2024 NR 602 Midterm APPB Exam New Latest Version with All Questions from Actual Past Exam, Exams of Nursing

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2024 NR 602 Midterm APPB Exam New Latest Version with

All Questions from Actual Past Exam and 100% Correct

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Who should receive the 2-dose HPV vaccine ---------- Correct Answer ------------ children who get the 1st dose BEFORE 15 yo. When should the second dose of HPV vaccine take place? ---------- Correct Answer ----- ------- 6 - 12 months after the first dose What is GABHS? ---------- Correct Answer ------------ group a beta-hemolytic streptococcus (Strep throat) What is the first line ABX for dog and cat bites? ---------- Correct Answer ------------ Amoxicillin clavulanate for 7-10 days Treatment of GABHS pharyngitis ---------- Correct Answer ------------ Penicillin V or Amoxicillin for 10 days. Amoxicillin 500mg PO BID X 10 days What are characteristics of fetal alcohol spectrum disorder? ---------- Correct Answer ---- -------- Poor prenatal and postnatal growth Hypotonia, poor coordination Cardiac defects (e.g., VSD, ASD) Narrow eyes, microphthalmia, large epicanthal folds, microcephaly, small upper jaw, smooth groove in the upper lip, thin upper lip Simian creases common Tertiary Care ---------- Correct Answer ------------ intensive care, subacute care highly complex care and therapy services from practitioners in a hospital or overnight facility quaternary care ---------- Correct Answer ------------ ● extension of tertiary care, extremely specialized services (e.g. burn units and transplant surgery) available typically only on a regional basis. Port-Wine Stain (Nevus Flammeus) present as ---------- Correct Answer ------------ pink- to-red, flat, stain-like lesions blanches to pressure irregular size/shape,usually, unilateral When should Port-Wine Stain be referred to a pediatric ophthalmologist? ---------- Correct Answer ------------ If the birthmark is present on the upper AND lower eyelids or on the V1 and V2 branches of the Trigeminal Nerve (CN V).

Why should a pt. with a Port-Wine Stain be referred to an ophthalmologist? ---------- Correct Answer ------------ to rule out congenital glaucoma or Sturge-Weber syndrome treatment for Port-Wine Stain ---------- Correct Answer ------------ pulsed dye laser The child who has one eye or best-corrected vision in one eye worse than 20/40 and a small face to fit should be required to wear ---------- Correct Answer ------------ molded polycarbonate sport frames (American National Standards Institute [ANSI] Z87. frames). Symptoms of Kawasaki disease ---------- Correct Answer ------------ Fever x5 days and one of the following: enlarged lymph in the neck bright-red rash b/L conjunctivitis dry cracked lips/strawberry tongue diagnostics of Kawasaki disease ---------- Correct Answer ------------ monitor ECG immediately. CBC w/ diff, platelet count, CMP, ESR, and CRP Requires echocardiogram & cardiologist. Treatment of Kawasaki Disease ---------- Correct Answer ------------ ● IV immunoglobulin

• a single dose of 2 g/kg over 8 to 12 hours, ideally in the first 10 days of the illness ● high-dose aspirin (80 to 100mg/kg/day in four divided doses, every 6 hours initially) until afebrile for at least 48 to 72 hours, then lowering the aspirin dose to 3 to 5 mg/kg/day for 6 to 8 weeks with discontinuation if the echocardiogram is normal How long should a child f/u w/ cardiology after Kawasaki disease? ---------- Correct Answer ------------ 1 year Live virus vaccines should be delayed for how long after administration of IV immunoglobulin. ---------- Correct Answer ------------ 11 months An 8-year-old has a painful limp. He reports that his knee hurts medially. On exam he has pain with internal rotation of the hip. How should the NP manage this situation? ----- ----- Correct Answer ------------ He should be immediately referred to orthopedic The NP should order a hip and knee x-ray, CBC and ESR. He should be referred for synovial fluid aspiration. congenital cataracts. ddx? ---------- Correct Answer ------------ TORCH (birth), galactase def (need surgery) What is the number-one bacteria that causes Cystic Fibrosis? ---------- Correct Answer -- ---------- Pseudomonas aeruginosa

symptoms of cystic fibrosis ---------- Correct Answer ------------ thick mucus builds up in the lungs Wheeziness of breathing Salty tasting skin pathophysiology of cystic fibrosis ---------- Correct Answer ------------ ● Defective Cl channel ● Secretion of abnormaly thick mucus that plugs lungs, pancreas and liver ● Recurrent pulmonary infections (pseudomonas spp, s. aureus), chronic bronchitis, bronchiectasis, pancreatic insufficiency (malabsorption, and steatorrhea), nasal polyp and meconium ileus in newborn ● Mutation often causes abnormal protein folding resulting in degradation of channel before reaching cell surface diet recommendation for cystic fibrosis. ---------- Correct Answer ------------ High protein and low fat complications of cystic fibrosis ---------- Correct Answer ------------ atelectasis, recurrent infections, cor pulmonale, respiratory failure, malabsorption, malnutrition, electrolyte imbalances, sterility, and infertility Diagnosis of Cystic Fibrosis ---------- Correct Answer ------------ pilocarpine iontophoresis Sweat chloride test asthma diagnostics ---------- Correct Answer ------------ ● Pulmonary function tests - Spirometry (PEFR or FEV1) ● chest x-ray PA and lateral ● Oxygen saturation (SaO2) ● CBC if anemia is suspected first line treatment for allergic rhinitis ---------- Correct Answer ------------ ● Avoid triggers ● nasal steroid sprays ● Fluticasone 50mcg (Flonase) 2 times aday Triamcinolone 55mcg (Nasacort 24HR) 1- 2x daily ● topical antihistamine spray ● Azelastine (Astelin) 1-2x daily ● Comolyn sodium nasal spray 3x daily (less effective than steroids) second line treatment for allergic rhinitis ---------- Correct Answer ------------ ● decongestants (pseudoephedrine or Sudafed) PRN do NOT give to pregnant/infants/young children ● oral antihistamines Benadryl (causes sedation) 2nd gen: Zyrtec/Claritin PO daily Enterovirus ---------- Correct Answer ------------ Poliovirus and coxsackievirus

