NURS 629 EXAM 3 LATEST 2024/2025 GUIDE;ACTUAL QUESTIONS AND ANSWERS SOLVED 100%-(MARYVILLE)

NURS 629 EXAM 3 LATEST 2024/2025 GUIDE; ACTUAL QUESTIONS AND ANSWERS SOLVED 100%-(MARYVILLE) Otitis media pathogens Caused by: S. Pneumoniae (most common); H. Influenzae, M. Catarrhils Otitis media Symptoms: Fever, Pain, discharge from ear, tugging at ear, irritability, crying, lethargy, decreased appetite, decreased sleep, Recent URI Objective findings in otitis media Red, bulging OM; Retracted with pus; no movement of TM, Inability to see landmarks; occasional hole in TM Treatment for AOM + Conjunctivitis d/t : H. Influenzae Amoxicillin-clavulanate 80-90 mg/kg/day BID x 10 days Treatment for AOM d/t S. Pneumoniae (most common): Amoxicillin 80-90 mg/kg/day BID x 10 days (high dose) Treatment for AOM with PCN Allergy: Non-Type 1: Cefdinir, Cefuroxime Treatment for AOM with PCN Allergy: Type 1: Azithromycin, clarithromycin OR Ceftriaxone 1-3 days Predisposing factors of otitis externa:Frequent moisture, local trauma, aggressive cleaning, Allergies/skin conditions Causative organisms for otitis externa: Psuedomonas aeruginosa (20-60%); Staphylococcus Aureus (10-70%); 10% fungal infection Symptoms of otitis externa: Discharge from ear, recent history of swimming or placing something in the ear, low-grade fever, pain with movement of tragus, decreased hearing, redness around ear Objective findings of otitis externa: Otalgia ( inner or outer ear pain), discharge, fullness, itching, pain with movement of tragus, redness around ear, decreased hearing. Treatment of pain and therapeutic management of otitis externa: Warm compresses, Auralgan, prednisone, Tylenol/ibuprofen, Wick (abx applied to wick ) When to wick with otitis externa: If lumen is reduced to >50%, wicks can help ensure delivery of topical abx to medial canal. Treatment of otitis externa: Topical fluroquinolones (Ciprofloxacin, Ofloxacin), ibuprofen and apap for pain, neomycin/polymixin b/hydrocortison otic (antibiotic/steroid) Hallmark sign of otitis externa: Traction of pinna elicits pain When do we begin hearing tests in clinic for children 4 years oldWhat is a normal audiology test result and how are results read Normal -10 to +15 The higher the number, the greater the loss, Severe loss 71-90 (learning disability, limited vocabulary), Profound loss 90 Risk factors related to elevated cholesterol Obesity, Diabetes, Hypertension, Family history: Coronary heart disease prior to age 55, Hyperlipidemia, Diabetes Clinical findings for tetralogy of Fallot: Cyanosis: caused by blood low in oxygen, Shortness of breath and rapid breathing, especially during feeding or exercise, Loss of consciousness, Clubbing of fingers and toes, Poor weight gain, delayed growth, Polycythemia, metabolic acidosis, Systolic murmur at 2nd left ICS & holosystolic murmur at LLSB What criteria would you have to consider inpatient admission in a patient with pneumonia Infants less than 4 months old, Infant with poor feeding, grunting, O2 saturation <92%, respiratory rate >70 , Older child with grunting, inability to tolerate oral intake, oxygen saturation ≤ 92 percent, respiratory rate > 50 breaths per minute, Any age: Comorbidities (e.g., chronic lung disease, asthma, unrepaired or incompletely repaired congenital heart disease, diabetes mellitus, neuromuscular disease) Visual acuity of a 2-month-old • Vision is 20/400 • Fix and follow objects Viral conjunctivitis etiology (causative agent): Adenovirus is the most common cause. Other causes: HSV, herpes zoster, and varicella Viral conjunctivitis symptoms: o Watery discharge (profuse and clear), foreign body sensation, redness o URI symptoms are common including sore throat and fever o Itchy conjunctiva and swollen eye lids o Often bilateral Viral conjunctivitis Clinical findings o Normal visual acuity, PERRLA, EOMI, Fundus normal o Mucoid-profuse watery discharge