Lecture 19: Febrile Illness/ID Flashcards
(175 cards)
1
Q
Rise in hypothalamic set-point due to endogenously produced pyrogens explains the etiology of a…
A
Fever
2
Q
MC cytokines that function as endogenous pyrogens
A
IL-1 and IL-6
3
Q
Core temperature is specifically defined as the temperature of blood within the () artery
A
Pulmonary artery
4
Q
Fever () the amount of iron available to invading bacteria
A
Decreases
5
Q
Generally, we prefer a rectal temp (most accurate) from birth to () years
A
Birth to 3 years
Same period as when fevers are MC
6
Q
Tympanic temperatures are unreliable in children () months
A
Under 6 months of age
7
Q
T/F: A well-appearing, well-hydrated child with evidence of a routine viral infection can be safely sent home with symptomatic treatment and careful return precautions
A
True
8
Q
Most febrile illnesses are (viral/bacterial)
A
Viral
9
Q
The MC reason to treat fever is if a child is…
A
Uncomfortable
10
Q
NSAIDs should generally not be used in child younger than () months and Tylenol should not be used in children younger than () months
A
- NSAIDs should be avoided in 6 months and younger.
- Tylenol should be avoided in 3 months and younger.
NO ASA DUE TO REYE’S SYNDROME
11
Q
You should see a child immediately if any of these are present.
- Child is less than () months of age
- Fever is greater than () celsius
- Child is crying ()
- Child cries when ()
- Child is difficult to ()
- () spots or dots are present on the skin
A
- Less than 3 months of age
- Greater than 40.6C
- Crying INconsolably/whimpering
- Crying when moved or even touched
- Difficult to awaken
- Stiff neck
- Purple spots
12
Q
You should a see a child within 24 hours if:
- Child is () to () months old (unless fever occurred within 48h of dtap with no other symptoms)
- Fever exceeds () C
- Burning or pain with ()
- Fever subsided for 24h but then ()
- Fever has persisted longer than ()
A
- 3-6 months old
- Exceeds 40C/104F
- Urination
- Returning fever
- Longer than 72h
13
Q
On average, a (viral/bacterial) infection usually disseminates faster in a younger child
A
Bacterial infection
14
Q
Fever is MC between the ages of…
A
Birth to 3 years
15
Q
() account for most bacterial infections in infants under 90 days
A
UTIs
They can’t clean down there themselves
16
Q
You should be especially concerned for a serious viral infection in an infant if they lack () vaccine or ()
A
- HiB
- Pneumococcal
17
Q
T/F: Presence of petechiae/purpura in a viral illness is very sus
A
True
18
Q
T/F: As long as child is 90 days old, their ill appearance does not require a full eval.
A
False
19
Q
The mainstay diagnostics for any child under 21 days old with a fever >= 38C are (3)
A
- UA
- Blood cultures
- LP
Inflammatory markers are optional.
20
Q
In order for a 21 day or younger neonate to be D/C’d off of IV abx and discharged, they must meet all of this criteria:
- Culture results are negative for ()
- Infant appears ()
- ()
A
- Negative culture results for 24-36h
- Infant appears well or is improving
- No other reason to hospitalize.
21
Q
For a 22-28 day old or a 29-60 day old, feverish, but well-appearing infant, the 3 diagnostics you must order initially are:
A
- UA
- Blood culture
- Inflammatory markers
22
Q
Generally, you want to order a procalcitonin alongside an ANC or CRP. If you CANNOT order procalcitonin, then you should obtain both ()
A
CRP and ANC
23
Q
T/F: You can treat a urine only infection in a 29-60 day old via oral abx.
A
True
24
Q
A 61-90 day old infant needs a full septic work-up if:
- They appear ()
- Signs of a () infection AND Abnormal (), (), or ()
A
- They appear toxic/ill
- They have signs of a focal infection.
- Abnormal WBC, inflammatory markers, or UA
25
One of the most important history things in a child with a fever of unknown source is...
Immunization status
26
T/F: In an infant aged 3 months to 36 months, full-workup is indicated if incompletely immunized.
