FNP2 EXAM 2 BLUEPRINT GNRS 5670
CORRECT QUESTIONS & SOLUTIONS
100% VERIFIED|| LATEST UPDATE 2025
Atopic and allergic disorders - ANSWER (don't have to memorize 4 types)
6 year old has recurrent springtime watery nasal discharge with nasal and eye itch, the
common OTC meds have not worked.
What do you want to ask? Timing (spring), ask about household allergens, personal
family hx of allergies, DD: allergic rhinitis
Allergic rhinitis - ANSWER ● Rinse with saline after being outside, or 3-4x/day during
allergy season
● 2nd most common atopic disorder
● Rare under the age of 6 months
● Seasonal: hay fever, tree, grass, weed pollen
● Perennial: year round, indoor allergen (pets, dust, mold, roaches)
● Episodic: intermittent exposure
● Clinical findings of allergic rhinitis:
○ Decreased nasal patency/stuffiness
○ Mouth breathing, snoring, nasal speech
○ Bogginess of mucosa
○ Clear thin watery seromucoid rhinorrhea
○ Allergic salute
○ Allergic shiners
○ Itching of palate, pharynx, nose eyes
○ Red conjunctivae
○ Enlarged tonsils, adenoids, cobblestone pharynx
● Treatment plan
○ Antihistamines Oral H1, helpful in seasonal; 2nd gen particularly effective
○ Topical nasal antihistamines: azelastine (>5yo)
○ Decongestants: limited long term benefits, rebound rhinorrhea DO NOT USE MORE
THAN 2 DAYS
○ Saline spray
○ Flonase (age range) - V. EFFECTIVE
○ Allergy testing
○ Avoidance of allergen
■ Determine, remove/avoid triggers
Atopic dermatitis/eczema - ANSWER ● Chronic pruritis inflammatory skin disorder
● Acute/chronic skin eruptions
● facial/extensor pattern in infants/children
● Xerosis, lichenification, cracking
● Exact immune mechanism not evident
,○ Epidermal barrier defects/immune dysregulation of immune system, risk of secondary
infection
○ Cytokine production, inflammation, lesions; abnormalities in histamine production
production
● Other key features
○ Tendency for dry skin/itching
○ Worse in winter months
○ Secondary infection
○ Hyperpigmentation
● Treatment
○ Emmolient
○ Hot water increases feeling of pruritis
○ Interrupt itch-scratch-itch cycle
○ Rehydration of stratum corneum
○ Topical corticosteroids if moisturizing ineffective
○ Non-soap surfactants
○ Avoid irritants and allergic triggers
○ Pharm mgt
■ Sedating dose of antihistamine at night
■ Topical corticosteroids reduce inflammation and pruritis
● 7 classes with varying potency - start with least potent
● ointments/gels
● Covering increases potency
■ Topical calcineurin inhibitors - tacrolimus 0.03% or 0.1% ointment and 1.0%
pimecrolimus cream (Elidel)
■ Prescription emmolient devices
■ Wet wrap therapy
■ Topical antimicrobials/antiseptics
○ Other nonpharm
■ Skin lube
■ Avoid triggers
■ Environmental mgt
● Increase humidity
● Soaps detergents clothing
● Allergenic agents
■ Dietary mgt
● Food allergens not acommon trigger
● Probiotics not recommended by guidelines
■ Complications
● 2ndary skin infection
● Lichenification
● ⅔ have less severe ssx, 20% complete remission
Juvenile idiopathic arthritis - ANSWER A child is newly diagnosed with JIA, what is the
treatment plan (don't have to memorize doses for test, know meds)
FIRST LINE: NSAIDS
,Be familiar with what we're talking
2nd line :
Steroids (systemic >4 joints, txt for 2 weeks)
non-biological DMARDS
(methotrexate, sulfasalazine, leflunomide)
biological DMARDS
(anti IL-1, anakinra, rilonacept, -amab, TNF-a agents (-mab))
DMARDS - ANSWER disease modifying anti-rheumatic drugs
NSAIDS for JIA - ANSWER Tolmetin, motrin, naproxen, indomethacin, celecoxib
reactive arthritis related to streptococcal infection - ANSWER Acute rheumatic fever
