Pediatric Fever
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, Toxic Appearance with Fever on Well-low risk infants (29-60 days): will
require CBC (bands (immature WBCs) elevation suggest bacterial
infection), CXR, blood cultures, WBC, urine testing. Often done in hospital.
-Neonates <28 days require full-work up and hospitalizations
-Abnormality in WBC or failure for low risk criteria d/t focal bacterial
infection or parent issues then infant should undergo LP and empiric
antibiotics
Toxic appears: Pale, very ill, lethargic, poor perfusion, breathing troubles
Evaluation of Well-appearing Infants 61-90 days: UA/culture, blood
testing guidelines depends on but sometimes blood cultures/CBC w/ diff &
inflammatory markers.
-Fever r/t immunization should less no more than 48hrs
Urinalysis/Culture: All infants less than 3 months of age and female <12
months of age and uncircumcised males is 102.2F and fever longer then 24-
48hrs.
-Prolonged Fever: a single illness in which the duration exceeds that
expected for the single clinical diagnosis.
🡪Fever of Unknown Origin (FUO): fever (core temp >38.1C/101F) once daily
for 14 days or more without cause of fever after 1 week extensive evaluation
and diagnostic work-up.
-25% thought to be caused by viral illness
-Labs: CBC, liver enzymes, CMP, sed rate, urinalysis, CXR, imaging is
decided based on clinical situation, test for EBV/cytomegaly virus
-infectious disease consults
-Empiric antibiotics should not be administered for FUO because it can
delay diagnosis and mask symptoms.
-Management of fever: acetaminophen is drug of choice, ibuprofen
children > 6months of age and has longer duration.
-ASA not used in children d/t risk of Reye’s Syndrome
Ankylosing Spondylitis
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, spondylarthritis. Chronic inflammatory condition. Sacroiliac joint and spine,
TMJ. Peaks onset age 20-30. Males > females. HLA-B27B genetic
connection.
-Difficult to diagnose.
-Sx: low back pain, poorly localized in glutes near SI joint common first sx.
Fever, weight loss, stiffness worse in morning, immobility early in morning
and late at night.
-Dx: pain present for at least 3 months. X-ray not needed for dx. CRP, Sed
elevated, RF negative, CBC mild anemia. Pt <45 with pain >3months.
Bones and spine and fuse🡪bamboo spine*
-Meds: NSAIDs first line, DMARDS not helpful.
-IBS, uveitis also can be seen
-affects shoulders/knees not small joints as much. Classic DMARDs not
helpful.
UTI
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-Most common in primary care, more common in women
-common cause e. coli, staph, staoh aureus, enterococcus, klebsiella
-Sx: dysuria, frequency, urgency, suprapubic pain, gross hematuria, men
may have more dribbling/nocturia, afebrile
-young men think STI
-Older patients changes in mental status or new onset incontinence
-Dx: clean catch UA
-Leukocyte esterase, nitrites (gram neg and gram-positive bacteria)
-negative UA does not rule out UTI
-if unclear, order culture with sensitivity (pregnant patients always)
Complicated: postmenopausal, UTI in any child or UTI in man or pregnant
women.
-Tx: Men (Cipro/fluroquinolone or Bactrim for 7-14 days)
Uncomplicated: premenopausal, no underlying conditions, afebrile, no
flank pain
, -Tx: Macrobid, Bactrim, uristat/AZO (OTC), pyridium, tx for 3-5 days
-Education: preventive, urinating before and after intercourse, push fluids,
improve in few days
-Recurrent UTI in Women: reinfection (more than 2 wks since tx and new
organism) or relapse (<2wks since tx and same organism)
-atrophic vaginosis increases postmenopausal women’s risk, vaginal
estrogen can decrease this risk
-Dx: urine culture
Prostate Cancer
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most common malignancy in men-adenocarcinoma most common
-DRE firm, nodule induration or stony asymmetric prostate
-Sx: asymptomatic, lower UTI sx, back pain in advanced
disease/paresthesia in lower extremities.
-Dx: elevated PSA >4 & biopsy
Osteoarthritis
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Give this one a try later!
