NR 602 FINAL CERTIFICATION
EVALUATION COMPLETE QUESTIONS AND
SOLUTIONS GRADED APLUS
●● 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
EVALUATION COMPLETE QUESTIONS AND
SOLUTIONS GRADED APLUS
●● 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
