PEDS Fever

Question 1

Define fever

Answer 1

Fever: >100.4º F (>38ºC)

Question 2

Define Hyperpyrexia

Answer 2

> 40C/104 F = hyperpyrexia

Question 3

Lethal fever

Answer 3

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

Question 4

Pattern of fever

Answer 4

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

Question 5

4 MC cause of Fever

Answer 5

Most common: Infectious
Inflammatory
Neoplastic
Miscellaneous

Question 6

How does fever effect the SZR threshold

Answer 6

Fever lowers seizure threshold

Question 7

An inconsolable child

Think

Answer 7

Meningitis

Question 8

MGMT of fever in >2 mo

Answer 8

HYDRATION!!

Question 9

Define fever of short duration

Answer 9

Localized Signs and Symptoms

Can establish diagnosis by clinical history and exam

Question 10

Define fever without a focus

Answer 10

Often in children <3yrs of age

H&P fails to establish cause

Question 11

Define Fever of unknown origin

Answer 11

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

Question 12

Is Teething assoc with fever

Answer 12

Teething rarely associated w/ temp >100.4º F

Question 13

If a less than 28 day old pt presents with fever

Think

Answer 13

Consider Herpes Simplex Virus in <28 days

Question 14

Most common cuase of fever in 0-3 months olds

Answer 14

UTI- E.coli

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

Question 15

Does petechia blanch

Answer 15

Nope

Question 16

MGMT for fever without focus in less than 1 mo

Answer 16

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!

Question 17

MGMT for fever without focus in 1mo-3 years

Answer 17

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

Question 18

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

Answer 18

Fever

Question 19

W/u for fever over 3 yo

Answer 19

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

Question 20

Common virus in the summer/ early fall

Answer 20

enteroviruses (coxsackieviruses)

Present as HFM, herpangina, aseptic (viral) meningitis

Question 21

Common viruses in the winter

Answer 21

RSV, influenza, Norovirus, Rotavirus

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

Question 22

Common virus in the fall

Answer 22

Parainfluenza

->Croup

Question 23

MC bacterial infections in peds

Answer 23

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

Question 24

Is step pharyngitis common in age under 3

Answer 24

NO

Question 25

If no obvious source of inception in a kid with fever Think

Answer 25

UTI

Question 26

Postive blood culutre in a well appearing child with no source Think

Answer 26

Bacteremia

Question 27

MC agent of bacteremia

Answer 27

Pneumococcus

Question 28

Define fever of unknown origin

Answer 28

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!

Question 29

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

Answer 29

Meningitis or encephalitis

Question 30

What two defects have an increased risk of meningitis

Answer 30

``` Complement defects (C5-8) Splenic dysfunction (sickle cell or asplenia) ```

Question 31

What is the mc cause of bacterial meningitis

Answer 31

Sterp pneumo

Question 32

What is the most common meningitis cause from daycares

Answer 32

Neisseria meningitis

Question 33

What is the rash of neisseria

Answer 33

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

Question 34

Clincal manifestations for meningitis

Answer 34

Fever URI S/S GI S/s Lethargy/ irratiability DIC, purpura, coma, death HOTN, tachycardia NUCHAL RIGIDITY HA, emesis, bulging fontanels SZR? AMS

Question 35

What is the most important step to Dx meningitis

Answer 35

LP

Question 36

C/I for LP

Answer 36

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

Question 37

What are the recommended ABX for meningitis

Answer 37

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

Question 38

What is the sequalae of treating meningitis

Answer 38

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

Question 39

MC viruses of encephalitis

Answer 39

Enteroviruses Arboviruses Herpesviruses

Question 40

What is the MC arbovirus that causes encephalitis

Answer 40

West Nile

Question 41

Presentation for encephalitis

Answer 41

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

Question 42

LABS for encephalitis

Answer 42

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

Question 43

MGMT for encephalitis

Answer 43

Supportive care | ICU

Question 44

Séqueles of Encephalitis

Answer 44

Motor incoordination, seizures, total or partial deafness, and behavioral disturbances Visual disturbances from chorioretinopathy and perceptual amblyopia