NR 602 Final exam 2024

Step 1 Asthma approach-Intermittent - ANSWERSsymptoms 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- FEV80% predicted Step 2 Asthma Approach-Mild persistent - ANSWERSSymptoms 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 - ANSWERSdaily 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 - ANSWERScontinual symptoms requires SABA multiple x a day extremely limited activity nighttime symptoms 7x a week FEV 60% Tx of asthma - ANSWERSStepwise 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 - ANSWERS Bulbar/palpebral conjunctival infection - ANSWERSMay be unilateral or bilateral Leukocoria - ANSWERSabnormal 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 - ANSWERSAt least once between ages 3-5 y/o according to USPSTF AOM - ANSWERSRF: genetics, males, Native American, siblings, low economic status, ages 6mo-3y, winter, supine bottle feeding, daycare, tobacco smoke S/S of AOM - ANSWERSerythema, otalgia, bulging TM, absent cone of light Dx of AOM - ANSWERSAudiometry, tympanometry, possible lateral neck xray to r/o mass TX of AOM - ANSWERSuncomplicated: 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 - ANSWERSPreceded by URI-typically worsens after 5-7 days- not resolved in 2 weeks Sx of bacterial rhinosinusitis - ANSWERSPurulant nasal congestion, drainage, facial pain, headache, fever No imaging required- if no improvement refer to ENT Bronchiolitis - ANSWERSUsually caused by RSV wheezing present 2 y/o other causes; influenza, adenovirus, rhinovirus S/s of bronchiolitis - ANSWERSIncreased work of breathing, prolonged expiration, grunting, retractions, nasal flaring Croup sx - ANSWERSLow grade fever, URI symptoms, barking cough, inspiratory stridor can occur Croup dx - ANSWERSMade from symptoms Croup tx - ANSWERSGlucocorticoids possibly 0.6mg/kg-1mg/kg humidified air bronchodilators Lead poisoning - ANSWERSInactivated heme synthesis by inhibiting insertion of iron-leads to microcytic hypochromic anemia Source of lead poisoning - ANSWERSLead based pain Those at risk for lead poisoning - ANSWERSChildren 2-3 y/o summer months Lead poisoning testing - ANSWERSChildren 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 Lead levels - ANSWERS5 is normal 69 requires chelation Genu varum - ANSWERSBow legged as a result of uterine position- normal finding up to 3y/o Legg-Calve-Perthes Disease - ANSWERSAvascular necrosis of femoral head- epiphyses associated with trauma, synovitis Legg-Calve-Perthes Disease RF - ANSWERSAssociated with low birth weight, socioeconomic status, or white race Legg-Calve-Perthes Disease s/s - ANSWERSOnset of painful limp of thigh, knee, or hip worse with activity, not relieved by rest restricted by abduction and rotation of affected hip Legg-Calve-Perthes Disease Tx - ANSWERSAbduction brace or long leg cast Congenital Hip Dysplasia s/s - ANSWERSThick fold asymmetry, leg length inequality, walking children- painless limp Congenital Hip Dysplasia Dx & Tx - ANSWERSPositive 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 Toxic trait synovitis - ANSWERSUnilateral inflammation arthritis; acute onset; decreased ROM extension and internal rotation; painful hip, crying at night; common in boy 3-6 y/o Toxic trait synovitis Dx and Tx - ANSWERSDx: WBC with leukocytosis, increased ESR, hip xray normal To: BR, NSAIDs, non WB