CMN 568 FINAL EXAM QUESTIONS & VERIFIED
ANSWERS
Fever causes by age in infants? (MODULE 1)
Causes:
Less than 1month: Group B Strep, E. Coli
1 mo-3 mo: strep pneumoniae, H. Influenzae, N. Meningitidis
Fever without source of infection: most common cause – H.Influenza Type B & Strep
Pneumoniae
Fever appearance in infants for non toxic vs toxic? (MODULE 1)
Non-toxic appearance: consolable
Toxic appearance: weak, high pitched cry, inconsolable
Seen Immediately: neck stiff, fever >40.6 C, <3mo + fever >38C, petechiae, drooling
saliva and unable to swallow anything, child has sickle cell disease/ splenectomy/ HIV/
chemotherapy/ organ transplant/ chronic steroids
Tympanic route is not accurate in infants <3mo.
RED FLAGS FOR SERIOUS ILLNESS:
<1mo: >40C temp, petechial rash, meningeal irritation, resp signs (tachypnea, stridor,
increased WOB, crackles, decreased breath sounds, cyanosis), hypotension. In
neonates, meningeal irritation can present as labile temperature.
Any infant less than 1 month old with fever should be hospitalized and have full sepsis
work up
Define fever temperature in infants? (MODULE 1)
Rectal temp: 38 degrees Celsius
or 100.4 degrees Fahrenheit.
Determine treatment based on presentation, whether they are non-toxic or toxic
appearing
,Acetaminophen dosing in children? (MODULE 1)
Acetaminophen (Tylenol) 10-15mg/kg q4 to 6 hours
MAX daily dose: 5 doses in 24 hours
Ibuprofen dosing in children? (MODULE 1)
Ibuprofen (Motrin/Advil)
5-10mg/kg q6 to 8 hrs.
MAX: 40mg/kg per day TOTAL
6 months or older
Fever treatment for....
Infants less than 4 weeks?
Infants 4 weeks to 3 months?
Infants 3 months to preschool?
(MODULE 1)
Infants less than 4 weeks:
risk of sepsis!!
Full septic work-up – blood culture, CXR if indicated, stool culture. AVOID
CEFTRIAXONE (Rocephin). Refer to ED. Ampicillin, cefotaxime, acyclovir.
Infants 4 weeks - 3 months:
Toxic appearance (risks for SBI [systemic bacterial infection]): full septic work up. CXR
if indicated, stool cultures. Refer to ED. Empiric IV abx pending culture.
Non-toxic appearance (no risk for SBI): full septic work-up. CXR. Outpatient if pt has
reliable caregiver. Rocephin 50mg/kg/day (empiric abx).
Infants 3 months - preschool:
Toxic appearance: septic workup. Lumbar puncture, CXR, stool culture, rapid viral
testing. Empiric abx (pending culture results)
,Non-toxic appearance: lab work-up guided by H&P. Empiric abx (pending culture
results)
Acute Otitis Media (AOM) (MODULE 1)
Moderate – severe bulging of TM. MUST have bulging TM and MEE (middle ear
effusion)
Severe DX: toxic appearance, pain >48hrs, temp >102.2 🡪 IMMEDIATE tx
Often proceeded by viral URI with secondary bacterial infection/
Causes: Strep pneumoniae, H. Flu, M. Cat
Does an ear effusion (fluid) mean there is an infection? (MODULE 1)
No.
Acute Otitis Media (AOM) treatment? (MODULE 1)
1st line:
Amoxicillin 90mg/kg/day divided BID (MAX 1000mg/dose)
Child weighs >40kg = 500-875mg PO q12hrs
2nd line:
Augmentin. If patient has taken abx within last 30 days. Fails to improve on amoxicillin
48-72hrs. Otitis-conjunctivitis syndrome
Do NOT use macrolides (azithromycin) after amoxicillin failure
PCN allergic children: erythromycin, clarithromycin, azithromycin
External Otitis...Onset? (MODULE 1)
Acute onset of severe ear pain. Clear 🡪 purulent discharge from EC.
