CMN 568 - Unit 2 Exam Questions with Complete Solutions

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 HERF BBB .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 HERF BBB .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 HERF BBB .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) HERF BBB .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. HERF BBB .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 o or legionelle --Rapid flu HERF BBB .Ages of children usually affected by croup - Answer-6 months to 5 years HERF BBB .Anatomical location of croup infection - Answer-Inflammation of mainstem bronchus HERF BBB .CAP caused by Viruses vs Bacteria? Which is more common in adults? Which is more common in kids? - Answer-Adults - Bacterial Peds - Viral HERF BBB .Cause of pertussis - Answer-Bordatella pertussis HERF BBB .Common causes of bacterial CAP - Answer-+ Strep pneumo -- #1 +Haemophilus influenzae + Mycoplasma pneumoniae + Chlamydia pneumoniae + Staph aureus + Neisseria meningitidis + Klebsiella pneumoniae + Moraxella catarrhalis + Legionella spp. HERF BBB .Common signs of CAP - Answer-+ Fever: present in 80%. May be low or absent, especially in elderly + Tachycardia + Tachypnea (may be the most sensitive sign in elderly) + Rales, inspiratory crackles or bronchial breath sounds + Dullness to percussion over areas of consolidation + Oxygen desaturation + Mental status changes, esp. in elderly NOTE: No clear constellation of signs or symptoms has been found to accurately predict the diagnosis of pneumonia. HERF BBB .Common symptoms of CAP - Answer-+ Cough, with our without sputum production + Fever, chills, rigor, sweats + Dyspnea + Chest/ pleuritic pain + Nausea, anorexia, diarrhea