○ Post-streptococcal reactive arthritis (PSRA)
○ Both can occur after group A strep infection
○ Antistreptococcal immunoglobulins attack human tissues
○ Strong genetic influence on susceptibility to GAS infection
○ Evidence of prior GAS infection needed for diagnosis - serology for ASO titers
No cardiac involvement
Resolves without joint damage
Kawasaki disease - ANSWER ○ Mucocutaneous lymph node syndrome or infantile
polyarteritis
○ Acute generalized systemic medium vessel vasculitis
○ Cause unknown - infectious agent may activate immune system in genetically
susceptible individual
○ Geographic/seasonal outbreaks; low person-to-person spread
○ EULAR/PREeS classification includes persistent fever for at least 5 days plus four of
the following:
■ ØBilateral conjunctival injection
■ ØChanges of lips/oral cavity
■ ØCervical lymphadenopathy
■ ØPolymorphous exanthema
■ ØChanges in peripheral extremities (swell of hands or feet) or perineal area
Kawasaki disease clinical findings - ANSWER ■ ØMay have atypical/incomplete KD
with coronary anomalies on echocardiogram
■ ØAtypical KD more common in children <1 year and >9 years of age
■ ØCoronary involvement more frequent in incomplete KD
■ ØOther clinical features:
● •Irritability
● •Aseptic meningitis
● •Mild acute iridocyclitis/uveitis
Kawasaki disease Stage 1 - acute - ANSWER Kawasaki Disease
○ Stage 1: Acute phase - 0 to 14 days
, ● ØAbrupt onset of high fever unresponsive to antipyretics/antibiotics
● ØIrritability
● ØBilateral conjunctival injection
● ØErythema of oropharynx, dryness/fissuring of lips
● Ø"Strawberry tongue"
● ØCervical lymphadenopathy
● ØPolymorphous rash
● ØUrethral erythema
● ØEdema of extremities are typical
Kawasaki disease stage 2. subacute (2-4 wks) - ANSWER Kawasaki Disease
○ Stage 2: Subacute phase - 2 to 4 weeks
● ØResolution of fever until all other symptoms resolved
● ØIrritability may be prolonged
● ØDesquamation of fingers, then toes
● ØTransient jaundice, abnormal LFTs
● ØArthralgia/arthritis
● ØOrchitis
● ØFacial palsy, sensorineural hearing loss
● ØCoronary artery aneurysms appear
● COMPLICATIONS IN CARDIOVASCULAR SYSTEM
Kawasaki disease stage 3. convalescent 6-8 wks - ANSWER ○ Stage 3: Convalescent
phase - 6 to 8 weeks
● ØAll clinical signs resolve, but laboratory values not returned to normal
● ØMay have nail changes - deep, transverse grooves
● ØCoronary complications may persist into adulthood
Kawasaki - diagnostic studies - ANSWER ● ØDiagnosis of exclusion
● ØAcute phase reactants may be normal early
● ØWBC may be increased
● ØThrombocytosis (>1 million) in subacute phase
● ØStage 1 - elevated ESR, PLT, CRP, leukocytosis
● ØBlood, urine, CSF, GABHS cultures to rule out other sources of fever, depending on
symptoms
● ØEchocardiograms at acute illness, 2 weeks, and 6-8 weeks to evaluate coronary,
myocardia, pericardial inflammation
Kawasaki management - ANSWER ■ ØEarly diagnosis to prevent aneurysms
● •Evoking rapid anti-inflammatory response
● •Preventing coronary thrombosis by inhibiting platelet aggregation
● •Minimizing long-term coronary risk factors - lifestyle
■ ØIVIG - in first 10 days to reduce incidence of coronary artery abnormalities
■ ØHigh-dose ASA - for anti-inflammatory properties until afebrile for 48-72 hours
■ ØSecond IVIG dose if IVIG resistant disease
■ ØMethylprednisone if IVIG not successful
CORRECT QUESTIONS & SOLUTIONS
100% VERIFIED|| LATEST UPDATE 2025
Atopic and allergic disorders - ANSWER (don't have to memorize 4 types)
6 year old has recurrent springtime watery nasal discharge with nasal and eye itch, the
common OTC meds have not worked.
