2024 NU665 EXAM 2 WITH
CORRECT ANSWERS
Predicting height for male and female - CORRECT-ANSWERS-Deviation can
be the first sign of an endocrine disorder
-Need to assess pattern of growth and current growth velocity
-Growth potential is based in large part on genetic potential and may change
with altered nutritional status and illness patterns
-Target height for boys - (mothers height plus 5 inches) + (fathers height)/2
-Target height for girls - (father's height - 5 inches) + (mother's height)/2
Testicular torsion - CORRECT-ANSWERS-Torsion of the spermatic cord; can
result in gangrene of testes
-Acute, painful swelling of scrotum, nausea, anorexia, vomiting, minimal
fever, if any, lack of urinary symptoms is the norm; enlarged, high tender
testis, scrotum enlarged on involved side, warm, erythematous, anxious
patient, resistant to movement, lifting testis does not relieve pain (Prehn's
sign), solid mass may be visualized with transillumination
-Immediate referral for surgery - performed within 6 hours to preserve
fertility and prevent atrophy and abscess
Incarcerated hernia - CORRECT-ANSWERS-Pain, irritability, erythema,
vomiting, and abdominal distention, tenderness, crying, nausea
-Surgical emergency
-Bowel ischemia is of immediate concern and testicular injury occurs from
torsion as a result of the direct pressure of the incarcerated hernia or as a
result of ischemia from cord compression
Phimosis and paraphimosis - CORRECT-ANSWERS-Phimosis - narrow,
nonretractile foreskin of childhood; not fully retractable to expose glans;
*normal in an uncircumcised male (primary phimosis)
-Paraphimosis - inability to replace foreskin over glans after retraction
-May be asymptomatic, painful urination, weak urine stream,
pain/tenderness with paraphimosis, ballooning of the foreskin when
urinating, may be normal if voiding uncompromised
-Phimosis - unretractable foreskin; paraphimosis - edema/discoloration of
foreskin and glans
-Management - maintain good hygiene, gentle stretch of foreskin during bath
(do not force, scarring and balanitis may occur), paraphimosis - goal is
reduction of swelling to reduce foreskin - ice, application of sugar to the
,penis, or wrapping distal penis in saline-soaked gauze and applying pressure
for 5-10 minutes
-Surgery - circumcision in phimosis with urinary obstruction; paraphimosis - if
unable to lubricate, compress the glans, and place traction - surgical release
of the constricting band must be done to prevent necrosis of the glans; rule
out sexual abuse
-If red, painful, sore, difficulty urinating - refer or treat with antibiotics
Balanitis and balanoposthitis - CORRECT-ANSWERS-Balanitis - inflammation
of the glans
-Balanoposhitis - an inflammation of the foreskin and glans penis occurring in
uncircumcised males or those with phimosis
-A fussy infant or pain and dysuria in an older child; edema and inflammation
are noted on the foreskin and glans
-Management - oral and topical antibiotics as directed by the cultures, along
with warm bathtub soaks; topical steroids if there is swelling
-Avoid forcible foreskin retraction
-Proper hygiene and removal of irritants
Eosinophilic esophagitis - CORRECT-ANSWERS-An emerging disease related
to food ingestion
-Isolated inflammation of the esophagus by a specific WBC, the eosinophil
-May present with feeding refusal or FTT in young children; recurrent
vomiting and abdominal pain in school-age children; older children may have
dysphagia, choking, and food impaction
-Diagnosis - upper endoscopy and biopsy
-Management - improvement in histology and quality of life, reduction in
clinical symptoms, and prevention of complications or long-term sequelae
-Dietary modification and pharmacotherapy - using an amino acid based
formula for infants, for older children eliminating milk, soy, egg, wheat, nuts
and fish and a referral to a pediatric allergist
-Also, PPIs and swallowed inhaled corticosteroids (fluticasone) for 12 weeks
Appendicitis - CORRECT-ANSWERS-Inflammation of the appendix that leads
to distention and can result in necrosis, perforation, and peritonitis or
abscess formation
-Presentation - poorly defined pain in the periumbilical area with shifting to
the RLQ which may occur a few hours after and become more intense,
continuous, and localized; nausea and vomiting, anorexia, stool is low
volume with mucus, fever may or may not occur; guarding, rebound
tenderness, pain over McBurney's point, positive psoas or obturator sign
-CBC, amylase, lipase, liver enzymes, US shows enlargement; CT scan more
accurate
-Surgery consult for appendectomy is needed
, Intussusception - CORRECT-ANSWERS-Involves a section of intestine being
pulled antegrade into adjacent intestine with the proximal bowel trapped in
