S. Pneumoniae.

(M. catarrhalis and H. influenzae are also common)

When a person has the common cold, their is an increase in the number of _____?

A. Leukocytes

B. Monocytes

C. Eosinophils

D. Neutrophils

The most common cause of nasopharyngitis is _______?

A. Rhinovirus

B. Humanmetapneumovirus

C. Parainfluenza

D. Adenovirus

D. Adenovirus

Adenoviruses are more likely to cause pharyngitis as a prominent symptom.

This virus can produce exudate on the tonsils, soft palate petechiae and diffuse adenopathy.

A. Adenovirus

B. Enterovirus

C. EBV

D. Parainfluenza

This virus can cause a follicular pattern on the pharynx with physical exam.

A. Adenovirus

B. Enterovirus

C. RSV

D. Parainfluenza

This virus can produe vesicle or ulcers on the tonsillar pillars and posterior fauces; coryza, vomiting; or diarrhea may be present

A. EBV

B. RSV

C. Enterovirus

D. Herpesvirus

This virus produces ulcers anteriorly and marked adenopathy

A. Herpesvirus

B. Enterovirus

C. EBV

D. Parainfluenza

These viruses can cause more lower respiratory tract disease with typical respiratory signs of stridor, rales, or wheezing

A. Enterovirus and Adenovirus

B. EBV and RSV

C.Parainfluenza and Adenovirus

D. RSV and Parainfluenza

D. RSV and parinfluenza

Causing diseases such as croup, pneumonia, and bronchiolitis

The most common bacterial etiology for pharyngitis is:

A. Strep. pneumoniae 

B. Strep. pyogenes

C. Staph. Aureus

D. Mycoplasma pneumoniae

What is the 1st line treatment for pharmacologic management of sinusitus?

A. Penicillin

B. Cephalosporine

C. Macrolides

D. None of the above

On physical exam, a 6 year old boy comes in with petechiae on soft palate and pharynx, swollen beefy red uvula, tonsillopharyngeal exuddate that is yellow and anterior lymphnodes, what is your first step towards diagnosis?

A. Obtain a chest xray

B. Prescribe antibiotics

C. Obtain a rapid strep test

D. No treatment, this is viral pharyngitis and should be rechecked if symptoms persist past 10 days

C. Obtain a rapid strep test

It is important to not do a strep test uless the patient has signs and symptoms, since a positive rapid stret test or positive throat culture can identigy a carrier state. 

Your 8 year old patient has been diagnosed with a right AOM. In your history taking you recall that this patient has an allergy to PCN. What will you prescribe?

A. Amoxicillin, unless he has had an acute reaction in the last 2 years

B. Amoxicillin, unless he has had an anaphylactic reaction with any usage of this drug.

C. Augmentin, better safe then sorry

D. Cephalosporin is always the first line tx for AOM

Your patient has been diagnosed with GABHS after a rapid strep test came back positive. What antimicrobial therapy will you start?

A. Penicillin V potassium

B. Amoxicillin

C. Penicillin G IM

D. Clindamycin

Name 3 of the major nonsuppurative late complications caused by GABHS?

1. Rheumatic Fever

2. Post-streptococcal reactive arthritis

3. Acute Glomerulonephritis

1. Purulent nasal discharge

2. Nasal Obstruction

3. Facial pain (pressure or fullness)

Lasting >10days <4weeks

If a child with a potential dx of sinusitis has symptoms of intracranial or soft tissue abscess, what would the PNP's next step be?

A. Refer to Neurology

B. Send patient to ER

C. Start antibiotics 

D. Obtain radiographic imaging

D. Obtain radiographic imaging

Facial swelling, acute rhinosinusitis unresponsive to 48 hours of antibiotics, a toxic appearing child, and chronic unresponsive asthma are also indications for imaging studies (Sinus radiograph, Ultrasonograms, or CT scans)

What is the most accepted imaging study for acute or chronic rhinosinusitis?

A. X-ray of the brain

B. CT of brain

C. MRI of brain

D. Ultrasonogram

Why are antibiotics prescribed for sinusitis if 60-80% of acute episodes resolve without antibiotics in about 4 weeks?

What sport is contraindicated with rhinosinusitis?

A. Football

B. Track

C. Swimming

D. Diving

Besides antibiotics, what are some other interventions for the management of rhinosinusitis?

