(2023) NR 602 Final Exam- Questions and Answers 160 Q&A

NR 602 Final Exam 2023 1. Step 1 Asthma approach-Intermittent: 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 2. Step 2 Asthma Approach-Mild persistent: 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 3. Step 3 Asthma Approach-Moderate Persistant: 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% 4. Step 4 Asthma Approach-Severe Persistent: continual symptoms requires SABA multiple x a day extremely limited activity nighttime symptoms 7x a week FEV <60% 5. Tx of asthma: 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 6. Step 6 Asthma Approach: 7. Bulbar/palpebral conjunctival infection: May be unilateral or bilateral 8. Leukocoria: abnormal appearance of a white film in the pupil; immediate refer- ral to pediatric ophthalmologist warranted Causes: retinal detachment, cataract, retinal dysplasia, newborn retinoblastoma 9. Visual screening in children: At least once between ages 3-5 y/o according to USPSTF 10. AOM: RF: genetics, males, Native American, siblings, low economic status, ages 6mo-3y, winter, supine bottle feeding, daycare, tobacco smoke 11. S/S of AOM: erythema, otalgia, bulging TM, absent cone of light 12. Dx of AOM: Audiometry, tympanometry, possible lateral neck xray to r/o mass 13. TX of AOM: 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 14. Bacterial rhinosinusitis: Preceded by URI-typically worsens after 5-7 days- not resolved in 2 weeks 15. Sx of bacterial rhinosinusitis: Purulant nasal congestion, drainage, facial pain, headache, fever No imaging required- if no improvement refer to ENT 16. Bronchiolitis: Usually caused by RSV wheezing present <2 y/o other causes; influenza, adenovirus, rhinovirus 17. S/s of bronchiolitis: Increased work of breathing, prolonged expiration, grunt- ing, retractions, nasal flaring 18. Croup sx: Low grade fever, URI symptoms, barking cough, inspiratory stridor can occur 19. Croup dx: Made from symptoms 20. Croup tx: Glucocorticoids possibly 0.6mg/kg-1mg/kg humidified air bronchodilators 21. Lead poisoning: Inactivated heme synthesis by inhibiting insertion of iron-leads to microcytic hypochromic anemia 22. Source of lead poisoning: Lead based pain 23. Those at risk for lead poisoning: Children 2-3 y/o summer months 24. Lead poisoning testing: Children with Medicaid need lead level @ 12 months and 24 months-capillary finger stick with venous sample as f/u AAP recommends mo as well as 3-4-5-6 y/o 25. Lead levels: <5 is normal >69 requires chelation 26. Genu varum: Bow legged as a result of uterine position- normal finding up to 3y/o 27. Legg-Calve-Perthes Disease: Avascular necrosis of femoral head- epiphyses associated with trauma, synovitis 28. Legg-Calve-Perthes Disease RF: Associated with low birth weight, socioeco- nomic status, or white race 29. Legg-Calve-Perthes Disease s/s: Onset of painful limp of thigh, knee, or hip worse with activity, not relieved by rest restricted by abduction and rotation of affected hip 30. Legg-Calve-Perthes Disease Tx: Abduction brace or long leg cast 31. Congenital Hip Dysplasia s/s: Thick fold asymmetry, leg length inequality, walking children- painless limp 32. Congenital Hip Dysplasia Dx & Tx: Positive Barlow maneuver, ortolani or Allis sign US for <4 months, X-ray AP of pelvis >4 months Tx: refer to orthopedist, pavlik harness, child should be seen weekly to prevent skin breakdown, necrosis 33. Toxic trait synovitis: Unilateral inflammation arthritis; acute onset; decreased ROM extension and internal rotation; painful hip, crying at night; common in boy 3-6 y/o 34. Toxic trait synovitis Dx and Tx: Dx: WBC with leukocytosis, increased ESR, hip xray normal To: BR, NSAIDs, non WB 35. Impetigo: Superficial layers of the skin Nonbullous or bullous nonbullous= honey-colored crusts on lesions caused by group A streptococcus, S.aerous or MRSA occurs more in summer months, low socioeconomic class 36. Impetigo exam: Lesions on hand, face, neck, extremities or perineium; region- al lymphadenopathy 37. Impetigo treatment: Topical antx if superficial, nonbullous or localized to one area bacitracin neomycin polymyxin B Widespread infection again S. Aerous= Augmentin, cephelexin, dicloxacillin, cloxacillin for 7-10 days 38. Cellulitis: In children often periorbital, perivaginal, perinatal, or buccal 39. Cellulitis hx: Recent URI, fever, pain, malaise 40. Cellulitis exam: Buccal cellulitis-blue/purple tinged= enzae 41. Cellulitis Dx: CBC, BCx if child appears toxic, has fever, or is <1 42. Cellulitis tx: IV antx if streptococcal= PCN, if allergy 3rd generation cephalosporin if staphylococcus=bactrim if child >2 months; doxy if child >8 and < 45 kg MRSA suspected= clindamycin H.influenzae=augmentin x 10 days 43. Folliculitis: Infection of hair follicle; s. Aerous most common 44. furnucle: Deeper infection of hair follicle involving the deep dermis 45. Hot tub folliculitis: Pseudomonas aeruginosa 46. Dx of folliculitis & furnucle: Grain stain and cx 47. Management of folliculitis and furnucle: Warm compresses, benzoyl perox- ide if superficial- topical antx-erythromycin or clindamycin if severe or widespread- cephalexin or dicloxacillin 48. Paronychia: Infection around fingernail/toenail S.aerous #1 then streptococcus or pseudomonas 49. Paronychia tx: Systemic oral antx if acute infection present candida-nystatin if purulant-loosen cuticle with blade 50. Candiasis: Tx: thrush-oral nystatin QID if resistant to tx: oral fluconazole skin diaper rash-nystatin, ketonazole 51. Tinea captitis: ringworm of the scalp diffuse fine scale without obvious hair loss discrete area of hair loss with broken hairs (black dot ringworm) trichophyton tonsurans and microsporum canis-most common organis African American boys most common 52. tx of tinea capitis: griseofulvin ultramicrosize once or twice daily for 6-8 weeks, take with fatty food to increase absorption shampoo with econazole or ketonazole in addition 53. tinea corporis: ringworm found on non hairy part of body 54. tx for tinea corporis: topical antifungals miconazole or clotrimazole 1-4 weeks BID