True
27
Febrile seizures are highest risk between the ages of () months and () years
6 months to 5 years
28
A generalized tonic/tonic-clonic seizure of less than **15 minutes** and occurring within **24 hours of fever onset** is most commonly known as a () and is most commonly caused by ()
Simple febrile seizures, MCC: Viral illness
| Complex is focal or b2b or > 15 mins
29
T/F: Prophylactic anticonvulsants are recommended for children with febrile seizures.
False
| Simple ones have no long-term adverse consequences
30
A Fever of Unknown Origin (FUO) is defined as a daily temp greater than () for **8 days with no apparent diagnosis.**
38.3C or 101F
31
The top 3 MCC of FUOs, in order of frequency, are:
1. Infectious diseases
2. CT/Rheumatologic disrders
3. Neoplasms
32
The MC autoimmune disease in children that can result in a FUO is...
Systemic JIA (juvenile idiopathic arthritis)
33
The MC malignancies in children that result in FUOs are (2)
* Leukemias
* Lymphomas
34
T/F: Most evaluations of FUOs begin inpatient.
False.
35
Ideally, a physical exam of a febrile infant is done when the infant is currently ()
Febrile
36
What might **bilateral red eyes in a pediatric patient** suggest in terms of underlying disease?
Kawasaki's disease
37
T/F: It is reasonable to order serological testing for FUOs.
True.
38
If an infant is ill with **persistent fever and NO diagnosis**, you could order ()
IgG, IgA, IgM
39
Generally, empiric antimicrobial therapy (is/is not) indicated in FUO.
Is NOT (unless life-threatening)
40
If () occurs more than 24h prior to delivery, Bacterial sepsis in newborns increases 10x.
| Normal rate is 1-2 in 1000
PROM (1 in 100 births)
| PROM + Chorioamnionitis = 1 in 10 live births!
41
The MCC of bacterial sepsis in a newborn are (4)
1. GBS
2. E. coli
3. Listeria
4. S. Aureus
42
Generally, bacterial sepsis of the newborn appears on day () of life
Day 1
43
T/F: An intrapartum maternal temperature of 100.4F or higher is a risk factor for Bacterial sepsis of the newborn.
True.
44
The MC presenting sign of bacterial sepsis in a newborn is...
Respiratory distress d/t PNA
45
The Dx of PNA in bacterial sepsis is via...
Pleural fluid from effusion
46
Tx of **early bacterial sepsis** in newborns is...
* Ampicillin
* Gentamicin/cefotaxime
| Q12 hrs
47
Tx of **late bacterial sepsis** in a newborn is...
* Ampicillin
* Gentamicin/Cefotaxime
* **Add on Vancomycin for staph**
| Late bacterial sepsis is MC due to staph aureus
## Footnote
10-14 days IV for proven sepsis.
48
Late onset bacterial sepsis of the newborn occurs after () days of life.
7 days of life.
| Most likely due to staph.
49
Prevention of neonatal GBS infection is usually achieved via intrapartum delivery of () more than () hours prior to delivery.
Penicillin, 4 hours prior to delivery.
50
GBS cultures are obtained from both () and () at ()-() weeks.
* Vaginal and rectal GBS cultures
* 35-37 weeks
51
Prophylaxis with pencillin is indicated for women who are () or who have () GBS status at delivery.
* GBS positive
* Unknown GBS status at delivery
52
The MCC of aseptic/viral meningitis is...
Non-polio enteroviruses
| MC **before the age of 1**
53
A full anterior fontanelle in the sitting position, a maculopapular rash, marked fever, irritability, and lethargy with an acute onset is suggestive of...
Viral meningitis
54
T/F: Meningeal signs are typically seen in pediatric patients.
False, generally only seen in older patients.
55
In both older and younger children, certain strains of () can cause flaccid paralysis in viral meningitis
Enteroviruses
| Similar to polio
56
The most useful diagnostic lab for viral meningitis is...
