Febrile Child

Question 1

What is the most common childhood CC?

in acute care

Answer 1

Febrile child

Question 2

Fever is defined as >_____F or _____C

Answer 2

100.4F or 38C

Question 3

The biggest concern of a febrile baby is ____

Answer 3

invasive bacterial infection (IBI) formerly referred to as Serious Bacterial Infection (SBI)

Question 4

Benefits of having a fever

Answer 4

inhibits growth of viruses and bacteria

controlled by the CNS

Question 5

In children, what is the standard method to take temp?

Answer 5

rectal

Oral is okay if they cooperate
Axillary is usu lower than actual (no conversion equation)
infared is sufficient

Question 6

Bacterial meningitis is MC in what part of your life?

Answer 6

within 1st mo of life

Question 7

a baby is sick within 7 days of life. How did they most likely get it?

Answer 7

vertical transmission from parents
Can be from community or hospital acquired tho

Question 8

5-10% of neonates with early onset Group B sepsis (GBS) have concurrent ______

Answer 8

meningitis

Question 9

Kids with meningitis may present with _____

Answer 9

seizures (20-50%)

Question 10

Decreased oral intake and acute change in sleep patterns can be clues to _____

Answer 10

invasive infection

Question 11

Uncircumcised baby presents with FTT, jaundice, and vomiting. What is the most likely Dx?

Answer 11

UTI

Question 12

a wheezing child most likely has what infx?

Answer 12

viral bronchiolitis

Question 13

Your preceptor tells you to check for signs of meningitis in a febrile baby. It can fully flex its head and has an unremarkable Hx. Can you rule out meningitis?

Answer 13

No, neonates with meningitis can present with full neck flexion and unremarkable history, so always maintain high index of suspicion

Question 14

No focal source is found in febrile baby <28 days. What should you order?

Answer 14

• Urinalysis and urine culture
• CBC
• Procalcitonin or CRP
• Blood Culture
• Lumbar Puncture, run CSF and culture

Lumbar puncture is to be done in all children <28 days
Low glucose and elevated WBC (pleocytosis) is indicative of infection
Run PCR to test for HSV

Question 15

What labs do you order for the CSF after doing a lumbar puncture on a baby?

Answer 15

• Low glucose and elevated WBC (pleocytosis) is indicative of infx
• PCR test for HSV

Question 16

What type of rash does meningitis cause

Answer 16

Petechial rash

Question 17

Admit a pt for at least ____hrs on empiric ABX

Answer 17

24-36

Question 18

2 MC pathogens you absolutely need to cover with ABX

Answer 18

GBS (Group B Strep)
Listeria
E coli
most S pneumonia
N meningitides

Question 19

Empiric ABX for febrile child

Answer 19

ampicillin and gentamicin
or
ampicillin and cefotaxime

Question 20

If febrile neonate is still ill-appearing after empiric ABX, add on ______

Answer 20

Acyclovir

Question 21

When can you discharge a recovering febrile neonate

Answer 21

if cultures and WU are (-)

Question 22

What CANT neonates get ceftriaxone?

Answer 22

biliary sludging -> kernicterus

Question 23

Age range for young infant

Answer 23

28-60 days

Question 24

MC cause of unexplained fever and bactermia in young infants & those 3mo-3yo

Answer 24

UTI

UTI and Bronchiolitis can occur at same time

Question 25

are young infants at higher risk for IBI if they have a confirmed viral infx? ## Footnote Invasive Bacterial Infection (IBI)

Answer 25

NO Infants 3 months or younger with confirmed viral infection are at lower risk of **IBI** when compared to kid with no identified virus

Question 26

Have high concern for septic shock if young infant presents with HR > ____ and RR > _____

Answer 26

HR > 160 RR > 60

Question 27

does bacterial meningitis show more SS in neonates or young infants?

Answer 27

neonates

Question 28

is a bulging fontanelle an early or late sign of a febrile young infant with poss meningitis

Answer 28

LATE

Question 29

The labs for a febrile neonate and young infant are the same except that you only do a lumbar puncture on a young infant if....

