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Clin Med II > Pediatric Fever- Ross > Flashcards

Pediatric Fever- Ross Flashcards

1
Q

What is a peds fever defined as

A

<28 days= 100.4

>28 days= 100.8

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2
Q

Can bundling cause a fever

A

no

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3
Q

Can teething cause a fever

A

no

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4
Q

What is the most effective way to check peds temp

A

rectal

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5
Q

What are the causes of serious bacteral infections in young infants

A

UTI
Cellulitis
Bacteremia
Bone and joint infxn

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6
Q

What are the causes of invasive bacterial infxn in young infants

A 
Meningitis
Pneumo
Sepsis
Osteomyelitis
Bacterial enteritis
Pyleonephritis
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7
Q

What is the most common source of infxn in pts less than 90 days old

A

UTI

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8
Q

What is the most common causative agent of bacterial infxn in infants <90 days old

A

E. coli

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9
Q

What causes the majority of fevers in infants

A

viral pathogens

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10
Q

What viral infxn is important to rule out in infants

A

herpes

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11
Q

What are the most common bacterial causes of fever for pts 0-28 days

A 
GBS
Listeria
E. coli
C. trachomatis
N. gon
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12
Q

What are the most common viral cause of fever in 0-28 days

A 
HSV
varicella
enteroviruses
RSV
Flu
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13
Q

What are the most common bacterial causes of fever in pts 1-3 months

A

H. flu
S. pneumo
N. men
E. coli

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14
Q

What are the most common viral causes of fever in pts 1-3 months

A

varicella
enterovirus
RSV
Flu

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15
Q

What are the most common bacterial causes of fever in pts 3-36 months

A

S. pneumo
N. men
E. coli

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16
Q

What are the most common bacterial causes of fever in pts 3 years to adulthood

A

S. pneumo
N. men
E. coli
GABS

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17
Q

What are the gross motor milestones for a one month old

A

raises head slightly from a prone position

makes crawling movements

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18
Q

What are the visual/motor/problem solving milestones for a 1 month old

A

Visually fixes

Has a tight grasp and follows objects to midline

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19
Q

What are the gross motor milestones of a 2 month old

A

holds head in midline

lifts chest off table

20
Q

What are the language/social/ and adaptive milestones of a 2 month old

A

smiles socially

21
Q

What are the visual/motor/problem solving milestones for a 4 month old

A

reaches with arms in unison

brings hands to environment midline

22
Q

What are the gross motor milestones of a 6 month old

A

sits unsupported

puts feet in mouth in supine position

23
Q

What are the language/social and adaptive milestones of a 6 month old

A

babbles

recognizes strangers

24
Q

Why aren’t infants that breast feed completely immunocompetent

A

They have decreased opsonin capabilities, leading to decreased macrophage and neutrophil fxn
poor Ig response to encapsulated orgs

25
Q

When is a pt at highest risk of SBIs

A

4 weeks old or less (first month of life)

26
Q

How do you manage febrile neonates with no known cause

A

admit and give a full work up - you won’t get clues from physical exam and labs will be negative

27
Q

When does as pt become risk stratifiable (based on labs or physical exam)

A

At one month old

28
Q

What is the work up for febrile neonates

A 
UA
CBC
BC
LP
Admission and call to neotalogist (with ABX on board)
29
Q

What protocols can be used to risk stratify an infant

A

Philadelphia protocol
Rochester protocol
Boston protocol

30
Q

Find out if we need to know the protocols (on back of notecard to refer to if needed)

A
31
Q

At what age can you start using risk stratification tools for febrile bbs

A

28 days old

32
Q

What should you always do if you are giving an infant antibiotics for fever with unknown eitology

A

LP

33
Q

What is something all protocols require when risk stratifying febrile babies

A

Get WBC -> pos if <5000 or >15000 or ANC >1500
Do UA- + if >10WBC/HPF
CXR if resp sx
LP- + if >10WBC mm3

34
Q

What are the low risk screen questions that can be answered to find out if a pt needs LP

A

REceived at least one pneumococcal vaccine and H flu vaccine within 2 months of life
No chronic med conditions
No hx or exam findings suggesting meningitis

35
Q

If an infant has a fever and it seems to be obvious broncholitis, how do you follow up

A

Still do a UA and 24 hour follow up to confirm

36
Q

What are the recommended emperic tx abx for infants (29-59 days old)

A

Ceftriaxone or cefotaxime (s.pneumo, h. flu, ecoli)
Ampicillin (listeria and GBS)
Vanco for MRSA
Acyclovir for ALL

37
Q

What should you be checking in infants that are >60 days old and febrile with no obvious source

A

Immunization status
UA always even if you think bronchiolitis
CBC before considering LP

38
Q

How do you tx febrile infants <60 days old that aren’t vaccinated

A

tx them as though they have pneumococcal meningitis->admit pt

39
Q

What is the step by step protocol method of risk strat for pediatric fever

A 
Follow each step in order:
Well appearing with normal peds assessment triangle ->
Age >28 days old ->
Leukocyturia neg ->
PCT <0.5 ng/mL ->
CRP <20 ng/L and ANC <10,000 mm3 ->
Then they are a low risk pt
40
Q

How do you use the step by step protocol to risk stratify

A

If you answer yes to any of the steps the pt fails the protocol and needs a work up

41
Q

What is the age criteria for the Rochester Criteria

A

<60 Days

42
Q

What is the hx for the rochester criteria

A

Term infant
No perinatal ABX
No underlying dx
No hospitalization longer than mom

43
Q

What are the physical exam criteria for the rochester criteria

A

Well-appearing

No ear, soft tissue, or bone infxn

44
Q

What are the lab parameters that define a low risk pt according to rochester criteria

A

WBC>5000, <15000
ANC <1500
UA

45
Q

Which parameter allows you to forego LP on low risk pts

A

rochester criteria

46
Q

What is one of the earliest signs of distress in peds pts

A

resistance to attempts to socialize

Clin Med II (8 decks)

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