NUNP 6541 Pediatric Final Exam-2023 with
complete updatedsolution
Recommended treatment for RSV in a 7 month old (outpatient) - answerUse 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 - answerAcute 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 - answerHaemophilus influenzae type B (Hib) vaccine
Steeple sign - answera 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? - answerDepends 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? - answerUse of saline drops and suctioning of the nares. There is no
evidence to support the routine use of antibiotics
Antibiotics for croup? - answerNebulized 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? - answerEstablish 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 - answerThe 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
,NUNP 6541 Pediatric Final Exam-2023 with
complete updatedsolution
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 - answerStep 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 - answerStep 2: Consider consultation with
asthma specialist. Low dose of inhaled corticosteroids.
Step 3 asthma mgmt for children 0-4 yrs - answerStep 3: Medium-dose of inhaled corticosteroids
Steps 4-6 asthma mgmt for children 0-4 yrs - answerStep 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 - answerStep 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 - answerStep 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. .
,NUNP 6541 Pediatric Final Exam-2023 with
complete updatedsolution
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 - answerStrep pharyngitis
Peritonsillar abscess
Viral pharyngitis
Infectious mononucleosis
Epiglottitis
small-for-gestational-age infants: which type of chromosomal analysis should be included? -
answerTrisomy 18
Holt-Olram
Trisomy 13
Turner Syndrome
Trisomy 21
Prader-Willi Syndrome
heart defects associated with Down syndrome - answerAtrioventricular Septal Defect
Ventricular Septal Defect
Persistant Ductus Arteriosus
Tetrology of Fallot
Contact sports with Down's Syndrome - answerDo not recommend due to atlantoaxial instability
Diagnosing Down Syndrome - answerUsually identified at birth by the presence of certain physical
traits: low muscle tone, a single deep crease across the palm of the hand, a slightly flattened facial
profile and an upward slant to the eyes. Because these features may be present in other babies, a
chromosomal analysis called a karyotype is done to confirm the diagnosis. To obtain a karyotype,
doctors draw a blood sample to examine the baby's cells. They photograph the chromosomes and
, NUNP 6541 Pediatric Final Exam-2023 with
complete updatedsolution
then group them by size, number, and shape. By examining the karyotype, doctors can diagnose.
Another genetic test called FISH can apply similar principles and confirm a diagnosis in a shorter
amount of time
Diagnosing Trisomy 18 (Edwards Syndrome) - answerA sample of the baby's dna is extracted from a
blood sample or other bodily cells or tissue and is cultured to examine a picture of the chromosomes
called a karyotype. In order to get this picture, the chromosomes are isolated, stained, and
examined under the microscope. Most often, this is done using the chromosomes in the white blood
cells. A picture of the chromosomes is taken through the microscope. A visible extra 18th
chromosome confirms a Trisomy 18 diagnosis
Diagnosing Holt-Oram Syndrome - answerA diagnosis may be suspected when a person is found to
have changes in the way the bones of the wrist and other bones of the upper limb are formed. The
diagnosis can be confirmed if a person has specific bone changes and a personal or family history of
an atrial septal defect, ventricular septal defect, or cardiac conduction disease. In order to establish
the diagnosis, a doctor may order tests including an x-ray of the hands, wrists, and arms, a
echocardiogram, and an electrocardiogram. The diagnosis may also be confirmed with genetic
testing of the TBX5 gene
Diagnosing Trisomy 13 - answerParents who are at risk to have a translocation due to their family
history can have a blood test called a karyotype, which can determine if a translocation is present.
Prenatal testing or screening is also available to determine if a current pregnancy is at risk for
chromosome disorders.
People with a family history who are interested in learning about genetic screening or testing for
themselves or family members are encouraged speak with a genetic counselor or other genetics
professional.
Diagnosing Turner Syndrome - answerA diagnosis may be suspected when there are a number of
typical physical features observed such as webbed neck, a broad chest and widely spaced nipples.
Sometimes diagnosis is made at birth because of heart problems, an unusually wide neck or swelling
of the hands and feet.