1. Decongestants, No RCT available to support its use, but if used limit to 5 days to avoid rebound edema.

2. Topical corticosteroids; may decrease symptoms in patients with uncomplicated sinusitis

3. Saline irrigation; used to thin nasal secretions

4. Antihitamines and intranasal steroids for recurrent or chronic rhinosinusitis is allergic manifestations.

5. Humidifier helps relieve the drying of mucous membranes associated with mouth breathing

6. Increase oral intake

During what stage of pertussis are children most contagious?

A. Catarrhal

B. Paroxysmal

C. Convalescent

D. All stages

All of the following are characteristics of pertussis in an infant <6 mos except:

A. Apnea

B. Severe pneumonia

C.Inspiratory whoop 

D.Pulmonary hypertension

What diagnostic test for pertussis is becoming rapidly more favorable?

A. Culture

B. PCR

C. RVP

D. IgA/IgM analyses

What antimicrobial agent would be your first choice when treating pertussis in a 1 month old?

A. Amoxicillin

B. Cephalosporin

C. Erythromycin

D. Azithromycin

D. Azithromycin at 10 mg/kg in single dose for 5 days is given to infants from 0-6 months of age (due to development of pyloric stenosis and erythromycin when used under 1 month of age.

For older kids, 5 day tx of Azithromycin--Day 1--10 mg/kg X 1. Day 2-5--5 mg/kg

What is the drug of choice to you give for chemoprophylaxis of all household and close contacts of a child with pertusis?

A. Azithromycin

B. Erythromycin

C. Corticosteroids

D. Amoxicillin

B. Erythromycin (40-50 mg/kg/day) PO in 4 divided doses is the drug of choice includeing children in daycare and staff and playmates, irrespective of their immunization status.

**Azithromycin is better tolerated by adolescents.

Recommendations for prophylactic measure for exposed children and adults includes immunization coverage by which vaccine?

A. Pertussis

B. Td

C. Tdap

D. Coverage is only recommended for the child infected.

What is the most common causative organism for Croup?

A. Adenovirus

B. Parainfluenza

C. RSV

D. Influenza

What is the most common age group at risk for croup?

A. 12-24 months

B. 6-36 months

C. 24-26 months

D. 4-24 months

Physical exam of a 12 month old reveals slight dyspnea tachypnea and retractions, a mild brassy or barking cough, stridor on inspiration. What is her diagnosis?

A. Bronchiolitis

B. Croup

C. RSV

D. Pneumonia

Which is most effective in the treatment of Croup?

A. Dexamethasone  IM

B. Prednisone PO

C. Nebulized budesonide

D. Albuterol Neb

What would the chest xray for croup show?

A. Thumb sign

B. Steeple sign

C. Hyperinflation

D. Consolidation

What is the causitive organism for Epiglottitis?

A. Adenovirus

B. H. Influenzae

C. S. Aureus

D. S. Pneumoniae

Absence of what sign on radiograph would rule out Epiglottitis?

A. Hourglass sign

B. Steeple sign

C. Thumb sign

D. Ring sign

Your 4 year old patient presents iwth flaring nostrils, inspiratory (and sometimes expiratory stridor), drooling, and aphonia, with positioning of hyperextention of the neck. What is your diagnosis?

A. Retropharyngeal Abscess

B. Peritonsillar Abscess

C. Epiglottitis

D. Croup

Once epiglottitis has been diagnosed, what is your first intervention as the PNP?

A. Apply oxygen via facemask

B. Start an IV and begin antibiotics

C. Place child in supine position and send to ER immediately

D. Leave child in tripod position and call EMS for transport

HIB has been identified as the source of a child's Epiglottitis. Rifampin prophylaxis should be initiated on all of the following household/close contacts except:

A.  Child younger than 4 years old who is unimunized or incompletely immunized

B. Children less than 12 months who have not received the primary series of HIB vaccine

C. Immunocompromised children

D. 1 case of nursery or daycare case of Hib

Based on history and exam findings, you have diagnosed your patient with bronchitis. What is your next step toward management?

A. Bronchodilators for dry cough

B. Cough suppressants and antihistamines

C. Tylenol for pain and hydration to avoid dehydration

D. Antibiotics

D.

"Infectious asthma" is another name for this respiratory disease.

A. Pneumonia

B. Bronchitis

C. Bronchiolitis

D. Croup

Pathophysiology of this disorder is described as obstruction of the lower respiratory tract as a result of acute inflammation, edema, and necrosis of the epithelial cells of the small bronchioles.

A. Cystic Fibrosis

B. Bronchitis

C. Bronchiolitis

D. Asthma

____is the term used for an infant seen with wheezing for the very first time and is the leading cause of hospitalizations in infants.

