NUNP 6551 ORIGINAL FINAL EXAM GENUINE
EXAM WITH ANSWERS
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
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
Epiglottitis prevention - ANSWER: Haemophilus influenzae type B (Hib) vaccine
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
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
Antibiotics for bronchiolitis? - ANSWER: Use of saline drops and suctioning of the
nares. There is no evidence to support the routine use of antibiotics
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
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.
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.
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
Step 2 Asthma management for children 0-4 years old - ANSWER: Step 2: Consider
consultation with asthma specialist. Low dose of inhaled corticosteroids.
Step 3 asthma mgmt for children 0-4 yrs - ANSWER: Step 3: Medium-dose of inhaled
corticosteroids
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
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.
Differentials for patient with sore throat - ANSWER: Strep pharyngitis
, Peritonsillar abscess
Viral pharyngitis
Infectious mononucleosis
Epiglottitis
small-for-gestational-age infants: which type of chromosomal analysis should be
included? - ANSWER: Trisomy 18
Holt-Olram
Trisomy 13
Turner Syndrome
Trisomy 21
Prader-Willi Syndrome
heart defects associated with Down syndrome - ANSWER: Atrioventricular Septal
Defect
Ventricular Septal Defect
Persistant Ductus Arteriosus
Tetrology of Fallot
Contact sports with Down's Syndrome - ANSWER: Do not recommend due to
atlantoaxial instability
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
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
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
EXAM WITH ANSWERS
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
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
Epiglottitis prevention - ANSWER: Haemophilus influenzae type B (Hib) vaccine
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
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
Antibiotics for bronchiolitis? - ANSWER: Use of saline drops and suctioning of the
nares. There is no evidence to support the routine use of antibiotics
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
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.
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.
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
Step 2 Asthma management for children 0-4 years old - ANSWER: Step 2: Consider
consultation with asthma specialist. Low dose of inhaled corticosteroids.
Step 3 asthma mgmt for children 0-4 yrs - ANSWER: Step 3: Medium-dose of inhaled
corticosteroids
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
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.
Differentials for patient with sore throat - ANSWER: Strep pharyngitis
, Peritonsillar abscess
Viral pharyngitis
Infectious mononucleosis
Epiglottitis
small-for-gestational-age infants: which type of chromosomal analysis should be
included? - ANSWER: Trisomy 18
Holt-Olram
Trisomy 13
Turner Syndrome
Trisomy 21
Prader-Willi Syndrome
heart defects associated with Down syndrome - ANSWER: Atrioventricular Septal
Defect
Ventricular Septal Defect
Persistant Ductus Arteriosus
Tetrology of Fallot
Contact sports with Down's Syndrome - ANSWER: Do not recommend due to
atlantoaxial instability
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
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
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