How is enterovirus transmitted? ---------- Correct Answer ------------ fecal-oral route what group is at risk for enterovirus ---------- Correct Answer ------------ <10 yrs. A nurse conducting a meeting on prevention of eye injuries. Which statements by the group members indicate that the group needs additional teaching? Select all that apply - --------- Correct Answer ------------ - "If you get hit in the eye with something, apply direct pressure with an ice pack." "If your eyes feel gritty while you are wearing contact lenses, put rewetting drops in them." The school nurse is teaching a group of parents about strategies to prevent eye injuries. Which statement by a parent indicates understanding of the teaching session? ---------- Correct Answer ------------ "My son wears a face shield when he plays hockey. if dark-red brown light reflex is on eye exam, what should the NP do ---------- Correct Answer ------------ ● Refer to an ophthalmologist, risk of retinoblastoma Best sports to play if you have asthma ---------- Correct Answer ------------ ● those physical activities of short duration—golf, volleyball, gymnastics, baseball, wrestling, football, and short-term track and field events. While some swimming can be a high- endurance event, the warmth and humidity around the pool make breathing easier down syndrome is caused by. ---------- Correct Answer ------------ Trisomy 21 clinical findings of down syndrome ---------- Correct Answer ------------ ● round flat face ● upward slanting eyes ● low set ears ● chronic open mouth d/t enlarged tongue ● simian crease ● cataracts ● heart defects ● congenital hearing loss people w/ down syndrome are at higher risk for congenital cataracts and should receive ---------- Correct Answer ------------ Ongoing ophthalmologic exam for cataracts tx for cataracts ---------- Correct Answer ------------ surgery parent education for down syndrome ---------- Correct Answer ------------ ● cervical spine positioning - avoid contact sports ● monitor for myelopathy (disease of the spinal cord) signs of otitis media ---------- Correct Answer ------------ ● Fever, TM erythema, TM bulging, TM dullness

treatment for otitis media ---------- Correct Answer ------------ ● only those with purulent otitis media, otherwise ● 1st line: Amoxicillin x10 days 80-90 mg/kg/day divided twice a day (maximum dose 2 to 3 gm daily) ● 2nd line: Amoxicillin-clavulanate or Azithromycin x5 days or Benzocaine otic drops can be used for children older than 5 years old When to just "watch and wait" instead of treating acute otitis media ---------- Correct Answer ------------ ● Young children with unilateral AOM without severe symptoms and fever <102.2°F [39°C] ● Children ≥24 months old without severe symptoms Watchful waiting (48-72 hours) recommended inchildren 6 months to 2-years of age Is tenderness of the mastoid area a complication of otitis externa ---------- Correct Answer ------------ no signs of otitis externa (swimmers ear) ---------- Correct Answer ------------ ● After swimming ● inflammation of the ear canal ● pain, itching, redness, swelling, hearing loss painful to touch tragus! treatment of otitis externa ---------- Correct Answer ------------ ● Otopical ABX/steroid drops: Ciprodex (Alcon) - Ciprofloxacin/Dexamethasone Use ≥6 months old What are the two locations of adolescent migraines ---------- Correct Answer ------------ ● Usually frontal/temporal ● Occipital location is unusual and should be carefully evaluated (occipital headache in children whether unilateral or bilateral is rare and calls for diagnostic caution; many cases are attributable to structural lesions) Clinical findings of an ACL sprain? ---------- Correct Answer ------------ ● Swelling/effusion and pain. ● Instability with lateral movement. ● POSITIVE Lachman test. What is the drug of choice in treating Scabies ---------- Correct Answer ------------ ● Begins with applying a thin layer of scabicide to the entire body, excluding the eyes. Reapplied in 7 days on all symptomatic patients. ● Permethrin 5% applied to face, neck, and body. Rinsed off in 8-14 hrs Rotavirus ---------- Correct Answer ------------ ● cause of diarrhea globally (teach diaper care). ● Rotavirus vaccine for infants between 6-32 weeks old (2 or 3 series orally) RV1 &RV ● Risk for intussusception usually occurs within 7 days following the first or second dose.

● The primary mode of transmission is the fecal-oral route, usually through direct contact between people. Scabies ---------- Correct Answer ------------ ● itching, worse at night. curving burrows under the skin, especially in webs of fingers ● Red-Brown vesiculopustular lesions tend to be found in infant on palms, soles, scalp, face, posterior auricular, and axillae, concentrated in the folds ● Treat with permethrin 5% Nevi ---------- Correct Answer ------------ ● found in up to 90% of African Americans (most common) ● Follow ABCDE mnemonic for melanoma Nevi, refer if.... ---------- Correct Answer ------------ Rapidly growing or changing nevus

• More than 50 nevi
• One or more atypical nevi
• History of one or more first-degree relatives with melanoma
• Presence of a giant or large congenital nevus
• Signs of excessive sun exposure (increased nevi and freckles in exposed areas)
• History of immunosuppression and multiple nevi on examination Primary care PNPs ---------- Correct Answer ------------ well-child care and the prevention and/or management of both common pediatric acute illnesses and chronic conditions Acute care PNPs ---------- Correct Answer ------------ ● provide care for acutely, critically, and chronically ill children who are unstable, experiencing life-threatening illness, are medically fragile and/or technologically dependent. ● is not the site where they practice, but the acuity of the patient for whom they are caring Tertiary Care ---------- Correct Answer ------------ ● requires both specialized expertise and equipment Quaternary Care ---------- Correct Answer ------------ ● requires highly specialized expertise and highly unusual or specialized equipment SIDS: ---------- Correct Answer ------------ ● Bedsharing with infants greatly increases the risk of SIDS. Meningococcal ---------- Correct Answer ------------ ● MenACYWY-D: at 12 months and 16 yrs old booster ● MenB-4C, MenB-FHbp 11-12 yrs and booster at 16 years Cath up immunizations ---------- Correct Answer ------------ ??

