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64 Cards in this Set
- Front
- Back
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what are Risk Factors for Acute Otitis Media
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male
older sibling premature birth onset of first AOM < 6 months family history of recurrent AOM day care cig smoke exposure lack of breast feeding extended pacifier use |
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what are the clinical presentations of AOM
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ear tugging
hearing loss otalgia (Ear pain) bulging tympanic membrane |
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severe AOM
non severe AOM what are the temperatures |
severe AOM > 39F
non-severe AOM < 39F |
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what bacteria cause AOM
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S. pneumonia
H. influenza M. catarrhalis |
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what is used to provide symptomatic treatment during observation period of AOM
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APAP
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what is the script the doctor gives parents to fill if the child doesn't get better within the 2-3 days of observation
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Safety Net Antimicrobial Prescription (SNAP)
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child < 6 months with confirmed AOM do you treat?
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<6 months + confirmed diagnosis
Antibiotic therapy |
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child < 6 months with uncertain diagnosis AOM do you treat
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< 6 months + uncertain diagnosis
Antibiotic therapy |
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child 6 months - 2 years with confirmed AOM do you treat?
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6 months - 2 years + confirmed AOM
Antibiotic therapy |
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child 6 months - 2 years with uncertain diagnosis of AOM do you treat?
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6 months - 2 years + uncertain diagnosis
Antibiotic therapy if severe OR Observe if non severe |
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child > 2 years with certain diagnosis do you treat?
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>2 years + certain diagnosis
Antibiotic therapy if severe OR Observe if non severe |
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child > 2 years with uncertain diagnosis do you treat?
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>2 years + uncertain diagnosis
Observe |
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what drugs are used in antibiotic therapy and what are their dosage forms
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Amoxicillin 90 mg/kg/day q 8-12
Amox/Clav 90 mg/kg/day q 12 Ceftriaxone 50 mg/kg/dose IM |
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if a patient with AOM is unable to take oral medication what can you give them
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ceftriaxone 50 mg/kg/dose IM
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Jane was previously treated with antibitotics for a upper respiratory infection 18 days ago. She now presents with AOM what PO agent can you give her?
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Amox/Clav 90mg/kg/day
GIVE AMOX/CLAV -if patient has had ABx therapy within 30 days |
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Jane took amoxicillin to treat her AOM and mother claimed she came down with hives, tongue, and eyes both became swollen. What is going on and what agent can you give her?
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Type 1 reaction (hives/anaphylactic reaction)
AGENTS: Sulfamethoxazole/Trimethoprim Azithromycin Clarithromycin |
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Jim took his Amox/Clav and mother claims he has come down with a rash. What is going on and what agent can you give him?
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Non type 1 reaction (rash, diarrhea, etc)
AGENTS: clindamycin cefdinir cefpodoxime cefuroxime |
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what is the STANDARD DURATION OF THERAPY FOR AOM and what age group
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10 days
age 2-5 or severe disease |
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what is the length of the SHORT DURATION of therapy for AOM and what age group
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5-7 days
> 6 years |
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what can be done for Risk Reduction of AOM
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alter day care schedule
breast feed until 6 months avoid supine bottle feeding reduce/eliminate pacifier once 6-12 months of age eliminate exposure to 2nd hand smoke VACCINATIONS (influenza/pneumococcal) |
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what is the clinical presentation of Sinusitis
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nasal discharge
daytime cough fever |
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what are some of the causative factors of sinusitis
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Cystic fibrosis
GERD Asthma Allergy |
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what are the causative organisms of Sinusitis
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H influenza
M catarrhalis S pneumoniae |
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after symptom resolution how much longer do you treat sinusitis
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7 days
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Jane has been diagnosed with sinusitis. She has not had any antibiotics since last year and does not attend day care. What agents can she get.
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No daycare, No antibiotics within 90 days:
Amoxicillin 90 mg/kg/day Amox/Clav 90 mg/kg/day |
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Jane has been diagnosed with sinusitis after recently overcoming a bacterial infection 3 months ago in which she took Ciprofloxacin. She also attends day care on the weekend. What agents can she get?
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Daycare attendence or Antibiotics within 90 days
Amox/Clav Cifdnir Cefuroxime Cefpodoxime |
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Jim has just been hospitalized for his Sinusitis. What agents can he get?
