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NU 664 Exam 1 with verified solutions
Gold |standard |for |CAP |diagnosis: |- |correct |answer |✔Chest |x-ray
If |CAP |symptoms |present |but |no |obvious |signs |of |infection |on |CXR |treatment
|is... |- |correct |answer |✔Same |as |if |CXR |was |positive
Immunizations |for |people |over | 65 |or |younger |people |with |comorbidities |such
|as |asthma, |CHF |COPD: |- |correct |answer |✔Pneumonia |and |flu |vaccines
Who |is |at |risk |for |CAP? |- |correct |answer |✔Extremes |of |age, |smokers, |alcoholics, |GERD, |chronic |disease, |institutionalization
CAP |presentation |in |adults: |- |correct |answer |✔Cough |(may |be |nonproductive), |dyspnea, |fever, |hemoptysis, |chest |pain, |fatigue, |tachycardia
If |lymphocytes |are |elevated? |- |correct |answer |✔Indicative |of |viral |process
If |monocytes |are |elevated? |- |correct |answer |✔Indicative |of |chronic |process
If |eosinophils |are |elevated? |- |correct |answer |✔Indicative |of |asthma, |allergic |reaction
If |basophils |are |elevated? |- |correct |answer |✔Indicative |of |chronic |process
If |neutrophils |are |elevated? |- |correct |answer |✔Indicative |of |acute |bacterial |process
CAP: |patient |present |with |symptoms |of |chills, |fever, |chest |pain, |productive |cough |with |purulent |sputum, |positive |chest |x-ray, |and |patient |had |URI |last
|week? |- |correct |answer |✔Streptococcus |pneumonia: |gram |+
In |the |United |States, |the |most |common |cause |of |myocarditis |in |children |is: |-
|correct |answer |✔Viruses
Your |next |patient |is |a |5-year-old |child |with |a |history |of |moderate |persistent |asthma. |He |has |been |wheezing |and |coughing |for |the |past |two |days, |and |his |mother |brings |him |in |today |for |evaluation. |He |has |been |using |albuterol |every |four |hours. |His |respiratory |rate |is | 13 |breaths |per |minute; |his |lungs |are |clear |to |auscultation; |and |no |retractions |are |noted. |What |may |be |your |assessment |and
|intervention |based |on |this |information? |- |correct |answer |✔Your |child |is |breathing |slower |than |normal |for |his |age. |We |need |to |send |him |to |the |ER |for |further |intervention.
Your |next |patient |is |a |6-year-old |male |here |for |his |annual |influenza |vaccine. |He |has |a |history |of |mild |persistent |asthma. |What |would |you |discuss |for
|medications |when |reviewing |his |asthma |action |plan? |- |correct |answer |✔Your |child |should |continue |his |low-dose |inhaled |corticosteroid |daily |and |add |albuterol |as |needed |for |an |exacerbation.
A |child |who |has |been |diagnosed |with |asthma |for |several |years |has |been |using |a |short-acting |Beta-agonist |(SABA) |to |control |symptoms. |The |PNP |learns |that |the |child |has |recently |begun |using |the |SABA |2-3 |times |each |week |to |prevent
The |parent |of |a |1-week |old |is |concerned |about |the |unusual |shape |of |their |child's |head. |In |the |physical |exam, |which |of |the |following |signs |would |not
|support |the |diagnosis |of |craniosynostosis? |- |correct |answer |✔A |palpable |lesion |at |the |occipital |region.