, Toxic Appearance with Fever on Well-low risk infants (29-60 days): will
require CBC (bands (immature WBCs) elevation suggest bacterial
infection), CXR, blood cultures, WBC, urine testing. Often done in hospital.
-Neonates <28 days require full-work up and hospitalizations
-Abnormality in WBC or failure for low risk criteria d/t focal bacterial
infection or parent issues then infant should undergo LP and empiric
antibiotics
Toxic appears: Pale, very ill, lethargic, poor perfusion, breathing troubles
Evaluation of Well-appearing Infants 61-90 days: UA/culture, blood
testing guidelines depends on but sometimes blood cultures/CBC w/ diff &
inflammatory markers.
-Fever r/t immunization should less no more than 48hrs
Urinalysis/Culture: All infants less than 3 months of age and female <12
months of age and uncircumcised males is 102.2F and fever longer then 24-
48hrs.
-Prolonged Fever: a single illness in which the duration exceeds that
expected for the single clinical diagnosis.
🡪Fever of Unknown Origin (FUO): fever (core temp >38.1C/101F) once daily
for 14 days or more without cause of fever after 1 week extensive evaluation
and diagnostic work-up.
-25% thought to be caused by viral illness
-Labs: CBC, liver enzymes, CMP, sed rate, urinalysis, CXR, imaging is
decided based on clinical situation, test for EBV/cytomegaly virus
-infectious disease consults
-Empiric antibiotics should not be administered for FUO because it can
delay diagnosis and mask symptoms.
-Management of fever: acetaminophen is drug of choice, ibuprofen
children > 6months of age and has longer duration.
-ASA not used in children d/t risk of Reye’s Syndrome
Ankylosing Spondylitis
Give this one a try later!
, spondylarthritis. Chronic inflammatory condition. Sacroiliac joint and spine,
TMJ. Peaks onset age 20-30. Males > females. HLA-B27B genetic
connection.
-Difficult to diagnose.
-Sx: low back pain, poorly localized in glutes near SI joint common first sx.
Fever, weight loss, stiffness worse in morning, immobility early in morning
and late at night.
-Dx: pain present for at least 3 months. X-ray not needed for dx. CRP, Sed
elevated, RF negative, CBC mild anemia. Pt <45 with pain >3months.
Bones and spine and fuse🡪bamboo spine*
-Meds: NSAIDs first line, DMARDS not helpful.
-IBS, uveitis also can be seen
-affects shoulders/knees not small joints as much. Classic DMARDs not
helpful.
UTI
Give this one a try later!
-Most common in primary care, more common in women
-common cause e. coli, staph, staoh aureus, enterococcus, klebsiella
-Sx: dysuria, frequency, urgency, suprapubic pain, gross hematuria, men
may have more dribbling/nocturia, afebrile
-young men think STI
-Older patients changes in mental status or new onset incontinence
-Dx: clean catch UA
-Leukocyte esterase, nitrites (gram neg and gram-positive bacteria)
-negative UA does not rule out UTI
-if unclear, order culture with sensitivity (pregnant patients always)
Complicated: postmenopausal, UTI in any child or UTI in man or pregnant
women.
-Tx: Men (Cipro/fluroquinolone or Bactrim for 7-14 days)
Uncomplicated: premenopausal, no underlying conditions, afebrile, no
flank pain
, -Tx: Macrobid, Bactrim, uristat/AZO (OTC), pyridium, tx for 3-5 days
-Education: preventive, urinating before and after intercourse, push fluids,
improve in few days
-Recurrent UTI in Women: reinfection (more than 2 wks since tx and new
organism) or relapse (<2wks since tx and same organism)
-atrophic vaginosis increases postmenopausal women’s risk, vaginal
estrogen can decrease this risk
-Dx: urine culture
Prostate Cancer
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most common malignancy in men-adenocarcinoma most common
-DRE firm, nodule induration or stony asymmetric prostate
-Sx: asymptomatic, lower UTI sx, back pain in advanced
disease/paresthesia in lower extremities.
-Dx: elevated PSA >4 & biopsy
Osteoarthritis
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