PCR of enteroviruses
57
In 95% of cases, protein should be less than () mg/dl and glucose more than () of serum values in **viral meningitis.**
* Protein less than 80 mg/dl
* Glucose MORE than 60% of serum values
58
The general tx for an infant with viral meningitis is...
* Admit
* Isolate
* Fluids
* Antipyretics
59
In an infant **younger than 1 month**, you should consider () in your differential alongside viral meningitis and start () until you have a diagnosis.
* You should consider herpes virus encephalitis
* Start empiric acyclovir until diagnosis is made.
60
The MOST important sign in very young infants when it comes to bacterial meningitis is...
A tense, bulging fontanelle
61
CSF of bacterial meningitis should show () WBCs, () glucose, () protein
* Elevated WBCs
* Decreased glucose
* Increased protein
62
One might see G() diplococci on smears of CSF sediment for bacterial meningitis
G+ diplococci
63
Empiric abx for bacterial meningitis in newborns is...
* IV **Vanco**
* IV **Cefotaxime**/Rocephin
* **Steroids** prior to abx to reduce cerebral edema and lower likelihood of hearing loss per viv / I wrote **IF no hx of HiB vaccine**, maybe its both?
64
The two MC time periods to contract neisseria meningitidis are...
* First year of life
* Teen years
65
In order to qualify for chemoprophylaxis for neisseria meningitis, you must have () exposure
**Direct exposure** to respiratory secretions
| Household members are high risk
66
MC agent for chemoprophylaxis for neisseria meningitis is...
Rifampin
67
A purpuric/petechieal rash in association with bacterial meningitis means it is most likely...
Meningococcemia w/ similar symptoms
68
T/F: You should treat meningococcemia in a newborn/kid as shock.
True
| Im guessing this is for meningococcemia
69
T/F: Pneumococcal meningitis and meningococcemia (meningitis due to N. meningitidis) are treated the same.
True.
70
MC bacteria for bacterial conjunctivitis
* Strep Pneumo
* H flu
* M cat
| Same as AOM top 3
## Footnote
**Pseudomonas if contact lens wearer**
71
Bacterial conjunctivitis is characterized by () discharge from the eye, and kids often complain that when they wake up, they feel as if their eyes are ().
* **Mucopurulent** discharge
* Eyes feel stuck together
72
A child remain contagious for bacterial conjunctivitis until they have taken their abx for at least () hrs.
24 hours
73
T/F: Bacterial conjunctivitis requires abx tx.
False. Self-resolving, abx speeds it up.
74
MCC of viral conjunctivitis
Adenovirus
75
Viral conjunctivitis is (very/not very) contagious, is (unilateral/bilateral), and has () discharge, and sometimes shows () on the conjunctiva
* Very contagious
* Starts unilaterally, then spreads
* **Watery** discharge
* Hyperemic conjunctivitis
| Can combine with URI and bilateral conjunctivitis
76
T/F: Preauricular LAN is seen in pharyngoconjunctival fever
Truee
77
Besides the usual viral conjunctivitis S/S, epidemic keratoconjunctivitis also has ()
Ptosis
78
The only treatment for viral conjuncitivitis is...
Just isolate for 2 weeks + supportive care.
| No antivirals indicated.
79
Allergic rhinitis and conjunctivitis are often associated together, and they are type () HSR.
Type 1 HSR.
80
Eye drops for allergic conjunctivitis
Olopatadine BID
| Antihistamine + Mast cell stabilizer
81
Severe allergic conjunctivitis is also known as... () conjunctivitis, and includes giant papillae of upper tarsal conjunctiva, ptosis, keratitis, and **characteristic white dots**.
Vernal conjunctivitis
| Recurrent, bilateral allergic conjunctivitis
82
The characteristic white dots within vernal conjuncitivits are accumulations of...
Eosinophils (mostly)
83
Tx of vernal conjunctivitis
Same as allergic: Olopatadine drops
84
Atopic conjunctivitis is most commonly associated with...
Eczema
85
The condition that is the #1 reason children get abx in the US is...