Abrasions ---------- Correct Answer ------------ ● red streaking. Assess circulation, sensation, motion, ****function of surrounding area Puncture wound ---------- Correct Answer ------------ Ultrasound is best for evaluation of radiolucent foreign objects including wood and plastic. Lacerations ---------- Correct Answer ------------ ● PE: neurovascular (pulses, motor function, sensation to distal laceration), ROM, do edges approximate Poison ---------- Correct Answer ------------ ● management: Basic life support focuses on airway, breathing, and circulation• Ocular: copious saline lavage• Skin: copious water rinse or gentle soap and water• Gastrointestinal: dilution; gastric emptying; activated charcoal administration; catharsis; whole bowel irrigation (after consulting poison control) Infant Development 1-3 Months Old: ---------- Correct Answer ------------ Digestive system fully functional at age of 3 months MIgraine HA ---------- Correct Answer ------------ ● include at least 2 of the following: unilateral location, pulsating quality, moderate to severe pain with an increase during exertion, nausea/vomiting, photophobia, or phonophobia. HA lasts 4-72hrs Infant Development 4-5 Months Old ---------- Correct Answer ------------ ● Roll from back to side first, then prone to supine ● visually follow their parent by turning their head ● squeals, coo and add vowel and consonant sound. Start to laugh. Locate sounds ● seek out environmental objects like mirrors, their hands. smile, mouth objects, eye-to- hand control Infant Development 6-8 Months Old ---------- Correct Answer ------------ ● roll back to abd., sit erect, crawl, bounce. , reach for items and transfer objects from hand to hand ● like to feed themselves Infant Development 9-12 Months Old ---------- Correct Answer ------------ ● pull to stand, walking while holding furniture or held ● wave bye-bye Precocious puberty: ---------- Correct Answer ------------ ● occurs when signs of puberty emerge earlier than 8-years-old for girls and 9-years-old for boys Hepatoviruses--> Hepatitis A ---------- Correct Answer ------------ ● Preicteric phase: Malaise, nausea, anorexia, vomiting, digestive complaints, fever rarely higher than 102 Icteric phase:Jaundice appears shortly after symptom onset, Urine darkens, and stools become clay colored.posterior cervical adenopathy, Mild hepatomegaly

Roseola Infantum (Exanthem Subitum) or sixth disease: HHV-6 and HHV- 7 ---------- Correct Answer ------------ rose-colored maculopapular rash, 2 to 3 mm in diameter, appears. fades on pressure. Varicella ---------- Correct Answer ------------ ● Scarlet fever: begins after flu like sx caused by GAS ● 1st day rash: papular rash, similar in appearance to sandpaper, associated w/ throat pain/pharingitis, flushed cheeks, increased density of neck,transverse lines /pastia sign, increased density in groin ● day 3: strawberry tongue, +blanching test Non-Group A or B Streptococci ---------- Correct Answer ------------ Penicillin G is the drug of choice with modification based on culture sensitivities ● Penicillin G is the drug of choice with modification based on culture sensitivities -------- -- Correct Answer ------------ ● Scarlet fever: begins after flu like sx caused by GAS ● 1st day rash: papular rash, similar in appearance to sandpaper, associated w/ throat pain/pharingitis, flushed cheeks, increased density of neck,transverse lines /pastia sign, increased density in the groin ● day 3: strawberry tongue, +blanching test Non-Group A or B Streptococci ---------- Correct Answer ------------ ● Penicillin G is the drug of choice with modification based on culture sensitivities ● 75: Penicillin G is the drug of choice with modification based on culture sensitivities ● DX: Spirometry Interpretation of percentage predicted is: >75%: Normal ● 60% to 75%: Mild obstruction ● 40% to 69%: Moderate Pityriasis Rosea ---------- Correct Answer ------------ ● Herald spot or patch" to trunk, upper arm, neck, or thigh. OR Christmas tree pattern ● Reassure the child's parents that the rash is benign and self-limited Port wine Stain (Vascular Nevi) ---------- Correct Answer ------------ ● port-wine stain purple-red macules permanent that grows with child. if forehead or eyelid involved and neuro/optho f/u is needed). Cataract ---------- Correct Answer ------------ Must see ophthalmologist if amblyopia may develop. Ear screening ---------- Correct Answer ------------ ● before 1 month of age w/ Evoked otoacoustic emission (EOAE) testing preventing AOM ---------- Correct Answer ------------ ● Exclusive breastfeeding until at least 6 MAvoid bottle propping, feeding infants lying down, and passive smoke exposurePneumococcal vaccine; specifically, PCV13, which contains subtype

