NUNP 6541 Pediatric Final Exam-Walden U 2024

Recommended treatment for RSV in a 7 month old (outpatient) - ANSWERSUse of saline drops and suctioning of the nares. Indications of when to use antipyretics. Signs of respiratory distress or dehydration. Guidelines for feeding an infant with signs of mild respiratory distress which includes smaller more frequent feedings; monitoring of the respiratory rate; and guarding against vomiting. The parents should be educated that the child may have the symptoms over the course of 2-3 weeks Epiglottitis s/s - ANSWERSAcute and rapid onset of high fever, chills, and toxicity. Severe sore throat and drooling saliva. Will not eat or drink, muffled (hot potato) voice, and anxiety. Sitting posture with hyperextended neck with open-mouth breathing. Stridor, tachycardia, and tachypnea Epiglottitis prevention - ANSWERSHaemophilus influenzae type B (Hib) vaccine Steeple sign - ANSWERSa radiologic sign found on radiograph where the subglottic tracheal narrowing produces a shape of a church steeple which supports a diagnosis of croup Foreign body aspiration antibiotic? - ANSWERSDepends on the nature of the material aspirated, plus the location and degree of obstruction. Bronchial or laryngeal foreign body aspiration, a bronchoscopy must be performed for removal of the foreign body Antibiotics for bronchiolitis? - ANSWERSUse of saline drops and suctioning of the nares. There is no evidence to support the routine use of antibiotics Antibiotics for croup? - ANSWERSNebulized epinephrine, corticosteroids (dexamethasone oral or IM), blow by oxygen or heliox in severe croup. Racemic epinephrine with the use of corticosteroids to limit rebound swelling Antibiotics for epiglottitis? - ANSWERSEstablish an airway preferably by nasotracheal intubation. Administer IV antibiotics such as rocephin to cover H.influenzae. Administer oxygen and respiratory support. Antibiotics should be continued for 10 days. Rifampin prophylaxis 20 mg/kg in a single dose (maximum of 600 mg) for 4 days for infants and children, 600 mg once a day for adults for 4 days. Should be provided for household contacts who are at risk (Younger than 4 years old who is non-immunized or incompletely immunized, children less than 12 months who have not received primary series of Hib, and immunocompromised children. Asthma treatment - ANSWERSThe pharmacological management of asthma in children is based on the severity of asthma and the child's age. After initial control, decrease treatment to the least amount of medication needed to maintain control. Systemic corticosteroids may be needed at any time and stepped up if there is a major flare-up of symptoms. Step 1 Asthma management for children 0-4 years old - ANSWERSStep 1: SABA (Short acting beta2-agonist) PRN: With viral respiratory symptoms short acting beta 2-agonist should be used every 4-6 hours up to 24 hours (longer with a physician consult). Consider short course of oral systemic corticosteroids if severe exacerbation. Frequent use of SABA may indicate the need to step up treatment Step 2 Asthma management for children 0-4 years old - ANSWERSStep 2: Consider consultation with asthma specialist. Low dose of inhaled corticosteroids. Step 3 asthma mgmt for children 0-4 yrs - ANSWERSStep 3: Medium-dose of inhaled corticosteroids Steps 4-6 asthma mgmt for children 0-4 yrs - ANSWERSStep 4: Medium-dose ICS and Long acting beta2-agonist or montelukast. Step 5: High dose ICS and Long acting beta 2-agonist or montelukast. Step 6: High dose of ICS and LABA or montelukast and oral corticosteroids Steps 1-3 asthma mgmt for children 5-11 yrs - ANSWERSStep 1: SABA (Short acting beta 2-agonist) PRN: Increasing the use of short-acting beta 2-agonist or use greater than 2 days a week for symptom relief generally indicates inadequate control and the need to step up treatment. Step 2: Consider consultation with asthma specialist. Low dose of inhaled corticosteroids. Step 3: Low dose of inhaled corticosteroid and LABA. Or medium dose of inhaled corticosteroids. Steps 4-6 asthma mgmt for children 5-11 yrs - ANSWERSStep 4: Medium-dose ICS and LABA or medium dose of inhaled corticosteroid and leukotriene receptor antagonist or