Answer 29

there is more than one inflammatory marker elevated

Question 30

Trmnt for febrile young infant

Answer 30

* Treat focal source of infx * ONLY US (+) -> discharge home on ABX (Cefuroxime) * ONLY CBC (+) -> consider discharge home on ABX * Well-appearing infants over 28 days old can be given single IM dose of ceftriaxone and encouraged to have 24 hour follow-up * If deciding to admit a patient, begin on empiric antibiotics and observe 24-36 hours, and discharge home if culture results are negative.

Question 31

# Febrile child 3mo - 3yo MC pathogens of bacterimia in this age group

Answer 31

1. Steptococcus pneumonia 2. H. flu type B (prior to vacc)

Question 32

# Febrile child 3mo - 3yo most common bacteria causing UTI

Answer 32

E. coli

Question 33

MC bacteria causing blood stream infx

Answer 33

Staph aureus (15%) ## Footnote associated with skin, soft tissue, or msk infx

Question 34

# Febrile child 3mo - 3yo Initial order for WU of fever and bacteremia with unknown ET

Answer 34

*Urine Analysis* (+) -> urine and blood cultures

Question 35

# Febrile 3mo - 3yo Lab findings suggestive of serious bacterial infx

Answer 35

* UA with WBCs, bacteria, or positive leukocyte esterase and nitrite findings * WBC >15K * Absolute Neutrophil Count (ANC) >10K * CRP >40mg/L * Procalcitonin > 0.5ng/mL

Question 36

Pts are demanding ABX for their non-toxic 1yo. Wdyd?

Answer 36

stand your ground and explain that empiric ABX is not reccommended for children 3mo - 3yo

Question 37

Fever of unknown origin (FUO) is defined as a fever >______C (_____F) at least once per day for ____ days with no apparent Dx after initial outpt or hospital eval.

Answer 37

38.3C (101F) 8+ days

Question 38

Most common infections that ***initially*** present as fever of unknown origin

Answer 38

Bartonellosis UTI ## Footnote Others: bacterial, fungal, viral

Question 39

MC inflammatory diseases that initially present as fever of unknwon origin

Answer 39

juvenille idiopathic arthritis SLE

Question 40

MC malignancies that initially present as fever of unknwon origin

Answer 40

leukemia lymphoma

Question 41

PE of pt with fever of uknown origin should focus on which body parts?

Answer 41

skin, lymph nodes liver, spleen eyes

Question 42

# fever of unknown origin lab orders

Answer 42

* CBC with peripheral smear * CMP * CRP * ESR * Urinalysis and blood culture * HIV serology * Hepatitis A and B serology * Tuberculosis screening tests or interferon gamma release assays * Throat culture * CMV, EBV testing * ANA * RF * Ferritin * Complement proteins

Question 43

# fever of uknown origin Imaging/study orders

Answer 43

Chest X-ray ECHOcardiography CT chest CT head→ MRI CT abdomen/pelvis PET Scan Endoscopy

Question 44

4yo child presents with: * Fever>5 days * Bilateral conjunctivitis * Oral mucosal change (strawberry tongue) * Extremity changes * Cervical Lymphadenopathy * Diffuse non-specific rash ## Footnote What infx is this most likely? why is it VITAL that you dont miss this Dx in children under 5yo

Answer 44

Kawasaki disease ## Footnote Kids get really sick, can develop heart disease due to vasculitis associated with coronary arteries, sometimes requiring heart transplants

Question 45

Treat a fever with _____

Answer 45

**_Antipyretics_** * **Acetaminophen:**10-15mg/kg every 4-6 hours * **Ibuprofen:** 10mg/kg every 4-6 hours (not indicated in children under 6 months old ## Footnote Pyretic = Feverish Antipyretics cause the hypothalamus to override a prostaglandin-induced increase in temperature. The body then works to lower the temperature, which results in a reduction in fever

Question 46

Which age grp of febrile children ALWAYS get a lumbar puncture to eval for meningitis

Answer 46

Neonates