PNP Boards Review

The PNP is examining an infant recently adopted from Western Europe. When should a foreign-born child undergo PPD testing? A) At the first health examination after entering the United States B) After the child develops signs and symptoms suggesting TB exposure C) Never (if the child has had BCG, a chest x-ray examination should be ordered) D) At the same time as infants born in the United States

a

The mother of a 2-year-old child is concerned about the child's fear of the dark. The PNP responds that: A) Fears of this type are a normal developmental process B) Young children with fears tend to have phobias as adults C) Fears that interfere with social development resolve as the child develops D) Parents should not allow the child to withdraw from a fearful situation

a

Which of the following does not suggest a UTI? a. increased protein b. increased WBCs c. increased RBCs d. increased nitrites

a

Which of the following is NOT a goal for appropriate asthma management? a. limited activity & exercise b. prevent recurrent exacerbations c. prevent chronic troublesome symptoms d. Maintain near normal pulmonary functions

a

Which of the following is associated with alcohol use in adolescence? a. family history of alcoholism b. authoritarian parenting style c. passive temperament d. high socioeconomic status

a

a common cause of aortic stenosis is

a history of rheumatic fever syncope

The PNP educates Sophia's mother to look for which of the following fine motor skills at 3 to 4 months old? a. Reaches for an object b. Grasps and shakes rattle c. Hand-to-hand transfer

a pg. 10

How many blocks should 18-month old Evan be able to stack? a. 3 blocks b. 5 blocks c. 6 blocks

a pg. 10 17-18month old infants should be able to stack 3 blocks

Jonathan is scheduled for his 2-year EPSDT. He weighed 8lbs at birth. How much does the PNP expect Jonathan to weight today? a. 32lbs b. 28lbs c. 24 lbs

a pg. 6 At 2 years old, children should quadruple their birth weight.

abcess

a pus filled lesion> 1cm

otitis, sinusitis and allergic rhinitis are complications of what?

acute nasopharyngitis

absence seizures:

appear as altered awareness and blank stare for brief period

12. An adolescent male who fails to develop secondary sex characteristics at puberty and who has small, underdeveloped testes should be suspected of having: a. Adrenal hyperplasia b. Klinefelter's syndrome c. Marfan syndrome d. Cerebral gigantism (sotos syndrome)

b

CN III oculomotor

(mixed, mainly motor) Moves the eyeball and eyelid, adjusts the lens of the eye for near vision and also constricts the pupil of the eye via motor fibres distributed to muscles located in and around the eye.

CN VI abducens

(mixed, mainly motor) Moves the eyeballs outwards by sending nerve impulses to the lateral rectus muscles

What are growth and development milestones of a 6-9 month old?

*Babbles and combine vowel/consonant sounds *Turns to sound *Responds to name *Rolls over *Sits independently *Transfers objects *Supports weight on feet *Uses thumb and fingers to pick up objects *Crawls

Moderate acne

- Doxycycline 100 mg BID daily Erythromycin 1gram in 2-3 divided doses Minocycline 50-100mg BID

OME findings

-fullness/cracking sensation in ear -color- yellow, dull opaque, or translucent TM, contour- appears retracted due to negative pressure in middle ear, mobility- decreased

Bronchiolitis

-palpable live and spleen due to hyperinflation of lungs

First Dentist

1 year old

Sexual Maturity Rating: Pubic Hair

1. Preadolescent 2. Sparse, pale, fine 3. Darker, increased amount, curlier 4. Adult in character but not as voluminous 5. Adult pattern.

when is head and chest circumference equal?

1yr

A healthy 24 month old can be expected to have achieved which of the following language milestones? a. counts three objects correctly b. has a 30-50 word vocabulary c. states full name d. tells a story

b

Auscultatory Areas

Aortic: RUSB Pulmonic: LUSB Aortic or mitral: Apex VSD or Tricuspid:LLSB **Are, Potatoes, Truly, Mash***

Burns 1st Degree:

Dry, red, no blisters, involves epidermis.

Asymmetric IUGR

Head circumference and length normal but weight below 10th percentile.

Burns 2nd Degree:

Moist, blisters, extends beyond epidermis.

otitis externa

Pneumatic otoscopy should demonstrate mobility tx- Acetic acid with or without hydrocortisone -Cortisporin (Neomycin, polymyxin B)

5-6 Months

Rolls back to front Hand to hand transfer Babbles

Crainosynostosis

Sutures of the skull close too early from unknown cause May note anterior fontanel closure (before 18 months)

A common cause of congestive heart failure in the first year of life is?

VSD

A 5-year-old child was born in Mexico and received bacille Calmette-Guérin (BCG) vaccine as an infant. A PPD is administered as part of a routine office visit. After 48 hours, there is a 10-mm reaction. How should the PPD be interpreted? A) Interpret the PPD as if the child had not received BCG B) This child should not have undergone PPD testing because the result will always be positive C) Interpret the PPD as a normal reaction D) This child should not have undergone PPD testing because the result will always be negative

a

Which of the following is not a major factor influencing healthcare delivery services? a. provider b. payers c. insurers d. agencies

d

Cephalohematoma

does not cross midline blood under periosteum and requires closer examination

Coloboma

fissure defect

serology results of anti-HAV and IgG indicate

immunity to hepatitis A not reportable

which of the following objectives from Healthy people 2000 have not made progress towards achieving its targeted goal

infant mortality

streptococcus

is a bacteria but not causitive agent of gastro

Which of the following would not alert you to microcephaly

normocephalic skull

White Red Reflex

retinoblastoma

CN V trigeminal

(mixed) This is largest cranial nerve and splits into the following 3 divisions, each of which includes both motor and sensory fibres. Ophthalmic nerve Maxillary nerve Mandibular nerve The motor fibres of all 3 divisions control the facial muscles involved in chewing. The sensory fibres convey sensations of touch, pain and temperature from the front of the head including the mouth and also from the meninges.

Developmental Hip Dysplasia DDH

**Orlanti's Click: heard or felt as dislocation is reduced when legs are abducted ( moving out) **Barlows: feeling of slip when legs are adducted and brought back inward. **Gazzeli's sign: unequal knee length **Alli's sign: unequal leg length

What are growth and development milestones of a 2 - 5 month old?

*Smiles and coos *Watches a per's face intently *Follows people and objects with eyes *Laughs aloud *Lifts head/chest when on stomach *Holds head steady when pulled to sit *Grasps rattle placed in hand *Startles to loud noise

What are growth and development milestones of a 19 to 24 month old?

*Walks up/down stairs *Jumps with both feet *Completes simple puzzles, circle shapes first *Stacks 6-7 blocks *uses 2 word sentences *30-50 word vocabulary

PNA tx based on setting of care, etiology, and age of child

-3 months-5 yrs old--> Amoxicillin 90mg/kg/day, +/- azithromycin for 7-10 days -5yrs or older--> azithromycin or amoxicillin 90mg/kg/day for 7-10 days or penicillin G

Inflammatory bowel disease Ulcerative Colitis

-Affects only the lining of the colon -Pattern of inflammation is mucosal and submucosal inflammation, diffuse and continuous Diarrhea--> mild to profuse bloody diarrhea -Wt loss -Abd pain--> LLQ Refer to gastro _CBC w/ diff shows microcytic anemia, increased WBC, elevated ESR and CRP, Chem panel shows low K and albumin -Stool studies- stool for calprotectin (released when inflammation is present in the intestine)

Cystic fibrosis role of primary care

-Annual influenza vaccine, aggressive use of abx for respiratory infections, close monitoring for CF complications -abx therapy based on sputum cx

external otitis media (EOM)

-acute infection and/or inflammation of external auditory canal (swimmers ear) - foul smelling (fungus related candida, aspergillus, and trichophyton) -S&S-> ear pain, accentuated by manipulation of pinna/tragus, lying on the affected ear or performance of otoscopic examine, pressure/fullness in ear -Physical findings- edematous/erythematous external canal (w/without exudate), TM normal, +/- pre or postauricular lymphadenopathy

TB S&S

-dry, hacking, or brassy, paroxysmal cough, persistent cough >3 weeks, localized wheezing, crackles, rales, Lymphadenopathy (cervical or axillary), poor wt gain, growth delay, low-grade fever, night sweats, chills, splenomegaly, hepatomegaly,

Sexual Maturity Rating: Breast Development

1. Preadolescent breast 2. Breast buds with areolar enlargement 3. Breast enlargement without separate nipple contour 4. Areola and nipple project as secondary mound. 5. Adult Breast: areola recedes and nipple retracts

Delayed puberty for girls

13 yrs

DTAP immunization

2,4,6, 15 months, and 6 yrs old do not gave after 6 yrs old

PCV (prevnar)

2,4,6,12, and 15 month -immunocompromised- booster between 24-29 months

Expressive language toddlers

425 word, 75% of understandable language (2yrs) Sentences (4-5 words) 3yrs old

PDA

5-10% in term infants but common in premies **Grade 2-4 holosystolic Machinery sound** LUSB ECG: LVH Xray: the same as the others

Weight gain per week during 1st 6 months

5-7oz

NO head lag in infant at what visit

6 mo

Stranger Danger

6 months

Weight doubles for newborn by

6 months

stanger anxiety

6 months of age

industry vs inferiority Erik Erikson (psychosocial)

6-12yrs old

Stranger anxiety develops

6-7 months

AOM tx and management

70-90% spontaneous resolution 1.option to observe may be indicated if older than 6 months of age and nonsevere illness 2. Initiate abx if younger than 6 months of age and any age with sever illness (high fever or bil OM) Antibiotics -1st line- amoxicillin high dose (80-90mg/kg) or amox-clavulanate. (10days) -allergic- defdinir, cefuroxime, cefpodoxime, and ceftriaxone -2nd line- failures of amox-clavulanate and ceftriaxone with clindamycin as an alternative -90-95% symptom relief w/in 48-72 hrs- if not better change abx

Low Birth weight

<= 2500g

Serology test of hepatitis

Active Hep A: Anti-HAV, IgM Recovered Hep A: Anti-HAV, IgG Active Hep B: HBsAG, HBeAG, Anti-HBc, IgM Chronic Hep B: HBsAG, Anti-HBc, Anti-Hbe, IgM, IgG Revcovered Hep B: Anti-Hbc, Anti-HBsAg Acute Hep C: Anti-HCV, HCV RNA Chronic Hep C: Anti-HCV, HCV RNA

intussusception

Acute episode of prolapse of one portion of intestine into the lumen of the adjoining part--Sudden cycle of inconsolable screaming, flexing of leg, colicky abdominal pain -nonbilious vomiting after pain -periods of quietness or sleepiness b/w episodes -currant jelly (blood w/ mucus) stool is passed -may palpate sausage-shaped mass RUQ or upper mid abdomen -distention and tenderness increased as obstruction increases -Hosp--> barium enema

Language milestones 12-17 months

Answers simple questions nonverbally -says 2-3 words to label a person or object -tries to immitate simple words -vocabulary of 4-6 words

B-chain synthesis is absent in

B-thalassemia major

AOM physical findings

Diagnosis determined by changes in color, contour, and mobility of TM -color erythematous, contour may be bulging, light reflexes and bony landmarks distorted, mobility decreased or absent via tympnometry or pneumatic otoscopy, conductive hearing loss

Clubfoot Talipes Equinovarus

Foot deformity that involves the foot and entire lower leg -can be congenital, teratologic, or positional -small foot with limited dorsiflexion, deep crease on the medial border of foot, calf muscles thin and atrophic DX- Radiographs -Management- refer to orthopedist -serial casting begins at birth, usually 3-6 months

Stool sample

If symptoms persist more than 72 hours or if bloody stool is present.

the following diagnostic finding is consistent with Wiskott Aldrich syndrom

IgG- normal

Paraphimosis

Inability to replace foreskin over glans after retraction -edema, discoloration of foreskin and glans -pain/tenderness -ballooning of foreskin when urinating; may be normal if voiding uncompromised Management--> goal is reducation of swelling to reduce foreskin, may be accomplished with ice, application of granulated sugar to the penis, or wrapping distal penis in saline-soaked gauze applying pressure for 5-10 mins

Hypothyroidism labs

Increase TSH decrease in T4 and free T4

Erik Erikson

Infancy 0-1yr Trust vs Mistrust Toddler 1-3yr Automomy vs Shame and doubt Preschool 3-6yr Initative vs Guilt School age 6-12yr Industry vs Inferiority Adolescence 12-18yr Identity vs Role Confusion

8-9 Months

Mama Dada Finger grasp Waves bye bye

Still Murmur

Most common innocent murmur Musical systolic murmur*** Heard best at LLSB and apex systolic ejection murmur. Due to turbulence of LVOT.

Functional dyspepsia

Persistent or recurrent pain in the upper abd above the umbilicus. No evidence via upper endoscopy of organic disease -Acid suppression can be useful in relief of symptoms

Phenotype

Presentation, Physical (Dysmorphic features, developmental delay, short stature, seizures, failure to thrive)

Amenorrhea

Primary amenorrhea--> failure of onset of menarche in females who are 16yrs and have normal pubertal growth and development; 14 yrs with with absence of normal pubertal growth and development; or in girls who have not begun menstruation 2 yrs after completed sexual maturation -estrogen deficiency, familial, obstruction of flow, androgen excess Secondary amenorrhea--> absence of menstruation for >3 cycles or at least 6 months after menstruation established -pregnancy, emotional stress, strenuous exercise, hypothalamic, pituitary or adrenal disorders

Enuresis management

Primary nocturnal -limit fluid intake after dinner, double voiding before bedtime, avoid punishment/criticism, usually self-limited, spontaneous resolution Motivational therapy -may be unsuccessful as exclusive treatment, verbal praise for dryness, reward system, dryness calendar Conditioning therapy - enuresis alarm, triggered by urine, may take 2-3 months Pharm tx--> Desmopressin acetate- synthetic analog of antidiuretic hormone/vasopressin, PO 0.2-0.6 mg 1hr before bedtime side effects--> HA, congestion, nasal irritation, epistaxis Secondary enuresis--> evaluate underlying etiology--> disease process, medication, aggressive/interdisciplinary tx of dysfunctional voiding

What domain does Erickson's theory cover?

Psychosocial domain

3-4 months

Reach for object

When to measure/follow BP

Starting at 3yrs

Milestones by age 19-24 months

Walks up/down stairs jumps with both feet completes simple puzzles, circle shapes first Stacks 6-7 blocks Uses 2 word sentences 30-50 words

27. Lyme disease is most closely associated with which of the following skin lesions? a. Erythema migrans b. Nodule c. Scale d. Pustule

a

The PNP is assessing a 9-year-old male and notes a murmur at the left upper sternal border. What structure of the heart is the PNP auscultating? a. Aortic b. Pulmonic c. Ventricle

b pg. 63

Trust vs mistrust Erik Erikson (psychosocial)

birth to 1 yr

Genu Varum

bow legged because they drank to much rum with a wide stance. normal variant in toddlerhood

An example of a pleiotropic genetic disorder is: A) Marfan's syndrome B) Cri du chat syndrome C) Vitamin D-resistant rickets D) Tay-Sachs disease

a

Physiological splitting of the second heart sound during inspiration in a child: a. is normal b. should be evaluated with an EKG c. suggests an ASD d. should be referred to a cardiologist

a

Separation anxiety is a common developmental stage in which the child exhibits fears and unusual behavior when a parent is absent. This behavior is most often expected at: A) Age 6 to 9 months B) Age 9 to 12 months C) Age 12 to 15 months D) Age 15 to 18 months

a

The PNP evaluates an infant born to a mother known to have autoimmune thyroid disease. Congenital hypothyroidism in infants is associated with which of the following? A) Excessive sleepiness B) Failure to thrive C) Tachycardia D) Diarrhea

a

The PNP examines a 12-month-old child for routine care. Of the following fine motor milestones, which would be most characteristic of a 12-month-old child? A) Uses a neat pincer grasp B) Transfers objects between hands C) Scribbles spontaneously D) Builds a tower of 4 cubes

a

The PNP is following a 15-year-old male adolescent with consistent blood pressure readings of 132 to 138/84 to 86 mm Hg, which is classified as significant hypertension. After performing a workup, the PNP determines that the adolescent has primary hypertension. The most judicious recommendation for therapy is: A) Diet and exercise counseling and referral to a specialist B) A diuretic, low-salt diet, exercise, and counseling by a dietician C) Perform an extensive family history to determine other risk factors D) A vasodilator, restricted activity, and a low-fat diet

a

Which of the following is the most appropriate information to use in providing anticipatory guidance for parents with a colicky baby? a. colicky babies are hypersensitive to stimuli b. teething can stimulate a colicky response c. symptoms increase at 3-4 months of age d. fever is often an accompanying symptom of colic

a

Which of the following is true about the children of parents who smoke cigarettes? a. Elevated risk for Sudden Infant Death Syndrome (SIDS) in infants of mothers who smoke b. Decreased likelihood that the child will smoke cigarettes as an adult c. Smoking cigarettes outside eliminates the risk that second-hand smoke poses to children d. No significant difference in the risk of asthma and lower respiratory tract infections when compared to children of non-smoking parents

a

Which of the following would usually not be considered a sign of a pituitary tumor in a an adolescent female? a. dysfunctional uterine bleeding b. galactorrhea c. loss of peripheral vision d. increase in headaches

a

Which of the follwoing statements regarding alternating doses of ibuprofen and acetaminophen for fever is most accurate? a. alternating drugs increases risk of dosage errors and toxicity b. alternating allows for lower total dosage of both drugs c. alternating drugs results in more rapid resolution of the fever than using either drug alone d. is appropriate only for children over the age of six months

a

According to the AAP, car seats should be rear-facing until age 2. What age do most states require rear-facing car seats? a. 1 year old b. 2 years old c. 3 years old

a *stated at live review

Which of the following children could reoutinely receive the MMR vaccine

a child with mild diarrhea

individuals with chronic adrenal insuffiecieny often have

a craving for salt

The PNP educates a new mom to respond to her baby every time the baby cries. The mom responding helps to establish what psychosocial development? a. Trust vs. Mistrust b. Autonomy vs. Shame and Doubt c. Industry vs. Inferiority

a pg. 8

abdominal migraines are characterized by

abdominal pain and nausea along with headache

Most healthy infants are able to reach, grasp, & hold onto a rattle or other small toy by about: a. 2mo b. 6mo c. 8mo d. 10mo

b

A 6-month-old infant who is new to the practice is brought to the office for a well-child visit. The infant is healthy today and has no history of allergies or reactions to previous immunizations. The PNP reviews the immunization record and finds the following: Birth Hep B Age 2 months DTaP, IPV, Hib, Prevnar, and Hep B Age 4 months DTaP, IPV, Prevnar, and Hib Today the infant should receive: A) DTaP, Hib, Prevnar, and Rv B) Hib, Hep B, and Rv C) DTaP, Hib, Prevnar, and Hep B D) DTaP, Hib, and IPV

c

Which one of the following best describes behavior associated with Piaget's concrete operations? a. Learning primarily by trial and error b. Interpreting events in relationship to self c. categorizing information d. drawing logical conclusions

c

Which represents information obtained during a review of systems (ROS)? a. mother of the child has asthma b. height and weight c. history of birthmarks or skin lesions d. number of previous hospitalizations

c

Which symptoms would prompt the ordering of a genetic test for Prader- Willi syndrome? a. obesity, daytime hyperactivity, increased libido b. large hands/feet, thin saliva c. neonatal hypotonia, feeding difficulties d. failure to thrive, hyperphagia, clitoromegaly

c

The PNP educates Sophia's mother to look for which of the following fine motor skills at 5 to 6 months old? a. Reaches for an object b. Grasps and shakes rattle c. Hand-to-hand transfer

c pg. 10

The PNP is performing a physical exam on 17-year-old Logan. Logan has no past medical history and is up-to-date with his vaccines. She notes his tall stature, long narrow face, thin extremities, and a heart murmur. What genetic condition does the PNP suspect? a. Klinefelter's Syndrome b. Turner's Syndrome c. Marfan Syndrome

c pg. 23

3-day-old Jennifer's mom is concerned because she has noticed blotchy red spots with white "pimples" on her skin. What does the on-call PNP tell Jennifer's mom? a. To immediately go to the emergency room because the rash indicate an emergency. b. To give Jennifer an oatmeal bath and apply scented lotion. c. To continue to watch the spots and that the redness should disappear by 2 weeks old.

c pg. 28 These rash described in erythema toxicum. They should blanch with touch.

The PNP is assessing a 2-month old infant. On exam to elicit red reflex, the PNP notes a whitish color. This discoloration can indicate what disease process? a. Retinoblastoma b. Congenital cataracts c. Both a and b

c pg. 29

The PNP ordered a hearing screening on a 2-day old infant. The PNP notes hearing loss on the results. Which of the following results indicate hearing loss? a. loss of 5 to 10 decibels b. loss of 10 to 20 decibels c. loss of 20 to 30 decibels

c pg. 35

The PNP is providing anticipatory guidance for 12-month-old Sullivan. His mother asks when she can give him a spoon to help prevent a mess when Sullivan is eating. What age is it suggested to introduce a spoon for eating? a. 9 to 12 months b. 12 to 15 months c. 15 to 17 months

c pg. 42 Do not force toddlers to eat because food "jags" are common

The PNP is assessing the language development of 2-year-old Nancy. Nancy can follow two-step commands and her mom complains that she speaks continuously. What other finding does the PNP expect to find? a. Knows at least 4 colors b. Can understand simple analogies c. Knows up to 50-words

c pg. 42 Should know 4 colors at 5 years old/ Should understand simple analogies at 4 years old

The PNP knows that these warning signs refer to which age: not aware of external environment, not able to ride tricycle, not follow simple directions, uses baby talk, and/or not imitating adult activities. a. 1 year old b. 2 years old c. 3 years old

c pg. 43

4-year-old Al presents for his well child appointment. His mom reports Al started stuttering about 1 month ago. She denies Al avoiding speaking. She reports he can understand phrases and simple analogies. When does the PNP consider referring Al for a speech evaluation and for management? a. Now b. in 3 months c. in 6 months

c pg. 44 Consider referral for stuttering lasting >6 months, child older than 6, and a child who avoids speaking.

The PNP knows that school age children need privacy and assigned chores. Which of the following is common in this age group? a. Nightmares b. Rebellion c. Lying

c pg. 49 Confront child in positive way and reinforce honesty

The PNP is seeing Jackson who is 17 years old. He is worried that he is continuing to gain weight even though he practices a healthy lifestyle. Jackson is currently 85kg and 182cm. What does the PNP educate Jackson as the maximum amount of kcal/day he should eat? a) 2,210 kcal/day b) 5,950 kcal/day c) 3,825 kcal/day

c pg. 5 As an adolescent, he should a maximum of 45 kcal/kg/day.

Megan is here for her 2-week check up. Her mom asks the PNP how long she should consider breastfeeding before switching to formula. Which of the following does the PNP say to educate the mother? a. "After 2-months breast feeding does not provide nutritional value." b. "The baby should be ok to switch to formula whenever you want." c. "It is suggested that your baby be exclusively breastfed for 6 months."

c pg. 6

The PNP is assessing an 8-year-old child. She notes S1 and S2 with no murmur. The PNP knows that S2 is the closing of which valves? a. Tricuspid and pulmonic valves b. Mitral and tricuspid valves c. Aortic and pulmonic valves

c pg. 62

The PNP is assessing a 1-year-old female and notes a murmur at Erb's point. What structure of the heart is the PNP auscultating? a. Aortic b. Mitral c. Both a and b

c pg. 63 Erb's point=Apex

The PNP is assessing a 3-month-old female and notes a thrill at the left lower sternal border. What structure of the heart is the PNP auscultating? a. Patent ductus arteriosus b. Atrial septal defect c. Ventricle septal defect

c pg. 63 Only CHD with thrill at LLSB is VSD. VSD is 30% of all CHD. *2LLs=Thrill + LLSB

The PNP is assessing a 13-year-old female and notes a murmur at the left lower sternal border. What structure of the heart is the PNP auscultating? a. Aortic b. Pulmonic c. Ventricle

c pg. 63 Usually indicative of VSD. Can be tricuspid valve defect.

