NR 602 Final exam
Step 1 Asthma approach-Intermittent - ANSWER-symptoms 2x or less per week
asymptomatic and normal PED
requires SABA 2 days/week
no interference with normal activities
brief exacerbations
nighttime symptoms 2x or less a month
lung fx- FEV>80% predicted
Step 2 Asthma Approach-Mild persistent - ANSWER-Symptoms >2 x a week, less than once per day
requires SABA more than 2days/week, no more than once a day
exacerbations may affect activity
nighttime symptoms 3-4x a month
FEV> 80% predicted
Step 3 Asthma Approach-Moderate Persistant - ANSWER-daily symptoms
daily use of SABA
some limitations
2x or more per week exacerbations
nighttime symptoms more than 1x per week, not nightly
FEV >60% but <80%
Step 4 Asthma Approach-Severe Persistent - ANSWER-continual symptoms
requires SABA multiple x a day
extremely limited activity
nighttime symptoms 7x a week
FEV <60%
Tx of asthma - ANSWER-Stepwise approach
step 1: SABA PRN
step 2: low dose ICS
Step 3: low dose ICS+ LABA or medium dose ICS
step 4: Medium dose ICS+LABA
Step 5: high dose ICS+ LABA
Step 6: High dose ICS+LABA + corticosteroid
Step 6 Asthma Approach - ANSWER-
Bulbar/palpebral conjunctival infection - ANSWER-May be unilateral or bilateral
Leukocoria - ANSWER-abnormal appearance of a white film in the pupil; immediate referral to
pediatric ophthalmologist warranted
Causes: retinal detachment, cataract, retinal dysplasia, newborn retinoblastoma
Visual screening in children - ANSWER-At least once between ages 3-5 y/o according to USPSTF
AOM - ANSWER-RF: genetics, males, Native American, siblings, low economic status, ages 6mo-3y,
winter, supine bottle feeding, daycare, tobacco smoke
S/S of AOM - ANSWER-erythema, otalgia, bulging TM, absent cone of light
, Dx of AOM - ANSWER-Audiometry, tympanometry, possible lateral neck xray to r/o mass
TX of AOM - ANSWER-uncomplicated: supportive with tylenol/ibuprofen; watchful waiting 48-72 in
6m-2y/o; <5 benzocaine otic drops
1st line antx: amoxicillin 80-90mg/kg/day Q12 x 10days
if allergy to PCN- augmentin, cefuroxime
Bacterial rhinosinusitis - ANSWER-Preceded by URI-typically worsens after 5-7 days- not resolved in 2
weeks
Sx of bacterial rhinosinusitis - ANSWER-Purulant nasal congestion, drainage, facial pain, headache,
fever
No imaging required- if no improvement refer to ENT
Bronchiolitis - ANSWER-Usually caused by RSV
wheezing present
<2 y/o
other causes; influenza, adenovirus, rhinovirus
S/s of bronchiolitis - ANSWER-Increased work of breathing, prolonged expiration, grunting, retractions,
nasal flaring
Croup sx - ANSWER-Low grade fever, URI symptoms, barking cough, inspiratory stridor can occur
Croup dx - ANSWER-Made from symptoms
Croup tx - ANSWER-Glucocorticoids possibly
0.6mg/kg-1mg/kg
humidified air
bronchodilators
Lead poisoning - ANSWER-Inactivated heme synthesis by inhibiting insertion of iron-leads to
microcytic hypochromic anemia
Source of lead poisoning - ANSWER-Lead based pain
Those at risk for lead poisoning - ANSWER-Children 2-3 y/o
summer months
Lead poisoning testing - ANSWER-Children with Medicaid need lead level @ 12 months and 24
months-capillary finger stick with venous sample as f/u
AAP recommends 6-9-12-18-24 mo as well as 3-4-5-6 y/o
Lead levels - ANSWER-<5 is normal
>69 requires chelation
Genu varum - ANSWER-Bow legged as a result of uterine position- normal finding up to 3y/o
Legg-Calve-Perthes Disease - ANSWER-Avascular necrosis of femoral head- epiphyses associated with
trauma, synovitis
Legg-Calve-Perthes Disease RF - ANSWER-Associated with low birth weight, socioeconomic status, or
white race
Legg-Calve-Perthes Disease s/s - ANSWER-Onset of painful limp of thigh, knee, or hip worse with
activity, not relieved by rest
restricted by abduction and rotation of affected hip