o Mild, diffuse injection and itching o *Preauricular lymphadenopathy Viral conjunctivitis Treatment: Symptomatic Only - Warm or cool compresses, Strict hand hygiene Pharyngitis Typically viral Causative organism for bacterial pharyngitis Group A Beta Hemolytic strep Subjective findings for strep pharyngitis: Rapid onset of sore throat, abdominal pain, headache, dysphasiay Objective findings for strep pharyngitis: Fever >103, Swollen glands, anorexia, lack of uri s/sx, irritability, Exudative tonsils, scarlatina rash, strawberry tongue, anterior cervical lymphadenopathy Treatment for strep pharyngitis Amoxicillin 5mg/kg/day x10 days If allergy to first line tx for strep pharyngitis, what do you prescribe? Cephalosporin or macrolide (azithromycin)Therapeutic tx for strep pharyngitis (in addition to abx) Warm water gargle/apap/ibu Education re strep pharyngitis: Discard toothbrush after 24hs on an abx and after treatment completion When may pt return to school with strep pharyngitis: This is contagious. May return to school after 24 hours on abx Scarlet fever: Occurs secondary to strep throat and progresses to acute rheumatic fever if no intervention Is scarlet fever common or rare? Rare Subjective/Objective findings of scarlet fever: Scarlatina begins on face and spreads down and out/strawberry tongue/Fever/pharyngitis Treatment of scarlet fever: amoxicillin 50-80 mg/kg/day x7 days Classic triad of mononucleosis Pharyngitis: Fever, equative pharyngitis POSTERIOR cervical lymphadenopathy Subjective sx of mononucleosis: malaise, fatigue, headache, anorexia, Objective s/sx of mononucleosis: Abnormal LFTs, splenic enlargement, CBC c difflymphocytosis c atypical cells, monospot positive, EBV virus specifics - VCA-IgM, VCA AgG, EA, EBNA, negative rapid strep c culture Treatment for mononucleosis: Symptomatic unless severe Treatment for mononucleosis with strep Macrolide to avoid pcn rash (azithromycin, erythromycin, clarithromycin) Education for mononucleosis:F/u in 1-2 weeks, Avoid contact sports until 1 month after symptoms subside - concern for rupture Is impetigo contagious? Yes- very - spreads by contact - frequently resides in nasopharynx Causative organisms for impetigo Staph (most common), strep Subjective findings for impetigo: Rash that does not go away/pruritus Objective findings for impetigo: Small vesicle that erupts with "honey-colored crust" that begin in a small area and spreads; if crust is removed underlying skin is erythematous and edematous Diagnosis of impetigo: wound culture - MRSA Treatment of impetigo: Topical mupirocin/bactroban t.i.d., x 7-14 days and Cephalexin (Keflex) 40mg/kg/day x10 days (alternative: erythromycin 30-50mg/g/day x10 days) - If failure use Bactrim/SeptraEducation for impetigo: Wash face BID with soap/water / Wash sheets and pillow cases /No school for 48 hours after starting treatment This virus usually affects mucus membranes (oral or genital) HSV How is HSV spread? Via droplets, contact with active lesions, contact with saliva Subjective findings for HSV Tenderness, pain, paresthesia, burning, malaise, irritability, anorexia, drooling - PAINFUL NOT PRURITIC Objective findings for HSV Adenopathy, fever, grouped vesicles on an erythematous base, gingivostomatitis, yellow/white plaques, halatosis Treatment for HSV Self limiting, Resolves in 2-3 weeks, Symptomatic tx, Oral antivirals to shorten course (20-40mg/kg/day x5 days (begin c/in 48-72 hours of onset), Topical acyclovir 5% 5x/day This disease process occurs in clusters, has a peak incidence in late winter/early spring, is common in ages 5-15, is communicable between exposure and onset of rash, has an incubation period of 5-15 days and has a causative organism of Human parvovirus B19 Fifth Disease "Slapped Cheek" Subjective findings for Fifth Disease Fatigue, nausea, headache, pruritus Objective findings for Fifth Disease Characteristic "slapped cheek", low grade fever, injected conjunctiva What are the 3 distinct phases of Fifth Disease? 