CMN 568 Exam Test Bank 232 Questions and Answers (All are Correct)
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Module
CMN 568
Institution
CMN 568
CMN 568 Exam Test Bank 232 Questions and Answers (All are Correct)
How long does effusion behind TM last post AOM? - Answer up to 3 months; if longer than 3mo, refer for hearing test and possible PE tubes
SNAP approach to AOM - Answer Safety Net Abx Prescription; watchful waiting for 48-72hr ...
CMN 568 Exam Test Bank
232 Questions and
Answers (All are Correct)
How long does effusion behind TM last post AOM? - Answer ✔ up to 3 months; if longer
than 3mo, refer for hearing test and possible PE tubes
SNAP approach to AOM - Answer ✔ Safety Net Abx Prescription; watchful waiting for
48-72hr to see if symptoms improve or worsen; allows many children to avoid abx use
and let infection clear on its own
treatment for AOM - Answer ✔ first line: amoxicillin 90mg/kg/day divided BID
if failed: augmentin 90mg/kg/day divided BID
mild PCN allergy: cefdinir
severe PCN allergy: macrolides: Bactrim or Zithromax
if cannot swallow PO meds: Rocephin IM
antibiotic failure of AOM - Answer ✔ patient has taken amoxicillin in the past 30 days or
has failed to improve 48-72hrs on amoxicillin, OR has AOM with purulent
conjunctivitis.... give augmentin for this (90mg/kg/day divided BID) or ceftriaxone
50mg/kg/day x3 days
how to treat child with PE tubes and otorrhea, but no systemic symptoms - Answer ✔
fluoroquinolone otic drops are first line
recurrence of AOM greater than 4 weeks apart - Answer ✔ likely a new pathogen, start
treating with amoxicillin first line
why shouldnt you prescribe macrolides such as azithromycin or clarithromycin after
failure of amoxicillin? - Answer ✔ due to high resistance of h. influenza and strep
mastoiditis - Answer ✔ infection that spreads from middle ear space to the mastoid
portion of temporal bone; bony destruction with mastoid air cells can occur; early
findings are severe pain on mastoid palpation; CT is best way to determine extent
,pathogens of mastoiditis - Answer ✔ strep, followed by h. influenza and s. pyogenes
treatment for mastoiditis - Answer ✔ IV abx treatment alone if no evidence of abscess
on CT; surgical intervention if no improvement after 24-48hr of abx; always check for
nuchal rigidity
otitis media with effusion (OME) - Answer ✔ MEE with decreased TM mobility; not
treated with abx; observe uncomplicated cases for 3mo before consideration of PE
tubes; TM may be neutral or retracted and may be whitish; fluid and/or air bubbles may
be visible
indications for PE tubes - Answer ✔ - hearing loss greater than 40dB
- TM retraction pockets
- ossicular erosion
- adhesive atelectasis
- cholesteatoma
Pediatric acute bacterial rhinosinusitis (ABR) pathogens - Answer ✔ strep, H. in, m.
catarrhalis, B-hemolytic strep
symptoms of pediatric ABR - Answer ✔ nasal congestion, purulent nasal discharge,
facial pain/ pressure, cough, headache, fever; symptoms must ;ast 10days or longer
without improvement or worsening of symptoms within 10 days after initial improvement;
if patient presents with focal signs of periorbital edema, severe sinus tenderness, or
severe headache, DO NOT wait 10 days to treat
abx for pediatric ABR - Answer ✔ - first line: amoxicillin or augmentin
- mild PCN allergy: cefdinir
- if h. influenza or strep: include clindamycin (dont use bactrim or azithromycin)
recurrent sinusitis - Answer ✔ successive episodes of bacterial infections, each lasting
less than 30 days and separated by interval of at least 10 days
chronic sinusitis - Answer ✔ episodes of inflammation of paranasal sinuses lasting more
than 90 days; need to rule out esophagitis; anaerobic or staph organisms; treatment is
nasal corticosteroids and nasal irrigation
rhinitis medicamentosa - Answer ✔ rebound congestion from long-term use of nasal
decongestants like phenylephrine (neo-synephrine or afrin); limit use to only 3 days to
avoid rebound
, foreign bodies in nose - Answer ✔ causes unilateral foul-smelling rhinorrhea, halitosis,
or nasal obstruction and bleeding; refer if not easily removable; electrical current
generated by disk type batteries cause necrosis of mucosa and cartilage destruction in
less than 4hr due to the moist cavity of the nose.....emergency!
treatment for epistaxis - Answer ✔ have patient sit up and lean forward, pinching soft
part of the nose to prevent arterial blood flow for at least 5min; administer one time dose
of afrin or neo-synephrine to stop bleeding; refer to ER after 15 minutes if still bleeding;
can use gelfoam on site; polysporin daily to prevent re-occurance until all crusting has
healed; avoid ASA and NSAIDs; consider VonWillebrand if needed
diagnosing pediatric pharyngitis - Answer ✔ patient complains of sore throat or has
pharyngeal erthyema; viral 90% of the time and associated with cough and rhinorrhea
hand foot and mouth - Answer ✔ ulcers on the tongue and oral mucosa; vesicles,
pustules, and papules on the palms, soles, between fingers, buttocks; caused by
enterovirus
herpangina - Answer ✔ 2-3mm ulcers on anterior pillars and soft palate and uvula;
caused by coxsackie virus
mononucleosis - Answer ✔ exudative tonsils; palpable spleen; fever; cervical and
axillary adenopathy; viral from EBV
pharyngoconjunctival fever - Answer ✔ exudative tonsils; conjunctivitis; enlarged nodes
and fever; caused by adenovirus
pediatric acute bacterial pharyngitis - Answer ✔ pathogen is GABHS; treat with PenV or
amoxicillin; for pcn allergy, use cephalexin, clinda, or azith
; if you do a rapid strep test in the office and its negative, follow up with C&S due to
untreated strep causing acute rheumatic fever/ heart disease, glomerulonephritis, and
cervical adenitis
retropharyngeal abscess in child - Answer ✔ cuased by GABHS and staph; presents
with fever, respiratory symptoms, neck hyperextension, dysphagia, drooling, gurgling
respirations; confirm with imaging showing RP tissues wider than c4 vertebral body;
SURGICAL EMERGENCY
ludwigs angina - Answer ✔ swelling of the floor of the mouth; upward dislpacememt of
tongue; fever; airway obstruction; rpaidly progresses to cellulitis of submandibular
space; caused by dental disease and group A strep; treat with high dose IV clinda or
ampicillin until c&s return; refer
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