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Senoir 21-2 > PEDS Fever > Flashcards

PEDS Fever Flashcards

1
Q

Define fever

A

Fever: >100.4º F (>38ºC)

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2
Q

Define Hyperpyrexia

A

> 40C/104 F = hyperpyrexia

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3
Q

Lethal fever

A

Body temperatures rarely rise above lethal levels (107.6F) in a neurologically intact child
Exception: heat stroke

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4
Q

Pattern of fever

A

Pattern of fever : Diurnal
Lower AM
Higher PM (late afternoon)

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5
Q

4 MC cause of Fever

A

Most common: Infectious
Inflammatory
Neoplastic
Miscellaneous

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6
Q

How does fever effect the SZR threshold

A

Fever lowers seizure threshold

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7
Q

An inconsolable child

Think

A

Meningitis

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8
Q

MGMT of fever in >2 mo

A

HYDRATION!!

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9
Q

Define fever of short duration

A

Localized Signs and Symptoms

Can establish diagnosis by clinical history and exam

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10
Q

Define fever without a focus

A

Often in children <3yrs of age

H&P fails to establish cause

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11
Q

Define Fever of unknown origin

A

Fever >8* days without identified etiology despite history, physical exam, lab tests

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12
Q

Is Teething assoc with fever

A

Teething rarely associated w/ temp >100.4º F

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13
Q

If a less than 28 day old pt presents with fever

Think

A

Consider Herpes Simplex Virus in <28 days

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14
Q

Most common cuase of fever in 0-3 months olds

A

UTI- E.coli

Or bacteremia/. Meningitis- E. coli or Group B strep

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15
Q

Does petechia blanch

A

Nope

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16
Q

MGMT for fever without focus in less than 1 mo

A

Hospitalize!

CBC, blood culture, UA/culture
LP for CSF analysis
CXR (if respiratory concerns)
Stool cultures (if GI concerns)

Empiric antibiotics:
-ampicillin/gentamycin or other combo abx regimen
(go by the local hospital antibiogram or peds guidance)

Don’t waste time trying to differentiate viral vs bacterial!

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17
Q

MGMT for fever without focus in 1mo-3 years

A

Hospitalize

CBC, blood culture, UA/culture
Strongly consider LP (if 1-3 mos old)

LP in 3-36mos old usually only if neurologic/meningeal signs

If respiratory signs, or fever with elevated WBC (>20K) = CXR

Consider stool cultures for GI symptoms

Treatment: Empiric ceftriaxone or cefotaxime

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18
Q

What is the most common reason 3 year olds see medical care

A

Fever

19
Q

W/u for fever over 3 yo

A

UA/culture for urinary symptoms

Stool studies for bloody/mucus diarrhea or >2 weeks

CXR, PCR testing if exam is not reliable or changes management

20
Q

Common virus in the summer/ early fall

A

enteroviruses (coxsackieviruses)

Present as HFM, herpangina, aseptic (viral) meningitis

21
Q

Common viruses in the winter

A

RSV, influenza, Norovirus, Rotavirus

Bronchiolitis (RSV, influenza), diarrheal illness (Norovirus, Rotavirus)

22
Q

Common virus in the fall

A

Parainfluenza

->Croup

23
Q

MC bacterial infections in peds

A

Most common: acute otitis media (AOM), streptococcus pharyngitis, PNA, UTI

24
Q

Is step pharyngitis common in age under 3

A

NO

25
Q

If no obvious source of inception in a kid with fever

Think

A

UTI

26
Q

Postive blood culutre in a well appearing child with no source

Think

A

Bacteremia

27
Q

MC agent of bacteremia

A

Pneumococcus

28
Q

Define fever of unknown origin

A

Children w/temp >100.4 F documented with no known cause lasting longer than 8 days

Duration of fever is main difference between this and fever without a source—FWS can progress!

29
Q

Peds pts presents with Headache, nausea, vomiting, anorexia, photophobia, restlessness, altered state of consciousness and irritability

+ Fever, neck pain and rigidity, focal neurologic deficits, seizures, obtundation and coma

Think

A

Meningitis or encephalitis

30
Q

What two defects have an increased risk of meningitis

A 
Complement defects (C5-8)
Splenic dysfunction (sickle cell or asplenia)
31
Q

What is the mc cause of bacterial meningitis

A

Sterp pneumo

32
Q

What is the most common meningitis cause from daycares

A

Neisseria meningitis

33
Q

What is the rash of neisseria

A

(meningococcemia)—petechial rash, evolves into ecchymotic and purpuric lesions

34
Q

Clincal manifestations for meningitis

A

Fever
URI S/S

GI S/s

Lethargy/ irratiability

DIC, purpura, coma, death

HOTN, tachycardia

NUCHAL RIGIDITY

HA, emesis, bulging fontanels

SZR? AMS

35
Q

What is the most important step to Dx meningitis

A

LP

36
Q

C/I for LP

A

Evidence of increased ICP (other than bulging fontanelle)

Papilledema, focal neuro findings, coma, h/o hydrocephalus, h/o prior neurosurgical procedure to include CSF shunt placement

Severe cardiopulmonary compromise

Infection of skin overlying site of LP

Thrombocytopenia is a RELATIVE contraindication

If LP delayed, then antibiotic therapy should be initiated

37
Q

What are the recommended ABX for meningitis

A

Vancomycin combined with 3rd generation cephalosporin !!(ceftriaxone)

  • Ceftriaxone (50mg/kg/dose Q12h)
  • Vancomycin (60mg/kg/day divided Q6-8h, follow troughs)

PCN or cephalosporin allergy?—can use meropenem

38
Q

What is the sequalae of treating meningitis

A

deafness, seizures, learning disabilities, blindness, paresis, ataxia, or hydrocephalus

SIADH

39
Q

MC viruses of encephalitis

A

Enteroviruses
Arboviruses
Herpesviruses

40
Q

What is the MC arbovirus that causes encephalitis

A

West Nile

41
Q

Presentation for encephalitis

A

Prodrome
Several days of nonspecific symptoms such as
-Sore throat, fever, headache, and abdominal complaints

Followed by the characteristic symptoms of progressive lethargy, behavioral changes, and neurologic deficits

Seizures are common at presentation

Maculopapular rash

42
Q

LABS for encephalitis

A

Serologic studies
-Arboviruses (including West Nile virus, at risk by hx), Epstein-Barr virus (EBV), Mycoplasma pneumoniae, cat-scratch disease, and Lyme disease

Test for less common pathogens as indicated by the travel, social, or medical history

Polymerase chain reaction (PCR) tests for HSV, enteroviruses, West Nile virus, and other viruses

Viral stool cultures & nasopharyngeal swab

43
Q

MGMT for encephalitis

A

Supportive care

ICU

44
Q

Séqueles of Encephalitis

A

Motor incoordination, seizures, total or partial deafness, and behavioral disturbances

Visual disturbances from chorioretinopathy and perceptual amblyopia

Senoir 21-2 (77 decks)

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