1. Phase 1: Facial redness < or equal to 4 days 2. Phase 2: Fishnet-like Lacey rash winton 2 days of facial redness. 3. Phase 3: Fever, pruritus, petechiae of hands and feet How is Fifth Disease diagnosed? Parvovirus IgG & IgM - CBC with decreased WBCs What is the clinical presentation of Fifth Disease? Low grade fever, malaise, sore throat What is the treatment for Fifth Disease? Symptomatic - Educate pt about hand washing to prevent spread. No school/daycare while infectious Fiery red, maculopapular facial rash concentrated on the cheeks (giving a slapped cheek appearance) Fifth Disease Pustular, ulcerating lesions on the hands and feet with oral lesions Hand-foot-and-mouth disease Vesicles and honey-colored crusted lesions Impetigo Scaly, hyper-pigmented lesions in a fir tree distribution usually found on the trunkPityriasis roses What is the treatment for Kawasaki disease? IV immunoglobulin, ASA, ECG and cardiac consult When can a patient return to school after starting treatment for impetigo? 48 hoursLesions that have ruptured with yellow serous fluid that crusts easily Bullous impetigo This disease mainly affects children younger than 10 years of age. It is caused by the coxsackievirus A16 Hand foot and mouth How is Hand Foot and Mouth disease spread? Direct contact with nasal discharge, saliva, blister, fluid, or stool. Most contagious during 1st week of illness What are the s/s of Hand Foot Mouth Disease? Low grade fever, pharyngitis, malaise, lymphadenopathy, anorexia, PETECHIAL-TYPE RASH THAT PRECEDES VESICLES, Multiple small vesicles on hands, feet, diaper area, and inside of the mouth, ulcers present in the mouth, throat, tonsils, and tongue, 3-7 mm red macular lesions that rapidly become pale white a red halo Are adults able to get HFMD? Yes What is the typical incubation period for HFMD? 3-6 days What is the causative organism for HFMD? Coxsackievirus A16 What is the tx for HFMD? Treatment is symptomatic as this is a self-limited disease. How long does it take for HFMD to go away? Spontaneous recovery typically in 5-7 days Should you give ASA to a child with HFMD? NO NO! What are some symptomatic treatments for HFMD? apap/ibu, oracle, benadryl/maalox mixture (magic mouthwash), salt-water gargle, cool/cold fluids, avoid sugary and acidic drinks Which rash has a characteristic pink, scaly, rash with a round raised border and central clearing Tinea Corporis What is the treatment for Tinea Corporis Topical antifungals: Ketoconazole, nystatin for 2-6 weeks Education for Tinea Corporis: Avoid contact with skin lesion. No contact sports for 48 hours after treatment This rash has a characteristic "herald patch" on the trunk that is slightly pruritic and erupts into Christmas tree pattern rash? Pityriasis Rosea What is thought to be the causative organism for Pityriasis Rosea? Viral (common in winter months), Females >males Prodome of fever, malaise, and pharyngitis and herald patch: 2-10 cm oval round lesion is indicative of what? Pityriasis Rosea What is the tx for Pityriasis Rosea? Antihistamines, topical steroids, avoid sun exposure, moisturizeHow long can it take for Pityriasis Rosea to resolve? Can take up to three months to resolve Annular lesions with a scaly border and central clearing? Tinea Corporis Improper alignment of the eyes: strabismus This disorder is caused by an IgE mediated inflammatory reaction to an allergy, chemical, or other unidentified etiology; with high likelihood of family history - has an unknown link to asthma Atopic Dermatitis "Eczema" Early onset (<2 years old) xerosis occurs Atopic Dermatitis "Eczema" Subjective findings for atopic dermatitis (Eczema) Intensely pruritic red rash, burning/stinging, dryness Objective findings for atopic dermatitis (Eczema) Pruritic papulovesicular rash