What do you want to ask? Timing (spring), ask about household allergens, personal
family hx of allergies, DD: allergic rhinitis
Allergic rhinitis - ANSWER ● Rinse with saline after being outside, or 3-4x/day during
allergy season
● 2nd most common atopic disorder
● Rare under the age of 6 months
● Seasonal: hay fever, tree, grass, weed pollen
● Perennial: year round, indoor allergen (pets, dust, mold, roaches)
● Episodic: intermittent exposure
● Clinical findings of allergic rhinitis:
○ Decreased nasal patency/stuffiness
○ Mouth breathing, snoring, nasal speech
○ Bogginess of mucosa
○ Clear thin watery seromucoid rhinorrhea
○ Allergic salute
○ Allergic shiners
○ Itching of palate, pharynx, nose eyes
○ Red conjunctivae
○ Enlarged tonsils, adenoids, cobblestone pharynx
● Treatment plan
○ Antihistamines Oral H1, helpful in seasonal; 2nd gen particularly effective
○ Topical nasal antihistamines: azelastine (>5yo)
○ Decongestants: limited long term benefits, rebound rhinorrhea DO NOT USE MORE
THAN 2 DAYS
○ Saline spray
○ Flonase (age range) - V. EFFECTIVE
○ Allergy testing
○ Avoidance of allergen
■ Determine, remove/avoid triggers
Atopic dermatitis/eczema - ANSWER ● Chronic pruritis inflammatory skin disorder
● Acute/chronic skin eruptions
● facial/extensor pattern in infants/children
● Xerosis, lichenification, cracking
● Exact immune mechanism not evident
,○ Epidermal barrier defects/immune dysregulation of immune system, risk of secondary
infection
○ Cytokine production, inflammation, lesions; abnormalities in histamine production
production
● Other key features
○ Tendency for dry skin/itching
○ Worse in winter months
○ Secondary infection
○ Hyperpigmentation
● Treatment
○ Emmolient
○ Hot water increases feeling of pruritis
○ Interrupt itch-scratch-itch cycle
○ Rehydration of stratum corneum
○ Topical corticosteroids if moisturizing ineffective
○ Non-soap surfactants
○ Avoid irritants and allergic triggers
○ Pharm mgt
■ Sedating dose of antihistamine at night
■ Topical corticosteroids reduce inflammation and pruritis
● 7 classes with varying potency - start with least potent
● ointments/gels
● Covering increases potency
■ Topical calcineurin inhibitors - tacrolimus 0.03% or 0.1% ointment and 1.0%
pimecrolimus cream (Elidel)
■ Prescription emmolient devices
■ Wet wrap therapy
■ Topical antimicrobials/antiseptics
○ Other nonpharm
■ Skin lube
■ Avoid triggers
■ Environmental mgt
● Increase humidity
● Soaps detergents clothing
● Allergenic agents
■ Dietary mgt
● Food allergens not acommon trigger
● Probiotics not recommended by guidelines
■ Complications
● 2ndary skin infection
● Lichenification
● ⅔ have less severe ssx, 20% complete remission
Juvenile idiopathic arthritis - ANSWER A child is newly diagnosed with JIA, what is the
treatment plan (don't have to memorize doses for test, know meds)
FIRST LINE: NSAIDS
,Be familiar with what we're talking
2nd line :
Steroids (systemic >4 joints, txt for 2 weeks)
non-biological DMARDS
(methotrexate, sulfasalazine, leflunomide)
biological DMARDS
(anti IL-1, anakinra, rilonacept, -amab, TNF-a agents (-mab))
DMARDS - ANSWER disease modifying anti-rheumatic drugs
NSAIDS for JIA - ANSWER Tolmetin, motrin, naproxen, indomethacin, celecoxib
reactive arthritis related to streptococcal infection - ANSWER Acute rheumatic fever