19AAnnual influenza vaccine helps prevent otitis mediaXylitol liquid or chewing gum as toleratedlicensed day care facilities with fewer children Bronchitis ---------- Correct Answer ------------ ● Management: pain med. hydration. bronchodilator if obstruction/wheezing ● SABA, atrovent, short term course of corticosteroids Pertussis (whooping cough) ---------- Correct Answer ------------ ● Tx: azithromycin, clarithromycin, and erythromycin is recommended for all ages. EXPECT risk for pyloric stenosis and erythromycin in infants younger than 1 month Atrial septal defect ---------- Correct Answer ------------ ● Left to right shunting (Acyanotic)↑ Pulmonary blood flow ● Opening in septum between atria ● Signs: widely split S2, right ventricle heave, systolic murmur at pulmonic or diastolic murmur at tricuspid ● Symptoms: asymptomatic; older children may have fatigue or exercise intolerance Ventricular sepal defect ---------- Correct Answer ------------ ● Opening in septum between ventricles; most common congenital defect; most close spontaneously ● Signs: systolic murmur at Erb's point or tricuspid; larger openings positive for heaves and thrill ● Symptoms: asymptomatic with small to moderate openings; infants with large openings exhibit symptoms (dyspnea, respiratory infections, diaphoresis, fatigue) Meningitis (bacterial, viral, fungal, or parasitic infection) ---------- Correct Answer ---------- -- ● S&S: fever, headache, neck stiffness, and nausea, vomiting and Altered mental status, phonophobia, photophobia, and a rash. Cerebral palsy ---------- Correct Answer ------------ ● 75% of CP cases are spastic or characterized by muscular rigidity, difficulty lifting his head and stiff legs that cross when picked up. Seizures ---------- Correct Answer ------------ ● Epilepsy is defined as a chronic condition of two or more unprovoked seizures that are greater than 24 hours apart or one seizure with a "high risk" of recurrent seizures Status epilepticus- must not miss Diagnosis ---------- Correct Answer ------------ ● A medical emergency Headache red flag ---------- Correct Answer ------------ ● Red flags: sudden onset, worsening patterns, systemic illness, and focal neurologic signs. MIgraine HA ---------- Correct Answer ------------ ● include at least 2 of the following: unilateral location, pulsating quality, moderate to severe pain with an increase during exertion, nausea/vomiting, photophobia, or phonophobia. HA lasts 4-72hrs

scoliosis ---------- Correct Answer ------------ Asymmetry related to scoliosis is noted in the posterior thoracic region. Asymmetry of the shoulders, scapula, and iliac crests is indicative of scoliosis What does the vaccines for children (VFC) program offer? ---------- Correct Answer ------ ------ enables PCPs to obtain ACIP-rec- ommended vaccines without cost. These vaccines are provided free to children < than 19 years old who are Medicaid- eligible, are uninsured, or who are Native American or Alaska Native. The VFC program pays for 50% of all vaccines administered to children in the United States younger than 6 years old What is the difference between a well child exam and a sports physical? ---------- Correct Answer ------------ ● The history is like the well-child check, but the physical assessment focuses on cardiovas- cular, neurological, and orthopedic wellness when is Chelation therapy, a medication that binds to lead to excrete via urine, recom in mended for lead poisoning? ---------- Correct Answer ------------ ● levels greater than 45 μg/dL When is lead screening recommended? ---------- Correct Answer ------------ ● 12 and 24 months, if elevated then repeat in 2-4 wks Lead levels greater than ___________ g1⁄4/dl are associated with anemia and decreased iron absorption ---------- Correct Answer ------------ ● 10 μg/dL How long should asthma be con- trolled for before stepping down? ---------- Correct Answer ------------ 3 months

. the most common type of headache with onset in adolescence is: ---------- Correct Answer ------------ tension headache best way to differentiate severity of asthma ---------- Correct Answer ------------ ● intermittent: less than 2 days a week ● mild: greater than 2 days a week ● moderate: daily ● severe: several times per day treatment of intermittent asthma? ---------- Correct Answer ------------ SABA PRN treatment of mild persistent asthma? ---------- Correct Answer ------------ low dose ICS (formoterol) + SABA prn Treatment of moderate persistent asthma ---------- Correct Answer ------------ ● low dose ICS + LABA combo (Ad- vair/Symbicort)+ SABA prn

treatment of mild persistent asthma? ---------- Correct Answer ------------ low dose ICS (formoterol) + SABA prn Treatment of moderate persistent asthma ---------- Correct Answer ------------ ● low dose ICS + LABA combo (Ad- vair/Symbicort)+ SABA prn scoliosis ---------- Correct Answer ------------ Asymmetry related to scoliosis is noted in the posterior thoracic region. Asymmetry of the shoulders, scapula, and iliac crests is indicative of scoliosis How is Kawasaki disease diagnosed? ------------ Correct Answer ------------ No specific lab test. (no blood test) Liver tests may be abnormal Diagnosis is made by meeting these criteria: Fever for at least 5 days 4 of these 5 conditions must be met

• Mucous membrane changes such as red tongue and dry fissured lips
• Swelling of hands and feet.
• Enlarged lymph nodes in the neck
• Diffuse red rash covering most of the body.
• Redness of eyes. o Illness cannot be explained by any known disease process. How to treat Kawasaki disease: ------------ Correct Answer ------------ IVIG and aspirin What is retinoblastoma? ------------ Correct Answer ------------ malignant tumor of the retina signs and symptoms of retinoblastoma ------------ Correct Answer ------------ whitish glow in pupil - cat's eye reflex (leukocoria). Eyes looking in different directions, poor vision, eye swelling, eye redness When should children be screened for retinoblastoma ------------ Correct Answer ---------- -- from birth up to the age of 7 years. After age 7 years, no further screening of asymptomatic children is recommended, unless they are known to carry an RB mutation. Most children diagnosed are younger than 3 years old. Risk factors for retinoblastoma ------------ Correct Answer ------------ Diets low in fruits and vegetables among mothers during pregnancy Exposure to chemicals in gasoline or diesel exhaust during pregnancy Exposure of fathers to radiation Older age among fathers s/sx of hypothyroidism in pediatric clients ------------ Correct Answer ------------ Slowed growth rate

Puffy face Swollen hands and feet Poor muscle tone Sluggishness, sleepiness Constipation Fatigue Dry, itchy scalp Dry, coarse skin Heavy menstruation in girls Mood swings Weight gain Hoarse cry or voice Dry, coarse skin Enlarged thyroid gland (goiter) Is imaging warranted in a pediatric client with Asthma ------------ Correct Answer -----------

