NURP 532 Exam 1 Latest
Update @ 2024
What is the standard temperature method for children under 3 years ago? How about
older children? What is the least accurate forms? - Answer - rectal- most accurate, but
invasive
- can use oral temperature afterwards
- axillary and tympanic not as accurate
T/F: the general appearance of the child/infant is a stronger indicator of an SBI (serious
bacterial infection) vs the degree of temperature elevation - Answer true
T/F: response to antipyretics should not be used to differentiate between serious and
non-serious illness; appearance should be used - Answer true
T/F: pts with viral infections tend to feel and look better than those with bacterial
infections - Answer true
What immunizations can prevent bacteremia? - Answer HiB or pneumococcal vaccines;
those without these will be at higher risk of bacteremia
What are s/sx of fever without focus? - Answer fever >100.4 F with no other localized
s/sx associated with it
How is fever without focus evaluated/diagnosed or evaluated? What are the special
groups that should get these evaluations as well? - Answer - acute fever of unknown
etiology/cause after thorough evaluation of a child less than 24 months
- infants and children who are ill or toxic appearing regardless of age or presence of
fever require sepsis work up
- those under 3 months old with fever (with or without source) needs (sepsis) full work
up despite known/unknown etiology due to high risk of serious bacterial infection
- rule out other diseases
What does the work up labs look like for those of fever without source for those under 3
months? What about those 3 months or older? What are the exceptions to the work up? -
Answer for those under 3 months:
- CBC with diff
,- serum glucose*
- CSF testing (to rule out meningitis)
- inflammatory markers (CRP and PCT)
- urinalysis/UA and urine culture- required for all infants under 3 months
- blood cultures
- chest x-ray if resp s/sx
- stool culture if diarrhea or blood or mucus in stool*
- for those 3 months or older: UA and urine culture is recommended for those with fever
>102.2 F, females less than 1 year, uncircumcised males, duration of fever greater than
24-48 hours, and absence of another infection; all other labs can be based on clinical
presentation and risk for SBI
exception to labs or work-up is not needed:
- when pt has viral infection like flu or RSV, no work up is needed for RSV; for flu, UA and
urine culture is recommended
- if infant had received an immunization within the past 24 hours and temperature is less
than 38.6 C/101.5 F
- monitor with close follow-up
if fever lasts more than 48 hours then further work up is needed
What are differential dx of fever without focus? - Answer - bacterial infections-
bacteremia, bacterial meningitis, bacterial pneumonia, skin infection, osteomyelitis,
bacterial gastroenteritis, septic arthritis, or UTI
- viral infections- enterovirus, influenza, RSV, rotavirus, adenovirus, herpes virus 6 or
parechovirus
- non-infectious disease- kawasaki disease, autoimmune/inflammatory disease related
to immunization.