External Otitis... What must you rule out? (MODULE 1)
Must rule out AOM with TM rupture or PE tubes: due to different tx
, External Otitis...What bacterias can cause this? (MODULE 1)
pseudomonas, or staph
External Otitis treatment if you CAN visualize the tympanic membrane? (MODULE 1)
gentle removal of debris
Neomycin polymyxin B/ hydrocortisone
External Otitis treatment if you CAN'T visualize the tympanic membrane? (MODULE 1)
MUST ASSUME PERFORATION
Do NOT give neomycin/polymyxin B
Use ear wick. If swelling too severe for ear wick, administer abx
🡪 REFER to otolaryngolist
Give Ciprofloxacin/dexamethasone
Cerumen Impaction (MODULE 1)
Relieved with detergent eat drops (3% hydrogen peroxide, 6.5% carbamide peroxide),
mechanical removal, suction, or irrigation (performed ONLY when TM is known intact).
Do NOT use WaterPik
Pharyngitis / Tonsillitis (MODULE 1)
First, decide if you are dealing with a viral or a bacterial infection
Over 90% of sore throat and fever = viral infections
CLUE: Pharyngitis (viral infection) is associated with cough and rhinorrhea =
ANTIOBITICS NOT INDICATED IN MOST CASES OF SORE THROAT
Pharyngitis / Tonsillitis: Differentiating viral causes? (MODULE 1)
Hand, Foot, & Mouth Disease: ulcers on the tongue and oral mucosa; vesicles,
pustules, & papules on the palms, soles, interdigital areas, and buttocks; caused by
enteroviruses
Herpangina: 2-3 mm ulcers on the anterior pillars and soft palate and uvula; caused by
Coxsackie virus
Infectious mononucleosis: exudative tonsillitis, generalized cervical adenitis, fever,
palpable spleen or axillary adenopathy (you must palpate for splenomegaly)
Pharyngoconjunctival Fever: Exudative tonsillitis, conjunctivitis, lymphadenopathy and
fever; caused by adenovirus
ANSWERS
Fever causes by age in infants? (MODULE 1)
Causes:
Less than 1month: Group B Strep, E. Coli
1 mo-3 mo: strep pneumoniae, H. Influenzae, N. Meningitidis
Fever without source of infection: most common cause – H.Influenza Type B & Strep
Pneumoniae
Fever appearance in infants for non toxic vs toxic? (MODULE 1)
Non-toxic appearance: consolable
Toxic appearance: weak, high pitched cry, inconsolable
Seen Immediately: neck stiff, fever >40.6 C, <3mo + fever >38C, petechiae, drooling
saliva and unable to swallow anything, child has sickle cell disease/ splenectomy/ HIV/
chemotherapy/ organ transplant/ chronic steroids
Tympanic route is not accurate in infants <3mo.
RED FLAGS FOR SERIOUS ILLNESS:
<1mo: >40C temp, petechial rash, meningeal irritation, resp signs (tachypnea, stridor,
increased WOB, crackles, decreased breath sounds, cyanosis), hypotension. In
neonates, meningeal irritation can present as labile temperature.
Any infant less than 1 month old with fever should be hospitalized and have full sepsis
work up
Define fever temperature in infants? (MODULE 1)
Rectal temp: 38 degrees Celsius
or 100.4 degrees Fahrenheit.
Determine treatment based on presentation, whether they are non-toxic or toxic
appearing
,Acetaminophen dosing in children? (MODULE 1)
Acetaminophen (Tylenol) 10-15mg/kg q4 to 6 hours
MAX daily dose: 5 doses in 24 hours
Ibuprofen dosing in children? (MODULE 1)
Ibuprofen (Motrin/Advil)
5-10mg/kg q6 to 8 hrs.
MAX: 40mg/kg per day TOTAL
6 months or older
Fever treatment for....
Infants less than 4 weeks?
Infants 4 weeks to 3 months?
Infants 3 months to preschool?
(MODULE 1)
Infants less than 4 weeks:
risk of sepsis!!
