NURS 6541 Final Exam Review
1) 7 month old RSV recommended treatment
a. Supportive treatment; hydration, oxygen
2) Epiglottitis – what decreases the incidence of it?
a. Caused by HIB. Drooling, insp& exp stridor, high fever, aphonia (muffled
voice), shore throat, flaring nares, retractions, tripod position while sitting,
extended neck as to make breathing easier
b. Thumb sign- on lateral neck x-ray, epiglottis are looks like a thumb (google
images has examples)
c. Do not examine the throat
d. Treatment: To surgery for exam w/otolaryngologist to establish airway,
antibiotics, and can be follow by pulmonary edema so watch for that.
e. 25% of cases are less than 1 year old. Otherwise common in 2 – 5 year olds.
f. All household contacts get rifampin if there are unimmunized people that live
there.
g. VACCINES PREVENT THIS
3) Antibiotics or not?
a. Asthma – No
b. Epiglottitis – Yes
c. Croup – No
d. Bronchiolitis – No
e. Foreign body aspiration – No. Only if secondary pneumonia develops.
4) 12 year old female with fever & sore throat – possible differentials
a. Strep, mono, apthous ulcers, peritonsillar abcess, epiglottitis, steven Johnson
syndrome, measles
5) SGA infant – which type of chromosomal analysis?
a. Testing would be chorionic villi sampling, amniocentesis, or fetal free DNA.
1
, b. Lots of detail in this answer, but we will likely need it later. Trisomy 18,
Edwards syndrome. These kids are small, don’t typically live past one year with
lots of issues. Didn’t look up much on this. Wasn’t in the book.
c. Trisomy 13 – Patau Sundrome – 1 in 5,000. Microcephaly, with midline defects
such as cyclopia, cleft lip, cleft palate.Sloping forehead, small easr, anopthalmia
or micropthalmia, micrognathia, and pre-auricular tags. VSD, ASD, TOF and
more hear defects. To test for this one, 17 week ultrasound is the best time to look
for it.
d. Turner syndrome – Short webbed neck, low hairline, posteriorly rotated ears,
ptosis, short legs and 4th& 5th metacarpals, family is generally short in stature, hip
dysplasia, hearing loss. Bicuspid aortic valve, CoA (35%), pulmonic stenosis.
e. Holt-Oram Syndrome – “Heart Hand Syndrome” – Upper limb abnormailities,
such as thumb, thenar and redial bone anomalies. Congenital heart lesions such
as ASD, VSD, and/or conduction issues. Can occur spontaneously but is
autosomal dominant. I have a feeling we are gonna have a question with a weird
arm x-ray and this will be the answer.
6) 15 day old with Down syndrome, which cardiac disorders?
a. AV septal defect, VSD, ASD, PDA, TOF (50%).
7) Basic info about Down syndrome.
a. 50% have one of the cardiac issues in #6 answer. Echo is done in the first few
weeks of life to rule it out. Prone to hirschprungs, imperforate anus, stenosis &
bowel atresia, 10 times for likely to get leukemia, hypotonia in babies, 50-70%
develop early onset alzheimers/dementia by age 60.
b. Can be diagnosed by ultrasound at 14-24 weeks
i. Nuchal fold thickness, amneiocentesis, & chorionic villi sampling.
8) Down syndrome and participating in sports
a. 40% of them have instability at C1 & C2 (atlantoaxial instability).
b. 61% have occipital hypermobility.
c. Trauma would result in subluxation and spinal cord compression.
9) Basic info about:
2
, a. Fragile X – Long narrow face, high arched dental palate, dental crowding,
prominent ears in teen years, short stature. Strabismus, recurrent OM, seizures,
Macrochidism after puberty, joint hyperlaxity, OSA, increased risk for obesity,
intellectual disability, language delays, autism, behavior problems, steropathies
(hand flapping). As an infant, poor growth, GER, feeding problems, diarrhea.
b. Kleinfelters (XXY) – Tall with long arms, dental decay, small penis,
gynecomastia, skin striae, delayed puberty, autoimmune disorders, scoliosis,
prone to malignancies (even male breast CA), shy/withdrawn, ADHD, immature
for age. Cardiac - prone to PDA & ASD.
c. Turner Syndrome – See question #5.
d. XXX – “triple x syndrome” – 1 in 1,000 women. Early growth, longer legs.
Problems with auditory disorders, language development, and trouble having
stable relationships. Psych disorders. Often goes undiagnosed over all or until
adulthood.
10) Diet of cystic fibrosis patients
a. Tough finding this answer. This is what I found.
b. Soy formula is bad for babies (causes increased FTT)
c. Lipase supplements and vitamin A, D, E & K are necessary. Monitor weight and
adjust plan accordingly.
d. High energy diets as they require more energy to function than a person without
CF
11) 6 week old boy: (not a ton of info on this. You guys are on your own if you want to read
more.)
a. RSV – can cause apnea
b. Rhinovirus – a cold
c. streptococcus pneumonia – Super rare in this age group
d. listeria – Diarrhea and GI upset
e. chlamydia trachomatis – Consider this as the diagnosis if symptomatic and there
was no prenatal care as it usually comes from Mom during delivery.