How do you manage/treat fever without focus for children under 3 months? - Answer -
after labs- if child is low-risk (non-problematic labs like PCT under 1500 bands and
healthy) with reliable caregivers and follow up, then discharge home and close f/u in
12-24 hours; instruct parents to administer acetaminophen 10-15 mg/kg every 4-6 hours
as needed
- if not low risk (bad labs), child should be admitted and have CSF studies and receive IV
antibiotics
- if low risk, but unreliable caregiver or follow up, child should be admitted for
,observation; do CSF studies and antibiotics if it worsens
What are the red flags for a serious bacterial infection in an infant or child? Which age of
pediatric patients are at greatest risk for serious complications? - Answer - ill or toxic
appearing with or without fever
- skin is blue, mottled, or pale
- lethargic, weak, high-pitched cry, poor feeding, decreased response
- tachypnea or tachycardia
- cap refill more than 3 seconds
- decreased UO/urine output
- bulging fontanel
- non-blanching skin rash
- underlying health problem/prematurity
- unreliable caretakers
- greatest risk for SBI is under 3 months
What are the s/sx of fever of unknown origin (FUO)? - Answer temperature >100.4 F for
more than 2-3 weeks with failure to reach a diagnosis despite one week fo intensive
investigation via hx, physical exam, and noninvasive tests/labs
What hx do you collect for fever without source and unknown origin (FUO)? - Answer -
immunizations
- medical hx and meds
- ill contacts
- travel
- hx of fever pattern
- family hx of autoimmune dz or hereditary fever syndrome
- family pets or exposure to animals
- eating habits
- hx of pica (eating things that are not food) or travel
- insects
An 18-month-old male presents to your office with a temperature of 102.4. The parent
, says he has been feverish for the past few days with a slightly decreased appetite and
energy level, but otherwise no complaints. What are 5 differential diagnoses you would
consider as a common reason for fever in this age of patient? - Answer - enterovirus,
UTI, influenza, bacterial gastroenteritis, RSV
What diagnostic tests will you consider in a patient with fever of unknown origin? What if
labs come back normal? - Answer - CBC with diff
- blood culture
- BMP/CMP
- LFT*
- erythrocyte sedimentation rate (ESR) *
- C-reactive protein
- UA and urine cultue
- chest X-ray
(basically the same as fever without focus except for these *)
If normal, then further work-up required with infectious disease referral/consult- more
specific labs and imaging like ux, CT, or MRI
What treatments do you give for fever without source? Which is drug of choice? empiric
tx? what are tx contras? - Answer - empiric tx with antibiotics not recommended- can
delay and mask dx
fever management:
- acetaminophen is drug of choice 10-15 mg/kg every 4-6 hours, not to exceed 5 doses in
24 hours
- ibuprofen- use in children 6 months to 12 years old; every 6-8 hours of dose 5-10mg/kg
due to longer duration of action
- adequate hydration
Contraindications:
- do not bundle
- cold/tepid water bath should not be used due to increased shivering and temp risk
- no aspirin due to risk of Reyes syndrome
What are the indications for hospitalization in an infant or child with fever? - Answer - if
labs are abnormal and pt is not low risk, send to hospital
Update @ 2024
What is the standard temperature method for children under 3 years ago? How about
older children? What is the least accurate forms? - Answer - rectal- most accurate, but
invasive
- can use oral temperature afterwards
- axillary and tympanic not as accurate
T/F: the general appearance of the child/infant is a stronger indicator of an SBI (serious
bacterial infection) vs the degree of temperature elevation - Answer true
T/F: response to antipyretics should not be used to differentiate between serious and
non-serious illness; appearance should be used - Answer true
T/F: pts with viral infections tend to feel and look better than those with bacterial
infections - Answer true
What immunizations can prevent bacteremia? - Answer HiB or pneumococcal vaccines;
those without these will be at higher risk of bacteremia
What are s/sx of fever without focus? - Answer fever >100.4 F with no other localized
s/sx associated with it
How is fever without focus evaluated/diagnosed or evaluated? What are the special
groups that should get these evaluations as well? - Answer - acute fever of unknown
etiology/cause after thorough evaluation of a child less than 24 months
- infants and children who are ill or toxic appearing regardless of age or presence of
fever require sepsis work up
- those under 3 months old with fever (with or without source) needs (sepsis) full work
up despite known/unknown etiology due to high risk of serious bacterial infection
- rule out other diseases
What does the work up labs look like for those of fever without source for those under 3
months? What about those 3 months or older? What are the exceptions to the work up? -
Answer for those under 3 months:
- CBC with diff
,- serum glucose*
- CSF testing (to rule out meningitis)
- inflammatory markers (CRP and PCT)
- urinalysis/UA and urine culture- required for all infants under 3 months
- blood cultures
- chest x-ray if resp s/sx
- stool culture if diarrhea or blood or mucus in stool*
- for those 3 months or older: UA and urine culture is recommended for those with fever
>102.2 F, females less than 1 year, uncircumcised males, duration of fever greater than
24-48 hours, and absence of another infection; all other labs can be based on clinical
presentation and risk for SBI
exception to labs or work-up is not needed:
- when pt has viral infection like flu or RSV, no work up is needed for RSV; for flu, UA and
urine culture is recommended
- if infant had received an immunization within the past 24 hours and temperature is less
than 38.6 C/101.5 F
- monitor with close follow-up
if fever lasts more than 48 hours then further work up is needed
What are differential dx of fever without focus? - Answer - bacterial infections-
bacteremia, bacterial meningitis, bacterial pneumonia, skin infection, osteomyelitis,
bacterial gastroenteritis, septic arthritis, or UTI
- viral infections- enterovirus, influenza, RSV, rotavirus, adenovirus, herpes virus 6 or
parechovirus
- non-infectious disease- kawasaki disease, autoimmune/inflammatory disease related
to immunization.
