Child with Fever

Question 1

What key history would you obtain from a parent who states their child has a fever?

Answer 1

Severity
Depression
Associated localizing symptoms
Appetite
Rash
Sick contacts
Day care
Immunizations
Past history

Question 2

What key physical exam would you perform on a child with fever?

Answer 2

Vital signs
HEENT
Neck exam
Heart exam
Lung exam
Abdominal exam
Skin exam

Question 3

20-day-old M presents for fever, decreased breastfeeding and lethargy. He was born at 36 weeks as a result of premature rupture of membranes. Differentials?

Answer 3

Neonatal sepsis
Meningitis
Pneumonia
UTI

Question 4

20-day-old M presents for fever, decreased breastfeeding and lethargy. He was born at 36 weeks as a result of premature rupture of membranes. Differentials: neonatal sepsis, meningitis, pneumonia, UTI. Workup?

Answer 4

Physical exam
CBC, electrolytes
UA, urine culture
Blood culture
CXR
LP

Question 5

3 yo M presents with two day history of fever and pulling on his right ear. He is otherwise healthy and his immunizations are up to date. His older sister recently had a cold. The child attends a day care center. Differentials?

Answer 5

Acute otitis media
URI
Meningitis
UTI

Question 6

3 yo M presents with two day history of fever and pulling on his right ear. He is otherwise healthy and his immunizations are up to date. His older sister recently had a cold. The child attends a day care center. Differentials: acute otitis media, URI, meningitis, UTI. Workup?

Answer 6

Physical exam (including pneumatic otoscopy)
CBC
UA

Question 7

12 month old M presents with fever for the last two days accompanied by a maculopapular rash on his face and body. He has not yet received the MMR vaccine. Differentials?

Answer 7

Measles (or other viral exanthem)
Rubella
Roseola
Erythema infectiosum (Fifth disease)
Varicella
Scarlet fever
Meningitis

Question 8

12 month old M presents with fever for the last two days accompanied by a maculopapular rash on his face and body. He has not yet received the MMR vaccine. Differentials: measles, rubella, roseola, erythema infectiosum (Fifth disease), varicella, scarlet fever, meningitis. Workup?

Answer 8

Physical exam
CBC
Viral antibodies/titers
Throat swab for cultures
LP

Question 9

4 yo M presents with diarrhea, vomiting, lethargy, weakness and fever. The child attends a day care center where several children have had similar symptoms. Differentials?

Answer 9

Gastroenteritis (viral, bacterial, parasitic)
Food poisoning
UTI
URI
Volvulus
Intussusception

Question 10

4 yo M presents with diarrhea, vomiting, lethargy, weakness and fever. The child attends a day care center where several children have had similar symptoms. Differentials: gastroenteritis (viral, bacterial, parasitic), food poisoning, UTI, URI, volvulus, intussusception. Workup?

Answer 10

Physical exam
Stool exam and culture
CBC, electrolytes
UA, urine culture
AXR