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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.
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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.
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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.
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Etiologies of serious bacterial illness? |
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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.
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Signs of meningitis in infants? |
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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.
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Another finding meningitis? |
neck stiffness or nuchal rigidity |
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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. |
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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.
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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. |
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Kernig's sign |
resistance to extension of the knee |
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Brudzinski sign |
flexion of the hip and knee in response to flexion of theneck by the examiner.
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DDx for infant with fever? |
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UTI |
fever no focus on exam unremarkable ROS fussiness lack of appetite |
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Pneumonia |
cough tachypnea fever rales low SaO2 |
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Sepsis/bacteremia |
fever
young infants -> hypothermia don't look well early sign -> high heart rate late sign:
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Bacterial meningitis |
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Viral meningitis |
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Roseola |
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Occult bacteremia |
high fever without no other symptoms |
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Primary HSV gingiviostomatitis |
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otitis media |
poor mobility and at least mild bulging of TM red tympanic membrane (no PPV) |
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vaccine reaction |
fever, 1-2 days after receiving vaccine
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Viral URI |
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How to test for fever without source? |
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interpretation of urinalysis? |
nitrite test leukocyte esterase test |
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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.
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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.
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What if nitrites and leukocyte esterase are positive? |
If both nitrites and leukocyte esterase are positive, it is strongly suggestive of a urinary tractinfection. |
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Follow up for first episode of pyelonephritis? |
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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.
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Renal technetium scan |
Provides evidence of pyelonephritisNot required in a patient who has responded well to treatment
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VCUG |
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
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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
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Treatment of pyelonephritis, parenteral? |
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Oral treatment of pyelonephritis? |
Cephalexin - best choice |