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FINAL EXAM SET - CMN 568
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FINAL EXAM SET - CMN 568
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FINAL EXAM SET - CMN 5681. 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
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