1. Fever of short duration 2. Fever w/out focus 3. Fever of unknown origin

Fever Flashcards by E *

Other disease processes ass/w fever besides infection?

Rheum Dz
IBD
Kawasaki's
Poisoning
Malignancy

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> 38 Celsius is what in F’?

> 100.4

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Fever is diurnal - what times of the day?

Lower AM

Higher in PM

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Will neonates have a febrile response?

Yes/No - fever may indicate serious infection!

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<5yo will have what type of fever response?

Exaggerated (Up to 105)

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Fever response decreases when?

> 5yo = high temps may indicate severe illness

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Categories of fever?

Fever of short duration
Fever w/out focus
Fever of unknown origin

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Characteristics of Fever of short duration

Localized S/S

Dx - clinically

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Characteristics of Fever w/out focus (source)

No localizing S/S or Source
MC <3yo
Cant Dx clinically

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Characteristics of Fever of unknown origin

> 14d w/out source despite a work up
OR
1wk admit/eval

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All febrile infants <4w age req what?

Admit for empirical Abx pending Cx

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DDx of <3mo w/ fever

MC - Viral
Bacteremia
Pneumonia
Meningitis
UTI
OM/septic arthritis

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Fever for 3mo-3yrs are increased risk for what infectious pathogens?

-- Polysaccharide capsule organisms
Strep Pneumo
H. Influenza
N. Meningitidis
Non-typhoidal Salmonella

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Eyes - Alert vs Lethargic?

Alert - eyes shiny/bright and interactive

Lethargic - glassy eyes, stares vacantly

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TXT fever w/

Remove clothes/blankets
Limit physical activity
Sponge baths w/ warm water
Antipyretics

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Types of antipyretics used to TXT fever?

APAP (10-15mg/kg q4-6h)
Ibuprofen (10mg/kg q6h) - not before 6mo old
NO ASA (Reye’s syndrome)

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Teething rarely ass/w temp higher than?

> 100.4 (not that high usually)

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1st on Ddx to consider of Fever w/out source?

UTI or Pneumonia

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W/U <1mo old w/ fever w/out source?

Admit
- CBC, Bld Cx, UA/Cx
- LP csf
- CXR
ABX after labs drawn (Ampicillin/gentamycin)

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W/U 1-36mo old and toxic appearing w/ fever w/out source?

Admit
- CBC, Bld Cx, UA/Cx
- LP csf (1-3mos OR 3-36mo and meningeal S/S)
- Stool Cx - (Diarrheal - WBC count)
- CXR - (if >102.1 + WBC >20k)
ABX after labs drawn (ceftriaxone or cefotaxime)

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MC Dx of Fever of Unknown origin?

MC - Occult infections

Inflammatory disease
Malignancy
No Dx

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W/U FUO >14 or >1wk admit?

CBC w/ diff
ESR/CRP
LFTs
UA/Cx - Bld Cx - CSF/Cx
ANA - antinuclear antibody
RF - rheumatoid factor
C3, C4, CH50 complement - serum complement
CXR

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MC infections causing FUO?

UTI’s
URI
Osteomyelitis
Occult abscesses

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MC inflammatory diseases causing FUO?

JRA (MC)
SLE
Vasculitis

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MC malignancies causing FUO?

Leukemia | Lymphoma

<5yo PEDs w/ SCA have increased risk for what? Why?

Bacteremia - impaired opsonization fx of spleen

Mgmt of SCA and severe illness w/ fever?

Admit if WBC <5 or >30k | Empiric Abx

Mgmt of SCA and fever outpt?

Blood Cx, Ceftriaxone

What conditions are MC w/ SCA? Organisms?

Osteomyelitis from Salmonella or S. Aureus | blood cx not always positive

Eval of FUO includes?

CBC, Bld Cx, UA/Cx, CMP, ESR HIV, PPD CXR

High fever w/ rapid defervescence may indicate?

JRA, lymphoma, TB

High fever w/ elevated baseline may indicate?

Infection

High fever w/out fluctuations may indicate?

typhoid

Fever recurring over long periods of time may indicate?

CNS or metabolic cause

FUO outpt mgmt?

