NURP 502 PRIMARY Exam 1 Solution Manual Fully Solved Latest Update 2025 Already Passed
What is the most important piece of data in a child with a fever? - Answers Thorough history
What is a brief diagnostic work-up for a fever in a child? - Answers - CBC with differential
- Urinalysis with Culture
- Rapid viral swabs (RSV and Flu)
What are the signs and symptoms of a toxic appearing 2 year old? - Answers - Lethargic
- Tachycardia
- Purpura
- Petechiae
- Cyanosis
What antibiotics are given to a child younger than 1 month with a fever? - Answers -Ampicillin* (100-200
mg/kg/day) IV or IM divided Q 6 hours
- Gentamycin (2.5mg/kg IV or IM Q 8 hours, with adjustments based on serum levels
Alternative:
- Ampicillin* (100-200 mg/kg/day IV or IM divided Q 6 hours)
- Cefotaxime (Claforan; 50mg/kg IV Q 8 hours)
What antibiotics are given to a child older than 1 month with a fever and urinary findings? - Answers -
Cefotaxime (Claforan; 50mg/kg IV Q 8 hours)
- Alternative: Cefixime (Suprax; 8 mg/kg twice on 1st day, then 8 mg/kg/day)
What antibiotics are given to a child 1-3 months in which you do NOT suspect meningitis? - Answers
Ceftriaxone (Rocephin; 50mg/kg/day IV or IM divided Q 12-24 hours
What antibiotics are given to a child 1-3 months in which you suspect meningitis? - Answers Ceftriaxone
(100mg/kg/day IV or IM divided every 12-24 hours)
What antibiotics are given to a child 1-3 months with a fever and findings of Listeria/Enterococcus? -
Answers Add Ampicillin* (100-200mg/kg/day IV or IM divided every 6 hours) to other abx
What antibiotics are given to a child 3 months or older with a fever and findings of pneumonia? -
Answers - Amoxicillin (80mg/kg/day divided Q 12 hours)
- Alternative: azithromycin (Zithromax; 10mg/kg orally on day 1, then 5 mg/kg daily for the next 4 days.
,What are clinical red flags in a child with a fever? - Answers - Parental concerns
- Physician instinct
- Change in crying pattern
- Inconsolability
- Moaning
- Cyanosis
- Crackles
- Decreased breath sounds
- Poor peripheral circulation
- Rapid breathing
- Shortness of breath
- Decreased skin elasticity/turgor
- Dehydration
- Meningeal irritation
- Petechial rash
- Seizures
- Unconsciousness
When do you order a chest x-ray for a child with a fever? - Answers - Older than 1 month with
respiratory symptoms (tachypnea, retractions, auscultatory findings, O2 level <95%)
- Fever > 102.2F (39C)
- WBC > 20,000 per mm3
When do you perform a lumbar puncture in a febrile child? - Answers - All febrile neonates (0-15w6d)
- Infants and young children with clinical signs of meningitis (nuchal rigidity, petechia, or abnormal
neurologic findings)
When is a lumbar puncture not recommended? - Answers - Children older than 3 months unless
neurologic signs present
,- Well appearing, previously healthy infant with no focal signs of infection (WBC 5000-15000, no pyuria,
no bacteruria)
When do you perform a urine culture on a child? - Answers - All males younger than 6 months
- All uncircumcised males under 12 months
- All females under 24 months
- Older females with s/s of UTI
A 17 day old child comes into the office for a persistent fever over 101.7F for the last 3 weeks with
diarrhea, what diagnostics studies should be ordered? Should this child be admitted? What is empiric
antibiotics can be given after cultures are obtained? - Answers - CBC with diff
- Blood cultures
- UA and culture
- Lumbar puncture
- Stool culture/WBC
- Chest x-ray
- Admit child
- Ampicillin, Gentamycin, Ampicillin with Cefotaxime
A 3 month old child presents to the office with a fever of 103.5F, cyanosis, poor perfusion, and
neurologic changes, what diagnostic studies should be ordered? Should this child be admitted? What
empiric antibiotics can be given after cultures are obtained? - Answers - CBC with diff
- Blood cultures
- UA and culture
- Lumbar puncture (since ill-appearing)
- Chest x-ray (cyanosis)
- Admit child
- Ceftriaxone or Cefotaxime
A 2 year old child presents to clinic with a persistent fever of 101.9F for the past 3 weeks, but is playful
in office with no signs of distress. Mother notes darker urine and frequent loose BMs. What diagnostic
studies should be ordered? Should this child be admitted? What antibiotics can be given for this child? -
Answers - UA and Culture
, - Possibly stool culture/WBC
- No need to admit, close follow up
- Ceftriaxone or Cefixime (urinary)
What are the clinical features of Kawasaki Disease? - Answers Reflect widespread inflammation of
primarily medium-sized muscular arteries
What are the signs and symptoms of Kawasaki Disease? - Answers - High fever (greater than 102.2) for 5
days plus four of the following:
- Bilateral conjunctival injection without exudate
- Polymorphous rash that may be urticarial or pruritic
- Inflammatory changes in the lips and oral cavity
- Changes in extremities (peripheral edema, erythema or palms/soles, desquamation of the hands and
feet only in convalescent period)
- Cervical lymphadenopathy often unilateral and anterior cervical
What is the treatment for Kawasaki Disease? - Answers IVIG and ASA
What are associated or negative symptoms of a fever? - Answers - Increased fluid loss (dehydration)
- Increased oxygen consumption
- Increased caloric needs
- Can precipitate seizures
- Headache
- Malaise
- Anorexia
- Irritability
- Tachypnea
- Tachycardia
Which medication is more effective for fever? - Answers Ibuprofen due to lasting longer and dosing less
often
What factors help in determining differential diagnosis of a fever? - Answers - Age of child