A |toddler |exhibits |exotropia |of |the |right |eye |during |a |cover-uncover |screen. |The |PNP |will |refer |to |pediatric |ophthalmologist |to |initiate |which |treatment? |-
|correct |answer |✔Patching |the |unaffected |eye |for | 2 |hrs./day
The |most |typical |radiograph |finding |with |a |diagnosis |of |asthma |- |correct |answer
|✔Hyperinflation
Nasal |mucosa |pale, |boggy |and |edematous |with |allergic |shiners |- |correct |answer
|✔Allergic |rhinitis
The |category |on |your |asthma |action |plan |when |you |have |had |exposure |to |a |known |trigger, |are |coughing |with |wheezing, |have |a |tight |chest |and |are
|coughing |at |night. |- |correct |answer |✔Yellow |or |cautious |phase
Classification |of |asthma |severity |for |a |child |who |is | 6 |years |old |who |has |symptoms | 3 |days |a |week, |uses |his |inhaler |daily |for |exercise, |but |not |otherwise, |has |minor |limitation |to |activity |and |wakes | 3 |times |a |month |with |cough |-
|correct |answer |✔mild |persistent |asthma
Should |not |be |used |to |treat |asthma |in |children |under |the |age |of |4? |- |correct
|answer |✔dry |powder |inhalers
In |addition |to |the |routine |PCV | 13 |vaccine |series, |sickle |cell |anemia |patients |older |than | 2 |years |of |age |should |receive |this |once |and |then |a |booster |in | 5
|years. |- |correct |answer |✔PPSV
cradle |cap |or |seborrheic |dermatitis |- |correct |answer |✔Often |treated |with |Selsun |blue |shampoo.
Bilateral |conjunctival |injection, | 5 |days |of |fever, |cervical |lymphadenopathy, |polymorphous |exanthema, |changes |in |peripheral |extremities |- |correct |answer
|✔Kawasaki |Disease
First |line |treatment |for |allergic |rhinitis |- |correct |answer |✔Oral |H |antihistamines |and/or |intranasal |steroids
Treatment |for | 3 |year |old |with |intermittent |asthma |- |correct |answer |✔SABA |prn |(Albuterol |and |levalbuterol)
Treatment |for |Kawasaki |- |correct |answer |✔IVIG |and |High |dose |aspirin
A |9-year-old |boy |presents |with |a |fever |of | 102 |and |leg |pains. |Mother |reports |he |had |an |upper |respiratory |infection |with |a |sore |throat |approximately | 2 |weeks |ago |which |subsided |without |therapy. |On |physical |exam, |he |has |tender, |swollen |knees |bilaterally. |His |heart |rate |is | 120 |beats |per |minute |and |a |blowing |systolic |murmur |is |heard |at |the |apex. |No |murmur |previously |noted. |The |most |likely
|diagnosis |is. |- |correct |answer |✔Rheumatic |Fever
labs |for |rheumatic |fever |- |correct |answer |✔ASO |Titer
A | 12 |day |old |concerned |about |breathing. |Feeding |stops |breathing |for | 10 |seconds. |Eats |well |never |appeared |pale/cyanotic, |and |has |never |become |limp |during |any |of |these |episodes. |What |would |the |PNP |discuss |w/ |the |parents? |-
|correct |answer |✔I |know |this |can |be |concerning. |This |can |be |a |normal |variant |for |infants.
A |child |is |diagnosed |with |community |acquired |pneumonia |and |will |be |treated |as |an |outpatient. |Which |antibiotic |will |the |PNP |choose? |- |correct |answer
|✔Amoxicillin
A |school-aged |child |has |had |nasal |discharge |and |a |daytime |cough |but |no |fever |for | 12 |days |without |improvement |in |symptoms. |The |child |has |not |had |antibiotics |recently |and |there |is |no |significant |antibiotic |resistance |in |the |local |community. |What |is |the |appropriate |treatment |for |this |child? |- |correct |answer
|✔Amoxicillin |45mg/kg/day |(treatment |of |acute |rhinosinusitis |(ARS) |based |on |duration |of |symptoms |without |clinical |improvement |in |symptoms)
The |parent |of |a |3-month |old |reports |that |the |infant |arches |and |gags |while |feeding |and |spits |up |undigested |formula |frequently. |The |infant's |weight |gain |has |dropped |to |the |5th |percentile |from |the |12th |percentile. |What |is |the |best
|course |of |treatment |for |this |infant? |- |correct |answer |✔Begin |a |trial |of |extensively |hydrolyzed |protein |formula |for |2-4 |weeks.