A preschooler who is ok with going to school and leaving their parent is in which psychosocial stage? a. Trust vs. Mistrust b. Autonomy vs. Shame and Doubt c. Initiative vs. Guilt

c pg. 8

Which of Erikson's psychosocial stages, does the PNP expect a child to be interested in earning trophies? a. Initiative vs. Guilt b. Identity vs. Role confusion c. Industry vs. Inferiority

c pg. 8

The PNP is deciding what to assess on a 2-old-child. Which of the following is appropriate? a. Blood pressure b. Bone mass c. Body mass index

c pg. 9

In the event of a malpractice lawsuit against the PNP, several elements must be proved. Included in these elements are the following: the PNP owed the plaintiff a duty or responsibility, the PNP's conduct or care fell below a recognized standard of care, and: A) The PNP operated outside a recognized standard of care B) The PNP was not properly credentialed C) The PNP did not consult with a supervising physician D) The plaintiff was injured by the PNP's conduct

d

what parasite is responsible for pinworm infestations?

enterobius vermicdoris

most common form of reimbursement for series provided by PNP is

fee for service

rett syndrome is seen exclusively in

females

a newborn with birth length <50% and microphallus should be suspected as having

growth hormone deficiency

Cholesteatomas

growth or cyst in the middle ear space, result of chronic otitis media, surgery required for removal symptoms- dizziness, hearing loss -pearly white, opacity, on or behind TM, hx of chronic OM with foul smelling purulent otorrhea -refer ENT

the most common thyroiditis is

hashimotos or chronic autoimmune thyroiditis

4yr presents with exudative pharyngitis and erythematous non blanching lesions on the legs. Rapid strep is +. What is the MOST likely diagnosis?

henoch-schenlon pupura

which substance (drug) is associated with pupillary constriction

heroin

Male patient presents with weight loss, abdominal pain, decreased urine output. You palpate a right sided mass noting tenderness in the abdomen and flank. UA with marked leukocytosis. IVP show delayed emptying from renal pelvis - what is the dx

hydronephrosis

Retropharyngeal abscess

infection of the retropharyngeal lymph nodes, inflammation of posterior aspect of pharynx -acute onset of high fever, severe throat pain, drooling, difficulty swallowing, dyspnea, stridor, neck and head hyperextension -prominent swelling of posterior pharyngeal wall -Emergency hospitalization

pneumonia is marked by what onset of symptoms

malaise shaking chills fever purulent sputum

Down syndrom physical findings

microcephaly flat nose protruding tongue

The refractive error that occurs when light is focused in front of the retina is known as

myopia

Slipped Capital Femoral Epiphysis

occurs when the head of the femur becomes displaced due to a separation at the growth plate -generally occurs without severe, sudden force or trauma -Pain in the groin and often referred to thigh and/or knee -Unable to properly flex hip as femur abduct/rotates externally -may observe limb shortening, resulting from proximal displacement of metaphysis -refer to ortho -no ambulation permitted

cystic fibrosis, foreign body aspiration, atelectasis are all in the differential for

recurrent lobar pneumonia

characterstics of telangiectasia nevi are

red, pink or pale spots that appear at birth frequently on the eyelids, nose and lower occipital bone

nephrogenic or vasopressin resistant diabetes insipidus is caused by

reduced renal responsiveness to antidiuretic hormone ADH

the differential for seizures includes which of the following

sleep disorders

School age Sleep

sleeps 8-10 hours a night

t test compares

the means of two groups

which finding in scoliosis would require surgical interrvention

thoracic curve greater than 40 degress or lunbar curve greater than 50 degrees

Staohylococcal scalded skin syndrome

toxin-mediated systemic bacterial infection-abrupt onset of fever and malaise, general exanthem w/ erythema and swelling more probounced in perioral, periorbital areas, flexor surfaces of neck, axilla, antecubital, groin, and popliteal areas -light pressure causes extreme pain, after peeling skin appears glistening and scalded -Hospitalization -Outpt tx w/ cefazolin for less toxic cases, increase hydration

pulmonic stenosis is asymptomatic t/f

true

what diagnostic test should be done before putting a infant on prokinetic medication?

upper GI

Which findings are associated with asymmetric intrauterine growth retardation

weight at 3rd percentile and length at 25th

Failure to thrive

weight is below the 3rd percentile and/or whose weight trajectory has decreased by 2 major growth percentiles

UTI

when local site of infection can't be found, consider UTI

Atonic

(generalized seizure) -"drop" attacks -sudden loss of muscle tone, which may result in head nodding or falling to the ground -usually no alteration in consciousness and lasts <15 minutes -protective helmet

Infantil spasms

(generalized seizure) -Occurring in the first 12 months of life -Sudden jerk followed by stiffening with arm extension and knees pulled up to body (jack-knife posture)

Sinusitis

**need to be older than 9yrs old -organisms--> S. pneumoniae, H. influenzae, M. catarrhalis Tx--> Augmentin for 10 days change to Levaquin if no improvement in 3 days (decongestants, antihistamines not useful in acute sinusitis)

Diaper dermatitis treatment (contact dermatitis)

*Mild erythema--> emollients to affected area w/ each diaper change (pertroleum jelly, zinc oxide) *Erythema w/ papules--> topical steroids (hydrocortisone) *Severe erythema and edema with papules, vesicles, and ulcerations--> wet dressings may be soothing, topical antibiotics *Monilia rash--> topical nystatin, clotrimazole, ketoconazole, oral nystatin for thrush Expose diaper area to air as much as possible -can change to fungal--> white--> hydrocortisone will exacerbate fungal infection

Acyanotic lesions

- L->R shunt, moving from L side of body (system) to R side of body to get oxygen-> goes up to the pulmonary beds VSD ASD AV canal Pulmonary stenosis PDA AS Coarctation of the aorta (obstruction lesion)

Superficial buren/ 1st degree/ minor burn

-Involve epidermis layer only, present w/ erythema, dryness, tenderness, and general discomfort,

pyloric stenosis

-Obstruction due to thickening of circular muscle of the pylorus -Average presentation from 3-6 weeks through 3-4 months of age -vigorous nonbilious vomiting after eating; with time becomes projectile with brownish color -"hungry" after emesis; progressing to lethargy and irritability -wt loss or poor wt gain -constipation, dehydration Physical findings -visible peristalic waves progressing from L to R across abdomen -palpable pyloric "olive" after vomiting, palpate epigastrium in the RUQ deep under edge, hard smooth mobile, nontender mass. -Tests US of abdomen -Hospitalization

Cellulitis tx

-Severe cases and those involving face and eyes need hospitalization -Not getting better or streaking present need IV abx -Need culture if drains or I and D performed Oral abx ***Empiric therapy Cefazolin (Keflex) If streptococcus-> cefazolin, amoxicillin If Haemophilus influenzae- augmentin If Staph- dicloxacillin -If MRSA--> Bactrim or clindamycin

Cyanotic lesions

-Shunts away from R side (pulmonary) and out to the system L side Tetrology of Fallot\Tricuspid atresia\Transposition of the great vessels\Total anomalous pulmonary venous reutrn\Truncus arteriosus

Bronchopulmonary dysplesia (BPD)

-any child requiring supplemental oxygen at 36 wks or greater w/ changes of chronic lung disease -Most have lung fx at birth but develop respiratory failure w/in first weeks of life -disease of infants <1000g at birth and <32 wks gestation Symptoms - acute resp distress in 1st week of life, poor growth and poor feeding skills, fussy w/ decreased endurance, FTT, carbon dioxide retention, chloride and K depletion, metabolic alkalosis -Immunizations, influenza, and RSV prevention -close f/u (every 1-3 months) to determine adequate oxygenation and growth -maintain adequate O2 >92-nutritional supplementation and hypercaloric formulas to provide additional calories -early intervention

Diptheria

-infectious disease caused by Gram-+ bacillus Corynebacterium diptheriae, contagious acute infection of the Upper respiratory tract and may lead to cutaneous disease (chronic, nonhealing sores or shallow ulcers w/ dirty gray membrane found in the nasopharynx, pharynx, or trachea) -Protected under the DTAP vaccine S&S--> sore throat, bloody nose, low grade fever, nasal discharge, hoarseness or cough, difficulty breathing, malaise, cervical lymphadenopathy, gray and white tonsillar exudates -Cx should be obtained from close contacts and abx therapy should be initiated

Gonorrhea

-leading cause of infertility in females -acute infectious process primarily involving henital tract, anorectum, throat, and opthalmic epithelium -women younger than 25 at highest risk Tests--> Nucleic acid amplification test (NAAT) vaginal swab and first-part void for men plus culture

Acne vulgairs (severe)

-lesions are much more numerous, covering larger areas -all lesions of mild and moderate acne, erythema with papules and pusutles, nodules and cysts (deep dermal lesions filled w/ follicle debris, w/ communicating tracks to other cysts -topical tretinoin, topical or oral abx (tetracycline, doxycycline, minocycline), oral tretinoin -refer to derm **black box warning with acutane/isotretinoin (cause suicide) tertogenic pregnancy

Café au lait spots

-light to medium brown pigmented macular lesions of varying sizes and shape found anywhere on the body; -lesions are usually present at birth, may develop ay any age -lesions are present throughout life -six or more lesions and/or lesions larger than 1.5cm in diameter may be associated with neurofibromatosis or Albright Syndrome (refer to derm)

Impetigo

-localized bacterial infection of skin often precipitated by insect bites or other trauma that breaks protective skin barrier; predominantly involves face -Caused by staph aureus and streptococci bacteria -highly communicable w/ incubation period of 1-10 days

Acute Otitis Media (AOM)

-middle ear infection -moderate to sever bulging of TM, new onset of ottorrhea not caused by otitis externa, or mild bulging of the TM associated with recent onset of ear pain (48hrs) or erythema -Most common pathogens--> S. pneumoniae, H.influenzae, and M. catarrhalis, viral, prevalence of b-lactamase producing strains

Common causes of wide fontanels

-premie -IUGR -hydrocephalus -Down syndrome -Hypothyroidism

Sexual Maturity Rating : Secondary sexual boys

1. Preadolescents testes, scrotum, penis 2. Enlargement of scrotum and testes, scrotum roughens and reddens. 3. Penis elongates 4. Penis enlarges in breadth and development of glans, rugae appear. 5. Adult shape and appearance

What are the stages of Jean Piaget?

1: Sensorimotor stage ( birth to 2 years) 2: Preoperation/ Preconceptual Stage ( 2 to 4 years) 3: Intuituve/Preoperational Thinking (4 to 7 years) 4: Concrete Thinking (7 to 11 years) 5: Formal Operational thought (11 to 15 years)

UTI medications/tx

1st line of drugs--> Trimethoprim-sulfamethoxazole infants >2months of age TMP 6-10mg/kg/day1SMX 30 to 60 mg/kg/day BID -recommended until sensitvities are available 2nd- Amoxicillin 30-50mg/kg/day TID 3rd- Augmentin 40mg/kg/day TID Follow up urine culture, second culture at 72hr after initiating tx if symptoms are not resolving -Culture 1 week after completion of tc when test of sure is indicated Education--> increase fluid intake, frequent voiding with complete emptying of bladder, good perianal hygiene with front-to-back, avoid bubble baths and other irritants

Intuitive/preoperational thinking Jean Piaget (cognitive development)

4-7yrs -beginning of causation (action causes reactions more aware)

Genital warts

Causative agent HPV -characterized by epithelial warts/tumors of mucous membranes and skin diagnosis based on clinical inspection Tx- no definitive tx available -podophyllum resin solution or gel monitoring of pap smears for cervical cancer -1st pap smear at 21 yrs old, repeat every 3 yrs -HPV testing not done until 30 yrs old HPV vaccine for types 6, 11, 16, 18 administered at 11 yrs old, 3 doses 1-2 months apart second vaccine, and 6 months apart for last administration

Impetigo tx

Caused by Staph or strep topical antimicrobials--> bacitracin or bactroban Based on organism--> use beta-lactamase resistant abx--> when needed for PO--> cephalexin, clinda, icloxacillin, erythromicin -need 48hr of abx before back to school

Primary Teeth

Central incisor 6-7 months Lateral Incisor 7-9mo Cuspid 16-18 mo First Molar 12-14mo Second Molar 20-24mo

Adrenocortical hyperfunction

Excess production and secretion by the adrenal gland or cortisol, adrenocortical androgens, estrogen, and aldosterone Cushing syndrome-->hypercortisolism--> slowed growth and development, obesity, emotional lability, depression and euphoria, delayed pubertal onset, easy bruising, increased appetite, back pain Feminizing adrenal tumors--> rapidly increasing height, development of secondary sex characteristics in girls with possible breakthrough vaginal bleeding; gynecomastia in males

Breast Feeding

Exclusively for 6 months Add Iron after 6 months 1mg/kg/day Add Vitamin D 400 IU per day after 2months Feed on Demand Add B12 for Vegan mothers

Peak Height Velocity

Girls reach this by age 11 to 12 prior to menarche.

Pulmonic Stenosis

Grade 2-5 systolic ejection click at LUSB. **Intensity of click decreases with inspiration and increases with expiration.** **Thrill at LUSB radiating to back and sides.** ECG: RVH Xray: normal

Strabismus

Ocular misalignment as a result of uncorrdinated ocular muscles >6 months need to refer S&S -squinting, decreased visual acuity, head tilt, face turning Esotopia- eye deviates inward Exotropia-eye deviates outward Hypertropia- eye deviates upward (immediately refer) Hypotropia- eyes deviate outward (immediately refer) -Hirschberg papillary light reflex is unequal

Hib

Series of 3 2-4-6 Months 1 booster at 12 months. can be given as early as 6 weeks but NO later than 5yr****

Sigmund freud

Sexual theory Psychosexual development Infancy--> oral stage Toddler--> anal stage Preschool--> phallic stage School age--> latency stage Adolescence--> genital stage

Sinusitis tx

Supportive with saline washes, steam, decongestants (though these may prolong illness) -*Antibiotic therapy same as AOM Chronic sinusitis may require abx for 3 weeks. -Topical inhaled steroids (budesonide) and normal saline spray - Don't use nasal decongestants for more than 3 days

Milestones by age 10-12 months

Takes simple action upon request Purposely says Mama and Dada Sits independently and plays** Pulls to stand** Communicates by reaching and pointing Moves purposely to get desired objects Has increasing curiosity Recognizes people Uses both hands equally well**

Vitals

Temp greater than 100.4 is fever HR 120-170 RR 30-80 BP less than 112/74

Headaches

Tension headaches most popular in pediatrics Need imaging if suggestive of intracranial etiology--> infection, bleeding, tumors, sudden onset with increased severity, neurologic exam abnormal, complaint of dizziness eliminate foods that may be triggers--> cheese, chocolate, MSG, caffeine Medication -Tylenol -Midrin if tylenol not affective and for children >11 yr old (combo of isometheptene mucate and acetaminophen)

A wdie pulse pressure that results from a high systolic blood pressure is usually not due to which of the following?

a patent ductus arteriosus

tightness in the hamstrings warrants

a recommendation of limiting activity

pulmonic senosis is loudest

at the left upper sternal border

The PNP expects her 16-year-old patient here for a sports physical to be in which of Erikson's psychosocial stages? a. Initiative vs. Guilt b. Identity vs. Role confusion c. Industry vs. Inferiority

b pg. 8

Adolescents are more prone to eating disorders. When examining adolescents, what exam finding is often the first sign of disorder eating? a. Depression b. Body modification c. Russell's sign

c pg. 61 Russell's Sign=Bruised knuckles. Other findings: change in gums/tooth erosion, nail discoloration, weight loss, anemia, amenorrhea, dry skin, constipation, low vital signs, and lanugo.

The PNP is assessing a 5-year-old child. She notes S1 and S2 with no murmur. The PNP knows that S1 is the opening of which valves? a. Tricuspid and pulmonic valves b. Mitral and tricuspid valves c. Aortic and pulmonic valves

c pg. 62

The PNP obtained an x-ray on a newborn with concern for congenital heart disease. What congenital heart defect is associated with an "egg on a string" appearance and increased pulmonary vascular markings? a. Tetrology of fallot b. Coarctation of the aorta c. Transposition of the great arteries

c pg. 65 Needs immediate intervention!

The PNP is assessing a 8-year-old and notes a systolic ejection click that decreases with inspiration and a thrill at the left upper sternal border. What heart lesion does the PNP suspect? a. Coarctation of the aorta b. Aortic stenosis c. Pulmonic stenosis

c pg. 66 Thrill at LUSB. Click increase with expiration and decrease with inspiration

what condition s are more common in dark skinned populations

café au lait Mongolian spots pityriasis alba

nutritional needs for lead poisoning?

calcium and iron

what do you suspect with a bright red raised rubbery lesion of irrefular shape on the occiput?

capillary hemangioma

diffuse edema of scalp that crosses suture lines in a newborn is

caput succedaneum

which of the following drugs are used for treatemtn of generalized tonic/clonic seizures

carbamazepine valproic acid phenytoin

A 17-year-old adolescent comes to the school-based clinic because of swelling, pain, and tenderness involving the Achilles tendon. The adolescent has been running long distances several times a week. The PNP diagnoses tendonitis and recommends rest, elevation, and: A) Heat applied to the area of the Achilles tendon B) Ice applied to the area of the Achilles tendon C) Steroids D) Ibuprofen

d

Glaucoma

increased intraocular pressure results in damage to the retina and optic nerve with loss of vision - Triad--> photophobia, abnormal overflow of tears, blepharospasm ( eyelid spasm) -decreased vision -corneal and ocular enlargement, corneal haziness and edema -irregular corneal light reflex

what would you rountinely recommend for lesions that may be oozing, weepy, crusting and itchy?

wet dressings/compresses to soothe the skin and relieve itching

meatal stenosis can be identified by all of these with the exception of

wide urinary stream

Labial adhesions oftern resolve

without intervention

a genetic disorder occurring b/c of genomic imprinting?

Prader willi

Bulla

serous filled vesicles> 1cm

CN I olfactory

Sensory Smell

Tdap

Series of 1 at 11 or 12 years Boosters every 10 years

angiotensin converting enzyme inhibitors can cause what exam finding in the asthma pt.

cough but not a wheeze

What does Piaget's theory cover (what domain)?

Cognitive domain

6-7 Months

Sits alone Raking grasp

Tumor

a firm elevated bump

Autism spectrum disorder screening

18 and 24 months When there is suspicion of a problem

Anterior fontanel closure

18 months, no larger than 4-5 cm in diameter

What are the two different stages in Freud's theory for infancy? What are the age groups?

1: Birth to 6 months: orally passive ( development of the id; biological pleasure principle) 2: 7 to 18 months: rally aggressive ( teething); oral satisfaction of needs by mother decreases tension

When does a child need to be evaluated while using a growth chart?

Any child who crosses over multiple sequential percentile lines needs further evaluation.

Visual Acuity

Blink Reflex and pupil constriction indicate newborn vision.

Severe >10%

Blood Pressure is normal, decreased HR decreased Cap refil prolonged Skin Turgor decreased Fontanel is sunken Urine < 1ml/kg/hour

Hepatitis B

Blood borne virus present in saliva, semen, vaginal secretions and all body fluids. incubation is 6wks-6months Hep B tends to have more insidious onset. ( slowly evolves) The risk of fulminant is <1% but when it occurs mortality is 60%.

Auscultary flow of heart

Blood flows from higher concentration to lower pressures -resistance of flow fetal vs neonatal --> fetal= increase pulmonary vascular resistance (not using lungs ) flow away from lungs cause of placenta and to system (decrease systemic vascular resistance -->cut cord at birth and PVR decreased and SVR increased-> push blood toward lung for O2

what is the most sensitive EARLY indicator of musculoskeletal inflammatory disorder?

CRP

Influenza

Can give at 6 months. Kids younger than 3yr gets 0.25ml*** 3yrs and older gets 0.5ml**** Kids under 9yrs gets one more shot one month following the first. FluMist for healthy kids 2-49 years...not if they have asthma though.

Receptive language toddlers

Carries 2-3 item command (3yr old) Understand opposite analogies (4yrs) Understands if, because, and when (5yrs)

Atrioventricular septal defect

Cyanotic Failure of central portion of heart to form, resulting in low ASD, high VSD, and abnormal mitral and tricuspid valves due to failure of endocardial cushion to develop

Turned in foot

Femoral anteversion : in toeing, normal until adolescence Tibial Torsion: self resolves by age 4.

Most common bacterial infections in neonate

First month: Group B strep and gram - Second Month: S.Pneumoniae and H.Influenza

APGARS

Five areas with total of 10 points Scores 0,1,2

What is the initial weight loss of an infant expected to be?

Initial weight loss is expected to be 10% loss.

10-12 months

Marks on paper Stands alone

Innocent Murmur

No associated symptoms. Low intensity systolic murmur grade 1-3 Mary vary with position of sitting and standing. No radiation to neck or back,

Moderate 6%-9%

Normal BP HR increased Cap refil WNL Skin turgor decreased Fontanel sunken slightly Urine <1ml/kg/hour

Assessment of Dehydration Mild 3%-5%

Normal BP Normal HR Cap refil WNL Skin turgor normal Fontanel Normal Urine is slightly decreased

Precocious Puberty

Onset of puberty before age 8 in girls and 9 in boys.

Bossing

Rickets, prematurity, crainiostenosis

where is elasticity of cartilage in the Dubowitz/Ballard exam?

ears

Off the Bottle and drinking from cup

Toddler

Sleep

Toddlers sleep 10-12 hours per night with daily naps. Nightmares begin around age 3 with night terrors 2-6 years old with most outgrowing them as they get older.

Play is a major psychosocial medium****

Toddlers: Onlooker and Parallel play PreSchoolers: Associative, cooperative, dramatic, physical play.....ROLE PLAYING

12-14 months

Walks

Autosomal Recessive

Will skip generations

primary hypertension with no known underlying disease is most common in

adolescents

the expected clinical severity of hemoglobin sickle C disease (Hgb SC) is

mild to moderate

Sunburn

- do not use sunscreen <6 months

SGA

less than 10th percentile

"incident to" billing is specific to

medicare

Aspergers

no language delay. Severe and sustained impairment in social interaction. Development of restricted , repetitve patterns of behavior, interest, and activities. May exhibit OCD tendencies.

a prominent feature in simple partial seizures is

no loss of consciousness

bronchiolitis is marked by what onset of symptoms

non-productive cough moderate fever wheezing

heart defect that presents with ejection click on the left upper sternal border

none

which diagnostic finding would be referred to a specialist immediately?

suspected foreign body aspiration

Cephlahematoma

swelling on one or both sides of the scalp that ***does not cross suture lines +/- bruising - may prolong neonatal jaundice from the resorption of a large hematoma -observe for hyperbilirubinemia

Gastroenteritis

virus are the majority of causes. Rotavirus is 50% of cases and adenovirus. Bacteria: Salmonella, Campylobactor ( odorus), Shigella ( bloody), E.Coli ( mild loose stool).

heart of a typical healthy 4yr old

visible apical pulse or point of maximal impulse

which evaluations are especially needed before a child with mild spastic diplegia enters mainstream school

vision and speech

Obesity

at risk for overweight--> BMI between the 85-95% for age -overweight- BMI >95% -<5yrs old suggests genetic cause

The PNP is educating a group of new moms. One of the moms asks when her child will double his birth weight. What does the PNP state? a. 4 months b. 5 months c. 8 months

b pg. 6

follow up for elevated cholesterol

repeat total cholesterol and obtain lipoprotein analysis

post nutrition for athletes?

replace carbs within 2hrs

Supraclavicular nodes

require aggressive investigation.

reimbursement under managed care

requires that the provider accept the financial risk for the care provided to a specific population of enrolled patients

in a newborn, a diagnosis of hip dislocations is confirmed by

resistance of the left leg when both legs are flexed and abducted

Patient safety and quality improvement act purpose

establish a confidential, liability free, voluntary database of medical errors so that patient safety organization can examine the data to help resolve patient safety and health care quality issues

Cluster headaches

less common in children younger than 20 -pain occurs in bursts, involve sharp stabbing pain on onse dise of head, painful when laying down, more frequent in males -30-90 minutes and may reoccur several times per day

No honey

less than 1 year of age

Extremely low birth weight

less than 1000g

Very Low Birth Weight

less than 1500g

normal development of sinuses

maxillary and ethmoid are present at birth

most common hematological presentation of leukemia in children is anemia along with

neutropenia and thrombocytopenia

when to refer for stuttering

stuttering lasts longer than >6months Child >6 years Child avoids speaking

Cafe au lait spots

subtle shade of discoloration located on flank on either flank. may not present at birth but will increase in size with age. **suspect neurofibromatosis if there are many large spots or if more than six spots in a child older than 5yrs***

mild persistent asthma

symptoms >2 days/week but not daily -nighttime awakenings 1-2x/month >5yrs old 3-4x/month -SABA >2days/week but not daily -minor limitation with activity -asthma exacerbation >2 in 6 months or wheezing 4x per year lasting TX -low dose ICS -alternative tx cromolyn or montelukast -SABA as needed

one difference b/n lesions of primary syphilis (chancre) and HSV genital lesions that may help differentiating the two is

syphilis chancre is painless while HSV lesions are painful

aortic stenosis is

systolic thrill heard at the right upper sternal border also as a systolic ejection click that does not vary with respiration

serevent side effects

tachycardia and headache

Which sound should be considered the diastolic blood pressure in children under 13yr?

the muffling sound (korotkoff IV)

Sensitivity measures

the proportion of actual positives to false positives

First sign of puberty in girls

thelarche

Jean Piaget

theory of cognitive development Sensorimotor stage- birth -->2yrs Preoperational thinking 2-7yrs Concrete operational thinking 7-12 yrs Formal operational thinking 12yr and onward

White forelocks

these with other anomalies are associated with deafness and retardation

acne that has worsedned to a moderate degree of severity and has been chronic and persistent - what medication do you prescribe

topical clinday topical erythro oral tetracycline

common treatment of condylomata acuminata

topical podophyllum resin laser tx no tx needed, may regress spontantously

use of acyclovir in the treatment of herpes simplex virus

topical treatment not recommended focus of treatment is decrease intensity symptom therapy is initiated within 6 days

which developmental theory best eplains the multifactorial etiology of FTT?

transactional theory

which developmental theory best explains the multifactorial etiology of FTT

transactional theory

potential adverse effects of chronic inhaled corticosteroids

verticle growth delay in 1st yr of treatment

Stills murmur

vibratory, groaning, or musical systolic murmur -heard best b/w lower-left sternal border and apex -due to turbulence in the LV outflow tract or vibration of the tendonae in the ventricles

strict vegan should have labs for what?

vit b12, zinc, iron

H. pylori does not present with

diarrhea

echocardiagrm is used to

diagnose conditions of the heart, not neuro issues

asthma is marked by what onset of symptoms

diaphoresis chest tightness hyperresonance difficulty completing a sentence

What treatment do you prescribe for folliculitis

dicloxacillin

Asymmetric tonic neck (fencing) reflex

diminishes by 3-4 months and disappears by 6 months

Hep B immunization

Birth 2 months 6 months

LGA

above greater than 90th percentile

Nodule

an elevated firm lesion >1cm.

most accurate test on vaginal swab for chlymydia?

culture

macrobiotic diet includes

whole grains veggies fruits white meat

Hep B Vaccine

0-2-6 months infants born to hep b + moms: administer hep b vaccine and 0.5ml of Hep B immune globin (HBIG) within 12 hours of birth ( test for HBsAG after three or more doses of hep b series ....usually around 9-18months of age) If mothers status in unknown: Administer hep b vaccine within 12 hours of birth if mom ends up testing + them gibe HBIG no later than 1 week of age.

Tylenol

10-15mg/kg every 4-6 hours

Caloric intake 7mon -1 yr

100 cal/kg/day

What are the nutritional requirements for 7 months to 1 year?

100 kcal/kg/day

What are the nutritional requirements for 2 to 10 years?

100 to 70 kcal/kg/day

Caloric requirements from 2-10yrs

100-70kcal/kg/day

Caloric requirements from 7 months to 1 yr

100kcal/kg.day

TDAP immunization

11 or 12 yrs old and then q10yrs

meningococcal vaccine

11-12 yrs old and 16 yrs old

What are the nutritional requirements for birth to 6 months?