AOM
86
Top 3 organisms for AOM
| This better be engraved onto your brain by now
1. Strep Pneumo
2. H flu
3. M Cat
| Viral URI also often precedes AOM
87
Top RFs for AOM (4)
* Prior Viral URI
* Smoke exposure
* Eustachian tube dysfunction
* Cleft palate
88
If you smell something funky during your otoscopic exam for AOM and see purulent material, you should suspect ()
Perforated tympanic membrane
89
According to the AAP, a diagnosis of AOM requires:
1. A () of abrupt signs and symptoms
2. Presence of () effusion indicated by () of the TM, () of the TM, or ().
3. S/S of middle ear inflammation by either erythema of the () or () resulting in decreased sleep and normal activity.
1. Hx of abrupt S/S
2. Middle ear effusion
3. Bulging of TM
4. Absent mobility of TM
5. Otorrhea
6. Distinct erythema of the TM
7. Otalgia resulting in decreased sleep/normal activity
90
The only age range you need to **immediately treat** with AOM is... or if they have 48hrs of ear pain, fever, otorrhea.
24 months or younger
91
A patient with AOM but incomplete HiB vaccination history should be treated preferably with...
A cephalosporin (H Flu more likely): Cefdinir
| Idk i wrote this in
92
First line tx for AOM is:
2nd line tx for AOM is:
1. Amoxicillin
2. Augmentin if amoxicillin failed
93
For those with severe allergies to penicillins, AOM is treated with (3)
* Macrolides
* Clindamycin
* Bactrim
94
Presence of tympanostomy tubes with infection but NO systemic symptoms can use ()
Drops (ciprodex, ofloxacin)
95
A white, plaque-like appearance on the TM due to chronic inflammation is known as...
Tympanosclerosis
96
A pearly/greasy mass seen in a retraction pocket in the ear or perforation is a .... and is treated primarily with...
* Cholesteatoma
* Surgical repair
| Usually perfs heal within 2 weeks
97
Generally, a child should improve within ()-() hours after starting abx for AOM.
48-72 hours
98
Generally, you would expect a child to follow up ()-() weeks after AOM dx. The one exception is if they are aged 2 or older and ()
* Normal followup: 8-12 weeks.
* Exception: age 2+ WITHOUT language/learning delays
99
Recurrent AOM is () or more episodes in 6 months, or () in a year
* 3+ eps in 6 months
* 4 in a year
100
Chronic OM with effusion is defined as lasting greater than () months or failing to respond to initial abx therapy.
3+ months
101
The initial tx for **effusions that occur after** an episode of AOM is...
Watchful waiting
102
Generally, if a child has MEE (middle ear effusions?) that persist over 3 months and start causing delays in language, you should refer them to...
Audiology
| Hearing => language
103
The MC pediatric infectious disease overall is...
Viral rhinitis (common cold)
104
The top cause of viral rhinitis is...
Rhinovirus
| hehe
105
* Sudden onset of clear/mucoid rhinorrhea
* Nasal congestion, sneezing
* Sore throat and cough
* Fever
* Feeding changes
All suggest what pediatric illness?
Viral rhinitis
106
The two symptoms that tend to persistent for 2-3 weeks in viral rhinitis are...
* Cough
* Rhinorrhea
107
You should not treat cough with honey in someone younger than...
1 year old
108
The MC form of HSV-1 infection in children is...
Acute gingivostomatitis
| **Grouped vesicles on an erythematous base**
109
LAN in the () region and () region are common in acute gingivostomatitis
* Cervical region
* Submandibular region
110
High fever, irritability, and drooling often occur in infants infected with HSV-1 because they have...
Acute gingivostomatitis
111
You want to avoid () or () foods with active herpetic gingivostomatitis
Acidic or salty foods
| Bland diet
112
The mainstay of tx for herpetic gingivostomatitis is...
Supportive tx.
| Antivirals are only indicated if severe.
113
Oral candidiasis/thrush (can/can't) be washed off
CanNOT
114
A common atopic condition, (), can predispose a child to thrush because it uses ()
Asthma due to inhaled corticosteroids.
115
Tx of oral thrush is via...
