Peds 10 Flashcards
Holly is a former full-term, previously well, fully immunized, 6-month-old girl with a two-day history of high fever and poor appetite. On exam she is tachycardic, appears dehydrated, and is poorly consolable without an apparent source for her fever. What labs do you order to further evaluate?
CBC w diff, blood culture, UA, urine culture
+/- LP (if cannot r/o meningitis on physical exam)
Holly is a former full-term, previously well, fully immunized, 6-month-old girl with a two-day history of high fever and poor appetite. On exam she is tachycardic, appears dehydrated, and is poorly consolable without an apparent source for her fever.
Dipstick demonstrates positive nitrite, leukocyte esterase, and blood
Dx?
pyelonephritis (upper UTI)
What lumbar puncture results would be indicative of bacterial meningitis?
glucose - low protein - elevated WBC - elevated predominant WBC type - Polymorphonuclear cells gram stain +/-
What lumbar puncture results would be indicative of viral meningitis?
glucose - normal protein - normal or elevated WBC - elevated predominant WBC type - lymphocytes gram stain -
How would you treat UTI or pyelonephritis?
IV and PO formulations
IV ceftriaxone
Cephalexin (Keflex)
What’s a follow-up imaging for pyelonephritis?
Renal and bladder ultrasound
A 6-month-old vaccinated infant arrives in the ED with a 12-hour history of poor feeding, emesis, and irritability. On exam, she is ill-appearing with T 39.2 C, P 160 bpm, R 40 bpm, BP 80/50 mmHg. CBC shows WBC 11.2, Hgb 13.5, Plt 250. Urinalysis shows > 100 WBC per hpf, positive leukocyte esterase, and positive nitrites. She has no history of prior urinary tract infection. Chest x-ray is negative. Urine and blood cultures are pending. After bringing her fever down, she is still uninterested in drinking, but her exam improved, and you are confident she does not have meningitis, so an LP is not performed. Which of the following is the best next step in management?
A. Intravenous ceftriaxone B. Intravenous ciprofloxacin C. Intravenous piperacillin + tazobactam D. Oral ampicillin E. Oral doxycycline
A. Intravenous ceftriaxone
A 3-month-old male presents to the ED with a fever that started the previous day. Mother reports that he is fussy and has decreased oral intake. He has had five fewer diaper changes than usual. He has no vomiting, diarrhea, or respiratory difficulty. On physical exam his temperature is 101.6 F, pulse 110 bpm, RR 24 bpm, and BP 95/67 mmHg. The baby seems irritable and is not consolable by the parent. HEENT exam is significant for dry mucous membranes. Other than his irritability, the rest of the physical exam is unremarkable. CBC shows WBC 3.5, but is otherwise normal. BMP is within normal limits. Urinalysis shows positive leukocyte esterase, positive nitrite, and WBCs > 10/hpf. An LP is performed, and urine and CSF culture results are pending. The patient is placed on IV fluids and is started on cefotaxime. What is the next best step in evaluation?
A. Intravenous pyelogram B. Kidney-ureter-bladder (KUB) x-ray C. Change antibiotic to oral ampicillin D. Renal bladder ultrasound E. VCUG
D. Renal bladder ultrasound
A 10-day-old boy is brought to the ED by his mother because of fever. Mother describes that the baby has been “sleepy” and feeding less vigorously than in the previous two days. She believes his urine output has also decreased. His birth history is notable for prolonged membrane rupture (about 32 hours), and maternal fever at the time of delivery. Prenatal and neonatal ultrasound revealed bilateral hydronephrosis. On exam, the infant is sleepy with a temperature of 38.5 C. A blood sample is sent for CBC, BMP, and culture. Attempts are made to obtain CSF and urine for analysis and culture, but only very small volumes of these fluids are obtained. Volume resuscitation is started. Chest x-ray is performed with indeterminate results. What is the most appropriate next step?
A. Admit for observation and continue supportive care
B. Attempt to obtain larger samples. Antibiotics should not be started until all needed results are pending.
C. Send samples for culture and begin parenteral antibiotic treatment
D. Send samples for gram stains and begin parenteral empiric antibiotic treatment
E. Send the urine for urinalysis and the CSF for cell count, glucose and protein and begin parenteral antibiotic therapy
C. Send samples for culture and begin parenteral antibiotic treatment
A 6-month-old female is brought into the pediatrician’s office for three days of high fever, fussiness, and decreased appetite. The patient has not had any upper respiratory tract symptoms, vomiting, diarrhea, or rash. On physical exam the patient is fussy, has a RR of 28 bpm and a pulse of 160 bpm. She is febrile to 102.8 F (rectal). The patient is alert, not toxic appearing, and fully moving all extremities. Apart from her vital signs, no other significant exam findings are noted. A CBC demonstrates leukocytosis of 17.0 cells x 103 / µL with elevated bands. Of the following, which diagnosis is most likely?
A. Acute otitis media B. Bacterial meningitis C. Measles D. Roseola E. Urinary tract infection
E. Urinary tract infection
A 6-month-old female presents to the Emergency Department because of decreased appetite and fussiness for four days and fever for one day. She had two episodes of non-bilious, non-bloody emesis today with decreased urine output. She was born at 40 weeks gestation. Pregnancy was uncomplicated and this is her first illness. Her vaccinations are up to date. She is non-toxic appearing but fussy. Temperature is 101 F. Her physical examination is non-focal. Which of the following is the most appropriate to evaluate her risk of urinary tract infection at this time?
A. Basic Metabolic Panel B. Midstream clean catch urine collection C. Renal bladder ultrasound D. Urinary catheterization E. Voiding cystourethrogram (VCUG)
D. Urinary catheterization
Holly is a former full-term, previously well, fully immunized, 6-month-old girl with a two-day history of high fever and poor appetite. On exam she is tachycardic, appears dehydrated, and is poorly consolable without an apparent source for her fever. What 7 differentials come to mind?
- Sepsis
- Meningitis
- Pneumonia
- Encephalitis
- Bacteremia
- AOM
- UTI
- Viral URI
How would a positive Kernig sign present?
Resistance to extension of the knee
How would a positive Brudzinski sign present?
Flexion of hip and knee in response to flexion of the neck
What CBC results would suggest a bacterial infection?
Elevated WBCs with “left shift” (inc polys and bands)