A. Asthma

B. Reactive airway disease

C. Bronchitis

D. Bronchiolitis

The virus that predominently causes bronchiolitis is:

A. Adenovirus

B. RSV

C. Parainfluenza

D. Rhinovirus

Bronchiolitis is most commonly spread by which of the following examples:

A. Sneezing around a baby

B. Picking up a contaminated toy

C. Playing with used tissues

D. Cleaning a counter with wipes

C. Playing with used tissues

It is spread by close contact with infected respiratory secretions or fomites. The most frequent mode of transmission is hand carriage of contaminated secretion

High respiratory rate, crackles, low grade fever, and mild conjunctivitis are all characteristics of an infant with what respiratory disease?

A. Bronchiolitis

B. Asthma

C. Pneumonia

D. Croup

How should bronchiolitis be managed?

A. Antipyretics and fluids

B. Antibiotics and fluids

C. Antipyretics and Beta agonists

D. Inhaled corticosteroids and humidification

Infants with bronchiolitis should be hospitalized if

A. <2 months

B. increased s/s of resp distress

C. Fever of 102 occurs

D. Both A & B

What prevention can be given to high risk babies during RSV season (premature, <2 yoa, heart defect)

A. Palivizumab

B. Ribavirin

C. Antileukotriene therapy

D. Inhaled corticosteroids

This is an infection in the lower respiratory tract with consolidation of the alveolar spaces involving the airways and parenchyma of the lung.

A. Bronchitis

B. Pneumonia

C. Cystic Fibrosis

D. Foreign Body

The most common pulmonary infection in both children and adolescents is

A. Bacterial Pneumonia

B. Non-bacterial Pneumonia

C. Atypical Pneumonia

D. Walking Pneumonia

Atypical pneumonia includes all of the following organisms except:

A. C. pneumoniae

B. M. pneumoniae

C. Chlamydia trachomatis

D. S. pneumoniae

Which organism is the leading cause of bacterial pneumonia in all age groups except newborns?

A. S. Aureus

B. Chlamydia trachomatis

C. S. Pneumoniae

D. S. Pyogenes

C. S. Pneumoniae

S. Pneumoniae causes a lobar pneumonia; P. aureus presents with empyema, abcess and pneumatocele formation.

Most common cause of pneumonia in children >5 yoa and into young adulthood?

A. S. pneumoniae

B. M. pneumoniae

C. S. aureus

D. Viral pneumoniae

What age group typically is affected by Chalmydia trachomatis pneumonia?

A. Newborns

B. Infants

C. Toddlers

D. School age

E. A&B

E. A&B

Most likely associated with newborns and infants between the ages of 2 and 19 weeks (1-3 months)

What is the differentiating clinical manifestation of bacterial pneumonia compared to all other types?

A. Abrupt high fever

B. Elevated WBCs

C. Acute onset

D. Fine crackles in lower lung fields

Downward placement of the spleen and wheezing would be indicative of which kind of pneumonia?

A. Bacterial

B. Viral

C. Mycoplasma

D. Chlamydia trachomatis

This type of pneumonia is characterized by a repetitive staccato cough with tachypnea, cervical adenopathy, crackles, and rearely wheezing. Conjunctivitis can sometimes alsobe associated with this type?

A. Bacterial

B. M. pneumoniae

C. Viral 

D. Chlamydia trachomatis

What factors indicate that a chest xray needs to be obtained in a child with pneumonia?

A. Fever >100

B. Fever >104 and <4 yoa

C. Strong suspicion of pneumonia based on history and physical exam

D. URI and crackles hearn on auscaltation

Children 0-4 months old need to be treated for chlamydia pneumoniae with what antibiotic?

A. Amoxicillin

B. Erythromycin

C. Augmentin

D. Cefotaxime

B. Erythromycin for 14 days or oral azithromycin for 5 days

Hospitalize pt if not chlamydia pathogen

A four month to four year old patient with bacterial pneumonia should be treated with what pharmacological management?

A. Azithromycin 12 mg/kg/day

B. Erythromycin for 14 days

C. Amoxicillin 80-100mg/kg/day for 10 days

D. Augmentin ES 600mg/5 ml for 10 days

The treatment for children 5 yoa and older for bacterial pneumonia is

A. Azithromycin 12 mg/kg/day X 5 days

B. Erythromycin X 14 days

C. Amoxicillin 80-100mg/kg/day for 10 days

D. Cefuroxime 80 mg/kg IM X 1

The organism most commonly found in bacterial conjuntivitis in children?