120 kcal/kg/day

Caloric requirements from birth to 6 months

120cal/kg/day

the peak incidence for adolescent gynecmastia occurs at age

13-14yr

the majority of American infants are able to walk by about

14 months

Delayed puberty for males

14 yrs

Introduce spoon

15-17 months of age

Psychosocial periods of adolescence Middle adolescence

15-17yrs body image, sexuality, dating asserting inderpendence

peak incidence of osteosarcoma is

15-19yr

4yr old speech should havehow many words?

1500

vocab spurt is common between what age?

16-24mo

Psychosocial periods of adolescence Late adolescence

18-21 yrs identity formation vocation and career choices intimacy and relationships

What does the Denver II measure?

1: Gross motor development 2: Fine motor development 3: Language 4: Personal-social development

18-22 months

2 word sentences

3yr- school age how many inches do they grow annually?

2.5 inches

Average Newborn length

20-21 inches

autosomal recessive

25% of children born to 2 carrier of the gene mutation will be affected

Sleep

2mo-1 year: 8-12 hours per night 2-3 naps a day avoid sleeping with infant

Rotavirus immunization

2months, 4 months, 4 wk interval complete by 8 months do not administer after 8 months (not effective) Rota can cause intussception

Pulmonic heart sound

2nd intercostal space, upper left sternal border (best heard)

Caloric intake adults

30-32cal/kg/day

Weight Gain

30g/day (1oz) for first 3 months 15-20g/day for next 3 months Initial loss 10% but regains within 7-14 days Doubles by 5 months Triples at 1 year Quadruples by 2 years 3 year- School age grows 2.5 inches a year School age gain 5-7lbs a year

Adequate nutrition for first 3 months

30g/day (1oz/day) Gain of 15-20g/day during subsequent 3 months

Average head circumference

33-35cm

0-3 month neonate needs how many calories for growth

345 cal/d

Term babies

37 weeks gestation and older

When does pulmonary vascular resistance drop?

4 weeks of life

What are the nutritional requirements for adolescents?

45 kcal/kg/day

Caloric intake adolescents

45cal/kg/day

Caloric requirements Adolescence

45kcal/kg/day

School age children how much do they gain wt annually?

5-7 lbs annually

Seperation anxiety

8 months

seperation anxiety

8 months of age

Precocious puberty for girls

8 yrs old

Amount of wt loss in average newborn in first 3-4 days of life

8-10%

Separation anxiety develops

8-9 months

average weight gain in second year

8-9oz

suggested blood glucose level for 7yr old with diabetes?

80-180

wen can a child return to daycare after mumps infection

9 days after onset of symptoms

what tests are helpful for a chil with suspected IBD

ESR serum total protein and albumin CBC w diff

What are the three components or personalities in Sigmund Freud theory?

A: Id ( principle of pleasure) B: Ego ( principle of reality/self-interest) C: Superego ( principle of morality or conscience)

Anti motility drugs should be used judicioulsy

ABX considered when the patient experiences more than 8-10 stools daily. Bactrim ( trimethoprim/sulfamethoxazole) is first line Indicated when organism is isolated or symptoms are not resolved. EXCEPT SALMONELLA ( not repsonsive)

Kawasaki disease

Acute febrile syndrome associated with generalized vasculitis affecting all blood vessels throughout the body, preferentially the coronary arteries

stage of identity vs role diffusion Erik Erikson (psychosocial)

Adolescents 12-18yrs old

Bone Age

An X-ray that measures extent of ossification for short stature findings.

Developmental Warning Signs

Apparent Visual delay Does not raise head when lying on stomach by 3mo Does not try to pick up a toy by 6 mo No reactions to noise or voice Does not laugh Does not seek interpersonal contact Does not sit up.

spina bifida patient with hydrocephalus has increase in gagging, spitting up, stridor - what is the cause?

Arnold chiari malformation

AOM 2nd line of treatment

Augmentin 90mg/kg/day of amox and 6.4mg/kg of claulanate -no improvement in 48-72 hrs or reoccurrence of AOM within 1 month -macrolide abx such as azithromycin and clarithromycin are not recommended second-line drug but may be used if penicillin allergy

Milestones by age 6-9 Months

Babbles and combines vowel/consonant sounds Turns to sound Repsonds to name Rolls over*** Sits independently**** Transfers objects Supports weight on feet Uses thumb and fingers to pick up objects Crawls

Menarche

Between breast development stages 3-4. predominantly at age 4.

Sensorimotor stage Jean Piaget (cognitive development)

Birth to 2yrs -Reflexes -Adapts inborn reflexes to the environment -Object permanence (8-9months) -Sensory abilities improve; become increasingly aware of environment -trial and error learning -simple-problem solving

Caloric requirements

Birth to 6 months 120kcal/kg/day 7mo-1yr 100kcal/kg/day 2yr-10yr 70-100kcal/kg/day adolescents 45kcal/kg/day

Epistaxis tx

CBC with diff, platelets, PT, PTT, coagulation profile, stool for occult blood apply pressure to anterior nasal septum(casablock triangle) with pt sitting upright with head tilted forward (most stop w/in 10-15mins) apply ice

Hepatitis Labs

CBC, UA, elevated AST, ALT ( will rise prior to onset of jaundice then fall after jaundice presents), LDH, bilirubin, PT is slightly elevated.

in chronic sinusitis the most accurate method of identify abnormalities

CT

Most risk management programs are based on the assumption that: a. many injuries to patients are preventable b. most legal liability is a result of poor documentation c. most injuries to patients are not preventable d. malpractice insurance is generally unnecessary

a

Permanet Teeth

Central Incisor 6-8 yr Lateral Incisor 7-9yr Cuspid 9-12 yr First Bicuspid 10-12yrs Second Bicuspid 10-12yrs First Molar 6-7yr Second Molar 11-13yr

Juvenile Idiopathic arthritis

Chronic autoimmune idiopathic arthritis characterized by presence of chronic synovial inflammation w/ associated swelling, pain, heat, and/or limited ROM -morning stiffness, lipm, refusal to walk, irritability, fatigue -Hallmark of systemic disease is high spiking fever with rash -Age <16yrs, duration of disease 6 weeks or longer -refer to rheumatologist

Anterior Fontanel

Closes by 18 months

Hearing loss (sensorineural)

Cochlea hair cells and/or auditory nerve damage - due to in utero infections (TORCH, CMV, rubella), congenital, birth trauma, anoxia, exposure to ototoxic drugs, birth wt less than 150g Acquired- meningitis, mumps, measles, labyrinthitis, head trauma, noise induced hearing loss (loud music..)

Herpes simplex /common cold sore

Contagious, predominately on lips and oral mucosa -Lip lesions--> grouped or singular vesicles on an erythematous base erupt and form crusts Oral cavity lesions--> erythema and edema of mucous membranes w/ singular or multiple vesicles and white ulcerations (may include tongue, palate, and gums) -halitosis may be present w/ oral lesions -lesions are present for 10-14days, gradually resolving -Tzanck smear confirms presence of multinuclear giant cell indicative of herpes Tx lip lesions- topical antiviral (acyclovir) Oral- oral acyclovir

gastroenteritis is

acute inflammation of the gastric mucosa

Breastfeeding jaundice unconjugated bili

Develops after the 7th day of life with max bili concentrations of 10-30 reached during the 2nd to 3rd week of life -levels falls rapidly with discontinuation of BF for 1-2 days, after which BF can be continued

Burns 3rd Degree:

Dry, leathery, black, pearly, waxy, extends from epidermis to dermis to underlying tissue, fat, and bones.

diabetes mellitus Type 1

Due to destruction of beta cells of pancreas, leading to absolute insulin deficiency -peaks occurs between 5 and 7 and at time of puberty S&S -polyuria, polydipsia, polyphagia -wt loss, or failure to gain weight, behavioral changes, HA, emotional lability, fatigue, abd pain, nausea, vomiting, constipation, nocturia, enuresis Labs--> hyperglycemia, glycosuria (urinary or blood ketones), random blood glucose >200, or fasting BG >126 (on 2 occasions), elevated glycosylated hgb A1c >6.5% (3month average) -measurement of diabetes islet cells antibodies present in >85 % for type 1

Bulima

Episodic Binge and purge episodes.

primary hypertension

Essential HTN, no known underlying disease present to cause hypertension - hereditary, salt intake, stress, sleep disturbances/apnea, obese - no symptoms usually severe- symptoms--> HA, dizziness, visual disturbances, epistaxis

Febrile sz

Family hx of sz disorder, mother with tobacco use during pregnancy, prematurity or frequent infections within 1st year -> tonic-clonic sz could last 5 mins -r/o meningitis -EEG -increase reoccurrence rate *teach parents protective measures (acetaminophen)

Denver II

Generalized assessment tool Birth to 6 years Not an intelligence test but a screening tool Measures: Gross, Fine, Language, personal -social Need two separate test to make an assessment of intellect.

Pharyngitis (bacterial)

Group A beta-hemolytic streptococcus (GABHS), neisseria gonorrhea (sexually active) S&S--> >2yrs and older, sudden onset of fever, HA, abd pain, and vomiting, scarlintina rash, strawberry tongue,beefy red appearance, petechial lesions on soft palate, enlarged tonsils with exudate, NO COUGH -Rapid strep--> send for culture if +

Bacterial infections, common organisms 1st month

Group B streptococcus (GBS) gram-negative enteric organisms

How many inches does a 3 year old through school age grow?

The child should gain 2.5 inches annually

When should the child's weight be quadrupled the infant weight?

The child's weight should be quadrupled the infant weight by 2 years of age.

4-5 months

Laughs

Atypical pneumonia

Mycoplasma pneumoniae -mostly children >5 yrs -abrupt onset with constitutional findings (malaise, myalgia, HA, rash, conjunctivitis, photophobia, sore throat) -gradually worsening nonproductive cough -CXR- interstitial infiltrates - Azithromycin 10mg/kg on day 1followed ny 5mg/kg daily for 4 more days (max 500mg on day 1 and 250mg)

meatal stenosis

Narrowing of distal end of urethra -penile pain/discomfort with urination, narrow, dorsally diverted urine stream, high-velocity urine stream -slit like, inflammation of glans Management- air exposure, warm soaks/baths, frequent diaper changes, care exercised at circumcision to avoid damage to frenular artery, cover glans following procedure

Milia

Pinpoint white papules on face, prominent on cheeks, nose, chin and forehead. Will disappear within 3-4 weeks of life. Will often have epsteins pearls too. If persist or wide distribution, may indicate genetic issue

croup virus strain?

Parainfluenza steeple sign

Cataracts

Partial or complete opacity of the lens Congenital- due to infections ( rubella, toxoplasmosis, cytomegalovirus) Acquired- DM, Marfan syndrome, trisomy 21, hypoparathyroidism, galactosemia, neurofibromatosis, toxin drugs, long term systemic corticosteroids --> decreased visual activity, strabismus, white plaque like opacities

Lice

Permethrin--> remove ova/nits after topical treatment w/ fine tooth comb -vinegar and water preparation may help soften cement -only treat other infested family members -wash clothes, bed linens, towels, and hats w/ hot water and dry in hot dryer -wash personal items like combs and brushes with pediculicide -lice can only live 24hrs away from human host

Hepatitis S/S

Pre-icteric: Fatigue, malaise, anorexia, n/v, headache, aversion to second hand smoke and alcohol odors. Icteric: weight loss, jaundice, pruritus, RUQ pain, clay colored stool, dark urine low grade fever, diffuse adbominal tenderness, hepatosplenomegaly.

****Common causes of wide fontanels*****

Prematurity IUGR Hydrocephalus Down Syndrome Hypothyroidsim

Autosomal Dominant

Present in every generation

Stuttering*******

Refer if last longer than 6 months Child is older than 6 years old Child avoids speaking

Mgmt of Hepatitis

Rest during active phase. increased fluid to 3,000-4,000ml/day Vit K for prolonged PT>15sec Avoid alcohol and medications detoxified by liver Little to no protein diet Rebetron ( interferon, ribavirin) may be RX for Hep C.

Catch up Pearls

Resume immunizations according to child's current age regardless of vaccines previously missed.

Clonic seizures

Rhythmic jerking of arms and legs that may involve both sides of the body -length varies, may progress to tonic-clonoic

Nutrition assessment of the child on a strict vegan diet should include regular growth monitoring, diet analysis, and laboratory assessment of a. vitamin b12, zinc, and iron status b. vitamin b12, calcium, and electrolytes c. electrolytes, iron, and vitamin b6 d. vitamin b6, zinc, and calcium

a

native American population has highest incidence of

SIDS

Hepatitis D

Secondary infection caused by a mutated hepatitis virus. Only develops in patients with Hepatitis B

Jean Piaget

Sensorimotor Stage Birth -2 years(object perm 8-9mo) Preoperational/Preconceptual 2-4 yrs ( magical thinking) Intuitive/Preoperational 4-7yr (causation) **Concrete Thinking 7-11yrs** (logical, categorize) Formal operation 11-15yrs (abstract)

When should a body mass index (BMI) be used?

The BMI should be calculated and plotted for children over 2 years old.

the preferred name now for insulin dependent diavetes mellitus is

Type 1 diabetes

Language milestones 6-11 months

Understands "no-no" -babbles - says ma-ma or da-da without meaning -tries to communicate by actions or gestures -tries to repeat your sounds -says first word

Amount of wt loss in average newborn in first 3-4 days of life

Wt regained in 7 days if formula fed and 14 days if BF

10. Which of the following is appropriate advice for the mother of a newborn? a. The child should sleep on her back b. The child should sleep on her back or side c. The child should be allowed to sleep in a carseat at night d. The child can sleep on her comforter

a

AGA

between 10th and 90th percentile

An infant should no longer have a head lag when pulled from the supine to sitting position at what age? a. 2mo b. 4mo c. 6mo d. 9mo

c

Anorexia

eating disturbances, weight loss, and refusal to maintain body weight at 85% of expected weight. Amennorhea ensues.

coarctation of the aorta exam finding

ejection click on the right upper sternal border

pulmonic stenosis presents with an

ejection click that varies with respiration

most common newborn rash

erythema toxicum

H. pylori are the most common cause of

peptic ulcers

Stage of autonomy vs shame Erik Erikson (psychosocial)

1-3 yr

a head injury in which bruising and tearing of the brain occurs is

contusion

More than one hair whorl

could mean poor brain growth

post term neonate PE finding

cracked peeling skin

which of the following is usually elevated with viral infections?

lymphocytes

clinical finding that is most significant for pertussis in teen?

lymphocytosis on CBC

Microcephaly

head circumference smaller than 2 standard deviation

What are signs consistet with pregnancy at 12 weeks

hegar sign goodell sign dopler auscultation of heart sounds

standard deviation

helps to determine if the results are indeed valid

to receive medicare reimbursement, the ARNP must

maintain a current license in the state in which they are practicing

practice using time outs with children is direct application of

operant conditioning

what is the best management for atopic derm with a secondary bacterial infection?

oral antibiotics

viral pneumonia xray results

scattered perihilar and peribronchial infiltrations

knowledge of ARNP is based on

scientific content and theory

Length increases by 50% by

1 yr

Motor milestones 4-5yrs

-prints some letters

17-18months

stacks 3 blocks

VSD

- -most common heart defect -opening b/w the R and L ventricle that may cause excess blood flow to the pulmonary system -+ thrill, holosystolic, louder, lower L sternal border, LVH progress to biventricular hypertrophy w/ large VSD -increase PVR

Drug eruption hypersensitivity

- caused by release of histamines in reaction to immune systems response to drug allergen - onset usually occurs w/in 1st wk of exposure' may be delayed for more than 2 wks, or after drug has been d/c -generalized and localized pruritus, morbilliform erythematous rash occurring first on the trunk and progressing to extremities; initially macular, becoming papular and confluent

Rocky mountain spotted fever

-Systemic vasculitis w/ petechial or purpuric rash -tickborne infection (gram negative bacterium) --Occurs only in the Western hemisphere most common in april to September S&S -triad of fever, rash, and hx of tick exposure or fever, rash, and HA -fever, myalgia, HA, anorexia, n/v precede rash ( -erythematous macular rash (usually appearing b/f the 6th day of illness) on wrists, ankles, spreading within hours to the trunk, and the palms and soles are often involved, macules become papular in 1-3 days -can last 3 weeks with multisymptom involvement -Diagnosis- culture Tx -Doxycycline drug of choice and initiated based on clinical picture b/f lab results

Burns TX

**Body surface area is greater the younger you are= loss of fluid is more TX--> minor burns outpt -monitor daily healing process, cool compresses and pain control -topical antimicrobial agents to prevent infection on open blistered areas (silver sulfadiazine- cant put on face causes hyperpigmentation) mupirocin -fluids to reduce possibility of dehydration -topical emollients to repair and maintain skin barrier

Pharyngitis (viral)

Acute inflammation and infection of the throat -nasal congestion, rhinorrhea, cough, hoarseness, conjunctivitis, diarrhea (adenovirus most common) -enlarges tonsils with exudate can be seen, erythema of pharynx -anterior cervical nodes enlarged w/ tenderness -Rapid strep test rule out -CBC- normal or decrease WBC -supportive care

Klinefelter syndrome XXY

Extra X chromosome S&S -Cardinal features--> small testicles with infertility, increased gonadotropin levels, gynecomastia, learning difficulties (reading and spelling) -low testosterone -tall for age, with disproportionate lower limb length, cryptochidism, small phallus (micro penis), hypospadius, less pubic and facial hair -speech and language dysfunction -increased risk of mediastinal cancers' breast cancer -MVP, cleft palate -behavioral and psychiatric disorders (shy, immature, anxious, aggressive, antisocial)

Impetigo signs and symptoms

Nonbullous--> underlying erythema w/ vesicles that erupt, resulting in honey-colored/serous crusts w/ erosion of epidermis (common 2-5yrs) Bullous--> underlying erythema w/ pustules and vesicles that erupt, resulting in smooth, shiny appearance (common in neonates and infants) - regional adenopathy w/ tenderness

Hydrocele

Painless scrotal swelling due to collection of peritoneal fluid within the tunica vaginalis surrounding the scrotum Noncommunicating--> tunica vaginalis is closed, limiting fluid collection to scrotum; sz of hydrocele constant Communicating--> tunica vaginalis is open, allowing fluid to flow between peritoneum and hydrocele sac; often associated with hernia S&S -swelling in scrotum, may be painful if full or tense, secondary to cough or straining. -translucent with transillumination, fluctuance Tests--> Abs US--> to differentiate between hydrocele from hernia Management Noncommunicating--> most resolve spontaneously w/o intervention Communicating--> occasional spontaneous resolution, frequency develops into hernia requiring surgery -refer for surgical intervention if present beyond 1yr

The PNP is seeing a new patient who has a repaired transposition of the great arteries. Prior to surgical repair, what did the patient's heart structure look like? a. Aorta from right ventricle b. Aorta from right atria c. Aorta from left atria

a pg. 65 "Egg on a string" on x-ray

The PNP is assessing a 6-year-old and notes a systolic thrill at the right upper sternal border and a systolic ejection click. What heart lesion does the PNP suspect? a. Coarctation of the aorta b. Aortic stenosis c. Pulmonic stenosis

a pg. 66 Thrill at RUSB. Click does not vary with respirations.

The PNP is thinking of creative ways to assess a child's cognitive stage. At what age could the PNP consider asking a child to name state capitols to demonstrate concrete thinking? a. 7 to 11 years old b. 5 to 7 years old c. 12 to 14 years old

a pg. 7

what cardiac med does not have negative interactions in asthma patients

angiotensin II receptor blocker calcium channel blocker

reportable findings to state and local authorities

animal bites gunshot wounds causes of TB

acute hepatitis A findings

anti-HAV and IgM serology

PNA Signs & Symptoms

-cough, occasionally productive -tachypnea is a key finding -fever -neck or chest pain, abd pain -wheezing (frequent in viral etiology) -rales/crackles, diminishes or tubular breath sounds

Varicella Zoster virus (chicken pox) S&S

-crops of skin lesions that may appear as maculopapular (early), vesicular, pustular w/ eventual crusts -rash usually present on scalp, face, trunk, and extremities, most lesions on face and trunk -vesicles become umbilicated and progress to pustules and crust w/in 8-12 hrs, vesicles are watery yellow, pustules have white pus, crusts are brownish-red ad fall off in 1-3 weeks, leaving pink often punched-out permanent scars

Bronchiolitis symptoms

-viral infection of the lower respiratory tract -characterized by acute inflammation, edema, and necrosis of epithelial cells of the small airways, increased mucus production and bronchospasm -RSV (most common) - wheezing Is the most prominent physical finding; crackles, very faint breath sounds suggest more severe disease with obstruction -tachypnea w/ shallow breathing, prolonged expiratory phase -rhinorrhea, -palpable liver and spleen due to hyperinflation of lungs

transposition of the great arteries xray finding

"egg on a string"

cxr findings for transposition of the great arteries is

"egg on a string" cardiomegaly increased pulmonary vascular marking

CN II optic

(sensory) Vision, also called eyesight. (Each optic nerve contains approx. a million nerve fibres that receive information from the rod and cone cells of the retina.)

ADHD

*** symptoms must present before the age of 7yrs Must be present for at least 6 months Symptoms must be more frequent and more severe than other children Must interfere in at least two settings: home, school, church, play..... ****med dosing....start low and go slow*** get feedback to assess effectiveness *** side effects of meds are insomnia, anorexia, weight loss, tachycardia, tics, headaches, stomach aches***

Klinefelters XXY

**No cardiac defect** Extra X Chromosome, only found in males Appears normal at birth and presents in puberty May present initial as infertility; not inherited. Most common cause of hypogonadism Tall stature, transverse crease, abnormal body proportions, underdeveloped sexual characteristics, Gynecomastia, learning disability, personality impairment.

Aortic Stenosis

**Systolic thrill at RUSB*** Systolic ejection click that does not vary with respiration Grade 2-4 ECG: LVH Xray: usually normal or CHF if AS severe.

What are growth and development milestones of a 13 to 18 months?

*Scribbles with large crayon *walks alone *Feeds self with fingers and begins using a spoon *4 to 10 word vocabulary *Follows simple directions *Coordinates use of both hands *Responds to name *Points to 2 pictures upon request *Long jabbering sentences *Throw ball overhead *Able to take 3 blocks (17-18 months)

What are growth and development milestones of a 10 to 12 month old?

*Takes simple action upon request *Purposefully says "Mama" or "Dada" *Sits in dependently and plays *Pulls to standing/cruise furniture *Communicates by reaching and pointing *Moves purposefully to get desired object *has increasing curiosity *Recognizes people *Uses both hands equally well

Type 1 DM Somogyi effect and Dawn phenomenon

*early morning hyperglycemia Somogyi effect--> when nocturnal hypoglycemia stimulates a surge of counter regulatory hormones (glucagon) that raise BS. This patient is hypoglycemia at 3am and rebounds with an elevated BS at 7 am tx--> reduce or eliminate the HS dose of insulin Dawn phenomenon--> when tissue becomes desensitized to insulin nocturnally. BS gets progressively higher throughout the night and is elevated at 7am. This desensitization is felt to be due to the presence of growth hormone (cortisol), which spikes at night. Tx--> add or increase the dose of HS insulin

pityriasis rosea tests and tx

- KOH r/o tinea corporis -symptomatic tx for pruritus--> topical calamine lotion on lesions, oral antipruritic agents (Benadryl), cool bath or compresses to lesions, low -potency steroid creams

Tuberculosis

- a chronic and serious granulomatous infections -Latent TB infection--> +TB skin test w/o clinical or radiographoc evidence of disease, children with LTBI serve as a major reservoir and have an increased risk of progression to TB -TB disease--> incubation 3-10wks after exposure, clinical manifestations occur 1-6 months after infection CXR- patchy infiltrates, CT chest for diagnosis Increased risk TB--> contacts of persons with TB, foreign-born persons from high risk countries (Asia, Africa, China, and Eastern europe, Haiti), homeless, migrant, institutionalized, or prison populations, immunodeficiency (HIV) or immunosuppressed, IV drug use, diabetes, chronic renal failure, malnourished

allergic rhinitis tx

- allergen avoidance 1st line of therapy -drug therapy--> antihistamines (loratidine, cetirizine, fexofenadine, diphenhydramine) nasal sprays--> nasal steroids- beclomethasone, fluticasone nasal antihistamine- azelastine nasal ipratropium spray for >6yrs old Leukotriene antagonist- montelukast useful, especially with concurrent asthma oral decongestants/sympathomimetic (psuedoephedrine/afrin) short term relief of nasal congestion **could have rebound effect if used longer than 7 days

rheumatic fever management

- refer to cardiology for valvle damage - abx tx of group A strep--> benzathine penicillin G IM or oral penicillin V -ant inflammatory agents for arthritis/discomfort- salicylates or NSAIDs - activity restriction during acute phase (competitive sports) - people w/ previous group A strep are at greater risk of recurrent attack of RF -antibiotics for endocarditis prophylaxis prior to dental work or surgical procedures are NOT recommended anymore

tonic-clonic seizure grand mal

(generalized seizure) -consists of motor manifestations with LOC Prodrome stage- change in mood, behavior, or thinking Tonic phase--> increase tone, sustained contraction of muscles, occurs suddenly and without warning, causes the person to fall to the ground, extensor posturing and tonic contraction, averages 10-30 seconds Clonic phase--> bilateral and rhythmic, repetitive muscle contractions, with jerking movements, may bite tongue, bowel or bladder incontinence may occur, averages 30-60 seconds Postictal phase--> period of cortical inhibition, vomiting may occur, confusion or lethargy, gradual recovery of consciousness

CN XII hypoglossal

(mixed, mainly motor) Supplies the muscles of the tongue - responsible for the tongue movements involved in speech and swallowing

caput succedaneum

-Crosses midline (fluid under skin, simple swelling) resolves in 2-3 days

Rheumatic fever

-post infection inflammatory disease in genetically predisposed individuals to group A beta hemolytic streptococcal pharyngitis -Diagnosed w/ Jones criteria -Diagnosis of acute rheumatic fever based on evidence of preceding group A streptococcal pharyngitis plus 2 major manifestations or one major and 2 minor manifestatios Major -Mitral valve damage and regurgitation most common

varicella vaccine

12-15 months and 4-6 yrs ager min 3 months apart -live virus vaccine

Influenza vaccine

2 form of vaccine 1. Live attenuated influenza vaccine--> only for healthy children with no known risk factors and approved for ages 5-49 yrs old -do not give to children with a hx of anaphylactis reaction to egg protein or a hx of Guillain Barre syndrome 2. Inactivated trivalent influenza vaccine given all other infants and children and close contacts of severly immunocompromised individuals **Children under 9yr old who are getting the influenza vaccine for the first time need 2 doses at least one month apart.

