NR 602 FINAL EXAM LEARNING WORKBOOK
2026 DIAGNOSTIC REASONING AND PATIENT
MANAGEMENT IN PRIMARY CARE
◉ diagnosis of intussusception.
Answer: ultrasound is gold standard
◉ Dance sign.
Answer: Sausage like mass in RUQ with emptiness in RLQ
(intussusception)
◉ Physical exam intussusception.
Answer: • Observe the infant's appearance and behavior over a
period of time; often the child appears glassy-eyed and groggy
between episodes, almost as if sedated.
• Dance sign
• The abdomen is often distended and tender to palpation.
• Grossly bloody or guaiac-positive stools.
◉ Management intussusception.
Answer: • Radiologic reduction using a therapeutic air contrast
enema under fluoroscopy is the gold standard.
,• Surgery is necessary if perforation, peritonitis, or hypovolemic
shock is suspected or radiologic reduction fails.
• IV antibiotics are often administered to cover potential intestinal
perforation.
◉ imaging ingested FB.
Answer: A single frontal radiograph that includes the neck, chest,
and entire abdomen is usually sufficient to locate the object.
Esophageal objects should be precisely located with frontal and
lateral chest radiographs. Coins in the esophagus are usually seen on
the frontal view, whereas tracheal coins are more often seen from
the side view
◉ esophageal foreign bodies.
Answer: must be removed, considered obstruction
◉ management lower GI tract or stomach.
Answer: Most can be left to pass through GI system. Sharp items
must be removed- and button batteries.
◉ symptoms appendicitis.
Answer: • Pain: Initially poorly defined periumbilical pain (earliest
sign); acute onset of severe pain is not typical of acute appendicitis.
A shifting of pain to the RLQ may occur after a few hours and
becomes more intense, continuous, and localized.
,• Nausea and vomiting: Typically occurs after pain; however, in
retrocecal appendicitis, this may be reversed. In gastroenteritis,
vomiting precedes the pain.
• Anorexia occurs (although up to 50% of children state that they
are hungry).
• Stool is low volume with mucus; diarrhea is atypical but can occur
especially after perforation (gastroenteritis has high-volume, watery
stools).
• Fever is neither sensitive nor specific for appendicitis; many
children present as afebrile or with low-grade fever. High fever may
be associated with perforation.
◉ physical exam appendicitis.
Answer: • RLQ pain, pain over McBurney's pt
• Heel-drop jarring test
• Positive psoas sign or obturator sign (or both).
• Rovsing sign or rebound tenderness
• Tenderness and possibly a mass (abscess) on the right side on
rectal examination.
◉ highest accuracy in diagnosis appendicitis.
Answer: CT
◉ complications appendicitis.
, Answer: Perforation, peritonitis, pelvic abscess, ileus, obstruction,
sepsis, shock, and death can occur
◉ colic definition.
Answer: Colic is defined as crying for no apparent reason that lasts
for 3 hours or more per day and occurs 3 days or more per week in
an otherwise healthy infant younger than 3 months of age
◉ management colic with probiotics.
Answer: No studies have shown any benefit
◉ treatment for colic.
Answer: • Relieve parental stress with the reassurance that crying
will stop
• Trial of background noise
• Rocking the baby (not shaking)
• no colic meds
• anti-gas meds are helpful for gas, not colic
• no need to change formula
◉ urine culture should be done when.
2026 DIAGNOSTIC REASONING AND PATIENT
MANAGEMENT IN PRIMARY CARE
◉ diagnosis of intussusception.
Answer: ultrasound is gold standard
◉ Dance sign.
Answer: Sausage like mass in RUQ with emptiness in RLQ
(intussusception)
◉ Physical exam intussusception.
Answer: • Observe the infant's appearance and behavior over a
period of time; often the child appears glassy-eyed and groggy
between episodes, almost as if sedated.
• Dance sign
• The abdomen is often distended and tender to palpation.
• Grossly bloody or guaiac-positive stools.
◉ Management intussusception.
Answer: • Radiologic reduction using a therapeutic air contrast
enema under fluoroscopy is the gold standard.
,• Surgery is necessary if perforation, peritonitis, or hypovolemic
shock is suspected or radiologic reduction fails.
• IV antibiotics are often administered to cover potential intestinal
perforation.
◉ imaging ingested FB.
Answer: A single frontal radiograph that includes the neck, chest,
and entire abdomen is usually sufficient to locate the object.
Esophageal objects should be precisely located with frontal and
lateral chest radiographs. Coins in the esophagus are usually seen on
the frontal view, whereas tracheal coins are more often seen from
the side view
◉ esophageal foreign bodies.
Answer: must be removed, considered obstruction
◉ management lower GI tract or stomach.
Answer: Most can be left to pass through GI system. Sharp items
must be removed- and button batteries.
◉ symptoms appendicitis.
Answer: • Pain: Initially poorly defined periumbilical pain (earliest
sign); acute onset of severe pain is not typical of acute appendicitis.
A shifting of pain to the RLQ may occur after a few hours and
becomes more intense, continuous, and localized.
,• Nausea and vomiting: Typically occurs after pain; however, in
retrocecal appendicitis, this may be reversed. In gastroenteritis,
vomiting precedes the pain.
• Anorexia occurs (although up to 50% of children state that they
are hungry).
• Stool is low volume with mucus; diarrhea is atypical but can occur
especially after perforation (gastroenteritis has high-volume, watery
stools).
• Fever is neither sensitive nor specific for appendicitis; many
children present as afebrile or with low-grade fever. High fever may
be associated with perforation.
◉ physical exam appendicitis.
Answer: • RLQ pain, pain over McBurney's pt
• Heel-drop jarring test
• Positive psoas sign or obturator sign (or both).
• Rovsing sign or rebound tenderness
• Tenderness and possibly a mass (abscess) on the right side on
rectal examination.
◉ highest accuracy in diagnosis appendicitis.
Answer: CT
◉ complications appendicitis.
, Answer: Perforation, peritonitis, pelvic abscess, ileus, obstruction,
sepsis, shock, and death can occur
◉ colic definition.
Answer: Colic is defined as crying for no apparent reason that lasts
for 3 hours or more per day and occurs 3 days or more per week in
an otherwise healthy infant younger than 3 months of age
◉ management colic with probiotics.
Answer: No studies have shown any benefit
◉ treatment for colic.
Answer: • Relieve parental stress with the reassurance that crying
will stop
• Trial of background noise
• Rocking the baby (not shaking)
• no colic meds
• anti-gas meds are helpful for gas, not colic
• no need to change formula
◉ urine culture should be done when.
