NR602 MIDTERM CERTIFICATION EVALUATION
SCRIPT 2026 TESTED QUESTIONS AND FULL
SOLUTION
◉ 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
SCRIPT 2026 TESTED QUESTIONS AND FULL
SOLUTION
◉ 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
