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T/F: newborns MAY NOT have a febrile response and maybe hypothermic even with overwhelming infection
TRUE
Fever: gold standard
Rectal temp 100.4 degrees
Fever of unknown origin: Fever for more than ___ d up to ___ degrees or higher
8-14; 100.4
MC organism for occult bacteremia
S. pneumoniae
2nd MC organism for occult bacteremia
HIB
Presence of +blood culture in child who looks well & is treated as out pt in whom the + result is not anticipated
Occult bacteremia (FWLS)
growth of bacteria in the blood of a child w/the clinical picture of toxicity and shock
Septicemia
Admit? Fever in infant <30 d
ADMIT!
Tx: fever in newborn
Hospitalization/empiric abx therapy; IV ampicillin + gentamycin or cefotaxime
Criteria used to assess febrile infants > 1 months < 3 months old
Rochester Criteria
T/F: well-appearing child b/w 3-36 m w/FWLS an be observed outpatient IF good F/U can be documented
TRUE
S/Sx: \"blueberry muffin\" rash, celery stalk lesions at ends of femur & humerus, hearing loss/deafness, cataracts/micropthalmia, hepatosplenomegaly
Rubella
RNA virus of the togavirus family
Rubella (German measles)
Prevention: Vaccination of all females ____ to ____.
prior to conception
Rubella: ___% of infected pregnant women are asymptomatic
50
Rubella: congenital infection rate highest during __ & __ trimester
1st & 3rd
S/Sx: swelling of salivary gland, low grade F, malaise, H/A, anorexia, abd pain
Mumps
Tx: Mumps
Supportive
S/Sx: high fever, 3 C\'s (cough, coryza, conjunctivitis), Koplik spots, rash
Measles (Rubeola)
Measles: Rash starts at the ___ & travels ____
head & travels downward
S/Sx: severe paroxysmal cough following an initial short catarrhal phase
Pertussis (whooping cough)
Name 3 phases & duration of pertussis
1. cattarrhal (7-10d) 2. paroxysmal (1-10w) 3. Convalescent
Pertussis phase with URI Sx w/low grade F & mild cough; later WBC\'s could be 50K w/lymphocyte predominance
Catarrhal phase
Phase where paroxysms less common cough gradually resolves
Convalescent phase
Phase characterized by bursts of numerous, rapid coughs followed by long inspiratory gasp w/high pitched whoop
Paroxysmal phase
Paroxysms occur more at ____
night
Tx: Pertussis
Supportive care; Erythromycin, Claarithromycin
S/Sx: F, HA, myalgias, ST, malaise, cough, rhinitis
Seasonal influenza
2 complications of influenza
OM & LRI
Tx: flu
Amantadine, Oseltamivir & Zanamivir
S/Sx: F, cough, ST, malaise, HA, N/V/D, chills, myalgias, arthralgias
Swine Flu (H1N1)
T/F: longer periods of shedding occur in children (esp infants), elderly, chronically ill & immunocompromised w/swine flu
TRUE
Whom to test for H1N1 Flu A:
children w/acute febrile respiratory illness & any sepsis-like syndrome
Tx: swine flu
Amantadine & Zanamivir
Suppurative infection of the middle ear
Otitis Media
MC in healthy children b/w __ m & __ y.o.
2 months & 2 yo
Increased risk of OM if (4)...
bottle fed, exposed to apssive smoking, winter months & cranial facial malformations (cleft palate)
Tx: OM
Amoxicillin
S/Sx: TM normal but external canal erythematous w/copious discharge. Extremely painful on manipulation of external pinna or tragus
Otitis Externa
MCC of OE
P. aeruginosa followed by S. aureus
S/Sx: sandpaper rash begins on trunk-->extremities, pastia lines, soft palate petechiae, strawberry tongue, Begins with: F, ST, HA, chills, abd pain
Streptococcal Scarlet Fever
Scarlet fever caused by _____
GABHS
MC associated with (2)
pharyngitis & impetigo
Tx: Scarlet fever
PCN/Amox for 10 d
Scarlet Fever: w/o Tx may develop ___
rheumatic fever
Even w/Tx may develop ____
PSGN (post streptococcal glomeruleronephritis
S/Sx: F, irritability & V followed by generalized erythematous exanthem that spreads rapidly from head to toe & simulates a suburn
Staphylococcal Scalded Skin (SSS)
SSS: larger portions of epidermis begin to separate inot sheets w/ light lateral traction of the skin leaving raw weeping surfaces
Nikolsky\'s sign
S/Sx: low-grade F, malaise, V followed by abrupt inc in F w/chills, worsening malaise, weakness, V & abd pain
Toxic shock syndrome (TSS)
Tx: TSS
Aggressive fluid replacement & antimicrobial therapy
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