NUNP 6541 Pediatric Final Exam-Walden
U UPDATED Actual Exam Questions and
CORRECT Answers
Recommended treatment for RSV in a 7 month old (outpatient) - CORRECT 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 - CORRECT 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 - CORRECT ANSWER- ✔✔Haemophilus influenzae type B (Hib)
vaccine
Steeple sign - CORRECT 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? - CORRECT 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? - CORRECT ANSWER- ✔✔Use of saline drops and suctioning
of the nares. There is no evidence to support the routine use of antibiotics
Antibiotics for croup? - CORRECT 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? - CORRECT 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 - CORRECT 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 - CORRECT 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 - CORRECT ANSWER- ✔✔Step 2:
Consider consultation with asthma specialist. Low dose of inhaled corticosteroids.
Step 3 asthma mgmt for children 0-4 yrs - CORRECT ANSWER- ✔✔Step 3: Medium-dose
of inhaled corticosteroids
Steps 4-6 asthma mgmt for children 0-4 yrs - CORRECT 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 - CORRECT 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 - CORRECT 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 - CORRECT ANSWER- ✔✔Strep pharyngitis
Peritonsillar abscess
Viral pharyngitis
Infectious mononucleosis
Epiglottitis
small-for-gestational-age infants: which type of chromosomal analysis should be included? -
CORRECT ANSWER- ✔✔Trisomy 18
Holt-Olram
Trisomy 13
Turner Syndrome
Trisomy 21
Prader-Willi Syndrome
, heart defects associated with Down syndrome - CORRECT ANSWER- ✔✔Atrioventricular
Septal Defect
Ventricular Septal Defect
Persistant Ductus Arteriosus
Tetrology of Fallot
Contact sports with Down's Syndrome - CORRECT ANSWER- ✔✔Do not recommend due
to atlantoaxial instability
Diagnosing Down Syndrome - CORRECT 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) - CORRECT 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 - CORRECT 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 echocardiogram, and an
electrocardiogram. The diagnosis may also be confirmed with genetic testing of the TBX5
gene
Diagnosing Trisomy 13 - CORRECT ANSWER- ✔✔Parents who are at risk to have a
translocation due to their family history can have a blood test called a karyotype, which can
determine if a translocation is present.
U UPDATED Actual Exam Questions and
CORRECT Answers
Recommended treatment for RSV in a 7 month old (outpatient) - CORRECT 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 - CORRECT 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 - CORRECT ANSWER- ✔✔Haemophilus influenzae type B (Hib)
vaccine
Steeple sign - CORRECT 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? - CORRECT 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? - CORRECT ANSWER- ✔✔Use of saline drops and suctioning
of the nares. There is no evidence to support the routine use of antibiotics
Antibiotics for croup? - CORRECT 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? - CORRECT 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 - CORRECT 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 - CORRECT 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 - CORRECT ANSWER- ✔✔Step 2:
Consider consultation with asthma specialist. Low dose of inhaled corticosteroids.
Step 3 asthma mgmt for children 0-4 yrs - CORRECT ANSWER- ✔✔Step 3: Medium-dose
of inhaled corticosteroids
Steps 4-6 asthma mgmt for children 0-4 yrs - CORRECT 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 - CORRECT 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 - CORRECT 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 - CORRECT ANSWER- ✔✔Strep pharyngitis
Peritonsillar abscess
Viral pharyngitis
Infectious mononucleosis
Epiglottitis
small-for-gestational-age infants: which type of chromosomal analysis should be included? -
CORRECT ANSWER- ✔✔Trisomy 18
Holt-Olram
Trisomy 13
Turner Syndrome
Trisomy 21
Prader-Willi Syndrome
, heart defects associated with Down syndrome - CORRECT ANSWER- ✔✔Atrioventricular
Septal Defect
Ventricular Septal Defect
Persistant Ductus Arteriosus
Tetrology of Fallot
Contact sports with Down's Syndrome - CORRECT ANSWER- ✔✔Do not recommend due
to atlantoaxial instability
Diagnosing Down Syndrome - CORRECT 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) - CORRECT 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 - CORRECT 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 echocardiogram, and an
electrocardiogram. The diagnosis may also be confirmed with genetic testing of the TBX5
gene
Diagnosing Trisomy 13 - CORRECT ANSWER- ✔✔Parents who are at risk to have a
translocation due to their family history can have a blood test called a karyotype, which can
determine if a translocation is present.