How do you manage/treat fever without focus for children under 3 months? - Answer -
after labs- if child is low-risk (non-problematic labs like PCT under 1500 bands and
healthy) with reliable caregivers and follow up, then discharge home and close f/u in
12-24 hours; instruct parents to administer acetaminophen 10-15 mg/kg every 4-6 hours
as needed
- if not low risk (bad labs), child should be admitted and have CSF studies and receive IV
antibiotics
- if low risk, but unreliable caregiver or follow up, child should be admitted for
,observation; do CSF studies and antibiotics if it worsens
What are the red flags for a serious bacterial infection in an infant or child? Which age of
pediatric patients are at greatest risk for serious complications? - Answer - ill or toxic
appearing with or without fever
- skin is blue, mottled, or pale
- lethargic, weak, high-pitched cry, poor feeding, decreased response
- tachypnea or tachycardia
- cap refill more than 3 seconds
- decreased UO/urine output
- bulging fontanel
- non-blanching skin rash
- underlying health problem/prematurity
- unreliable caretakers
- greatest risk for SBI is under 3 months
What are the s/sx of fever of unknown origin (FUO)? - Answer temperature >100.4 F for
more than 2-3 weeks with failure to reach a diagnosis despite one week fo intensive
investigation via hx, physical exam, and noninvasive tests/labs
What hx do you collect for fever without source and unknown origin (FUO)? - Answer -
immunizations
- medical hx and meds
- ill contacts
- travel
- hx of fever pattern
- family hx of autoimmune dz or hereditary fever syndrome
- family pets or exposure to animals
- eating habits
- hx of pica (eating things that are not food) or travel
- insects
An 18-month-old male presents to your office with a temperature of 102.4. The parent
, says he has been feverish for the past few days with a slightly decreased appetite and
energy level, but otherwise no complaints. What are 5 differential diagnoses you would
consider as a common reason for fever in this age of patient? - Answer - enterovirus,
UTI, influenza, bacterial gastroenteritis, RSV
What diagnostic tests will you consider in a patient with fever of unknown origin? What if
labs come back normal? - Answer - CBC with diff
- blood culture
- BMP/CMP
- LFT*
- erythrocyte sedimentation rate (ESR) *
- C-reactive protein
- UA and urine cultue
- chest X-ray
(basically the same as fever without focus except for these *)
If normal, then further work-up required with infectious disease referral/consult- more
specific labs and imaging like ux, CT, or MRI
What treatments do you give for fever without source? Which is drug of choice? empiric
tx? what are tx contras? - Answer - empiric tx with antibiotics not recommended- can
delay and mask dx
fever management:
- acetaminophen is drug of choice 10-15 mg/kg every 4-6 hours, not to exceed 5 doses in
24 hours
- ibuprofen- use in children 6 months to 12 years old; every 6-8 hours of dose 5-10mg/kg
due to longer duration of action
- adequate hydration
Contraindications:
- do not bundle
- cold/tepid water bath should not be used due to increased shivering and temp risk
- no aspirin due to risk of Reyes syndrome
What are the indications for hospitalization in an infant or child with fever? - Answer - if
labs are abnormal and pt is not low risk, send to hospital
