NUNP 6541 Pediatric Final Exam Questions
With Correct Answers 100% Guaranteed
Pass.
Recommended treatment for RSV in a 7 month old (outpatient) - Answer✔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
Epiglottitis s/s - Answer✔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
Epiglottitis prevention - Answer✔Haemophilus influenzae type B (Hib) vaccine
Steeple sign - Answer✔a 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? - Answer✔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
Antibiotics for bronchiolitis? - Answer✔Use of saline drops and suctioning of the nares. There is
no evidence to support the routine use of antibiotics
Antibiotics for croup? - Answer✔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
Antibiotics for epiglottitis? - Answer✔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.
1|Page
,Asthma treatment - Answer✔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.
Step 1 Asthma management for children 0-4 years old - Answer✔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
Step 2 Asthma management for children 0-4 years old - Answer✔Step 2: Consider consultation
with asthma specialist. Low dose of inhaled corticosteroids.
Step 3 asthma mgmt for children 0-4 yrs - Answer✔Step 3: Medium-dose of inhaled
corticosteroids
Steps 4-6 asthma mgmt for children 0-4 yrs - Answer✔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
Steps 1-3 asthma mgmt for children 5-11 yrs - Answer✔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.
Steps 4-6 asthma mgmt for children 5-11 yrs - Answer✔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. .
2|Page
,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 - Answer✔Strep pharyngitis
Peritonsillar abscess
Viral pharyngitis
Infectious mononucleosis
Epiglottitis
small-for-gestational-age infants: which type of chromosomal analysis should be included? -
Answer✔Trisomy 18
Holt-Olram
Trisomy 13
Turner Syndrome
Trisomy 21
Prader-Willi Syndrome
heart defects associated with Down syndrome - Answer✔Atrioventricular Septal Defect
Ventricular Septal Defect
Persistant Ductus Arteriosus
Tetrology of Fallot
Contact sports with Down's Syndrome - Answer✔Do not recommend due to atlantoaxial
instability
Diagnosing Down Syndrome - Answer✔Usually 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 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) - Answer✔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,
3|Page
, 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 - Answer✔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
Diagnosing Trisomy 13 - Answer✔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.
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 - Answer✔A 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
Diagnosis is confirmed by a blood test, called a karyotype. This is used to analyze the
chromosomal composition of the female
Fragile X Syndrome (Martin-Bell Syndrome) - Answer✔a genetic condition that causes a range
of developmental problems including learning disabilities and cognitive impairment. Usually,
males are more severely affected by this disorder than females.
Affected individuals usually have delayed development of speech and language by age 2, mild to
moderate intellectual disability, about one-third of affected females are intellectually disabled.
4|Page
With Correct Answers 100% Guaranteed
Pass.
Recommended treatment for RSV in a 7 month old (outpatient) - Answer✔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
Epiglottitis s/s - Answer✔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
Epiglottitis prevention - Answer✔Haemophilus influenzae type B (Hib) vaccine
Steeple sign - Answer✔a 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? - Answer✔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
Antibiotics for bronchiolitis? - Answer✔Use of saline drops and suctioning of the nares. There is
no evidence to support the routine use of antibiotics
Antibiotics for croup? - Answer✔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
Antibiotics for epiglottitis? - Answer✔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.
1|Page
,Asthma treatment - Answer✔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.
Step 1 Asthma management for children 0-4 years old - Answer✔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
Step 2 Asthma management for children 0-4 years old - Answer✔Step 2: Consider consultation
with asthma specialist. Low dose of inhaled corticosteroids.
Step 3 asthma mgmt for children 0-4 yrs - Answer✔Step 3: Medium-dose of inhaled
corticosteroids
Steps 4-6 asthma mgmt for children 0-4 yrs - Answer✔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
Steps 1-3 asthma mgmt for children 5-11 yrs - Answer✔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.
Steps 4-6 asthma mgmt for children 5-11 yrs - Answer✔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. .
2|Page
,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 - Answer✔Strep pharyngitis
Peritonsillar abscess
Viral pharyngitis
Infectious mononucleosis
Epiglottitis
small-for-gestational-age infants: which type of chromosomal analysis should be included? -
Answer✔Trisomy 18
Holt-Olram
Trisomy 13
Turner Syndrome
Trisomy 21
Prader-Willi Syndrome
heart defects associated with Down syndrome - Answer✔Atrioventricular Septal Defect
Ventricular Septal Defect
Persistant Ductus Arteriosus
Tetrology of Fallot
Contact sports with Down's Syndrome - Answer✔Do not recommend due to atlantoaxial
instability
Diagnosing Down Syndrome - Answer✔Usually 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 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) - Answer✔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,
3|Page
, 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 - Answer✔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
Diagnosing Trisomy 13 - Answer✔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.
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 - Answer✔A 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
Diagnosis is confirmed by a blood test, called a karyotype. This is used to analyze the
chromosomal composition of the female
Fragile X Syndrome (Martin-Bell Syndrome) - Answer✔a genetic condition that causes a range
of developmental problems including learning disabilities and cognitive impairment. Usually,
males are more severely affected by this disorder than females.
Affected individuals usually have delayed development of speech and language by age 2, mild to
moderate intellectual disability, about one-third of affected females are intellectually disabled.
4|Page
