NUR-629 PEDS EXAM 2 CORRECTLY ANSWERED QUESTIONS GRADED A+| 100% VERIFIED| 2023\2024, Exams of Pediatrics

Download NUR-629 PEDS EXAM 2 CORRECTLY ANSWERED QUESTIONS GRADED A+| 100% VERIFIED| 2023\2024 and more Exams Pediatrics in PDF only on Docsity! NUR-629 PEDS EXAM 2 CORRECTLY ANSWERED QUESTIONS GRADED A+| 100% VERIFIED| 2023\2024 Strabismus Correct Answer: Misalignment of the eyes. Lazy eye or cross-eyed. Results in loss of depth perception and double vision. Assessment techniques to detect strabismus Correct Answer: Red light reflex Cover-uncover test Deviation of the weak eye outward Correct Answer: Exotropia Deviation of the weak eye inward Correct Answer: Esotropia Visual axis of one eye is higher than the fellow fixating eye Correct Answer: Hordeolum Correct Answer: Sty; an acute infection of a sebaceous gland of the eyelid Obstruction of the sebaceous glands or eyelid. Staphylococcal aureus is the most common causative organism. What might a patient with a hordeolum complain of Correct Answer: Swollen, red, painful lesion on the lid margin Itchiness of the eyelid Pimple or abscess in either lid External - next to eyelash Internal - under eyelid Painful swelling Typically develops suddenly Treatment for a hordeolum Correct Answer: Warm compresses-20 minutes qid Antimicrobial ointment or drops Good eye hygiene and hand washing Chalzion Correct Answer: Chronic inflammation of the eyelid. Blocked meibomian gland - may result from internal hordeolum. Often not painful but sensation of pressure. Develop over weeks to months. Clinical finding of chalzion Correct Answer: Mild erythema and edema of the eyelid that resolves and results in a painless, non-pigmented mass Itchiness of the eyelid Pimple or abscess in either lid External - next to eyelash Treatment of chalzion Correct Answer: Erythromycin drops or ointment if hordeolum is present Cellulitis develops - treat with erythromycin or cephalexin Most important vital sign for a patient with an eye complaint Correct Answer: Visual acuity Peritonsillar abscess (PTA) Correct Answer: Collection of pus or fluid around the tonsil Symptoms of PTA Correct Answer: Increased fever Anorexia Drooling Dyspnea Restless & irritable Muffled voice Stridor Respiratory distress Physical exam findings of PTA Correct Answer: Fiery red asymmetric swelling of one tonsil Uvula is often displaced and often forward Large, tender lymphadenopathy Management of PTA Correct Answer: Aspiration of the abscess may be performed for accurate diagnosis and treatment. CT scan of the head and neck Monitor airway at all times ENT consult is essential Usual Management - IV antibiotics - Inpatient management Benzocaine Warm/cold compress of ears 1st line of treatment for AOM Correct Answer: Amoxicillin 80 - 90 mg/kg/day BID for 10 days If use of antibiotics for AOM in last 3 monthsm, antibiotic of choice? Correct Answer: Augmentin 80 - 90 mg/kg/day BID for 10 days If either Amoxicillin or Augmentin fail, referal to ENT Alternative antibiotic management of AOM if PCN allergy Correct Answer: 1st line: Cefdinir, cefuroxime 2nd line: Azithromycin, clarithromycin 3rd line: Rocephin 1 or 3 days IM Bullous Myringitis Correct Answer: Mycoplasma pneumonia AOM in which bullae form between the inner and middle layers of the TM and bulge outward Intensely painful Treat with a macrolide When do you refer a pt for tympanostomy tubes? Correct Answer: Over 3 confirmed ear infections in 6 months OR 4 or more episodes in 12 months Treatment of children with AOM and tympanostomy tubes Correct Answer: Oral antibiotics + topical: Floxin otic (Ofloxacin) [1 yr - 12 yr] 0.3% - 5 gtts BID x 10 days Ciprodex (Cipro) [>6 months] 4 gtts BID x 7 days perforated tympanic membrane Correct Answer: Hole in eardrum Occurs in association with AOM Trauma - blow to ear, blasts, ear cleaning, FB insertion Perforated Tympanic Membrane s/s Correct Answer: Loss of hearing Blood drainage from the ear Pain Whistling sound when blowing nose or sneezing Spontaneous relief of pain w/ AOM What medications are NOT safe to give with a perforated tympanic membrane? Correct Answer: Gentamycin Neomycin Tobramycin What medications are SAFE to give with a perforated tympanic membrane? Correct Answer: Fluoroquinolones Cholsteatoma Correct Answer: Result of chronic ear infections Involves the formation of an epidermal inclusion cyst of the middle ear or mastoid As it grows, destroys the surrounding structures Acquired or congenital S/S vertigo, hearing loss,pearly white lesion on or behind TM Mastoiditis Correct Answer: Suppurative infection of the mastoid cells Most common in children < 2 y.o. Accompanies AOM Antibiotics for AOM may mask mastoiditis w/ normal TM S/S: fever, otalgia, concurrent AOM unresponsive to antibiotics, postauricular swelling Urgent ENT referral At what age should visual screening begin? Correct Answer: 4 Can use the objects chart or E chart If strabismus is still present