NR 602 Mid-term Complete Exam with Questions and Answers – 100% Solved
(coartication) of the aorta (COA) - ✔✔✔-- Narrowing of a small or long segment of the aorta
- Risk: male, other L heart abnormalities
- Sx: Severe: may be apparent in first 6 weeks. might have no sx until 3-5 yo. Upper extremity
HTN, lower ext hypo., delayed timing or weak distal arterial pulses, bounding or bounding
brachial radial & carotid pulse, CHF signs, Systolic murmur, gallop
- Dx: Echo will confirm, MRI defines location & severity.
- Tx: PGE1 used in sev. neonates, surgery (restenosis likely if done <1yo),
Acyanotic Defects - ✔✔✔-- ASD, VSD,A/VSD/ PDA, PVS, coarctation of the aorta, AS
Asthma - ✔✔✔-- Step 1 (intermittent): sx <2x/week, normal PFts, nighttime sx <2/month,
exacerbations brief, no interference with normal activity
- Step 2 (mild persistent): >2x/week but not more than 1 per day, 3-4 nighttime sx/month, FEV
>80%
- Step 3 (mod persistent): daily sx, daily SABA, some limitations, exacerbations affect activity and
may last days. FEV >60 but <80
- Step 4 (severe persistent): Continual sx, requires SABA several x's/day, extremely limited
physical activity, frequent exacerbations, nightly sx, FEV <60%
Asthma treatment steps - ✔✔✔-- Step 1: SABA PRn
- Step 2: Low-dose ICS, OR LTRA, Cromolyn
- Step 3: Low-dose ICS + LABA OR Med- dose ICS
- Step 4: Med- dose ICS + LABA OR med-dose ICS + LTRA
- Step 5: High-dose ICS + LABA AND omalizumab for pts who have allergies
- Step 6: High-dose ICS + Laba + Oral steroid AND omalizumab for allergies
- consult asthma specialist after step 3-4( for sure at 4)
atrial septal defect - ✔✔✔-- hole in atrial septum (5-10% OF CHD)
,NR 602 Mid-term Complete Exam with Questions and Answers – 100% Solved
- Sx: easily fatigued, no murmur till 2-3yo, murmur at pulmonic area split S1 sometimes, split S2,
- Tx: may close spontaneously, or need surgery, ASA x 6m post surgery
Blepharitis - ✔✔✔-- acute or chronic bacterial (staph) inflammation of eyelash follicle or
sebaceous gland of eyelid. bilateral usually
-flaky, scaly debris over eyelid margin when awakening
- tx: warm compress, scrub with weak shampoo, sometimes bacitracin or erythromycin,
-no contacts during tx
C. diff - ✔✔✔-- unknown incubation, duration: after several weeks of ATB
- Sx: explosive diarrhea, bloody stools, abd pain, fever, n/v
- acquired from the environment or oral-fecal route
-Test: stool culture, enzyme immunoassay for toxin a or a and B
- Tx: d/c ATB (esp. clinda, ampa, or cephalosporins), fluid & lyte replacement. ** If ATB still
needed, treat with oral Metronidadole or Vanco for 7-10 days, probiotic
Cafe au lait spots - ✔✔✔-- First sign of Neurofibromatosis
-Tan to brown macules found anywhere on skin.
Celiac Disease - ✔✔✔-- Gluten-sensitivity. Immune mediated systemic disorder
- Frequently occurs with other autoimmune diseases (DM 1, liver disease, IgA nephropathy,
juvenile chronic arthritis)
-Risk: immigration from another country, born by c-section, 6m-2years, female,
- Sx: Chronic or intermittent diarrhea, persistent or unexplained Gi symptoms, wt loss,
prolonged fatigue, growth failure, steatorrhea, low trauma fractures, dental enamel defects
- Test: serologic testing, IgA tTGA and IGA EMA (more expensive and less accurate in <2yo). No
home blood testing. Endoscopy & biopsy for definitive dx.
-Tx: strict GFD (<10mg gluten)
, NR 602 Mid-term Complete Exam with Questions and Answers – 100% Solved
chalazion - ✔✔✔--chronic sterile inflammation of eyelid from a lipogranuloma of the
meibomian gland
- initially, mild redness & swelling, then after a few days, a slow-growing, round, nonpigmented
PAINLESS mass remains.
- Acute tx: hot compress, refer to eye MD
Conjunctivitis - ✔✔✔--most common peds infection, yellow-green purulent discharge, matted
eyes when waking, itching
-bacterial (unilateral), viral (bilateral)
- usually self-limiting, but may treat with atbx
- tx: sodium sulfacetamide or tmp+polymycin B, or erythromycin, azith (>12m), -floxacins
(>12m). no -mycins)
-newborn: chlamydia trach. (erythromycin PO), gonorrhea (ceftriaxone IM/IV). DFA conjunctival
test
-
Contraceptives - ✔✔✔-- OCP do not increase risk of breast CA (decr. cervical CA)
- No IUD restrictions based on age, parity, STDs, ectopic pregnancy or hx of PID.
- combined oral contraceptives should be avoided in people with migraines WITH aura.
- all contraceptives safe with epilepsy. but some anticonvulsants like topiramate can decrease
the contraceptives efficacy.
- Implant: suppresses ovulation,. thicken cervical mucus,good for teens. progestin only. most
effective BC. no pelvic exam required, relief of dysmenorrhea
- IUD: pts don't need to check their strings. woman will still ovulate
- Depo: progestin only. Q 3 months. suppresses ovulation, thins lining of endometrium. need
pregnancy test. repeat injection can be given 2 weeks late without additional contraceptive
protection or preg. test. menstrual suppression/irregular bleeding. wt gain. may affect bone
density that is reverse when discontinued.