• imaging should be minimized r/t the exposure to radiation in children. What is intermittent asthma? ------------ Correct Answer ------------ Rule of 2's: Symptoms: <2 days/week Nighttime: <2 times/ mo Rescue inhaler use: <2 days per week Limitation with activity: none Lung function: FEV1>80% , normal between exacerbations. Intermittent asthma means that you only have symptoms sometimes. People with intermittent asthma usually have symptoms 2 days a week or less often What is mild persistent asthma? ------------ Correct Answer ------------ • Symptoms: > days/week but not daily
• Nighttime awakenings: 3-4x/month
• SABA use: > 2 days/week but not daily
• Interference with normal activity: Minor
• Lung Function:
• FEV*: > 80% predicted
• FEV1/FVC: normal Persistent asthma means that you have symptoms regularly. People with mild persistent asthma have asthma symptoms more than twice a week, but not every day. What is moderate persistent asthma? ------------ Correct Answer ------------ • Symptoms: Daily
• Nighttime awakenings: >1x/week but not nightly
• SABA use: Daily
• Interference with normal activity: Some limitations
• Lung Function:

• FEV*: < 60% but< 80% predicted
• FEV1/FVC: reduced 5% People with moderate persistent asthma have asthma symptoms every day. Your lung spirometry tests will show decreased lung function. What is severe persistent asthma? ------------ Correct Answer ------------ • Symptoms: throughout the day
• Nighttime awakenings: often nightly
• SABA use: Several times a day
• Interference with normal activity: Extremely limited
• Lung Function:
• FEV*: < 60% predicted
• FEV1/FVC: reduced 5% People with severe persistent asthma have asthma symptoms every day, throughout the day. As a result, your daily activities are extremely limited. You might wake up every night because of your asthma symptoms. You must use rescue medicines several times a day. Your lung spirometry tests will show severely decreased lung function. Treating Pediatric asthma ------------ Correct Answer ------------ What is the recommendation(s) for human papillomavirus (HPV) vaccine? ------------ Correct Answer ------------ HPV vaccine is recommended for routine vaccination at age 11 or 12 years. (Vaccination can be started at age 9.) ACIP also recommends vaccination for everyone through age 26 years if not adequately vaccinated when younger. What population(s) at-risk for contracting meningococcal infection? ------------ Correct Answer ------------ Anyone can get meningococcal disease, but rates of disease are highest in children younger than 1 year old, with a second peak in adolescence. Among teens and young adults, those 16 through 23 years old have the highest rates of meningococcal disease. What vaccines are contraindicated in pregnancy or those planning to become pregnant? ------------ Correct Answer ------------ Human papillomavirus (HPV) vaccine Measles, mumps, and rubella (MMR) vaccine Live influenza vaccine (nasal flu vaccine) Varicella (chicken pox) vaccine Which vaccines should I get if I am pregnant? ------------ Correct Answer ------------ the inactivated flu vaccine (the injection, not the live nasal flu vaccine) and the Tdap vaccine. What are possible complications for a person with Down's syndrome ------------ Correct Answer ------------ Heart Defects

GI Defects immune disorders such as pneumonia Sleep apnea Obesity Spinal problems leukemia Dementia When to genetically test a child ------------ Correct Answer ------------ If the child is having trouble with sight, hearing, movement and balance, mood, immune system irregularities, slow or poor growth, problems with appetite, eating and digestion, or the disorder may cause seizures, heart arrhythmias or hormonal imbalances. first line treatment for back pain ------------ Correct Answer ------------ Acetaminophen and nonsteroidal anti-inflammatory drugs are first-line medications for chronic low back pain. when should you do imaging for back pain ------------ Correct Answer ------------ imaging for low back pain in (1) patients who have had up to 6 weeks of medical management and physical therapy for low back pain without improvement in symptoms, and (2) patients with red flag symptoms for serious pathology. What is Osgood-Schlatter disease ------------ Correct Answer ------------ involves inflammation of the growth plate or area where the patellar tendon connects to the tibia (tibial tubercle) and is commonly diagnosed during the adolescent growth spurt. Signs and symptoms of Osgood-Schlatter disease ------------ Correct Answer ------------ Pain and swelling of tibial tubercle which worsens with athletic activity but relieved by rest Pronounced tibial tubercle Tight anterior and posterior upper leg muscles Diagnose with an x-ray Treatment of Osgood-Schlatter disease ------------ Correct Answer ------------ Rest Modified activity Ice Nonsteroidal anti-inflammatory drugs (NSAIDs) Strengthening and stretching Patellofemoral pain syndrome ------------ Correct Answer ------------ "runner's knee", which refers to anterior knee pain that worsens while going up or down stairs, walking hills, or prolonged sitting with knees flexed. Pain in the front of the knee and around the patella, or kneecap. Activities like running and jumping can cause this. Patellofemoral pain syndrome treatment ------------ Correct Answer ------------ Rest, Rice Method, NSAIDs