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Cefotaxime
Ceftriaxone |
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what agents are given to SInusitis patients with a TYPE 1 PCN ALLERGY
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Azithromycin
Clarithromycin Clindamycin |
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what agents are given to SInusitis patients with a Non Type 1 PCN allergy
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Ceftriaxone
Cefdinir Cefpodoxime Cefuroxime |
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what is done if treatment failure occurs (48-72 hrs still sick) in Sinusitis patients?
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change to a different antibiotic
increase dose of current antibiotic |
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what can be given as Adjunctive therapy for treatment of Sinusitis
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Saline nasal spray/drops
-decrease inflammation -aids in drainage APAP IBU |
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what agents are not recommended as Adjunctive therapy for treatment of Sinusitis
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oral antihistamines
oral decongestants corticosteroid spray |
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when does RSV typically occur
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November - April
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what are the Risk factors of RSV
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conginital heart disease
premature birth passive smoking day care siblings lower socioeconomic class |
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what is the prophylaxis for RSV
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hand hygiene
avoid crowds during RSV season Palivizumab |
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what is the dosing of Palivizumab and AE
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dose: 15 mg/kg IM given monthly
AE: increase AST/ALT |
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born before 32 weeks gestation and <= 6 months at beginning of RSV season
what is the maximum # of doses |
5 max doses
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born <28 weeks gestation and up to 12 months
what is the maximum # of doses |
5 max doses
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infant with chronic lung disease who are <= 2 years who required medical management of their chronic lung disease in previous 6 months
what is the maximum # of doses |
5 max doses
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born between 32-35 weeks gestation and <= 3 months at beginning of RSV season with at least one of the following risk factors:
-attends daycare ->=1 sibling <= 5 years who lives with them what is the maximum # of doses |
3 max doses
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under what circumstances would an infant get a max of 3 doses
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born between 32-35 weeks gestation and <=3 years old with one of the following risk factors:
-daycare attendence ->=1 sibling <= 5 years old who lives with them |
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<=24 months with hemodynamically significant congenital heart disease
what is the maximum # of doses |
5 max doses
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infant <=12 months with congenital abnormalities of the airway or neuromuscular disease that compromises the handling of respiratory tract secretions
what is the maximum # of doses |
5 max doses
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what is the treatment of RSV
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hydration
O2 supplementation Mechanical ventilation |
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what is the clinica presentation of meningitis
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positive kernig sign
positive brudzinski sign bulging fontanelle |
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lift child's head and the build up of pressure is painful for them so their knees automatically lift up to relieve that pressure
what is this? |
+ brudzinski sign
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bend thigh to 90 degrees at hip and then try to extend their leg at the knee but you meet a lot of resistance because that's painful for the child
what is this? |
+ kernig sign
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what are the lab values for bacterial meningitis
WBC NEUTROPHILS PROTEIN GLUCOSE RBC |
WBC: >1000
NEUTROPHILS: > 50 PROTEIN: > 100 GLUCOSE: < 30 RBC: 0-10 |
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<1 month with meningitis
what agent do they get? |
ampicillin + cefotaxime
OR ampicllin + aminoglycoside |
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1 - 23 months with meningitis
what agent do they get? |
vancomycin + ceftriaxone
OR vancomycin + cefotaxime |
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1 -23 months with meningitis
what are the possible causative agents |
N meningitidis
H influenzae S pneumoniae |
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2-18 years with meningitis
what is used to treat? |
vancomycin + ceftriaxone
OR vancomycin + cefotaxime |
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2 - 18 years old with meningitis
what are the possible causative agents |
S pneumoniae
N meningitidis |
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when can Dexamethasone be given to treat meningitis
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given w/ first dose of ABx
or before first dose of ABx |
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Dexamethasone only works against what bacteria
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H influenzae
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what are the HIGH RISK groups that qualify for meningitis prophylaxis
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household contact
nursery or day care center contact direct contact with affected patient's secretions |
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if the bacteria is N meningitidis what drugs can be given for meningitis prophylaxis
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Rifampin
OR Ceftriaxone |
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if the bacteria is H influenzae what drugs can be given for meningitis prophylaxis
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Rifampin
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what is the dose of Rifampin given to a child <1 month to treat N meningitidis
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5 mg/kg/dose
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what is the dose of Rifampin given to a child > 1 month to treat N meningitidis
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10 mg/kg/dose
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what is the dose of Rifampin given to an adult
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600 mg
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what is the dose of Ceftriaxone given when < 12 years
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125 mg IM
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what is the dose of Ceftriaxone given when > 12 years
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250 mg IM
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what is the dose of Rifampin given to treat H influenzae
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20 mg/kg/dose
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