3
1) 7 month old RSV recommended treatment
a. Supportive treatment; hydration, oxygen
2) Epiglottitis – what decreases the incidence of it?
a. Caused by HIB. Drooling, insp& exp stridor, high fever, aphonia (muffled
voice), shore throat, flaring nares, retractions, tripod position while sitting,
extended neck as to make breathing easier
b. Thumb sign- on lateral neck x-ray, epiglottis are looks like a thumb (google
images has examples)
c. Do not examine the throat
d. Treatment: To surgery for exam w/otolaryngologist to establish airway,
antibiotics, and can be follow by pulmonary edema so watch for that.
e. 25% of cases are less than 1 year old. Otherwise common in 2 – 5 year olds.
f. All household contacts get rifampin if there are unimmunized people that live
there.
g. VACCINES PREVENT THIS
3) Antibiotics or not?
a. Asthma – No
b. Epiglottitis – Yes
c. Croup – No
d. Bronchiolitis – No
e. Foreign body aspiration – No. Only if secondary pneumonia develops.
4) 12 year old female with fever & sore throat – possible differentials
a. Strep, mono, apthous ulcers, peritonsillar abcess, epiglottitis, steven Johnson
syndrome, measles
5) SGA infant – which type of chromosomal analysis?
a. Testing would be chorionic villi sampling, amniocentesis, or fetal free DNA.
1
, b. Lots of detail in this answer, but we will likely need it later. Trisomy 18,
Edwards syndrome. These kids are small, don’t typically live past one year with
lots of issues. Didn’t look up much on this. Wasn’t in the book.
c. Trisomy 13 – Patau Sundrome – 1 in 5,000. Microcephaly, with midline defects
such as cyclopia, cleft lip, cleft palate.Sloping forehead, small easr, anopthalmia
or micropthalmia, micrognathia, and pre-auricular tags. VSD, ASD, TOF and
more hear defects. To test for this one, 17 week ultrasound is the best time to look
for it.
d. Turner syndrome – Short webbed neck, low hairline, posteriorly rotated ears,
ptosis, short legs and 4th& 5th metacarpals, family is generally short in stature, hip
dysplasia, hearing loss. Bicuspid aortic valve, CoA (35%), pulmonic stenosis.
e. Holt-Oram Syndrome – “Heart Hand Syndrome” – Upper limb abnormailities,
such as thumb, thenar and redial bone anomalies. Congenital heart lesions such
as ASD, VSD, and/or conduction issues. Can occur spontaneously but is
autosomal dominant. I have a feeling we are gonna have a question with a weird
arm x-ray and this will be the answer.
6) 15 day old with Down syndrome, which cardiac disorders?
a. AV septal defect, VSD, ASD, PDA, TOF (50%).
7) Basic info about Down syndrome.
a. 50% have one of the cardiac issues in #6 answer. Echo is done in the first few
weeks of life to rule it out. Prone to hirschprungs, imperforate anus, stenosis &
bowel atresia, 10 times for likely to get leukemia, hypotonia in babies, 50-70%
develop early onset alzheimers/dementia by age 60.
b. Can be diagnosed by ultrasound at 14-24 weeks
i. Nuchal fold thickness, amneiocentesis, & chorionic villi sampling.
8) Down syndrome and participating in sports
a. 40% of them have instability at C1 & C2 (atlantoaxial instability).
b. 61% have occipital hypermobility.
c. Trauma would result in subluxation and spinal cord compression.
9) Basic info about:
2
, a. Fragile X – Long narrow face, high arched dental palate, dental crowding,
prominent ears in teen years, short stature. Strabismus, recurrent OM, seizures,
Macrochidism after puberty, joint hyperlaxity, OSA, increased risk for obesity,
intellectual disability, language delays, autism, behavior problems, steropathies
(hand flapping). As an infant, poor growth, GER, feeding problems, diarrhea.
b. Kleinfelters (XXY) – Tall with long arms, dental decay, small penis,
gynecomastia, skin striae, delayed puberty, autoimmune disorders, scoliosis,
prone to malignancies (even male breast CA), shy/withdrawn, ADHD, immature
for age. Cardiac - prone to PDA & ASD.
c. Turner Syndrome – See question #5.
d. XXX – “triple x syndrome” – 1 in 1,000 women. Early growth, longer legs.
Problems with auditory disorders, language development, and trouble having
stable relationships. Psych disorders. Often goes undiagnosed over all or until
adulthood.
10) Diet of cystic fibrosis patients
a. Tough finding this answer. This is what I found.
b. Soy formula is bad for babies (causes increased FTT)
c. Lipase supplements and vitamin A, D, E & K are necessary. Monitor weight and
adjust plan accordingly.
d. High energy diets as they require more energy to function than a person without
CF
11) 6 week old boy: (not a ton of info on this. You guys are on your own if you want to read
more.)
a. RSV – can cause apnea
b. Rhinovirus – a cold
c. streptococcus pneumonia – Super rare in this age group
d. listeria – Diarrhea and GI upset
e. chlamydia trachomatis – Consider this as the diagnosis if symptomatic and there
was no prenatal care as it usually comes from Mom during delivery.
3
