Nurs 629 Exam 3 (Maryville)
Otitis media pathogens - Answer Caused by: S. Pneumoniae (most common); H.
Influenzae, M. Catarrhils
Otitis media Symptoms: - Answer Fever, Pain, discharge from ear, tugging at ear,
irritability, crying, lethargy, decreased appetite, decreased sleep, Recent URI
Objective findings in otitis media - Answer 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 - Answer Amoxicillin-clavulanate
80-90 mg/kg/day BID x 10 days
Treatment for AOM d/t S. Pneumoniae (most common): - Answer Amoxicillin 80-90
mg/kg/day BID x 10 days (high dose)
Treatment for AOM with PCN Allergy: Non-Type 1: - Answer Cefdinir, Cefuroxime
Treatment for AOM with PCN Allergy: Type 1: - Answer Azithromycin, clarithromycin
OR Ceftriaxone 1-3 days
Predisposing factors of otitis externa: - Answer Frequent moisture, local trauma,
aggressive cleaning, Allergies/skin conditions
Causative organisms for otitis externa: - Answer Psuedomonas aeruginosa (20-60%);
Staphylococcus Aureus (10-70%); 10% fungal infection
Symptoms of otitis externa: - Answer 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: - Answer 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: - Answer Warm
compresses, Auralgan, prednisone, Tylenol/ibuprofen, Wick (abx applied to wick )
When to wick with otitis externa: - Answer If lumen is reduced to >50%, wicks can help
ensure delivery of topical abx to medial canal.
Treatment of otitis externa: - Answer Topical fluroquinolones (Ciprofloxacin, Ofloxacin),
ibuprofen and apap for pain, neomycin/polymixin b/hydrocortison otic (antibiotic/steroid)
,Hallmark sign of otitis externa: - Answer Traction of pinna elicits pain
When do we begin hearing tests in clinic for children - Answer 4 years old
What is a normal audiology test result and how are results read - Answer 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 - Answer Obesity, Diabetes, Hypertension,
Family history: Coronary heart disease prior to age 55, Hyperlipidemia, Diabetes
Clinical findings for tetralogy of Fallot: - Answer 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 - Answer 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 - Answer • Vision is 20/400 • Fix and follow objects
Viral conjunctivitis etiology (causative agent): - Answer Adenovirus is the most common
cause. Other causes: HSV, herpes zoster, and varicella
Viral conjunctivitis symptoms: - Answer 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 - Answer 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: - Answer Symptomatic Only - Warm or cool compresses,
Strict hand hygiene
Pharyngitis - Answer Typically viral
Causative organism for bacterial pharyngitis - Answer Group A Beta Hemolytic strep
Subjective findings for strep pharyngitis: - Answer Rapid onset of sore throat,
abdominal pain, headache, dysphasiay
, Objective findings for strep pharyngitis: - Answer Fever >103, Swollen glands,
anorexia, lack of uri s/sx, irritability, Exudative tonsils, scarlatina rash, strawberry
tongue, anterior cervical lymphadenopathy
Treatment for strep pharyngitis - Answer Amoxicillin 5mg/kg/day x10 days
If allergy to first line tx for strep pharyngitis, what do you prescribe? - Answer
Cephalosporin or macrolide (azithromycin)
Therapeutic tx for strep pharyngitis (in addition to abx) - Answer Warm water
gargle/apap/ibu
Education re strep pharyngitis: - Answer Discard toothbrush after 24hs on an abx and
after treatment completion
When may pt return to school with strep pharyngitis: - Answer This is contagious. May
return to school after 24 hours on abx
Scarlet fever: - Answer Occurs secondary to strep throat and progresses to acute
rheumatic fever if no intervention
Is scarlet fever common or rare? - Answer Rare
Subjective/Objective findings of scarlet fever: - Answer Scarlatina begins on face and
spreads down and out/strawberry tongue/Fever/pharyngitis
Treatment of scarlet fever: - Answer amoxicillin 50-80 mg/kg/day x7 days
Classic triad of mononucleosis Pharyngitis: - Answer Fever, equative pharyngitis
POSTERIOR cervical lymphadenopathy
Subjective sx of mononucleosis: - Answer malaise, fatigue, headache, anorexia,
Objective s/sx of mononucleosis: - Answer Abnormal LFTs, splenic enlargement, CBC
c diff- lymphocytosis c atypical cells, monospot positive, EBV virus specifics - VCA-IgM,
VCA AgG, EA, EBNA, negative rapid strep c culture
Treatment for mononucleosis: - Answer Symptomatic unless severe
Treatment for mononucleosis with strep - Answer Macrolide to avoid pcn rash
(azithromycin, erythromycin, clarithromycin)
Education for mononucleosis: - Answer F/u in 1-2 weeks, Avoid contact sports until 1
month after symptoms subside - concern for rupture
Otitis media pathogens - Answer Caused by: S. Pneumoniae (most common); H.
