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37 Cards in this Set

  • Front
  • Back

When do the majority of adverse reactions to vaccines occur?

first 24 to 48 hours after the firstdose of the particular innoculation.

Examples of vaccines that can cause fever?

The immunization against rotavirus is a live-virus vaccine that can cause fever in someinfants, usually within the first several days.

What is fever without source?

when a complete history has been obtained and a detailedphysical examination performed, and there is no identified source of the child's fever.

Etiologies of serious bacterial illness?

  • Urinary tract infection (UTI)-the most common
  • Meningitis
  • Sepsis
  • Pneumonia
  • Bacterial gastroenteritis
  • Osteomyelitis
  • Septic arthritis
  • Occult bacteremia

What is occult bacteremia?

Generally applied to a child with bacteremia who looks fairly well (or is a little fussy). A child withbacteremia who appears ill or "toxic" is more likely to be septic. The distinction is made becausemost children with occult bacteremia will NOT develop a serious bacterial illness (SBI), whereasa child with sepsis represents a medical emergency.

Signs of meningitis in infants?

  • fever
  • hypothermia
  • bulging fontanelles
  • lethargy, irritability, restlessness
  • paroxysmal crying
  • poor feeding
  • vomiting/diarrhea

What happens if an infant has kernig's or brudzinski's sign?

must assume that he2/13or she may have meningitis and perform a lumbar puncture.

Another finding meningitis?

neck stiffness or nuchal rigidity

Value of the WBC and diff?

In a low-risk child (immunized and looked well), given the low prevalence of bacteremia inthat setting the positive predictive value of the WBC count would be very low. Almost allpatients with a positive WBC would be false positives.

It is a piece of the puzzle, however, and in the setting of a child with an increased likelihoodof SBI, the elevated WBC and bands increase the likelihood of a SBI.

Oral vs parenteral antibiotics?

Criteria for parenteral therapy include patients judged to be "toxic" or unable to retain oralmedications or situations in which compliance with oral medications is a concern.

What is the role of prophylactic antibiotics?

benefit in reducing UTI recurrence in childrenwith VUR in a high quality, placebo-controlled, randomized controlled trial.

Renal scarring, however, was unchanged when prophylactic antibiotics were compared toplacebo.

Kernig's sign

resistance to extension of the knee

Brudzinski sign

flexion of the hip and knee in response to flexion of theneck by the examiner.

DDx for infant with fever?

  • UTI
  • Pneumonia
  • Sepsis/bacteremia
  • bacterial meningitis
  • viral meningitis
  • roseola
  • occult bacteremia
  • HSV
  • otitis media
  • vaccine reaction
  • viral URI



no focus on exam

unremarkable ROS


lack of appetite






low SaO2



young infants -> hypothermia

don't look well

early sign -> high heart rate

late sign:

  • delayed cap refill
  • low bp
  • altered mental status
  • evidence of organ failure

Bacterial meningitis

  • fever
  • do B and K sign

Viral meningitis

  • less severe than bacterial meningitis
  • fever
  • loose stools, rash, URI


  • caused by HHV-6
  • high fever
  • rash as fever resolves

Occult bacteremia

high fever without no other symptoms

Primary HSV gingiviostomatitis

  • can be asymptomatic
  • fever and irritability
  • oral lesions start as vesicles
  • evolve into ulcerations

otitis media

poor mobility and at least mild bulging of TM

red tympanic membrane (no PPV)

vaccine reaction

fever, 1-2 days after receiving vaccine

Viral URI

  • congestion
  • cough
  • rhinorrhea
  • coryza

How to test for fever without source?

  • urinalysis
  • urine culture
  • CBC and diff
  • Blood culture
  • LP

interpretation of urinalysis?

nitrite test

leukocyte esterase test

nitrite test

A positive nitrite on urinalysis is extremely helpful: It is highly specific for the presence ofbacteria in the urine (few false positives).7/13A negative nitrite, however, has a very poor sensitivity (lots of false negatives) for bacteruria,especially in young infants who urinate frequently.

leukocyte esterase test

A positive leukocyte esterase usually indicates the presence of white blood cells WBCs inthe urine, but pyuria can be seen in a variety of conditions in addition to urinary tractinfection. Thus, a positive leukocyte esterase test alone is insufficient to make the diagnosisof a urinary tract infection.

What if nitrites and leukocyte esterase are positive?

If both nitrites and leukocyte esterase are positive, it is strongly suggestive of a urinary tractinfection.

Follow up for first episode of pyelonephritis?

  • US for kidneys and bladder
  • Renal technetium scan
  • voiding cysturethrogram

US for kidneys and bladder

Unless the illness is of unusual severity, or the child is not improving on antibiotics, theultrasound may be obtained at completion of the antibiotic course.

Renal technetium scan

Provides evidence of pyelonephritisNot required in a patient who has responded well to treatment


Should not be performed routinely in children after a first febrile UTI unless there are findingson the renal and bladder ultrasound that suggest high-grade vesicoureteral reflux

Management of occult bacteremia?

A young febrile child who appears ill, however, should be evaluated carefully, because sepsisfrom non-vaccine pneumococcal serotypes and other bacteria still occurs-though rarely. It isimportant always to:Discuss your concerns with the parent(s)Provide close and careful follow-up, andDocument your findings in the medical recordIn this way, any patients who develop more serious complications will receive prompt treatmentand will likely have a good outcome

Treatment of pyelonephritis, parenteral?

  • amp and gent
  • ceftriaxone
  • pip tazo
  • cipro

Oral treatment of pyelonephritis?

Cephalexin - best choice