Jones criteria of signs and symptoms for rheumatic fever diagnosis

2 major or one major and 2 minor such as cariditis and fever

IPV vaccine

2 mon, 4,6, and 4-6 yrs -inactivated=live virus vaccine

Abdominal migraine

3 or more paroxysmal episodes of acute, midline, abd pain, lasting for 2 hrs to several days w/ intervening symptom-free episodes. -At least 2 of the following--> HA during episodes, photophobia during episodes, fam hx of migraines, HA confined to one side only and aura. -Pizotifen (serotonergic agent) has been found to improve symptoms

When does social smile in response to persons begin around

6 weeks

Average newborn weight

7lbs or 3.1kg

Screen hemoglobin

9-12months 11-21 yr

Developmental Dysplasia of Hip

Abnormal development dislocation of the hips, or ligamentation that is congenital S&S -Galeazzi sign--> knee height comparison w/ infant in supine position w/ flexed hips/kness--> asymmetry evident in DDH, shortening of the femoral segment limits abduction and full extension -Limited abduction of affected hip in older children -Limp noticeable at onset of walking -Barlows sign--> Positive when movement of femoral head can be felt as t slips out onto the posterior lip of the acetabulum, Not reliable after 6 months -Ortolanis sign--> newborn period positive finding with click or clunk is heard as femoral head enters or exits acetabulum, not reliable after 1 yr of age. After newborn peroid decreased abduction of flexed legs (at hips) is more significant

Chlamydia tx

Abx uncomplicated genital tract infection Adolescents--> doxycycline, 100 mg 2x daily for 7 days or azithromycin 1f in single dose Pregnancy--> azithromycin 1000mg po x 1 amoxicillin 500 mg po TID daily for 7 days Children 6 months-12 yrs -erythromycin 50mg/kg/day QID daily for 7 days, or azithromycin 20mg/kg in single dose Infants <6months Erythromycin 50mg/kg/day QID for 14 days, monitor for hypertrophic pyloric stenosis -no need to retest after tx with doxycycline, azithromycin, unless symptoms persist or if possibility of reinfection -partners must be treated to avoid reoccurence

Sickle cell disease Management/tx

Administer all immunizations as recommended, including pneumococcal, meningococcal, and annual influenza -Should also receive polysaccharide pneumococcal vaccine (PPV23)) every 5-10yrs as recommended -prophylactic penicillin- initiated by 2 months of age and continue until at least 5 yr old -Seek medical attention with fever -Any fever greater than 101.5 (38.5), require immediate eval--> CBC, clood culture, and a dose of broad spectrum antibiotics (ceftriaxone) Education/Prevention--> factors that may precipitate painful events--> dehydration, fever, hypoxia, exposure to extreme temperatures

Von Willebrand Disease

An inherited hemorrhagic disorder characterized by defective primary hemostasis and due to a quantitative or qualitative abn in von willebrand factor S&S -variability in severity -nosebleeds, bleeding gums, heavy menstrual bleeding, prolonged oozing from cuts, increased bleeding after trauma/surgery -easy bruising, multiple sites of bruising Tests -bleeding time usually prolonged, Von Willebrand factor usually decreased or absent, VWF antigen decreased or absent

Di George Syndrome 22q11 deletion Thymic hypoplasia

Autosomal dominant disorder characterized by syndrome features 1. CHD (ASD, VSD, TA, TOF) 2. abnormal facies 3. Thymic aplasia or hypoplasia (Tcell immunodeficiency) 4. Cleft lip/palate 5. Hypocalcemia 6. Adolescent onset schizophrenia Characteristic features--> receding chin, hypertelorism ( increased distance between the orbits (eyes), shortened lip frenulum, low set, notched pinnae, and nasal cleft Labs--> decreased T cells, lymphopenia, hypocalcemia

Wilms tumor

A primary malignant renal tumor S&S -abd mass usually non painful, occasionally and pain, malaise, fever, loss of appetite, vomiting, blood in urine -HTN -associated congenital anomalies--> aniridia ( absence of the iris), hemihypertrophy (genetic disorder characterized by overgrowth of one side of his or her body in. comparison with the other.), genitourinary anomalies tests--> CBC, UA for anemia and hematuria CT of abd Primary care--> immunizations held while on chemotherapy and resume 6-12 months after therapy completed -sibling immunizations not affected -Fever on therapy requires CBC/BC and hospitalization

gonorrhea tx

Ceftriaxone IM in single dose tx for chylamydia azithromycin PO 1gm

Developmental Dysplasia of Hip Dx and Tx

DX- US before 6 months of age, Xray after 6 months of age Management (3 degrees of hip dysplesia_ 1. Subluxation- high incidence of spontaneous improvement in perinatal period. Observe and reexamine 3-4 weeks after birth 2. Dislocated hips--> treat at time of diagnosis, before 6 months of age ****If unstable, stabilize with an abduction flexion device (Pavlik harness); triple diapers not effective -If diagnosis made after 6 months of age--> surgical reduction indicated

Renal tubular acidosis

Defect in normal urine acidification with resulting persistent metabolic acidosis Type 1- (distal tube) defect in distal tube secretion of hydrogen ions Type 2- defect in reabsorption of bicarb (proximal tube) S&S -growth failure, GI complaints, muscle weakness -Urine pH less than 5.5-5.8, hyperkalemia, serum bicarb less than 16 Goal-->achieve optimal growth and bone mineralization and prevent nephrocalcinosis and progression to renal failure -normal growth resumes with corrected acidosis

Growing pains

Diagnosis of exclusion for lower extremity pain -pain/ache localized to lower extremities, usually intermittent and sometimes nocturnal -Lab studies normal, CBC, ESR, CPR, radiograph normal Management--> prescribe anti-inflammatory medication, massage and heat pads

Lyme disease S&S

Early localized stage - appearance of well-circumscribed, erythematous, annular rash w/ central clearing rash known as erythema migrans (EM) at site of recent tick bite. An expanding macule that is painless and not pruritic, usually flat except at the central bite mark -accompanied by fever, malaise, HA, arthralgia, conjunctivitis, or mild neck stiffness, myalgia Early disseminated stage -Multiple EM, occurring several weeks after the tick bite -accompanied by systemic symptoms such as arthalgia, myalgia, HA, and fatigue, carditis Late disease stage (weeks to months later) -migratory pain in joints, muscles, and bones -transient, but severe HA and stiff neck -poor memory, mood changes, comnolence -muscle weakness and poor coordination -chest pain, cardiac abnormalities -dizziness/fainting -facial palsies, peripheral neuropathies -joint stiffness, recurrent arthritis affecting large joints, esp the knees Physical findings - Typical rash that occurs 1-2 weeks after a tick bite, central clearing -Heart block (late) -Neurologic findings- seventh cranial nerve palsy -fever, HA, myalgias (pain in muscle), fatigue, arthralgias

hyperlipidemia

Elevated serum lipid and lipoprotein concentration -total cholesterol of 200 or above - measurement of fasting lipid panel in children between 2 and 8 yrs old and 12 and 16yrs of age w/ + family hx of early heart disease or known dyslipidemia or if child has diabetes, HTN, BMI >95% -non-HDL cholesterol levels significant predictor of the presence of atherosclerosis in children, More predictive of persistent dyslipidemia than total cholesterol, LDL cholesterol, or HDL -universal screening with either non fasting lipid profile or a fasting lipid profile recommended b/w 9 and 11 pf age and b/w 17-21

Constipation (Functional)

Functional-->most commonly due to voluntary withholding of stool following the passage of painful bowel movement. Can lead to impaction and encoporesis S&S - during infancy, particularly after change from BM to formula, or starting solids; 1-3 yr of age after life change, new sibling, home, introduction of toilet training -complains of abd pain, blood streaked stools, straining or dancing around indicates withholding -Stools- hard, dry stools, "pellets"; occasionally stool caliber ver large/wide, may be dark or strong odor - Rectal exam may show fissure, ampulla full of stool, normal tone, may have no palpable abd mass, may have abd pain or cramping, no distention, normal growth and development -

Asthma primary care

Goal-->reduce current impairment and reduce future risk -Classifications divided into 2 groups- intermittent, mild persistent, moderate persistent, severe persistent -Classifications based on 1. frequency and timing of symptoms 2. interference with daily activities, 3. PFTs, 4. need for short-acting medications **if a child falls between 2 levels of severity, child should be treated for the highest level (most aggressive) -At every visit review the written asthma action plan -close f/u, return visits every 1 to 6 months -Those with persistent asthma should have skin testing or in vitro testing to identify specific allergens

TGA

Grade 2-5 systolic ejection murmur with holosytolic thrill. LLSB ECG: RVH ****Xray: Egg on a string****

VSD

Grade 2-5 systolic ejection murmur. **Holosystolic thrill felt at LLSB.*** ECG: LVH progressing to biventricular hypertrophy is VSD is large. Xray: cardiomegaly and increased vascular markings

Sprains

Grading 1. Few fibers torn w/in ligament; does not compromise ligaments strength. Minimal pain and swelling, Full ROM,no increase in joint laxity Grade 2--> tears portion of the ligament, clinically significant pain and swelling, impairment of ROM, detectable increase in joint laxity Grade 3--> Complete tear in ligament, marked laxity evident when ligament stressed Radiograph- rule out fracture or tumor, MRI--> evaluate torn ligament or damage to cartilage Management - RICE, Rest, Ice, Compression, Elevation reduce swelling and hematoma, ROM exercise, avoid wt bearing, stabilize ankle,

Chronic diarrhea

Gradual or acute increase in number and volume of stools -Allergy to whole milk or other foods -Noninfectious due to abx theraoy -Functional or nonspecific--> daily painless, recurrent passage of 3 or more large, unformed stools for 4 or more weeks; most common cause of diarrhea in young children; assess for overfeeding, excessive fruit juice or sorbitol consumption, excessive carbohydrate ingestion w/ low fat intake

GERD meds

H2 receptor antagonist- inhibit gastric acid secretion caused by histamine (Zantac, pepcid) PPI--> block gastric acid secretion caused by histamine, acetylcholine, or gastrin (omeprazol Prilosec)

Symmetric IUGR

Head circumference, weight, and length all below 10th percentile.

how can assess uncompliant diabetic diabetes control?

Hgb A1c

Pinworms

Human pinworms, adult worm lives in rectum, comes out at night to lay eggs on perianal skin and dies, causing pruritus; scratching and finger-to-mouth contact transfers eggs to intestine, these develop into mature worms and repeat cycle (2 weeks) -S&S -nocturnal anal/vaginal itching -excoriation of perianal and perineal area, threadlike worms will be seen on visualization of anus Test -Adhesive cellophane tape at night examine for egss Meds -older than 2yrs old and not pregnant--> Albendazole 400mg orally single does, repeat in 2 wks -test other family members

Hirschsprungs ( Aganglionic Megacolon)

If untreated will be fatal. More common in boys Failure to pass meconium, BILIOUS VOMITING, jaundice, infrequent explosive bowel movements, progressive abd distention, tight anal sphincter with an empty rectum, failure to thrive, malnutrition. abd xray, barium enema, rectal colon biopsy. referral to GI specialist

allergic rhinitis

Ig-E mediated response to inhaled allergens or irritants producing nasal mucosa inflammation -hypertrophied turbinates, nasal mucosa pale, boggy, and edematous with watery or mucoid secretions -CBC- eosinophils and total IgE elevated

Immune Thrombocytopenia (ITP) Idiopathic thrombocytopenic purpura

Immune-mediated disorder characterized by production of antiplatelet antibodies S&S -bruising, nose bleeds, bleeding gums and lips, petechia, menorrhagia -petechiae, purpura, and eccymoses -hemorrhages in mucous membranes Tests -Hgb- normal or slightly reduced with prior bleeding -Platelet count <20,000 diagnostic for ITP <100,000 diagnostic for chronic ITP -WBC normal Acute ITP--> tx not indicated if platelets >50,000 tx if <20,000 platelets -inhibit autoantibody-mediated platelet clearance--> high dose corticosteroids (prednisone 2-5mg/kg/day orally for 1-3 weeks with slow wean Education--> avoid all competitive contact sports that could result in head trauma or ruptured spleen -avoid aspirin and aspirin containing medications, and NSAIDS Postslenectomy care--> all immunization, including mengingocococcal, pneumococcal, and influenza -prophylactic penicillin or amoxicillin -increased risk for infection, and fever greater than 101 requires CBC, blood cx, and dose of ceftriaxone

PERTUSSIS TX

Infants <6 months azithromycin 10mg/kg/day orally once daily for 5 days ***need to monitor for one month after tx for hypertrophic pyloric stenosis (neythromycin 40mg/kg/day in 4 divided doses for 7-14 days) Infants 1-5 months clariomycin alternative 15mg/kg per day in 2 divided doses for 7days Bactrim (trimethoprim-sulfamethoxazole) alternative for pt over 2 months of age unable to tolerate macrolides or who may have a macrolide resistant strain 8-10mg/kg/day BID for 14 days -erythromycin recommended for all household contacts and other close contacts regardless of vaccination status Prevention -Vaccine DTAP at 2 months, 4 months, 6 months, 15 months and 6 yrs Booster- TDaP 11-12yrs then every 10 yrs.

Hearing loss signs and symptoms

Infants- failure to elicit startle or blink reflex to loud sound Children- substitution of gestures for words, especially after 15 months, failure to develop intelligible speech by 24 months -refer to audiological and language eval - hearing and language screening- birth to 4 months- 4 to 24 months

Osteomyelitis

Inflammation of bone caused by a pyogenic organism -Caused by staph aureus -peak age infancy (less than 1 yr) and preadolescents (9-11) S&S -neonates usually afebrile, swollen or motionless limb early sign -earliest symptom in child may refusal to bear weight or flexion of hip in comfortable position -fever, local bone tenderness, if subperiostal or soft tissue abscess develops, fluctulasnt mass present Dx- WBC, CRP, ESR elevated, radiographs- show soft tissue swelling -Aspiration to identify pathogen -refer

Marfans syndrome

Inherited disorder of connective tissue; autosomal dominant inheritance of defective fibrilin gene S&S -Ghent diagnostic criteria -->Aortic root score, pectus carinatum, pectus evactum or chest asymmetry, -wrist and thumb sign-->the thumb and little finger overlap, when grasping the wrist of the opposite hand) -tall, long limbs (increased arm span to height ratio) -aortic root dilation, mitral valve prolapse/regurg -ectopia lentis (displacement or malposition of the crystalline lens of the eye) - myopia, retinal detachment, exotropia/strabismus -spontaneous pneumothorax -connective tissue problems -joint hyperextensibility -dolichocephaly (head is longer than would be expected, relative to its width), downward-slanting palpebral fissures, enophthalmos (posterior displacement of the eyeball within the orbit), retrognathia (abnormal posterior positioning of the maxilla or mandible), and malar hypoplasia (underdeveloped cheek bones) -Cant participate in contact sports due to aortic dilation, more at risk for aortic aneurysm -avoidance of wind instruments, sky diving, scuba diving

Head injury

Instructions for home observation -Need to seek medical attention if--> -Increased drowsiness, prolonged sleepiness, inability to wake up -disorientation -confusion, trouble with blurred vision, speech, or hearing -vomiting more than twice -sz -change in swelling of scalp -watery or bloody d/c from ear or nose -HA that gets worse or last longer than 24hr -stumbling or trouble walking

Enuresis

Involuntary urination after child has reached age when bladder control is usually attained; may occur during daytime (diurnal) or at night, especially while sleeping -usually resolves by 5-7 yrs of age and is considered outside the norm if occurring after their 7th birthday Primary enuresis--> child has never been dry/attained control causes--> small bladder capacity, toliet training problems, delayed maturation of voiding inhibitory reflex, sleep problems (deep sleeper), lack of AHD, ingestion of increased fluids, dysfunctional voiding (inattention/too busy to void) Secondary enuresis--> reoccurrence of incontinence following a period of at least 6 months of dryness -causes--> UIT, diabetes, GU abnormalities, medications, stress

How does tooth eruption take place in a child?

Mandibular, then maxillary, incisors, cuspids, and then molars (Come Little Children Munch Meat) Primary teeth: Central Incisors: 6 to 7.5 months old Lateral Incisors: 7 to 9 months old Cuspid: 16 to 18 months old First Molar: 12 to 14 months old Second Molar: 20 to 24 months old Permanent Teeth Central Incisor: 6 to 8 yrs Lateral Incisor: 7 to 9 years Cuspid: 9 to 12 years First Bicuspid: 10 to 12 years Second Bicupid: 10 to 12 years First Molar: 6 to 7 years Second Molar: 11 to 13 years

Turner's XO Karotype

Most common sex chromosome anomaly in GIRLS 95% of embryo's do not survive to term. Lymphedema...Puffy babies Webbed neck, low hairline, learning disabilities, lack of secondary sex characteristics, Shield shaped chest with wide set nipples, Mass on neck, hypertension ( many have hashimotos) bicuspid aortic valve and coarctation of aorta.

CN IV trochlear (mixed, mainly motor)

Moves the eyeballs by sending nerve impulses to the superior oblique muscles which are among the group of muscles that rotate the eyeballs in their sockets. (The action of this nerve is coordinated with those of the oculomotor and abducens nerves i.e. cranial nerves III and VI.)

Systemic Lupus erythematosus

Multisystem autoimmune disorder that is characterized by widespread inflammatory involvement of connective tissues with immune complex vasculitis S&S -fever, malaise, wt loss, malar facial rash (butterfly distribution across bridge of nose and over each cheek), discoid rash over sun exposure areas, arthritis, kidney involvement in all children, proteinuria, HTN Refer to rheumatology -repeated remissions and exacerbations

Miliaria

Obstructed sweat ducts. sometimes referred to as prickly heat.

Chlamydia

Parasite -most common reported STD, with primary sites of infection being genital tract, cornea, and resp system -reporting based on state Complications--> endometritis, perihepatitis, PID, epididymitis, reiter syndrome for males -Screening is recommended for all women younger than 25 yrs, pregnant women, men who have sex with men, and young men in high-prevalence areas Tests--> NAATs- specimen vaginal or **urine for rectal and pharyngeal sites -Tissue culture

Duchenne Muscular Dystrophy

Progressive genetic disorder that afftects muscles in lower extremities and eventually muscles of upper extremities, chest wall, and heart -X-linked recessive genetic disorder that results in absence or severe deficiency or cytoskeletal protein known as dystrophin S&S -clinciallly evident by 3-5 yrs of age -abnormalities in gait and posture (clumsy walk), -hx of delayed developmental milestones -large muscular looking calves -inability to keep up with peers when running -increase lumbar lordosis -pelvic walddling **Gowers sign--> child may "walk" hands up to legs to attain a standing position when arising from floor - progressive over next 2 decades- wkness more evident in proximal muscles -wheelchair dependent by 7-12 yrs old -cardiac involvement in all pts (cardiomopathy) DX- obtain 3 generational fam hx, carrier in female have symptoms of weakness and cramping muscles Lab--> CK elevated, EKG, muscle biopsy, genetic testing -refer neuromuscular

Nurse maid elbow

Radial head subluxation, unable to use affected arm, pain upon supination, unable to bring arm down, hold arm across body +/-Xray Tx--> bring arm out, pull out, twist and flex it while holding the arm supinated the elbow is then maximally flexed the physician's thumb applies pressure over the radial head and a palpable click is often heard with reduction of the radial head

Heart Sounds

S1: AV valves close S2: semilunar valves close Systole: period between s1 and s2 Diastole: Period between S2 and S1.

Dtap

Series of 3 2-4-6 months Booster at 15 months and 6 years DONT GIVE PAST 7 YEARS OLD!!***

Rotavirus

Series of 3 6wks-32wks at 4 week intervals DONT GIVE PAST 32 weeks or 8 months*** Intussecption sometimes 3 wks after dose

Slipped capital femoral epiphysis

Spontaneous discoloration of femoral head, occurs through adolescent growth spurt (10-17yrs). -Before menarche in girls -Incidence greater among obese adolescents with sedentary lifestyles S&S -most children have limp (greater than 3 weeks consider chronic) -varying degrees of aching or pain (in groin, often referred to thigh/knee) -pain in groin and hip area to back of thigh -unable to properly flex hip as femur abducts/rotates externally -may observe limb shortening, resulting from proximal displacement of metaphysic -loss of internal rotation w/ hip flexed to 90 degrees Dx- Radiograph--> referral to ortho

ADHD meds and side effect

Stimulants--> methylphenidates (ritalin, concerta, metadate, focalin) Amphetamines (adderall) -titrate slowly to focus -SE--> insomnia, anorexia, weight loss*** tachycardia, temporary decrease in rate of growth and development, tics, HA, stomach aches

Influenza

Sudden onset of fever, chills, malaise, HA, myalgia, dry cough, sore throat, bad pain, nausea, vomiting, diarrhea -Mid-October to February -Nasopharyngeal swab obtained w/in the first 72 hours, or a rapid antigen test -Diagnosis usually made based on clinical symptoms and available prevalence data -Antiviral med Oseltamivir or zanamivir may be given w/in 48hr of symptoms to help decrease length of illness and severity ***children <1yr with influenza sx should be treated with oseltamivir -Exposure to infected individuals in at risk populations may receive prophylactic antiviral therapy with oseltamivir

Tonic seizures

Sudden significant increase in muscle tone lasting less than 20 seconds -often occur during sleep, happens while awake, the person will fall -abrupt onset with rapid return to baseline

TB diagnostic tests

TB skin test -risk assessment every 6 months until 2 yrs old, after 2 yr perform annual risk assessment, skin test all children w/ increased risk -Skin test annually any children w/ HIV, incarcerated adolescents, children w/ increased risk of progression LTBI -+ test induration of 15mm or greater is considered + in any population, reaction >5 to 14mm may be considered + in certain high risk groups -QuantiFERON - TB Gold, IGRA is more specific than TST (negative result not necessarily absence of infection

Acquired syphilis Test and Tx

Tests- Microsdope tests--> direct fluorescent antibody tests- presence of spirochetes from scrapings or washings of primary lesions; Definitive diagnosis serologic tests- presumptive dx Nontreponemal tests- rapid plasma reagin (RPR), VDRL, TRUST (toluidine red unheated serum test) Treponemal tests--> fluorescent treponemal antibody absorption (FTA-ABS) and treponema pallidum particle agglutination (TP-PA) greater specifity TX Children- Penicillin G 50,000U/kg IM up to adult dose 2.4 million units, as 3 single doses administered at 1-week intervals Adults-Penicllin G 7.2 million units total administered as 3 doses of 2.4 million units IM per dose at 1-week intervals -if allergic and not pregnant--> doxycylcine 100 mg orally BID daily for 4 weeks or tetracycline 500 mg orally QID daily for 4 weeks F/u- primary and secondary 6 and 12 months after tx,

What is the corrected gestational age (CGA)?

The CGA is the adjustment of developmental expectations for a premature infant through the age of 2 years.

When does the infants weight double?

The infant's weight should be doubled by 5 months of age.

Hyperthyroidism tests/meds

Thyroid function test--> elevated T4, free T4, and T3 resin uptake with TSH suppression and low serum cholesterol refer to endocrinologist Meds -Beta-adrenergic receptor blockers to control nervousness and cardiovascular symptoms (propranolol, atenolol) -side effects of antithyroid meds (methimazole)--> rashes, uticaria, arthralgias, and decreased WBC count, all children on tx require a CBC for fever or sore throat --> black box warning for the use of PTU risk of liver disease)

external otitis media (EOM) treatment

Topical antibiotic otic drops- neomycin, polymyxin, and fluoroquinolone are effective (ofloxacin is safe with PE tubes or TM perforation) the addition of hydrocortisone (Cipr HC) helpful when canal is edematous - Significant swelling- abx saturated with abx solution for first 24-28 hrs avoid swimming -reexamine in 1-2 weeks for eval of TM -Refer to ENT if not better in 2-3 days or worsening

Hepatitis C

Transmission- blood and blood products, occasionally blood transfusion; maternal-fetal transmission. The duration of presence of passive maternal antibody in infants can be as long as 18 months--> testing for anti-HCV should not be performed until after 18 months of age. Children often asymptomatic, mild disease with symptoms of icteric (yellow eyes), gradual onset of HA, fever, nausea, fatigue, anorexia, can become chronic carriers

Neuroblastoma*******

Tumor arising from neural tissue. frequently from the adrenal gland and can spread to bone marrow, liver, lymph nodes, skin, and orbits of eyes. MOST COMMON BEFORE 5YRS. S/S: FTT, enlarged abdominal mass, profuse sweating, tachycardia. Lab: Abd US. Refer for CT, urine catecholamines REFER TO ONCOLOGIST

Insect bites

Tx for secondary bacterial infection w/ topical mupriocin, oral if extensive cephalexin

Seizure work up

Underlying cause? Pica- possible lead ingestion -CBC, LFTs, serum fasting glucose, calcium, magnesium, nd serum electrolytes Cranial CT or MRI--> 1st sz in all adolescents EEG-standard in all children to diagnose and define seizure type, after 1st nonfebrile seizure *normal EEG does not exclude diagnosis Refer to neuro Protective measure -Protect child from injury, do not restrain, assess adequate airway, do not insert items in mouth, note time, duration, and activity, sz last longer than 5 minutes call 911 -supervised swimming only

Hydronephrosis

Unilateral or bilateral dilation of kidneys -caused by anatomic block of urine flow from kidney S&S -N, abd or flank pain, decreased urine output Tx- surgery to relieve obs, follow up long term for continued assessment of renal fx

Hypospadias

Urethral meatus opening on underside (ventral) surface of penis -Urethral folds along midline fail to fuse Management--> refer to urologist, avoid circumcision foreskin used for repair

UTI diagnosis/test

Urine analysis--> presence of urinary leukocyte esterase, nitrate, and blood suggestive of UTI, not diagnostic Urine culture mandatory for accurate diagnosis Bagged urine--> most useful for exclusion of diagnosis of bacteriuria, if + need culture Clean catch- appropriate for mild sx or follow up, + with colonies of 50,000-100,000 colony forming units (CFUs) of single organism Strainght cath--> used w/ infants/children who cannot void voluntary, + with colonies >10,000 CFUs of single or multiple organisms Indications for imaging studies -symptoms of pyleonephritis regardless og age and gender -UTI in any child <3 months of age - Males with 1st infection and females with 2nd infection VCUG- grades 1-3 of reflux will resolve as child grows if there is no underlying dysfunctional voiding or elimination syndrome

Varicella Zoster virus (chicken pox)

VZV occurs in a nonimmune host -infected individual contagious for 24-48 hrs prior to outbreak of lesions, until all lesions have crusted over -Primary infections generally confers lifelong immunity -There is a latent phase in which the virus resides in the dorsal root ganglia and may be reactivated at a later time as eruptions of shingles Tx- self limiting, lasts 7-10 days -supportive tx, acetaminophen for fevers (aspirin could cause reyes syndrome) -Oral acyclovir is beneficial in reducing duration of new lesions formation and total number of lesions (20mg/kg/dose QID) should be treated w/in 24hr of onset for max benefit -Varicella zoster immune globulin should be given to immune-suppressed contacts to provide passive protection **children may return to school when all lesions crusted, or in immunized children w/o crusts when the lesions appear to be resolving

Hepatitis B

Vaccine series Transmission--> blood or body fluids; virus can survive more than 1 week on inanimate objects -Majority of perinatally infected neonates become carriers -Children often asymptomatic- macular rash and arthritis (early sign), anorexia, nausea, malaise, arthralgia

Migraines

Vascular, recurrent hA with varied frequency, intensity, and duration -unilateral dull, insidious Diagnostic criteria -repeated episodes of HA accompanied by at least 3 of the following sx - recurrent abd pain, N/V, extreme sensitivity to light or sound -often have an aura (light flashing, photophobia, nausea, tingling sensation) -throbbing or punding pain (resolves after sleeping) -oain restricted to one side of head (may shift sides), bilateral before puberty -Relief of pain by brief periods of sleep -fam hx

Patch

a flat discoloration that looks as though its a collection of multiple tiny pigment changes, may sometimes be a subtle surface change.

