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CMN 571 FINAL EXAM STUDY GUIDE QUESTIONS AND ANSWERS 100% CORRECT
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CMN 571 FINAL EXAM STUDY GUIDE
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CMN 571 FINAL EXAM STUDY GUIDEReview the types of immunity
(Start Module 1) - answerInnate immunity: Everyone is born with innate (or natural)
immunity, a type of general protection. For example, the skin acts as a barrier to block
germs from entering the body. And the immune system recognizes when certain
invaders are foreign and could be dangerous.
Adaptive immunity: Adaptive (or active) immunity develops throughout our lives. We
develop adaptive immunity when we're exposed to diseases or when we're immunized
against them with vaccines.
Passive immunity: Passive immunity is "borrowed" from another source and it lasts for a
short time. For example, antibodies in a mother's breast milk give a baby temporary
immunity to diseases the mother has been exposed to
active immunity - answerActive immunity is usually permanent.Acquired through
exposure and infection with the disease or artificially acquired through
immunization.Onset is a few weeks and usually last a lifetime
passive immunity - answerA person is given antibodies to a disease rather than
produterm-61cing their own & it is short -term immunity. ( Example Mother to baby).
herd immunity - answerThis occurs when a significant portion of the population is
vaccinated and that provides a portion of immunity for those that have not developed
immunity. The population (herd) helps prevent disease in the unprotected population.
The herd protects those who can not safely get vaccinations. Generally 90 -95% of the
population should be vaccinated to haveeffective Herd immunity.
Review the routine immunization required for infant and children 0-6 as found on the
CDC immunization schedule. - answer
Immunization given @ birth - answerHep B (B=HepB)
Immunizations @ 2 mths - answerHepB, DTaP, RV, Hib, IPV, PCV
(2 B Dr Hip)
Immunizations @ 4 mths - answerDTaP, RV, HiB, IPV, PCV
(4 Dr Hip)
Immunizations @ 6 mths - answerHepB, DTaP, RV, Hib, Influenza (yrly) PCV, IPV
(B Dr Hip In 6mths)
,Immunizations @ 1-1.5 yrs - answerMMR, HepA, DTaP, Hib, PCV, Varicella
(1 MAD HPV)
Immunizations @ 4-6 yrs - answerVaricella, DTaP, IPV, MMR
(Very Dim 4-6pm)
How long should live-virus vaccination be delayed if an immunoglobulin (1g) or blood
product was given? - answer3-11 months
What paperwork is required to review with the caregiver/parent before vaccination
administration? - answerVaccine Information Sheets (VIS) for each vaccine given.
Obtain from CDC website. Dr. Lang's notes.
What is the difference between DTap and Tdap? - answer. The pediatric formulation will
have about 3-5 times the amount of diphtheria component compared to the adult
formulation. Therefore, you will see it indicated with an upper-case "D" (DTaP) and
lower-case "d" in the adult formulation (Tdap, Td).
Think of it like this, DTaP helps young children develop immunity to diphtheria, tetanus,
and (whooping cough) pertussis. Tdap served as a "booster" for continued protection.
How many HepB doses does a child need before 6yo and which months are they
recommended? - answer3 doses recommended at birth, 1-2mos & 6-18 mos
Review " Newborn Exam" by Dr. Nina Gold, MD, this is Very important! Video
What first? - answerFirst, when you enter room. Introduce yourself & ask if it's a good
time to examine baby.
general observation - answer-asleep or awake?
-warm or cool?
-VS
If baby is in distress you need to - answernotify resident/physician
you can console child by: - answerlaying hand on head or pacifier if parents ok with it
Examine a newborn head to toe. - answer
Head - answer-hand behind posterior part of head, place measuring tape in cm around
head circumferance to measure
-look at the shape
-Skull design: allow sskull to me malleable which can cause transformation
-cephalhematoma: doesn't cross suture lines. bleeding below periosteium. common
after birth using triceps. increased risk for jaundice
,-caput succandanemum: cross suture lines; fluid accumulation above periosteum;
results from birth canal but resolves in few days after birth
-rarely: subgaleal hemmorhage
-finally, run fingers over back of head scapel to check for cutis aplasia (congenital
anomaly where scalp hasn't formed properly, not dangerous but throrough examination)
- answerAsses the ears, alignment drawn from the corner of eye to make sure aligned.