that oozes and crusts over, lichenification occurs secondary to itching/physical trauma, indistinct borders, excoriations of lesions Atopic Dermatitis (Eczema) Management of Atopic Dermatitis (Eczema) Avoid harsh soaps. Low potency topical steroids. Immunomodulator (elide/Protopic). AAbx if secondary infection. Bleach bath. What is the most common cause of sore throat? Viral pharyngitis What are the most common viruses that cause viral pharyngitis? Rhinovirus, adenovirus, EBV, RSV What are the sx of viral pharyngitis Rhinorrhea, low-grade fever, conjunctivitis, cough, tonsillar exudate and/or enlarged tonsils, malaise Treatment for viral pharyngitis Gargle with warm salt water, increase fluid intake, ibu or apap for fever/throat pain Fluid accumulation in middle ear without evidence of infection Otitis media with effusion (OME) Is OME viral or bacterial? It can be either What are the most common bacterial etiologic agents that cause OME streptococcus pneumonia, H influenza, Moraxella catarrhalis What is the incubation period for mono? 2-5 weeks What virus causes Mono? Epstein-Barr Virus How do you treat a patient with elevated BP (stage 1) during initial visit? Repeat in 1-2 weeks and average the BP over 3 visitsHow do you treat a child with asthma when it is disruptive several times during the night/interrupting sleep at least 3 times a week. What do you prescribe? Inhaled steroid (Flovent, Asmanex, etc.) Risk factors related to elevated cholesterol Obesity, Diabetes, HTN, Fm Hx: CAD prior to age 55, HLD, Diabetes What are the clinical findings of tetralogy of Fallot? Cyanosis caused by blood low in oxygen/SOB and rapid breathing, especially during feeding or exercise/LOC/Clubbing of fingers and toes/Poor weight gain, delayed growth/Polycythemia, metabolic acidosis/Systolic murmur at 2nd left ICS & holosystolic murmur at LLSB How to treat a patient with elevated BP (stage 1) during initial visitRepeat in 1-2 weeks and average the BP over 3 visits How to treat a patient with asthma that is disruptive several times during the night, interrupting sleep at least 3 times a week Prescribe an inhaled steroid (Flovent, Asmanex, etc.) Causative organism of bronchiolitis Respiratory syncytial virus (RSV) most likely cause Treatment for prehypertension seen in a patient on initial visit Monitor BP over the next 3 visits, Encourage healthy lifestyle choices What is a murmur with a decrease in intensity when patient moves from supine to standing position? Innocent (benign) murmur Characteristics of innocent (benign) murmur Heard in up to 50% of children/No radiation/Systolic/Grade <III/Does not interfere with S1 & S2/Decreases with sitting and standing/Equal femoral and radial pulses/Normal PMI Symptoms of Croup Barking cough/Fever/URI sx Symptoms of Bronchiolitis Inspiratory and expiratory wheezing accompanied by: Fever, URI symptoms including profuse clear nasal discharge When do you use inhaler to treat exercise induced asthma? Use resume inhaler 15-30 min prior to activity What is Kawasaki Disease? Idipathic multi system disease characterized by vasculitis of small and medium blood vessels including coronary arteries Who typically gets Kawasaki Disease? 75% of diagnose are <5 years old. More common in boys. More common in winter and early spring. What is the etiology of Kawasaki Disease? Viral Is Kawasaki Disease contagious? Nope Clinical findings of Kawasaki Disease? Fever for at least 5 days (102-104) and at least 4 of the 5 following features: 1.Changes in extremities (edema, erythema, desquamation (peeling ofhands) 2. Conjunctival injection 3. Cervical lymphadenopathy 4. Cracking of lips and oral cavity 5. Polymorphous exanthema, usually truncal At what age do we always treat with abx for AOM? Under 6 months If a patient is 6months - 24 months old with AOM, a high fever, bilateral involvement, severe otalgia, and longe than 7-day