PNP |performs |the |vision |screen |on |a |four |month |old |and |notes |the |presence |of |convergence |and |accommodation |with |esotropia |of |the |1eft |eye. |What |will |the
|NP |do? |- |correct |answer |✔Refer |the |infant |to |a |pediatric |ophthalmologist
What |radiographic |finding |is |diagnostic |for |croup? |- |correct |answer |✔Steeple |sign |(Subglottic |airway |narrowing |at |the |cricoid |cartilage)
A |school-age |child |who |has |an |abrupt |onset |of |sore |throat, |nausea, |headache, |and |a |temperature |of |102.3 |F. |An |examination |reveals |petechiae |on |the |soft |palate, |beefy-red |tonsils |with |yellow |exudate, |and |scarlatiniform |rash. |A |rapid |antigen |detection |test |(RADT) |is |negative, |what |is |the |next |step |in |the
|management |for |this |child? |- |correct |answer |✔Perform |a |follow-up |throat |culture
Fluorescein |staining |could |be |used |to |detect |this. |- |correct |answer |✔Corneal |abrasion
Confirming |the |diagnosis |that |newborn |chlamydia |conjunctivitis |would |be |best
|done |by |obtaining |this. |- |correct |answer |✔Culture |of |conjunctival |scrapings
Acute |sudden |onset |high |fever, |severe |sore |throat, |muffled |voice |drooling, |choking |sensation |restless |with |hyper |extension |of |neck. |- |correct |answer
|✔Epiglottitis
Helps |with |the |prevention |of |epiglottitis |- |correct |answer |✔Hib |Vaccine
What |is |the |drug |of |choice |for |treating |pertussis? |- |correct |answer
|✔Azithromycin |10mg/kg |x |5days
Sneezing, |discomfort |and |unilateral |purulent |it |malodorous |or |bloody |nasal
|discharge |is |a |sign |of. |- |correct |answer |✔nasal |foreign |body
First |line |therapy |for |AOM |- |correct |answer |✔Amoxicillin |(cefdinir |if |allergy)
Second |line |therapy |for |AOM |- |correct |answer |✔Augmentin |(no |improvement |48-72 |hrs, |recurrence |within | 1 |month, |concomitant |conjunctivitis)
Third |line |therapy |for |AOM |- |correct |answer |✔Ceftriaxone
If |allergic |to |penicillin |what |do |you |treat |the |AOM |with |- |correct |answer
|✔Cephalosporin
If |a |child |is |being |treated |for |an |AOM |and |is |vomiting |or |unable |to |tolerate |oral
|medication |what |do |you |prescribe |- |correct |answer |✔Rocephin |IV |or |IM
Otitis |media |with |effusion |what |is |the |most |common |organism |- |correct |answer
|✔H. |influenzae
What |is |the |most |common |cause |of |hearing |loss |in |children |- |correct |answer
|✔otitis |media |with |effusion
Refer |to |ENT |for |AOM |- |correct |answer |✔Persistent, |resistant |to |treatment |over |1-2 |months; | 3 |infections |in | 6 |months |or | 4 |infections |in | 1 |year
Management/treatment |of |OME |- |correct |answer |✔Most |cases |resolve |w/o |abx |Limit |use |of |abx |prophylaxis |due |to |marginal |benefit |Limit |passive |smoking
|exposure, |control |allergies |Referral |to |ENT |if |persists |>3 |months |f/u |every |3- |weeks
Treatment |for |chlamydia |conjunctiva |- |correct |answer |✔Systemic |Erythromycin |50mg/kg/day |in |four |divided |doses |for | 14 |days |or |Azithromycin |20mg/kg |for | 3 |days |(not |topical)
