Final Exam Old Material

Question 1

How is a fever defined?

Answer 1

T > 100.4 (38)

Question 2

Define Fever without focus/fever without source

Answer 2

acute febrile illness of less than 1 week duration in children under 24 months of age in which fever etiology is not apparent after careful H&P

Question 3

Define fever of unknown origin

Answer 3

Temperature greater than 38 (101) or greater on several occasions of more than 2-3 weeks duration with failure to reach a dx despite 1 week of intense investigation

Question 4

How would you work up a fever in an infant aged:
29-60 days
61-90 days
90 days +

Answer 4

• Infants 29-60 days: if well appearing – UA, CBC
• Infants 61-90 days: UA, CBC
• Infants 90 days-24 months: UA and culture to start

Question 5

What is the general approach to managing pediatric fever?

Answer 5

• Infants 0-4 weeks: ER referral
• ILL appearing infants 29-60 days: ER referral
• Empiric treatment is not recommended
• If immunization within past 24 hours and temp <101.5: watchful waiting

Question 6

What is included in the diagnostic criteria of Kawasaki disease?

Answer 6

Diagnostic criteria: Fever ≥ 5 days* and ≥ four of the following five principal clinical features

• Oropharyngeal mucosal changes: strawberry tongue, oral and pharyngeal erythema
• Bilateral non-purulent bulbar conjunctivitis
• Polymorphous rash: maculopapular, erythema multiforme-like rash
• Extremity changes
  
  • Acute: edema of hands and feet, erythema of palms and soles
  • Subacute: desquamation of fingers and toes
• Cervical lymphadenopathy

Question 7

Which children are at high risk for UTI?

Answer 7

• Females under 12 months (females 6months+ are at high risk for UTI)
• Uncircumcised males esp if fever is 102.2+ and lasts longer than 24-28 hours

Question 8

Match the presentation of UTI to the age group:

1. stomach discomfort, anuresis, malodor, vomiting/diarrhea, malaise, fever, diaper rash
2. irritable, fever, poor feeding, pain, hypothermia, vomiting/diarrhea, cyanosis, abd distension/pain
3. frequency, urgency, pain with urination, fever/chills, malaise

Answer 8

1. Older child
2. Neonate/infant
3. school age/adolescents

Question 9

What do you treat Pediatric UTI with?

Answer 9

Bactrim

Augmentin if suspicious of pyelonephritis

Question 10

For what criteria would you perform a renal and bladder US?

Answer 10

• <2 yo w/ first UTI
• All children w/ fever and UTI or pyelonephritis
• Recurrent UTI

Question 11

What is used to treat acute otitis media? When should patients start to see improvement in symptoms?

Answer 11

• Adults: Amoxicillin
• Peds: Amoxicillin, cephalosporin; Augmentin if amox given in the last 30 days; ceftriaxone if patient vomiting
• Should see improvement in 3 days, if don’t see improvement may try Augmentin to widen the coverage

Question 12

What would be used for acute otitis media if the tympanic membrane is perforated, there is otorrhea present or patent tubes in place?

Answer 12

Ciprofloxacin drops

Question 13

What is the “watchful waiting” criteria for acute otitis media?

Answer 13

• Observe, analgesics, and f/u 48-72 hrs IF
  
  • Unilateral AOM without fever > 102.2 or severe symptoms
  • 24 months, no severe symptoms

Question 14

When would you start treatment right away for acute otitis media in a pediatric patient?

Answer 14

• < 6 months or underlying conditions
• 6 months with severe signs/sx
• 6-23 months with bilateral AOM
• Unreliable caregiver

Question 15

What are the components of the CENTOR score for GAS?

Answer 15

• C: Absence of cough +1
• E: Exudate +1
• N: Tender anterior cervical lymphadenopathy +1
• T: Fever +1
• OR: Age modifier
  
  • Age less than 15 +1
  • Age greater than 45 -1

Question 16

How would you interpret the results of the CENTOR score?

Answer 16

• Rapid strep if CENTOR score 2-5
• Empiric antibiotics if CENTOR score >6 (Amoxicillin)
• If rapid strep is negative, follow up with regular culture for peds - do not need to do this in adults

Question 17

What are the 1st and second line meds for Group A Strep pharyngitis?

Answer 17

• 1st line: PCN or amoxicillin
• 2nd line: Cephalexin, clindamycin or macrolide

Question 18

Head injury red flags (7)

Answer 18

• Decreased LOC
• Confused/restless/agitation
• Focal neuro deficits
• Amnesia
• Neck pain
• Loss of consciousness > 30 seconds
• Otorrhea/rhinorrhea

Question 19

Headache red flags (7)

Answer 19

• Worst headache of their life
• Unexplained abnormal exam finding w/ non-acute HA pattern
• Recent change in pattern, frequency, severity
• Progressive worsening despite appropriate tx
• Onset w/ exertion, cough or sexual activity
• Onset after age 40
• Thunderclap headache

Question 20

What can be used as abortive vs. preventative therapy for migraine?

