Pediatric Refresher Exam Questions and Answers, Exams of Pediatrics

Download Pediatric Refresher Exam Questions and Answers and more Exams Pediatrics in PDF only on Docsity! FNP PEDIATRIC REFRESHER EXAM 180 QUESTIONS AND CORRECT ANSWERS ALREADY GRADED A+ What is the average age of menarche? -ANS___________________ 12. What are some risks for giving infants cow's milk before 12 months of age? - ANS___________________ IDA, GI bleed. What vitamin supplementation must be given to breastfed infant? - ANS___________________ Vitamin D drops. IS weight loss normal in a newborn? -ANS___________________ Yes, an infant may lose 5 to 7 % starting after birth, but should gain is back and reach birth weight again in 2 weeks. What happens to the birth weight at 6 months? 12 months? - ANS___________________ Doubles at 6 months, triples at 12 months. What is an infant born with undescended testicle (cryptorchidism) at risk for if this is left uncorrected? -ANS___________________ Testicular cancer. When does the startle reflex, aka morrow reflex disappear? - ANS___________________ 3 to 4 months of age. When does the suckle, or rooting reflex, disappear? -ANS___________________ 3 to 4 months. A strong and exaggerated morrow reflex in an infant > 6 months of age is indicative of what? -ANS___________________ Brain damage. At what age may a flu vaccine be given to infants? -ANS___________________ 6 months of age. What age may the first MMR vaccine be given? -ANS___________________ 12 months of age. Any sooner and the immature immune system can't build up antibodies. What is the only vaccination that is given to the infant after delivery? - ANS___________________ Hepatitis B. How often do newborns eat? -ANS___________________ Every 2 to 3 hours, up to 8 to 10 times daily. Do newborns produce tears? -ANS___________________ No, the tear ducts are very immature at this stage and do not produce tears. How many hours a day do infants sleep? -ANS___________________ 16 hours daily. At what age do infants start to crawl on average? -ANS___________________ 9 months. At what age do infants begin walk? -ANS___________________ Usually around 12 months of age (9-12). What age range requires babies to sit facing rear in a car seat? - ANS___________________ Infants to 2 years of age. What aged children should always be seated in the back seat? - ANS___________________ All children 13 and younger. What is a risk of moderate to severe elevated bilirubin levels due to increased breakdown of RBCs in infants? -ANS___________________ Neurotoxic due to the binding capacity to nerves and brain tissue. What is the mainstay treatment of newborn jaundice that is moderate to severe? - ANS___________________ Phototherapy in the blue wavelength. What should one suspect if an absent or delayed femoral pulse in comparison to the brachial pulse, in a newborn is found? -ANS___________________ Coarctation of the aorta. What should one suspect in an infant with asymmetry in the crease of the legs? - ANS___________________ Hip dysplasia. What is the most common cancer in children? -ANS___________________ Acute lymphocytic leukemia. After what age is bedwetting considered abnormal? -ANS___________________ After five years of age. What is the danger of giving aspirin to a febrile child? -ANS___________________ Reyes syndrome. Progresses quickly, mortality rate is 52%. Can progress over a few hours to several days. Acute onset of severe groin pain, n/v, absent cremaster reflex, usually most common in puberty. -ANS___________________ Testicular torsion. What is the leading cause of death in adolescents? -ANS___________________ MVA. Autosomal recessive disorder consisting of an alteration in the water and chloride movement across cell membranes, leading to thickened secretions, affects the lungs, GI tract and pancreas, and leads to chronic lung disease. -ANS___________________ Cystic fibrosis. When are children first screened for lead poisoning? -ANS___________________ At 9 to 12 months and at 24 months. What is a leading risk factor for lead poisoning? -ANS___________________ Living in a place built before 1950. When are Apgars scored? -ANS___________________ 1 and 5 minutes after birth. What does APGAR stand for? -ANS___________________ Appearance (color) Pulse Grimacing Activity Respiration What is the APGAR range? -ANS___________________ 0 is critical 10 is excellent. Score between 0 and 10. When is a newborn screened for PKU? -ANS___________________ 2 days after birth and at 2 weeks. What can untreated PKU lead to? -ANS___________________ Intellectual disability, seizures, behavioral problems, and mental disorders.