(coartication) of the aorta (COA) - ✔✔✔-- Narrowing of a small or long segment of the aorta
- Risk: male, other L heart abnormalities
- Sx: Severe: may be apparent in first 6 weeks. might have no sx until 3-5 yo. Upper extremity
HTN, lower ext hypo., delayed timing or weak distal arterial pulses, bounding or bounding
brachial radial & carotid pulse, CHF signs, Systolic murmur, gallop
- Dx: Echo will confirm, MRI defines location & severity.
- Tx: PGE1 used in sev. neonates, surgery (restenosis likely if done <1yo),
Acyanotic Defects - ✔✔✔-- ASD, VSD,A/VSD/ PDA, PVS, coarctation of the aorta, AS
Asthma - ✔✔✔-- Step 1 (intermittent): sx <2x/week, normal PFts, nighttime sx <2/month,
exacerbations brief, no interference with normal activity
- Step 2 (mild persistent): >2x/week but not more than 1 per day, 3-4 nighttime sx/month, FEV
>80%
- Step 3 (mod persistent): daily sx, daily SABA, some limitations, exacerbations affect activity and
may last days. FEV >60 but <80
- Step 4 (severe persistent): Continual sx, requires SABA several x's/day, extremely limited
physical activity, frequent exacerbations, nightly sx, FEV <60%
Asthma treatment steps - ✔✔✔-- Step 1: SABA PRn
- Step 2: Low-dose ICS, OR LTRA, Cromolyn
- Step 3: Low-dose ICS + LABA OR Med- dose ICS
- Step 4: Med- dose ICS + LABA OR med-dose ICS + LTRA
- Step 5: High-dose ICS + LABA AND omalizumab for pts who have allergies
- Step 6: High-dose ICS + Laba + Oral steroid AND omalizumab for allergies
- consult asthma specialist after step 3-4( for sure at 4)
atrial septal defect - ✔✔✔-- hole in atrial septum (5-10% OF CHD)
,NR 602 Mid-term Complete Exam with Questions and Answers – 100% Solved
- Sx: easily fatigued, no murmur till 2-3yo, murmur at pulmonic area split S1 sometimes, split S2,
- Tx: may close spontaneously, or need surgery, ASA x 6m post surgery
Blepharitis - ✔✔✔-- acute or chronic bacterial (staph) inflammation of eyelash follicle or
sebaceous gland of eyelid. bilateral usually
-flaky, scaly debris over eyelid margin when awakening
- tx: warm compress, scrub with weak shampoo, sometimes bacitracin or erythromycin,
-no contacts during tx
C. diff - ✔✔✔-- unknown incubation, duration: after several weeks of ATB
- Sx: explosive diarrhea, bloody stools, abd pain, fever, n/v
- acquired from the environment or oral-fecal route
-Test: stool culture, enzyme immunoassay for toxin a or a and B
- Tx: d/c ATB (esp. clinda, ampa, or cephalosporins), fluid & lyte replacement. ** If ATB still
needed, treat with oral Metronidadole or Vanco for 7-10 days, probiotic
Cafe au lait spots - ✔✔✔-- First sign of Neurofibromatosis
-Tan to brown macules found anywhere on skin.
Celiac Disease - ✔✔✔-- Gluten-sensitivity. Immune mediated systemic disorder
- Frequently occurs with other autoimmune diseases (DM 1, liver disease, IgA nephropathy,
juvenile chronic arthritis)
-Risk: immigration from another country, born by c-section, 6m-2years, female,
- Sx: Chronic or intermittent diarrhea, persistent or unexplained Gi symptoms, wt loss,
prolonged fatigue, growth failure, steatorrhea, low trauma fractures, dental enamel defects
- Test: serologic testing, IgA tTGA and IGA EMA (more expensive and less accurate in <2yo). No
home blood testing. Endoscopy & biopsy for definitive dx.
-Tx: strict GFD (<10mg gluten)
, NR 602 Mid-term Complete Exam with Questions and Answers – 100% Solved
chalazion - ✔✔✔--chronic sterile inflammation of eyelid from a lipogranuloma of the
meibomian gland
- initially, mild redness & swelling, then after a few days, a slow-growing, round, nonpigmented
PAINLESS mass remains.
- Acute tx: hot compress, refer to eye MD
Conjunctivitis - ✔✔✔--most common peds infection, yellow-green purulent discharge, matted
eyes when waking, itching
-bacterial (unilateral), viral (bilateral)
- usually self-limiting, but may treat with atbx
- tx: sodium sulfacetamide or tmp+polymycin B, or erythromycin, azith (>12m), -floxacins
(>12m). no -mycins)
-newborn: chlamydia trach. (erythromycin PO), gonorrhea (ceftriaxone IM/IV). DFA conjunctival
test
-
Contraceptives - ✔✔✔-- OCP do not increase risk of breast CA (decr. cervical CA)
- No IUD restrictions based on age, parity, STDs, ectopic pregnancy or hx of PID.
- combined oral contraceptives should be avoided in people with migraines WITH aura.
- all contraceptives safe with epilepsy. but some anticonvulsants like topiramate can decrease
the contraceptives efficacy.
- Implant: suppresses ovulation,. thicken cervical mucus,good for teens. progestin only. most
effective BC. no pelvic exam required, relief of dysmenorrhea
- IUD: pts don't need to check their strings. woman will still ovulate
- Depo: progestin only. Q 3 months. suppresses ovulation, thins lining of endometrium. need
pregnancy test. repeat injection can be given 2 weeks late without additional contraceptive
protection or preg. test. menstrual suppression/irregular bleeding. wt gain. may affect bone
density that is reverse when discontinued.
