NUR 6541 PEDIATRIC MIDTERM
COMPREHENSIVE TEST PAPER WITH
COMPLETE SOLUTIONS
●● Epiglottitis s/s
Answer: Acute and rapid onset of high fever, chills, and toxicity. Severe
sore throat and drooling saliva. Will not eat or drink, muffled (hot
potato) voice, and anxiety. Sitting posture with hyperextended neck with
open-mouth breathing. Stridor, tachycardia, and tachypnea
●● Epiglottitis prevention
Answer: Haemophilus influenzae type B (Hib) vaccine
●● Steeple sign
Answer: a radiologic sign found on radiograph where the subglottic
tracheal narrowing produces a shape of a church steeple which supports
a diagnosis of croup
●● Foreign body aspiration antibiotic?
Answer: Depends on the nature of the material aspirated, plus the
location and degree of obstruction. Bronchial or laryngeal foreign body
aspiration, a bronchoscopy must be performed for removal of the foreign
body
,●● Antibiotics for bronchiolitis?
Answer: Use of saline drops and suctioning of the nares. There is no
evidence to support the routine use of antibiotics
●● Antibiotics for croup?
Answer: Nebulized epinephrine, corticosteroids (dexamethasone oral or
IM), blow by oxygen or heliox in severe croup. Racemic epinephrine
with the use of corticosteroids to limit rebound swelling
●● Antibiotics for epiglottitis?
Answer: Establish an airway preferably by nasotracheal intubation.
Administer IV antibiotics such as rocephin to cover H.influenzae.
Administer oxygen and respiratory support. Antibiotics should be
continued for 10 days. Rifampin prophylaxis 20 mg/kg in a single dose
(maximum of 600 mg) for 4 days for infants and children, 600 mg once
a day for adults for 4 days. Should be provided for household contacts
who are at risk (Younger than 4 years old who is non-immunized or
incompletely immunized, children less than 12 months who have not
received primary series of Hib, and immunocompromised children.
●● Asthma treatment
Answer: The pharmacological management of asthma in children is
based on the severity of asthma and the child's age. After initial control,
decrease treatment to the least amount of medication needed to maintain
control. Systemic corticosteroids may be needed at any time and stepped
up if there is a major flare-up of symptoms.
,●● Step 1 Asthma management for children 0-4 years old
Answer: Step 1: SABA (Short acting beta2-agonist) PRN: With viral
respiratory symptoms short acting beta 2-agonist should be used every
4-6 hours up to 24 hours (longer with a physician consult). Consider
short course of oral systemic corticosteroids if severe exacerbation.
Frequent use of SABA may indicate the need to step up treatment
●● Step 2 Asthma management for children 0-4 years old
Answer: Step 2: Consider consultation with asthma specialist. Low dose
of inhaled corticosteroids.
●● Step 3 asthma mgmt for children 0-4 yrs
Answer: Step 3: Medium-dose of inhaled corticosteroids
●● Steps 4-6 asthma mgmt for children 0-4 yrs
Answer: Step 4: Medium-dose ICS and Long acting beta2-agonist or
montelukast.
Step 5: High dose ICS and Long acting beta 2-agonist or montelukast.
Step 6: High dose of ICS and LABA or montelukast and oral
corticosteroids
, ●● Steps 1-3 asthma mgmt for children 5-11 yrs
Answer: Step 1: SABA (Short acting beta 2-agonist) PRN: Increasing
the use of short-acting beta 2-agonist or use greater than 2 days a week
for symptom relief generally indicates inadequate control and the need
to step up treatment.
Step 2: Consider consultation with asthma specialist. Low dose of
inhaled corticosteroids.
Step 3: Low dose of inhaled corticosteroid and LABA. Or medium dose
of inhaled corticosteroids.
●● Steps 4-6 asthma mgmt for children 5-11 yrs
Answer: Step 4: Medium-dose ICS and LABA or medium dose of
inhaled corticosteroid and leukotriene receptor antagonist or
theophylline. .
Step 5: High dose ICS and LABA or high dose of inhaled corticosteroid
and leukotriene receptor antagonist or theophylline. .
Step 6: High dose of ICS and LABA and oral corticosteroids or high
dose of inhaled corticosteroids and leukotriene receptor antagonist or
theophylline and oral corticosteroids.