the distal segment
-The most frequent reason for intestinal obstruction in children
-Intermittent colicky abdominal pain, vomiting, and bloody mucous stools;
screaming with drawing up of the legs with periods of calm, sleeping, or
lethargy between episodes
-A sausage like mass may be felt in the RUQ of the abdomen with emptiness
in the RLQ
-Diagnosis - Ultrasound; air contrast enema can be diagnostic and a
treatment
-Emergency management and consultation with a pediatric radiologist and a
pediatric surgeon is recommended; rehydration, radiologic reduction,
surgery if perforation, peritonitis, or shock; IV antibiotics
Hirschsprung disease - CORRECT-ANSWERS-An absence of ganglion cells in
the bowel wall, most often in the rectosigmoid colon; this results in that part
having no motility causing functional obstruction
-Most common cause of neonatal obstruction of the colon
-Failure to pass meconium in the first 48 hours; FTT, poor feeding, chronic
constipation, vomiting, abdominal obstruction, diarrhea, Down syndrome
-Diagnosis - barium enema, anorectal manometry study, abdominal x-ray;
established by rectal suction biopsy which will determine the absence of
ganglion cells
-Surgical resection of the affected bowel, with or without a colostomy
Celiac disease - CORRECT-ANSWERS-Gluten-sensitivity enteropathy, which is
an immune-mediated systemic disorder triggered by dietary exposure to
wheat gluten and related proteins in barley and rye; also oats
-Presentation - chronic or intermittent diarrhea, persistent or unexplained GI
symptoms (n/v), sudden or unexpected weight loss, prolonged fatigue
-All malabsorption syndromes - excessive flatus with abdominal distention,
chronic diarrhea with frequent, large, foul-smelling, pale stools, growth
failure, delayed puberty, voracious appetite or food avoidance, pallor,
dermatologic abnormalities, dizziness
-Diagnosis - Gluten needs to be eaten in more than one meal every day for 6
weeks prior to testing; IgA tTGA) and IgA endomysial antibody; EMA is more
expensive an less accurate; if serum is positive, endoscopy with biopsy;
colonoscopy is not needed if level is greater than 100; tTGA testing every six
months of gluten-free diet and then yearly; bone density testing; follow
growth parameters
-Management - gluten free diet of 10 mg or less of gluten; enzyme therapy is
being explored
-Need protein
CORRECT ANSWERS
Predicting height for male and female - CORRECT-ANSWERS-Deviation can
be the first sign of an endocrine disorder
-Need to assess pattern of growth and current growth velocity
-Growth potential is based in large part on genetic potential and may change
with altered nutritional status and illness patterns
-Target height for boys - (mothers height plus 5 inches) + (fathers height)/2
-Target height for girls - (father's height - 5 inches) + (mother's height)/2
Testicular torsion - CORRECT-ANSWERS-Torsion of the spermatic cord; can
result in gangrene of testes
-Acute, painful swelling of scrotum, nausea, anorexia, vomiting, minimal
fever, if any, lack of urinary symptoms is the norm; enlarged, high tender
testis, scrotum enlarged on involved side, warm, erythematous, anxious
patient, resistant to movement, lifting testis does not relieve pain (Prehn's
sign), solid mass may be visualized with transillumination
-Immediate referral for surgery - performed within 6 hours to preserve
fertility and prevent atrophy and abscess
Incarcerated hernia - CORRECT-ANSWERS-Pain, irritability, erythema,
vomiting, and abdominal distention, tenderness, crying, nausea
-Surgical emergency
-Bowel ischemia is of immediate concern and testicular injury occurs from
torsion as a result of the direct pressure of the incarcerated hernia or as a
result of ischemia from cord compression
Phimosis and paraphimosis - CORRECT-ANSWERS-Phimosis - narrow,
nonretractile foreskin of childhood; not fully retractable to expose glans;
*normal in an uncircumcised male (primary phimosis)
-Paraphimosis - inability to replace foreskin over glans after retraction
-May be asymptomatic, painful urination, weak urine stream,
pain/tenderness with paraphimosis, ballooning of the foreskin when
urinating, may be normal if voiding uncompromised
-Phimosis - unretractable foreskin; paraphimosis - edema/discoloration of
foreskin and glans
-Management - maintain good hygiene, gentle stretch of foreskin during bath
(do not force, scarring and balanitis may occur), paraphimosis - goal is
reduction of swelling to reduce foreskin - ice, application of sugar to the
,penis, or wrapping distal penis in saline-soaked gauze and applying pressure
for 5-10 minutes
-Surgery - circumcision in phimosis with urinary obstruction; paraphimosis - if