Paul, 14, is accompanied by his guardian with complaints of fever, headache, neck stiffness, and nausea. He is alert but not oriented to time and place. Which of the following diagnoses is likely? ------------ Correct Answer ------------ Meningitis Annabella is a 5-day-old newborn who is accompanied by her mother. Her mother is concerned that the baby is crying inconsolably and not eating well. She states that Annabella was diagnosed with hydrocephalus at birth and a shunt was placed. Which of the following assessment finding is a priority concern? ------------ Correct Answer ---------- -- Bulging fontanelles hydrocephalus ------------ Correct Answer ------------ abnormal accumulation of fluid (CSF) in the brain hydrocephalus s/sx in children ------------ Correct Answer ------------ In an infant include a progressively enlarging head, bulging fontanelles, and enlarged scalp veins. Older children may experience headaches, drowsiness, decreased cognitive ability, and blurred vision. How to treat hydrocephalus ------------ Correct Answer ------------ Referral to a neurosurgeon for ventriculoperitoneal (VP) shunt or surgical correction is warranted. Cerebral palsy ------------ Correct Answer ------------ is a neurologic condition characterized by motor impairment from a gestational brain injury Cerebral palsy risks ------------ Correct Answer ------------ CP rates are higher in low-birth- weight infants, those born before 32 weeks, and those born after difficult labor. Over 75% of CP cases are spastic or characterized by muscular rigidity Ataxic CP is characterized by difficulties with balance and control, whereas athetoid (dyskinetic) CP involves a lack of muscular control. Concussion ------------ Correct Answer ------------ A concussion is a mild traumatic brain injury that affects normal brain function. It occurs as a result of a direct or indirect blow to the head. Signs and symptoms of concussion may be subtle and may appear immediately or even hours after impact. They include headache, drowsiness, dizziness, photophobia, and impaired cognition. Migraine headache ------------ Correct Answer ------------ Migraine signs and symptoms include at least 2 of the following: unilateral location, pulsating quality, moderate to severe pain with an increase during exertion, nausea/vomiting, photophobia, or phonophobia. HA lasts 4 to 72 hours. Meningitis ------------ Correct Answer ------------ Meningitis is a bacterial, viral, fungal, or parasitic infection within the subarachnoid space or meningeal or ependymal cells. The infection leads to inflammatory responses causing neurologic damage. Signs and symptoms of meningitis include headache, fever, stiff neck, and altered mental status

Cluster HA ------------ Correct Answer ------------ Cluster headaches, or trigeminal autonomic cephalgia, are a group of idiopathic headaches that are associated with trigeminal neuralgia. The location is always unilateral around the eye. Presents as a deep explosive excruciating pain that begins quickly, ptosis of the eyelid, and miosis. Lacrimation, swollen eyelids, and nasal discharge may also occur. Duration is 30 minutes to 3 hours. Sinus HA ------------ Correct Answer ------------ The sinus headache is associated with sinusitis. It is accompanied by pressure in the cheeks or forehead, congestion, and fatigue. Pain increases with bending forward. It involves the nasal mucosa, turbinates, or septum. Tension-type HA ------------ Correct Answer ------------ Tension-type HATension headache, or stress headache, is often musculoskeletal in origin and is the most common headache. The location of the headache is usually bilateral around the forehead area but may present as unilateral pain. It is described as a band-like pressure or tightness that comes and goes. It can also be described as a steady, pulsating mild to moderate pain. The duration is usually variable with no associated symptoms. Reducing SIDS ------------ Correct Answer ------------ recommended screening age for lead? ------------ Correct Answer ------------ All children with Medicaid are recommended to have lead testing two times: at 12 months and 24 months Lead levels ------------ Correct Answer ------------ if the initial screening level is higher than 3.5 μg/dl, a venous blood lead level should be obtained to confirm findings. The higher the level, the more urgent the need for confirmation. What to do about lead poisoning ------------ Correct Answer ------------ education about lead exposure prevention environmental investigation into potential sources report test results to the local health department assess for calcium and iron deficiencies obtain abdominal X-ray contact a Pediatric Environmental Health Specialty Unit (PEHSU) or poison control center repeat test in 2 weeks to 1 month medication for lead poisoning ------------ Correct Answer ------------ Chelation therapy, a medication that binds to lead to excrete via urine, is recommended for levels greater than 45 μg/dL. primary, secondary, tertiary ------------ Correct Answer ------------

Quartenary care ------------ Correct Answer ------------ Quaternary care is considered an extension of tertiary care. However, it is even more specialized and highly unusual. Experimental medicine and procedures Uncommon and specialized surgeries vaccines in children ------------ Correct Answer ------------ sickle cell disease ------------ Correct Answer ------------ is an inherited disorder causing red blood cells to be hard, sticky, and malformed with a shorter lifespan. Over 80% of Blacks are carriers of the gene. treatment of sickle cell anemia ------------ Correct Answer ------------ Treatment focuses on preventing complications, such as infection, anemia, clotting, and pain. Treat with plenty of fluids, blood transfusions, pain control, and a medication called hydroxyurea How can you diagnose sickle cell anemia? ------------ Correct Answer ------------ Diagnosis can be made using isoelectric focusing (IEF), hemoglobin electrophoresis, or sickle solubility testing normal physiological murmur ------------ Correct Answer ------------ Changes in blood pressure gradients or velocity cause chaotic flow and vibration that are often noticeable as a palpable thrill or heave seven characteristics of a murmur ------------ Correct Answer ------------ intensity - easily heard upon auscultation, soft, no thrill timing - systolic location - pulmonic area radiation - also heard in the left axilla quality - harsh crescendo-decrescendo duration - heard in mid systole pitch - medium sound 6 grades of murmur ------------ Correct Answer ------------ A grade 1 murmur is barely audible. A grade 2 murmur is soft but easily audible. A grade 3 murmur is louder but is not accompanied by a thrill. A grade 4 murmur is loud with a palpable thrill. A grade 5 murmur can be heard with the stethoscope partially off the chest and a thrill is palpable. Finally, the grade 6 murmur is audible without a stethoscope. All murmurs louder than grade 3 are pathological. How to diagnose HF ------------ Correct Answer ------------ Electrocardiography (ECG), chest x-ray, and laboratory findings can help determine if a child's signs and symptoms are related to HF. The heart will appear enlarged on chest x-ray. ECGs may reveal ST- segment or T-wave changes and arrhythmias may be present. B-type natriuretic peptide (BNP) and N-terminal proBNP concentrations are elevated. 4 types of HF ------------ Correct Answer ------------

