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NR602 FINAL EXAM PEDS 75+ QUESTIONS AND ANSWERS 2024
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NR602 FINAL EXAM PEDS 75+ QUESTIONS AND ANSWERS 2024
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Step 1 Asthma approach-Intermittent - ANSWER>>>>>symptoms 2x or less perweek
asymptomatic and normal PED
requires SABA 2 days/week
no interference with normal activities
brief exacerbations
nighttime symptoms 2x or less a month
lung fx- FEV>80% predicted
Step 2 Asthma Approach-Mild persistent - ANSWER>>>>>Symptoms >2 x a week,
less than once per day
requires SABA more than 2days/week, no more than once a day
exacerbations may affect activity
nighttime symptoms 3-4x a month
FEV> 80% predicted
Step 3 Asthma Approach-Moderate Persistant - ANSWER>>>>>daily symptoms
daily use of SABA
some limitations
2x or more per week exacerbations
nighttime symptoms more than 1x per week, not nightly
FEV >60% but <80%
Step 4 Asthma Approach-Severe Persistent - ANSWER>>>>>continual symptoms
requires SABA multiple x a day
extremely limited activity
nighttime symptoms 7x a week
FEV <60%
Tx of asthma - ANSWER>>>>>Stepwise approach
step 1: SABA PRN
step 2: low dose ICS
Step 3: low dose ICS+ LABA or medium dose ICS
step 4: Medium dose ICS+LABA
Step 5: high dose ICS+ LABA
Step 6: High dose ICS+LABA + corticosteroid
,Step 6 Asthma Approach - ANSWER>>>>>
Bulbar/palpebral conjunctival infection - ANSWER>>>>>May be unilateral or
bilateral
Leukocoria - ANSWER>>>>>abnormal appearance of a white film in the pupil;
immediate referral to pediatric ophthalmologist warranted
Causes: retinal detachment, cataract, retinal dysplasia, newborn retinoblastoma
Visual screening in children - ANSWER>>>>>At least once between ages 3-5 y/o
according to USPSTF
AOM - ANSWER>>>>>RF: genetics, males, Native American, siblings, low economic
status, ages 6mo-3y, winter, supine bottle feeding, daycare, tobacco smoke
S/S of AOM - ANSWER>>>>>erythema, otalgia, bulging TM, absent cone of light
Dx of AOM - ANSWER>>>>>Audiometry, tympanometry, possible lateral neck xray
to r/o mass
TX of AOM - ANSWER>>>>>uncomplicated: supportive with tylenol/ibuprofen;
watchful waiting 48-72 in 6m-2y/o; <5 benzocaine otic drops
1st line antx: amoxicillin 80-90mg/kg/day Q12 x 10days
if allergy to PCN- augmentin, cefuroxime
Bacterial rhinosinusitis - ANSWER>>>>>Preceded by URI-typically worsens after 5-7
days- not resolved in 2 weeks
Sx of bacterial rhinosinusitis - ANSWER>>>>>Purulant nasal congestion, drainage,
facial pain, headache, fever
No imaging required- if no improvement refer to ENT
Bronchiolitis - ANSWER>>>>>Usually caused by RSV
wheezing present
<2 y/o
other causes; influenza, adenovirus, rhinovirus
S/s of bronchiolitis - ANSWER>>>>>Increased work of breathing, prolonged
expiration, grunting, retractions, nasal flaring
Croup sx - ANSWER>>>>>Low grade fever, URI symptoms, barking cough,
inspiratory stridor can occur
, Croup dx - ANSWER>>>>>Made from symptoms
Croup tx - ANSWER>>>>>Glucocorticoids possibly
0.6mg/kg-1mg/kg
humidified air
bronchodilators
Lead poisoning - ANSWER>>>>>Inactivated heme synthesis by inhibiting insertion
of iron-leads to microcytic hypochromic anemia
Source of lead poisoning - ANSWER>>>>>Lead based pain
Those at risk for lead poisoning - ANSWER>>>>>Children 2-3 y/o
summer months
Lead poisoning testing - ANSWER>>>>>Children with Medicaid need lead level @ 12
months and 24 months-capillary finger stick with venous sample as f/u
AAP recommends 6-9-12-18-24 mo as well as 3-4-5-6 y/o
Lead levels - ANSWER>>>>><5 is normal
>69 requires chelation
Genu varum - ANSWER>>>>>Bow legged as a result of uterine position- normal
finding up to 3y/o
Legg-Calve-Perthes Disease - ANSWER>>>>>Avascular necrosis of femoral head-
epiphyses associated with trauma, synovitis
Legg-Calve-Perthes Disease RF - ANSWER>>>>>Associated with low birth weight,
socioeconomic status, or white race
Legg-Calve-Perthes Disease s/s - ANSWER>>>>>Onset of painful limp of thigh, knee,
or hip worse with activity, not relieved by rest
restricted by abduction and rotation of affected hip
Legg-Calve-Perthes Disease Tx - ANSWER>>>>>Abduction brace or long leg cast
Congenital Hip Dysplasia s/s - ANSWER>>>>>Thick fold asymmetry, leg length
inequality, walking children- painless limp
Congenital Hip Dysplasia Dx & Tx - ANSWER>>>>>Positive Barlow maneuver,
ortolani or Allis sign
US for <4 months, X-ray AP of pelvis >4 months
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