NR602 /NR 602 MIDTERM EXAM WEEK 4 ACTUAL
EXAM COMPLETE ACCURATE EXAM 620
QUESTIONS WITH DETAILED 100% CORRECT
ANSWERS /ALREADY GRADED A+
Wilm's Tumor - ANSWER..Most common malignancy of the GU tract. Ages 2-5
years old. Higher in African Americans, lower in Asian
-Firm, smooth mass in the abdomen or flank that DOES NOT cross the midline
that it is associated with congenital abnormalities including renal, cryptorchidism,
hypospadias, duplication of the collecting system, ambiguous genitalia,
hemihypertrophy, aniridia, cardiac abnormalities, and Berkwith- Wiedemann,
Denys-Drash, and Perlman syndromes
Wilm's tumor stage 1 - ANSWER..limited to kidney and can be completely
excised
Wilm's tumor stage 2 - ANSWER..extends beyond the kidney but can still be
completely excised
Wilm's tumor stage 3 - ANSWER..post-surgical residual non-hematogenous
extension confined to the abdomen
Wilm's tumor stage 4 - ANSWER..hematogenous metastasis, frequently to the
lung
Wilm's tumor stage 5 - ANSWER..bilateral kidney involvement
wilm's tumor S&S - ANSWER..increased abdominal size or palpable mass
diagnostic studies for wilms tumor - ANSWER..Chest and abdominal can be
performed to differentiate neuroblastoma, abdominal ultrasonography to
differentiate a solid from cystic mass or hydronephrosis, UA shows hematuria in
25-33%, CT to stage disease
differential for wilm's tumor - ANSWER..Neuroblastoma but this will cross the
midline.
,management of wilms tumor - ANSWER..based on stage and patient condition.
Surgery, chemo and radiotherapy are options
complications of wilms tumor - ANSWER..lungs and liver are most common
sites of metastasis, HTN b/c of renal ischemia
wilms tumor prognosis - ANSWER..80-90% for infants with stage 4, re-
occurrence- less than 50% response to chemo
turner syndrome - ANSWER..Short stature, short neck with webbing, low
posterior hairline, posteriorly rotated ears, ptosis, short 4th/5th metacarpals, short
legs, hyperconvex nails, bicuspid aortic valve, COA, hip dysplasia, scoliosis,
horseshoe kidney, chronic OM with conductive hearing loss, delayed
puberty/infertility
turner syndrome - PCP concerns - ANSWER..Monitor growth- short stature is
expected, GH tx is typically begun early (4-5 yrs)
- Nonverbal (math) learning disabilities are common
- Annual hearing exam, recurrent otitis media, progressive mid frequency
sensorineural hearing loss
- Ongoing vision assessment- strabismus
- Early onset osteo-penia/ -porosis, vitamin D supp, appropriate estrogen therapy,
exercise
- Monitor BP (HTN)
- Annual thyroid screen (Hyper/ hypo)
- Ongoing assessment for celiac disease (tissue transglutaminase immunoglobulin
A)
- Careful early monitoring for kyphosis, scoliosis, lordosis
- Increased risk for hyperlipidemia, cardiac defects (aortic root dilation, bicuspid
aortic valve, coarctation of aorta (35%), renal anomalies, pulmonic stenosis
- Supplemental estrogen therapy for sexual development and preservation of bone
mineral density
- Tendency to form keloids
Down Syndrome- Trisomy 21 - ANSWER..Short stature, brachycephaly, midface
hypoplasia with flat nasal bridge, brushfield spots, epicanthal folds with up-
,slanting palpebral fissures, small mouth with protruding tongue,
Myopia/cataracts, small ears/narrow canals, extra skin at nape of neck, lax joints,
short broad hands/feet/digits, single palmar crease, clinodactyly, exaggerated
space/plantar groove between great and second toes, congenital heart disease, at
risk for leukemia, hypothyroidism, and Alzheimer disease
- Intellectual/cognitive disability/ developmental delays, hearing loss, hypotonia
(infant)
down syndrome PCP concerns/issues - ANSWER..- Careful review of newborn
screen or hypothyroid
- Careful review of newborn critical congenital heart disease
- Ongoing ophthalmologic exam for cataracts
- Increased risk for duodenal atresia
- High risk for atlantoaxial instability
- Monitor for neurological conditions (infantile spasms, seizures, moyamoya
malformation)
- Systemic screening for celiac disease
- Increased risk for leukemia
ophthalmia neonatorum management - ANSWER..saline irrigation to the eyes
until exudate is gone; follow with erythromycin ointment. N. gonorrohea:
ceftriaxone IM or IV. Chlamydia:
ceftriaxone IM or IV. Chlamydia: - ANSWER..ophthalmia neonatorum
management x/t N. gonorrohea:
Erythromycin or possibly azithromycin PO - ANSWER..ophthalmia neonatorum
management d/t Chlamydia:
Antivirals IV or PO - ANSWER..Ophthalmia neonatorum management d/t HSV
Bacterial conjunctivitis - ANSWER..pinkeye; very contagious
Bacterial conjunctivitis - ANSWER..in neonates 5-14 days, preschoolers,
sexually active teens: Haemphilus influenza (Most common organism),
streptococcus pneumoniae, S. Aureus, N. gonorrohea. Erythema, chemosis,
itching, burning, mucopurulent exudate, matter in the eyelashes - worse in the
, morning, causing eyelashes to be shut; worse in winter; Dx through cultures
(required in neonates), r/o pharyngitis, AOM, URI, seborrhea
chemosis - ANSWER..edema of the conjunctiva
Bacterial conjunctivitis neonate treatment - ANSWER..Erythromycin 0.5%
ophthalmic ointment
Bacterial conjunctivitis >1 year treatment - ANSWER..fourth generation
fluoroquinolone. If concurrent AOM: treat accordingly for AOM. Warm soaks to
eyes TID; don't share towels or pillows; no school or work until treatment begins
Chronic Bacterial Conjunctivitis - ANSWER..Lasts more than 3 weeks and
unresponsive to treatment
Most common org is Staphylococcus Aureus. Gram negative orgs include:
-moraxella lacunata, serratia marcescens, ecoli, klebsiella pneumoniae, proteus.