Chlamydia |conjunctiva |symptoms |- |correct |answer |✔Begins |5-14 |days |of |life |up |to | 6 |weeks; |moderate |eyelid |swelling |and |palpebral |or |bulbar |conjunctival |injection |and |moderate, |thick, |purulent |discharge, |assess |for |systemic |infection |(pharyngitis, |ear |infection, |pneumonia)
At | 12 |months |of |age |the |head |and |chest |circumference |should |be |- |correct
|answer |✔Equal
Mastoiditis |- |correct |answer |✔suppurative |infection |of |the |mastoid |cells |that |may |occur |with |AOM |or |follow |an |AOM, |mucoperiosteal |lining |of |the |mastoid |air |cells |becomes |inflamed |with |subsequent |progressive |swelling |and |obstruction |caused |by |drainage |from |the |mastoid
What |vaccines |decrease |the |incidence |of |mastoiditis |and |what |are |the |two
|most |common |causes? |- |correct |answer |✔Hib |and |S. |pneumoniae |are |the | 2 |common |causes |Pneumococcal |vaccine |decreases |incidence
Mastoiditis |management |and |treatment |- |correct |answer |✔Urgent |ENT |referral, |hospitalization, |abx, |myringotomy, |tube |placement, |mastoidectomy
Management/treatment |of |retinoblastoma |- |correct |answer |✔Curable |if |diagnosed |early |Urgent |referral |to |pediatric |ophthalmologist; |eval |within | 72 |hours |Chemo, |radiation, |laser |therapy |and/or |surgical |removal |Genetic |counseling
Hordeolum |- |correct |answer |✔Infection |of |meibomian |glands |(internal) |or |glands |of |Zeis |or |Moll |(external |or |stye) |of |eyelid
Treatment |of |hordeolum |- |correct |answer |✔Warm |compress |May |use |topical |anti-infective |ointment |(erythromycin |or |bacitracin/polymyxin |B) |Refer |if |mass |fails |to |disappear |after |several |weeks
Retinopathy |of |Prematurity |(ROP) |- |correct |answer |✔Involves |abnormal |growth |of |retinal |vessels |in |incompletely |vascularized |retinas |of |premature |infant
Ocular |misalignment |after |age | 4 |months |- |correct |answer |✔Considered |suspicious |Child |should |be |referred
Periorbital |cellulitis |- |correct |answer |✔Inflammation |and |infection |of |eyelids |and |periorbital |tissue |Treatment: |If |concerned |for |MRSA |use |monotherapy |of |clindamycin |or |combo |with |oral |trimethoprim-sulfamethoxazole |and |amoxicillin |or |amoxicillin-clavulanate, |cefpodoxime, |of |cefdinir
Hyphema |- |correct |answer |✔blood |in |the |anterior |chamber |of |the |eye, |refer |to |ophthalmologist
Nasolacrimal |duct |obstruction |(dacryostenosis) |- |correct |answer |✔defect |of |lacrimal |drainage |system |resulting |in |blockage |Treatment: |Massage |lacrimal |sac |several |times |a |day |If |secondarily |infected |treat |with |anti-infective |Refer |to |ophthalmologist |if |not |resolved |by | 12 |months |of |age
Corneal |abrasion |- |correct |answer |✔Scratched, |abraded, |or |denuded |cornea, |May |see |uneven |light |reflection |or |cloudiness |of |cornea |May |see |foreign |body |After |staining |with |fluorescein |and |using |cobalt-blue |light |or |Wood's |lamp |will |see |area |of |green |staining |(persists |with |blinking) |Decreased |visual |acuity |Instill |topical |ophthalmic |anti |infective |ointment |Patching |not |recommended
Allergic |conjunctivitis |clinical |pearls |- |correct |answer |✔ • |Cold |compresses | • |Lubricants | • |Topical |antihistamines/decongestants/NSAIDs/mast |cell |stabilizers | • |Systemic |antihistamines |Avoid |rubbing |eyes |Handwashing |Will |last |about |10- 14 |days
