Rickets
Name 3 clinical features that are most characteristic of rickets in a growing child
Bowing of the legs
Metaphyseal Cupping
Rachitic Rosary
Delayed Growth
Difficulty Ambulating
what are the most common pathogens for sepsis in a term newborn
GBS
EColi
Listeria
age group for febrile seizures
6 months to 5 years
What acute phase reactant is the most sensitive for bacterial infections
Procalcitonin
What is the primary cause of nutritional rickets in exclusively breast fed infants?
VitD deficiency
what is the meningitic dose and sepsis dose for rocephin
100mg/kg q24
50mg/kg q24
Do febrile seizures increase risk of epilepsy?
No
What is the definition of UTI based on how the urine was obtained?
Straight cath: > 50,000 CFU
Clean Catch: > 100,000 CFU
Which radiographic findings are diagnostic of rickets
Metaphyseal Cupping
Fraying of the metaphyses
Widening of the metaphyses
How do you decide to change from empiric management to narrower coverage
Culture results & sensitivities
Risk Factors for Febrile Seizures
Rate of rise for fever
Viral infection
Vaccines (Dtap and MMR)
Genetic Predisposition
Why do UA's of infants with a UTI often show negative nitrites
the conversion of nitrates to nitrites by bacteria requires time and infants often pee too quickly to allow for this to happen
What laboratory anomalies would you see in a child with rickets?
Elevated alkaline phosphatase
Elevated PTH
Low to normal serum calcium
Low to normal serum phosphate
Low vitamin D
You have an term 32 day old febrile (Tm 102) admitted to your team. What initial work-up would you like?
CBC
CMP
CRP/Procal
UA with culture
Blood Culture
How do you differentiate a febrile seizure from simple v complex
Simple: x1 in 24 hours, duration < 15min, generalized
Complex: >1 in 24 hours, focal or generalized, prolonged duration
How do you determine when to stop empiric antibiotic therapy?
Negative blood culture at 36 - 48 hours.
96% of blood cultures will grow by 36 hours
99% of blood cultures will grow by 48 hours
What genetic disorder can present similar to rickets and how is it differentiated?
25 hydroxylase deficiency
VitD levels do not rise appropriately with treatment
Your initial work-up comes back with elevated inflammatory markers, what do you do next?
Obtain LP and send cell counts, protein, glucose, enterovirus or meningitis panel
A 15-month-old boy is brought to the ED after a seizure. His mother states he had a generalized tonic-clonic seizure lasting 3 minutes and was febrile at home. He returned to baseline within 15 minutes and has no history of prior seizures. His temperature in the ED is 38.7°C (101.7°F). Physical exam is unremarkable. What do you do?
Anti-pyretics & observe
Name the EEG finding in infantile spasms and the treatment?
Hypsarrythmia
Steroids