Nelson - Ch. 177 Fever Without a Focus

Question 1

Fever without a focus refers to

Answer 1

Rectal temp of 38C or higher as sole presenting feature

Question 2

MC serious bacterial infection in 1-3 month infants

Answer 2

UTI/pyelonephritis

Question 3

MC pathogen in infants 1-3 months old

Answer 3

E. coli

Question 4

Hyperpyrexia is defined by a temp of

Answer 4

> 40C

Question 5

Patients with sickle cell disease are at high risk for developing sepsis, pneumonia, and meningitis caused by what organism

Answer 5

S. pneumoniae

Question 6

Patients with complement or properdin deficiency are at high risk for sepsis caused by

Answer 6

N. meningitidis

Question 7

Patients with AIDS are at high risk of infection from which organisms (3)

Answer 7

1) S. pneumoniae 2) H. influenza 3) Salmonella

Question 8

Patients with central venous lines are at high risk for developing infection from what organisms (3)

Answer 8

S. aureus, coagulase-negative staphylococci, Candida

Question 9

Patients with malignancy have high risk for developing bacteremia caused by what organisms (3)

Answer 9

G- enteric bacteria, S. aureus, coagulase-negative staphylococci

Question 10

Patients with malignancy have high risk for developing fungemia caused by what organisms (2)

Answer 10

Candida, Aspergillus

Question 11

In general, neonates who have a fever and do not appear ill have a ___% risk of having a serious bacterial infection

Answer 11

7

Question 12

Neonates are mainly at high risk for late-onset neonatal bacterial disease caused by (3)

Answer 12

1) Group B strep 2) E. coli 3) Listeria monocytogenes

Question 13

If excessive clothing and blankets encasing the infant are suspected of falsely elevating the body temperature, then the excessive coverings should be removed and the temp retaken in ___

Answer 13

15-30min

Question 14

T/F All febrile neonates should be hospitalized

Answer 14

T, blood, urine, and CSF should be cultured and the child should receive empirical IV antibiotics

Question 15

___ should be started as treatment in neonates if HSV infection is suspected

Answer 15

Acyclovir

Question 16

Large majority of children with fever without localising signs in the 1-3 months age group likely have what illness

Answer 16

Viral syndrome

Question 17

Pyelonephritis is the MC serious bacterial infection in 1-3 months age group and is more common in what subgroup

Answer 17

1) Uncircumcised boys 2) Infants with urinary tract abnormalities

Question 18

MC pathogen identified in bacteremic infants

Answer 18

E. coli

Question 19

Organisms most frequently identified in bacteremic infants 1-3 months after E. coli

Answer 19

Group B streptococcus and S. aureus

Question 20

In 1-3 months, most significant blood cultures turn positive within

Answer 20

24 hrs

Question 21

In 1-3 months, ___% of the most significant blood cultures turn positive within 48 hours

Answer 21

99

Question 22

Recommended initial antimicrobial regimen for ill-appearing infants without focal findings to cover for the usual bacterial pathogens causing illness in very young infants

Answer 22

Ampicillin + either ceftriaxone or cefotaxime

Question 23

Antimicrobial agent to be included in initial regimen for ill-appearing infants if meningitis us suspected because of CSF abnormalities

Answer 23

Vancomycin (to treat possible penicillin-resistant S. pneumoniae)

Question 24

T/F Infants in whom a virus has been detected are at low or no risk of a serious bacterial infection

Answer 24

T

Question 25

___ are the cause of the vast majority of fevers in 3-36 month old

Answer 25

Viral infections

Question 26

Account for most cases of occult bacteremia in 3-36 month olds (3)

Answer 26

1) S. pneumoniae 2) N. meningitides 3) Salmonella

Question 27

Risk factors indicating increased probability of occult bacteremia

Answer 27

1) Temp ≥39C 2) WBC ≥15,000/uL 3) Elevated ANC, ABC, ESR, or CRP

Question 28

T/F Socioeconomic status appear to affect the risk for occult bacteremia

Answer 28

F

Question 29

T/F Without therapy, occult bacteremia caused by pneumococcus can resolve spontaneously without sequelae

Answer 29

T, in 30-40%

Question 30

T/F Hib bacteremia is characteristically associated with a higher risk for localized serious infection than is bacteremia caused by S. pneumoniae

Answer 30

T

Question 31

FUO is defined as fever documented by a healthcare provider and for which the cause could not be identified after

Answer 31

3 weeks of evaluation as an outpatient OR 1 week of evaluation in the hospital

Question 32

In cases of drug fever, discontinuation of the drug is associated with resolution of the fever generally within

Answer 32

72 hours to as long as 1 month

Question 33

Connective tissue disease associated most commonly with FUO

Answer 33

JIA and SLE

Question 34

FUO lasting >6 months is uncommon in children and suggest ___ diseases (3)

Answer 34

1) Granulomatous 2) Autoinflammatory 3) Autoimmune

Question 35

T/F Immunization of dogs against specific disorders such as leptospirosis can prevent canine disease and prevents the animal from carrying and shedding leptospires and transmitting to household contacts

Answer 35

F, may still carry, shed, and transmit

Question 36

A history of ingestion of rabbit or squirrel meat might provide a clue to the diagnosis of

Answer 36

Tularemia

Question 37

Ingestion of ___ is a particularly important clue to infection with Toxocara canis (visceral larva migrant or Toxoplasma gondii (Toxoplasmosis)

Answer 37

Dirt

Question 38

___ conjunctivitis in a child with FUO suggests Kawasaki disease or leptospirosis

Answer 38

Bulbar

Question 39

Chorioretinitis suggests what infectious illnesses

Answer 39

1) CMV 2) Toxoplasmosis 3) Syphilis

Question 40

A clue to FUO caused by hypothalamic dysfunction is

Answer 40

Failure of pupillary constriction

Question 41

Fever resulting from ___ may be suggested by lack of tears, an absent corneal reflex, or a smooth tongue with absence of fungiform papillae

Answer 41

Familial dysautonomia

Question 42

Recurrent oral candidiasis may be a clue to various disorders of the immune system especially involving the ___

Answer 42

T lymphocytes

Question 43

Hyperactive DTRs can suggest ___ as the cause of FUO

Answer 43

Thyrotoxicosis

Question 44

Tenderness over this muscle may be a clue to sub diaphragmatic abscess

Answer 44

Trapezius

Question 45

An ANC of ___ is evidence AGAINST indolent bacterial infection other than typhoid fever

Answer 45

Less than 5000/uL

Question 46

T/F A low ESR eliminates the possibility of infection or JIA

Answer 46

F

Question 47

T/F CRP returns to normal more rapidly than ESR

Answer 47

T

Question 48

Polymicrobial bacteremia suggest (2)

Answer 48

1) Factitious self-induced infection 2) GI pathology

Question 49

Tuberculin skin testing should be performed with ID placement of how many units purified protein derivative?

Answer 49

5

Question 50

___ is useful for detecting osteomyelitis before plain roentgenograms

Answer 50

Techenetium-99m phosphate

Question 51

T/F Children with FUO have a better prognosis than do adults

Answer 51

T