A. Gonorrhea

B. Chlamydia

C. S. pneumoniae

D. H. influenza

D. H. influenza

According to a 2010 study the causative bacteria most commonly associated with conjunctivitis was H. influenza

The most common cause of conjunctivitis is:

A. Fungal

B. Viral

C. Chemical

D. Bacterial

What is the most common cause of Opthalmia neonatorum?

A. Gonorrhoeae

B. Chlamydia trachomatis

C. Herpes Simplex virus

D. Haemophilus influenza

This type of conjunctivitis specifically causes moderate eyelid swelling and palpebral or bulbar conjunctival injection and moderate thick purulent discharge.

A. C. trachomatis

B. N. gonorrhoeae

C. Chemical induced

D. Viral Conjunctivitis

This type of conjunctavitis typically presents at birth or in the first 4 weeks of life.

A. C. trachomatis

B. N. Gonorroeae

C. HSV

This type of conjunctivitis typically causes acute conjunctivial inflammation and lid edema, erythema and excessive, purulent discharge.

A. C. trachomatis

B. N. gonorrhoeae

C. HSV

D. Chemical induced

This type of conjunctivitis commonly begins between 5 to 14 days of life; it can also occur in nebworns born via cesarean section with intact membranes.

A. C. trachomatis

B. N. gonorrhoeae

C. HSV

D. Chemical induced

This type of conjunctivits frequently manifests as non-purulent discharge and edematous bulbar and palpebral conjunctiva.

A. C. trachomatis

B. N. gonorrhoeae

C. HSV

D. Chemical induced

This type of conjunctavitis typically appears in the first 3 to 5 days of life.

A. C. trachomatis

B. N. gonorrhoeae

C. HSV

D. chemical induced

Viral Conjunctivitis is typically caused by which organism?

A. Parainfluenza

B. RSV

C. Varicella

D. Adenovirus

For neonatal conjunctivitis, no matter what the organism, what should your first intervention be after diagnosis?

A. Irrigate the eyes with sterile normal saline until clear of exudate.

B. Start the appropriate antibiotic immediately.

C. Topical silver nitrate application

D. Obtain swab and scrapings to confirm organism.

D. Obtain swab and scrapings to confirm organism.

If gonorrhea is suspected also check for C. trachomatis. Any infant younger than 2 weeks of age should be tested for gonorrhea. 

All of the following are acceptable cultures for gonorrhea except:

A. Chocolate agar

B. Thayer-Martin

C. Aggressive scraping for Gram stain

D. Wright Stain

Management of gonococcal conjunctivitis should include:

A. 10-14 days of IV or IM cefotaxime

B. Topical Silver nitrate  

C. Erythromycin 0.5% ointment 3-4 days

D. Hospitalization with antivirals

A. A. 10-14 days of IV or IM cefotaxime.

Ceftriaxone is another option but should be avoided in neonates with hyperbilirubinemia.

For nongonococcal conjunctivitis, pharmacological management includes:

A. Systemic Antivirals

B. Cefriaxone

C. Erythromycin or moxifloxacin

D. Amoxicillin

C. Erythromycin or moxifloxacin. 

Erythromycin 0.5% opthalmic ointment for neonates. >1 year use fourth generation fluoroqinolone

Stringy, mucoid exudate, swollen eyelids and conjunctivae, itching, tearing would indicate which kind of conjunctivitis?

A. Viral

B. Bacterial

C. Chemical

D. Allergic

D. Allergic

Eosinophils would be seen in conjunctival scrapings

What managment is best for C. trachomatis in neonates?

A. Oral EES despite knowing it may cause Pyloric stenosis

B. Azithromycin and clarithromycin though not FDA approved

C. Topical Erythromycin

D. Trimethoprim-sulfamethoxazole for 14 days

A. Oral EES despite knowing it may cause Pyloric stenosis

Their is known increased incidence of idiopathic hypertrophic pyloric stenosis with infants <6 weeks old following EES. However this has not altered the recommendation of EES as the preferred treatment.

Bacterial conjunctivits the most common in all of the following age groups except:

A. Infants

B. Neonates

C. Preschoolers 

D. Sexually active teens

B. Infants

In neonates 5-14 days old, preschoolers, and sexually active teens H. influenzae is the most common form of bacterial conjunctivitis.

Erythema of one or both eyes, usually starting unilaterally and becoming bilateral; yellow green purulent discharge, encrusted and matted eyelids on awakening indicates that this conjunctivitis is:

A. Viral

B. Bacterial

C. Opthalmia Neonatorum

D. Allergic

All of the following is true about bacterial conjunctivitis except:

A. Bacterial conjunctivitis is considered a self-limited disease that usuallky reolves within 8-10 days

B. Because both gram negative and gram positive organisms have been implicated, children who receive topical antibiotics demonstrate faster clinical improvement

C. Fluorqinolone opthalmic drops are the gold standard for bacterial conjunctivitis and are prescribed for children less than 12 months of age.

