FINAL EXAM SET - CMN 568

FINAL EXAM SET - CMN 568




1. Fever causes by age in infants? (MODULE 1): Causes: L
x x x x x x x x x


ess than 1month: Group B Strep, E. Coli
x x x x x x x


1 mo-3 mo: strep pneumoniae, H. Influenzae, N. Meningitidis
x x x x x x x x


Fever without source of infection: most common cause -
x x x x x x x x


H.Influenza Type B & Strep Pneumoniae
x x x x x x


2. Fever appearance in infants for non toxic vs toxic? (MODULE 1): Non-
x x x x x x x x x x x


toxic appearance: consolablex x




Toxic appearance: weak, high pitched cry, inconsolable
x x x x x x


Seen Immediately: neck stiff, fever >40.6 C, <3mo + fever >38C, petechiae, drooling sal
x x x x x x x x x x x x x


iva and unable to swallow anything, child has sickle cell disease/ splenectomy/ HIV/ c
x x x x x x x x x x x x x


hemotherapy/ organ transplant/ chronic steroids x x x x




Tympanic route is not accurate in infants <3mo. RE x x x x x x x x




D FLAGS FOR SERIOUS ILLNESS:
x x x x


<1mo: >40C temp, petechial rash, meningeal irritation, resp signs (tachypnea, stridor,
x x x x x x x x x x


ncreased WOB, crackles, decreased breath sounds, cyanosis), hypotension. In neonat
x x x x x x x x x


s, meningeal irritation can present as labile temperature.
x x x x x x x




Any infant less than 1 month old with fever should be hospitalized and have full sepsis w
x x x x x x x x x x x x x x x x


rk up x


3. Define fever temperature in infants? (MODULE 1): Rectal temp: 38 degrees C
x x x x x x x x x x x


elsius
or 100.4 degrees Fahrenheit.
x x x


Determine treatment based on presentation, whether they are non-x x x x x x x x


toxic or toxic appearing x x x



1x/x28

,4. Acetaminophen dosing in children? (MODULE 1): Acetaminophen (Tylenol) 1 x x x x x x x x


0-15mg/kg q4 to 6 hours x x x x


MAX daily dose: 5 doses in 24 hours
x x x x x x x


5. Ibuprofen dosing in children? (MODULE 1): Ibuprofen (Motrin/Advil) 5
x x x x x x x x


-10mg/kg q6 to 8 hrs. x x x x


MAX: 40mg/kg per day TOTAL 6
x x x x x x


months or older x x


6. Fever treatment for.... Infan x x x


ts less than 4 weeks? Infants
x x x x x x


4 weeks to 3 months?
x x x x


Infants 3 months to preschool? (MODU
x x x x x


LE 1): Infants less than 4 weeks:
x x x x x x




2x/x28

, risk of sepsis!! x x


Full septic work-up - blood culture, CXR if indicated, stool culture. AVOID CEFTRI-
x x x x x x x x x x x x


AXONE (Rocephin). Refer to ED. Ampicillin, cefotaxime, acyclovir.
x x x x x x x x




Infants 4 weeks - 3 months: x x x x x


Toxic appearance (risks for SBI [systemic bacterial infection]): full septic work up. CXR
x x x x x x x x x x x x


indicated, stool cultures. Refer to ED. Empiric IV abx pending culture.
x x x x x x x x x x




Non-toxic appearance (no risk for SBI): full septic work- x x x x x x x x


up. CXR. Outpatient if pt has reliable caregiver. Rocephin 50mg/kg/day (empiric abx).
x x x x x x x x x x x




Infants 3 months - preschool: x x x x


Toxic appearance: septic workup. Lumbar puncture, CXR, stool culture, rapid viral test
x x x x x x x x x x x


g. Empiric abx (pending culture results)
x x x x x




Non-toxic appearance: lab work- x x x


up guided by H&P. Empiric abx (pending culture results)
x x x x x x x x


7. Acute Otitis Media (AOM) (MODULE 1): Moderate - x x x x x x x


severe bulging of TM.MUST have bulging TM and MEE (middle ear effusion)
x x x x x x x x x x x x x




Severe DX: toxic appearance, pain >48hrs, temp >102.2 >IM
x j MEDIATE tx
x x x x x x x x x


Often proceeded by viral URI with secondary bacterial infection/ Ca
x x x x x x x x x


uses: Strep pneumoniae, H. Flu, M. Cat
x x x x x x


8. Does an ear effusion (fluid) mean there is an infection? (MODULE 1): No.
x x x x x x x x x x x x


9. Acute Otitis Media (AOM) treatment? (MODULE 1): 1st line: A
x x x x x x x x x


moxicillin 90mg/kg/day divided BID (MAX 1000mg/dose) x x x x x


Child weighs >40kg = 500-875mg PO q12hrs
x x x x x x




2nd line: x


Augmentin. If patient has taken abx within last 30 days. Fails to improve on amoxicillin 48-
x x x x x x x x x x x x x x x


72hrs. Otitis-conjunctivitis syndrome x x


Do NOT use macrolides (azithromycin) after amoxicillin failure PC
x x x x x x x x


N allergic children: erythromycin, clarithromycin, azithromycin
x x x x x


10. External Otitis...Onset? (MODULE 1): Acute onset of severe ear pain. Clear >j pu
x x x x x x x x x x x x


rulent discharge from EC. x x x


11. External Otitis... What must you rule out? (MODULE 1): Must rule out AOM wit
x x x x x x x x x x x x x


h TM rupture or PE tubes: due to different tx
x x x x x x x x x


12. External Otitis...What bacterias can cause this? (MODULE 1): - x x x x x x x x


pseudomonas, or staph x x




3x/x28