Chalazion

a nodule or cyst, usually on the upper eyelid, nontender, inflammation of the meibomian glands -slow growing round, non pigmented mass to the eyelid, firm, localized nodule TX- warm compresses Large/recurrent/ or infected lesions tx with local antibacterial drops or ointment (sulfacetamide sodium 10%) 4x daily x1 wk, +/- systemic abx

The PNP is admitting a neonate to the newborn nursery. The mother's HBsAG status is unknown. What order does the PNP expect to write? a. Administer HepB vaccine within 12 hours of birth b. Obtain labwork for HBsAG from infant c. Administer IVF at 12cc/hour x 12 hours

a pg. 17 Determine mother's status ASAP. If mother tests positive, admin HBIG within 1 weeks of age.

Which of the following children is most likely to experience a typical febrile seizure? a. a 1yr old with otitis and fever >104 b. 3 month old with unequal pupils and bulging fontanels c. 11yr with fever >101 who is on valproic acid for seizures d. 5yr old with bacterial meningitis

a..

type of migraine syndrome

abdominal migraines confusional migraines

What position do you want the child to be in to prevent any further disruption in dislocated hip? (DDH)

abducted

in boys lack of secondary sex charac after 17yr suggests

abnormal testicular function

duchenne muscular dystrophy is characterized by which of the following signs and symtpoms

abnormalities of gait and posture become evident during preschool years

Syncope due to cardiac reasons

abrupt onset with no prodromal symptoms, associated with exercise/activity/exertion, may not have spontaneous recovery -Restrict from activity until evaluated by cardiologist

area all all findings of a 4yr old with allergic rhinitis

allergic shiners hypertrophy of gingival mucosa edema of nasal mucosa

childs eye drifts to nasal side of eye

amblyopia

Croup

an acute inflammatory disease of upper airway and larynx by a viral infection -parainfluenza virus is the most common -6months to 6yrs

severe malnutrition, hypopituitarism, craniosynostosis would be differential for

an infant with microcephaly

hordeolum (stye)

an infected sebaceous gland of the eyelid -S&S--> sudden onset of a tender, edema, red papule, typically on lid margin. Tx- war, compresses, abx ointment opth or drops Sulfacetamide sodium 10%, polymyxin B bacitracin, or erythromycin opth ointment -Doesn't resolve in 48hr- refer to I and D -Cleanse with diluted baby shampoo daily

Low FEV1/FVC ratios (below 75-80%) usually indicate

an obstructive pulmonary disease (asthma)

treat allergic conjunctivis with

an oral antihistamine

decreased platelets may not be found in which of the following?

anemia

The underlying emotion of an insecurely attached (avoidant) relationship is:

anger

Prolonged (nonphysiologic) neonatal hyperbili unconjugated bili

associated with BF, maternal diabetes, induced labor, prematurity, Asian ethnicity, and male gender

tuberous sclerosis is caused by

autosomal dominant mutant gene

Hypertension

average systolic/diastolic BP In 95% for age and sex on at least 3 separate occasions using the same arm, cuff, and position

A 2-month-old breastfed infant weighing 11 lb 8 oz (birth weight 8 lb) is seen in the clinic. The mother appears exhausted and reports that she is nursing on demand, every hour for 5 to 10 minutes. The PNP suggests that the mother: A) Supplement the infant with formula after breastfeeding B) Nurse longer than 10 minutes at each feeding C) Give 1 tablespoon of rice cereal once a day to the infant D) Continue nursing on demand

b

A 2-week-old neonate is brought to the office for the first time. The mother states that the doctor in the hospital suspected Down's syndrome, and she begins to cry. On physical examination the infant has characteristics that may indicate Down's syndrome. The phenotypic features the PNP recognizes as commonly associated with Down's syndrome include: A) Large ears and small mouth, short fingers, and jaundice B) Small ears, short neck, and hypotonia C) Flat nasal bridge and normocephaly D) Protuberant tongue, microcephaly, and jaundice

b

A 6-month-old infant is brought to the clinic for a well-child visit. On physical examination, increased tone and lower leg scissoring are noted. The PNP recognizes this as a probable sign of: A) Down's syndrome B) Cerebral palsy C) Fragile X syndrome D) Muscular dystrophy

b

Appropriate management of a full-term, 3-day-old, breastfed infant with a bilirubin level of 16 mg/L would consist of: A) Observation, close follow-up, parental instructions to breastfeed every 2 hours, and an office visit to determine serum bilirubin level in 10 days B) Exposure of the infant to indirect sunlight, supplementation with formula after breastfeeding if the mother's milk has not yet come in, and close clinical follow-up C) Phototherapy and follow-up in the office 10 days later to determine serum bilirubin level D) Exchange transfusion and then hospital discharge with close clinical follow-up

b

At an 18-month-old child's well-child visit, the father states that the child is a picky eater and has 4 oz of milk by bottle at nap time and 8 oz of milk by bottle at bedtime. The rest of the child's fluids are taken by cup. Of the following, what is the most pertinent information for the PNP to obtain? A) The total intake of milk for 24 hours B) A 24-hour recall diet C) A list of foods the child refuses D) The family's financial status

b

Blood pressure should be measured at well child visits, beginning at age: a. 2yo b. 3yo c. 4yo d. 5yo

b

Credentialing of the pediatric nurse practitioner requires which of the following? a. recognition by third party payers b. verification of license c. authorization to perform specific services d. certification of specialty

b

If an APRN practices beyond his/her scope: a. malpractice insurance will protect him/her from a charge of practicing medicine without a license b. malpractice insurance will not protect him/her from a charge of practicing without a license c. he or she is legally accountable to the certifying body d. The collaborating physician is legally accountable to the certifying body

b

Licensure is: a. federal process that is used to standardize healthcare facilities b. is granted by a state government agency and grants permission to engage in the practice of a given profession c. Cannot be used to prohibit anyone from practicing a given profession d. is a federal process that is used to standardize educational programs

b

The most important PRIMARY care goal for a school aged child with a prosthetic heart valve is to a. prohibit exercise and sports participation b. maintain endocarditis prophylaxis c. provide home schooling d. maximize carbohydrate calories for growth

b

Which of the following is responsible for sexual maturation of males? a. estrogen b. testosterone c. progesterone d. adrogen

b

Which of the following is the best INITIAL counseling for a family of a 5 year old with nocturnal enuresis? a. wake the child frequently during the night so urination is effective b. symptoms are often a developmental lag and will be outgrown c. medication therapy has the best long term response rate d. an alarm system is the best choice as it is usually covered by health insurance

b

You receive a call from a mother of a 2yo girl with a temp of 101F and diarrhea for 5 days with 6-8 liquid stools/day. How would you advise this mother? a. Go to ER now b. Come to the office tomorrow morning c. NPO d. Loperamide 10ml after each loose stool

b

The PNP is seeing a 2 month old patient. How much weight should the baby be gaining to confirm adequate nutritional intake? a. 15 to 20g/day b. 30g/day c. 40g/day

b pg. 6 Infants <3 months old should gain 30g/day (1oz/day).

The PNP is assessing a 10-year-old child. She notes S1 and S2 with no murmur. The PNP knows that S2 is the opening of which valves? a. Aortic and pulmonic valves b. Mitral and tricuspid valves c. Tricuspid and pulmonic valves

b pg. 62

At his 12-month well child appointment, the PNP expects Elizabeth to have which teeth erupting? a. Cuspid teeth b. Front molars c. Back molars

b pg. 7

swollen eyelid with purulent discharge indicates

bacterial conjunctivitis

asplenic children are at increased risk for which of the following

bacterial infections

shift to the left is present when which of the following are elevated

bands or stabs

What are specific tests for dislocated hip?

barlows test ortolanis test Trendelenburg test

Precocious puberty for boys

before 9 yrs old

two small red puncture marks surround by a blanched area with an erythematous border what do you suspect

black widow spider

Hepatitis C

blood transfusion 50% of cases are related to IV drug use. Incubation is 4-12wks.

mongolian spots are typically what color

blue

tetralogy of fallot xray findings

boot shaped heart

what age does the tonic neck reflex disappears?

by 3 months

when does the moro reflex disappear

by 3-4 months

10. Which one of the following is not characteristic of constitutional growth delay? a. There is generally no hx of a similar growth pattern in other family members b. The child usually remains constitutionally small as an adult c. Final adult stature tends to be normal d. Weight & height at birth are generally in the lower percentiles

c

19. Joshua is the 9mo old infant son of parents of Lousinana-French descent. The child stopped rolling over. Mother reports he is increasingly irritable. Which of the following physical exam findings is most consistent with Tay-Sachs disease? a. Cardiomyopathy b. Retinal detachment c. "cherry red" spot on retina d. hepatomegaly

c

22. Which of the following factors is not associated with increased risk for infantile botulism? a. Rural environments b. Use of honey c. Use of corn syrup d. Farm families

c

At the 6-month well-child visit the PNP is counseling a mother about what foods to add to the infant's diet. The mother asks if she can offer cow's milk in a cup. The PNP informs the mother that cow's milk: A) Is safe and nutritious B) Has too much fat for the infant C) Should not be introduced to an infant D) Is more expensive than formula

c

During an annual physical exam, you notice that Lisa has developed breast buds. You tell her she can expect which of the following in 2 years: a. Pubic hair growth b. Peak height velocity c. Onset of menses d. axillary hair

c

In counseling a parent regarding possible lead poisoning in the child, the PNP states that the most common source of lead is: A) Soil B) Batteries C) Lead-based paint D) Drinking water

c

Spasticity in an infant may be an early sign of: a. neurofibromatotis b. hydrocephalus c. cerebral palsy d. muscular dystrophy

c

The first sign of puberty in girls is usually: A) Acne B) Pubic hair growth C) Thelarche D) Menarche

c

The pediatric nurse practitioner performs the "cover test" on a 3-year-old patient to screen for strabismus. When the left eye is covered, the right eye moves outward to fix on a near object. The cover test has revealed which of the following conditions? a. Pseudostrabismus b. Left eye strabismus c. Right eye strabismus d. Normal ocular alignment

c

Which of the following best defines the term health literacy? a. An individual's formal health education level b. An individual's ability to read written information about health education c. An individual's capacity to obtain and understand basic health information needed to make appropriate health decisions d. An individual's motivation to make good personal health decisions

c

Which of the following is a true statement regarding nocturnal enuresis? A) Psychologic stressors are a common cause of nocturnal enuresis B) There is a true organic cause in most cases of nocturnal enuresis C) Physiologic causes of enuresis include having a small bladder capacity D) Urinalysis is unnecessary in most cases of enuresis

c

Femoral anteversion is normal until what age? a. Preschool b. School Age c. Adolescents

c pg. 40 Femoral anteversion= in-toeing

turner syndrome ongoing assessments

cardiac Tanner staging thyroid

coarctation of the aorta presents with

cardiomegaly pulmonary vascular marking rib notching

pediculosis humanus

caused by an insect that does not fly or jump gravid females lay ova in seams of clothing same med used for scabies

Medicaid provides health insurance coverage to

certain categories of people whose personal income falls below the federal poverty level

which of the following is included as part of the initial therapy for ALL

chemo radiation intrathecal chemo

most common sexually transmitted disease in the US

chlamydia

management of a child with hypospadious

chromosomal analysis

meatal stenosis, narrowing of the distal urethra is seen folowing

circumcision

disseminated herpes disease symptoms in infant

clinical picture consistent with sepsis acutely ill during 1st week of life unresponsive to abx

S1 heart sound

closure of MV and TV (semilunar valves) during systole at aorticpulmonic valves open; best heard at apex; corresponds to carotid/radial pulse

categories of migraine headaches

common classice

communicating hydrocele is best differentiated from the noncommunicating type by the fact that

communicating frequently develops into a hernia

which of the following is an appropriate goal for a child being treated for osteomyelitis

complete course of antibiotics

all definitions of primary health care include

concept of universal access and accountability

education of sexually active adolescents concerning use of condoms to presvent STDs would included

condom use is only method to prevent STD and AIDS

The most likely cause of language delay in a child with repeated episodes of middle ear effusion is

conductive hearing loss

patient safety and quality improvement act provides

confidentiality protections for patient safety information

the most common cuase of primary amenorrhea is

constitutional or familial

what is an appropriate strategy to instruct parents of 18mo old diagnosed with a fevrile seizure and has a fever of 104

continue with tepid water for at least 1hr

strabismus**

crossed eyes, may deviate outward (exotropia), inward (esotropia), downward (hypotropia), upward (hypertorpia) -eyes are unable to view the same object - Abnormal when >6 months S&S--> squinting, decreased vision, head tilting, face turning, overpointing - Hirschberg sign- corneal light reflex always misaligned (abnormal) -Cover-uncover test abnormal movement of eye, vision screening, decreased - refer to optho after ocular misalignment after 4 months of age -immediate referral for constant or fixed strabismus

Caput succedaneum

crosses midline fluid under the skin resolves in 2-3 days

a systolic murmur is heard best at the mid to upper left sternal border with episodes of turning blud, fast labored breathing after vigourous crying, when he falls asleep color improves

cyanotic spell related to Tetralogy of Fallot

A 1-year-old child is brought to the clinic with a temperature of 102ºF and left flank pain. The urine dipstick test indicates nitrates and leukocyte esterase. The presenting signs and symptoms suggest left pyelonephritis. Based on the data, the most appropriate action for the PNP is to: A) Send urine for culture and sensitivity testing B) Provide symptomatic treatment for 24 hours, and repeat the urine dipstick test C) Refer the child to a urologist for diagnosis and treatment D) Consult with a physician

d

A 7-year-old child is brought to the clinic for a routine examination. The child likes to skateboard and does it almost every day. The PNP reviews specific injury prevention related to skateboarding. The most common injuries that occur during skateboarding are: A) Injuries to the trunk B) Head and neck injuries C) Injuries or fractures of the lower extremities D) Injuries or fractures of the upper extremities

d

Title V of the Social Security Act of 1935 was amended in 1981 and 1986 to expand coverage for children with special health care needs under: A) Title XIX of the Social Security Act B) The Supplemental Security Income (SSI) Program for the Aged, Blind, and Disabled C) The U.S. Public Health Service D) The Maternal and Child Health Services Block Grant

d

a differential diagnosis for child abuse would include all of the following except: a. birth marks b. unintentional injury c. inadequate parenting d. Prader-Willi syndrome

d

which of the following tests provide the most definitive diagnosis for suspected syphilis

dark field microscopy

Hyperthyroidism labs

decrease TSH increase T4 and T3

Moro reflex

disappears by 6 months is an infantile reflex normally present in all infants/newborns up to 3 or 4 months of age as a response to a sudden loss of support, when the infant feels as if it is falling

which of the following is true of renal tubular acidosis type 1

distal tube defect affecting secretion of hydrogen ions

what clinical signs would you expect to see in 7% dehydration

dry mucous membranes

base line studies for infant diagnosed with 22q11 deletion syndrome?

echo renal US immunologic screen

school age child with syncope, initial eval should include what?

electrolyte panel

Hypertension work up

elevated BP on 3 separate occasions -CBC, UA, BUN, Creatinine, Renal US, lipid profile, Echo Tx- refer, dietary education, wt reduction, exercise meds (when life style changes not successful)- 1st line--> ACE inhibitors (captopril, lisinopril, enalapril), 2nd angiotensin receptor blockers ( losarten)

expected lab finding in asthma

elevated white blood cell count with eosinophilia

an instruments validity is tested by

ensuring that the variable itself is tested accurately and yields the intended information

what is the lowest contributor to congenital defects in the US

enviromental

a 7yr old male presents with an abrupt onset of high fever, stridor, drooling and hyperextension of the neck. Which of the following would you suspect?

epiglottitis peritonsillar abcess retropharyngeal abscess

2nd degree/ partial thickness burns

erythema, edema, moist, few vesicles/blisters may develop, sensitive to the touch and air -white, dry, decreased sensitivity to touch, pain, and temp, and may blanch w/ pressure

erythema toxicum physical findings

erythematous macules followed by wheals, vesicles and rarely pustules

individual living with infant diagnosed with pertussis whould receive what?

erythromycin

best treatment for bacterial conjunctivitis is

erythromycin ointment

what is the Dubowitz tool?

estimations of gestational age are performed by examining physical characterstic and neuromuscular development of the newborn

drug therapy commonly used to treat absence seizures, in adition to valproic acid, includes:

ethosuximide clonazepam

which of the following are suspected etiologic factors of systemic lupus erythematosis

excessive sun exposure, drug reaction infection

milia presents with

exposed sebaceous glands that appear as raised pinpoint sized white papules on the face

genu varum is considered an abnormal condition when

extreme bowing continues after 2yr of age

for children age 1-4yr the most common cause of head injury is

falls

in counseling a new mother about her infant with cleft lip what would be discussed?

feeding techniques referral to otolaryngologist referral to pediatric dentist

what is the moro reflex

flinging arms to the side when startled

asymmetric moro and irritability when lift infant head - what do you suspect?

fractured clavicle

Epistaxis

frequent in childhood due to increase vascularity -Systemic disease--> bleeding that is prolonged, severe, or recurrent or concurrently bilateral (HTN, clotting abn, hemophilia, leukemia, aplastic anemia, ITP, platelet dysfunction) ASA, and NSAID overuse, - look for other signs, bruising, petechia/purpura

toddler with low grade temp, foul smelling watery stool x 1 month what do you suspect?

giardia

which of the following would most likely occur in a 4yr old boy? a. pyloric stenosis b. recurrent abdominal pain c. intussusception d. giardia

giardia

in a healthy 8mo old with diarrhea, but no dehydration, what would be the most appropriate advice to parents?

give banans and cereal as tolerated

transposition of the great arteries presents with a

grade II systolic murmur

adolescent female development

growth acceleration breast development pubic hair menarch axilla hair

vesicles and/or ulcers present on the posterior oral cavity, fever, and headache and backache all support the diagnosis of

herpangina

secondary hypertension

high blood pressure caused by the effects of another disease ( renal artery thrombosis, coarc, renal artery stenosis, endocrine disorders, neurogoenic tumors, drugs, increased intracranial pressure bronchopulmonary dysplesia)

expected xray findings in bronchiolitis

hyperinflated lungs

the following is characterstic features of Digeorge syndrome

hypertelorism cleft palate cardiac defects

Assessment findings for gestational age

hypertonic flexion plantar creases whether eyes are fused open

what would not elevate the pulse of a child?

hypo thyroidism

in the newborn period, infantsof diabetic mothers are particulary at risk for

hypoglycemia

sign associated with anorexia?

hypothermia

reliability gauges

if an instrument will measure results the same way over time, test questions repeated over multiple administrations indicate high reliability when they elicit the same response from the same test takers.

Junctional Nevi

if present in large numbers suspect tuberous sclerosis, xeroderma pigmentosis, or generalized neurofibromatosis,

etiologic factors in PMS

imbalance of water and sodium vit b12 deficiency synthesis of prostaglandins

Why are infant and young children predisposed to development of otitis media?

immaturity of immune mechanism and eustachiantube is short and horizontal

preventative health guidelines include references to

immunizations counseling health screening disease prophylaxis education

characteristics of CHD

increase RR/effort at rest or activity, including feeding poor feeding, fatigue during feeding excessive sweating in infant (esp while feeding) recurrent resp infections cyanosis poor perfusion (mottle, cool extremities, decrease pulse intensification, decrease cap refill) decrease exercise intolerance poor growth/wt gain tachycardia peripheral edema

treatmet of a child with glomerulonephritis would include

increased fluids to maintain hydration

Appendicitis

inflammation of the appendix -Abd pain (midline constant pain for several hours) Pain eventually move to RLQ -pain on ambulation, pain precedes vomiting -N/V/ constipation/diarrhea variable -rebound tenderness -+McBurneys point-halway b/w the umbilicus and anterior iliac crest (point of tenderness) -Rovsings sign- pain RLQ w/ left sided pressure -Obturator sign- rotating the R thigh may produce pain in RLQ -ER

blepharitis

inflammation of the eyelid margins -irritation, burning sensation of eyelids, sensation of foreign body, loss of eye lashes, reddened to eyelid margins tx- warm moist compresses several times per day/ rinse with shampoo application of topical abx ointment massaged in lid margins -shampoo with selenium sulfide shampoo with seborrheic dermatitis

Otitis media with effusion (OME)

inflammation/fluid accumulation in middle ear (serous, not purulent fluid) with decreased TM mobility on pneumatic otoscopy but w/o signs and symptoms of ear infection

which of the following is considered preventative management for iron deficiency anemia

iron fort ceral 6-12mo no cows milk until 1yr BF sup w iron drops or cereal

astigmatism

irregular curvature of the cornea or changes in lens - pain in and around eyes, HA, fatigue, reading problems, frowning -abn vision screening -asymmetrical hirschberg (corneal light reflex) - refer to optho

the us of topical application of conjugated estrogen cream with labial adhesions

is highly successful in resolving most adhesions within 2 onths

r value

is not a measurement in statistical analysis

medicare reimbursement for services

is not dependent on the patients income level

Healthy People 2020 purpose

is to improve patient outcomes by enhancing the quality of care

facts about hep B immunications

it can survive for more than 1 week on fomites it is the most common form of hepatitis perinatally infected infant are likely to become carriers

what is a true statement about cleft lip and palate?

it is more common to have both than one without the other

24-28 months

jumps

Genu Valgum

knocked knees normal variant in preschooler

Microglassia

large tongue hypothyroidism

What is the most helpful advice foe baby with GE reflux

laying prone after eatng will decrease the amount of vomiting

results reveal hypochromic, microcytic anemia in a 3yr old what does your differential include?

lead poisoning

Problems associated with NF-1 most likely to require treatments include which of the following

learning disabilities

What is the most concisitent finding with ulcerative colitis

left sided abdominal pain

ASD is heard

left upper sternal border grade II systolic ejection murmur

PNp finds limited passive internal rotation and abduction of the hip joint on pPE - what is the diagnosis

legg calve perthes

What is proper management of pityriasis alba?

lesions develop until puberty is completed

Low Birth Weight

less than 2500g

decreased platelets may be found in the following

leukemia ITP med usage - ampicillin, ceph

S. pneumonis xray results

lobar consolidation

physiologic peripheral pulmonary stenosis (innocent)

low-intensity systolic ejection murmur heard best at upper L sternal border, axillae, and back in neonates until 3-6 months of age -attributed to relative hypoplasia of branch pulmonary arteries at birth and anatomy of L pulmonary artery

blood glucose levels of younger children with diabetes ar maintained at slightly higher levels tha blood glucose levels of older children b/c

lowering the risk of hypflycemiain younger children is particulary important in order to avoid the potential for hypoglycemia with consequent neurological system damage

Title VI of SS act ament to include coverage for children with special needs

maternal and child health services block

internal consistency

measures the reliability of the inquires (or instruments) by grouping together carious instruments that are aimed at achieving the same response. By asking the same 3 questions in 3 different ways, you have tested whether each instrument is providing the appropriate information

positive family history in immediate relative, pain relieved by brief sleep and recurrent abdominal pain are all associated with what

migraine headaches

which of the following is true for idiopathic scoliosis which occurs primarily in adolescents

mild curves occur equally between the sexes

1st and 2nd degree burns appear

moist with edema, erythema and a few vesicles

what is helpful in the management of diarrhea

monitor stool for blood or mucus encourage solids monitor urine output

what is the most common agent for nonviral pneumonia from older preschool to yound adulthood?

mycoplasma/chlamydia

seizures of all types are associated with tuberous sclerosis but most commonly

myoclonic jerks

Phismosis

narrow, nonretractable foreskin of childhood; not fully retractable to expose glans -newborns normally have adhesions, glans to foreskins -may not be fully retractable until 10yr of age or older S&S Maybe asymptomatic, painful urination, weak urine stream, ballooning of foreskin when urinating; may be normal if voiding uncompromised Management--> good hygiene, gentle stretch of foreskin during bath, advise family against forceful retraction; scarring and balanitis may occur -circumcision with urinary obstruction

Which is included in the diagnostic criteria for migraine headache in children

nausea and vomiting + family hx aura

folliculitis commonly occurs on which body surface

neck and scalp

Hyperthyroidism S&S

neonates--> poor weight gain, prematurity, poor feeding, restlessness, irritability, tachycardia -lid retraction, proptosis, periorbital edema, face may be flushed increased GI motility children/adolescents--> wt loss, increased appetite, nervousness, irritability, decreased attention span, heat intolerance, increased perspiration, visualdisturbances, increased lacrimation, diplopia, photophobia, blurring, palpitations, frequent urination, stooling, amenorrhea, -increased energy, lack of sleep, proptosis, exophthalmos, upper lid lag with downward gaze

Black spot on red reflex

no clear pathway from lens to retina

what is characterstic of constitutional growth delay

no hisotyr of similar growth pattern in other fam members child usully remains constitutionally small as adult wt and ht at birth are generally lower in percentiles

majority of pain crisis with sickle cell are triggered by what?

no identified cause

what management and treatment is recommended for scabies?

nonwashable items in plastic bag and store for 1 week topical antiparasitic topical steroids or oral antihistmines

what are characterstics of a capillary hemangioma?

not present at birth but noticed site was blanched begins to resolve between 12-15mo completely resolves by 10yr

thumb sucking when are we concerned

not until age 4-5yr

the first clue a child may have primary blindness would be the presence of:

nystagumus

vomitus that is bilious suggests?

obstructive below the ampulla of vater

herpes zoster is characterized by clustered vesicles and?

often develops along trigeminmal nerve

cholesterol screening should be done

only for children with a family history of premature cardiovascular disease

Ibuprofen

only for older than 6months 10mg/kg every 6 hours ***Don't alternate**

Comedomes****

open black heads closed white heads mgmt: avoidance of topical, oil based products, use of oil free, mild soaps or cleansers. Mild Acne: topical treatment with benzoyl peroxide (2.5-10%) -if not responsive, retinoic acid 0.025-0.1% ( pregnancy category C) -Salicyltic acid preparations ( Neutrogena 2%) topical abx such as erythromycin or clindamycin lotions or pads. Moderate Acne: resquires systemic antibiotics along with topical treatments: -Doxyclycline 100mg twice daily -Erythromycin 1g in 2-3 doses -Minocycline 50-100mg twice daily. Severe that doesn't respond to above should be referred out.