presentation, how do we treat? High dose amoxicillin (80- 90mg/kg/day) in two divided doses - If allergic use Cefdinir ALSO oral analgesics If a patient is 6 months - 24 months and presents with unilateral non-severe illness of AOM, how do we treat? Watchful waiting for 48-72 hours If a patient is greater than 2 years old and presents with AOM, when do we treat w ABX? High grade fever/bilateral ear involvement/severe otalgia/longer than 7 days What is a non pharmacologic treatment for AOM? Local heat application What virus causes mono? Epstein-Barr virus Signs and symptoms of mono? Malaise, fatigue, fever, chills, headache, pharyngitis (may be painful, severe, and exudative), POSTERIOR cervical adenopathy, spenomegaly, palatal petechiae Treatment for mono Rest, no vigorous exercise, contact sports, or heavy lifting for abs 6-8 weeks or until spleen is no longer enlarged, warm salt-water gargles, avoid stress, apap for fever, aches Is it normal for eyes to briefly cross in a newborn until about 2 months of age YEP Symptoms include injected conjunctiva, profuse tearing, mucus discharge, burning, gritty, sandy feeling, concurrent upper respiratory infection, enlarged or tender prearicular nodes (initially unilateral, then bilateral Viral conjunctivitis Earliest age that visual acuity screeinging in primary care practice should be included in the overall well child assessment 4 years of age Rash that usually begins on the trunk and scalp then moves preipherally with moderate to intense itching and a fever chickenpox (Varicilla) Are chickenpox contagious? Yep When are varicella vaccinations given 1 year and 5 year When are chickenpox contagious? from 2 days prior to presentation of rash until all lesions have crusted over Incubation period of chickenpox? < or equal to 21 days Causative organism for chickenpox? Varicella zoster virusAfter contracting chickenpox, when can a child return to school? About 2 weeks - lesions have to be crusted up before returning to school What precautions do we use for chickenpox?Contact with erupted vesicles and droplet What is the prodrome of chickenpox? Low grade fever early, then high >101 / Headache / Listlessness, fatigue / Backache / URI s/sx What does chickenpox rash look like? Begins centrally and spreads to the periphery / moderate-intense pruritus / 4 days of vesicular eruption / 2-4 mmm umbilicate vesicles / ALL LESIONS ARE IN DIFFERENT STAGES OF ERUPTION AND HEALING Treatment for Kawasaki Disease IVIG, Echo, Cardiac Consult, ASA How do you diagnose Chickenpox? VZV PCR, Direct fluorescent antibody (DFA) What education do you provide for Chickenpox? Symptomatic treatment, prevent scratching to avoid "pox" scars, Cool compresses, caladryl/benadryl - No Benadryl <2 years of age (it increases cardiac events), if severe or in immunocompromised pt, use IV acyclovir (get early) This rash is viral, spread by contact, droplet, and airborne transmission, has an incubation period of 7-21 days, and is contagious from 4 days prior to rash presentation and 4 days after rash disappears? Measles/Rubeola This rash presents with fever, malaise, cough, coryza, conjunctivitis, Kopli spots (small white papule inside cheeks), and a *erythematous maculopapular rash that begins at the head and spreads down and out? Measles/Rubeola How is measles/Rubeola diagnosed? IgM antibody and/or measles PCR Treatment for measles/Rubeola? Supportive care and Vitamin A. 50,000 IU <6 mo; 100,000 IU 6-11 mo; 200,000 IU >or equal to 12 mo This disease is a generalized viral illness with painful enlargement of > or equal to 1 salivary/parotid gland. It is transmitted via contact and droplet. Happens more in late winter/spring. Has an incubation period of 12-25 days and is communicable 2 days before glandular edema and 5 days after onset? Mumps/Parotitis What is the causative organism for mumps/Parotitis? Paramyxoviridae virus Are mumps