at what age should they ber refered for intervention? Correct Answer: 6 months At what age: Sees and responds to change in light, fixes on contrasts, jerky eye movements, pupillary reflex present Correct Answer: Birth to 2 weeks At what age: Recognizes parent's smile, looks from near to far, focuses close again, beginning depth perception, follows 180 degrees, reaches towards toy, few exodeviations, esotropia abnormal Correct Answer: 3 - 4 months At what age: Color vision near that of an adult, tears present Correct Answer: 4 months At what age: Vision is close to fully developed Correct Answer: 12 months How to differentiate a hordeolum from a chalzion Correct Answer: Hordeolum - PAINFUL, ACUTE Chalzion - not painful, chronic What is ophthalmia neonatorum? Correct Answer: Conjunctivitis in the first month of life *Neisseria*: Occurs 3-4 days, copious discharge, marked chemosis, and can ulcerate and perforate cornea. Rx IM ceftriaxone w/ copious irrigation *Chlamydia*: 1 week, mild swelling, hyperemia, and papillary rxn (follicular later in life). Oral erythromycin *HSV*: Rare, presents in 2nd week of life Chemical: Mild self-limited irritation within 24h Most common cause of viral conjunctivitis Correct Answer: Adenovirus Symptoms of viral conjunctivitis Correct Answer: **Watery discharge - profuse & clear FB sensation Redness **URI symptoms common - sore throat & fever, preauricular lymphadenopathy Itchy conjuctiva Swollen eye lids **Often bilateral Treatment for viral conjunctivitis Correct Answer: Warm or cool compresses Strict eye hygiene Comfort Common causes of bacterial conjunctivitis (pink eye) Correct Answer: staph strep haemophilus Higher supplemental O2 causes slowed VEGF = slowed vessel growth What is blepharitis? Correct Answer: Acute or chronic inflammation of eyelash follicles or meibomian sebaceous glands Bilateral Contaminated makeup or contact lens solution Corenal abrasion and symptoms Correct Answer: Damage to or loss of epithelial cells of cornea Severe pain and photophobia Tearing Decreased vision Conjunctival erythema Sensation of FB Management of corneal abrasion Correct Answer: Minor abrasions heal spontaneously w/o scarring; topical anti-infectives; compresses Refer severe corneal injuries Otitis externa Correct Answer: Swimmer's ear- infection of outer ear Can involve the pinna or TM Most common pathogens of otitis externa Correct Answer: Pseudomonas & Staph Signs/Symptoms of otitis externa Correct Answer: Pain, severe, esp. w/ movement of the tragus (pushed) or pinna (pulled) Swollen EAC - may not be able to see TM which may be perf'd Red, crusty, or pustular speading lesions **Unilateral Low-grade fever Fullness Decreased hearing Differentials for otitis externa Correct Answer: AOM w/ perforation Chronic suppurative otitis media Necrotizing OE Mastoiditis Dental infection Eczema Herpes Zoster FB Treatment of otitis externa Correct Answer: Antibiotic ear drops; aminoglycoside or fluorquinolone +/- corticosteroid Avoid further moisture or ear injury Warm compresses NSAIDs/Tylenol Wick - if greater than 50% obstructed Auralgan - OTC benzocaine Diabetic or immunocompromised patients may develop malignant otitis externa (necrotizing infection extending into blood vessels, bone and cartilage) requiring hospitalization and IV ABX Prevention of Otitis Externa Correct Answer: Avoid prolonged exposure to moisture Eliminate self-inflecting trauma to canal w/ cotton swabs & other foreign objects Use ear plugs when swimming Mixing 1 drop of alcohol w/ 1 drop of white vinegar - after ears get wet. Good tip for surfers Blow dryer to ears after getting them wet What factors should be considered when choosing the otic drop for otitis externa Correct Answer: - efficacy - resistance patterns - low incidence of adverse effects - cost - likelihood of compliance Which drugs are known to cause damage to the cochlea if the TM is NOT intact Correct Answer: Neomycin Polymyxin Hydrocortisone Education of instillation of otic drops for OE to the parents Correct Answer: -Child should be lying on side, affected ear up - Fill the EAC with drops - Move the pinna to-and-fro or pump the tragus to remove any trapped air - Remain lying down for 3 - 5 minutes. Open to air. Treatment of otitis externa if caused by impetigo Correct Answer: - Clear canal using water or antiseptic solution - Follow w/ warm water rinse -Apply antibiotic ointment - mupirocin BID x 5 - 7 days Which of the 4 sinuses are not developed until 1 year of age? a. Frontal b. Maxillary c. Ethmoid d. Sphenoid Correct Answer: a. Frontal Sinusitis Correct Answer: Infection/inflammation of the nasal sinuses Bacterial vs. viral URI symptoms >10 days w/o improvement - symptoms worse on day 6 or 7 of URI Severe symptoms with high fever AND purulent drainage at onset lasting 3 to 4 days (Must have both) Sinusitis management Correct Answer: -Because the vast majority of acute sinusitis cases are