Acne vulgaris (Mild)

open comedones (blackhead) closed (whitehead) Mild-lesions are scattered, covering small areas Open comedones/blackheads- lesions filled w/ dry, oxidized sebum; brown in color Closed comedones/whiteheads- lesions filled w/ follicle cells and sebum Tx- topical benzoyl peroxide -monitor progress every 4-6 wks, use topical exfoliates and comedolytic preparations

2yr old male with retracted and discolored foreskin with swelling of the glans. what is your diagnosis

paraphimosis

Giardia

parasite that causes gastro

CF xray findings

patchy infiltrates

which of the following would be the most appropriate initial management of newborn diagnosed with developmental dysplasia of the hip

pavlik harness

which of the following statements is true about acute osteomyelitis

peak ages are infancy (less than 1 yr) and preadolescence (9-11)

confusional migraine are characterized by

periods of confusion and diorientation followed by vomiting and deep sleep common in younger children

galactorreha, loss of peripheral vision and increase of headache in adolescent female - what would you think is cause?

pituitary tumor

one or more scaly areas of hypopigmentation, mild itching in ares of hypopigmentation, lesions more prounoced when exposed to light lead you to think of what diagnosiss

pityriasis alba

which condition is thought to be more common in darker skinned individuals?

pityriasis alba

15-18 months

points to body parts

which physical finding helps to confirm a diagnosis of milia

popular lesions yellow in color observed on the hard palate

which of the following symptoms are characterstic of rubella?

postauricular lymphadenopathy and low grade fever

ADHD diagnosis

predominantly inattentive type predominantly hyperactive-impulsive type -symptoms must be present before 7yrs old -symptoms must persist for at least 6 months -symptoms must be more frequent and more severe than those observed in other children at the same level of development -symptoms interfere with functioning in at least 2 out of 3 settings--> home, school, and play (2/3) (teacher given assessment)

flat areola with no bud is indicative of what finding in the newborn

premature newborn

what are the expected results of a wrights stained smear?

presence of eosinophils

long term goal of management with neurogenic bladder?

prevent kidney disease

rubeola is

preventable by active immunization

which of the following contraceptive methods would be least suitable for adolescents

progestin only, mini pill

The APRN consensus model is

proposed regulatory model for advanced practice nursing

what is included in patient education for lyme disease?

protective clothing and tick repellent should be worn in heavily wooded areas

Health insurance portability and accountability act

protects health insurance coverage for workers and their families when they change or lose their jobs

You would be concerned about the language development of a child who?

prounounces words that are not understandable at 36 months

which of the following is factors influence health care delivery system

provider payors insurers

gynecomastia in a male is normal in the following

pubertal development steroid use testicular tumor

recurrent afebrile seizure lasting >10min what would you give?

rectal diazepam on onset

anticipatory guidance for Hurlers syndrome

recurrent upper resp infections are common in children who have Hurlers syndrome

red cell distribution width is increased as

red blood cells may change in shape and size

what is the babinski reflex and when does it dissappear?

reflexes in the toes takes a full year to outgrow

apnea

respiratory pause lasting >20 sec or associated with cyanosis, bradycardia, marked pallor, or hypotonia -central apnea-->caused by decrease central nervous system stimuli to respiratory muscles; cessation of airflow w/o accompanying respiratory effort -apnea of infancy--> pathologic apnea in infants that are >37 wks gestation at onset, always demands diagnostic evaluation -ALTE--> nearly half are dut to reflux, sz, and lower respiratory tract infection, more than 50% unexplained, no cause with SIDS (admit to hospital and observation) -frequent f/u--> ht, wt, and head circumference, development assessment

where is a venus hum heard?

right upper sternal border

after beginning iron therapy what are lab changes?

rise in retic on 3rd day, hgb normal in 6-10 weeks

childhood disintegrative disorder presents with

seemingly normal development until the age of 2 then the child begins deteriorating motor, language and social skills

osgood schlatter disease treatment

self limiting condition symptomatic treatment stretching before and icing after

baseline management of all neonates with ABO incompatibility includes

serial monitoring of bilirubin levels

which of the following is the earliest screening test used in the 1st trimmest of pregancy

serum alpha fetoprotein

lack of iron lab findings

serum iron lower mean corpuscular volume lower mean corpuscular hgb lower

which of the following is not an absolute contraindication for oral contraceptives

severe hypertension

intracranial HA

severe occipital HA -exacerbated by straining, sneezing, or coughing -awaken child from sleep -exacerbated or improved markedly by position changes -associated with projectile vomiting or vomiting w/o nausea -hx of focal sz

Epliglottitis

severe, rapidly developing inflammation and swelling of the supraglottic structures leading to airway obstruction -decreasing incidence due to Hib vaccine -acute sudden onset of high fever, severe sore throat, muffled voice, drooling, poor color, labored breathing, refuses to speak, restless, irritable, anxious, hyperextension of neck - do not attempt to visualize throat if suspected - ER

what are the most common bacterial causes of gastroenteritis?

shigella, clostridium, e. coli

nasal polyps

shiny grape like masses between turbinates and septum - Sweat test to rule out CF on every child with polps

Turners syndrome features

short stature low hairline chronic ear infections learning disabilities

Strabismus

should be referred by 6 months of age

Moraxella catarrhalis is often associated with what diagnosis

sinusitis and otitis

diagnostic criteria for neurofibromatosis

six or more lesions and/or lesions larger than 1.5cm in diameter

pulmonary or aortic flow murmur

slightly harsh systolic ejection murmur heard best at second to 3rd intercostal space -attributed to turbulent flow in R or L ventricle outflow tract

Micrognathia

small chin Peirre Robin Treacher collin syndrome hallermann streiff syndrome

Microstomia

small mouth trisomy 13 and 18

hemolysis does not contribute to which of the problems associated with sickle cell disease

splenic dequestration

what exam finding is found in mono

splenomegaly early rise in IgM permanent rise in IgG

what type of hemorrhage would be expected with severe Factor VIII deficiency

spontaneous hemarthrosis

Best explanation for the 1% incidence of cryptorchidism at one year is

spontaneous resolution often occurs in the first year

one of the most common organisms found in cervical adenitis is

staphylococcus aureus

what relfex is the first to disappear in children one to two months of age

stepping reflex

what are interventions for a 6mo with a suspected dx of infantile botulism

stool and blood cultures stool softeners supportive care

How do you establish a definitive diagnosis of UTI in the office setting for a 3yr old?

straight cath collection

allergic conjunctivitis presents

stringy, not purulent, discharge and increased tearing

True statements regarding UTIs

symptoms are nonspecific urine culture required to dx trimethoprim is drug of choice

Sepsis

systemic inflammatory response (SIRS) ***Presence of 2 or more of the following criteria, one or more of the criteria must be abnormal temp or leukocyte count -Temp >38.5C or <36C -Tachycardia, defined as a mean HR more than 2 standard deviations above normal age, or for children younger than 1 yrs of age -Leukocyte count elevated or depressed for age -Refer to ER -Close follow up outpt seen w/in 24 hrs after d/c from hospital

restrictive lung disease

t in a decreased ability to expand the lungs, volume reduced in expiratory flow rates, trouble inhaling air= breath shallow ex- consolidation PNA

which of the following disorders is usually associated with adduction of the forefoot?

talipes equinovarus congenita

klinefelter syndrome causes these features

tall stature hypogonadism learning disabilities gynecomastia

erythema multiforme reactions

target bulls-eye lesions with necrotic center surrounded by a plae macular middle area and then erythematous peripheral ring itching at side of affect skin areas pain at site of affected areas, especially in oral cavity

Most stage based theories of development focus primarily on:

the discontinuity of development

Down syndrome

trisomy 21 -risk factors--> advance maternal age, previous child with Down syndrome or another chromosomal abn, parental balanced translocation, parents with chromosomal problems S&S phenotypical features--> head- midface hypoplasia, small brachycephalic head with epicanthal folds, flat nasal bridge, upward-slanting palpebral fissures, brushfield spots, small mouth, protruding tongue, crystals in eyes, hypotonia, hyperflexability, small ears, excess skin at nape of neck, hand and feet have simian crease and short fifth with clinodactyly (shortened digits) -increased risk of CHD (VSD, enodocardial cushion effect) genotype--> 47, XY or 47 XX, +21 karyotype -Annual screening for TSH, hemoglobin, hearing screening -early intervention Parental educations--> increased risk of infection, self-help skills, care of dry skin, avoidance of contact sports and trampolines, call provider if changes in gait, bowel or bladder dysfunction, new onset of weakness due to atlantoaxial instability

which statement is true about complete precocity or incomplete pseudoprecocity

true precocity occurs b/c of hormonal stimulation from the pituitary or hypothalamus causing gonadal maturation and fertility

conjunctivitis bacterial tx

tx--> erythromycin 0.5% opth ointment Tetracycline 1% Polymyxin B opth solution or ointment

a tympanogram provides direct information on:

tympanic membrane mobility

conjunctivitis (herpes simplex)

unilateral, small eyelid vesicles, mild conjunctivitis, watery discharge, begins within 2 weeks +/- neurologic s/s (lethargy, poor feedings) TX- refer to optho, hospital, acyclovir

the following type of infection is not associated with hypogamaglobulinemia

urinary tract infection

for a newborn the correct management of hip dislocation should include

use of flexion abduction device such as pavlic harness to stabilizehip

Oral candidiasis (thrush)

yeast infection -Nystatin oral suspension applied to oral mucosa 4x/day, not responding--> consider fluconazole -check diaper area for concurrent monilial diaper rash and tx w/ nystatin ointment -BF tx mom with on breast -sterlize nipples, pacifiers if bottle fed

School age 6-12yrs

Concrete operation thinking ***** language becomes fluid and descriptive can grasp concept of conversation can classify things can use concepts of time and money masters cause and effect understads concept of space capable of deductive reasoning.

School aged development (thought)

Concrete operational thought (black and white)

Spina bifida

Congenital abnormality of the CNS or spine resulting from failure of neural tube to close during early embryonic development Risk factors- maternal folic acid deficiency, maternal use of valporic acid or carbamazepine, or maternal diabetes S&S -sacral dimples, hairy patch at base of spine, uneven gluteal fods -meningocele or myelomeningocele--> lesion at some point along thoraco-lumbarsacral spine, cystlike structure protruding

Hypothyroidism

Congenital vs acquired congenital-->can cause severe mental retardation unless treated early, newborn screening can identify hypothyroidism in infants by 3wks of age. Caused by underdevelopment of gland, dysfunction in transport of iodine, PTUm iodine deficiency Acquired--> onset within 1st yr of life Primary--> thyroid gland failure Secondary--> disorder of the pituitary gland that compromises thyroid gland function Tertiary--> disorder of the hypothalamus compromises thyroid gland function

Language milestones birth to 5 months

Coos vocalized pleasure and displeasure sounds differently -makes noises when talked to

Infectious Mononucleosis Diagnosis and Management

Epstein-Barr virus is the causative agent -viral shedding occurs many months after acute infection and intermittently lifelong; asymptomatic carriage is common -Test-->Positive monospot after 7-10 days, or positive Epstein Barr virus IgM titer w/ acute illness LFTs may be elevated with hepatomegaly Rapid strep test and throat culture- + beta-hemolytic streptococcal infection Supportive tx -self limited disease lasting 2-3 weeks -Rest and liquids, saline gargles -May return to school or work when completely recovered -Avoid strenuous exercise and contact sports until fully recovered which can be 3-4 weeks or up to 2 months status post from illness onset and when the spleen is no longer palpable -Avoid amoxicillin and other penicillin's may result in nonallergic rash -Short course of corticosteroids are not recommended but may be prescribed for patients w/ marked tonsillar hypertrophy and impending airway obstruction prednisone 1mg/kg/day for 5-7 days with taper

Folliculitis and furuncles

Folliculitis- superficial involovement of upper follicle Furuncles or boil- deeper involvement of follicle and dermal appendages -localized area of erythema and edema w/ papular and pustular lesions on face, scalp, neck, buttocks, and other areas, nodules are present w/ deep seated furuncles, tenderness and warmth present Tx - wash w/ antimicrobial soap and apply warm, most compresses to affected areas topical abx (mupirocin) Oral abx- cephalexin

Absence seizure (petit mal)

Generalized seizure Onset b/w 4-8 years old -brief, generalized, nonconvulsive episode with no aura and no postictal state -characterized by interruption of activity, brief state that begins and ends suddenly, and unresponsiveness -usually lasts less than 10 seconds but may be as long as 20 seconds -episodes begins and ends abrubtly -child unaware of episode and is fully alert afterward

Lymphomas

Malignant disorders characterized by proliferations of cells, usually restricted to lymphoid cells Hodgkins and non-hodgkins S&S Hodgkins--> painless, firm swelling lymph node, fatigue, decrease appetits and unintentional wt loss, unexplained fever, drenching night sweats -affected nodes--> often fixed, firm, nontender, discrete, cervical and supraclavicular areas most common Non-hodgkins--> difficulty swallowing, breathing or cough, swelling in neck, face, upper extremities, lymphadenopathy, abd pain Primary care--> immunizations held while on chemotherapy and resume 6-12 months after therapy completed -sibling immunizations not affected -Fever on therapy requires CBC/BC and hospitalization

Rubeola (red measles)

Measles virus- characterized by macularpapular rash, cough, coryza, conjunctivitis, and a pathognomonic exanthem (Koplik spots) -Characterized by a prodrome of URI sx followed by a generalized maculopapular eruptions progresses in a caudal directions --> beginning behind the ears and at the hairline -infected individuals are contagious 3-5 days before appearance of rash to 4 days after appearance of rash -Confluent, erythematous maculopapular rash; after 3-4 days rash assumes a brownish appearance, profuse coryza (redness around eyes), conjunctivitis, photophobia, periorbital edema, pulm findings craskles, rales, hacking bark-like cough, Koplik spots (red eruptions w/ white centers on buccal mucosa) prior to appearance of rash Tests--> IgM and IgG serology (ELISA), presence of measles specific IgM antibody TX - referral, Vitamin A to children 6 months to 2 yrs old, ( deficiency causes impaired intestinal absorption and malnutrition) -uncomplicated measles- suppotive tx, OM most common complication

Gonorrhea S&S

S&S - Asymptomatic on 10% to 40% in males and 50% to 80% in females -vaginal or penile creamy d/c, perineal discomfort, menstrual irregularities, frequent, urgent, painful urination, rectal pain/itching, sore throat, fever, malaise, chills External genitalia--> erythema, edema, thick, purulent, greenish-yellow d/c Female--> cervical erythema, friability, exudate, vaginal wall d/c/erythema, cervical/adnexal tenderness Male--> thick creamy penile d/c, enlarged, tender prostate, scrotal or groin pain (unilateral), tender swelling above testis Disseminated gonorrhea infection spread--> polyarthralgias, tenosynovitis, dermatitis triad (knees, wrists, and ankles), purulent arthritis

Sickle cell disease S&S

S&S -Infection--> fever, malaise, anoerxia, poor feeding -Acute painful crisis--> vaso-occlusive crisis--> pain most often in bones, but can occur in any body part; -in children <2yrs usually in hands or feet ( DACTYLITIS) -Swelling sometimes seen at site of pain, and low grade fever Splenic sequestration--> weakness, irritability, unusual sleepiness, paleness, large spleen, tachycardia, pain in the L side of abd, Hgb below baseline, platelets decreased Aplastic crisis (associated with paro virus B19) -->pale, malaise, HA, fever, mild URI, Hgb below steady state, retic count >1/0%

newborn screening for hypothyroidism measures?

T4 & TSH

11. A 5yo female presents for a school physical with a complaint of hyperactivity, a mild developmental delay, aversion of gaze, hand mannerism, long thing face with slightly dysmorphic ear. What is the likely diagnosis? a. Fragile X b. Turner's Syndrome c. Fetal alcohol syndrome d. Williams syndrome

a

9. A mother with Marfan syndrome comes with her 5yo for a checkup. The child has myopia & a + wrist & thumb sign. She reports that she was told by her last health care provider not to worry about this child. What is the next best step? a. Raise the issue of a genetic referral b. Reassure her c. Follow the child for further signs of Marfan syndrome d. Refer to ophthalmology

a

Hepatitis E

-Endemic to Asia, Africa, Mexico; US travelers to those high risk areas -Transmission- fecal-oral route, contaminated water -Acute illness with arthralgia, abd pain, jaundice, malaise, anorexia, and fever

When to start Vit D

2 months 400IU per day till adolescence

Gender identity

2 yr olds can distinguish gender and will identify themselves as boy or girl 3-4 yr olds tend to show sex-typed preferences; gender identity is usually firmly established and unlikely to change

Hib immunization

2, 4, 6, and 12 months 1st dose as early as 6 weeks not recommended after 5yrs

prophylactic penicillin should be initiated in children with sickle cell anemia by

2-3mo of age

How can you tell an infant is getting adequate nutrition with breast feeding?

Adequate nutrition is confirmed by weight gain 30 g/day for the first 3 months Gain of 15-20 g/day during the subsequent 3 months

cystic fibrosis

Autosomal recessive disorder, that causes defective epithelial ion transport, which results in dehydrated, viscous secretions that obstruct the exocrine ducts in the respiratory, hepatobiliary, gastrointestinal, and reproductive tracts. Causes increase sodium reabsorption and decrease chloride secretion tests-->pilocarpine iontophoresis sweat test - newborn screening -elevated immunoreactive trypsin (IRT) in newborn -PFTs- identify obstructive pattern -Sputum cx- CF pathogens--> staph aureus, haemophilus influenzae, psuedomonas aeruginosia, burkholderia cepacia -hyponatremia, hypoproteinemia, hypochloremic alkalosis, increased liver enzymes (ALT or AST), fat soluble vitamin (A, E, and K) deficiencies, glucose testing

The PNP knows that assessing weight, length, and head circumference are part of which domain of growth and development? a) Physical domain b) Cognitive domain c) Psychosocial domain

a pg. 5

The PNP is caring for 9-year-old Riley who's BMI is in the 96th percentile. What is the goal of treatment for Riley? a. Stabilize weight b. Lose 20lbs in 3 months c. Growth hormones to encourage growth

a pg. 50 Goal is to stabilize weight until child grows and linear growth will compensate. Encourage healthy eating/provide nutritional planning/increase physical activity

The PNP knows that a school age child grows at a slower rate than an infant. How much weight should a school age child gain yearly? a. 5 to 7 pounds b. 4 to 6 pounds c. 7 to 10 pounds

a pg. 6

You would be concerned about the language development of a child who: a. repeats simple phrases at 32mo b. stutters when excited or tired at 42mo c. has a vocabulary of 10 words at 12mo d. pronounces words that are understandable at 36mo

b

good communication between families, schools, and primary care providers is an example of which ecological concept? a. microsystem b. mesosystem c. exosystem d. macrosystem

b

Which of the following is the best approach for conducting a physical examination of the 2-3 year-old child? a. Proceed systematically from head-to-toe b. Perform the most uncomfortable or traumatic parts of the examination first c. Have the parent leave the room before conducting the examination d. Allow the patient to remain with the parent and perform the uncomfortable/traumatic parts of the examination last

d

warm moist compresses for 15minute throughout the day, incision and drainage, and topical antibiotic drops are considered as treatment options for

hordeolum

which of the following physical stigmata are common in newborns with downs

hypotonia, large appearing tongue and small mouth, upward slant to eyes

radiographic findings of disease progression and sphericity of femoral head is helpful in the diagnosis and follow up of

llegg calve perthes

what are appropriate management of epistaxis?

local compression of nares position in upright head forward phenylephrine refer if persistent profuse bleeding

Sinusitis symptoms

persistent URI beyond 7-10 days with purulent watery drainage, erythema of nasal mucosa and/or throat, facial pain, toothache, HA, or tenderness over involved sinuses, low grade fever, cough

which of the following ear disorders doesnot need an otolaryngologist referral?

persistent chronic OME for 8 weeks

3 epiglotitis pathogens

pneumococci streptococci h. flu

ofpathogens causing AOM, which is most likely require antibiotics?

strep pneumoniae

An integrated delivery system: a. one that delivers high quality care but is often not cost effective b. delivers a vertical integration of services with capitated payment c. does not include rationing of resources d. does not include a capitated payment scheme

b

In considering client situations, which one requires the use of an inactivated (not live) vaccine? a. history of nonspecific allergies b. immunocompromised client c. concurrent antimicrobial therapy d. mild acute illness

b

In providing anticipatory guidance to the parents of a 5-year-old child with cerebral palsy, the PNP teaches the parents to be aware of abnormal eye movements, drooling, and shaking movements that cannot be stopped. These are all signs of: A) Syncope B) Seizures C) Febrile seizures D) Infantile spasms

b

The PNP is caring for a 10-day-old neonate who was born by vaginal delivery at a birthing center. The neonate was sent home at age 24 hours and received the initial thyroid function tests. The tests revealed a mildly low T4 and an elevated TSH level. The infant has been feeding without difficulty, has regained birth weight plus 3 oz, and appears alert during the examination. The PNP's management of the child should include: A) Beginning levothyroxine therapy and referring the family to an endocrinologist B) Repeating the test, including serum T4, TSH, thyroxine-binding globulin, and T3 C) Referring the parents for genetic counseling D) Beginning fludrocortisone therapy and repeating the initial tests

b

The PNP is completing a preadmission college physical for a student entering college in the fall. The PNP discusses with the student the need for a: A) Hepatitis A vaccine B) Meningococcal vaccine C) Lyme disease vaccine D) DT vaccine

b

The PNP is performing well-child examinations on 2-year-old twins. One twin is verbal and interactive, initiating play with the PNP. The other twin is nonverbal, acts fearful, and refuses to make eye contact with the PNP. The mother reports that the second twin rarely speaks intelligible words. Growth parameters are normal for both children, and the physical examinations are normal. Intervention for this family should include: A) Encouraging the mother to initiate and play verbal games with the twins that require verbal responses from both children B) Scheduling a professional speech, language, and hearing evaluation for the second twin C) Performing audiometry examinations to rule out hearing deficits in the second twin D) Continued observation, rechecking in 6 months to evaluate language development in both twins, and reassuring the mother that development is different in each child

b

The PNP understands that many factors complicate the inheritance patterns known as the Mendelian inheritance patterns. Neurofibromatosis can be used as an example of all of the following influencing factors except: A) Reduced penetrance B) Genomic imprinting C) New mutation D) Variable expression

b

Which of the following represents the best organizational approach when changing one's practice based on clinical evidence? a. Establish clinical question, develop and implement care plan, evaluate effectiveness of care plan, collect and evaluate relevant research b. Collect and evaluate relevant research, establish clinical question, develop and implement care plan, evaluate effectiveness of care plan c. Establish clinical question, collect and evaluate relevant research, develop and implement care plan, evaluate effectiveness of care plan d. Establish clinical question, collect and evaluate relevant research, develop and implement care plan

c

Which of the following topics would not be appropriate to include when providing anticipatory guidance to the parent of a 4mo old infant? a. introduction of solid foods b. teething c. negativism d. introduction of a cup

c

the most common form of child abuse seen in pediatric primary care is: a. burns b. fractures c. soft tissue injury d. shaken baby syndrome

c

A 7-year-old child has been seen in the clinic and emergency room several times in the past month for epistaxis. The nosebleeds last approximately 20 minutes and eventually stop with the application of pressure, but the child tends to begin bleeding again within a couple of days. While the PNP is obtaining a family history, the mother states that she experienced frequent nosebleeds as a child. When questioned, the mother states that she now has heavy menses. What is the mostlikely diagnosis for this child?

d

The PNP is examining a 12-year-old female child with enlarged breasts and areolas and curly, dark, coarse pubic hair. The PNP uses Tanner staging and classifies this child as: A) Tanner stage V B) Tanner stage II C) Tanner stage IV D) Tanner stage III

d

Which of the following is an appropriate strategy to instruct the parents of an 18mo child who has just been diagnosed with a febrile seizure and who has a fever >104? a. aspirin every 4hr for temp >101 b. bathe with cold water mixed with alcohol c. dress warmly to avoid chills d. continue sponge baths with tepid water for atleast 1hr

d.

