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CMN 568 FINAL EXAM SET – QUESTIONS AND ANSWERS.
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  • August 25, 2024
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  • 2024/2025
  • Exam (elaborations)
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CMN 568 FINAL EXAM SET – QUESTIONS
AND ANSWERS




Fever \causes \by \age \in \infants? \(MODULE \1) \- \correct \Answers \✔✔ \-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) \- \correct \Answers \✔✔ \-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) \- \correct \Answers \✔✔ \-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) \- \correct \Answers \✔✔ \-Acetaminophen \(Tylenol) \
10-15mg/kg \q4 \to \6 \hours

MAX \daily \dose: \5 \doses \in \24 \hours

Ibuprofen \dosing \in \children? \(MODULE \1) \- \correct \Answers \✔✔ \-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) \- \correct \Answers \✔✔ \-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) \- \correct \Answers \✔✔ \-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) \- \correct \Answers \✔✔ \-No.

Acute \Otitis \Media \(AOM) \treatment? \(MODULE \1) \- \correct \Answers \✔✔ \-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) \- \correct \Answers \✔✔ \-Acute \onset \of \severe \ear \pain. \Clear
\🡪 \purulent \discharge \from \EC.


External \Otitis... \What \must \you \rule \out? \(MODULE \1) \- \correct \Answers \✔✔ \-Must \rule \out \
AOM \with \TM \rupture \or \PE \tubes: \due \to \different \tx

External \Otitis...What \bacterias \can \cause \this? \(MODULE \1) \- \correct \Answers \✔✔ \-
pseudomonas, \or \staph

External \Otitis \treatment \if \you \CAN \visualize \the \tympanic \membrane? \(MODULE \1) \- \correct \
Answers \✔✔ \-gentle \removal \of \debris

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