Step 1 Asthma approach-Intermittent: 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
2. Step 2 Asthma Approach-Mild persistent: Sy...
1. Step 1 Asthma approach-Intermittent: 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
2. Step 2 Asthma Approach-Mild persistent: 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
3. Step 3 Asthma Approach-Moderate Persistant: 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%
4. Step 4 Asthma Approach-Severe Persistent: continual symptoms
requires SABA multiple x a day
extremely limited activity
nighttime symptoms 7x a week
FEV <60%
5. Tx of asthma: 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
6. Step 6 Asthma Approach:
7. Bulbar/palpebral conjunctival infection: May be unilateral or bilateral
8. Leukocoria: abnormal appearance of a white film in the pupil; immediate refer-
ral to pediatric ophthalmologist warranted
Causes: retinal detachment, cataract, retinal dysplasia, newborn retinoblastoma
, NR 602 Final exam
9. Visual screening in children: At least once between ages 3-5 y/o according to
USPSTF
10. AOM: RF: genetics, males, Native American, siblings, low economic status,
ages 6mo-3y, winter, supine bottle feeding, daycare, tobacco smoke
11. S/S of AOM: erythema, otalgia, bulging TM, absent cone of light
12. Dx of AOM: Audiometry, tympanometry, possible lateral neck xray to r/o mass
13. TX of AOM: 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
14. Bacterial rhinosinusitis: Preceded by URI-typically worsens after 5-7 days-
not resolved in 2 weeks
15. Sx of bacterial rhinosinusitis: Purulant nasal congestion, drainage, facial
pain, headache, fever
No imaging required- if no improvement refer to ENT
16. Bronchiolitis: Usually caused by RSV
wheezing present
<2 y/o
other causes; influenza, adenovirus, rhinovirus
17. S/s of bronchiolitis: Increased work of breathing, prolonged expiration, grunt-
ing, retractions, nasal flaring
18. Croup sx: Low grade fever, URI symptoms, barking cough, inspiratory stridor
can occur
19. Croup dx: Made from symptoms
20. Croup tx: Glucocorticoids possibly
0.6mg/kg-1mg/kg
humidified air
bronchodilators
21. Lead poisoning: Inactivated heme synthesis by inhibiting insertion of
iron-leads to microcytic hypochromic anemia
22. Source of lead poisoning: Lead based pain
23. Those at risk for lead poisoning: Children 2-3 y/o
summer months
, NR 602 Final exam
24. Lead poisoning testing: Children with Medicaid need lead level @ 12 months
and 24 months-capillary finger stick with venous sample as f/u
AAP recommends 6-9-12-18-24 mo as well as 3-4-5-6 y/o
25. Lead levels: <5 is normal
>69 requires chelation
26. Genu varum: Bow legged as a result of uterine position- normal finding up to
3y/o
27. Legg-Calve-Perthes Disease: Avascular necrosis of femoral head- epiphyses
associated with trauma, synovitis
28. Legg-Calve-Perthes Disease RF: Associated with low birth weight, socioeco-
nomic status, or white race
29. Legg-Calve-Perthes Disease s/s: Onset of painful limp of thigh, knee, or hip
worse with activity, not relieved by rest
restricted by abduction and rotation of affected hip
30. Legg-Calve-Perthes Disease Tx: Abduction brace or long leg cast
31. Congenital Hip Dysplasia s/s: Thick fold asymmetry, leg length inequality,
walking children- painless limp
32. Congenital Hip Dysplasia Dx & Tx: Positive Barlow maneuver, ortolani or Allis
sign
US for <4 months, X-ray AP of pelvis >4 months
Tx: refer to orthopedist, pavlik harness, child should be seen weekly to prevent skin
breakdown, necrosis
33. Toxic trait synovitis: Unilateral inflammation arthritis; acute onset; decreased
ROM extension and internal rotation; painful hip, crying at night; common in boy
3-6 y/o
34. Toxic trait synovitis Dx and Tx: Dx: WBC with leukocytosis, increased ESR,
hip xray normal
To: BR, NSAIDs, non WB
35. Impetigo: Superficial layers of the skin
Nonbullous or bullous
nonbullous= honey-colored crusts on lesions
caused by group A streptococcus, S.aerous or MRSA
occurs more in summer months, low socioeconomic class
36. Impetigo exam: Lesions on hand, face, neck, extremities or perineium; region-
al lymphadenopathy
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