Which of the following responses during a tonic-clonic seizure is most appropriate to teach family members of a child who has these seizures? a. restrain the child b. insert an airway into the mouth to prevent tongue biting c. note the time, duration, and activity of the seizure d. protect child from injury

d.

what is the management of functional abdomonimal pain

ibuprofen 200mg stay home during episode decrease milk

AOM prevention

proper feeding techniques for infants BF eliminate exposure to smoke immunizations (influenza, Hib and pneumoccocal) Refer to otolaryngolost- persistent AOM -frequent recurrent OM 3 in 6 months, 4 to 5 epsiodes in 1 year -persistent chronic OME persisting longer than 3 months -evidence of hearing deficit or language delay

vitiligo

-acquired autoimmune condition involving patches of depigmentation on skin surfaces and in mouth and genitalia -unknown cause (affected areas of hypopigmentation have loss or destruction of melanocytes) -milky-white macular patches of depigmentation with sharply demarcated borders occur in unilateral or bilateral pattern on skin of normal texture -condition often permanent w/o repigmentation -protect skin from sunlight -refer to derm, topical steroids applications and controlled ultra-violet light exposure -wateresistant color makeup

Refer to cardiology for murmur

-symptomatic -cardiovascular abn on PE, pathologic murmur findings -uncertainty regarding innocence of murmur -change to murmur intensity -persistent parental concern

Croup tx

-symptoms worse at night -Xray- steeple sign -corticosteroids indicated for all children with croup regardless of severity- Dexamethasone Rac epi

Lyme disease

A zoonotic infection that is transmitted b/w vertebrate animals and humans that has an immune-mediated, inflammatory response, transmitted primarily via deer tick -Most often seen in Northern Hemisphere in the northeast from Massachusetts to Maryland, the midwest, primarily in Wisconsin and Minnesota and California; primarily in heavy wooded areas with nearby tall grass areas Diagnosis -enzyme linked immunosorbent assay (ELISA) detect antibodies against B. burgdorferi -Western blot used to validate + ELISA -Serum immunoglobulins, IgM, IgG elevated

Iron deficiency anemia diagnostics

Hypochromic, microcytic red cells, confirmed RBC indices, MCV decreased by 2 standard deviations below the age appropriate mean -Wide red cell distribution (RDW) >17, increased -Serum ferritin (stored iron)- decreased (1st value to fall) -Serum iron and iron-binding capacity--> decreased total serum iron, increased iron binding capacity (TIBC), decreased iron saturation (16% or less) -free erythrocyte protoporphyrin (FEP) elevated H&H decreased, MCV decreased, MCHC decreased, RBC decreased, RDW increased

Lead poisoning S&S

S&S -low-level exposure may be asymptomatic -mild--> resembles gastroenteritis, n/v/constipation/diarrhea, abd pain, sleep disturbances, metallic taste in mouth, limb, pain and HA -severe--> lethargy, difficulty walking, tingling, cognitive impairment, personality changes -90% will have pica -May see bluish discoloration of gingival border (Burtonian blue lines) -bradycardia, neuropathy, papilledema, ataxia

A 5-year-old child is brought to the clinic for a prekindergarten physical. The father has refused the MMR vaccine, stating that the child is allergic to eggs. Upon further questioning, it is determined that the child experienced stomach cramps and diarrhea after eating eggs. The child has had 4 DTaP, 3 IVP, 3 Hep b, 3 Hib, a PPD, and varicella. What immunizations would be appropriate to administer to this child today? A) DTaP, IPV, MMR, and varicella, as well as a PPD test (if warranted) B) DTaP and IPV, as well as a PPD test C) DTaP, IPV, and varicella, as well as a PPD test D) DTaP, IPV, MMR, varicella (if warranted), and pneumococcal vaccine (Pneumovax)

a

A 7-year-old is brought to the clinic with "a cold that just won't go away" and green, thick rhinorrhea of 10 days' duration. The PNP diagnoses sinusitis and treats with: A) Amoxicillin and a decongestant B) Amoxicillin and an antihistamine C) Saline nasal drops and a decongestant D) A topical nasal steroid and cefixime (Suprax)

a

A 9-month-old infant was diagnosed with sickle cell disease shortly after birth. The mother telephones the PNP to report that the infant has a fever of 103.2°F. The best response to the mother is: A) "Take the infant to the emergency room immediately." B) "Administer a dose of ibuprofen, and call back in 6 hours if the fever continues." C) "Give extra fluids and acetaminophen, and call back tomorrow if the fever continues." D) "Give extra fluids and acetaminophen, and bring the infant to the clinic tomorrow morning."

a

For which of the following individuals is there no indication for obtaining a chromosomal analysis? A) A child with phenylketonuria (PKU) B) A child with multiple congenital anomalies and mental retardation C) A couple with a history of multiple miscarriages D) A man with large testes and mental retardation

a

Internationally adopted children from ANY country should receive testing for a. tuberculosis, hep B and C, syphilis, HIV b. measles, hep A and C, tuberculosis, malaria c. syphilis, cytomegalovirus, hep A and C, HIV d. measles, hep A and C, cytomegalovirus, malaria

a

The 19-year-old mother of an infant in the PNP's care has just found out that she is expecting her second child. The mother's first prenatal visit is scheduled soon. The mother smokes two packs of cigarettes a day. What action should the PNP take? A) Inform the mother about the risks to herself and to her children from secondhand smoke B) Sign the mother up for smoking cessation classes C) Let the obstetrician/gynecologist assess and manage this issue D) Write the mother a prescription for nicotine replacement therapy

a

The PNP is discussing laser therapy for a capillary vascular malformation with the parents of a child and advises the parents: A) "Multiple treatments over many months may be required." B) "Transient edema can be expected to last several months." C) "Gray-black discoloration will fade in 3 to 4 days." D) "The birthmark will gradually fade over 1 to 2 years."

a

The father of a 10-month-old is concerned because over the lack of eruption of primary teeth in the infant. The PNP suggests: A) This is within the range of normal dental development B) Consulting the pediatrician at the 15-month-old well-child visit C) The infant's teeth will erupt on a similar schedule as the parents D) An immediate referral to the dentist

a

Kim has Trisomy 21. Which of the following findings is not associated with his chromosomal makeup? a. Hypertonia b. Hearing impairment c. Brushfield spots

a pg. 22 Hypotonia is associated with Trisomy 21

Amy has Trisomy 21. Which of the following findings is not associated with her chromosomal makeup? a. Macrocephaly b. Flattened nose c. Protruding tongue

a pg. 22 Microcephaly and abnormal shaped head are associated with Trisomy 21

The PNP has a newborn patient diagnosed with Turner's Syndrome in utero. Which congenital heart defect is most associated with Turner's Syndrome? a. Coarctation of aorta b. Ventricular septal defect c. Patent ductus arteriosus

a pg. 23 Biscuspid aortic valve is also associated with Turner's Syndrome

12-month-old Jeremiah is in for his well child appointment. His mom is concerned because he is not able to sit up anymore. Upon assessment, the PNP notes a cherry red macula. Which genetic disorder does the PNP suspect? a. Tay-Sachs Disease b. Duchenne's Muscular Dystrophy c. DiGeorge Syndrome

a pg. 23 Progression of Tay-Sachs: Decreased muscle tone-> Cherry red macula->listlessness->Blindness->Deafness->Seizures->Dementia->Vegetative State->Death

Hypoparathyroidism, aortic arch anomalies, micrognathia, and lateral displacement of the inner canthi are associated with which genetic disorder? a. DiGeorge Syndrome b. Trisomy 21 c. Turner's Syndrome

a pg. 24 Other features: short palpebral fissures, short philtrum, ear anomalies, cognitive/behavioral psychiatric problems

While assessing a 2-month old new patient, the PNP notes a red, soft, raised lesion above the right eyebrow. What does the PNP educate the mother to help alleviate her concerns? a. The lesion begins to shrink and fade after 6 months old b. The lesion causes concern for Sturge-Webber

a pg. 28 A hemangioma is described. Sturge-Webber should be ruled out with Port Wine Stains.

The PNP is assessing a 6-month old infant. Which of the following primitive reflexes should be present? a. Babinski b. Rooting c. Sucking

a pg. 28 Rooting and sucking should disappear at 3 to 4 months old.

Donald is in for his 2-week check up and his mother is concerned about pinpoint white papules on his face. What treatment plan does the PNP develop? a. Educate Donald's mother that the spots will go away in 3 to 4 weeks. b. Educate Donald's mother to apply hydrocortisone BID. c. Educate Donald's mother to stop breastfeeding and switch to soy formula.

a pg. 28 These are milia. Usually prominent on cheeks, nose, and forehead

The PNP is assessing for developmental dysplasia of the hip in a 2-month old. With the hips flexed at 90 degrees and the knees together and the PNP's fingers over the greater trochanters, the PNP abducts the hips and then adducts the hips. During adduction, the PNP notes a click that reduces dislocation. What is the name of this exam finding? a. Ortolani's click b. Babinski reflex c. Barlow's maneuver

a pg. 31 Ortolani's clicks= "adds to body"/ hard to assess for after 6 months old

The PNP is providing anticipatory guidance at Michelle's 6-month well child appointment. The PNP educates that Michelle may have already developed stranger anxiety at 6 months old, but Michelle may still develop separation anxiety. At what age should Michelle's mom expect her to show fear of being left alone? a. 8 months b. 12 months c. 15 months

a pg. 36

At what age does the PNP expect tibial torsion to self resolve? a. 4 years old b. 6 years old c. 8 years old

a pg. 40

The PNP is assessing a 3-year old patient. The PNP notes fissures at the corner of the child's lips. What does this finding create a concern for? a. Vitamin deficiency b. Anemia c. Eczema

a pg. 40 "Mouth and throat exam"

The PNP is assessing the gross motor skills of Lester, 2-years-old. Lester is able to walk up and down steps and run with a wide gait. What other finding is would the PNP expect to see from Lester? a. Kicks ball without falling b. Hops c. Rides tricycle

a pg. 41 Other 2 options are for 3 years old

The PNP knows that these warning signs refer to which age group: poor school adjustment, not working to full potential, frequent illnesses or need to stay home from school, and/or lack of social interaction and problems with peers. a. Young school age b. Older school age c. Adolescents

a pg. 49

The PNP is educating an expectant mother about feeding choices for her baby. The mother asks about why breastfeeding is considered the best option vs. formula feeding. Which of the following does the PNP state? a) With formula feeding, the baby is more likely to gastrointestinal problems such as GERD. b) With formula feeding, the baby receive maternal antibodies that help prevent infection and decrease allergies c) Formula is a duplicate breast milk, and the baby will receive the same benefits.

a pg. 5-6

When interviewing the adolescent patient, the PNP needs to remember that adolescents are trying to be independent and are often identity seeking. What other characteristics are common among adolescents? a. May be rebellious and often inflexible b. Feel the need to please their parents and do well in school c. Have fear of dangerous activities and often share their concerns

a pg. 57

The PNP is evaluating a 6-year-old female child for precocious puberty. The PNP knows that males with precocious puberty experience the onset of puberty before 9 years old. What age do females with precious puberty have onset of puberty? a. 8 years old b. 9 years old c. 10 years old

a pg. 59

The PNP knows that adolescents experience Identity vs. Role Confusion. Which stage of adolescence experiences conformity with peer groups, have parent/child conflict, and express anger? a. Early adolescence b. Middle adolescence c. Late adolescence

a pg. 59 Often they have the "worst parents"

When educated a prenatal class about the benefits of breastfeeding, the PNP states which of the following? a. Breastfeeding during painful procedures provides analgesia. b. The longer a child is breastfed, the more a chance a child will be overweight. c. Children who are breastfed experience more food allergies.

a pg. 6

Allie is here for her 4-month well child appointment. Her mom is concerned that she is not gaining enough weight because she is smaller than her cousin who is the same age. How much weight should Allie be gaining? a. 15 to 20g/day b. 30g/day c. 40g/day

a pg. 6 After 3 months of age, infants should gain 15 to 20g/day for the next 3 months.

The PNP is assessing a 3-year-old child. She notes S1 and S2 with no murmur. The PNP knows that S1 is the closure of which valves? a. Mitral and tricuspid valves b. Aortic and pulmonic valves c. Tricuspid and pulmonic valves

a pg. 62

The PNP is assessing 2-year-old male and auscultates an ejection click at the apex and right upper sternal border. What heart lesion does the PNP suspect? a. Coarctation of the aorta b. Aortic stenosis c. Pulmonic stenosis

a pg. 67 X-ray= rib notching

At what age does the PNP expect a child to have an awareness of their anatomical sexual parts? a. 3 to 6 years old b. 1 to 3 years old c. 6 to 7 years old

a pg. 8 Freud's phallic stage

The PNP is trying to decide how to assess cognitive development. Which of the following screening tools is the most established? a. Denver II b. Ages and Stages c. PSQ-9

a pg. 9 *Stated at live review

These warning signs refer to which age: not imitating sounds, not pulling to stand, not indicating desires by pointing. a. 1 year old b. 2 years old c. 3 years old

a pg.43

Rheumatic Fever

a post infectious inflammatory process that follows a group A strep infection. Most common 6-15 years ( more school age) MV is most commonly affected. DX is fever plus to major or one major and two minor... Major: Carditis, polyarthritis, chorea, erythema marginatum, subcu nodules. Minor: arthralgia w/o inflammation, Fever > 102.2, ESR and CRP elevated, ****prolonged PR interval on ECG with evidence of group A infection.*** Labs: positive throat culture, rapid strep test, increased or rising strep antibody titer, ECG, Echo. Mgmt: Refer to pediatric cardiologist, aggressive mgmt of the strep infection, bed rest if acute carditis.

Papule:

a small < 1cm elevated firm skin lesion.

Vesicle

a small <1cm lesion with filled serous fluid

Pustule

a small pus filled lesion <1cm

Jones criteria for the diagnosis of rheumatic fever

a strep infection + 2 major or 1 major & 2 minor major: carditis chorea polyarthritis erythema marginatum subcutaneous nodules minor: arthralgia w/o inflamm fever >102.2 prolonged PR interval on ECG abdominal pain, malaise, epistaxis

shallow painful ulcers in the mouth that can be brought on by stress and/ot trauma and considered idiopathic are?

apthous ulcers

bronchiolitis xray results

areas of scattered consolidation

A 4-year-old child is examined in the clinic. The parents report that the child has limited language skills and does not speak in three-word sentences. The PNP is interested in further assessing the child and chooses the following: A) Clinical Adaptive Test/Clinical Linguistics Auditory Milestone Scale (CAT/CLAMS) B) Vineland Social Maturity C) Denver Articulating Screening Examination (DASE) D) Denver II

c

The Denver II screening tool is used for child 6 years of age and younger. How does the PNP assess cognition in older children? a. Denver III Screening Tool b. IQ testing c. School achievement

c *stated at live review

When should the PNP expect all permanent teeth to have erupted? a. 8 years old b. 10 years old c. 12 years old

c *stated at live review

The PNP knows that adolescents experience Identity vs. Role Confusion. Which stage of adolescence are less emotional labile, establish rapport with parents, have better sense of self-esteem, and are more interested in the opposite sex? a. Early adolescence b. Middle adolescence c. Late adolescence

c pg 59

At what age should Susannah be able to say "Mama" and "Dada" and wave 'bye-bye"? a. 5 to 6 months old b. 7 to 8 months old c. 8 to 9 months old

c pg. 10

At what age should the PNP expect to assess pincer grasp on an infant? a. 5 to 6 months old b. 7 to 8 months old c. 8 to 10 months old

c pg. 10

18. a 2yo female has lymphedema of the hands & foot, with low posterior hairline, cubitus valgus, & a hx of intrauterine growth retardation. Which of the following defects is the most common among the children with this defect? a. Aortic valve stenosis b. Mitral valve prolapse c. Dissecting aortic aneurysm d. Coarctation of the aorta

d

Compared to single component vaccines, combination vaccines a. are associated with significant incidence of adverse effects b. expose children to many more antigens than previous vaccines c. are more likely to overload an infant's immune system d. can be used if the child previously received component of the vaccine.

d

A 16-year-old adolescent comes to the school-based clinic with chest pain. The most common cause of cardiac pain in children and adolescents is: A) Tachycardia B) Mitral valve prolapse C) Myocarditis D) Preventricular contractions

b

For the parents of an 8 month old, the MOST appropriate age-related anticipatory guidance related to safety should include which of the following? a. cover electrical outlets, keep small objects out of reach, turn car seat to forward-facing position b. keep medications out of reach, continue to use car seat in rear-facing position, cover electrical outlets c. avoid finger foods that can be easily aspirated, teach stranger safety, place Mr. Yuk stickers on toxic materials d. keep matches out of reach, place Mr. Yuk stickers on toxic materials, teach stranger safety

b

The PNP is completing the ROS on a 4mo. What response from the mother might indicate a cardiac problem in the infant & require a more thorough history? a. the baby gets the hiccups often. b. it takes the baby over 30min to complete a bottle c. the baby's heart seems to beat rapidly sometimes d. sometimes the baby sounds congested

b

The PNP is providing anticipatory guidance to the foster mother of a 10-month-old infant weighing 20 lb, 1 oz. The most appropriate advice the PNP can give the foster mother concerning the use of car seats is: A) "A child weighing more than 20 pounds may face forward in the car seat." B) "Keep using a rear-facing car seat until age 1 year." C) "It is safe to keep your child in a car seat in the front seat of the car as long as there is not a passenger-side airbag." D) "A booster seat should be used when your child has outgrown a convertible car seat but is still too small to fit properly in a vehicle safety belt."

b

The PNP preceptor is discussing with the PNP student the use of an aminoglycoside in the treatment of an infant in a special care nursery. The use of an aminoglycoside may result in the following complication: A) Permanent liver damage B) Ototoxicity and nephrotoxicity C) Bone marrow depression (if not properly monitored) D) Encephalopathy

b

Sadie is in for her 9-month check up. The PNP knows that Sadie lives in a rural area. What should the PNP do in order to assess how much fluoride is available in the local water? a. Call the Environmental Protection Agency b. Call the Board of Health c. Call the local water company

b *Stated at live review

Max is here for a 2-year-old EPSDT. Which of the following fine motor skills should the PNP assess for? a. Jumps b. Stacks 6 to 7 blocks c. Walks up and down stairs

b pg. 10 The other 2 are gross motor skills

The PNP is seeing a 2-day in the nursery. What immunizations does the PNP expect this infant to receive? a. Hepatitis A b. Hepatitis B c. Hepatitis C

b pg. 17

Noah is a 9-month-old who was born to a HBsAG positive mother. He completed his Hepatitis B immunization series at his 6-month check up. Along with his routine labs, what does the PNP expect to order? a. HBsAG b. HBsAG antibodies c. Both a and b

b pg. 17 They should be obtained when the child has completed the HepB series around ages 9 to 18 months.

The PNP is assessing a 6-hour newborn. He notes a swelling on the newborn's head that crosses the midline. He knows that the swelling should resolve in 2 to 3 days. What condition does the PNP document? a. Bossing b. Caput succedaneum c. Cephalohematoma

b pg. 29 Bossing is seen with rickets and prematurity. Cephalohematoma does not cross midline and requires closer exam.

The PNP knows that when assessing the newborn that a palpable 1 cm inguinal lymph node and/or a palpable 2 cm cervical lymph node are normal variants. Which of the following may indicate malignancy and indicate a need for aggressive investigation? a. Shotty nodes b. Supraclavicular nodes c. Femoral nodes

b pg. 35 Shotty nodes indicate past infection

At what age does the PNP expect the pediatric patient to be able to experience pure tone audiometry? a. 2 years old b. 3 years old c. 4 years old

b pg. 42 May have them raise their hand when they hear sound

Associative, cooperative, dramatic, and physical plays are expected with what age group? a. Toddlers b. Preschoolers c. School age

b pg. 42 Toddlers prefer onlooker and parallel play

The PNP knows that these warning signs refer to which age: not walking up stairs, not using 2 to 3 word phrases, not noticing cars or animals, and/or initiating self-stimulation behaviors such as head banging and rocking. a. 1 year old b. 2 years old c. 3 years old

b pg. 43

The PNP knows that these warning signs refer to which age: magical thinking is still dominant and/or no impulse control. a. 4 years old b. 5 years old c. 6 years old

b pg. 44

In a school age child, what age does the PNP expect to order a hematocrit? a. 6 years old b. 8 years old c. 10 years old

b pg. 47

The PNP knows that these warning signs refer to which age: revert back to dependence, shyness, passive role, cannot make and/or keep friends, poor school performance, disinterest in extra academic activities, and/or destructive behavior to express self. a. Young school age b. Older school age c. Adolescents

b pg. 49

The PNP is planning a nutritional class for parents of school age children. She wants to ensure that the parents know if their child is meeting their nutritional requirements. How many kcal/kg/day should a child this age take in? a) 120 kcal/kg/day b) 70 kcal/kg/day c) 45 kcal/kg/day

b pg. 5 Children 2 to 10 years old require 70 to 100 kcal/kg/day.

The PNP is assessing a 12-year-old female for her well child appointment. The patient has breast buds with areolar enlargement. Using Tanner staging, what stage of maturity is this patient currently in? a. Tanner stage 1 b. Tanner stage 2 c. Tanner stage 3

b pg. 58

The PNP is seeing a patient for his 1-year check up. When analyzing the patient's weight, the PNP expects which of the following? a. The patient doubles his weight b. The patient triples his weight. c. The patient quadruples his weight.

b pg. 6

The PNP obtained an x-ray on a newborn with concern for congenital heart defect. What congenital heart defect is associated with a "boot-shaped" heart appearance without cardiomegaly? a. Coarctation of the aorta b. Tetrology of fallot c. Transposition of the great arteries

b pg. 65 Can auscultate a loud systolic click at the middle and upper left sternal border.

The PNP obtained an x-ray on an infant with concern for congenital heart defect. What congenital heart defect is associated with cardiomegaly, pulmonary venous congestion and rib notching? a. Pulmonic stenosis b. Coarctation of the aorta c. Aortic stenosis

b pg. 67

5-year-old Heath asks when he will lose a tooth since his best friend already lost one. When does the PNP expect Heath to lose primary central incisor? a. 5 to 6 years old b. 6 to 8 years old c. 7 to 10 years old

b pg. 7

At what age does a child begin to understand their actions can cause other actions to happen? a. 3 years old b. 4 years old c. 10 years old

b pg. 7

The PNP knows that Grant should have his primary cuspid teeth erupt at what age? a. 7 to 9 months old b. 16 to 18 months old c. 20 to 24 months old

b pg. 7

Which type of seizure is first seen between 4 and 8 months of age, may be confused with myoclonic seizures and may be associated with serious develpmental problems? a. febril seizures b. infantile spasms c. absence seizrues d. tonic clonic

b.

