CMN 568 EXAM PREP VERIFIED
QUESTIONS AND ANSWERS
COMPREHENSIVE REVIEW SHEET
●● Definition of fever
Answer: Rectal temperature ≥ 100.4°F
●● Tympanic temperature
Answer: Not accurate in infants under 3 months
●● Fever Causes
Answer: Most common Benign viral illness, can also caused by bacterial
or fungal infections, drug reactions including immunizations,
malignancies, autoimmune or metabolic disorders, CNS disorders,
excessive environmental temperatures.
●● Factors that increase likelihood of serious bacterial illness
Answer: Age under 3 months, history of prematurity, chronic medical
conditions such as immunosupression or aspenia, previous
hospitalizations, daycare. Toxic appearance
●● Non-Toxic appearance
Answer: Strong cry
,Consolable
Alert and easy to arouse
Pink skin tones
Good hydration; good turgor, tears, moist mucous membranes
Smiles, responsive to environment
●● Toxic appearance
Answer: Weak or high pitched cry
Inconsolable
Difficult to arouse
Pale, ashen, cyanotic, or mottled skin tones
Poor hydration; poor turgor, dry mucous membranes, no tears
No smile, listless, dull, infant won't alert to environment
●● Signs of serious illness
Answer: Fever greater than 40 (105)
Nuchal rigidity
Petechial skin rash
Seizure activity
Stridor or increased WOB
●● Physical exam signs of serious infection: Skin
,Answer: Petechiae, rashes
●● Physical exam signs of serious infection: head/neck
Answer: Sunken or bulging fontanelles, nuchal rigidity
●● Physical exam signs of serious infection: ears
Answer: Bulging TM, AOM, mastoiditis
●● Physical exam signs of serious infection: Chest
Answer: Tachypnea, wheezing, rales, rhonchi
●● Physical exam signs of serious infection: Heart
Answer: Murmurs
●● Physical exam signs of serious infection: Abdomen
Answer: Tenderness, distension
●● Physical exam signs of serious infection: Musculoskeletal
Answer: Refusal to bear weight or use an extremity, erythema/warmth
over joint
●● Diagnostic tests for fever in infant and young child
, Answer: CBC w/ Diff (WBC > 15,000 may indicate SBI. Child with
overwhelming sepsis my have WBC <5,000)
UA/ C&S: R/O UTI
CXR: R/O Pneumonia
Lumbar Puncture: R/O meningitis
Blood cultures: R/O Bacteremia
Stools for C&S: R/O Infectious diarrhea
●● Management of fever in infant < 4 weeks
Answer: Refer to pediatrician
Hospitalization
Full septic workup
IV antibiotics pending culture results
●● Management of fever in infant 4 weeks - 3Mo
Answer: Toxic appearance:
Refer to pediatrician
Hospitalization
Full septic workup
IV antibiotics pending culture results
Non-Toxic appearance/No risk factors for SBI:
Full septic workup
QUESTIONS AND ANSWERS
COMPREHENSIVE REVIEW SHEET
●● Definition of fever
Answer: Rectal temperature ≥ 100.4°F
●● Tympanic temperature
Answer: Not accurate in infants under 3 months
●● Fever Causes
Answer: Most common Benign viral illness, can also caused by bacterial
or fungal infections, drug reactions including immunizations,
malignancies, autoimmune or metabolic disorders, CNS disorders,
excessive environmental temperatures.
●● Factors that increase likelihood of serious bacterial illness
Answer: Age under 3 months, history of prematurity, chronic medical
conditions such as immunosupression or aspenia, previous
hospitalizations, daycare. Toxic appearance
●● Non-Toxic appearance
Answer: Strong cry
,Consolable
Alert and easy to arouse
Pink skin tones
Good hydration; good turgor, tears, moist mucous membranes
Smiles, responsive to environment
●● Toxic appearance
Answer: Weak or high pitched cry
Inconsolable
Difficult to arouse
Pale, ashen, cyanotic, or mottled skin tones
Poor hydration; poor turgor, dry mucous membranes, no tears
No smile, listless, dull, infant won't alert to environment
●● Signs of serious illness
Answer: Fever greater than 40 (105)
Nuchal rigidity
Petechial skin rash
Seizure activity
Stridor or increased WOB
●● Physical exam signs of serious infection: Skin
,Answer: Petechiae, rashes
●● Physical exam signs of serious infection: head/neck
Answer: Sunken or bulging fontanelles, nuchal rigidity
●● Physical exam signs of serious infection: ears
Answer: Bulging TM, AOM, mastoiditis
●● Physical exam signs of serious infection: Chest
Answer: Tachypnea, wheezing, rales, rhonchi
●● Physical exam signs of serious infection: Heart
Answer: Murmurs
●● Physical exam signs of serious infection: Abdomen
Answer: Tenderness, distension
●● Physical exam signs of serious infection: Musculoskeletal
Answer: Refusal to bear weight or use an extremity, erythema/warmth
over joint
●● Diagnostic tests for fever in infant and young child
, Answer: CBC w/ Diff (WBC > 15,000 may indicate SBI. Child with
overwhelming sepsis my have WBC <5,000)
UA/ C&S: R/O UTI
CXR: R/O Pneumonia
Lumbar Puncture: R/O meningitis
Blood cultures: R/O Bacteremia
Stools for C&S: R/O Infectious diarrhea
●● Management of fever in infant < 4 weeks
Answer: Refer to pediatrician
Hospitalization
Full septic workup
IV antibiotics pending culture results
●● Management of fever in infant 4 weeks - 3Mo
Answer: Toxic appearance:
Refer to pediatrician
Hospitalization
Full septic workup
IV antibiotics pending culture results
Non-Toxic appearance/No risk factors for SBI:
Full septic workup
