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NURS 629 EXAM 4 QUESTIONS AND
ANSWERS
1. What are the two types of biliary atresia?
ANS fetal- noted in womb (other defects like heart, spleed, intestines) perinatal- appears 2-4 weeks after birth
2. What is hypospadias?
ANS Hypospadias is a birth defect in boys in opening of the urethra is not located at the tip of the penis.
3. What are the Clinical signs of premature adrenarche
ANS Premature adrenarche (PA) refers to the presentation of androgenic signs - appearance of pubic and axillary hair, adult-type body odor, oily hair, acne or come dones - before the age of 8 years in girls or 9 years in boys in the absence of central puberty
4. What is physiological jaundice?
ANS -occurs when baby accumulates bilirubin -secondary to immature liver in newborns -common first 2-4 days of life and resolves by 2 weeks
5. What does a positive coomb's test in a pregnant mother mean
ANS may lead to physiological jaundice in child she developed antibodies IgG and may lead to hemolytic disease in newborn
6. What level is conjugated hyperbilirubinemia?
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ANS serum conjugated bilirubin concentration greater than 1 mg/dL if the total bilirubin is less than 5.0 mg/dL or more than 20% of the total bilirubin if the the total bilirubin is greater than 5 mg/dL (p. 862 AAP book)
7. What is breastfeeding jaundice?
ANS -due to poor intake that causes lack of stools and urine output -common in the first week and resolves once milk comes in and the infant is feeding well-more stools and urinary output -peaks around 2-3 weeks
8. How do you diagnose jaundice?
ANS -dx with a bili level of 5 mg/dL -12 mg/dL threshold for all newborns having jaundiced appearan -direct/indirect bili levels -CBC -reticulocyte count
9. How do you treat jaundice?
ANS increased intake indirect sunlight phototherapy IV fluids
10. What are other causes of jaundice?
ANS abnormal blood cell shapes (like sickle cell)
-LFTs -abdominal x-ray -abdominal US -liver bx
15. How do you treat biliary atresia?
ANS surgery (Kasai procedure) liver transplant
16. What are signs and symptoms of Intussusception?
ANS paroxysmal, episodic abdominal pain with vomiting every 5 to 30 minutes, drawing up of legs with periods of rest, bloody diarrhea
- May have fever -Sausage like mass felt in RLQ (Dance Sign) -Ab distention and tenderness
17. What are risk factors for dehydration?
ANS GI virus vomiting/diarrhea
18. What are s/sx of dehydration?
ANS sunken anterior fontanel tachycardia and decrease cap refill decrease urine output is sensitive but nonspecific increase in urine specific gravity decrease BP- late finding=more than 10% fluid loss
19. How do you treat dehydration?
ANS if minimal, mild, moderate- oral rehydration if severe (drowsy, cold extremities, lethargic, sunken/dry eyes, very depressed an- terior fontanel, no tears, dry mouth/tongue, very decreased skin turgor, rapid/some- times impalpable pulse, decreased/unrecordable pulse, deep/rapid respiratory rate, markedly reduced urine output) - IV fluids
20. What is emesis?
ANS vomiting=symptom must distinguish from regurgitation in infants integrated response to noxious stimuli-coordinated by CNS
21. What is acute emesis?
ANS short-term abrupt onset
22. What is recurrent emesis?
ANS at least 3 episodes over 3 months chronic, relatively mild that occurs frequently
23. What is cyclic emesis?
ANS recurrent, intense episodes separated by asympto- matic periods
bloody stools abdominal cramping thirst decreased urination dizziness fatigue
28. What is chronic diarrhea?
ANS 1 or more liquid to semi-solid stools passed per day for 14+days
29. What are causes of chronic diarrhea?
ANS latrogenic- excessive fluids; <25% of calories from fat infants- formula protein intolerance toddlers- chronic, nonspecific; usually resolves by 5 years of age children/adolescents- acquired lactose intolerance viral or bacterial
30. Diagnostics for diarrhea
ANS Acute- stool cultures, CMP, CBC (if indicated by usually resolves on own) Chronic- stool cultures, CBC w/diff, CMP, ESR, lactose tolerance test
31. What is GERD?
ANS neuromuscular problem where lower esophagus and and GE sphincter (cardiac sphincter) are lax and allow for easy reguritation of gastric contents
32. What are the three classifications of GERD?
ANS 1. physiologic- infre- quent/episodic vomiting
2. functional- painless, effortless
3. pathologic- frequent with alteration in physical functioning (up to 70% of infants
<1700g have this type with 85% being symptoms free by 1 yr)
33. What are s/sx of GERD?
ANS recurrent regurgitation w/wo vomiting heartburn gas/abdominal pain failure to thrive ruminative behavior hematemesis dysphagia respiratory disorders (wheezing, stridor, cough) hoarseness feeding difficulties typically asymptomatic by 6 weeks of age
wt loss, dehydration, constipation
39. Diagnostic testing for pyloric stenosis
ANS US, upper GI series which can show a "string sign" which is a fine elongated pyloric canal "olive mass" palpable in epigastric area to right of midline Treatment is surgery (pyloromyotomy)
40. What is appendicitis?
ANS inflammation/infection of the vermiform appendix- small appendage arising from the cecum most common 6-19 yo