Oral nystatin rinse
116
Hand Foot Mouth disease is caused by...
Coxsackie Virus
117
HFMD is usually (pruiritic/not)
Non-pruiritic
118
HFMD is treated primarily with...
Supportive care.
| Resolves in 3-5 days usually.
119
Herpangina is caused by...
Coxsackie Virus
| Same as HFMD
120
A linear pattern of **ulcers with erythematous halos** on the anterior tonsillar pillars, soft palate, and uvula with **none on the anterior mouth** is most likely....
Herpangina
121
Herpangina is treated with...
Supportive care.
| Same as HFMD
122
You would expect more atypical findings in strep pharyngitis if the child is aged () or younger
3 yo or younger
123
You should NOT test a child for strep pharyngitis if they show:
* (c)
* (c)
* (c)
* Anterior (s)
* Ulcers/vesicles in the ()
* Diarrhea
* Cough
* Congestion
* Coryza
* Anterior stomatitis
* Throat
124
In a child younger than 3, you **should test them** for strep pharyngitis if...
* Prolonged () drainage
* Tender () LAN
* () fever
* Prolonged nasal drainage
* Tender anterior cerivcal LAN
* Low grade fever
125
The preferred tx for strep pharyngitis is...
Amoxicillin
| its yummier
126
Patient education for strep pharyngitis:
* You are contagious for () hours after your first dose
* You should change your toothbrush after () days
* 24 hours after first dose
* 1 day
127
You perform a rapid antigen strep test which comes back negative. You still suspect strep pharyngitis. Your next step is to...
Send for bacterial cultures
128
Infectious mononucleosis is caused by...
EBV
129
Although strep pharyngitis and mono have similar symptoms, the LAN in mono is located ()
**Posterior cervical** LAN is more Mono
130
Besides URI stuff, Mono also affects (organ)
Hepato and splenomegaly.
131
A child being treated for suspected strep pharyngitis with amoxicillin develops a rash. You suspect that the reason for their rash is...
They actually have mono
132
Under the age of (), mono causes mild symptoms.
Age of 4.
133
If a monospot test is negative but you still suspect mono, you should order () next
Anti-EBV antibodies
134
The most notable lab finding on CBC for mono would be....
Atypical lymphocytosis
135
Tx of mono is via...
* Supportive tx
* NO CONTACT SPORTS for 4-5 weeks
136
Viral pharyngitis is MCC by...
Adenovirus
137
Viral pharyngitis is very similar to strep pharyngitis, but can also lead to ()
Pneumonia
138
Viral pharyngitis is treated primarily with...
Supportive care.
139
MCC of viral croup is...
Parainfluenza virus
140
MC age range for viral croup is () months to () years
3 months to 3 years
141
* Clinical diagnosis
* Seal like cough
* Prodrome of URI followed by cough
* Inspiratory stridor
Most likely suggests...
Viral croup
142
Pertussis is treated with...
* Erythromycin for 14 days
* Clarithomycin for 7 days
* Azithromycin for 5 days (**also rec if younger than 1**)
| Bactrim for allergies
143
T/F: Pertussis contacts need prophylaxis
Truee
144
The MCC of CAP in children older than 6 months is...
Strep Pneumo
| Chlamydia if younger than 6, v weird. Often follows a lower resp infxn.
145
A febrile child younger than 3 months with pneumonia should be treated empirically with 2 abx:
* Ampicillin
* Gentamicin
| Bc PNA is the first sign of sepsis in newborn?
146
An **afebrile** infant aged 1-6 months of age with pneumonia due to chlamydia is treated with...
Azithromycin
147
Amoxicillin is first line tx for pneumonia in children aged () months to () years
6 months to 5 years
148
Atypical pneumonia, more common in children older than 5 years, sometimes presents with a () rash and is caused usually by ()
* Erythema multiforme rash
* Mycoplasma
149
# ,
1st line tx for atypical pneumonia is..
