NR 602 FINAL COMPREHENSIVE COURSE
REVIEW
◉ 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
REVIEW
◉ 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