Atypical ear displacement isn't dangerous but could be genetic
-check for pits and skin tags
-ear formation: helix, crus, pits, skin tags, variation is normal
eyes - answerwidely spaced? horizontal, upslating, downslating
Look at pupils by cupping hand over eyeballs and quickly shine othalmaslpe
should see a flash of red IN EACH EYE... if asymetric red reflex detected anomaly
(CONGENITAL CATARACT OR RETINAL BLASTOMA)
AND REFER
Coloma-refer
NOSE - answermost important feature is assessing patency of nares (ability to bbreath)
-- put small french catheter through nares to test
-common to have transient obstruction/edema after birth suctioining
-asses for choanasal atresia (refer!!)
mouth jaw - answerput finger and glide, feel hard palate; should suck on finger relex
-check for cleft lip (REFER) -- common isolated
tongue - answerpush past lower lips if not may need done
neck - answercheck for webbing
-run fingers over clavicle for fx
chest - answerinspect: flat, concave, convex
-isolated pectus is considered not a refer
Heart - answerHR 120-160 newborn
-continuous mumur from patent ductus but resolve
Assess inpiration. Normal for periodic breathing (pauses)
-lungs should be clear RR 30-60 min
Abdoment - answercheck for distention, hernia can
-out pouching of skin around umbilical cord- hernia: reduce by gently pushing back
towards abd unless it's firm or stuck in place (REFER)
-palpate w/ one hand on top of other & assess liver (should be by newborns ribs
groin - answer-assess femoral pulses by pressing against groin; unable to find pulse
may have aortic coraction (investigate)
, -check for inguinal hernia
-check genitalia: labia & clitors may appear engorged from hormones; may have small
vagnal bleeding or fouschette (normal)
-testes: hydrocele: fluid around testes resolve spontaneous
hypospadius; hypospadius -- hooded foreskin ventral dispalcement of the rethral
meatus
-check patency of anus
hip dysplasia - answercongenital deformation or misalignement. more common if fam hx
of hip dysplaisa or breech presentation in utero
Hips one time using Barlow (moving inward to the knee)
Ortalina (flex knees 90 degrees) if clunk of dislocation (REFER)
If have risk fx assess w/ CT 4-6 wks
Hand - answersome may have fifth finger & normal. Look at length, look at place.
Transverse palm crease: common in down syndrom & neuro condition
-minor variant shouldn't prompt genetic involvement unless other s&s
Back - answerBlue-grey macules (common, fade over times)
Erythema toxicum: pulules on erythematous base. appears 24-48 hrs of life
sacral dimple: check; if you can't may have tehetered cord or spina bifida
concerning: patch of hair on lower back assymetric gluteal cleft
Neuro - answerawake/asleep
test muscle tone by gently pulling babies arm towards you; look at sensation,
movement, reflexes & if symmetrical
moro reflex: hold infant & pull forward above bassinet, drop head gently in other hand &
hands should open & upper extrement extend then retract
palmar grasp reflex: wrapping finger
rooting reflex: finger on side of mouth & suck
swaddle baby at end & thank family & ask if any questions
Newborn Screening Program - answerCriteria for screening newborns for a disorder
include its frequency, its consequences if untreated, the ability of therapy to mitigate
consequences, the cost of testing, and the cost of treatment. With the availability of
tandem mass spectrometry, newborn screening has expanded greatly to now include 35
core conditions and multiple secondary conditions screened by most states. In general,
amino acidopathies, organic acidurias, and disorders of fatty acid oxidation are the
disorders for which screening now occurs. Most states also screen for hypothyroidism,
congenital adrenal hyperplasia, hemoglobinopathies, biotinidase deficiency,
galactosemia, cystic fibrosis, and severe combined immune deficiency. Point-of-care
screening occurs for hearing loss and congenital heart disease. An increasing number
of states have begun screening for some of the lysosomal and peroxisomal disorders,
and a few states have begun screening for spinal muscular atrophy (SMA). The
Recommended Uniform Screening Panel (RUSP) from the Secretary of the Department
of Health and Human Services provides guidance for the addition of new disorders to
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