Answer 20

• Abortive
  
  • NSAIDS
  • triptans
• Preventative
  
  • Anticonvulsants
  • Beta-blockers, CCBs
  • TCAs, SSRIs

Question 21

Name the condition:

• Visual disturbances, weakness of the limbs
• Facial paralysis, vertigo (brain stem); coordination, tremors (cerebellum)
• Impaired vision, pain w/ movement (optic nerve)
• Diplopia, bowel & bladder dysfunction

Answer 21

Multiple sclerosis

Question 22

Name the components of the Ottowa knee rule

Answer 22

• Age ≥55
• Isolated tenderness of the patella (no other bony tenderness)
• Tenderness at the fibular head
• Unable to flex knee to 90°
• Unable to bear weight both immediately and in ED (4 steps, limping is okay)

Question 23

Match the part of the knee to the presentation and provocative test:

• medial knee pain, swelling and instability not common
• Test: Valgus stress test

Answer 23

MCL

Question 24

Match the part of the knee to the presentation and provocative test:

• acute lateral knee pain, instability leading to the knee giving way
• Test: Varus Stress Test

Answer 24

LCL

Question 25

Match the part of the knee to the presentation and provocative test: * Pop or dizziness, sweating or fainting * Swelling and pain * **Test: Lachman test, anterior drawer test**

Answer 25

ACL

Question 26

Match the part of the knee to the presentation and provocative test: * Pop or dizziness, sweating or fainting * Swelling and pain * **Test: posterior drawer test**

Answer 26

PCL

Question 27

Match the part of the knee to the presentation and provocative test: * May have feeling of locking or giving way, esp while descending stairs or walking on uneven surfaces * **Tests: Thessaly, McMurray, Apley compression**

Answer 27

Meniscus

Question 28

What are the imaging guidelines for back pain?

Answer 28

* Imaging (x-ray or MRI w/ gado) if red flags present or no improvement w/in 4-6 weeks * Age \> 50 * Recent unexplained wt loss * Failure to improve after 1 mo of conservative tx * Fever * New lower extremity weakness * Bowel/bladder dysfunction

Question 29

What can be used to treat impetigo?

Answer 29

* Mupirocin topical * Oral Dicloxacillin, cephalexin, azithromycin, Augmentin

Question 30

What can be used to treat erysipelas?

Answer 30

* Oral PCN V or cephalosporin or macrolide if PCN allx * If MRSA concern: clindamycin, doxycycline, Bactrim

Question 31

What can be used to treat erythasma

Answer 31

* Benzoyl peroxide wash * Clindamycin or azole creams

Question 32

What can be used to treat intertrigo?

Answer 32

* Drying agents: zinc, aluminum, calcium * + fungal infection: clotrimazole, ketoconazole, oxiconazole, econazole; nystatin * Oral: culture and determine abx

Question 33

What can be used to treat paronychial infection?

Answer 33

* Topical abx, antifungals, steroids * Oral abx for substantial infection

Question 34

What can be used to treat rosacea?

Answer 34

* Papules and pustules: topical or oral abx: * Metronidazole, azelaic acid, sulfacetamide/sulfur, brimonidine * Doxycycline, tetracycline * Phymatous or severe cases: refer to derm

Question 35

What does ABCDE stand for in regards to malignant melanoma?

Answer 35

* Asymmetric w/ nonmatching sides * Border is irregular * Color not uniform; brown, black, red, white, blue * Diameter usually \>6mm * Evolving lesions - new or changing

Question 36

What does PUT ON stand for (BCC)?

Answer 36

* Pearly papule * Ulcerating * Telangiectasia * On the face, scalp or pinnae * Nodules

Question 37

What does NO SUN (SCC) stand for?

Answer 37

* Nodular * Opaque * Sun-exposed areas * Ulcerating * Non-distinct borders

Question 38

What considerations does an HIV positive pregnant mom need?

Answer 38

* Mom should be treated during pregnancy * Baby on antiretroviral therapy for 4-6 weeks after birth * Newborns should have RNA or DNA checked at 2 weeks of age and 1-2 months and 4-6 months and 12-18 months * A negative antibody confirms that the baby is not infected * No breastfeeding

Question 39

When is a TST considered positive? * \> 5mm * \> 10mm * \> 15mm

Answer 39

* \>5 is considered positive in * Recent contact of a person w/ TB * Immunosuppressed patients * \>10mm considered positive in * High-risk population * Children \< 4 years * \>15mm considered positive in general population

Question 40

Hep A lab results interpretation What does a positive result of the following indicate?: IgM, IgG, Total Hep A antibody test

Answer 40

* IgM indicates current or recent infection: detectable 2 weeks after sx begin until 6 months post recovery * IgG detectable for life, used to detect past infection or immunity by vaccination * Total hepatitis A antibody test: detects both IgM and IgG antibodies, identifies current and past infections

Question 41

Hep B lab results interpretation What does a positive result of the following indicate?: HBsAg, anti-HBs, anti-HBc, IgM

Answer 41

* HBsAg: present in acute or chronic infection * Anti-HBs: produced within a few weeks to months after exposure or vaccination * Anti-HBc: detectable for life; appears as patient develops symptoms * IgM: current or recent infection within the last 6 months

Question 42

Hep C lab results interpretation What does a positive result of the following indicate?: anti-HCV, C RNA test, genotype test

Answer 42

* Anti-HCV: produced in response to infection, will be positive for life * C RNA test: measure the amount of HCV in the body if anti-HCV is positive * Genotype test: genotype the strain for treatment