NR 602 Final Exam Questions And
Answers
Step 1 Asthma approach-Intermittent - Answer symptoms 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- FEV>80% predicted
Step 2 Asthma Approach-Mild persistent - Answer Symptoms >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 - Answer daily 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 - Answer continual symptoms
requires SABA multiple x a day
extremely limited activity
nighttime symptoms 7x a week
FEV <60%
,Tx of asthma - Answer Stepwise 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 - Answer
Bulbar/palpebral conjunctival infection - Answer May be unilateral or bilateral
Leukocoria - Answer abnormal 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 - Answer At least once between ages 3-5 y/o according to
USPSTF
AOM - Answer RF: genetics, males, Native American, siblings, low economic status,
ages 6mo-3y, winter, supine bottle feeding, daycare, tobacco smoke
S/S of AOM - Answer erythema, otalgia, bulging TM, absent cone of light
Dx of AOM - Answer Audiometry, tympanometry, possible lateral neck xray to r/o mass
TX of AOM - Answer uncomplicated: 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 - Answer Preceded by URI-typically worsens after 5-7 days- not
resolved in 2 weeks
Sx of bacterial rhinosinusitis - Answer Purulant nasal congestion, drainage, facial pain,
headache, fever
No imaging required- if no improvement refer to ENT
Bronchiolitis - Answer Usually caused by RSV
wheezing present
<2 y/o
other causes; influenza, adenovirus, rhinovirus
S/s of bronchiolitis - Answer Increased work of breathing, prolonged expiration,
, grunting, retractions, nasal flaring
Croup sx - Answer Low grade fever, URI symptoms, barking cough, inspiratory stridor
can occur
Croup dx - Answer Made from symptoms
Croup tx - Answer Glucocorticoids possibly
0.6mg/kg-1mg/kg
humidified air
Answers
Step 1 Asthma approach-Intermittent - Answer symptoms 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- FEV>80% predicted
Step 2 Asthma Approach-Mild persistent - Answer Symptoms >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 - Answer daily 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 - Answer continual symptoms
requires SABA multiple x a day
extremely limited activity
nighttime symptoms 7x a week
FEV <60%
,Tx of asthma - Answer Stepwise 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 - Answer
Bulbar/palpebral conjunctival infection - Answer May be unilateral or bilateral
Leukocoria - Answer abnormal 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 - Answer At least once between ages 3-5 y/o according to
USPSTF
AOM - Answer RF: genetics, males, Native American, siblings, low economic status,
ages 6mo-3y, winter, supine bottle feeding, daycare, tobacco smoke
S/S of AOM - Answer erythema, otalgia, bulging TM, absent cone of light
Dx of AOM - Answer Audiometry, tympanometry, possible lateral neck xray to r/o mass
TX of AOM - Answer uncomplicated: 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 - Answer Preceded by URI-typically worsens after 5-7 days- not
resolved in 2 weeks
Sx of bacterial rhinosinusitis - Answer Purulant nasal congestion, drainage, facial pain,
headache, fever
No imaging required- if no improvement refer to ENT
Bronchiolitis - Answer Usually caused by RSV
wheezing present
<2 y/o
other causes; influenza, adenovirus, rhinovirus
S/s of bronchiolitis - Answer Increased work of breathing, prolonged expiration,
, grunting, retractions, nasal flaring
Croup sx - Answer Low grade fever, URI symptoms, barking cough, inspiratory stridor
can occur
Croup dx - Answer Made from symptoms
Croup tx - Answer Glucocorticoids possibly
0.6mg/kg-1mg/kg
humidified air