unilateral or bilateral? Can be either! Prodrome of mumps/parotitis: Fever, headache, anorexia, neck and muscular pain, malaise Primay/swelling stage of mumps/parotitis 24 hours after prodrome, painful parotitis, hours to days, resolves in 3-7 days, Rare: maculopapular rash on trunk, "Pickle sign" anything sour causes extreme pain, fever How do you diagnose mumps/parotitis? PCR, IgG, IgM Treatment for mumps/parotitis? Supportive, steroids, NSAIDSThis rash appears c/in 2 weeks of exposure, typically in children from 6 mo of age to 3 years of age, is caused by HHV-6 and HHV-7Roseola Infantum/Exanthem Subitum "Sixth Disease" Findings for this rash include: several days of high fever followed by a nonspecific rash. Typical small pink spots or patches c a white ring around the spots. Rash begins on trunk and spreads outward. Roseola Infantum/Exanthem Subitum Treatment for Roseola Infantum/Exanthem SubitumSupportive, rest, fluids, apap/ibu for fever This disease is tick-borne and typically happens in the NE and mid-atlantic states?Lyme disease Causative organism for Lyme disease Borrelia burgdorferi How many stages of Lyme disease? Three What happens in the first stage of Lyme disease? Occurs 1-2 weeks after bite / Erythema migrant starts as a red, annular macule or papule at the site of bite c/in 48 hours / Multiple lesions occur at different sites / Rash is warm and pruritic, but not painful / Flu like symptoms / Can last weeks to months s treatment What happens in the second stage Lyme disease? Dissemination through hematologic or lymphatic channels / Secondary annular lesions smaller than erythema migrans / Can have neurologic, cardiac, and or generalized symptoms / Lasts weeks to 2 years s treatment What happens in the third stage of Lyme disease? Periarticular or monoarticular arthritis / weeks to months after initial bite / chronic neurological symptoms Diagnosis of Lyme disease Clinical hx / IgG and IgM antibodies Treatment of Lyme disease <8 years old - Amoxicillin 50 mg/kg/day x14 days. >8 years old - Doxycycline 200 mg x1 - PCN or doxy allergy - cefuroxime Causative organism for RMSF Rickettsia rickettsia via tick S/S of RMSF Fever >104, chills, severe ha, myalgia, NVD, cough, conjunctival injection, photophobia, altered mental status, maculopapular rash 2-5 days after fever Diagnosis of RMSF PCR, IFA - gold standard Treatment for RMSF Must occur within 5 days of clinical symptoms, Doxycycline <100 lbs 2.2 mg/kg/day x7-10 days , >100 lbs 100 mg bid x7-10 days Causative organism for cat scratch disease/Lymphoreticulosis B. henselae This disease causes a systemic illness, erythematous papular rash 1 week after inoculation lasting less than or equal to 4 weeks, linear pattern that follows cat scratch, lymphadenopathy 1-4 weeks after inoculation that lasts 1 month to 1 year cat scratch disease/Lymphoreticulosis Diagnosis of cat scratch disease/Lymphoreticulosis IFA for serum antibodiesTreatment of cat scratch disease/Lymphoreticulosis Symptomatic treatment, Moist wraps, needle aspiration, abx if additional bacterial superinfection or immunocompromised patient - MACROLIDES This disease is droplet transmission. Its causative organism is N. meningitidis A, B, C, W-135, Y meningitis S/S of meningitis Fever, headache, myalgia, cold extremities, flu like symptoms, septic shock, stiff painful neck, petechial rash Diagnosis of meningitis BCX, peripheral gram skin, CSF, Sputum, rash scraping, PCR assays Treatment of meningitis Hospitalization c IV abx for 5-7 days - fatal without early intervention and treatment Prophylaxis for meningitis Close contact for extended period of time, treat empirically; Airline travel of 8 hours of exposure - oral rifampin and vaccination This is spread via contact-droplet with typical epidemic in winter months over 4-8 weeks Influenza Causative organism for influenza Orthomyxovirus types A, B, and C This virus