Fever - Hoffman

Question 1

Fever Criteria
Rectal:
Oral:
Axillary:

Answer 1

Rectal: 100.4 F or 38 C
Oral: add 1/2 degree, starts at 99.9 F
Axillary: add 1 degree, starts at 99.4 F
Aural - accurate if perfect seal achieved

Question 2

Fever Without a Source

Answer 2

children with a fever lasting for one week or less without adequate explanation after a careful history and thorough physical examination

Question 3

Fever of Unknown Origin

Answer 3

fever > 101 F of at least 8 days duration

no diagnosis apparent after initial outpatient or hospital evaluation

Question 4

All babies 3 months or younger with a fever of 100.4 or higher MUST

Answer 4

BE SEEN THAT SAME DAY!

Question 5

Fever in Infants < 3 months: Bacterial S&S

Answer 5

bacterial infections

s&s: low grade fever, poor feeding, irritability, sleepiness/sleeplessness

Question 6

Fever in Infants < 3 months: History

Answer 6

Associated Symptoms: respiratory, GI, ENT

Behavioral Symptoms: poor feeding, irritability, poor sleeping, abnormal cry

Exposure to Sick Contacts: siblings, babysitter, day care

Previous Illness

Birth History

Question 7

Fever in Infants < 3 months: Physical Exam

Answer 7

Gestalt
Abnormal Vital Signs
Toxic Appearance
Signs of Localized Infection

Question 8

Toxic Appearance

Answer 8

irritability
inconsolability
poor perfusion
poor tone
decreased activity
lethargy

Question 9

Common Pathogens < 3 months - Bacteremia

Answer 9

S. pneumoniae
Hib
group B strep
N. meningitis
salmonella
Listeria monocytogenes

Question 10

Common Pathogens < 3 months - UTI

Answer 10

E. coli

Question 11

Common Pathogens < 3 months - Pneumonia

Answer 11

S. aureus
S. pneumoniae
group B strep

Question 12

Common Pathogens < 3 months - Meningitis

Answer 12

S. pneumoniae
Hib
group B strep
meningococcus
herpes simplex
enterovirus

Question 13

Sepsis Evaluation

Answer 13

CBC w/ differential
Serum Glucose
Lumbar Puncture
Blood Culture
Urine Culture
Inflammation Indicators: ESR, CRP, Procalcitionin
Consider: stool culture, CXR

Question 14

When to admit fever in infant < 3 months for empiric antibiotics? (3)

Answer 14

Toxic Looking
< 1 month of age
Poor social situation

Question 15

Outpatient Observation Fever < 3 months

Answer 15

Option 1: blood culture, urine culture, lumbar puncture - Ceftriaxone - re-evaluate in 24 hours

Option 2: urine culture, careful observation

Question 16

Fever in Children < 3 years

Answer 16

most illness in this age group are self-limited viral infections

increased risk of occult bacteremia

Question 17

Common Pathogens for Fever in Children < 3 years

Answer 17

S. pneumoniae
Hib
N. meningitis
non-typhoidal Salmonella

UTI and pneumonia are possible causes of occult infection

Question 18

Fever in Children < 3 years - History

Answer 18

Functional Status: oral intake, activity level, irritability

Cough, Vomiting, Dysuria, Frequency, Potty Accidents

Immunization Status!!!!

Question 19

Physical Exam Children 3-36 Months - Findings warranting extra attention

Answer 19

Toxic Appearing
Cyanosis
Hypo/Hypervenilation
Abnormal Vital Signs - SpO2 < 95%
Tachycardia
Tachypnea
Lesions in Oropharynx
Abdominal Tenderness
Pain with bone palpation or passive ROM
Petechiae, cellulitis, viral exanthem

Question 20

Gestalts in feverish children < 3 years

Answer 20

Alertness
Playfulness
Irritability
Consolability

Question 21

Risk Factors for Occult Bacteremia

Answer 21

Temp > 102.2 F
WBC > 15,000/mm3
Elevated neutrophils or bands
Elevated ESR, CRP or PCT

Question 22

What type of fever has:

high spike and rapid resolution

Answer 22

Intermittent Fever

TB, lymphoma, JIA/JRA

Question 23

What type of fever has:

fluctuant peaks, but doesn’t return to normal

Answer 23

Remittent Fever

viral, endocarditis, sarcoid, lymphoma, atrial myxoma

Question 24

What type of fever has:

fever persists with little fluctuation (unless meds given)

Answer 24

Sustained Fever

typhoid fever, typhus, brucellosis

Question 25

What type of fever has: | fevers that relapse after 1 or more days with no fever

Answer 25

Relapsing Fever Malaria, rat-bite fever, Borrelia infection, lymphoma

Question 26

What type of fever has: | episodes of fever more than 6 months duration

Answer 26

Recurrent Fever other causes: metabolic defects, CNS abnormalities, immunodeficiency

Question 27

Fever of Unknown Origin

Answer 27

``` weight loss drug/medications immunizations immunosuppressive therapy Pica exposure to soil borne or water borne organisms history of blood transfusions travel exposure to animals ticks of mosquitos recent surgery or dental work tattoos, body piercing sexual activity ```

Question 28

Fever of Unknown Origin - Skin Examination

Answer 28

presence of sweating petechiae rash sparse hair

Question 29

Fever of Unknown Origin - Eye Examination

Answer 29

``` Conjunctivitis Retinopathy Absence of pupillary response Absent tears or corneal reflexes Abnormal fundoscopic exam ```

Question 30

Fever of Unknown Origin - Oropharynx Examination

Answer 30

``` Hyperemia of posterior pharynx Dental abscess Abnormal Dentition Smooth tongue Ginigival Hypertrophy ```

Question 31

Fever of Unknown Origin - Lymph Node Examination

Answer 31

Enlarged and/ore multiple lymph nodes

Question 32

Fever of Unknown Origin - Chest Examination

Answer 32

Crackles | New onset murmur

Question 33

Fever of Unknown Origin - Abdomen Examination

Answer 33

Organomegaly | Tenderness with liver palpation

Question 34

Fever of Unknown Origin - Musculoskeletal

Answer 34

Tenderness to bones or muscles | Hyperactive DTRs

Question 35

Fever of Unknown Origin - GU

Answer 35

STD testing Careful exam for any masses or abscesses Stool should be examined for occult blood