NUNP 6541 Pediatric Final Exam- Updated
2026/2027 Questions with Answers with
Rationales
1. 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
2. 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
3. Epiglottitis prevention - ANSWER-Haemophilus influenzae type B (Hib)
vaccine
4. 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
5. 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
6. Antibiotics for bronchiolitis? - ANSWER-Use of saline drops and
suctioning of the nares. There is no evidence to support the routine use of
antibiotics
7. 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
,8. 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.
9. 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.
10.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
11.Step 2 Asthma management for children 0-4 years old - ANSWER-Step 2:
Consider consultation with asthma specialist. Low dose of inhaled
corticosteroids.
12.Step 3 asthma mgmt. for children 0-4 yrs - ANSWER-Step 3: Medium-
dose of inhaled corticosteroids
13.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
,14.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. .
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.
15.Differentials for patient with sore throat - ANSWER-Strep pharyngitis
Peritonsillar abscess
Viral pharyngitis
Infectious mononucleosis
Epiglottitis
16.small-for-gestational-age infants: which type of chromosomal analysis
should be included? - ANSWER-Trisomy 18
Holt-Oorlam
Trisomy 13
Turner Syndrome
Trisomy 21
Prader-Willi Syndrome
17.Heart Defects associated with Down syndrome - ANSWER-
Atrioventricular Septal Defect
, Ventricular Septal Defect
Persistent Ductus Arteriosus
Tetro logy of Fallot
18.Contact sports with Down's Syndrome - ANSWER-Do not recommend due
to atlantoaxial instability
19.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
20.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,
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
21.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
22.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.
2026/2027 Questions with Answers with
Rationales
1. 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
2. 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
3. Epiglottitis prevention - ANSWER-Haemophilus influenzae type B (Hib)
vaccine
4. 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
5. 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
6. Antibiotics for bronchiolitis? - ANSWER-Use of saline drops and
suctioning of the nares. There is no evidence to support the routine use of
antibiotics
7. 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
,8. 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.
9. 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.
10.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
11.Step 2 Asthma management for children 0-4 years old - ANSWER-Step 2:
Consider consultation with asthma specialist. Low dose of inhaled
corticosteroids.
12.Step 3 asthma mgmt. for children 0-4 yrs - ANSWER-Step 3: Medium-
dose of inhaled corticosteroids
13.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
,14.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. .
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.
15.Differentials for patient with sore throat - ANSWER-Strep pharyngitis
Peritonsillar abscess
Viral pharyngitis
Infectious mononucleosis
Epiglottitis
16.small-for-gestational-age infants: which type of chromosomal analysis
should be included? - ANSWER-Trisomy 18
Holt-Oorlam
Trisomy 13
Turner Syndrome
Trisomy 21
Prader-Willi Syndrome
17.Heart Defects associated with Down syndrome - ANSWER-
Atrioventricular Septal Defect
, Ventricular Septal Defect
Persistent Ductus Arteriosus
Tetro logy of Fallot
18.Contact sports with Down's Syndrome - ANSWER-Do not recommend due
to atlantoaxial instability
19.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
20.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,
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
21.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
22.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.
