NUNP 6541 Pediatric Final Exam-Walden U
1. Recommended treatment for RSV in a 7 month old (outpatient): Use 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
2. Epiglottitis s/s: Acute 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
3. Epiglottitis prevention: Haemophilus influenzae type B (Hib) vaccine
4. Steeple sign: a radiologic sign found on radiograph where the subglottic tracheal
narrowing produces a shape of a church steeple which supports a diagnosis of croup
5. Foreign body aspiration antibiotic?: Depends 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
6. Antibiotics for bronchiolitis?: Use of saline drops and suctioning of the nares.
There is no evidence to support the routine use of antibiotics
7. Antibiotics for croup?: Nebulized 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
8. Antibiotics for epiglottitis?: Establish 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.
, NUNP 6541 Pediatric Final Exam-Walden U
9. Asthma treatment: The 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.
10. Step 1 Asthma management for children 0-4 years old: Step 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
11. Step 2 Asthma management for children 0-4 years old: Step 2: Consider
consultation with asthma specialist. Low dose of inhaled corticosteroids.
12. Step 3 asthma mgmt for children 0-4 yrs: Step 3: Medium-dose of inhaled
corticosteroids
13. Steps 4-6 asthma mgmt for children 0-4 yrs: Step 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
14. Steps 1-3 asthma mgmt for children 5-11 yrs: Step 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.
, NUNP 6541 Pediatric Final Exam-Walden U
15. Steps 4-6 asthma mgmt for children 5-11 yrs: Step 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.
16. Differentials for patient with sore throat: Strep pharyngitis
Peritonsillar abscess
Viral pharyngitis
Infectious mononucleosis
Epiglottitis
17. small-for-gestational-age infants: which type of chromosomal analysis
should be included?: Trisomy 18
Holt-Olram
Trisomy 13
Turner Syndrome
Trisomy 21
Prader-Willi Syndrome
18. heart defects associated with Down syndrome: Atrioventricular Septal
Defect
Ventricular Septal Defect
Persistant Ductus Arteriosus
Tetrology of Fallot
19. Contact sports with Down's Syndrome: Do not recommend due to atlantoaxial
instability 20. Diagnosing Down Syndrome: Usually identified at birth by the presence of
, NUNP 6541 Pediatric Final Exam-Walden U
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 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
21. Diagnosing Trisomy 18 (Edwards Syndrome): A 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
22. Diagnosing Holt-Oram Syndrome: A 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
23. Diagnosing Trisomy 13: Parents 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.
1. Recommended treatment for RSV in a 7 month old (outpatient): Use 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
2. Epiglottitis s/s: Acute 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
3. Epiglottitis prevention: Haemophilus influenzae type B (Hib) vaccine
4. Steeple sign: a radiologic sign found on radiograph where the subglottic tracheal
narrowing produces a shape of a church steeple which supports a diagnosis of croup
5. Foreign body aspiration antibiotic?: Depends 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
6. Antibiotics for bronchiolitis?: Use of saline drops and suctioning of the nares.
There is no evidence to support the routine use of antibiotics
7. Antibiotics for croup?: Nebulized 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
8. Antibiotics for epiglottitis?: Establish 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.
, NUNP 6541 Pediatric Final Exam-Walden U
9. Asthma treatment: The 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.
10. Step 1 Asthma management for children 0-4 years old: Step 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
11. Step 2 Asthma management for children 0-4 years old: Step 2: Consider
consultation with asthma specialist. Low dose of inhaled corticosteroids.
12. Step 3 asthma mgmt for children 0-4 yrs: Step 3: Medium-dose of inhaled
corticosteroids
13. Steps 4-6 asthma mgmt for children 0-4 yrs: Step 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
14. Steps 1-3 asthma mgmt for children 5-11 yrs: Step 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.
, NUNP 6541 Pediatric Final Exam-Walden U
15. Steps 4-6 asthma mgmt for children 5-11 yrs: Step 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.
16. Differentials for patient with sore throat: Strep pharyngitis
Peritonsillar abscess
Viral pharyngitis
Infectious mononucleosis
Epiglottitis
17. small-for-gestational-age infants: which type of chromosomal analysis
should be included?: Trisomy 18
Holt-Olram
Trisomy 13
Turner Syndrome
Trisomy 21
Prader-Willi Syndrome
18. heart defects associated with Down syndrome: Atrioventricular Septal
Defect
Ventricular Septal Defect
Persistant Ductus Arteriosus
Tetrology of Fallot
19. Contact sports with Down's Syndrome: Do not recommend due to atlantoaxial
instability 20. Diagnosing Down Syndrome: Usually identified at birth by the presence of
, NUNP 6541 Pediatric Final Exam-Walden U
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 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
21. Diagnosing Trisomy 18 (Edwards Syndrome): A 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
22. Diagnosing Holt-Oram Syndrome: A 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
23. Diagnosing Trisomy 13: Parents 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.
