CMN 568 - Unit 2 Exam Questions with
Complete Solutions
3 stages of pertussis - Answer-*Stage 1 - Catarrhal: usually 7-10 days, up to 3 weeks*
+ Coryza (runny nose)
+ Low-grade fever
+ Mild, occasional cough
+ Resembles a mild URI
* Stage 2 - Paroxysmal: 1-6 weeks (up to 10 weeks)*
+ Paroxysms of numerous rapid coughs, thick mucus makes it difficult to clear bronchial
tree
+ Long inspiratory effort followed by high-pitched "whoop" at end of cough
+ Cyanosis
+ Vomiting and exhaustion
+ Attacks occur more frequently at night
+ Attacks worsen for weeks 1-2, stay the same for 2-3 weeks, then gradually lessen
*Stage 3 - Convalescent: 7-10 days (up to 3 weeks)*
+ Paroxysms gradually lessen
+ Gradual recovery
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.AAP contraindications in treatment of bronchiolitis - Answer-+ Routine RSV testing
NOT recommended unless infant has been on prophylaxis with Palivizumab, testing
doesn't change treatment
+ Routine CXR NOT recommended if no respiratory distress
+ Albuterol or salbutamol treatment is NOT recommended due to lack of evidence that it
is effective
+ Corticosteroids are NOT recommended due to lack of evidence that they are effective
+ Antibiotics are NOT recommended unless a bacterial infection is present or strongly
suspected.
+ Ribavirin antiviral aerosol treatment reserved for severely ill children with immune or
anatomic cardiopulmonary defects
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.AAP recommendations for tx of bronchiolitis - Answer-+ Supportive measures: fluids to
maintain hydration, nasal saline & suctioning for congestion
+ Use of supplemental oxygen is appropriate for patients with hypoxemia on room air (If
patients are hypoxemic, they are usually admitted.)
+ Most children can be safely treated as out-patients
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.ABX tx of CAP in previously healthy patients with comorbid conditions,
immunosuppression or recent antibiotic use? - Answer-+ Respiratory fluoroquinolones (-
floxacins)
Choose *ONE* of the following regimes:
+ A respiratory fluoroquinolone:
-- Moxifloxacin 400mg/d
-- Gemifloxacin 320mg/d
-- Levofloxacin 750mg/d
+ Combination of a macrolide (see slide #16 for drugs and doses) PLUS a beta-lactum:
-- Amoxicillin 1 gm TID
-- Amoxicillin-clavulanate 2 gm BID
-- Cefpodoxime 200 mg BID or cefuroxime 500 mg BID (not as effective as the
penicillins, but available for pts with PCN allergies)
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.ABX tx of CAP in previously healthy patients with no recent antibiotic use? - Answer-
MACROLIDES (-mycins) or Doxycycline
+ Azithromycin (z-pack) 500mg/d x1 day, then 250mg/d x 4d
OR
+ Clarithromycin 500mg BID x 5 days
OR
+ Doxycycline 100mg BID x 5 days
NOTE: Use of fluoroquinolones is discouraged in ambulatory patients without co-
morbidities or recent antibiotic use.
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.After a positive CXR, what other tests should patients have to confirm dx of CAP? -
Answer-+ NONE for most pts. Start tx with empiric abx
+ Atypical causes (Exposure to TB or flu, recent travel, immunosuppressed) should prob
undergo additional testing.
--Sputum gram stain
--UA antigen tests for s.pneumo or legionelle
--Rapid flu
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.Ages of children usually affected by croup - Answer-6 months to 5 years
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