DNP Peds Midterm Test Questions and Answers 2023

posterior fontanel closes - 6-8 weeks pincer grasp developed - 10 months grasp an object with full hands - 2-3 months sit alone - 7-8 months head lag disappears - 4-6 monhts rolling over - 5-6 months doubles birth weight - 6 months builds a tower of 2 blocks, sometimes fails - 12 months anterior fontanel closes - 12-18 months can pull to stand - 9-11 months comprehends "no" - 9-10 months says 3-5 words with meaning - 12 months introduction to solid food - 4-6 months able to crawl - 6-7 months forms words combinations - 18 months can tie own shoes - 5 years can stand on one foot for a few seconds - 3 years birth weight quadrupled - 30 months picky eater due to decreased growth - 18 months transition to whole milk - 1 year Normal vision - newborn - 20/400 normal vision-6 months of age - 20/100 children that require further evaluation with pediatric ophthalmologist - 5 years or with visual acuity 20/30 or worse 3 years of age with visual acuity 20/50 or worse infants who fail gross visual acuity testing all age groups who demonstrate more than one-line difference between the eyes cause of abnormal red reflex - leukocoria - a white pupillary reflex can indicate: *cataracts *retinal detachment *retinoblastoma: an eye cancer that begins in the back of the eye (retina), most commonly in children. Conjunctivitis IN NEWBORNS - ALL NEONATES WITH CONJUNCTIVITIS REQUIRE EVALUATION BY A PEDIATRIC OPHTHALMOLOGIST in ALL cases of neonatal conjunctivitis, conjunctival swabs and scrapings must be obtained for culture , with tx based on test results Allergic conjunctivitis - * Itching is the hallmark of this condition, often accompanied by tearing, burning, nasal congestion, and mucoid discharge * Rhinitis or allergic pharyngitis, mild lid edema, fine papillary hypertrophy (cobblestone appearance of conjunctiva) * Remove the offending allergen when possible; Instill artificial tears during acute phase Oral antihistamines( Zyrtec, Allegra); Antihistamine eye drops; Mast-cell stabilizers Chlamydial conjunctivitis - ■ Usually presents in young sexually active persons between the ages of 18-30. ■ Transmission occurs from autoinoculation from infected genital secretions ■ Patient may have photophobia and enlarged, tender preauricular nodes ■ Adolescents- Systemic antibiotics (e.g. azithromycin or doxycycline) - oral ABX ■ Once diagnosis is established, a genital work-up of patient and sexual partner is indicated Investigation for other sexually transmitted diseases ■ newborns: Systemic erythromycin, Investigate for other sexually transmitted diseases * subacute or chronic in nature - may have symptoms for months Hyperacute bacterial conjunctivitis - ●A severe, rapidly progressing sight-threatening ocular infection most often affecting sexually active young adults and newborn infants ● In adolescents/adults organism is transmitted from genitals to hands and then to eyes ● In newborns, transmission is via vaginal delivery from an infected woman (3-5 days of age) ■ Characterized by abrupt onset of copious yellow-green purulent discharge that is bilateral, with lid edema, erythema, and chemosis ■ Preauricular adenopathy often present ■ Immediate referral to an ophthalmologist for aggressive management to prevent serious complications ● Systemic antibiotics; topical antibiotics Bacterial conjunctivitis - ■ Acute onset of ocular irritation and tearing ■ Develops in one eye initially and then spreads to the other eye within 48 hours ■ Within 1-2 days, mucopurulent or purulent discharge develops ■ Eyelids often edematous with collection of debris at base of lashes and matting of eyelashes upon awakening ■ Diffuse hyperemia of bulbar and tarsal conjunctiva ■ Lymphadenopathy is minimal ■ Broad spectrum antibiotic ● Azithromycin 1% soln; Fluoroquinolones (moxifloxacin, gatifloxacin) are highly effective, some resistance is occurring; Polytrim ● Dose should be delivered in a single drop. If two drops required, instructions to wait 5 minutes between drops should be given (eyelid capacity to hold fluid is typically exceeded by one drop) Viral conjunctivitis - ■ Leading cause of conjunctivitis in children; highly contagious ■ Usual mode of transmission are contaminated fingers and pool water ■ Characterized by conjunctival hyperemia, edema, and watery discharge; acute onset ■ Usually starts unilateral with bilateral involvement within 24-48 hours ■ Vision unaffected; photophobia uncommon ■ Preauricular node involvement is common ■ Usually self-limiting ■ Some evidence that topical antibiotic shortens course and prevents bacterial superinfection: -short course (5 days) -topical erythromycin 5mg/g opth ointment or Polytrim (polymyxinB-trimethoprim soln) ■ Diluted Chamomile tea and other herbal remedies used in some cultures (ask about home remedies) ■ If using topical antibiotics, Children 2 years treat with broad spectrum topical eye drops such as Polytrim Cover and uncover test - *child fixates on a point (eg. small toy, penlight) *cover one eye for 1-2 secs *rapidly uncover the eye, observe for mvt of previously covered eye from a deviated position back to fixation on object Abnormal: positive test suggests latent Strabismus Normal: uncovered eye maintains current position (does not wander) Esotropia-nasal deviation Exotropia-outward deviation Hypertropia-upward deviation Hypotropia-downward deviation Amblyopia - *most common cause of monocular vision loss among children and adolescents *characterized by marked decrease in visual acuity most often in one eye, due to an interruption of normal visual development during the first few years of life (before the age of 7) *also affects binocularity and depth perception Strabismus - *defined: misaligned or "crossed eye" *Major complication is the development of amblyopia *newborns-eyes are rarely aligned during first few weeks of life, but should be aligned by 3 months or referred to pediatric ophthalmologist *constant ocular deviation is ABNORMAL at any age and require referral