NR 602 FINAL PAPER FULL QUESTIONS
AND CORRECT ANSWERS PREMIUM STUDY
SHEET
●● diagnosis of intussusception
Answer: ultrasound is gold standard
●● Dance sign
Answer: Sausage like mass in RUQ with emptiness in RLQ
(intussusception)
●● Physical exam intussusception
Answer: • Observe the infant's appearance and behavior over a period of
time; often the child appears glassy-eyed and groggy between episodes,
almost as if sedated.
• Dance sign
• The abdomen is often distended and tender to palpation.
• Grossly bloody or guaiac-positive stools.
●● Management intussusception
Answer: • Radiologic reduction using a therapeutic air contrast enema
under fluoroscopy is the gold standard.
,• Surgery is necessary if perforation, peritonitis, or hypovolemic shock is
suspected or radiologic reduction fails.
• IV antibiotics are often administered to cover potential intestinal
perforation.
●● imaging ingested FB
Answer: A single frontal radiograph that includes the neck, chest, and
entire abdomen is usually sufficient to locate the object. Esophageal
objects should be precisely located with frontal and lateral chest
radiographs. Coins in the esophagus are usually seen on the frontal view,
whereas tracheal coins are more often seen from the side view
●● esophageal foreign bodies
Answer: must be removed, considered obstruction
●● management lower GI tract or stomach
Answer: Most can be left to pass through GI system. Sharp items must
be removed- and button batteries.
●● symptoms appendicitis
Answer: • Pain: Initially poorly defined periumbilical pain (earliest
sign); acute onset of severe pain is not typical of acute appendicitis. A
shifting of pain to the RLQ may occur after a few hours and becomes
more intense, continuous, and localized.
,• Nausea and vomiting: Typically occurs after pain; however, in
retrocecal appendicitis, this may be reversed. In gastroenteritis, vomiting
precedes the pain.
• Anorexia occurs (although up to 50% of children state that they are
hungry).
• Stool is low volume with mucus; diarrhea is atypical but can occur
especially after perforation (gastroenteritis has high-volume, watery
stools).
• Fever is neither sensitive nor specific for appendicitis; many children
present as afebrile or with low-grade fever. High fever may be
associated with perforation.
●● physical exam appendicitis
Answer: • RLQ pain, pain over McBurney's pt
• Heel-drop jarring test
• Positive psoas sign or obturator sign (or both).
• Rovsing sign or rebound tenderness
• Tenderness and possibly a mass (abscess) on the right side on rectal
examination.
●● highest accuracy in diagnosis appendicitis
Answer: CT
●● complications appendicitis
, Answer: Perforation, peritonitis, pelvic abscess, ileus, obstruction,
sepsis, shock, and death can occur
●● colic definition
Answer: Colic is defined as crying for no apparent reason that lasts for 3
hours or more per day and occurs 3 days or more per week in an
otherwise healthy infant younger than 3 months of age
●● management colic with probiotics
Answer: No studies have shown any benefit
●● treatment for colic
Answer: • Relieve parental stress with the reassurance that crying will
stop
• Trial of background noise
• Rocking the baby (not shaking)
• no colic meds
• anti-gas meds are helpful for gas, not colic
• no need to change formula
●● urine culture should be done when
Answer: urine sample positive for nitrites or leukocyte esterase if the
child has symptoms of UTI, the risk criteria for UTIs are met, or the
child has a high fever without a source
AND CORRECT ANSWERS PREMIUM STUDY
SHEET
●● diagnosis of intussusception
Answer: ultrasound is gold standard
●● Dance sign
Answer: Sausage like mass in RUQ with emptiness in RLQ
(intussusception)
●● Physical exam intussusception
Answer: • Observe the infant's appearance and behavior over a period of
time; often the child appears glassy-eyed and groggy between episodes,
almost as if sedated.
• Dance sign
• The abdomen is often distended and tender to palpation.
• Grossly bloody or guaiac-positive stools.
●● Management intussusception
Answer: • Radiologic reduction using a therapeutic air contrast enema
under fluoroscopy is the gold standard.
,• Surgery is necessary if perforation, peritonitis, or hypovolemic shock is
suspected or radiologic reduction fails.
• IV antibiotics are often administered to cover potential intestinal
perforation.
●● imaging ingested FB
Answer: A single frontal radiograph that includes the neck, chest, and
entire abdomen is usually sufficient to locate the object. Esophageal
objects should be precisely located with frontal and lateral chest
radiographs. Coins in the esophagus are usually seen on the frontal view,
whereas tracheal coins are more often seen from the side view
●● esophageal foreign bodies
Answer: must be removed, considered obstruction
●● management lower GI tract or stomach
Answer: Most can be left to pass through GI system. Sharp items must
be removed- and button batteries.
●● symptoms appendicitis
Answer: • Pain: Initially poorly defined periumbilical pain (earliest
sign); acute onset of severe pain is not typical of acute appendicitis. A
shifting of pain to the RLQ may occur after a few hours and becomes
more intense, continuous, and localized.
,• Nausea and vomiting: Typically occurs after pain; however, in
retrocecal appendicitis, this may be reversed. In gastroenteritis, vomiting
precedes the pain.
• Anorexia occurs (although up to 50% of children state that they are
hungry).
• Stool is low volume with mucus; diarrhea is atypical but can occur
especially after perforation (gastroenteritis has high-volume, watery
stools).
• Fever is neither sensitive nor specific for appendicitis; many children
present as afebrile or with low-grade fever. High fever may be
associated with perforation.
●● physical exam appendicitis
Answer: • RLQ pain, pain over McBurney's pt
• Heel-drop jarring test
• Positive psoas sign or obturator sign (or both).
• Rovsing sign or rebound tenderness
• Tenderness and possibly a mass (abscess) on the right side on rectal
examination.
●● highest accuracy in diagnosis appendicitis
Answer: CT
●● complications appendicitis
, Answer: Perforation, peritonitis, pelvic abscess, ileus, obstruction,
sepsis, shock, and death can occur
●● colic definition
Answer: Colic is defined as crying for no apparent reason that lasts for 3
hours or more per day and occurs 3 days or more per week in an
otherwise healthy infant younger than 3 months of age
●● management colic with probiotics
Answer: No studies have shown any benefit
●● treatment for colic
Answer: • Relieve parental stress with the reassurance that crying will
stop
• Trial of background noise
• Rocking the baby (not shaking)
• no colic meds
• anti-gas meds are helpful for gas, not colic
• no need to change formula
●● urine culture should be done when
Answer: urine sample positive for nitrites or leukocyte esterase if the
child has symptoms of UTI, the risk criteria for UTIs are met, or the
child has a high fever without a source