causes a fever >102, headaches, vertigo, chills, pharyngitis, body aches, dry, hacking cough, NVD, Croup, and a toxic appearance Influenza Complications of influenza Myocarditis/CHF / Pneumonia/ Atelectasis Diagnosis of influenza Rapid flu Treatment of influenza Supportive / Tamiflu c/in 48 hours of onset if: under age 2, immunocompromised, chronic respiratory disease, Tamiflu can cause psychological issues/nightmares This disease process has a gradual onset with Coryza, rhinorrhea, pharyngitis, mild cough, low grade fever, erythematous nasal mucosa, milt throat erythema, anterior cervical lymphadenopathy, with lungs CTA Viral Upper Respiratory infections Treatment for Upper Respiratory infection (viral) Supportive Secondary to flaccidity of supporting tracheal cartilage, widening of posterior membranous wall, reduce anterior-posterior airway caliber traheomalacia This disease process causes difficulty breathing after birth, symptoms worsen with coughing, crying, and feeding, mild-severe symptoms, noisy high-pitched and rattling breathing that improves with changes in position and sleep tracheomalacia Diagnosis of trachomalacia laryngoscopy, airway fluoroscopy X-ray, barium swallow, ct scan, PFT, MRITreatment of trachomalacia Humidified air, careful feeding, abx if uri occurs, typical spontaneous resolution at 18-24 months Inflammation of the epiglottisEpiglottitis What age does epiglottitis usually occur 1-5 years old Causative organism of epiglottitis? ***HIB , strep, Bacillus This disorder causes inflammation of the epiglottis, has a sudden onset with fever, sore throat, hoarse voice, dyspnea, drooling, respiratory distress, tripod position, stridor, retractions, and nasal flaring Epiglottitis Treatment of epiglottitis? DO NOT examine mouth; DO NOT lay supine; MUST GO TO ER ASAP, Xray shows "thumb sign" This disease if very rare d/t vaccinations. The toxin production post-infection is more lethal than primary infection -myocarditis, electoral pathway changes, respiratory compromise, cranial nerve neuropathies, peripheral neuropathies Diptheria Causative organism of diphtheria C.diptheriae Findings for diphtheria: Low grade fever, pharyngitis, rhinorrhea, hoarse voice, cough, gray color to nasopharynx, pharynx, and or trachea, cutaneous throat lesions - non healing ulcers w gray membrane colonization Treatment for diphtheria Antitoxin administration, PCN or erythromycin, supportive care Cough lasting 6-10 weeks with high pitched inspiratory "whoop" followed by spasm of coghing Pertussis "Whooping cough" Prolonged cough c characteristic whooping sound c inspiration, cough is spasmodic pertussis "whooping cough" How do we diagnose pertussis? Blood test and report to CDC Treatment for Pertussis Macrolide (erythromycin, azithromycin, carithromycin etc,) Must treat all household and close contacts How long are you contagious with pertussis?2 weeks after the onset of cough Acute onset with uri sx, productive cough with cradles and wheezing Bronchiolitis/RSV URI sx for 3-7 days, gradual respiratory distress, bronchial spasms, tachypnea, crackles, wheezing Bronchiolitis/RSV Treatment for bronchiolitis/RSV Hydration / supportive care / If severe - hospitalization Viral etiology more common in oder children and adults with dry, hacking cough, rhinitis, fine rales, high pitched ronchi BronchitisTreatment for bronchitis supportive, cough suppressant - detromethorphan (robitussin) Steroids Common in children <6 years of age, Steeple sign on neck and soft tissue xray Larngotracheobronchitis "Croup" Causative organism for croup Staph aureus Harsh, barking cough with inspiratory strider, URI s/sx - prodrome, hoarseness, toxic presentation, gradual onset with worsening onset HS, low grade fever, edema and erythema of lateral walls of the trachea below the vocal cords in subglottic space Croup Management of laryngotracheobronchitis (Croup) humidified