What is the most important piece of data in a child with a fever? - Answers Thorough history
What is a brief diagnostic work-up for a fever in a child? - Answers - CBC with differential
- Urinalysis with Culture
- Rapid viral swabs (RSV and Flu)
What are the signs and symptoms of a toxic appearing 2 year old? - Answers - Lethargic
- Tachycardia
- Purpura
- Petechiae
- Cyanosis
What antibiotics are given to a child younger than 1 month with a fever? - Answers -Ampicillin* (100-200
mg/kg/day) IV or IM divided Q 6 hours
- Gentamycin (2.5mg/kg IV or IM Q 8 hours, with adjustments based on serum levels
Alternative:
- Ampicillin* (100-200 mg/kg/day IV or IM divided Q 6 hours)
- Cefotaxime (Claforan; 50mg/kg IV Q 8 hours)
What antibiotics are given to a child older than 1 month with a fever and urinary findings? - Answers -
Cefotaxime (Claforan; 50mg/kg IV Q 8 hours)
- Alternative: Cefixime (Suprax; 8 mg/kg twice on 1st day, then 8 mg/kg/day)
What antibiotics are given to a child 1-3 months in which you do NOT suspect meningitis? - Answers
Ceftriaxone (Rocephin; 50mg/kg/day IV or IM divided Q 12-24 hours
What antibiotics are given to a child 1-3 months in which you suspect meningitis? - Answers Ceftriaxone
(100mg/kg/day IV or IM divided every 12-24 hours)
What antibiotics are given to a child 1-3 months with a fever and findings of Listeria/Enterococcus? -
Answers Add Ampicillin* (100-200mg/kg/day IV or IM divided every 6 hours) to other abx
What antibiotics are given to a child 3 months or older with a fever and findings of pneumonia? -
Answers - Amoxicillin (80mg/kg/day divided Q 12 hours)
- Alternative: azithromycin (Zithromax; 10mg/kg orally on day 1, then 5 mg/kg daily for the next 4 days.
,What are clinical red flags in a child with a fever? - Answers - Parental concerns
- Physician instinct
- Change in crying pattern
- Inconsolability
- Moaning
- Cyanosis
- Crackles
- Decreased breath sounds
- Poor peripheral circulation
- Rapid breathing
- Shortness of breath
- Decreased skin elasticity/turgor
- Dehydration
- Meningeal irritation
- Petechial rash
- Seizures
- Unconsciousness
When do you order a chest x-ray for a child with a fever? - Answers - Older than 1 month with
respiratory symptoms (tachypnea, retractions, auscultatory findings, O2 level <95%)
- Fever > 102.2F (39C)
- WBC > 20,000 per mm3
When do you perform a lumbar puncture in a febrile child? - Answers - All febrile neonates (0-15w6d)
- Infants and young children with clinical signs of meningitis (nuchal rigidity, petechia, or abnormal
neurologic findings)
When is a lumbar puncture not recommended? - Answers - Children older than 3 months unless
neurologic signs present
,- Well appearing, previously healthy infant with no focal signs of infection (WBC 5000-15000, no pyuria,
no bacteruria)
When do you perform a urine culture on a child? - Answers - All males younger than 6 months
- All uncircumcised males under 12 months
- All females under 24 months
- Older females with s/s of UTI
A 17 day old child comes into the office for a persistent fever over 101.7F for the last 3 weeks with
diarrhea, what diagnostics studies should be ordered? Should this child be admitted? What is empiric
antibiotics can be given after cultures are obtained? - Answers - CBC with diff
- Blood cultures
- UA and culture
- Lumbar puncture
- Stool culture/WBC
- Chest x-ray
- Admit child
- Ampicillin, Gentamycin, Ampicillin with Cefotaxime
A 3 month old child presents to the office with a fever of 103.5F, cyanosis, poor perfusion, and
neurologic changes, what diagnostic studies should be ordered? Should this child be admitted? What
empiric antibiotics can be given after cultures are obtained? - Answers - CBC with diff
- Blood cultures
- UA and culture
- Lumbar puncture (since ill-appearing)
- Chest x-ray (cyanosis)
- Admit child
- Ceftriaxone or Cefotaxime
A 2 year old child presents to clinic with a persistent fever of 101.9F for the past 3 weeks, but is playful
in office with no signs of distress. Mother notes darker urine and frequent loose BMs. What diagnostic
studies should be ordered? Should this child be admitted? What antibiotics can be given for this child? -
Answers - UA and Culture
, - Possibly stool culture/WBC
- No need to admit, close follow up
- Ceftriaxone or Cefixime (urinary)
What are the clinical features of Kawasaki Disease? - Answers Reflect widespread inflammation of
primarily medium-sized muscular arteries
What are the signs and symptoms of Kawasaki Disease? - Answers - High fever (greater than 102.2) for 5
days plus four of the following:
- Bilateral conjunctival injection without exudate
- Polymorphous rash that may be urticarial or pruritic
- Inflammatory changes in the lips and oral cavity
- Changes in extremities (peripheral edema, erythema or palms/soles, desquamation of the hands and
feet only in convalescent period)
- Cervical lymphadenopathy often unilateral and anterior cervical
What is the treatment for Kawasaki Disease? - Answers IVIG and ASA
What are associated or negative symptoms of a fever? - Answers - Increased fluid loss (dehydration)
- Increased oxygen consumption
- Increased caloric needs
- Can precipitate seizures
- Headache
- Malaise
- Anorexia
- Irritability
- Tachypnea
- Tachycardia
Which medication is more effective for fever? - Answers Ibuprofen due to lasting longer and dosing less
often
What factors help in determining differential diagnosis of a fever? - Answers - Age of child
