NUNP 6541 Pediatric Final
Exam-Walden U
,Recommended treatment for RSV in a 7 month old (outpatient) - CORRECT
ANSWERS-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 - CORRECT ANSWERS-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 - CORRECT ANSWERS-Haemophilus influenzae type B (Hib)
vaccine
Steeple sign - CORRECT ANSWERS-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? - CORRECT ANSWERS-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? - CORRECT ANSWERS-Use of saline drops and suctioning
of the nares. There is no evidence to support the routine use of antibiotics
Antibiotics for croup? - CORRECT ANSWERS-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? - CORRECT ANSWERS-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 - CORRECT ANSWERS-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 - CORRECT ANSWERS-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 - CORRECT ANSWERS-Step 2:
Consider consultation with asthma specialist. Low dose of inhaled corticosteroids.
Step 3 asthma mgmt for children 0-4 yrs - CORRECT ANSWERS-Step 3: Medium-dose
of inhaled corticosteroids
Steps 4-6 asthma mgmt for children 0-4 yrs - CORRECT ANSWERS-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 - CORRECT ANSWERS-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 - CORRECT ANSWERS-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 - CORRECT ANSWERS-Strep pharyngitis
Peritonsillar abscess
Viral pharyngitis
Exam-Walden U
,Recommended treatment for RSV in a 7 month old (outpatient) - CORRECT
ANSWERS-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 - CORRECT ANSWERS-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 - CORRECT ANSWERS-Haemophilus influenzae type B (Hib)
vaccine
Steeple sign - CORRECT ANSWERS-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? - CORRECT ANSWERS-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? - CORRECT ANSWERS-Use of saline drops and suctioning
of the nares. There is no evidence to support the routine use of antibiotics
Antibiotics for croup? - CORRECT ANSWERS-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? - CORRECT ANSWERS-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 - CORRECT ANSWERS-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 - CORRECT ANSWERS-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 - CORRECT ANSWERS-Step 2:
Consider consultation with asthma specialist. Low dose of inhaled corticosteroids.
Step 3 asthma mgmt for children 0-4 yrs - CORRECT ANSWERS-Step 3: Medium-dose
of inhaled corticosteroids
Steps 4-6 asthma mgmt for children 0-4 yrs - CORRECT ANSWERS-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 - CORRECT ANSWERS-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 - CORRECT ANSWERS-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 - CORRECT ANSWERS-Strep pharyngitis
Peritonsillar abscess
Viral pharyngitis