** Theophylline levels must be monitored.
COMPREHENSIVE TEST PAPER WITH
COMPLETE SOLUTIONS
●● Epiglottitis s/s
Answer: Acute and rapid onset of high fever, chills, and toxicity. Severe
sore throat and drooling saliva. Will not eat or drink, muffled (hot
potato) voice, and anxiety. Sitting posture with hyperextended neck with
open-mouth breathing. Stridor, tachycardia, and tachypnea
●● Epiglottitis prevention
Answer: Haemophilus influenzae type B (Hib) vaccine
●● Steeple sign
Answer: a radiologic sign found on radiograph where the subglottic
tracheal narrowing produces a shape of a church steeple which supports
a diagnosis of croup
●● Foreign body aspiration antibiotic?
Answer: Depends on the nature of the material aspirated, plus the
location and degree of obstruction. Bronchial or laryngeal foreign body
aspiration, a bronchoscopy must be performed for removal of the foreign
body
,●● Antibiotics for bronchiolitis?
Answer: Use of saline drops and suctioning of the nares. There is no
evidence to support the routine use of antibiotics
●● Antibiotics for croup?
Answer: Nebulized epinephrine, corticosteroids (dexamethasone oral or
IM), blow by oxygen or heliox in severe croup. Racemic epinephrine
with the use of corticosteroids to limit rebound swelling
●● Antibiotics for epiglottitis?
Answer: Establish an airway preferably by nasotracheal intubation.
Administer IV antibiotics such as rocephin to cover H.influenzae.
Administer oxygen and respiratory support. Antibiotics should be
continued for 10 days. Rifampin prophylaxis 20 mg/kg in a single dose
(maximum of 600 mg) for 4 days for infants and children, 600 mg once
a day for adults for 4 days. Should be provided for household contacts
who are at risk (Younger than 4 years old who is non-immunized or
incompletely immunized, children less than 12 months who have not
received primary series of Hib, and immunocompromised children.
●● Asthma treatment
Answer: The pharmacological management of asthma in children is
based on the severity of asthma and the child's age. After initial control,
decrease treatment to the least amount of medication needed to maintain
control. Systemic corticosteroids may be needed at any time and stepped
up if there is a major flare-up of symptoms.
,●● Step 1 Asthma management for children 0-4 years old
Answer: Step 1: SABA (Short acting beta2-agonist) PRN: With viral
respiratory symptoms short acting beta 2-agonist should be used every
4-6 hours up to 24 hours (longer with a physician consult). Consider
short course of oral systemic corticosteroids if severe exacerbation.
Frequent use of SABA may indicate the need to step up treatment
●● Step 2 Asthma management for children 0-4 years old
Answer: Step 2: Consider consultation with asthma specialist. Low dose
of inhaled corticosteroids.
●● Step 3 asthma mgmt for children 0-4 yrs
Answer: Step 3: Medium-dose of inhaled corticosteroids
●● Steps 4-6 asthma mgmt for children 0-4 yrs
Answer: Step 4: Medium-dose ICS and Long acting beta2-agonist or
montelukast.
Step 5: High dose ICS and Long acting beta 2-agonist or montelukast.
Step 6: High dose of ICS and LABA or montelukast and oral
corticosteroids
, ●● Steps 1-3 asthma mgmt for children 5-11 yrs
Answer: Step 1: SABA (Short acting beta 2-agonist) PRN: Increasing
the use of short-acting beta 2-agonist or use greater than 2 days a week
for symptom relief generally indicates inadequate control and the need
to step up treatment.
Step 2: Consider consultation with asthma specialist. Low dose of
inhaled corticosteroids.
Step 3: Low dose of inhaled corticosteroid and LABA. Or medium dose
of inhaled corticosteroids.
●● Steps 4-6 asthma mgmt for children 5-11 yrs
Answer: Step 4: Medium-dose ICS and LABA or medium dose of
inhaled corticosteroid and leukotriene receptor antagonist or
theophylline. .
Step 5: High dose ICS and LABA or high dose of inhaled corticosteroid
and leukotriene receptor antagonist or theophylline. .
Step 6: High dose of ICS and LABA and oral corticosteroids or high
dose of inhaled corticosteroids and leukotriene receptor antagonist or
theophylline and oral corticosteroids.
** Theophylline levels must be monitored.