Full septic work-up – blood culture, CXR if indicated, stool culture. AVOID
CEFTRIAXONE (Rocephin). Refer to ED. Ampicillin, cefotaxime, acyclovir.
Infants 4 weeks - 3 months:
Toxic appearance (risks for SBI [systemic bacterial infection]): full septic work up. CXR
if indicated, stool cultures. Refer to ED. Empiric IV abx pending culture.
Non-toxic appearance (no risk for SBI): full septic work-up. CXR. Outpatient if pt has
reliable caregiver. Rocephin 50mg/kg/day (empiric abx).
Infants 3 months - preschool:
Toxic appearance: septic workup. Lumbar puncture, CXR, stool culture, rapid viral
testing. Empiric abx (pending culture results)
,Non-toxic appearance: lab work-up guided by H&P. Empiric abx (pending culture
results)
Acute Otitis Media (AOM) (MODULE 1)
Moderate – severe bulging of TM. MUST have bulging TM and MEE (middle ear
effusion)
Severe DX: toxic appearance, pain >48hrs, temp >102.2 🡪 IMMEDIATE tx
Often proceeded by viral URI with secondary bacterial infection/
Causes: Strep pneumoniae, H. Flu, M. Cat
Does an ear effusion (fluid) mean there is an infection? (MODULE 1)
No.
Acute Otitis Media (AOM) treatment? (MODULE 1)
1st line:
Amoxicillin 90mg/kg/day divided BID (MAX 1000mg/dose)
Child weighs >40kg = 500-875mg PO q12hrs
2nd line:
Augmentin. If patient has taken abx within last 30 days. Fails to improve on amoxicillin
48-72hrs. Otitis-conjunctivitis syndrome
Do NOT use macrolides (azithromycin) after amoxicillin failure
PCN allergic children: erythromycin, clarithromycin, azithromycin
External Otitis...Onset? (MODULE 1)
Acute onset of severe ear pain. Clear 🡪 purulent discharge from EC.
External Otitis... What must you rule out? (MODULE 1)
Must rule out AOM with TM rupture or PE tubes: due to different tx
, External Otitis...What bacterias can cause this? (MODULE 1)
pseudomonas, or staph
External Otitis treatment if you CAN visualize the tympanic membrane? (MODULE 1)
gentle removal of debris
Neomycin polymyxin B/ hydrocortisone
External Otitis treatment if you CAN'T visualize the tympanic membrane? (MODULE 1)
MUST ASSUME PERFORATION
Do NOT give neomycin/polymyxin B
Use ear wick. If swelling too severe for ear wick, administer abx
🡪 REFER to otolaryngolist
Give Ciprofloxacin/dexamethasone
Cerumen Impaction (MODULE 1)
Relieved with detergent eat drops (3% hydrogen peroxide, 6.5% carbamide peroxide),
mechanical removal, suction, or irrigation (performed ONLY when TM is known intact).
Do NOT use WaterPik
Pharyngitis / Tonsillitis (MODULE 1)
First, decide if you are dealing with a viral or a bacterial infection
Over 90% of sore throat and fever = viral infections
CLUE: Pharyngitis (viral infection) is associated with cough and rhinorrhea =
ANTIOBITICS NOT INDICATED IN MOST CASES OF SORE THROAT
Pharyngitis / Tonsillitis: Differentiating viral causes? (MODULE 1)
Hand, Foot, & Mouth Disease: ulcers on the tongue and oral mucosa; vesicles,
pustules, & papules on the palms, soles, interdigital areas, and buttocks; caused by
enteroviruses
Herpangina: 2-3 mm ulcers on the anterior pillars and soft palate and uvula; caused by
Coxsackie virus
Infectious mononucleosis: exudative tonsillitis, generalized cervical adenitis, fever,
palpable spleen or axillary adenopathy (you must palpate for splenomegaly)
Pharyngoconjunctival Fever: Exudative tonsillitis, conjunctivitis, lymphadenopathy and
fever; caused by adenovirus
