60 days: if well appearing – UA, CBC
- Infants 61-90 days: UA, CBC
- Infants 90 days-24 months: UA and culture to start
What is the general approach to managing pediatric fever?
- Infants 0-4 weeks: ER referral
- ILL appearing infants 29-60 days: ER referral
- Empiric treatment is not recommended
- If immunization within past 24 hours and temp <101.5: watchful waiting
What is included in the diagnostic criteria of Kawasaki disease?
Diagnostic criteria: Fever ≥ 5 days* and ≥ four of the following five principal clinical features
- Oropharyngeal mucosal changes: strawberry tongue, oral and pharyngeal erythema
- Bilateral non-purulent bulbar conjunctivitis
- Polymorphous rash: maculopapular, erythema multiforme-like rash
- Extremity changes
- Acute: edema of hands and feet, erythema of palms and soles
- Subacute: desquamation of fingers and toes
- Cervical lymphadenopathy
Which children are at high risk for UTI?
- Females under 12 months (females 6months+ are at high risk for UTI)
- Uncircumcised males esp if fever is 102.2+ and lasts longer than 24-28 hours
Match the presentation of UTI to the age group:
- stomach discomfort, anuresis, malodor, vomiting/diarrhea, malaise, fever, diaper rash
- irritable, fever, poor feeding, pain, hypothermia, vomiting/diarrhea, cyanosis, abd distension/pain
- frequency, urgency, pain with urination, fever/chills, malaise
- Older child
- Neonate/infant
- school age/adolescents
What do you treat Pediatric UTI with?
Bactrim
Augmentin if suspicious of pyelonephritis
For what criteria would you perform a renal and bladder US?
- <2 yo w/ first UTI
- All children w/ fever and UTI or pyelonephritis
- Recurrent UTI
What is used to treat acute otitis media? When should patients start to see improvement in symptoms?
- Adults: Amoxicillin
- Peds: Amoxicillin, cephalosporin; Augmentin if amox given in the last 30 days; ceftriaxone if patient vomiting
- Should see improvement in 3 days, if don’t see improvement may try Augmentin to widen the coverage
What would be used for acute otitis media if the tympanic membrane is perforated, there is otorrhea present or patent tubes in place?
Ciprofloxacin drops
What is the “watchful waiting” criteria for acute otitis media?
- Observe, analgesics, and f/u 48-72 hrs IF
- Unilateral AOM without fever > 102.2 or severe symptoms
- 24 months, no severe symptoms
When would you start treatment right away for acute otitis media in a pediatric patient?
- < 6 months or underlying conditions
- 6 months with severe signs/sx
- 6-23 months with bilateral AOM
- Unreliable caregiver
What are the components of the CENTOR score for GAS?
- C: Absence of cough +1
- E: Exudate +1
- N: Tender anterior cervical lymphadenopathy +1
- T: Fever +1
- OR: Age modifier
- Age less than 15 +1
- Age greater than 45 -1
How would you interpret the results of the CENTOR score?
- Rapid strep if CENTOR score 2-5
- Empiric antibiotics if CENTOR score >6 (Amoxicillin)
- If rapid strep is negative, follow up with regular culture for peds - do not need to do this in adults
