FM 21 - Fever

Question 1

Modified Centor Criteria (McIsaac Score) for strep (4)

Answer 1

• +1: tonsillar exudate/erythema, anterior cervical lymphadenopathy, absent cough, fever, age 3-14 years
• 0: age 15-45 years
• -1: age 45+ years
• perform rapid antigen test with score 2+

Question 2

Complications of influenza (5)

Answer 2

• bacterial pneumonia (strep/staph)
• otitis media
• neurologic (aspetic meningitis, GBS, febrile seizures)
• myositis
• myocarditis

Question 3

Pneumonia treatment

Answer 3

• strep/<5yo: amoxicillin 30mg/kg/day TID x7-10 days.

- atypical/>5yo: macrolides (azyithromycin) 10mg/kg then 5mg/kg x4 days

Question 4

Child BMI Interpretation

Answer 4

• Healthy: 5th-85th percentile
• Overweight: 85th-95th percentile
• Obese: 95th+ percentile

Question 5

Adult BMI Interpretation

Answer 5

• Healthy: 18.5-24.9
• Overweight: 25-29.9
• Obese: >30

Question 6

DM2 Screening in kids

Answer 6

• age 10, BMI >85th percentile with risk factors (fasting glucose >100, elevated fasting insulin level)
• age 10, BMI >95th percentile, no risk factors
• recheck every 2 years

Question 7

HLD Screening in kids

Answer 7

• BMI >85th percentile

- goal total = 170, LDL=130

Question 8

Complications of Obesity (6)

Answer 8

• MSK (Blount’s, slipped femoral epiphysis)
• GI (steatosis, gallbladder disease)
• GYN (early menarche, PCOS)
• Skin (acanthosis nigricans, intertrigo)
• Psychosocial (stigmatization, bullying, low self-esteem, depression)
• Other: OSA, asthma, pseudotumor cerebri

Question 9

Pediatric Weight Management Steps (4)

Answer 9

1. Prevention Plus (5-2-1-0)
2. Structured weight management
3. comprehensive multidisciplinary intervention
4. tertiary care intervention

Question 10

Pulmonary findings that do not indicate consolidation (2)

Answer 10

-wheezes, rhonchi

Question 11

Pulmonary findings indicating consolidation (5)

Answer 11

-egophony, tactile fremitus, dullness to percussion, crackles, whispered pectoriloquy

Question 12

Influenza treatment (4)

Answer 12

• zanamivir, oseltamivir, amantadine, rimantadine
• give within 48hrs of illness onset (unless pneumonia or worsening)
• shorten symptoms duration 24 hours

Question 13

Child pneumonia organisms and treatment (4 age ranges)

Answer 13

• 0-3 weeks: E.coli, GBS, Listeria; ampicillin + gentamicin
• 3weeks-3mos: S. pneumo, C trachomatis, adenovirus, influenza, RSV, parainfluenza; ampicillin, penicillin G, ceftriaxone
• 3mos-5years: C pneumo, Mycoplasma, S pneumo; ampicillin, penicillin G, ceftriaxone
• 5yo+: c pneumo, m pneumo, s pneumo; azithromycin

Question 14

Acute pediatric cough DDX (3)

Answer 14

• URI
• Asthma
• Bronchiolitis

Question 15

Acute pediatric cough and fever DDX (6)

Answer 15

• bacterial pneumonia
• viral pneumonia (extrapulmonary symptoms)
• atypical pneumonia
• acute bronchitis
• influenza
• GAS pharyngitis

Question 16

Risk factors for Influenza complications (8)

Answer 16

• < 5 years (especially <2)
• COPD
• decreased ability to handle respiratory secretions/increased risk of aspiration
• CHD
• metabolic conditions
• Chronic Renal Disease
• Immunosuppression
• Long term aspirin therapy