Step 1 Asthma approach-Intermittent - ANSWER-symptoms 2x or less per week
asymptomatic and normal PED
requires SABA 2 days/week
no interference with normal activities
brief exacerbations
nighttime symptoms 2x or less a month
lung fx- FEV>80% predicted
Step 2 Asthma Approach-Mild persistent - ANSWER-Symptoms >2 x a week, less than once per day
requires SABA more than 2days/week, no more than once a day
exacerbations may affect activity
nighttime symptoms 3-4x a month
FEV> 80% predicted
Step 3 Asthma Approach-Moderate Persistant - ANSWER-daily symptoms
daily use of SABA
some limitations
2x or more per week exacerbations
nighttime symptoms more than 1x per week, not nightly
FEV >60% but <80%
Step 4 Asthma Approach-Severe Persistent - ANSWER-continual symptoms
requires SABA multiple x a day
extremely limited activity
nighttime symptoms 7x a week
FEV <60%
Tx of asthma - ANSWER-Stepwise approach
step 1: SABA PRN
step 2: low dose ICS
Step 3: low dose ICS+ LABA or medium dose ICS
step 4: Medium dose ICS+LABA
Step 5: high dose ICS+ LABA
Step 6: High dose ICS+LABA + corticosteroid
Step 6 Asthma Approach - ANSWER-
Bulbar/palpebral conjunctival infection - ANSWER-May be unilateral or bilateral
Leukocoria - ANSWER-abnormal appearance of a white film in the pupil; immediate referral to
pediatric ophthalmologist warranted
Causes: retinal detachment, cataract, retinal dysplasia, newborn retinoblastoma
Visual screening in children - ANSWER-At least once between ages 3-5 y/o according to USPSTF
AOM - ANSWER-RF: genetics, males, Native American, siblings, low economic status, ages 6mo-3y,
winter, supine bottle feeding, daycare, tobacco smoke
S/S of AOM - ANSWER-erythema, otalgia, bulging TM, absent cone of light
, Dx of AOM - ANSWER-Audiometry, tympanometry, possible lateral neck xray to r/o mass
TX of AOM - ANSWER-uncomplicated: supportive with tylenol/ibuprofen; watchful waiting 48-72 in
6m-2y/o; <5 benzocaine otic drops
1st line antx: amoxicillin 80-90mg/kg/day Q12 x 10days
if allergy to PCN- augmentin, cefuroxime
Bacterial rhinosinusitis - ANSWER-Preceded by URI-typically worsens after 5-7 days- not resolved in 2
weeks
Sx of bacterial rhinosinusitis - ANSWER-Purulant nasal congestion, drainage, facial pain, headache,
fever
No imaging required- if no improvement refer to ENT
Bronchiolitis - ANSWER-Usually caused by RSV
wheezing present
<2 y/o
other causes; influenza, adenovirus, rhinovirus
S/s of bronchiolitis - ANSWER-Increased work of breathing, prolonged expiration, grunting, retractions,
nasal flaring
Croup sx - ANSWER-Low grade fever, URI symptoms, barking cough, inspiratory stridor can occur
Croup dx - ANSWER-Made from symptoms
Croup tx - ANSWER-Glucocorticoids possibly
0.6mg/kg-1mg/kg
humidified air
bronchodilators
Lead poisoning - ANSWER-Inactivated heme synthesis by inhibiting insertion of iron-leads to
microcytic hypochromic anemia
Source of lead poisoning - ANSWER-Lead based pain
Those at risk for lead poisoning - ANSWER-Children 2-3 y/o
summer months
Lead poisoning testing - ANSWER-Children with Medicaid need lead level @ 12 months and 24
months-capillary finger stick with venous sample as f/u
AAP recommends 6-9-12-18-24 mo as well as 3-4-5-6 y/o
Lead levels - ANSWER-<5 is normal
>69 requires chelation
Genu varum - ANSWER-Bow legged as a result of uterine position- normal finding up to 3y/o
Legg-Calve-Perthes Disease - ANSWER-Avascular necrosis of femoral head- epiphyses associated with
trauma, synovitis
Legg-Calve-Perthes Disease RF - ANSWER-Associated with low birth weight, socioeconomic status, or
white race
Legg-Calve-Perthes Disease s/s - ANSWER-Onset of painful limp of thigh, knee, or hip worse with
activity, not relieved by rest
restricted by abduction and rotation of affected hip
