NR 602 - Midterm Quiz. Questions with Answers. Complete Solutions Provided. All 100% Correct.

NR 602 - Midterm Quiz. Questions with Answers. Complete Solutions Provided. All 100% Correct. 1 1. Asthma – all levels of severity What are s/s of asthma?  Wheezing Continuous/persistent cough Long expir. phase Diminished breath sounds Signs of resp. distress Tachypnea Retractions Nasal flaring Accessory muscles Apprehension Drowsiness Tachycardia Cyanosis of lips How is asthma dx'd?  O2 sat PFT: -Spirometry -FEV1: normal 75%, mild 60-75%, mod 50-59%, severe 49%. -FVC: normal 80-120%, mild 70-79%, mod 50-69%, severe 50%. What are mild asthma s/s?  Wheezing @ end of expiration or no wheezing No/min intercostal retraction along post. axil. line Slight prolongation of exp. phase Normal aeration in all lung fields Can talk in sentences What are moderate asthma s/s?  Wheezing throughout expiration Intercostal retractions Prolonged expiratory phase Decreased breath sounds at base What are severe asthma s/s?  Use of accessory muscles plus lower rib/suprasternal retractions Nasal flaring Inspir/expir. wheezing or no wheezing heard w/poor air exchange Blepharitis What is blepharitis? Inflammation/infection of the lid margins (chronic problem) What are the two types of blepharitis?  Seborrheic (non-ulcerative)  Ulcerative What can cause seborrheic blepharitis? Irritants (smoke, makeup, chemicals) What are s/s of seborrheic blepharitis?  Chronic inflammation of eyelid  Erythema  Greasy scaling of anterior eyelid  Loss of eyelashes  Seborrheic dermatitis of eyebrows/scalp What usually causes ulcerative blepharitis?  Infection w/staph or strep What are s/s of ulcerative blepharitis?  Itching 2  Tearing  Recurrent styes  Chalazia  Photophobia  Small ulceration at eyelid margin  Broken/absent eyelashes  Most frequent complaint: ongoing eye irritation, conjunctiva redness What is the treatment for blepharitis?  Clean w/baby shampoo 2-4 times/day  Warm compresses  Lid massage (right after warm massage) How are infected eyelids with blepharitis treated?  Antistaph abx: bacitracin, erythromycin 0.05% x1 wk and quinolone ointments How is blepharitis infection resistant to topical abx treated?  Tetracycline 250mg PO x4  Doxy 100mg PO x2 Café au lait spot What are cafe au lait spots?  Smooth, regular borders of darkened patch If a child has 5 cafe au lait spots that are 1.5cm, what should be suspected?  Possible Von Recklinghausen's dz (90-100%) LEOPARD syndrome: -Lentigines -Electrographic abnormalities -Ocular hypertelorism -Pulmonary stenosis -Abnormalities of genitalia -Retardation of growth -Deafness In kids 5yo with 5 or more cafe au lait spots of at least 0.5cm, what should be suspected?  Neurofibromatosis What is a rare but diagnostic sign of neurofibromatosis?  Smaller 1-4cm diameter cafe au lait spots in axillae (axillary freckling or Crow's sign) Celiac Disease  Malabsorption syndromes can be caused by many different genetic, congenital, and acquired conditions and usually lead to an initial decrease in weight followed by a deceleration in height velocity.  Celiac disease is an immune-mediated systemic disorder triggered by dietary exposure to wheat gluten and related proteins in barley and rye.  It is characterized by the presence of a variable combination of gluten-dependent clinical manifestations, celiac disease–specific antibodies, HLA-DQ2.5 or HLA-DQ8 haplotypes, and enteropathy.  Celiac disease has a worldwide distribution with overall prevalence of 1% Risk factors o Demographic changes o Increased gluten exposure o infants born by cesarean section; o The most typical presentation occurs between 6 months and 2 years old. Parent reported gastroenteritis occurring at the time gluten was introduced into the child's diet does not appear to be associated with celiac disease. Clinical Findings • Chronic or intermittent diarrhea, persistent or unexplained GI symptoms (e.g., nausea and vomiting), sudden or unexpected weight loss, and prolonged fatigue. • Delayed puberty can coexist with malabsorption, Impaired growth, FTT, unexplained iron deficiency anemia, abdominal distention, bloating or cramping pain 3 • May have no symptoms at all despite evidence of small bowel changes;  maintain a high suspicion for celiac disease in children with metabolic bone disease (such as rickets or osteomalacia), low-trauma fractures, or those with dental enamel defects.  An estimated 85% to 90% of individuals with celiac disease are undiagnosed • Pallor, fatigue, hair and dermatologic abnormalities, digital clubbing, dizziness, cheilosis, glossitis, peripheral neuropathy (symptoms of vitamin deficiency seen with malabsorption), Skinfold thickness and lean body mass Diagnostic Studies • See chronic diarrhea tests Specific Tests for Celiac Disease • Serologic testing should be done if there is clinical suspicion of celiac disease, the child has an associated disorder, or there is a first-degree relative with celiac disease. • Gluten should be eaten in more than one meal every day for 6 weeks prior to testing. • Recommended serologic tests include IgA tissue transglutaminase antibody (tTGA) and IgA endomysial antibody (EMA) because of their high sensitivity and specificity • EMA is more expensive and less accurate in children younger than 2 years old • Home blood testing is not recommended • If serologic testing is positive, refer for endoscopy with biopsy for a definitive diagnosis, although colonoscopy may not be necessary if the tTGA level is greater than 100 units/mL • Careful follow-up of growth parameters, tTGA testing after 6 months of gluten-free diet (GFD), and then yearly • Bone density testing (bone problems may be first symptom of celiac disease). Management Celiac Disease • A strict GFD for life is currently the only effective treatment for celiac disease. • The standard for being gluten-free is a limit of 20 ppm of gluten • Adding pure oats to a GFD can improve palatability and increase fiber and vitamin B intake without causing a systemic or autoantibody response Complications and Prognosis • Growth failure is the primary complication of celiac disease. • risk for fractures and osteoporosis (due to reduced bone mineral density), lymphoma, autoimmune diseases (e.g., type 1 diabetes, thyroid disorders), primary biliary cirrhosis, and primary sclerosing cholangitis. • Sensory peripheral neuropathy may be related to gluten • Celiac crisis consisting of abdominal distention, explosive watery diarrhea, dehydration with hypoproteinemia, electrolyte imbalance, hypotensive shock, and lethargy, although rare, can be the first indication of celiac disease. Chalazions What is a chalazion? Benign, chronic lipogranulomatous inflammation of the eyelid What causes a chalazion? Blockage of the meibomian gland What puts a person at risk for a chalazion?  Hordeolum or any condition which may impede flow through the meibomian gland. Mite species that reside in lash follicles. What are physical exam findings for a chalazion?  Painless Does NOT involve lashes Lid edema or palpable mass Red or grey mass on inner aspect of lid margin What is prevention for chalazion? Good eye hygiene What is treatment for chalazion? Warm, moist compresses 3x a day If secondarily infected: sulfacetamide or erythromycin What is the follow-up for chalazion?  In 2-4 weeks If still present after 6wks, follow up w/ophthalmologist Clostridium difficile