FNP: Primary Care Exam 1 Questions And Answers|
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What does acute otitis media present like? - CORRECT ANSWER -Ear pain, irritability, fever,
younger children may pull at their ear; may have URI s/s (cough, nasal congestion, chest
congestion); TM may be bulging, dull, retracted; mobility may be decreased; erythema within
the inner ear and canal
What is the first line treatment for acute otits media in children? - CORRECT ANSWER -First line
antibiotic is amoxicillin, 80-90mg/kg/day, usually in 2 divided doses per day; recommended
duration of therapy is 10 days, but a course of 5-7 days may be considered for uncomplicated or
isolated cases is children > 2 years old; Azithromycin may be used for those allergic to PCNs;
Second line antibiotic is Augmentin
Ibuprofen vs Tylenol for pediatrics: age? indication? - CORRECT ANSWER -At 6 months, children
can have Ibuprofen - ibuprofen is indicated for fever 102.5 or greater - for children 6 months to
12 years give 5mg/kg/dose for fevers <102.5, for fevers > 102.5 give 10mg/kg/dose every 6-8
hours (max dose is 40mg/kg/day); OTC pediatric labeling for ibuprofen is 7.5mg/kg/dose every
6-8 hours, for children 6 months - 11 years; Tylenol can be given at 0-3 months for 6-11lbs or
2.7-5.3kg at a dose of 40mg, every 4-6 hours
2. What is the treatment of choice for bacterial pneumonia in pediatric patients (know dose as
well)? - CORRECT ANSWER -5 months to 5 years old: Amoxicillin 80-100mg/kg/day either
divided TID or BID
3. What would be a diagnostic evaluation for a child with abnormal breath sounds? - CORRECT
ANSWER -Pulse oximetry, spirometry (FEV1, FVC, peak flow), vital signs (HR, RR, BP,
temperature); consider CXR or CT thorax depending on H&P; also consider CBC with differential,
CMP, ABGs if clinically indicated
4. How do you treat an infant with a UTI? - CORRECT ANSWER -Neonates and most infants are
admitted to the hospital for UTIs;
, Common pathogens: E. coli, Klebsiella spp., enterococcus, proteus mirabilis; 10% of
infants/babies with have a negative urine dipstick so a urine culture must be obtained;
treatment of choice for neonates: IV Ampicillin and gentamycin or 3rd generation
cephalosporin, such as ceftriaxone until clinically improved; oral treatment is 10-14 days; lower
tract infection is treated orally with amoxicillin or Bactrim (for infants over 2 months),
cephalexin, Augmentin for 5-7 days
Repeat urine culture if fever >3 days, not improving; obtain another UA and culture for
subsequent febrile illnesses
5. What would be criteria for admitting vs. not admitting a young child with a fever? - CORRECT
ANSWER -Signs patient should be admitted: lethargy, poor perfusion, cyanosis, hypo or hyper-
ventilation (toxic appearance); signs of bacteriemia: petechial or purpuric rashes (purpura:
associated more often with meningococcemia than in the presence of petechiae alone); nuchal
rigidity may not be seen in infants (unlike kids/teens) with bacterial meningitis;
Signs of serious bacterial illness in children 3 months to 3 years - CORRECT ANSWER -ill
appearance, fever with vomiting, tachypnea with retractions, and delayed capillary refill;
Signs of serious illness in children older than 1 month - CORRECT ANSWER -parental concerns,
physician instincts, changes in crying patterns, shrill high-pitched cry, drowsiness,
inconsolability, moaning, crackles, cyanosis, decreased breath sounds, poor peripheral
circulation, rapid breathing, SOB, decreased skin elasticity, hypotension, meningeal irritation,
petechial rash, seizures, unconsciousness;
what are the Basic red flags that may warrant admission (peds) - CORRECT ANSWER -parental
concerns, physician instinct, changes in crying pattern, drowsiness, inconsolability, moaning,
crackles, cyanosis, decreased breath sounds, poor peripheral circulation, rapid breathing, SOB,
decreased skin elasticity, hypotension, meningeal irritation, petechial rash, seizures,
unconsciousness; Other criteria to admit (FUO): Very ill, concern for Munchausen's by proxy,
FTT, very young, follow up unreliable
6. What are some common lab values indicative of a bacterial infection? - CORRECT ANSWER -
UA (bacteria more than 10,000 or positive leukocytes or nitrites), WBC more than 15,000