Atrial septal defect ------------ Correct Answer ------------ Opening in septum between atria Signs: widely split S2, right ventricle heave, systolic murmur at pulmonic or diastolic murmur at tricuspid Symptoms: asymptomatic; older children may have fatigue or exercise intolerance Ventricular septal defect ------------ Correct Answer ------------ Opening in septum between ventricles; most common congenital defect; most close spontaneously Signs: systolic murmur at Erb's point or tricuspid; larger openings positive for heaves and thrill Symptoms: asymptomatic with small to moderate openings; infants with large openings exhibit symptoms (dyspnea, respiratory infections, diaphoresis, fatigue) How do you catch rotavirus? ------------ Correct Answer ------------ put your unwashed hands that are contaminated with poop into your mouth. touch contaminated objects or surfaces and then put your fingers in your mouth. eat contaminated food. How do you treat rotavirus ------------ Correct Answer ------------ oral rehydration. resolves within three to seven days. enterovirus infection ------------ Correct Answer ------------ sx include fever, runny nose, sneezing, cough, skin rash, mouth blisters, and body and muscle aches. There is no specific treatment for enterovirus infections, but most people recover completely. Practice good hand hygeine. gold standard in foreign body imaging ------------ Correct Answer ------------ CT scanning motrin age ------------ Correct Answer ------------ No motrin before 6 months, use tylenol. Tylenol can be used before 6 months. Fever - See Immediately ------------ Correct Answer ------------ The child is less than 3 months of age with a fever > 100.4°F (38°C). The child is 3 to 36 months old with a fever > 100.4°F (38°C) for more than three days or looks sick. The child is 3 to 36 months old with a fever > 102°F (38.9°C). The child of any age has a fever > 104°F (40°C). The child with fever is crying inconsolably, lethargic, has a stiff neck, dyspnea, dysuria, or has had a seizure. The child with fever also has a chronic health condition, takes long-term steroids, or is undergoing chemotherapy. Fever see within 24 hours ------------ Correct Answer ------------ The child is age 3 to 6 months and recently received the diphtheria, tetanus, and pertussis (DTaP) vaccine. The child is over 3 years old with fever more than three days Fever was gone for more than 24 hours and is noted again

Recurrent fevers of more than 7 days allergic rhinitis ------------ Correct Answer ------------ an IgE moderated inflammatory disorder of the upper respiratory tract and nasal passages. Sx are nasal congestion, runny nose, watery eyes, sneezing, itching eyes. Treatment of Allergic rhinitis ------------ Correct Answer ------------ aimed at environmental control to reduce symptoms. Intranasal corticosteroids are considered first-line treatments scarlet fever ------------ Correct Answer ------------ a papular rash, similar in appearance to sandpaper, associated with bacterial pharyngitis, and common in school-aged and adolescent children. Seen a lot on the back. The rash begins a few days after flu-like symptoms and is caused by group A streptococcus (GAS). treatment of scarlet fever ------------ Correct Answer ------------ penicillin. A first- generation cephalosporin, clindamycin, or erythromycin may also be used if the client is allergic to penicillin. pediculosis ------------ Correct Answer ------------ infestation with lice. Treatment of pediculosis ------------ Correct Answer ------------ The primary treatment for lice infestation is the removal of all nits or louse ova. Over-the-counter medications with permethrin (approved for children over 2 months) or pyrethrins (approved for children over age 2) are recommended for treatment. port-wine stain ------------ Correct Answer ------------ a flat vascular birthmark made up of dilated blood capillaries, creating a large, reddish-purple discoloration on the face or neck Nevi ------------ Correct Answer ------------ medical term for moles Scabies ------------ Correct Answer ------------ an infestation of the skin by the human itch mite. The most common symptoms of scabies are intense itching and a pimple-like skin rash. Treatment of scabies ------------ Correct Answer ------------ 1% lindane or 5% permethrin in a lotion or cream applied to the skin from shin to bottom of feet and left on overnight. Wash off in the morning. Repeat x 7 days. Antihistamines or topical steroids if needed for itching Lindane is more toxic and should be avoided in children younger than 2, pregnant, lactating, or extensive dermatitis

All bedclothes and clothing of infected patients and household contacts should be washed. All close physical contacts should receive scabicide tx as well. Chiggers ------------ Correct Answer ------------ Chigger bites are itchy red bumps that can look like pimples, blisters, or small hives. They are usually found around the waist, ankles, or in warm skin folds. They get bigger and itchier over several days, and often appear in groups. chigger bite treatment ------------ Correct Answer ------------ antihistamines Using topical creams or lotion (calamine lotion). Taking diphenhydramine (Benadryl ®) or other antihistamines. Taking an anti-parasite medication (permethrin). Applying a cold compress. Cleaning the affected area of skin with soap and water regularly. contact dermatitis ------------ Correct Answer ------------ An inflammation of the skin caused by having contact with certain chemicals or substances; many of these substances are used in cosmetology. Avoid the allergen or irritant to treat. acute otitis media ------------ Correct Answer ------------ usually associated with an upper respiratory infection and is most commonly seen in young children. Is an infection of the middle ear. often experience pain and diminished hearing, with redness or bulging of the tympanic membrane. Amoxicillin 45 to 90mg/kg is recommended treatment. otitis externa ------------ Correct Answer ------------ Infection of the outer ear (ear canal). Also known as swimmers ear. patients often experience redness, inflammation, swelling, itching, pain, and pus discharge Tympanic membrane (TM) perforation ------------ Correct Answer ------------ can occur due to trauma (foreign body), infection, or barometric changes (airplane, scuba diving). Signs and symptoms include whistling sounds during sneezing or nose blowing, decreased hearing, ear infections with colds or water entries, and copious purulent discharge. Pain indicates a concurrent disease process but usually perforations are painless. Periorbital cellulitis ------------ Correct Answer ------------ skin infection around the eye. It is often caused by trauma or sinusitis and is unilateral in most cases. Trauma can include insect bites and facial injuries. Treatment is based on the type of trauma. Bacterial infections are often caused by Staphylococcus aureus. The treatment for methicillin-resistant Staphylococcus aureus (MRSA) cases is clindamycin. Conjunctivitis ------------ Correct Answer ------------ Conjunctivitis, or "pink eye", is divided into three categories: allergic, infectious, and chemical.Allergic conjunctivitis occurs with other allergy symptoms and is not infectious. It can be accompanied by itchy eyes and watery discharge that appears unilaterally or bilaterally. Treatment with antihistamines