Azithromycin
| Augment 2nd
150
* Koplik spots
* Cough, coryza, Conjunctivitis
* Maculopapular rash beginning on forehead
What childhood exanthem is this
Rubeola/measles
| Has an O because its the ORIGINAL measles
151
The fever in rubeola/measles peaks when the rash ()
When rash appears
152
Anyone with exposure to measles/rubeola within the past 72 hours is treated with...
Vaccine
| If they're at least 6 months old.
153
Rubella's main clinical significance is due to...
Congenital defects
| its very rare since theres a vaccine.
154
Congenital rubella causes primarily:
* (eye)
* (cardiac)
* (ear)
* Cataracts/glaucoma
* VSD/PDA
* Sensorineural hearing loss
| EYE HEART (RUB)Y (EAR)RINGS
## Footnote
I heart ruby earrings is how i remember the main congenital rubella things
155
Erythema infectiosum/Fifth's disease is caused by...
Parvovirus B19
156
Slapped cheek rash describes...
Erythema infectiosum/Fifth's disease
| High Fived the cheeks
157
Getting infected with erythema infectiosum while pregnant may cause...
Hydrops fetalis
158
The more systemic complications of fifth's disease are... (2)
* Arthritis
* Aplastic crisis
159
Roseola infantum is caused by...
HHV6 and HHV7
160
The main characteristic of roseola is...
Acute febrile illness
| Abrupt onset of high fever, followed by a rash.
## Footnote
MCC of exanthemous fevers in age group.
161
The MC age range for roseola is... () months to () years)
6 months to 3 years.
162
The only thing you treat in roseola is...
Fever with tylenol.
| Otherwise its benign.
163
Jones Criteria is used to diagnose rheumatic fever. To be diagnosed with rheumatic fever, you need () major criteria or () major + () minor criteria.
* 2 major criteria
* 1 major + 2 minor criteria
164
Major Jones criteria mnemonic for rheumatic fever is JONES, which stands for...
* Joint involvement
* O = heartshaped, myocarditis
* Nodules, subcutaneous
* Erythema marginatum
* Sydenham chorea
## Footnote
Sydenham chorea mainly involves jerky, uncontrollable and purposeless movements of the hands, arms, shoulder, face, legs, and trunk
165
Minor Jones criteria for rheumatic fever is CAFEPAL, which stands for...
* CRP
* Arthralgia
* Fever
* ESR
* Prolonged PR
* Anamnesis of rheumatism
* Leukocytosis
| Anamnesis just means history of
166
167
The underlying cause of rheumatic fever is...
GABHS
168
* GABHS is eradicated via (abx)
* Arthritis is managed via (NSAIDs)
* Sydenham chorea is self-limited
in Rheumatic fever
* Penicillin G IM
* Aspirin or Naproxen
169
Who gets secondary prevention of rheumatic fever and what is the regimen?
* Anyone with an attack and risk for recurrence.
* Long acting PCN G every 3-4 weeks.
170
The main cause of acquired heart disease in the US for children is...
Kawasaki's disease
| Peaks at age 2.
171
Kawasaki's disease requires 4 of out 5 criteria + fever, which are:
1. () cavity changes
2. Bilateral, painless, nonexudative ()
3. () LAN >= 1.5 cm and unilateral
4. Polymorphous ()
5. () changes
1. Oral/lip cavity (cracking, strawberry tongue)
2. Conjunctivitis
3. Cervical
4. Polymorphous Exanthema (stocking-glove)
5. Extremity changes (redness/swelling/desquamation)
172
**As soon as you suspect** Kawasaki's Disease, the initial imaging you need is...
Echocardiogram
| Lots of heart complications.
173
What lab findings are abnormal with Kawasaki's?
* CBC
* LFTs
* CRP and ESR
* UA
* CBC showing leukocytosis + thrombocytosis
* Elevated LFTs with hypoalbuminemia
* ESR > 40, CRP > 3
* UA with > 10WBCs/hpf
174
Initial tx of kawasaki's is with () and ()
High dose IVIG and ASA
175
After level () risk, Kawasaki's must be followed by a pediatric cardiologist.
Level 2 or higher risk.