Bacterial |conjunctivitis |medications |- |correct |answer |✔Erythromycin |ophthalmic |ointment |Trimethoprim-polymyxin |B |ophthalmic |ointment |or |drops |(Polytrim) |>2 |months |old |Moxifloxacin |or |Moxeza |(>4 |months |old) |Levofloxacin |(>1 |year |old) |Treat |conjunctivitis-otitis |syndrome |for |otitis |only, |concurrent |use |of |topical |abx |not |needed
Pneumonia |treatment | 3 |months-5 |years: |- |correct |answer |✔amoxicillin |90mg/kg/d |w |or |w/o |azithromycin |for |7-10 |days
Pneumonia |treatment | 5 |or |older: |- |correct |answer |✔azithromycin |or |amoxicillin |90mg/kg/d |for |7-10 |days |or |penicillin |G
Underlying |lung |diseases |in |older |patients |(COPD) |Abrupt |onset |Fever, |cough, |chills, |purulent |sputum |Pleuritic |chest |pain |(+/-) |Physician |exam |and |chest |xray
|consistent |with |consolidation |- |correct |answer |✔Hemophilus |influenza: |Gram |-
Extremely |ill |patients |(inpatient |ICU) |Often |follows |post |influenza |pneumonia |Complications |can |include: |empyema, |lung |abscess, |pneumothorax |- |correct
|answer |✔Staphylococcus |aureus: |Gram |+
ETOH |Abuse/Debilitated |Patients |Dense |consolidation |usually |in |upper |lobe |"Current |jelly" |sputum |Increased |mortality |rate |(25-50%) |- |correct |answer
|✔Klebsiella |pneumonia: |Gram |-
Common |in |structural |lung |disease- |CF |patient |Steroid |Therapy |Malnutrition
|Antibiotic |therapy |within |the |past |month |- |correct |answer |✔Pseudomonas |aeruginosa: |Gram |-
Nonbacterial |and |bacterial |organisms |that |do |not |share |the |expected |characteristics |of |most |bacteria. |Younger |population |generally |- |correct |answer
|✔ATYPICAL |ORGANISMS
Insidious |onset: |headache, |sore |throat, |malaise |Usually |in |persons |<35 |years |old |Nonproductive, |dry |cough |Usually |milder, |but |may |take |up |to | 6 |weeks |to |resolve |10-20% |develop |maculopapular |rash |Normal |CBC, |unimpressive |exam,
|negative |sputum |- |correct |answer |✔MYCOPLASMA |PNUEMONIA
Begins |with |severe |sore |throat |Similar |in |presentation |to |mycoplasma |Cough, |fever, |usually |milder |Occurs |in |those |in |close |living |facilities |- |correct |answer
|✔CHLAMYDOPHILA |PNA
Water/contaminated |aerosols/plumbing |Mild |self |limited |to |severe |with |respiratory |failure |Risk |factors: |COPD, |smoking, |DM, |immunocompromised |-
|correct |answer |✔LEOGINELLA |PNA |***
Outbreaks |seen |in |communities/facilities |Starts |with |URI |but |progresses |to |paroxysms |of |coughing |(nonproductive |"whoop"), |convalescent |phase |can |last
|1-3 |months |- |correct |answer |✔Nasal |swab |or |serology |if |patient |presenting |later |in |course |BORDATELLA |PERTUSIS
*NEW |GUIDELINES |FOR |THE |U.S. |DUE |INCREASED |TO |S. |PNEUMONIAE |>25%
|CAP |(WITHOUT) |COMORBIDITY |OR |RECENT |ABX |USE(within | 3 |mos)* |- |correct
|answer |✔Doxycycline |100mg |bid
TREATING |CAP |IN |PREGNANCY |- |correct |answer |✔Consider |combination |BETA |LACTAM |therapy |with: |ceftriaxone, |cefuroxime, |or |ampi-sulbactum |+ |Azithromycin
Mild |COPD |PFT |- |correct |answer |✔>80%
Moderate |COPD |PFT |- |correct |answer |✔50-79%
Severe |COPD |PFT |- |correct |answer |✔30-49%