caused by viruses, antibiotics are largely unhelpful -Antimicrobial therapy indicated for acute uncomplicated bacterial sinusitis -Empirical antibiotic therapy for 7 to 10 days; Augmentin; avoid Macrolides due to increasing resistance to S. pneumonia (33% of bacterial etiology); avoid Bactrim due to resistance of S. pneumonia and H influenza (32% of bacterial etiology) -Saline nasal spray -Dedicated sinus irrigation two or more times a day -Oral analgesics for pain -Expectorants such as guaifenesin to liquefy sinus secretions and facilitate drainage -Anti-inflammatory topical steroids in nasal spray preparations Causes of epistaxis in pedatric population Correct Answer: Most common: Trauma Allergies Recent URI Dry air Others: LFTs Rapid strep EBV specific antibodies - VCA-IgM, VCA-AgG, EA, & EBNA Should concurrent strep with mono be treated with amoxicillin or PCN? Correct Answer: No, avoid rash by treating with erythromycin or a macrolide How frequently should a mono patient follow-up? Correct Answer: Every 1 - 2 weeks until symptoms have resolved. Thrush (oral candidiasis) Correct Answer: candidiasis of mouth characterized by white, creamy patches of exudate on inflamed oral mucosa and tongue Common in breast fed patients, immunocompromised patients, or patiens who use inhaled corticosteroids Physical exam findings of thrush Correct Answer: Friable, adherent white plaques that won't scrape away Cracked lips Fissured and inflamed corners of lips Treatment for thrush Correct Answer: Nystatin suspension QID until patches are gone for 1 - 2 days Breastfeeding mother should put solution on nipples to prevent reinfection Ankyloglossia (tongue tie) Correct Answer: developmental anomaly characterized by a shortened lingual frenum that limits movement of the tongue. Can cause speech problems, periodontal defects, and problems with breast feeding. More common in males Treatment of Ankyloglossia Correct Answer: frenectomy observation - depending on severity What are the 2 most common keratolytics used in the 1st line treatment of mild acne? Correct Answer: Benzoyl peroxide Retinoic acid Oral retinoid used to treat nodulocystic acne not responsive to other treatments? Correct Answer: Isotretinoin (acutane) Topical antibiotics for acne Correct Answer: Abx (clindamycin, erythromycin, & sufacetamide) ↓ P. acnes and ↓ inflammation; well tolerated, MUST USE WITH BENZOYL PEROXIDE (or else tolerance) Oral antibiotics for acne Correct Answer: Tetracycline, Amoxicillin/Ampicillin, Doxycycline, Minocycline, Septra, Erythromycin What is impetigo? Correct Answer: Contagious bacterial infection marked by clusters of small blisters Has 2 forms: 1. Nonbollus - honey-colored crusts on the lesions 2. Bollous **Consider MRSA Signs/Symptoms of impetigo Correct Answer: Classic signs and symptoms of impetigo: -Red sores that quickly rupture, ooze for a few days and then form a yellowish-brown crust. -The sores usually occur around the nose and mouth but can be spread to other areas of the body by fingers, clothing and towels. -Bullous impetigo, may feature larger blisters that occur on the trunk or diaper area of infants and young children. -Pruritus -Weakness, fever, and diarrhea w/ bullous impetigo Findings from physical examination of impetigo Correct Answer: Classic: -1- to 2-mm erythematous papules or pustules that progress to vesicles or bullae -Honey colored crusty lesions on mildly erythematous, eroded skin - Little pain -Spreads rapidy Differential diagnosis for impetigo Correct Answer: Herpes simplex Varicella Nummular eczema Contact dermatitis Tinea Scabies How do you diagnose impetigo? Correct Answer: Gram Stain & culture - S. aureus (G+, Cocci, clusters) Physical exam Management of impetigo Correct Answer: -Mupirocin or bactroban TID x 7-14 days if only a few lesions - Bacitracin TID x 7 - 14 days - Keflex (40 mg/kg/day x 10 days) or Erythromycin (30 - 50 mg/kg/day x 10 days) if systemic - Treatment fx switch to Septra b/c worry about MRSA -Reevaluate in 3-5 days -Gently wash with antibacterial soap to remove crust if Bactroban is used - Highly contagious - no school or daycare for 24 to 48 hrs - Wash sheets and pillowcases -Monitor for serious sequelae Macule Correct Answer: - flat, colored spot on the skin - Nonpalpable - <1 cm Papule Correct Answer: small, solid skin elevation < 1 cm Patch Correct Answer: A flat, discolored area on the skin > than 1 cm Vesicle Correct Answer: Fluid-filled < 1 cm Pustule Correct Answer: Raised spot on the skin containing pus < 1 cm Plaque Correct Answer: Raised, palpable a solid mass greater than 1 cm in diameter and limited to the surface of the skin Bullae Correct Answer: fluid filled blisters > 1 cm Cyst Correct Answer: Raised, encapsulated, fluid-filled Wheal Correct Answer: raised red skin lesion due to interstitial fluid Circumscribed skin edema Crusts Correct Answer: Areas of dried pus and blood, commonly called scabs Varied colors