41. What causes appendicitis?
ANS obstruction of the appendiceal lumen (inside of appendix) usually by fecalith (fecal stone) or lymphoid hyperplasia (#of lympho- cytes) -may also be caused by inspissated secretion of CF -may also be caused by parasitic tumor or foreign body
42. Symptoms of appendicitis
ANS initial- dull, steady periumbilical pain for 4-6 hrs shifts to RLQ as peritoneal inflammation develops
24-36 hrs- rupture likely- may have initial decrease in pain with worsening shortly after *N/V pain awakens from sleep decreased appetite likely no fever before perforation
43. Diagnostic testing for appendicitis
ANS CBC w/ diff- look for shift to left, *elevat- ed WBCs usually 10-20, neutrophils, elevated bands UA CT w/ contrast- highest accuracy may use US/MRI **surgery referral, emergent
44. What is Markle's sign?
ANS Appendicitis abdominal assessment- heel drop jar- ring test, on toes for 15 sec, dropping down forcefully on heels will elicit RLQ pain
45. What is rebound tenderness?
ANS Appendicitis abdominal assessment- involun- tary guarding over McBurney's point on abdominal exam
46. What is Rosving's sign?
ANS Appendicitis abdominal assessment- pressure deep in the LLQ with sudden release elicits pain in the RLQ which strongly suggests peritoneal irritation
47. What is Psoas sign?
51. What are uncomplicated UTI symptoms?
ANS common symptoms- dysuria, urgency, frequency, no fever
52. What are complicated UTI symptoms?
ANS fever, toxicity, dehydration, child <6 months, structural abnormality
53. Diagnostic testing for UTI
ANS UA w/ culture *E.Coli most common cause dipstick= leukocytes, nitrates, RBCs if pyelo suspected- CBC, ESR, BUN, creatinine
54. Treatment for UTI
ANS trimethoprim/sulfamethoxazole (bactrim) 8-10 mg/kg/day (>2 months) *first drug of choice cefixime >= 6 yo tx 7-10 days f/u to make sure treatment effective
55. What is Osgood-Schlatter disease?
ANS caused by microtrauma in the deep fibers of the patellar tendon at insertion point -most common in later adolescence -most common with sports participation
56. How do you diagnose Osgood-Schlatter disease?
ANS physical exam, history, x-ray
57. Clinical findings for Osgood-Sclatter disease
ANS pain, swelling, tenderness at tibial tuberosity knee pain that worsens with activity tightness of the surrounding muscles, especially quads pain varies from mild with activity to nearly constant and debilitating
58. How do you treat Osgood-Schlatter
ANS decrease with quad loading and bend- ing RICE treatment quad and hamstring stretching*** NSAIDs
59. What is Legg-Calve-Perthes disease?
ANS idiopathic osteonecrosis of the femoral head onset usually 4-8 yo unilateral in 90% of cases 4x more common in males
60. Symptoms of Legg-Calve-Perthes Disease
ANS hip, thigh, or knee pain painless limp
P- pattern changes from prior headaches
66. Diagnostics for headaches
ANS headache diary CT only if tumor suspected
67. Treatment for headaches
ANS NSAIDs prophylactic CCBs, tricyclic antidepressants abortive ANS triptans not approved in children nonpharmacologic- reduce triggers
68. What are seizures?
ANS paroxysmal events thought to represent abnormal elec- trical activity in cerebral neurons usually idiopathic
69. Tonic clonic seizure
ANS tonic-entire body becomes rigid, first phase clonic- uncontrolled jerking may cry, groan, fall risk, bite inside of tongue/cheek, incontinent
70. Tonic seizure
ANS body becomes tense, usually lasts less than 20 seconds usually occurs with patient is sleeping and involve most or all of the brain
71. Absent seizures
ANS very quick, <10 seconds- often missed generalized onset involving both sides of the brain at the same time most common type stops all activity then patient stares off eyes may roll up eyelids flutter
72. Atypical absent seizures
ANS starts with patient staring off, change muscle tone and movement blinking repeatedly smacking lips or chewing movements rubbing fingers together or making other hand motions lasts longer than absent >20 seconds
73. Myoclonic seizures
ANS usually involve the neck, shoulders, upper arms usually occurs after waking up- beginning around puberty
74. Atonic seizures
ANS muscles suddenly become limp eyelids may droop head may drop forward fall risk typically lasts <15 seconds
75. Infantile seizures
ANS from birth secondary- birth trauma
78. What are observed s/sx of concussion?
ANS amnesic to event appears dazed/stunned confusion moves clumsily answers slowly loses consciousness shows mood, behavior, personality changes
79. Diagnostics for concussion
ANS based on symptoms all children with moderate head trauma (GCS 9-12) and severe (GCS 3-8) needs CT
80. Signs of normal cognition development in toddlers
ANS emerging empathy understanding social rules constructing narratives reciprocity in play
81. What are symptoms of ADHD?
ANS attention deficit hyperactivity disorder inattention hyperactivity impulsivity
82. How do you diagnose ADHD?
ANS have to have at least 6 hyperactivity/impulse symptoms and 6 inattention symptoms DSM IV
83. What is treatment for ADHD?
ANS stimulants- methylphenidate, ampheta- mine/dextroamphetamine
84. What are symptoms of sensory processing disorder in adolescents?
ANS -
overly sensitive to touch, noise, smell, or other people poor self-esteem afraid of failing at new tasks lethargic and slow always on the go impulsive distractible clumsy, slow, poor motor skills or handwriting can't find this in the book or in PP from brenda lee's study guide
85. What are comorbidities of depression?
ANS anxiety disorder can correlate with depression ADHD conduct, learning, and oppositional defiant disorders SAD
