NR602 FINAL EXAM PEDS 75 QUESTIONS AND
ANSWERS 2024.
Step 1 Asthma approach-Intermittent - ANSWER 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 - ANSWER 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 - ANSWER 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 - ANSWER continual symptoms
requires SABA multiple x a day
extremely limited activity
nighttime symptoms 7x a week
FEV <60%
Tx of asthma - ANSWER 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 - ANSWER
Bulbar/palpebral conjunctival infection - ANSWER May be unilateral or bilateral
, Leukocoria - ANSWER 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 - ANSWER At least once between ages 3-5 y/o
according to USPSTF
AOM - ANSWER RF: genetics, males, Native American, siblings, low economic
status, ages 6mo-3y, winter, supine bottle feeding, daycare, tobacco smoke
S/S of AOM - ANSWER erythema, otalgia, bulging TM, absent cone of light
Dx of AOM - ANSWER Audiometry, tympanometry, possible lateral neck xray to r/o
mass
TX of AOM - ANSWER 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 - ANSWER Preceded by URI-typically worsens after 5-7
days- not resolved in 2 weeks
Sx of bacterial rhinosinusitis - ANSWER Purulant nasal congestion, drainage, facial
pain, headache, fever
No imaging required- if no improvement refer to ENT
Bronchiolitis - ANSWER Usually caused by RSV
wheezing present
<2 y/o
other causes; influenza, adenovirus, rhinovirus
S/s of bronchiolitis - ANSWER Increased work of breathing, prolonged expiration,
grunting, retractions, nasal flaring
Croup sx - ANSWER Low grade fever, URI symptoms, barking cough, inspiratory
stridor can occur
Croup dx - ANSWER Made from symptoms
Croup tx - ANSWER Glucocorticoids possibly
0.6mg/kg-1mg/kg
humidified air
bronchodilators
Lead poisoning - ANSWER Inactivated heme synthesis by inhibiting insertion of
iron-leads to microcytic hypochromic anemia
Source of lead poisoning - ANSWER Lead based pain
ANSWERS 2024.
Step 1 Asthma approach-Intermittent - ANSWER 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 - ANSWER 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 - ANSWER 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 - ANSWER continual symptoms
requires SABA multiple x a day
extremely limited activity
nighttime symptoms 7x a week
FEV <60%
Tx of asthma - ANSWER 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 - ANSWER
Bulbar/palpebral conjunctival infection - ANSWER May be unilateral or bilateral
, Leukocoria - ANSWER 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 - ANSWER At least once between ages 3-5 y/o
according to USPSTF
AOM - ANSWER RF: genetics, males, Native American, siblings, low economic
status, ages 6mo-3y, winter, supine bottle feeding, daycare, tobacco smoke
S/S of AOM - ANSWER erythema, otalgia, bulging TM, absent cone of light
Dx of AOM - ANSWER Audiometry, tympanometry, possible lateral neck xray to r/o
mass
TX of AOM - ANSWER 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 - ANSWER Preceded by URI-typically worsens after 5-7
days- not resolved in 2 weeks
Sx of bacterial rhinosinusitis - ANSWER Purulant nasal congestion, drainage, facial
pain, headache, fever
No imaging required- if no improvement refer to ENT
Bronchiolitis - ANSWER Usually caused by RSV
wheezing present
<2 y/o
other causes; influenza, adenovirus, rhinovirus
S/s of bronchiolitis - ANSWER Increased work of breathing, prolonged expiration,
grunting, retractions, nasal flaring
Croup sx - ANSWER Low grade fever, URI symptoms, barking cough, inspiratory
stridor can occur
Croup dx - ANSWER Made from symptoms
Croup tx - ANSWER Glucocorticoids possibly
0.6mg/kg-1mg/kg
humidified air
bronchodilators
Lead poisoning - ANSWER Inactivated heme synthesis by inhibiting insertion of
iron-leads to microcytic hypochromic anemia
Source of lead poisoning - ANSWER Lead based pain
