21- fever

Question 1

Whispered pectoriloquy

Answer 1

When you have the patient whisper words, “one-two-three,” you hear it louder with the stethoscope over areas of consolidation or cavity.

Question 2

Which of the lung findings would signify that there is a lung consolidation

Answer 2

A. Egophony
B. Increased tactile fremitus

D. Dullness to percussion
E. Crackles

G. Whispered pectoriloquy

Question 3

Modified Centor for evaluating strep throat

Answer 3

Give one point for each positive response:

Tonsillar exudate or erythema
Anterior cervical adenopathy
Cough absent
Fever present:

Age 3 to 14 years: +1 point
Age 15 to 45 years: 0 points
Age over 45 years: -1 point

Question 4

if strep Score 4 to 5:

Answer 4

Treat with antibiotics

Question 5

If Strep Score 2 to 3:

Answer 5

Perform rapid antigen test

positive: Treat with antibiotics
negative: Throat Culture (…in children only.

Question 6

if Strep Score 0 to 1:

Answer 6

Provide Pharyngitis Symptomatic Treatment

Question 7

Influenza testing is done via

Answer 7

nasopharyngeal swab: a flexible shaft is inserted through the nostril to the back of the throat.

Question 8

bronchiolitis

Answer 8

Caused by viruses such as respiratory syncytial virus (RSV).

Seen in young children with the incidence peaking at 6 months of age.

Often starts as a viral illness and progresses to wheezing, cough, dyspnea, and cyanosis.

Infants require supportive treatment including oxygen if hypoxic, while they are recovering

Question 9

Bacterial pneumonia

Answer 9

fever> 38 degrees C (100.4 degrees F) + sputum

Most commonly caused by streptococcus pneumoniae.

NO prodrome like rhinorrhea or myalgias

symptoms include pleuritic chest pain, fever, chills, and dyspnea. maybe cough. half have pleural effusion.

**Crackles , focal wheezing, whistling

Question 10

Viral pneumonia

Answer 10

atypical presentation, i.e., chills, fever, dry, nonproductive cough, and the predominance of extrapulmonary symptoms such as GI symptoms and arthralgias.

Causes: influenza, RSV, parainfluenza, rhinovirus, adeno

More common in children aged four months to five years.

Question 11

Atypical pneumonia

Answer 11

Adults!

Mycoplasma or Chlamydia pneumoniae

headache, pleuritic chest pain, and vague abdominal pain. Vomiting, diarrhea, pharyngitis, and otalgia/otitis are other common symptoms.

Question 12

Acute bronchitis

Answer 12

Self-limited inflammation of the large airways in the lung characterized by cough.

Inflammation leads to excessive tracheobronchial mucus production sufficient to cause purulent sputum in half of patients.

Cause is usually viral.

coughing persists for more than five days.

rhonchi, wheezes, or normal

Question 13

influenza

Answer 13

upper and lower respiratory tract symptoms accompanied by systemic symptoms such as myalgia, high fever, headache, and weakness

abrupt! winter time

Rhonchi

Question 14

Group A beta hemolytic strep pharyngitis

Answer 14

Typically causes fever, sore throat, and tender cervical lymphadenopathy.

Question 15

supportive therapy for viral influenza

Answer 15

ibuprofen or acetaminophen for pain and fever, fluids, and rest.

Question 16

when are antivirals for the flu given?

Answer 16

within 48 hours

1) if the patient has moderate to severe community acquired pneumonia with findings consistent with influenza
2) if the patient is clinically worsening at the time of the initial outpatient visit

Question 17

examples of antivirals for influenza and their main goal

Answer 17

zanamivir, oseltamivir, amantadine, and rimantadine

decrease symptoms by a day

Question 18

Acute Bronchitis Treatment

Answer 18

90% viral- supportive

beta2 agonists if wheezing

Question 19

The most common complications of influenza are:

Answer 19

otitis media

lower respiratory tract infections including bronchitis and pneumonia (staph, strep)

Question 20

Less common neuro complications of influenza:

Answer 20

aseptic meningitis
Guillain-Barre syndrome
febrile seizures

Question 21

Rare complications of influenza:

Answer 21

myositis

myocarditis

Question 22

first line antibiotic for streptococcal pneumonia and hat age group is typical

Answer 22

amoxacillin

age 3 mo-5 yrs

Question 23

how long does flu usually last

Answer 23

3-5 days

Question 24

when can kid with flu return to school

Answer 24

until most symptoms have improved and the child has been afebrile for 24 hours.

Question 25

For uncomplicated pneumonia in children more than five years old,a what med is indicated

Answer 25

azithromycin because the prevalence of atypical pneumonia is higher.

Question 26

common bacteria 3 weeks - 3 months and meds to treat

Answer 26

S.pneumoniae; Chlamydia trachomatis,

Adenovirus, Influenza virus, RSV, and Parainfluenza viruses

Ampicillin or penicillin G or ceftriaxone

Question 27

The goal total cholesterol and LDL are

Answer 27

total: 170 mg/dL.

LDL: 130 mg/dL.

Question 28

Drug treatment is recommended for children who

Answer 28

have an LDL >190 mg/dL or and LDL > 160 mg/dL with risk factors. Drug treatment is only recommended for children who are older than 10 and who are either Tanner stage 2 (male) or have achieved menarche.

Question 29

strongest risk factor for high cholesterol

Answer 29

BMI

Question 30

strongest risk factor for HTN

Answer 30

obesity

Question 31

metabolic syndrome

Answer 31

adults as having at least three: 
hypertriglyceridemia,
 low HDL,
 elevated fasting blood glucose levels, 
excessive waist circumference, or
  hypertension,

Question 32

Prevention Plus- If no improvement after 3-6 months use (5-2-1-0) counseling

Answer 32

5 serving of fruits and vegetables
2 hours of screen time
1 hour of physical activity
0 sugar-sweetened beverages
Family meals
Healthy breakfast
Allow child to self-regulate meals

Question 33

. Structured Weight Management

for children who have no had improvement on prevention plus
after 3-6 months if no improvement for all children with BMI > 85-94 percentile

Answer 33

Reduce energy-dense foods
Structured meals: plan 3 meals a day and 1 to 2 healthy snacks and no other food
1 hour of screen time
Diet and activity monitoring for 3 to 6 months
Monthly office visits
Additional support by dietitian, counselor, or exercise therapist as needed

Question 34

Comprehensive Multidisciplinary Intervention

next step for children
ages 2-5; >95 percentile or

ages 6-18; 95-99 percentile

Answer 34

Above plus referral to multidisciplinary obesity care team and behavioral modification

Question 35

Tertiary Care Intervention

for ages 6-18, final step

Answer 35

Above plus referral to pediatric tertiary weight management center

Question 36

Risk factors for complications of Influenza are

Answer 36

children <5 years, increased in children less than 2 years of age,

COPD, conditions that affect the ability to handle respiratory secretions/increased risk of aspiration,

CHD, metabolic conditions, Chronic Renal Disease,

Immunosuppression, and Long term aspirin therapy.