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What does acute otitis media present like? - CORRECT ANSWER -Ear pain, irritability, fever,
younger children may pull at their ear; may have URI s/s (cough, nasal congestion, chest
congestion); TM may be bulging, dull, retracted; mobility may be decreased; erythema within
the inner ear and canal
What is the first line treatment for acute otits media in children? - CORRECT ANSWER -First line
antibiotic is amoxicillin, 80-90mg/kg/day, usually in 2 divided doses per day; recommended
duration of therapy is 10 days, but a course of 5-7 days may be considered for uncomplicated or
isolated cases is children > 2 years old; Azithromycin may be used for those allergic to PCNs;
Second line antibiotic is Augmentin
Ibuprofen vs Tylenol for pediatrics: age? indication? - CORRECT ANSWER -At 6 months, children
can have Ibuprofen - ibuprofen is indicated for fever 102.5 or greater - for children 6 months to
12 years give 5mg/kg/dose for fevers <102.5, for fevers > 102.5 give 10mg/kg/dose every 6-8
hours (max dose is 40mg/kg/day); OTC pediatric labeling for ibuprofen is 7.5mg/kg/dose every
6-8 hours, for children 6 months - 11 years; Tylenol can be given at 0-3 months for 6-11lbs or
2.7-5.3kg at a dose of 40mg, every 4-6 hours
2. What is the treatment of choice for bacterial pneumonia in pediatric patients (know dose as
well)? - CORRECT ANSWER -5 months to 5 years old: Amoxicillin 80-100mg/kg/day either
divided TID or BID
3. What would be a diagnostic evaluation for a child with abnormal breath sounds? - CORRECT
ANSWER -Pulse oximetry, spirometry (FEV1, FVC, peak flow), vital signs (HR, RR, BP,
temperature); consider CXR or CT thorax depending on H&P; also consider CBC with differential,
CMP, ABGs if clinically indicated
4. How do you treat an infant with a UTI? - CORRECT ANSWER -Neonates and most infants are
admitted to the hospital for UTIs;
, Common pathogens: E. coli, Klebsiella spp., enterococcus, proteus mirabilis; 10% of
infants/babies with have a negative urine dipstick so a urine culture must be obtained;
treatment of choice for neonates: IV Ampicillin and gentamycin or 3rd generation
cephalosporin, such as ceftriaxone until clinically improved; oral treatment is 10-14 days; lower
tract infection is treated orally with amoxicillin or Bactrim (for infants over 2 months),
cephalexin, Augmentin for 5-7 days
Repeat urine culture if fever >3 days, not improving; obtain another UA and culture for
subsequent febrile illnesses
5. What would be criteria for admitting vs. not admitting a young child with a fever? - CORRECT
ANSWER -Signs patient should be admitted: lethargy, poor perfusion, cyanosis, hypo or hyper-
ventilation (toxic appearance); signs of bacteriemia: petechial or purpuric rashes (purpura:
associated more often with meningococcemia than in the presence of petechiae alone); nuchal
rigidity may not be seen in infants (unlike kids/teens) with bacterial meningitis;
Signs of serious bacterial illness in children 3 months to 3 years - CORRECT ANSWER -ill
appearance, fever with vomiting, tachypnea with retractions, and delayed capillary refill;
Signs of serious illness in children older than 1 month - CORRECT ANSWER -parental concerns,
physician instincts, changes in crying patterns, shrill high-pitched cry, drowsiness,
inconsolability, moaning, crackles, cyanosis, decreased breath sounds, poor peripheral
circulation, rapid breathing, SOB, decreased skin elasticity, hypotension, meningeal irritation,
petechial rash, seizures, unconsciousness;
what are the Basic red flags that may warrant admission (peds) - CORRECT ANSWER -parental
concerns, physician instinct, changes in crying pattern, drowsiness, inconsolability, moaning,
crackles, cyanosis, decreased breath sounds, poor peripheral circulation, rapid breathing, SOB,
decreased skin elasticity, hypotension, meningeal irritation, petechial rash, seizures,
unconsciousness; Other criteria to admit (FUO): Very ill, concern for Munchausen's by proxy,
FTT, very young, follow up unreliable
6. What are some common lab values indicative of a bacterial infection? - CORRECT ANSWER -
UA (bacteria more than 10,000 or positive leukocytes or nitrites), WBC more than 15,000