unable to lubricate, compress the glans, and place traction - surgical release
of the constricting band must be done to prevent necrosis of the glans; rule
out sexual abuse
-If red, painful, sore, difficulty urinating - refer or treat with antibiotics
Balanitis and balanoposthitis - CORRECT-ANSWERS-Balanitis - inflammation
of the glans
-Balanoposhitis - an inflammation of the foreskin and glans penis occurring in
uncircumcised males or those with phimosis
-A fussy infant or pain and dysuria in an older child; edema and inflammation
are noted on the foreskin and glans
-Management - oral and topical antibiotics as directed by the cultures, along
with warm bathtub soaks; topical steroids if there is swelling
-Avoid forcible foreskin retraction
-Proper hygiene and removal of irritants
Eosinophilic esophagitis - CORRECT-ANSWERS-An emerging disease related
to food ingestion
-Isolated inflammation of the esophagus by a specific WBC, the eosinophil
-May present with feeding refusal or FTT in young children; recurrent
vomiting and abdominal pain in school-age children; older children may have
dysphagia, choking, and food impaction
-Diagnosis - upper endoscopy and biopsy
-Management - improvement in histology and quality of life, reduction in
clinical symptoms, and prevention of complications or long-term sequelae
-Dietary modification and pharmacotherapy - using an amino acid based
formula for infants, for older children eliminating milk, soy, egg, wheat, nuts
and fish and a referral to a pediatric allergist
-Also, PPIs and swallowed inhaled corticosteroids (fluticasone) for 12 weeks
Appendicitis - CORRECT-ANSWERS-Inflammation of the appendix that leads
to distention and can result in necrosis, perforation, and peritonitis or
abscess formation
-Presentation - poorly defined pain in the periumbilical area with shifting to
the RLQ which may occur a few hours after and become more intense,
continuous, and localized; nausea and vomiting, anorexia, stool is low
volume with mucus, fever may or may not occur; guarding, rebound
tenderness, pain over McBurney's point, positive psoas or obturator sign
-CBC, amylase, lipase, liver enzymes, US shows enlargement; CT scan more
accurate
-Surgery consult for appendectomy is needed
, Intussusception - CORRECT-ANSWERS-Involves a section of intestine being
pulled antegrade into adjacent intestine with the proximal bowel trapped in
the distal segment
-The most frequent reason for intestinal obstruction in children
-Intermittent colicky abdominal pain, vomiting, and bloody mucous stools;
screaming with drawing up of the legs with periods of calm, sleeping, or
lethargy between episodes
-A sausage like mass may be felt in the RUQ of the abdomen with emptiness
in the RLQ
-Diagnosis - Ultrasound; air contrast enema can be diagnostic and a
treatment
-Emergency management and consultation with a pediatric radiologist and a
pediatric surgeon is recommended; rehydration, radiologic reduction,
surgery if perforation, peritonitis, or shock; IV antibiotics
Hirschsprung disease - CORRECT-ANSWERS-An absence of ganglion cells in
the bowel wall, most often in the rectosigmoid colon; this results in that part
having no motility causing functional obstruction
-Most common cause of neonatal obstruction of the colon
-Failure to pass meconium in the first 48 hours; FTT, poor feeding, chronic
constipation, vomiting, abdominal obstruction, diarrhea, Down syndrome
-Diagnosis - barium enema, anorectal manometry study, abdominal x-ray;
established by rectal suction biopsy which will determine the absence of
ganglion cells
-Surgical resection of the affected bowel, with or without a colostomy
Celiac disease - CORRECT-ANSWERS-Gluten-sensitivity enteropathy, which is
an immune-mediated systemic disorder triggered by dietary exposure to
wheat gluten and related proteins in barley and rye; also oats
-Presentation - chronic or intermittent diarrhea, persistent or unexplained GI
symptoms (n/v), sudden or unexpected weight loss, prolonged fatigue
-All malabsorption syndromes - excessive flatus with abdominal distention,
chronic diarrhea with frequent, large, foul-smelling, pale stools, growth
failure, delayed puberty, voracious appetite or food avoidance, pallor,
dermatologic abnormalities, dizziness
-Diagnosis - Gluten needs to be eaten in more than one meal every day for 6
weeks prior to testing; IgA tTGA) and IgA endomysial antibody; EMA is more
expensive an less accurate; if serum is positive, endoscopy with biopsy;
colonoscopy is not needed if level is greater than 100; tTGA testing every six
months of gluten-free diet and then yearly; bone density testing; follow
growth parameters
-Management - gluten free diet of 10 mg or less of gluten; enzyme therapy is
being explored
-Need protein