Teens: Chlamydia
Erythema, chemosis, itching, burning, mucopurulwnt exudate, matter in the
eyelashes; foreign body; Dx by gram stain culture to r/o dacryostenosis,
blepharitis, corneal ulcers, trachoma
Chronic Bacterial Conjunctivitis treatment - ANSWER..depends on prior
treatment, lab results, and differential diagnosis. Review compliance of previous
drug choices; consult ophthalmologist
Inclusion conjunctivitis - ANSWER..occurs in neonates 5-14 days old and
sexually active teenagers: caused by : Chlamydia trachomatis; Erythema,
chemosis, itching, burning, mucopurulnt exudate or clear drainage, palpebral
follicles. Cultures: ELISA, PCR r/o sexual activity
Inclusion conjunctivitis treatment - ANSWER..Neonates: erythromycin or
azithromycin PO; Adolescents: doxycycline, azithromycin, EES, erythromycin
base, levofloxacin PO
Viral conjunctivitis - ANSWER..adenovirus MC; HSV-1 (dendritic ulcers);
Erythema, chemosis, bilateral tearing; HSV and herpes zoster: unilateral with
photophobia, fever; Zoster: nose lesion. Cultures to r/o corneal infiltration
EXAM COMPLETE ACCURATE EXAM 620
QUESTIONS WITH DETAILED 100% CORRECT
ANSWERS /ALREADY GRADED A+
Wilm's Tumor - ANSWER..Most common malignancy of the GU tract. Ages 2-5
years old. Higher in African Americans, lower in Asian
-Firm, smooth mass in the abdomen or flank that DOES NOT cross the midline
that it is associated with congenital abnormalities including renal, cryptorchidism,
hypospadias, duplication of the collecting system, ambiguous genitalia,
hemihypertrophy, aniridia, cardiac abnormalities, and Berkwith- Wiedemann,
Denys-Drash, and Perlman syndromes
Wilm's tumor stage 1 - ANSWER..limited to kidney and can be completely
excised
Wilm's tumor stage 2 - ANSWER..extends beyond the kidney but can still be
completely excised
Wilm's tumor stage 3 - ANSWER..post-surgical residual non-hematogenous
extension confined to the abdomen
Wilm's tumor stage 4 - ANSWER..hematogenous metastasis, frequently to the
lung
Wilm's tumor stage 5 - ANSWER..bilateral kidney involvement
wilm's tumor S&S - ANSWER..increased abdominal size or palpable mass
diagnostic studies for wilms tumor - ANSWER..Chest and abdominal can be
performed to differentiate neuroblastoma, abdominal ultrasonography to
differentiate a solid from cystic mass or hydronephrosis, UA shows hematuria in
25-33%, CT to stage disease
differential for wilm's tumor - ANSWER..Neuroblastoma but this will cross the
midline.
,management of wilms tumor - ANSWER..based on stage and patient condition.