[1] It may also result in a musty smell and lighter skin. What area of the cranium is measured in infants? -ANS___________________ Directly above the ears and eyebrows at the largest part of the head. What area of the chest is measured in infants for circumference?? - ANS___________________ Directly over the nipple line. What should the head and chest ratio be between 6 and 24 months? - ANS___________________ 1:1 What is the normal BP range for newborns? -ANS___________________ 60/40 to 90/60 What is significant about heart rate and respiratory rate in the infant? - ANS___________________ They will both be irregular. What is an expected finding of O2 saturation in newborns? - ANS___________________ It should be 85-90%. All other age ranges should be between 95-99%. At what age does an infant usually begin to smile? -ANS___________________ 3 months of age When is toilet training usually completed in a child? -ANS___________________ 3- 4 years of age. Sometimes up to 5. At what temperature do providers normally treat a fever? - ANS___________________ 101.5 F How do you distinguish a toxic fever in a child vs a benign fever in a child? - ANS___________________ Usually in a benign illness, a child will appear better when the fever breaks. In a toxic illness, the child will still appear very ill when the fever breaks. What is the first drug of choice with a febrile child? -ANS___________________ Tylenol 10-15 mg/kg po q 4-6 hr prn. What is a non-pharmacologic intervention that can be initiated in a child with a temp >104 F -ANS___________________ Tepid sponge bath. Who should be treated if the mother or child has candidiasis with breastfeeding (nipple or mouth)? -ANS___________________ Both. What vaccinations are given at 2 months of age? -ANS___________________ B, D, R, H, I, P (2 Be Dr Hipp) which is hep B, Dtap, Rotavirus, Haemophilus, IPV, Pneumococcal What vaccinations are given at 4 months? -ANS___________________ 4 D, R, H, I, P (4 DR Hip) which is Dtap, Rotavirus, Haemophilus, IPV, Pneumococcal What vaccinations are given at 6 months? -ANS___________________ B, D, R, H, I, P, I (Be Dr HIP in 6 months) which is Hep B, Dtap, Rotavirus, Haemophilus, IPV, Pneumococcal, Influenza What vaccinations are given at 1 year? -ANS___________________ M, A, D, H, P, V (1 MAD HPV), which is MMR, Hep A, Dtap, Haemophilus, Pneumococcal, Varicella What vaccines are given at 4-6 years of age? -ANS___________________ V, D, I, M (Very DIM at 4-6 pm) which is Varicella, Dtap, IPV, MMR What vaccines are given between 11-12 years of age ? -ANS___________________ T, H, M (Tada, humans become men) at 11-12 which is Td, HPV, Meningiococcal What booster is given between 16-18 yrs of age? -ANS___________________ Meningococcal B vaccine Age infants sit independently, roll over, free head lifts in prone position? - ANS___________________ 6 months of age motor development. What age do infants crawl and sit alone well? -ANS___________________ 7 months of age gross motor development. How many germs (antigens) do normal healthy children produce daily to help fight off organisms in their environment? -ANS___________________ 2000 to 6000 daily. Who usually pays 100 % of vaccines to providers to administer to children <18 who are uninsured or on Medicaid? -ANS___________________ Vaccines For Children Program What must be included in vaccination documentation? -ANS___________________ The vaccine, lot number, person administering it, and site location. Does giving Tylenol with immunizations augment the effectiveness of giving vaccines? - ANS___________________ No, may give as needed with vaccinations. At what age is DTaP replaced with TDaP? -ANS___________________ 7 years of age. What does the Hib vaccine protect against? -ANS___________________ Protects against haemophilus influenzae type B illnesses, which include otitis media, pneumonia, meningitis, epiglottitis, pericarditis, and other infections in those less than 4 years of age. Is it permissible to give live vaccines to immunocompromised patients? - ANS___________________ No, not without consulting an infectious disease specialist. What vaccine has the highest rate of adverse effects? -ANS___________________ MMR (measles) fever up to 103 F, rash, can last 2-5 days. Is there a risk for a child acquiring chicken pox infection with the varicella vaccine? - ANS___________________ Yes, but it is a much milder illness than acquiring the actual infection. What percentage of healthy people immune and previously infected with Mono actively shed the virus at any given time? -ANS___________________ 20-30% What are the signs and symptoms of mononucleosis? -ANS___________________ Fatigue, malaise, sore throat, anterior AND posterior cervical adenitis, may have a rash. Spleenomegaly, hepatomegaly. How is mono diagnosed? -ANS___________________ Positive monospot, >20% atypical lymphocytes, can have elevated LFTs, if monospot is negative but is still highly suspected can check a viral culture or PCR to rule out mono. How is severe Hib disease treated? -ANS___________________ With Rocephin. How can chickenpox rashes be differentiated from smallpox rashes? - ANS___________________ Chickenpox will have lesions in various stages of healing. In smallpox, the rash will develop all at the same time, and take much longer to heal compared to chickenpox. When can solid foods be introduced to an infant? -ANS___________________ In 4- 6 months, and only one new food every four or five days. What treatment do we give to an infant born to a woman with positive hepatitis B surface antigen? -ANS___________________ Hepatitis B vaccine and immune globulin. How is the polio virus spread? -ANS___________________ Fecal oral route. What is possible after immunization with the OPV vaccine? - ANS___________________ Polio virus may be shed in stool after OPV vaccination. What is also known as plumbism? -ANS___________________ Lead poisoning. In a child with a lead level of 40 to 50 or higher, what treatment is usually initiated? - ANS___________________ Chelation therapy. What does RSV (respiratory syncytial virus) cause? -ANS___________________ Bronchiolitis. What are the most common