This can be confirmed by prenatal testing to obtain cells from the unborn baby for chromosomal
analysis. If a diagnosis is confirmed prenatally, the baby may be under the care of a specialist
pediatrician immediately after birth
complete updatedsolution
Recommended treatment for RSV in a 7 month old (outpatient) - answerUse 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 - answerAcute 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 - answerHaemophilus influenzae type B (Hib) vaccine
Steeple sign - answera 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? - answerDepends 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? - answerUse of saline drops and suctioning of the nares. There is no
evidence to support the routine use of antibiotics
Antibiotics for croup? - answerNebulized 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? - answerEstablish 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 - answerThe 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
,NUNP 6541 Pediatric Final Exam-2023 with
complete updatedsolution
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 - answerStep 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 - answerStep 2: Consider consultation with
asthma specialist. Low dose of inhaled corticosteroids.
Step 3 asthma mgmt for children 0-4 yrs - answerStep 3: Medium-dose of inhaled corticosteroids
Steps 4-6 asthma mgmt for children 0-4 yrs - answerStep 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 - answerStep 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 - answerStep 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. .
,NUNP 6541 Pediatric Final Exam-2023 with
complete updatedsolution
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 - answerStrep pharyngitis
Peritonsillar abscess
Viral pharyngitis
Infectious mononucleosis
Epiglottitis
small-for-gestational-age infants: which type of chromosomal analysis should be included? -
answerTrisomy 18
Holt-Olram
Trisomy 13
Turner Syndrome
Trisomy 21
Prader-Willi Syndrome
heart defects associated with Down syndrome - answerAtrioventricular Septal Defect
Ventricular Septal Defect
Persistant Ductus Arteriosus
Tetrology of Fallot
Contact sports with Down's Syndrome - answerDo not recommend due to atlantoaxial instability
Diagnosing Down Syndrome - answerUsually identified at birth by the presence of certain physical
traits: low muscle tone, a single deep crease across the palm of the hand, a slightly flattened facial
profile and an upward slant to the eyes. Because these features may be present in other babies, a
chromosomal analysis called a karyotype is done to confirm the diagnosis. To obtain a karyotype,
doctors draw a blood sample to examine the baby's cells. They photograph the chromosomes and
, NUNP 6541 Pediatric Final Exam-2023 with
complete updatedsolution
then group them by size, number, and shape. By examining the karyotype, doctors can diagnose.
Another genetic test called FISH can apply similar principles and confirm a diagnosis in a shorter
amount of time
Diagnosing Trisomy 18 (Edwards Syndrome) - answerA sample of the baby's dna is extracted from a
blood sample or other bodily cells or tissue and is cultured to examine a picture of the chromosomes
called a karyotype. In order to get this picture, the chromosomes are isolated, stained, and
examined under the microscope. Most often, this is done using the chromosomes in the white blood
cells. A picture of the chromosomes is taken through the microscope. A visible extra 18th
chromosome confirms a Trisomy 18 diagnosis
Diagnosing Holt-Oram Syndrome - answerA diagnosis may be suspected when a person is found to
have changes in the way the bones of the wrist and other bones of the upper limb are formed. The
diagnosis can be confirmed if a person has specific bone changes and a personal or family history of
an atrial septal defect, ventricular septal defect, or cardiac conduction disease. In order to establish
the diagnosis, a doctor may order tests including an x-ray of the hands, wrists, and arms, a
echocardiogram, and an electrocardiogram. The diagnosis may also be confirmed with genetic
testing of the TBX5 gene
Diagnosing Trisomy 13 - answerParents who are at risk to have a translocation due to their family
history can have a blood test called a karyotype, which can determine if a translocation is present.
Prenatal testing or screening is also available to determine if a current pregnancy is at risk for
chromosome disorders.
People with a family history who are interested in learning about genetic screening or testing for
themselves or family members are encouraged speak with a genetic counselor or other genetics
professional.
Diagnosing Turner Syndrome - answerA diagnosis may be suspected when there are a number of
typical physical features observed such as webbed neck, a broad chest and widely spaced nipples.
Sometimes diagnosis is made at birth because of heart problems, an unusually wide neck or swelling
of the hands and feet.
This can be confirmed by prenatal testing to obtain cells from the unborn baby for chromosomal
analysis. If a diagnosis is confirmed prenatally, the baby may be under the care of a specialist
pediatrician immediately after birth
