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MSN 626 Final questions with correct answers.
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- Maryville University Of St. Louis
MSN 626 Final questions with correct answers.
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MSN 626 Final questions with correct answersVAP Correct Answer-Occurs >48h after intubation
DD: heart fx, atelectasis, aspiration, ARDS
S/S: 2+ more findings (leukocytosis, fever, purulent sputum) w/ new
opacities on CXR
Dx: Blood cx, CXR, clinical s/s
Tx: Empiric abx (Cipro, ceftazadine) - to kill K. aureus
HAP Correct Answer-Occurs w/in 48h after admission
DD: heart fx, atelectasis, aspiration, ARDS
S/S: 2+ more findings (leukocytosis, fever, purulent sputum) w/ new
opacities on CXR
Dx: Blood cx, CXR, clinical s/s
Tx: Empiric abx (Cipro, ceftazadine) - to kill K. aureus
H. influenzae Correct Answer-Common CAP causes in infants and
children, can cause meningitis (needs tx for 7d), can cause otitis media,
epiglottis
What is the abx choice for H. influ that causes otitis media? Correct
Answer-Amoxicillin 500mg-1g PO TID for 10d
What bacteria causes epiglottis? Correct Answer-Encapsulated H. influ
(can cause potientally life-threatening airway obstruction
,Peritonsillar abscess (quincy) Correct Answer-Presents w/: severe sore
throat, odynophagia, trismus, medical deviation of the soft palate,
abnormal muffled voice (hot potato)
What is helpful in dx peritonsillar abscess, but not required? Correct
Answer-ultrasound
How do you confirm the dx of peritonsillar abscess? Correct Answer-By
aspirating pus just superior and medial to the upper pole of the tonsil
What is the tx for peritonsillar abscess in the ER? Correct Answer-
Parenteral amoxicillin (1g), amoxicillin-sulbactam (3g), or clindamycin
(600-90mg)
Peritonsillar abscess: tx for less severe cases that can do PO intake
Correct Answer-7-10d w/ PO abx, amoxicillin 500mg TID, clindamycin
300mg QID
How do you prevent recurrence of a peritonsillar abscess? Correct
Answer-Quinsy tonsillectomy
AOM: general considerations Correct Answer-Bacterial infx of the
middle ear, usually precipitated by a viral URI that causes eustachian
tube obstruction
What are the most common pathogens of AOM? Correct Answer-S.
PNA, H. inf, S. pyogenes
,AOM: S/S Correct Answer-Otalgia, aural pressure, decreased hearing,
fever
physical findings: erythema and decreased motility of the tympanic
membrane, occasionally bullae
AOM: when is tympanic membrane at risk for rupture? Correct Answer-
When middle ear empyema is severe, the TM bulges outward
AOM: S/S of TM rupture Correct Answer-Sudden decrease of pain,
followed by an onset of otorrhea
AOM: Tx Correct Answer-Abx w/ nasal decongestants
- amoxicillin (80-90 mg/kg/d divided 2x daily)
AOM: recurring/resistant infx Correct Answer-Complete
tympanocentesis for bacterial of fungal cx
AOM: tx when complication arises (mastoiditis, meninigitis) Correct
Answer-Surgical drainage of the middle ear (myringotomy)
AOM: recurrent tx Correct Answer-Single daily dose of
sulfamethoxazole (500mg) or amoxicillin (250 or 500mg) given over 1-
3m - fx of this tx results in insertion of ventilating tubes
, What is the main concern for pts who have pharyngitis/tonsillitis?
Correct Answer-Group A beta-hemolytic streptococcal (GABHS) since
it can lead to rheumatic fever and glomerulonephritis
Pharyngitis/tonsillitis: S/S (GABHS) Correct Answer-Clinical features
of GABHS: fever >38, tender anterior cervical adenopathy, lack of a
cough, pharyngotonsillar exudate (if 2-3 factors: intermediate likelihood
of GABHS)
Pharyngitis/tonsillitis: S/S (not GABHS) Correct Answer-IF only 1/4
symptoms present: not suggestive of GAHBS (no swab needeD) Severe
sore throat w/ odynophagia, tender adenopathy, and scarlatiniform rash,
elevated WBC, left shift- NO cough
Pharyngitis/tonsillitis: S/S suggestive of mono Correct Answer-marked
lymphadenopathy and a shaggy, white-purple tonsillar exudate, often
extending into the nasopharynx (avoid ampicillin d/t rash that might
occur)
Pharyngitis/tonsillitis: LAB FINDINGS Correct Answer-Single-swab
throat cx and rapid antigen detection testing for GABHS
Pharyngitis/tonsillitis: if someone has 4/4 criteria for GABHS, do they
need a throat cx? Correct Answer-No, tx w/ empiric abx w/o swab
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