○ Post-streptococcal reactive arthritis (PSRA)
○ Both can occur after group A strep infection
○ Antistreptococcal immunoglobulins attack human tissues
○ Strong genetic influence on susceptibility to GAS infection
○ Evidence of prior GAS infection needed for diagnosis - serology for ASO titers
No cardiac involvement
Resolves without joint damage
Kawasaki disease - ANSWER ○ Mucocutaneous lymph node syndrome or infantile
polyarteritis
○ Acute generalized systemic medium vessel vasculitis
○ Cause unknown - infectious agent may activate immune system in genetically
susceptible individual
○ Geographic/seasonal outbreaks; low person-to-person spread
○ EULAR/PREeS classification includes persistent fever for at least 5 days plus four of
the following:
■ ØBilateral conjunctival injection
■ ØChanges of lips/oral cavity
■ ØCervical lymphadenopathy
■ ØPolymorphous exanthema
■ ØChanges in peripheral extremities (swell of hands or feet) or perineal area
Kawasaki disease clinical findings - ANSWER ■ ØMay have atypical/incomplete KD
with coronary anomalies on echocardiogram
■ ØAtypical KD more common in children <1 year and >9 years of age
■ ØCoronary involvement more frequent in incomplete KD
■ ØOther clinical features:
● •Irritability
● •Aseptic meningitis
● •Mild acute iridocyclitis/uveitis
Kawasaki disease Stage 1 - acute - ANSWER Kawasaki Disease
○ Stage 1: Acute phase - 0 to 14 days
, ● ØAbrupt onset of high fever unresponsive to antipyretics/antibiotics
● ØIrritability
● ØBilateral conjunctival injection
● ØErythema of oropharynx, dryness/fissuring of lips
● Ø"Strawberry tongue"
● ØCervical lymphadenopathy
● ØPolymorphous rash
● ØUrethral erythema
● ØEdema of extremities are typical
Kawasaki disease stage 2. subacute (2-4 wks) - ANSWER Kawasaki Disease
○ Stage 2: Subacute phase - 2 to 4 weeks
● ØResolution of fever until all other symptoms resolved
● ØIrritability may be prolonged
● ØDesquamation of fingers, then toes
● ØTransient jaundice, abnormal LFTs
● ØArthralgia/arthritis
● ØOrchitis
● ØFacial palsy, sensorineural hearing loss
● ØCoronary artery aneurysms appear
● COMPLICATIONS IN CARDIOVASCULAR SYSTEM
Kawasaki disease stage 3. convalescent 6-8 wks - ANSWER ○ Stage 3: Convalescent
phase - 6 to 8 weeks
● ØAll clinical signs resolve, but laboratory values not returned to normal
● ØMay have nail changes - deep, transverse grooves
● ØCoronary complications may persist into adulthood
Kawasaki - diagnostic studies - ANSWER ● ØDiagnosis of exclusion
● ØAcute phase reactants may be normal early
● ØWBC may be increased
● ØThrombocytosis (>1 million) in subacute phase
● ØStage 1 - elevated ESR, PLT, CRP, leukocytosis
● ØBlood, urine, CSF, GABHS cultures to rule out other sources of fever, depending on
symptoms
● ØEchocardiograms at acute illness, 2 weeks, and 6-8 weeks to evaluate coronary,
myocardia, pericardial inflammation
Kawasaki management - ANSWER ■ ØEarly diagnosis to prevent aneurysms
● •Evoking rapid anti-inflammatory response
● •Preventing coronary thrombosis by inhibiting platelet aggregation
● •Minimizing long-term coronary risk factors - lifestyle
■ ØIVIG - in first 10 days to reduce incidence of coronary artery abnormalities
■ ØHigh-dose ASA - for anti-inflammatory properties until afebrile for 48-72 hours
■ ØSecond IVIG dose if IVIG resistant disease
■ ØMethylprednisone if IVIG not successful