cancers in teens 15-19 years old? - ANS___________________ Hodgkin's lymphoma and germ cell cancers (testicular and ovarian). How long after Tanner II stage (breast buds) do girls start to menstruate? - ANS___________________ 1 to 2 years. How is Gardasil (HPV vaccine) dosed? -ANS___________________ Give at 11 or 12 years of age. Give the second dose 6 to 12 months from the first dose. According to the new guidelines, at what age is meningococcal vaccine now given? - ANS___________________ 11 to 12 years of age. What can happen to the ALK during puberty and during growth spurts? - ANS___________________ It will be elevated due to ALK production by growing long bones. At what Tanner stage does puberty begin in boys and girls? At what Tanner stage does it end? -ANS___________________ Starts at Tanner II, ends at Tanner V. What are some labs drawn to rule out causes of amenorrhea? - ANS___________________ TSH, prolactin, LH, FSH, pregnancy test. Name some signs of anorexia nervosa? -ANS___________________ BMI <18.5, bradycardia, hypotension, osteoporosis, lanugo, amenorrhea, edema due to low albumin, frequent exercise or caloric restriction. How is scoliosis treated? -ANS___________________ Curvature less than 20 degrees, monitor. Between 20-40 degrees, Milwaukee brace. Greater than 40%, Harrington rod placement on spine. Always refer patients with scoliosis to a pediatric orthopedic specialist. Inflammation of the anterior patellar tendon of the knee due to overuse, especially during rapid growth spurts in the teenage years. Usually self-limiting and stops when growth halts. -ANS___________________ Osgood-Schlatter disease. What is the treatment of Osgood-Schlatter disease? -ANS___________________ Use RICE, Nsaids, Tylenol, activity modification, quads strengthening, hamstring stretches. At what age should a child's cholesterol (fasting lipid panel) be checked if there is a significant family history of premature (<55 in men, <65 in women) CAD? - ANS___________________ At two years of age lipids should be checked, and in 3-5 years if the values are normal. How much screen time should be the limit for pediatric patients at age 2? - ANS___________________ Limit to one to two hours of screen time daily (TV, Ipad, tablet). How much juice can a child consume daily between 6 months and 5 years of age? What type? -ANS___________________ Should consume no more than 6 oz daily, whole 100 % juice is preferred with no added sugar, may flavor water with juice. At what age is BMI screening began? -ANS___________________ 2 years of age BMI screening is began. Should a child between the ages of 6 and 11 months be vaccinated with MMR before traveling outside of the U.S.? -ANS___________________ Yes, they should receive at least one MMR vaccine before traveling. How is MMR given to children who have no history of MMR vaccination? - ANS___________________ Two doses will be given, one month apart. Who should be serologically tested for immunity to rubella? - ANS___________________ Pregnant women or those who could become pregnant. In children younger than 8 years of age who have never been vaccinated against influenza, how is the first vaccine given? -ANS___________________ They receive 2 doses of influenza vaccine, 4 weeks apart. What BMI is considered obesity in childhood? -ANS___________________ BMI of 95% or greater for age. 17% of children meet this criteria. At what level does the lead level raise concern for public health? - ANS___________________ Levels >10 raise concern. Why is lead screening and detection of plumbism so imperative in the very young pediatric patient? -ANS___________________ Lead toxicity affects the growing brain (child's brain reaches 95% of the adult size at 2 years of age). What labs can be checked to investigate suspected IDA in pediatric patients? - ANS___________________ Cbc with indices, serum iron level, TIBC, ferritin, lead level When in childhood does sickle cell anemia usually start to present with symptoms? - ANS___________________ In the second half (6 months) of the first year of life as hemoglobin F decreases and hemoglobin S increases. Children with sickle cell anemia have increased risk for infections (leading cause of death in SCA children). What is given prophylactically to reduce infection in this age group? -ANS___________________ Penicillin bid is initiated at 2 months of age, and continued until the child is 5 years of age (Or until the child has received two doses of PPSV23). . For children with severe Sickle cell anemia and frequent crises, what drug can be initiated? -ANS___________________ Hydroxyurea, a gentle DNA synthesis inhibitor. Autoimmune response to a viral illness in which platelets are destroyed. Most cases resolve within 6 months, occurs between children 1 and 4 years old. - ANS___________________ ITP (idiopathic thrombocytopenic purpura) What are some signs and symptoms of ITP? -ANS___________________ Platelet count <150,000, may be as low as 20,000, nosebleeds, bruising, petechiae, viral symptoms 1 to 4 weeks before onset of bleeding symptoms. How is ITP with a platelet count >20,000 treated? -ANS___________________ Avoidance of aspirin, NSAIDS, contact sports, and injuries. May use corticosteroids if platelets <20,000. What is the greatest concern regarding a child with ITP? - ANS___________________ Rare risk of intracranial hemorrhage. Watch for signs of headache.