No Abx until cause identified | Fever diary - no antipyretics

When does in-utero infant receive maternal antibodies

Third trimester (pre-term infants don't receive all mom's antibodies)

SIRS stands for?

Systemic inflammatory response syndrome

SIRS criteria?

2 or more - TEMP - (<96.8 or >100.4) - TACHYPNEA - HR - (>90bpm or >2 SD for age) - WBC - (<4k or >12k or bands >10%)

Sepsis is defined as?

SIRS due to infection

Severe sepsis is defined as?

1 or more end organ compromise

Septic Shock is defined as?

Severe infection > HOTN and inadequate organ perfusion.

Meningitis is defined as?

Inflammation of meninges by pathogen

Aseptic meningitis refers to what?

Viral meningitis

Meningitis after surgery or head trauma is most likely due to what organism?

Staphylococcal

Partially treated meningitis refers to?

Abx TXT prior to CSF LP - Negative Cx but findings of infection.

Viral meningitis is commonly caused by?

Enteroviruses and parechoviruses | - HSV, EBV, CMV, HIV, Mumps virus (unvaccinated)

Pathogens that cause rapid onset meningitis?

S. Pneumo or N. Meningitides

Presentations of meningitis

URI is common Meningeal inflammation symptoms Fever

Meningeal inflammation symptoms are?

``` May not be present w/ young infants HA-photophobia Irritable N/V Nuchal rigidity Lethargy ```

>12mo old w/ meningitis PE tests used to ID?

Kernig sign | Brudzinski sign

Meningitis causes what type of focal neurologic signs?

Shock, Seizures, coma Increased ICP Arthralgia/myalgia

Blood/skin manifestations ass/w meningitis?

Petechial or purpuric lesions

Meningeal - ICP manifestations?

HA, diplopia, vomiting | Bulging fontanelle

Meningeal - ICP w/ brain herniation manifestations?

``` Ptosis 6th nerve palsy anisocoria bradycardia HTN Apnea ```

CNS abscess are Dx via?

TXT of meningitis due to N. meningitidis and H. Influenzae?

Cefotaxime OR ceftriaxone

Infants <2mo add what antibiotic for listeria monocytogenes

Ampicillin + Cefotaxime OR ceftriaxone

Txt duration of N. meningitidis?

5-7d

Txt duration of H. Influenzae?

7-10d

Txt duration of S. pneumonia?

10-14d

H. Influenzae meningitis TXT?

Cefotaxime OR ceftriaxone | Initiate Dexamethasone w/ 1st dose Abx

Newborn (0-28d) TXT for meningitis

Cefotaxime OR ceftriaxone + ampicillin +- gentamicin (ALT - Ampicilin + gentamicin) (ALT - Ampicillin + Ceftazidime)

Infant and toddler (1mo-4yo) TXT for meningitis

Cefotaxime OR ceftriaxone + vancomycin (ALT rifampin)

Children/adolescents/adults 5-13yo) TXT for meningitis

Cefotaxime OR ceftriaxone + vancomycin | ALT - Cefepime OR ceftazidime

Complications to PVT w/ meningitidis?

``` Hearing loss Shock/arrythmia DIC - SIADH Increased ICP/ Cerebral edema Seizure/coma ```

Before disposition of PEDs w/ meningitidis you must obtain?

Hearing evaluation and at follow up appointment

Meningitidis ass/w subdural effusions are correlated to what organisms?

S. Pneumo and H. Influenzae

When should you drainage of subdural effusions only occur if?

Increased ICP present or Focal neuro S/S

Encephalitis is defined as?

Inflammed brain parenchyma leading to cerebral dysfx

MC organisms ass/w encephalitis?

Viruses - HSV, Arbovirus, Enteroviruses

Encephalitis presents as?

Prodrome (Sore throat, fever, HA, Abd complaints > then lethargy, behavior change, neuro deficits) Seizures Maculopapular rash

Complications during Encephalitis?

Coma Transverse myelitis Anterior horn cell disease Peripheral NP

Complications after Encephalitis recovery?

``` Paresis or spasticity Cognitive impairment Weakness Ataxia Recurrent seizures ```

Fever Flashcards

(73 cards)