NR 602 FINAL EXAM REVIEW QUESTIONS
WITH VERIFIED SOLUTIONS
Step 1 Asthma approach-Intermittent
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
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
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
continual symptoms
requires SABA multiple x a day
extremely limited activity
nighttime symptoms 7x a week
FEV <60%
Tx of asthma
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
Bulbar/palpebral conjunctival infection
May be unilateral or bilateral
Leukocoria
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
At least once between ages 3-5 y/o according to USPSTF
AOM
RF: genetics, males, Native American, siblings, low economic status, ages 6mo-3y, winter,
supine bottle feeding, daycare, tobacco smoke
S/S of AOM
erythema, otalgia, bulging TM, absent cone of light
Dx of AOM
Audiometry, tympanometry, possible lateral neck xray to r/o mass
TX of AOM
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
Preceded by URI-typically worsens after 5-7 days- not resolved in 2 weeks
Sx of bacterial rhinosinusitis
Purulant nasal congestion, drainage, facial pain, headache, fever
No imaging required- if no improvement refer to ENT
Bronchiolitis
Usually caused by RSV
wheezing present
, <2 y/o
other causes; influenza, adenovirus, rhinovirus
S/s of bronchiolitis
Increased work of breathing, prolonged expiration, grunting, retractions, nasal flaring
Croup sx
Low grade fever, URI symptoms, barking cough, inspiratory stridor can occur
Croup dx
Made from symptoms
Croup tx
Glucocorticoids possibly
0.6mg/kg-1mg/kg
humidified air
bronchodilators
Lead poisoning
Inactivated heme synthesis by inhibiting insertion of iron-leads to microcytic hypochromic
anemia
Source of lead poisoning
Lead based pain
Those at risk for lead poisoning
Children 2-3 y/o
summer months
Lead poisoning testing
Children with Medicaid need lead level @ 12 months and 24 months-capillary finger stick with
venous sample as f/u
AAP recommends 6-9-12-18-24 mo as well as 3-4-5-6 y/o
Lead levels
<5 is normal
>69 requires chelation
Genu varum
Bow legged as a result of uterine position- normal finding up to 3y/o
Legg-Calve-Perthes Disease
WITH VERIFIED SOLUTIONS
Step 1 Asthma approach-Intermittent
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
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
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
continual symptoms
requires SABA multiple x a day
extremely limited activity
nighttime symptoms 7x a week
FEV <60%
Tx of asthma
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
Bulbar/palpebral conjunctival infection
May be unilateral or bilateral
Leukocoria
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
At least once between ages 3-5 y/o according to USPSTF
AOM
RF: genetics, males, Native American, siblings, low economic status, ages 6mo-3y, winter,
supine bottle feeding, daycare, tobacco smoke
S/S of AOM
erythema, otalgia, bulging TM, absent cone of light
Dx of AOM
Audiometry, tympanometry, possible lateral neck xray to r/o mass
TX of AOM
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
Preceded by URI-typically worsens after 5-7 days- not resolved in 2 weeks
Sx of bacterial rhinosinusitis
Purulant nasal congestion, drainage, facial pain, headache, fever
No imaging required- if no improvement refer to ENT
Bronchiolitis
Usually caused by RSV
wheezing present
, <2 y/o
other causes; influenza, adenovirus, rhinovirus
S/s of bronchiolitis
Increased work of breathing, prolonged expiration, grunting, retractions, nasal flaring
Croup sx
Low grade fever, URI symptoms, barking cough, inspiratory stridor can occur
Croup dx
Made from symptoms
Croup tx
Glucocorticoids possibly
0.6mg/kg-1mg/kg
humidified air
bronchodilators
Lead poisoning
Inactivated heme synthesis by inhibiting insertion of iron-leads to microcytic hypochromic
anemia
Source of lead poisoning
Lead based pain
Those at risk for lead poisoning
Children 2-3 y/o
summer months
Lead poisoning testing
Children with Medicaid need lead level @ 12 months and 24 months-capillary finger stick with
venous sample as f/u
AAP recommends 6-9-12-18-24 mo as well as 3-4-5-6 y/o
Lead levels
<5 is normal
>69 requires chelation
Genu varum
Bow legged as a result of uterine position- normal finding up to 3y/o
Legg-Calve-Perthes Disease