D. Older children and teens may be treated conservatively without using antibiotics.

. Fluorqinolone opthalmic drops are the gold standard for bacterial conjunctivitis and are prescribed for children less than 12 months of age.

Fluroquinolone opthalmic drops may be prescribed for children older than 12 months; Erythromycin 0.5% opthalmic ointment is recommended for patients with sulfa allergy and for infants.

Conjunctivitis-Otitis syndrome is caused by:

A. H. influenza

B. Adenovirus

C. S. pneumoniae

C. S. aureus

A. H. influenza

Treat with topical antibiotic and treat for otitis media with oral antibiotic (Most likely Amoxicillin 80-90 mg/kg/day

This child has tearing and profuse clear, watery eye discharge along with fever, HA, anorexia, malaise, URI s/s including sore throat, also has enlarged preauricular nodes. What conjunctivitis is most likely?

A. Bacterial

B. Allergic

C. Viral

D. Chemical

C. Viral

Pharyngitis-conjunctivitis-fever triad with adenovirus

What is a key finding of allergic conjunctivitis?

A. Rhinitis, eczema, asthma

B. Profuse clear watery discharge

C. Severe itching and tearing

D. Hyperemia and swollen eyelids

Best initial treatment for allergic conjunctivitis includes:

A. Antibiotic drops

B. Artificial tears

C. Topical decongestants

D. Topical steroids

Blepharitis is usually caused by

A. S. aureus

B. S. pneumoniae

C. P. aeruginosa

D. M. Catarrhalis

A. S. aureus; the ulcerative form

Poor hygiene, tear deficiency, rosacea, and seborrheic dermatitis of the scalp and face are possible etiologic factors

Management of Blepharitis should include all of the following except:

A. Remove contact lenses and wear glasses for duration of treatment

B. Refer to allergist for allergen immunotherapy

C. Apply erythromycin 0.5% opthalmic ointment

D. Scrub eyelashes and eyelid with containing 50% no tears shampoo

The most common organism for a hordeolum (stye) is:

A. P. aeruginosa

B. S. aureus

C. adenovirus

D. S. pneumoniae

Periorbital cellulitis is often associated with all of the following except:

A. Bacteremia

B. Eyelid abscess

C. Sinusitis

D. Chalazion

Clinical findings of this eye disorder include acute febrile illness, swelling and rythema of tissues surrounding the eye (upper lid mainly), deep red eyelid, symptoms of bacteremia or sinusitis, orbital disconmfort.

A. Chalzion

B. Corneal Abrasion

C. Periorbital cellulitis

D. Traumatic hyphema

To differentiate periorbital cellulitis from orbital cellulits, the PNP knows that orbital cellulitis has all of the following clinical manifestations except:

A. Proptosis

B. Limited EOM

C. Reduced visual acuity

D.Headache and URI s/s

D.Headache and URI s/s

The best way to treat orbital cellulitis includes:

A. Ceftriaxone IM X 10 days

B. Ceftriaxone IM X 1, then Amoxicillin 7-14 days

C. Topical opthamalogic ointment X 10 days

D. Antibiotic gtts TID X 14 days

Traumatic hyphema management includes all of the following except:

A. Refer the patient immediately to an opthalmologist

B. A slit lamp examinination is indicated

C. Place a perforated eye patch over the eye

D. Elevate HOB to 30 degrees, complete bedrest with bathroom priviledges for 5 days

Otitis Externa is most commonly caused by:

A. Pseudomonas aeruginosa

B. S. aureus

C. S. pneumoniae

D. S. pyogenes

E. Both A&B

F. Both A&D

What treatment should you use with someone dx with otitis externa who has a perforated TM:

A. CiproDex

B. Polymyxin B and neomycin

C. Cipro HC otic

D. Auralgan

A. Ciprodex can be used in infants >6 months of abe and is not ototoxic

Neomycin, polymyxin, or hydrocortisone drops should not be used if there is a nonintact TM because it is known to cause allergic reaction manifested by redness, irritation, itching, and drainage

Which vaccine decreases the incidence of AOM?

A. Hib

B. PCV

C. IPV

D. Hep B

The 5 month old child is diagnosed with AOM. You should:

A. Treat with amoxicillin

B. Watch for 2-3 days to see if it worsens

C. Refer to ENT

D. Treat with tylenol and encourage fluids