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CMN 568 Final Exam – Questions With A+ Solutions
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CMN 568 Final Exam – Questions With A+ Solutions
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CMN 568 Final Exam – Questions With A+ SolutionsIncidence of Fever Right Ans - One of most common reasons for parents to
seek medical care.
Preschoolers have an average 6-8 febrile illnesses a year.
Definition of fever Right Ans - Rectal temperature ≥ 100.4°F
Tympanic temperature Right Ans - Not accurate in infants under 3 months
Fever Causes Right Ans - Most common Benign viral illness, can also
caused 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 Right Ans - Age
under 3 months, history of prematurity, chronic medical conditions such as
immunosupression or aspenia, previous hospitalizations, daycare. Toxic
appearance
Non-Toxic appearance Right Ans - 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 Right Ans - 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 Right Ans - Fever greater than 40 (105)
Nuchal rigidity
Petechial skin rash
Seizure activity
Stridor or increased WOB
,Physical exam signs of serious infection: Skin Right Ans - Petechiae, rashes
Physical exam signs of serious infection: head/neck Right Ans - Sunken or
bulging fontanelles, nuchal rigidity
Physical exam signs of serious infection: ears Right Ans - Bulging TM, AOM,
mastoiditis
Physical exam signs of serious infection: Chest Right Ans - Tachypnea,
wheezing, rales, rhonchi
Physical exam signs of serious infection: Heart Right Ans - Murmurs
Physical exam signs of serious infection: Abdomen Right Ans - Tenderness,
distension
Physical exam signs of serious infection: Musculoskeletal Right Ans -
Refusal to bear weight or use an extremity, erythema/warmth over joint
Diagnostic tests for fever in infant and young child Right Ans - 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 Right Ans - Refer to pediatrician
Hospitalization
Full septic workup
IV antibiotics pending culture results
Management of fever in infant 4 weeks - 3Mo Right Ans - 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 followup in 24 hours
Management of fever in 3Mo to Preschool Right Ans - 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 followup by visit or
phone
Fever >39 (102) antipyretics, consider empiric antibiotics, close followup by
visit or phone
Antipyretic Right Ans - 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 Right Ans - 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 Right Ans - 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 Right Ans - Always brace finger against patients
cheek
Adult: Pinna up and back
Peds: Pinna down and back
Normal Otoscope View Right Ans - 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 Right Ans - Cellulitis of the soft tissues of the external
auditory canal
Hallmark - tragus pain (doesn't hurt with middle ear infection)
Pathogens: Otitis Externa Right Ans - Pseudomonas aeruginosa
Staphylococcus aureus
Aspergillis or other fungi (esp. Diabetes)
Risk factors for Otitis External Right Ans - Moisture in ear from swimming,
showering, ect.
Trauma to the external ear canal form q-tips, ear plugs, hearing aids,
scratching
Keeping ears too clean removes protective cerumen and increases pH with
promotes bacterial growth
Otitis External: signs and symptoms Right Ans - Edema and erythema of
the external canal, may be swollen shut.
Sever ear pain, made worse by movement of the pinna or tragus
Purulent discharge from the external canal, canal may be filled wih debris,
making visualization of the TM difficult or impossible
May have periauricular or cervical lymphadenopathy
Otitis externa: differential diagnosis Right Ans - AOM with TM rupture or
patent PE tubes
Furunculosis(pimple/boil) of the ear canal, mastoidisis
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