or artificial tears along with avoiding the irritant is recommended. Infectious conjunctivitis can be bacterial or viral. Bacterial conjunctivitis is localized with cloudy discharge while viral has systemic symptoms and a clear discharge. Only bacterial conjunctivitis is treated with antibiotic eye drops. Chemical conjunctivitis is caused by an irritant like chlorine in swimming pools. Eyes can be flushed with saline and irritant should be avoided. dacryostenosis ------------ Correct Answer ------------ narrowing of the tear duct causing excessive tearing The first-line treatment for GABHS pharyngitis ------------ Correct Answer ------------ amoxicillin 50 mg/kg/day (maximum: 1,000 mg per day) Mastoiditis ------------ Correct Answer ------------ is an infection of the mastoid bone of the skull. Peritonsillar abscess ------------ Correct Answer ------------ Collection of pus or fluid around the tonsil. Needle aspiration remains the gold standard for diagnosis and treatment of peritonsillar abscess. After performing aspiration, appropriate antibiotic therapy (including penicillin, clindamycin, cephalosporins, or metronidazole) Respiratory Syncytial Virus (RSV) ------------ Correct Answer ------------ is a virus that can cause nasal drainage, decrease in appetite, coughing, sneezing, fever, and wheezing. Anyone can get RSV but it is more serious in infants and older adults. Fluids and Tylenol for fever are used to manage rsv. Upper respiratory infection (URI) ------------ Correct Answer ------------ infection of the nasal cavity, pharynx, or larynx (commonly called a cold) Common symptoms of URIs include stuffy or runny nose, sore throat, cough, difficulty swallowing, and hoarseness or loss of voice. cystic fibrosis ------------ Correct Answer ------------ A genetic disorder that is present at birth and affects both the respiratory and digestive systems. Patients with cystic fibrosis produce thick and sticky mucus and have high levels of salt in their sweat. The thick mucus can block respiratory passages, leading to wheezing and coughing, as well as chronic respiratory infections. Mucus can also block the pancreatic ducts, blocking the release of the pancreatic enzymes needed to digest nutrients Acute viral bronchitis ------------ Correct Answer ------------ Acute bronchitis is usually caused by a viral infection and goes away on its own in a few weeks. Most people don't need treatment for acute bronchitis.A persistent cough that lasts one to three weeks is the main symptom of bronchitis. You usually bring up mucus when you cough with bronchitis, but you might get a dry cough instead and wheeze. Down Syndrome ------------ Correct Answer ------------ ◦ There are three types: Trisomy 21, Translocation, and Mosaic.

◦ It is the most common chromosomal condition in the United States. ◦ Mother's age is a risk factor. Common problems among children with this condition include a low intelligence quotient (IQ), hearing loss, obstructive sleep apnea, ear infections, eye diseases, and heart defects at birth. fetal alcohol spectrum disorder ------------ Correct Answer ------------ disorder affecting babies whose mothers consumed large amounts of alcohol while they were pregnant. ◦ It is preventable. ◦ Children can have a wide range of related conditions from mild to severe depending on the exposure in-utero. ◦ There is no medical test to confirm the diagnosis. There are different diagnoses based on symptoms. Tanner stages ------------ Correct Answer ------------ Developmental Milestones ------------ Correct Answer ------------ By two months, infants watch movement and react to sound By three months, infants can lift their heads and clasp their hands By six months, they begin to babble, may roll over, sit with support, reach for objects and transfer them from hand to hand. By nine months, infants imitate sounds and know their name By one year, infants can stand, start to take steps, begin to say words, and can follow one-step commands, Strength and coordination of gross and fine motor skills begin to develop,Vocabulary develops Vision and Hearing Screening ------------ Correct Answer ------------ Prior to age 3, children are evaluated by asking the parent if they have concerns about vision or hearing. Vision screening using a chart begins at age 3 years. Hearing evaluation through audiometry beings at age 4 years. Children who still can't be tested at age 4 are more likely to have developmental delays (for these children, you may need to refer for formal audiology and/or ophthalmology for screening, especially if developmental delays are suspected). vision screening at ages 3, 4, 5, 6, 8, and 10. Hearing screenings are recommended at ages 4, 5, 6, 8, and 10. A yearly comprehensive eye exam by an optometrist is recommended Protective eyewear should be worn as needed Gender Identity Development ------------ Correct Answer ------------ refers to an internal feeling that is derived from an interaction of biological traits, developmental influences, and environmental conditions. dren start to become aware of physical differences in boys and girls around age 2. Around age 4, most children have established their gender identity.

Pediatric physical exam ------------ Correct Answer ------------ Infant Nutrition ------------ Correct Answer ------------ Exclusive breastfeeding for the first 6 months of life is recommended; continued breastfeeding, with appropriate infant foods, is encouraged until 12 months Breastfed infants should receive supplemental vitamin D to prevent deficiency and rickets After 6 months, infants may begin solid food. It is important to educate parents about proper first foods, food preparation, and choking hazards Toddlers require a variety of foods from each food group. Avoid foods and beverages with added sugar and high amounts of sodium. Encourage water between meals. Some toddlers are "picky eaters". It may take 8-10 times before a child accepts a new food.