air, corticosteroids, racemic episode, hospitalization, intubation CAP causative organisms Can be viral or bacterial - viral is most common - if bacterial most often s. Pneumoniae Gradual onset of 1-2 days, may have abrupt high grade fever >103, consolation of lungs, crackles, cough CAP Diagnosis of CAP CXR to show consolidation of the aveolar spaces in the lungs Treatment for CAP if pt is <4mo old Hospitalization Treatment for CAP if pt is 4 months to 4 years old High dose amoxicillin 90 mg/kg/day BID x10 days Treatment for CAP if pt is >5 years old Azithromycin Multisystem, genetic - autosomal recessive disorder ODH screen tests for this disorder Cystic Fibrosis Must have one of the following CLINCIAL features for diagnosis of Cystic Fibrosis: 1. Chronic sinopulonary disease 2. GI/nutiritional abnormalities 3. Salt loss syndrome 4. Chronic metabolic alkalosis 5. Male urogenital abnormalities - obstructive azoospermia Must have one of the following LAB findings for diagnosis of Cystic Fibrosis: 1. Positive sweat test 2. CFTR mutation 3. Elevated glycosylated hemoglobin This disorder has s/s of COPD, Gi disturbances, and exocrine dysfunction; viscous mucous and dehydration of airway secretion- obstruction and chronic infections; and thick, fat, foul-smelling stool Cystic Fibrosis Management of Cystic Fibrosis Specialist consultation/management; pancreatic enzyme replacement; antibiotic and anti-inflammatory therapy; recurrent hospitalization; double lung and heart transplant Acute airway inflammation causing bronchoconstriction, edema and formation of mucus plugs asthmaIs asthma reversible yes, but chronic and may result in irreversible changes S/S of asthma Wheezing, sob, chest tightness, cough, tachypnea Management of asthma Prevention is key. Avoid triggers, take prescribed meds - Based on step approach dependent on symptom severity. At every step, pt should have a rescue inhaler. Essential to have an asthma action plan in place at school and home Step 1 - Symptoms <2 days/week; 0 nighttime awakenings; < or equal 2 days/wk abluterol use; no interference with daily activities; exacerbations require oral steroids 0-1x/year Mild intermittent Step 2 - Symptoms > 3d/week; 1-2 nighttime awakening / month; >2 days/week use of albuterol but not daily; mild interference with daily activity; >2 exacerbation in 6 months requiring oral steroids Mild persisitent Step 3 - Daily symptoms; 3-4 nighttime awakenings/month; daily use of albuterol; some interference c normal activity; >2 exacerbations in 6 mo requiring oral steroids Moderate persistent Step 3 and consider use of oral steroids; Daily, throughout the day symptoms, > or equal to 1 nighttime awakening; daily use of albuterol several times per day; extreme interference c normal activitySevere persistent Treatment for asthma Step 1: SABA PRN Treatment for asthma Step 2: SABA + Low dose ICS Treatment for asthma Step 3: SABA + Low dose ICS + LABA Treatment for asthma Step 4: SABA + Medium dose ICS + LABA Treatment for asthma Step 5: SABA + High dose ICS + LABA Treatment for asthma Step 6: SABA + High dose ICS + LABA + Oral corticosteroid Average systolic BP and/or diastolic BP > or equal to 95th% for gender, age and height on 3 or more occasions Hypertension >90th% but less than 95% Borderline HTN 95% Stage 1 HTN >95th% + 12mmhg Stage 2 HTN What age do we follow adult guidelines for HTN 13 years old What age do we begin monitoring BP 3 years How to determine HTN: Must have average systolic and/or diastolic BP > or equal to 95% on at least 3 different occasionsDiagnostics for HTN: Renal ultrasound, TSH, CMP, UA, CBC, ESR/CRP, ECG Primary HTN likely happens in adolescence - what pt education to provideRestrict sodium, proper diet, increase exercise Secondary HTN causes: Obesity, sedentary lifestyle, stress, *renal, vascular, and/or endocrine disorders, steroids, amphetamines, OCPs