NR602/NR 602 final Exam
Questions and Answers/A GRADE
triad symptoms intussusception - • Paroxysmal, episodic abdominal pain with
vomiting every 5 to 30 minutes. Vomiting is nonbilious initially. Some children do not
have any pain.
• Screaming with drawing up of the legs with periods of calm, sleeping, or lethargy
between episodes.
• Stool, possibly diarrhea in nature, with blood ("currant jelly").
diagnosis of intussusception - ultrasound is gold standard
Dance sign - Sausage like mass in RUQ with emptiness in RLQ (intussusception)
Physical exam intussusception - • 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 - • 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 - 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 - must be removed, considered obstruction
management lower GI tract or stomach - Most can be left to pass through GI system.
Sharp items must be removed- and button batteries.
,symptoms appendicitis - • 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 - • 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 - CT
complications appendicitis - Perforation, peritonitis, pelvic abscess, ileus,
obstruction, sepsis, shock, and death can occur
colic definition - 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 - No studies have shown any benefit
treatment for colic - • 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 - 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
enuresis diagnosis - According to the ICCS a diagnosis of enuresis requires a
minimum age of 5 years old, and one episode a month for a duration of 3 months.
, before treating nocturnal enuresis: - • Constipation: It cannot be overemphasized
how important it is to determine if constipation or impaction exists before treating
nocturnal enuresis.
causes of enuresis - • Familial disposition
• Neurologic developmental delay.
• ADHD, mental health disorders
• Functional small bladder capacity
• Sleep disorders: Obstructive sleep apnea and disordered sleep patterns result in
increased nocturnal enuresis incidence
• Stress and family disruptions
• Polyuria: This can be caused by nocturnal drinking as well as caffeine intake
• Inappropriate toilet training: This is especially common when parents are overly
demanding or punitive of the child.
history questions enuresis - • Urgency, dysuria, or dribbling
• Are there voiding or stooling postponement behaviors?
• Number of voids per day: is nocturia present?
• Cluster voiding: for example, is the child waiting until after school?
• Frequency of wetting—day and night
• Type of urinary stream
referral warranted for enuresis - • Weak or interrupted urinary stream
• Need to use abdominal pressure to urinate
• Combined daytime incontinence and nocturnal enuresis
physical exam enuresis - • Assess the external genitalia for signs of irritation,
infection, labial fusion, and/or meatal stenosis.
• Examine the abdomen for masses, especially at the suprapubic midline and in the
left lower quadrant.
• Examine the lower back for dimples and hair tufts.
• Assess for neurologic function and deep tendon reflexes.
treatment enuresis in children >6 yrs old - • Urotherapy
• Enuresis alarms
• Drug therapy: Drug therapy can be combined with urotherapy and/or alarm therapy,
but it is not curative.
drug therapy for enuresis - Desmopression
Effective in children with nocturnal polyuria and normal bladder volume.
Short-term treatment only (4-8 weeks).
Not recommended in children younger than 6 years.
Not recommended to use nasal spray.
Questions and Answers/A GRADE
triad symptoms intussusception - • Paroxysmal, episodic abdominal pain with
vomiting every 5 to 30 minutes. Vomiting is nonbilious initially. Some children do not
have any pain.
• Screaming with drawing up of the legs with periods of calm, sleeping, or lethargy
between episodes.
• Stool, possibly diarrhea in nature, with blood ("currant jelly").
diagnosis of intussusception - ultrasound is gold standard
Dance sign - Sausage like mass in RUQ with emptiness in RLQ (intussusception)
Physical exam intussusception - • 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 - • 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 - 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 - must be removed, considered obstruction
management lower GI tract or stomach - Most can be left to pass through GI system.
Sharp items must be removed- and button batteries.
,symptoms appendicitis - • 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 - • 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 - CT
complications appendicitis - Perforation, peritonitis, pelvic abscess, ileus,
obstruction, sepsis, shock, and death can occur
colic definition - 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 - No studies have shown any benefit
treatment for colic - • 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 - 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
enuresis diagnosis - According to the ICCS a diagnosis of enuresis requires a
minimum age of 5 years old, and one episode a month for a duration of 3 months.
, before treating nocturnal enuresis: - • Constipation: It cannot be overemphasized
how important it is to determine if constipation or impaction exists before treating
nocturnal enuresis.
causes of enuresis - • Familial disposition
• Neurologic developmental delay.
• ADHD, mental health disorders
• Functional small bladder capacity
• Sleep disorders: Obstructive sleep apnea and disordered sleep patterns result in
increased nocturnal enuresis incidence
• Stress and family disruptions
• Polyuria: This can be caused by nocturnal drinking as well as caffeine intake
• Inappropriate toilet training: This is especially common when parents are overly
demanding or punitive of the child.
history questions enuresis - • Urgency, dysuria, or dribbling
• Are there voiding or stooling postponement behaviors?
• Number of voids per day: is nocturia present?
• Cluster voiding: for example, is the child waiting until after school?
• Frequency of wetting—day and night
• Type of urinary stream
referral warranted for enuresis - • Weak or interrupted urinary stream
• Need to use abdominal pressure to urinate
• Combined daytime incontinence and nocturnal enuresis
physical exam enuresis - • Assess the external genitalia for signs of irritation,
infection, labial fusion, and/or meatal stenosis.
• Examine the abdomen for masses, especially at the suprapubic midline and in the
left lower quadrant.
• Examine the lower back for dimples and hair tufts.
• Assess for neurologic function and deep tendon reflexes.
treatment enuresis in children >6 yrs old - • Urotherapy
• Enuresis alarms
• Drug therapy: Drug therapy can be combined with urotherapy and/or alarm therapy,
but it is not curative.
drug therapy for enuresis - Desmopression
Effective in children with nocturnal polyuria and normal bladder volume.
Short-term treatment only (4-8 weeks).
Not recommended in children younger than 6 years.
Not recommended to use nasal spray.
