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Children's Health > Fever without a Focus > Flashcards

Fever without a Focus Flashcards

1
Q

At what gestational age do the kidneys begin to form?

A

from 5/40

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2
Q

When do glomeruli stop forming in the kidneys of a foetus?

A

34/40 GA

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3
Q

What is the most common renal anomaly?

A

Renal Hypoplasia

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4
Q

What happens to the epidemiology of UTI when comparing boys and girls, as an infant and as a child?

A

Infants - more common in boys than girls

Children - more common in girls than boys

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5
Q

When is the highest incidence of UTI in paediatrics?

A

In infancy, when the child is under 1 year old

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6
Q

What is the most common UTI pathogen in paediatrics?

A

E.Coli

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7
Q

What is the prevalence (%) of UTI in females under 16?

A

12%

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8
Q

What is the prevalence (%) of UTI in males under 16?

A

4%

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9
Q

When should children have their urine tested?

A

If they have presented with an unexplained fever of 38°C or higher
This must be done within 24 hours of presentation
This is only if the source of infection is unknown or not obvious to be anything else

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10
Q

What are the 4 most common signs of a UTI in; an infant under 3 months?

A
  • Fever
  • Vomiting
  • Lethargy
  • Irritability
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11
Q

What is the most common sign of a UTI in; an infant/child over 3 months old who is preverbal?

A
  • Fever
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12
Q

What are the 2 most common signs of a UTI in; an infant/child over 3 months old who is verbal?

A
  • Urinary frequency

- Dysuria

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13
Q

What are the 6 less common signs of a UTI in; an infant under 3 months?

A
  • Poor feeding
  • Failure to Thrive
  • Abdominal pain
  • Jaundice
  • Haematuria
  • Offensive smelling urine
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14
Q

What are the 9 less common signs of a UTI in; an infant/child 3 months and older who is preverbal?

A
  • Abdominal pain
  • Loin tenderness
  • Vomiting
  • Poor feeding
  • Lethargy
  • Irritability
  • Haematuria
  • Offensive smelling urine
  • Failure to Thrive
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15
Q

What are the 10 less common signs of a UTI in; an infant/child 3 months and older who is verbal?

A
  • Dysfunctional voiding
  • Changes in continence
  • Abdominal pain
  • Loin tenderness
  • Fever
  • Malaise
  • Vomiting
  • Haematuria
  • Offensive smelling urine
  • Cloudy urine
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16
Q

How would you interpret the following dipstick result; leukocyte esterase +ve and Nitrite +ve?

A
  • This child should be regarded as having a UTI
  • Abx should be started
  • Send the urine for culture if they have a high-intermediate risk of serious illness
17
Q

How would you interpret the following dipstick result; leukocyte esterase -ve and Nitrite +ve?

A
  • Start Abx if this was definitely a clean catch of urine

- Send the urine for culture - subsequent management will be based off this

18
Q

How would you interpret the following dipstick result; leukocyte esterase +ve and Nitrite -ve?

A
  • Send the sample for microscopy and culture
  • DO NOT start Abx, unless there is good clinical evidence of UTI
  • Leukocytes may be a contaminated urine sample indicator
19
Q

How would you interpret the following dipstick result; leukocyte esterase -ve and Nitrite -ve?

A
  • This child does not have a UTI
  • Abx should not be started
  • Do not send the urine for culture
20
Q

When should a urine sample be sent for culture?

A
  • If the child is suspected to have acute pyelonephritis/upper UTI
  • Infants and children with a high to intermediate risk of serious illness
  • Infants under 3/12
  • Any positive on a urine dip
  • Recurrent UTI
  • Infection unresponsive to Treatment within 24-48h
  • When clinical Sx and urine dip do not align
21
Q

Where would you determine the location of the UTI to be if the child presented with; clinical symptoms, bacteriuria and a fever of 38°C or higher?

A

Acute pyelonephritis therefore in the kidney or upper urinary tract.

22
Q

Where would you determine the location of the UTI to be if the child presented with; clinical symptoms and loin pain/tenderness?

A

Acute pyelonephritis therefore upper urinary tract

23
Q

Where would you determine the location of the UTI to be if the child presented with; bacteriuria but no systemic features?

A

Cystitis (bladder) therefore a lower urinary tract infection

24
Q

When is a UTI classed as recurrent?

A
  1. A infant/child has 2< upper UTI’s
  2. A infant/child has 1 upper UTI and 1< lower UTI’s
  3. 3< lower UTI’s
25
Q

What are the features of atypical UTI?

A
  • Seriously ill
  • Poor urine flow
  • Abdominal or bladder mass
  • Raised creatinine
  • Septacaemia
  • Failure to respond to treatment with suitable Abx in 48 hours
  • Infection with non-E.coli organisms
26
Q

When a child has had a UTI, what investigation needs to be organised at discharge and how long after discharge?

A

Renal USS in 6/52

27
Q

Which 3 investigations are selectively used in children with UTI?

A
  • Renal USS
  • MCUG
  • DMSA
28
Q

When is a renal USS indicated in a paediatric patient?

A
  1. Infant <6 months old with confirmed UTI

2. Children >6 months old ONLY when it is an atypical UTI

29
Q

What is the purpose of a renal USS?

A
  • Look at the size, shape and location of the kidneys

- Identification of renal pelvic dilatation (hydronephrosis)

30
Q

What is an MCUG?

A

Micturating cystogram

31
Q

When is the use of MCUG indicated in a paediatric patient?

A
  1. Infants <6 months old with atypical or recurrent UTI

2. Consider in children >6 months if USS shows dilatation, poor urine flow, non-E.coli infection or FHx of VUR

32
Q

How is a MCUG carried out?

A

The child is catheterised, the bladder is filled with radio-contrast agent and then x-rays are taken ad they void urine to see how it is passed.

33
Q

What can MCUG identify?

A

Vesicoureteric reflux (VUR)

34
Q

What is DMSA?

A

Dimercapto succinic acid is a short-lived radioisotope that goes directly into the kidneys, with a short half-life it only stays in the body for a few hours.

35
Q

When is a DMSA indicated in a paediatric patient?

A
  1. In all children with recurrent UTI

2. In children under 3 years with atypical UTI

36
Q

What are the characteristics of an Autosomal Dominant Inheritance?

A
  1. Males and females are equally as affected
  2. There are affected individuals present in every generation after a condition has arisen
  3. In autosomal dominant conditions in general, variable penetrance is common
  4. In autosomal dominant conditions in general, spontaneous mutations are common
37
Q

Which medicine therapy is a risk factor for AKI in childhood?

A

NSAID therapy

38
Q

Which is the most common cause for AKI in childhood; prerenal, intrinsic renal or postrenal?

A

Prerenal

Children's Health (14 decks)

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