Influenzae, M. Catarrhils
Otitis media Symptoms: - Answer Fever, Pain, discharge from ear, tugging at ear,
irritability, crying, lethargy, decreased appetite, decreased sleep, Recent URI
Objective findings in otitis media - Answer 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 - Answer Amoxicillin-clavulanate
80-90 mg/kg/day BID x 10 days
Treatment for AOM d/t S. Pneumoniae (most common): - Answer Amoxicillin 80-90
mg/kg/day BID x 10 days (high dose)
Treatment for AOM with PCN Allergy: Non-Type 1: - Answer Cefdinir, Cefuroxime
Treatment for AOM with PCN Allergy: Type 1: - Answer Azithromycin, clarithromycin
OR Ceftriaxone 1-3 days
Predisposing factors of otitis externa: - Answer Frequent moisture, local trauma,
aggressive cleaning, Allergies/skin conditions
Causative organisms for otitis externa: - Answer Psuedomonas aeruginosa (20-60%);
Staphylococcus Aureus (10-70%); 10% fungal infection
Symptoms of otitis externa: - Answer 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: - Answer 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: - Answer Warm
compresses, Auralgan, prednisone, Tylenol/ibuprofen, Wick (abx applied to wick )
When to wick with otitis externa: - Answer If lumen is reduced to >50%, wicks can help
ensure delivery of topical abx to medial canal.
Treatment of otitis externa: - Answer Topical fluroquinolones (Ciprofloxacin, Ofloxacin),
ibuprofen and apap for pain, neomycin/polymixin b/hydrocortison otic (antibiotic/steroid)
,Hallmark sign of otitis externa: - Answer Traction of pinna elicits pain
When do we begin hearing tests in clinic for children - Answer 4 years old
What is a normal audiology test result and how are results read - Answer 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 - Answer Obesity, Diabetes, Hypertension,
Family history: Coronary heart disease prior to age 55, Hyperlipidemia, Diabetes
Clinical findings for tetralogy of Fallot: - Answer 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 - Answer 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 - Answer • Vision is 20/400 • Fix and follow objects
Viral conjunctivitis etiology (causative agent): - Answer Adenovirus is the most common
cause. Other causes: HSV, herpes zoster, and varicella
Viral conjunctivitis symptoms: - Answer 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 - Answer 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: - Answer Symptomatic Only - Warm or cool compresses,
Strict hand hygiene
Pharyngitis - Answer Typically viral
Causative organism for bacterial pharyngitis - Answer Group A Beta Hemolytic strep
Subjective findings for strep pharyngitis: - Answer Rapid onset of sore throat,
abdominal pain, headache, dysphasiay
, Objective findings for strep pharyngitis: - Answer Fever >103, Swollen glands,
anorexia, lack of uri s/sx, irritability, Exudative tonsils, scarlatina rash, strawberry
tongue, anterior cervical lymphadenopathy
Treatment for strep pharyngitis - Answer Amoxicillin 5mg/kg/day x10 days
If allergy to first line tx for strep pharyngitis, what do you prescribe? - Answer
Cephalosporin or macrolide (azithromycin)
Therapeutic tx for strep pharyngitis (in addition to abx) - Answer Warm water
gargle/apap/ibu
Education re strep pharyngitis: - Answer Discard toothbrush after 24hs on an abx and
after treatment completion
When may pt return to school with strep pharyngitis: - Answer This is contagious. May
return to school after 24 hours on abx
Scarlet fever: - Answer Occurs secondary to strep throat and progresses to acute
rheumatic fever if no intervention
Is scarlet fever common or rare? - Answer Rare
Subjective/Objective findings of scarlet fever: - Answer Scarlatina begins on face and
spreads down and out/strawberry tongue/Fever/pharyngitis
Treatment of scarlet fever: - Answer amoxicillin 50-80 mg/kg/day x7 days
Classic triad of mononucleosis Pharyngitis: - Answer Fever, equative pharyngitis
POSTERIOR cervical lymphadenopathy
Subjective sx of mononucleosis: - Answer malaise, fatigue, headache, anorexia,
Objective s/sx of mononucleosis: - Answer Abnormal LFTs, splenic enlargement, CBC
c diff- lymphocytosis c atypical cells, monospot positive, EBV virus specifics - VCA-IgM,
VCA AgG, EA, EBNA, negative rapid strep c culture
Treatment for mononucleosis: - Answer Symptomatic unless severe
Treatment for mononucleosis with strep - Answer Macrolide to avoid pcn rash
(azithromycin, erythromycin, clarithromycin)
Education for mononucleosis: - Answer F/u in 1-2 weeks, Avoid contact sports until 1
month after symptoms subside - concern for rupture
