CMN 568 Final Exam Questions & Answers 2024/2025

CMN 568 Final Exam Questions & Answers 2024/2025 Incidence of Fever - ANSWER-One of most common reasons for parents to seek medical care. Preschoolers have an average 6-8 febrile illnesses a year. Definition of fever - ANSWER-Rectal temperature ≥ 100.4°F Tympanic temperature - ANSWER-Not accurate in infants under 3 months Fever Causes - ANSWER-Most common Benign viral illness, can also cause by bacterial or fungal infections, drug reactions including immunizations, malignancies, autoimmune or metabolic disorders, CNS disorders, excessive environmental temperatures. Factors that increase likelihood of serious bacterial illness - ANSWER-Age under 3 months, history of prematurity, chronic medical conditions such as immunosuppression or asplenia, previous hospitalizations, daycare. Toxic appearance Non-Toxic appearance - ANSWER-Strong cry Consolable Alert and easy to arouse Pink skin tones Good hydration; good turgor, tears, moist mucous membranes Smiles, responsive to environment Toxic appearance - ANSWER-Weak or high-pitched cry Inconsolable Difficult to arouse Pale, ashen, cyanotic, or mottled skin tones Poor hydration; poor turgor, dry mucous membranes, no tears No smile, listless, dull, infant won't alert to environment Signs of serious illness - ANSWER-Fever greater than 40 (105) Nuchal rigidity Petechial skin rash Seizure activity Stridor or increased WOB Physical exam signs of serious infection: Skin - ANSWER-Petechiae, rashes Physical exam signs of serious infection: head/neck - ANSWER-Sunken or bulging fontanelles, nuchal rigidity Physical exam signs of serious infection: ears - ANSWER-Bulging TM, AOM, mastoiditis Physical exam signs of serious infection: Chest - ANSWER-Tachypnea, wheezing, rales, rhonchi Physical exam signs of serious infection: Heart - ANSWER-Murmurs Physical exam signs of serious infection: Abdomen - ANSWER-Tenderness, distension Physical exam signs of serious infection: Musculoskeletal - ANSWER-Refusal to bear weight or use an extremity, erythema/warmth over joint Diagnostic tests for fever in infant and young child - ANSWER-CBC w/ Diff (WBC > 15,000 may indicate SBI. Child with overwhelming sepsis my have WBC <5,000) UA/ C&S: R/O UTI CXR: R/O Pneumonia Lumbar Puncture: R/O meningitis Blood cultures: R/O Bacteremia Stools for C&S: R/O Infectious diarrhea Management of fever in infant < 4 weeks - ANSWER-Refer to pediatrician Hospitalization Full septic workup IV antibiotics pending culture results Management of fever in infant 4 weeks - 3Mo - ANSWER-Toxic appearance: Refer to pediatrician Hospitalization Full septic workup IV antibiotics pending culture results Non-Toxic appearance/No risk factors for SBI: Full septic workup Specific treatment for any diagnosed conditions Empiric antibiotics after cultures: Rocephin 50mg/kg/day (up to 1 gm max) Must have reliable caregiver with phone and transportation Close follow up in 24 hours Management of fever in 3Mo to Preschool - ANSWER-Toxic appearance: Septic work up Consider hospitalization and IV antibiotics, especially if no focal source of fever can be identified Non-Toxic appearance: Lab work up guided by H&P CBC with Diff CXR if cough or dyspnea Stool C&S if diarrhea UA: all girls under 2yo, all males under 6Mo, uncircumcised males under 12Mo Non-Toxic appearance: Fever <39 (102) no obvious source: Antipyretics, close follow up by visit or phone Fever >39 (102) antipyretics, consider empiric antibiotics, close follow up by visit or phone Antipyretic - ANSWER-Acetaminophen: 10-15mg/kg Q 4-6 Hrs (Max 5 doses in 24 hours) Ibuprofen: 5-10mg/kg Q 6-8hrs (max 40mg/kg/day) Never use aspirin Educate parents on risk of overdosing and review concentration information. Fever-Home Care - ANSWER-Increased fluids to maintain hydration Light clothing/blankets to help reduce fever Tepid sponge baths if fever unresponsive to antipyretics No alcohol or cold-water baths Parents should check every 4 hours for: Temp, activity level, fluid intake and report any change in condition to medical provider Fever - Follow up - ANSWER-Close follow up is essential for safe out-patient management of fever in infants and young children Follow up by office visit or phone in 24 hours Follow up on all labs and cultures and focus treatment on any positive findings Proper otoscope technique - ANSWER-Always brace finger against patients cheek Adult: Pinna up and back Peds: Pinna down and back Normal Otoscope View - ANSWER-Malleus, Umbo, Cone of light Cone of light at 7 o'clock in left and 5 o'clock on right Cone of light disappears when there is fluid Otitis Externa - ANSWER-Cellulitis of the soft tissues of the external auditory canal Hallmark - tragus pain (doesn't hurt with middle ear infection) continues...