Surgery, chemo and radiotherapy are options
complications of wilms tumor - ANSWER..lungs and liver are most common
sites of metastasis, HTN b/c of renal ischemia
wilms tumor prognosis - ANSWER..80-90% for infants with stage 4, re-
occurrence- less than 50% response to chemo
turner syndrome - ANSWER..Short stature, short neck with webbing, low
posterior hairline, posteriorly rotated ears, ptosis, short 4th/5th metacarpals, short
legs, hyperconvex nails, bicuspid aortic valve, COA, hip dysplasia, scoliosis,
horseshoe kidney, chronic OM with conductive hearing loss, delayed
puberty/infertility
turner syndrome - PCP concerns - ANSWER..Monitor growth- short stature is
expected, GH tx is typically begun early (4-5 yrs)
- Nonverbal (math) learning disabilities are common
- Annual hearing exam, recurrent otitis media, progressive mid frequency
sensorineural hearing loss
- Ongoing vision assessment- strabismus
- Early onset osteo-penia/ -porosis, vitamin D supp, appropriate estrogen therapy,
exercise
- Monitor BP (HTN)
- Annual thyroid screen (Hyper/ hypo)
- Ongoing assessment for celiac disease (tissue transglutaminase immunoglobulin
A)
- Careful early monitoring for kyphosis, scoliosis, lordosis
- Increased risk for hyperlipidemia, cardiac defects (aortic root dilation, bicuspid
aortic valve, coarctation of aorta (35%), renal anomalies, pulmonic stenosis
- Supplemental estrogen therapy for sexual development and preservation of bone
mineral density
- Tendency to form keloids
Down Syndrome- Trisomy 21 - ANSWER..Short stature, brachycephaly, midface
hypoplasia with flat nasal bridge, brushfield spots, epicanthal folds with up-
,slanting palpebral fissures, small mouth with protruding tongue,
Myopia/cataracts, small ears/narrow canals, extra skin at nape of neck, lax joints,
short broad hands/feet/digits, single palmar crease, clinodactyly, exaggerated
space/plantar groove between great and second toes, congenital heart disease, at
risk for leukemia, hypothyroidism, and Alzheimer disease
- Intellectual/cognitive disability/ developmental delays, hearing loss, hypotonia
(infant)
down syndrome PCP concerns/issues - ANSWER..- Careful review of newborn
screen or hypothyroid
- Careful review of newborn critical congenital heart disease
- Ongoing ophthalmologic exam for cataracts
- Increased risk for duodenal atresia
- High risk for atlantoaxial instability
- Monitor for neurological conditions (infantile spasms, seizures, moyamoya
malformation)
- Systemic screening for celiac disease
- Increased risk for leukemia
ophthalmia neonatorum management - ANSWER..saline irrigation to the eyes
until exudate is gone; follow with erythromycin ointment. N. gonorrohea:
ceftriaxone IM or IV. Chlamydia:
ceftriaxone IM or IV. Chlamydia: - ANSWER..ophthalmia neonatorum
management x/t N. gonorrohea:
Erythromycin or possibly azithromycin PO - ANSWER..ophthalmia neonatorum
management d/t Chlamydia:
Antivirals IV or PO - ANSWER..Ophthalmia neonatorum management d/t HSV
Bacterial conjunctivitis - ANSWER..pinkeye; very contagious
Bacterial conjunctivitis - ANSWER..in neonates 5-14 days, preschoolers,
sexually active teens: Haemphilus influenza (Most common organism),
streptococcus pneumoniae, S. Aureus, N. gonorrohea. Erythema, chemosis,
itching, burning, mucopurulent exudate, matter in the eyelashes - worse in the
, morning, causing eyelashes to be shut; worse in winter; Dx through cultures
(required in neonates), r/o pharyngitis, AOM, URI, seborrhea
chemosis - ANSWER..edema of the conjunctiva
Bacterial conjunctivitis neonate treatment - ANSWER..Erythromycin 0.5%
ophthalmic ointment
Bacterial conjunctivitis >1 year treatment - ANSWER..fourth generation
fluoroquinolone. If concurrent AOM: treat accordingly for AOM. Warm soaks to
eyes TID; don't share towels or pillows; no school or work until treatment begins
Chronic Bacterial Conjunctivitis - ANSWER..Lasts more than 3 weeks and
unresponsive to treatment
Most common org is Staphylococcus Aureus. Gram negative orgs include:
-moraxella lacunata, serratia marcescens, ecoli, klebsiella pneumoniae, proteus.
Teens: Chlamydia
Erythema, chemosis, itching, burning, mucopurulwnt exudate, matter in the
eyelashes; foreign body; Dx by gram stain culture to r/o dacryostenosis,
blepharitis, corneal ulcers, trachoma
Chronic Bacterial Conjunctivitis treatment - ANSWER..depends on prior
treatment, lab results, and differential diagnosis. Review compliance of previous
drug choices; consult ophthalmologist
Inclusion conjunctivitis - ANSWER..occurs in neonates 5-14 days old and
sexually active teenagers: caused by : Chlamydia trachomatis; Erythema,
chemosis, itching, burning, mucopurulnt exudate or clear drainage, palpebral
follicles. Cultures: ELISA, PCR r/o sexual activity
Inclusion conjunctivitis treatment - ANSWER..Neonates: erythromycin or
azithromycin PO; Adolescents: doxycycline, azithromycin, EES, erythromycin
base, levofloxacin PO
Viral conjunctivitis - ANSWER..adenovirus MC; HSV-1 (dendritic ulcers);
Erythema, chemosis, bilateral tearing; HSV and herpes zoster: unilateral with
photophobia, fever; Zoster: nose lesion. Cultures to r/o corneal infiltration