theophylline. . Step 5: High dose ICS and LABA or high dose of inhaled corticosteroid and leukotriene receptor antagonist or theophylline. . Step 6: High dose of ICS and LABA and oral corticosteroids or high dose of inhaled corticosteroids and leukotriene receptor antagonist or theophylline and oral corticosteroids. ** Theophylline levels must be monitored. Differentials for patient with sore throat - ANSWERSStrep pharyngitis Peritonsillar abscess Viral pharyngitis Infectious mononucleosis Epiglottitis small-for-gestational-age infants: which type of chromosomal analysis should be included? - ANSWERSTrisomy 18 Holt-Olram Trisomy 13 Turner Syndrome Trisomy 21 Prader-Willi Syndrome heart defects associated with Down syndrome - ANSWERSAtrioventricular Septal Defect Ventricular Septal Defect Persistant Ductus Arteriosus Tetrology of Fallot diet for cystic fibrosis patients - ANSWERSHigh calorie with added salt A child has not received abx for a bacterial respiratory infection, what would you treat them with? - ANSWERSAmoxicillin A 7-month old presents with 1-day cough, yellow sinus drainage and a low grade temp, treatment options? - ANSWERSTylenol and monitor A 3 yr old presents with wheezing for past 3 months, what tests would you order? - ANSWERSSpirometry RSV symptoms in 6 wk old infant - ANSWERSIn very young infants (less than 6 months old), the only symptoms of RSV infection may be: irritability decreased activity decreased appetite apnea (pauses while breathing) Fever may not always occur with RSV infections Rhinovirus symptoms in 6 wk old infant - ANSWERSThe first indication of the common cold in a baby is often: A congested or runny nose Nasal discharge that may be clear at first but might thicken and turn yellow or green Other signs and symptoms of a common cold in a baby may include: Fever Sneezing Coughing Decreased appetite Irritability Difficulty sleeping Trouble nursing or taking a bottle due to nasal congestion Streptococcus pneumonia in 6 wk old infant - ANSWERSPneumonia in infants aged three weeks to three months is most often bacterial; Streptococcus pneumoniae is the most common pathogen Listeria in 6 wk old infant - ANSWERSListeriosis is caused by an infection with the bacterium Listeria monocytogenes . These bacteria can be carried by many animals and birds, and they have been found in soil, water, sewage, and animal feed. Listeriosis is considered a food-borne illness because most people are probably infected after eating food contaminated with Listeria monocytogenes When a full-term baby becomes infected with Listeria during childbirth, that situation is called late-onset disease. Commonly, symptoms of late-onset listeriosis appear about two weeks after birth. Babies with late-term disease typically have meningitis; yet they have a better chance of surviving than those with early-onset disease Listeriosis is treated with the antibiotics ampicillin or sulfamethoxazole-trimethoprim Chlamydia trichomonas in 6 wk old infant - ANSWERS5 to 30% of infected neonates will develop pneumonia. Approximately half of these infants will have a history of C. Trachomatis conjunctivitis. The condition is generally recognized between 4 and 12 weeks of age, although most infants are symptomatic as early as 8 weeks of age. Cough and nasal congestion without discharge are common, although discharge can be thick. Onset is insidious and characteristic features include a staccato cough, tachypnea. Rales is common upon auscultation, but wheezing is not. The liver and spleen may be palpable secondary to hyperinflated lungs. The patient is usually afebrile, and does not appear particularly ill. WBC is normal, but eosinophils can be elevated. Arterial blood gas shows moderate hypoxemia. Chest X-ray shows hyperinflation with bilateral, symmetrical interstitial infiltrates 2-year-old girl with increased work of breathing had a fever, abdominal pain, post-tussive emesis and no diarrhea. What lab test would be beneficial? - ANSWERSRapid flu test, respiratory viral panel Reactive Airway Disease (Asthma) symptoms - ANSWERSMost asthma flare-ups start slowly. You may notice small changes in your child's body before a flare-up. Changes include: Runny or stuffy nose Sneezing