16. Varicella zoster infection is most commonly associated with which of the following skin lesions? a. Vesicle b. Comedone c. Nodule d. Macule

a

Catherine in 1 month old. The PNP expects her to be in what cognitive stage? a. Sensorimotor state b. Preoperational stage c. Trust vs. Mistrust

a pg. 7

MRSA

- A type of Staphylococcus aureus that is resistant to available beta-lactam antibiotics, anti-staphylococcal penicillins and cephalsporins -Gram positive pathogen S&S -erythematous skin lesions or pustules in single or multiple forms -irritation or pain at indwelling catheter site -infectious unresponsive to PCN -hx of presumed spider bite -abscess formation -lymphatic streaking, fever, fatigue DX- Culture and sensitivity Management--> Bactrim is first choice; tetracycline can be used, clindamycin can be used but a resistant test should be done prior to initiation of clinda

Syncope Vasovagal

- all patients require an EKG -most common neurocardiogenic/ vasovagal (a transient reflex failure of peripheral vascular tone in combination with relative bradycardia) -Symptoms- associated with orthostatic intolerance, dizziness, tunnel vision, nausea, vision changes, pallor diaphoresis, quick recovery Tx--> increase fluid intake, increase Na and salt intake, avoid caffeine, assume supine position at onset of symptoms education regarding to prevent venous blood pooling- cross legs, isometric extremity contraction, and toe raises.

diabetes

-Balance of protein, carbs, and fats to promote normal growth and development -Blood glucose may drop in the first 30-60 minutes of exercise a 15-20g carb snack may prevent postexercise hypoglycemia -Want a minimum of 4 BG checks per day, before meals and at bedtime **Dawn phenomenon--> tissue desensitize nocturnally--> 3am BS is increased at 7am BS increased due to desensitization of growth hormone that spikes at night and cortisol increased--> add increase dose of insulin **Both types have early morning hyperglycemia-->nocturnal hypoglycemia stimulates surge of counter regulating hormone (glucagon)--> raises BD and morning they are increased, then have to reduce bedtime insulin -Annual dilated eye exam to screen for retinopathy -CDC does not recommend the live attenuated vaccine of flu

pityriasis rosea

-acquired common mild inflammatory condition characterized by scaly, hypopigmented, and hyperpigmented lesions predominately on the trunk, upper arms, and upper thighs -unknown cause, +/- viral association (prodromal) -possible prodrome of malaise and low-grade fever before onset of rash+ S&S -scaly hyperpigmented pink salmon to violaceous lesions w/ progressive pattern -**Herald patch of 1 cm to 5 cm on trunk or buttocks, usually occurs 5-10 days b/f generalized rash -round and oval scaly, macular lesions develop over 2 week period on skin lines and in parallel fashion suggestive of Christmas tree pattern*** -individual lesions clear in central to peripheral pattern -on darker skinned populations, lesions are more predominant on neck, axillary, and inguinal areas -resolve spontaneously in 3-4 months

Dacryostenosis

-obstruction of the nasolacrimal duct -most common cause of persistent tearing in children (usually resolves by 12mo of age) -crusty lashes -Tx: maintain patency by applying pressure and massaging duct at least 2x daily; surgery to probe the duct -purulent discharge- intermittent use of erythromycin refer to optho 6-12 months

Bacterial pneumonia

-often caused by Streptococcus pneumoniae -all ages -abrupt onset fever, chills, cough, and chest pain -ill appearance -CXR--> shows patchy infiltrates in infants, lobar consolidation w/ strep pneumoniae and Haemophilus influenzae, pleural effusion may be present 6months-5yrs -Amoxicillin or Augmentin 90mg/kg per day BID/TID >5yrs -Amoxicillin 90mg/kg per day BID/TID -Patients with non-type 1 hypersensitivity to penicillin--> cefdinir 14mg/kg per day BID -pts w/ type 1 hypersensitivity to penicillin-> clindamycin 30 to 40 mg/kg per day in TID or QID

Motor milestones 9-12 months

-picks things up with pincer grasp (thumb and one finger) -drops and picks up toy -manipulates toys with hands and fingers -uses both hands together to play -creeps (moves forward on hands and knees) -pulls to stand -stands w/o support -walks with support -can take independent steps

conjunctivitis (gonococcal)

-prophylactic tx via erythromycin opth S&S-acute purulent discharge 2-4 days after birth, chemosis, significant lid edema -Need culture Tx-Can cause blindness, hospitalization for IM ceftriaxone (rocephin) avoid cetriaxone in newborns with hyperbilirubinemia (need to tx for chlamydia as well)

Fungal diaper rash

-redness, sores in diaper area, blisters, fiery red rash with satellite lesions Tx- nystatin

pharyngitis (gonoccal)

-sexually active -tx- IM ceftriaxone

Motor milestones 5-6yrs

-skips -cuts out simple shapes -copies a triangle -colors within lines

Motor milestones 12-18 months

-walks alone - begins to walk sideways and backward -comes to standing without support -crawls up and down stairs -picks up small objects -stacks one object on top of another -puts object in and dumps them out of containers -pulls apart objects -fits single puzzles pieces -scribbles

Motor milestones 2-3yrs

-walks well, run, stops, steps up, squats down -walk on tip toes -walks up stairs with an alternating foot pattern with one hand on rail -walk down stairs with a same step foot placement -jumps 2 inches off ground or over 2 inches hurdle -stnad on one leg 1-3 seconds -kicks a ball -throws a ball overhand -stacks more than 1 object -string large beads -imitates drawing horizontal or circular scribbles

Weight triples for newborn by

1 yr

Hep A- vaccine

1 yr (2 doses 6 months apart)

Leukemias

A malignant neoplasm of bone marrow characterized by proliferation of immature white cells -peak incidence is b/w 2-5 yrs old S&S -fatigue, HA, bruising, fever, nosebleeds, bone pain, limp -pallor, purpura, ecchymosis (discoloration of skin), organomegaly (liver/spleen), lymphadenopathy, testiculomegaly, cranial nerve palsy Tests -CBC--> presence of blast cells on peripheral blood smear- need bone marrow examine Leukemia is also classified as lymphocytic . Lymphocytic leukemia refers to abnormal cell growth in the marrow cells that become lymphocytes, a type of white blood cell that plays a role in the immune system Primary care--> immunizations held while on chemotherapy and resume 6-12 months after therapy completed -sibling immunizations not affected -Fever on therapy requires CBC/BC and hospitalization

Tetanus (Lockjaw)

A neurologic disease characterized by severe muscle spasms and hyperreflexia -Caused by a neurotoxin in contaminated wounds -S&S -insidious onset, gradual over 1-7 days -muscle spasms aggravated by stimuli, sound, movement, light -muscle rigidity -increased oral secretions -begins w/ pain at site of wound, followed by regional muscle spasm, by 48 hrs there is difficulty opening the jaw, followed by generalized tetany -Medical referral Prevention -DTaP vaccine

Infant botulism

A neuroparalytic disorder affecting young infants <6 months resulting from ingestion of Clostridium botulinum spores with release of toxins as organism colonizes GI tract -Toxin ingestion leads to clinical syndrome characterized by CN palsies and descending symmetrical flaccid paralysis -Associated with honey, and contaminated canned vegetables, fruits, fish products, soil S&S -Paralysis of CN II, IV, VI ( blurred vision, diplopia, impaired accommodation, ptosis) -Oculobulbar weakness (feeding difficulties, weakened cry) -Hypoglossal weakness (CN IX, X, XII) -Dysarthria (CN IX,X, XII) -Dysphagia ( CN IX, X, XII) -symmetrical descending, flaccid paralysis, -constipation -truncal weakness, loss of head and neck control -loss of facial expression, decreased movement Diagnosis -stool specimen for toxin assay is test of choice -TX -supportive care -Human-derived antitoxin is tx choice -Hospitalization for respiratory support -Report to state health department

Osteosarcoma

A solid tumor of the bone in which malignant spindle cell stroma produce osteoid - increased risk with taller children (may appear during growth spurt) -peak incidence during adolescent growth spurt between 15 and 19 yrs of age S&S -local pain, local swelling, mass at end of long bone, decreased ROM -pain over involved site, palpable mass, swelling Xray and MRI Primary care--> immunizations held while on chemotherapy and resume 6-12 months after therapy completed -sibling immunizations not affected -Fever on therapy requires CBC/BC and hospitalization

Stepping reflex

Disappears by voluntary walking

When should an breastfeed infant begin iron, and how much iron should be given to a breastfeed infant?

For exclusive breastfeed infants: about 1 mg/kg/day of iron is recommended after 6 months of age ideally iron should come from fortified cereals elemental iron supplements can be given if iron intake from diet is not adequate

23PS Pneumovax

For kiddos 24-59 months who completed the PCV13 series but are immunocompromised should receive this at 24 months.****

Tay-Sachs Disease

Found in Jewish population Normal at birth and deterioration starts at 3-6months Decerased muscle tone, cherry red macula, listlessness, blindness, deafness, seizures, dementia, vegetative state, death.

Malabsorption

Impaired intestinal absorption of essential nutrients and electrolytes cause by enzymatic deficiency, celiac disease, gluten intolerance, infectious agents, and abnormalities of the intestinal mucosa. S/S: FTT, severe chronic diarrhea, bulky foul stool, seatorrhea, vomititing. abd pain, protuberant abd, associated with vitamin defeciency or malaborption Labs: sweat chloride, lactose and sucrose breath hydrogen testing, serum calcium, phos, protien, feritin, folate, liver functions. be sure to check amylase, lipase, and tripsin if giving pancreatic enzyme replacements.

Osgood-Schlatter disease

Inflammation of tibial tubercle from repetitive stresses in athletes with immature skeletal development -occurs 10 to 15 yrs of age when immature cartilage susceptible to repeated trauma S&S -pain and tenderness localized to tibial tubercle in acute phase -point tenderness over tibial tubercle = prominence/enlargement of tibial tubercle compared w/ an unaffected side after acute phase -Diagnosis accurate by clinical examination, radiographs used to rule out presence of other serious bone pathology Management--> self-limiting condition, pain resolves with full ossification of tibial tubercle and closure of apophysis Activity limitations--> complete avoidance of sport activities not recommended, Limit activity to control pain at tibial tubercle, stretching exercises before activity, icing may help after -USE Knee immobilizer help with pain relief , thigh muscle strengthening

Marfan Syndrome

Inherited connective tissue disorder. Tall stature Arm span exceeds height** Thin extremities and fingers. Long narrow face. Pectus Hyperextension of joints Genu Recurvatum Kyphoscolious **Cardiac, aortic regurg, Mitral prolapse, aortic aneursym....MEANS NO CONTACT SPORTS***** aortic root dissection. ectopia lentis and irdodonesis.

Tuberous Sclerosis

Neurocutaneous syndrome with a combination of skin abnormalities, seizures, and cognitive deficits, progressive disorder Autosomal dominant mutant gene Establish diagnosis on detecting 2 major features or one major plus 2 minor features Skin--> hypopigmented macules, of elliptical shape (ash leaf spots) -fibroadenomas- adenoma sebaceum -distinctive brown patch on forehead -Shagreen patch- raised lesion in lumbosacral region Teeth--> pitting of enamel Eye--> choroidal hamartomas, hypopigmented defect of iris CNS--> periventricular tubers, cerebral astrocytoms, nonspecific EEG abnormalities, hypoarrythmia -Cardiovascular--> cardiac rhabdomyomas, aortic and major artery constrictions -seizuers of all types

11. Which of the following best describes the treatment for roseola? a. Acetaminophen or ibuprofen for fever, parental reassurance b. Warm compresses for salivary gland swelling c. Oral acyclovir, 20mg/kg/dose, four times/day d. Bed rest, saline gargles for sore throat

a

13. the following blood level is not considered lead poisoning? a. <10ug/dl b. 10-14ug/dl c. >15ug/dl d. >25ug/dl

a

15. What percent of factor VII/IX is associated with severe hemophilia A & B? a. >1 b. 1-5 c. 5-25 d. 30-50

a

27. The following diagnostic finding is consistent with Wiskott-Aldrich syndrome: a. IgG-normal b. IgA-decreased c. IgM-increased d. B cells-decreased

a

28. Many infectious diseases present with rashes along with general complaints of fever, malaise, and headaches. Which of the following clusters of symptoms would make you consider Lyme disease as a likely diagnosis? a. Fever, malaise, headace, arthalgia, and well circumscribed, erythematous, annular rash with central clearing b. Fever, malaise, headache, transient bone pain, and generalized erythematous, maculopapular rash that began on the face and spread to trunk and extremities c. Fever, malaise, anorexia, and confluent, erythematous, brownish maculopapular rash d. Fever, malaise, anorexia, and erythematous rash beginning on wrists and ankles then spreading to the trunk

a

8. A 5yo child is born at 28 weeks gestation has mild spastic diplegia. Which evaluation is important before the child is placed in regular kindergarten? a. Stanford-binet IQ test b. Carey scale of temperament c. CBC with diff d. Chromosome studies

a

9. Rubeola is: a. Preventable by active immunization b. Caused by human herpesvirus 6 c. Treated with intravenous acyclovir d. Not associated with severe complications (e.g., encephalitits, pneumonia

a

A 12-year-old child is brought to the office for a yearly physical. The child states that he has recently noticed an enlargement of his testes and scrotum. When counseling the boy as to what to expect next in pubertal development the PNP tells him: A) The penis will grow in length B) The penis will grow in width C) Facial hair will appear D) Changes in voice will occur

a

A 12-year-old child is seen in the office for a yearly physical. The boy states that he has recently noticed an enlargement of his testes and scrotum. When counseling the child about what to expect next in pubertal development, the PNP states that: A) The penis will grow in length B) Changes in voice will occur C) The penis will grow in width D) Facial hair will appear

a

A 15 yo female comes to the clinic for a health maintenance visit. The patient reports no complaints. She does well in school, has many friends, and gets along well with her parents and two siblings. She has recently become sexually active with her boyfriend of 6mo. The physical exam is normal for her age. What screening, lab tests, and/or immunizations should the PNP order? a. Vision, hearing, urinalysis, STD screen, pelvic exam, and immunizations as needed b. STD screen, pneumococcal vaccine, pelvic exam, and cholesterol screening as indicated c. vision, hearing, STD screen, pelvic exam, and hemoglobin if indicated. d. Measles vaccine, vision, hearing, STD screen, pelvic exam exam, and cholesterol screen if indicated.

a

A 15-year-old adolescent is brought to the office for a routine examination. The adolescent is healthy and has no history of allergies or reaction to previous immunizations. There is no reliable history of varicella. The PNP reviews the adolescent's immunization record and finds the following: Age 3 months DTP and OPV Age 5 months DTP and OPV Age 9 months DTP and OPV Age 18 months DTP, Hib, and MMR Age 5 years DTP, OPV, and MMR The PNP should administer the following immunizations today: A) Td, Hep B, and Var (the adolescent should be asked to return in 1 month for another Hep B) B) Td and Hep B (the adolescent should be asked to return in 1 month for another Hep B) C) Hep B, IPV, and Var (the adolescent should be asked to return in 1 month for another Hep B) D) Var and MMR (the adolescent should be asked to return in 1 month for another Var)

a

A 2-year-old child is currently receiving chemotherapy for neuroblastoma. An older sibling is due to receive a poliovirus vaccine before starting kindergarten. The appropriate action at this time is to: A) Give IPV B) Withhold IPV, and give it 1 year after the sibling completes chemotherapy C) Withhold IPV, and give it as soon as the sibling completes chemotherapy D) Give oral poliovirus (OPV)

a

A 3-year-old child is brought to the clinic with the complaint of vomiting; low-grade fever; and watery, frequent stools for the past 24 hours. The PNP recommends: A) Increased liquids and a modified diet of bananas, rice, applesauce, and toast B) A diet of bananas, rice, applesauce, toast, and milk C) Oral antidiarrheal agents D) Clear fluids and rest for 24 hours

a

A 4-year-old child is brought to the office for a preschool physical examination. The PNP asks the child to sit on the floor in a cross-legged position and then get up without using the hands. The child is unable to do so and rolls onto all four extremities before standing. The PNP is concerned that the child may have a: A) Neuromuscular disorder B) Developmental problem C) Cognitive deficit D) Neurologic deficit

a

A 4-year-old is brought to the office for a preschool physical examination. The child was hospitalized for Kawasaki's syndrome and treated with intravenous immune globulin (IVIG) 9 months ago. According to the immunization records, the child requires DTaP, polio, and MMR immunizations at this time. What immunizations should the PNP administer today? A) DTaP, IPV, and MMR B) Only MMR C) None (immunizations should be given at the school physical examination next year) D) DTaP and IPV (the parent should be instructed to schedule an appointment in 2 months for the MMR)

a

A 5 year old complains of a painful left eye after being accidentally scratched by a sibling two hours ago. Fluorescein exam shows a small central corneal abrasion. The most appropriate management during the first 24 hours is a. frequent application of topical antibiotic b. observation of the injured eye c. frequent application of topical non-steroidal anti-inflammatory drops d.occlusive patching of the injured eye

a

A 5-year-old child has a 3-day history of sore throat, fever (101ºF to 103ºF), headache, and one episode of vomiting. The child's symptoms started with a runny nose and slight cough yesterday. The physical examination is normal except for +2 to +3 tonsils, palatal petechiae, erythema, and a clear runny nose. The PNP's best course of action is to: A) Perform a throat culture before prescribing an antibiotic B) Discuss symptom control for seasonal allergies C) Prescribe antibiotics for strep throat because the child has classic symptoms of the infection D) Reassure the parent that only symptomatic treatment is necessary and that the virus needs to run its course

a

A 6-year-old boy is brought to your office for a routine well-child examination. Significant findings in the child's history, reported by his mother, include unspecified "birth trauma" and a 9-year-old brother who has "difficulty in school." The mother also reports that her son cannot "sit still" or play with toys for long periods and notes that he recently had to change schools when the family moved. Physical examination reveals a well-nourished, appropriately dressed 6-year-old boy and no remarkable physical findings. The boy is unable to follow simple commands; he grabs your stethoscope from your neck and then runs around the examination room with it. On the basis of this child's history and physical, which of the following is the most appropriate initial action? a. refer for CT or MRI of head b. have mother bring the child back for F/U in 1mo c. refer to psych d. do nothing

a

A 9-year-old child has circumscribed, coalescent, generalized, erythematous raised lesions of various sizes. The PNP recognizes that the most common cause of hives is: A) Ingestion of foods and food additives B) Cold exposure C) Sun exposure D) Insect bites

a

A child diagnosed with HIV can best be monitored by assessing: A) CD4 antigen counts and viral burden B) Anorexia and fatigue C) ELISA results D) Weight loss and fatigue

a

A child who has a 250-word vocabulary, uses three-word sentences, walks upstairs alternating steps, rides a tricycle, and uses a spoon well is approximately aged: A) 3 years B) 6 years C) 5 years D) 4 years

a

A child who is able to run, kick a ball, wash and dry the hands, tower two cubes, and use pronouns indiscriminately is probably aged: A) 24 months B) 18 months C) 40 months D) 36 months

a

A deficiency of which of the following vitamins may cause night blindness, xerophthalmia, or keratomalacia? A) Vitamin A B) Vitamin K C) Vitamin D D) Vitamin E

a

A healthy 12yo female is at the clinic for a well checkup. On physical examination, a marked elevation of the right scapula and right thoracic hump and spinal curve abnormally are noted. Spinal films indicate 20 degree curve. The PNP should: a. refer the patient to an orthopedist b. monitor the patient every 3 mo until menarche c. refer the patient for physical therapy d. recommend bedrest and back brace

a

A low-birth-weight neonate is examined in the clinic. The mother is Native American and smoked heavily during the pregnancy. The PNP recognizes that the Native American population has an increased incidence of: A) Sudden infant death syndrome (SIDS) B) Reactive airway disease C) Developmental disability D) Neonatal sepsis

a

A mother asks about the term Moro reflex. The PNP explains that the reflex is present in a neonate and disappears or phases out at about age: A) 3 to 5 months B) 6 to 8 months C) 7 to 9 months D) 10 to 12 months

a

A neonate is diagnosed with trisomy 21 based on karyotyping. What type of follow-up will the infant need? A) Echocardiography; thyroid function tests at birth, 3 months, and yearly thereafter; a CBC; and an audiology consult B) An ophthalmologic evaluation, neck x-ray films by age 3 years, and referral to early intervention and parent education C) Karyotyping, echocardiography, audiologic and ophthalmologic evaluation, and referral to early intervention and parent education D) Karyotyping; echocardiography; renal ultrasonography; thyroid function tests at birth, age 3 months, and yearly thereafter; and referral to early intervention and parent education

a

A preschool boy whose parents have separated and are beginning divorce procedures: a. may think that he caused the divorce by misbehaving b. should not be told of the impending divorce until the parents are sure of their decision c. is likely to experience gender identity confusion d. should be able to make a decision about which parent he prefers living with

a

A single, 15-year-old mother, who attends high school, brings a 3-month-old infant to the clinic. The infant seems to be healthy and thriving, but the mother is vague when reporting the infant's feeding and sleeping habits. To get more accurate information about the specifics of the infant's routine and care, the PNP should: A) Ask about the day care arrangements B) Make a referral to a social service agency C) Ask the mother if she has a learning disability D) Make a referral to a home nursing agency

a

A term infant born by C-section, with birthweight of 5 lbs 5 oz (2.4 kg), develops tachypnea with a respiratory rate of 68 at 2 hours of life. The most likely diagnosis is a. transient tachypnea of the newborn b. pneumothorax incurred during delivery c. respiratory distress syndrome d. congenitally acquired pneumonia

a

All definitions of primary health care include: a. the concept of universal access and accountability b. the concept of universal access and AIDS prevention c. the concept of universal access and focus on self-responsibility for health d. the concept of universal access and a focus on reimbursement for services rendered

a

An 8-year-old child who was born and raised in Vermont is healthy and has no known risk factors for tuberculosis (TB). A PPD skin test results in 7-mm induration and redness. How should this be interpreted? A) As a negative skin test result B) As a positive skin test result C) As a negative skin test result (but testing should be repeated in 3 months) D) As an unequivocal skin test result (and testing should be repeated now)

a

An infant brought to the clinic is diagnosed with failure to thrive (FTT), persistent growth deficiency of the head, and delayed development. Some unusual facial abnormalities are noted. The mother has a history of consuming large amounts of alcohol. The PNP suspects fetal alcohol syndrome (FAS) and refers the infant: A) To a First Steps Program or Birth to Three Program B) For consultation with a neurologist C) For a genetic workup D) For consultation with an endocrinologist

a

An infant's neurologic status is being evaluated. The PNP preceptor asks when the parachute developmental reflex occurs. The PNP student responds: A) Age 8 to 10 months B) Age 2 to 4 months C) Age 5 to 7 months D) Age 4 to 6 months

a

Cholesterol screening should be done: a. children 2yrs+ who have a parent with a total cholesterol level of 240mg/dL or greater b. once all children at 6yrs of age c. overweight children with a family history of premature cardiovascular disease d. once for all children at 12yrs of age

a

Current prescriptive authority for APRN: a. varies among states b. is fairly consistent among the states c. provides DEA numbers for APRN d. allows APRN to move freely from state to state

a

Developmental milestones for a 5 month old include a. rolling from back to front, reaching for an objects and smiling spontaneously at familiar faces b. sitting unsupported, transferring an object form hand to hand, smiling, and cooing c. making sounds that mimic one syllable words, rocking on hands and knees, fine pincer grasp d. crying when parent leaves the room, beginning to creep, holding onto a toy

a

During auscultation of a 3yo's chest, you note an irregular heartbeat of 90bpm that slows when resp rate slows & accelerates when the child breathes faster. The rest of the exam is normal. What is appropriate response to this finding from the choices below? a. record the finding in the child's chart b. order a chest x-ray c. order an echocardiogram d. refer the child to a cardiologist

a

Following tympanostomy tube insertion, it is important that the tubes remain patent. Which of the following methods may be used to determine patency? a. visual inspection b. impedance tympanometry c. valsalva maneuver d. instillation of an ototopical suspension

a

In conducting educational health programs for patients with chronic illness, the most effective model involves: a. Individualized education aimed at encouraging patients to take charge of their own health b. Disseminating accurate information about self-care and treatment options without considering each patient's individual strengths or challenges c. Eliminating patients from the program who don't change their behavior based on the health information provided d. Single-session programs to provide the maximum amount of information in the shortest time possible

a

In supporting parents of a school aged child with a learning disability, the most important PNP role is to: a. understand the development of the IEP (Individualized Education Plan) and 504 Plan b. have a collaborative relationship with the local psychiatrist who works with learning disabled children c. identify the participants in the student study team or child guidance group d. prescribe the most common medications used for ADHD

a

Informed consent is characterized by: a. The duty to provide all relevant information to a patient about their condition and alternative treatments b. The duty to respect a patient's individual values and choices c. The duty to benefit patients and protect their interests d. The duty not to inflict harm on patients

a

Kali is HIV + and has just delivered a 3.8kg male infant. Which of the following should be included in her postpartum counseling? a. suggest use of commercially prepared formula b. encourage HIV testing of the infant at birth & at 2mo c. avoid day care until infant has had 2 negative HIV tests d. instruct that oral polio vaccine is recommened

a

Of the following, the MOST effective method to prevent childhood gun injuries and death is a. parents preventing children's access to guns b. educating children with the Eddie the Eagle program c. educating children with the STAR Program d. children's awareness of gun presence in the home.

a

One of a young child's greatest fears is: A) Separation from parents or caregivers B) Not getting enough food C) Not being accepted by peers D) Having limits set by caregivers

a

One of the major psychosocial tasks of infancy is: a. development of secure attachment b. separation-individuation c. symbiosis d. regulation

a

Public Laws 94-142 and 101-476 mandate that a child with disabilities is entitled to: A) An individualized education program (IEP) B) Genetic evaluation and counseling C) Benefits provided by the Supplemental Security Income Program for the Aged, Blind, and Disabled D) Evaluation with the Wechsler Intelligence Scale for Children III (WISC III)

a

Reimbursement under managed care: a. requires that the provider accept the financial risk for the care provided to a specific population of enrolled patients b. requires that the managed care organization accept the financial risk for the care provided to a specific population of enrolled patients. c. does not reward efficient care delivery d. is not available to APRN

a

Standards of practice may be used to: a. establish minimal levels of performance b. establish reimbursement schemes for APRN c. Mandate nursing practice across the nation d. Mandate nursing practice in certain states

a

Tammy has mild persistent asthma. Appropriate daily medications for this 4yo preschooler should include: a. an inhaled low dose corticosteroid b. short acting beta2 agonists c. an oral systemic corticosteroid d. a cough suppressant

a

The PNP examines a 4-year-old child who is home-schooled and immunization-delayed. The child has pain when chewing; a fever; and enlarged, tender salivary nodes. The PNP diagnoses mumps and informs the mother that mumps is contagious for: A) 7 days before the onset of symptoms B) 10 days before the onset of symptoms C) 1 to 2 days before and 5 days after D) As long as 3 days after the onset of symptoms

a

The PNP examines a 9-year-old child with a history of reactive airway disease since birth for the first time. In the past 2 weeks the child has had three exacerbations. After evaluating the child, the PNP determines that the mostappropriate medication is: A) Oral steroids and albuterol B) Pirbuterol acetate (Maxair) or Salmeterol C) Albuterol (Ventolin, Proventil) D) Beclomethasone (Beclovent) or Fluticason (Flovent)

a

The PNP has completed vision screens on the children who attend a day care and preschool center. Which of the following children should be referred for further testing? A) A 3-year-old child (tested with a Sjögren hand chart) with the following results: right eye, 20/40; left eye, 20/20 B) A 4-year-old child (tested with an HOTV chart) with the following results: right eye, 20/40; left eye, 20/40 C) A 4-year-old child (tested with a Snellen E chart) with the following results: right eye, 20/20; left eye, 20/30 D) A 3-year-old child (tested with an Allen chart) with the following results: right eye, 20/30; left eye, 20/30

a

The PNP has prescribed salmeterol (Serevent) by inhalation for an asthmatic. The family should be warned about which of the following side effects that occur with this medication? A) Tachycardia and headache B) Weight gain and acne C) Nausea and vomiting D) Dysrhythmia and dry mouth

a

The PNP is evaluating a 15-year-old adolescent with acne. Upon examination the adolescent has papules and a few pustules on the face, chest, and back. An appropriate plan of care for this patient would include: A) A combination topical antibiotic and exfoliating agent B) Oral tetracycline and anticipatory guidance for skin care C) Oral isotretinoin and pregnancy prevention counseling D) A topical exfoliating agent

a

The PNP is examining a 6mo old infant with what is believed to be craniosynostosis. The suture lines reveal a prominent bony ridge over the occipital and coronal sutures. The PNP should: a. refer the infant to a neurologist b. remeasure the head circumference in 2mo c. discuss with the parents the need for PT d. order chromosomal studies

a

The PNP is in the nursery to examine a neonate. The results of the neonatal screen are noted in the chart. The T4 level is low, and the TSH level is elevated. The PNP should: A) Consult with the physician, and repeat the tests B) Discharge the neonate, and schedule a follow-up visit in the office in 1 week C) Examine the neonate for signs of hypothyroidism D) Begin the neonate on thyroxine based on the test results

a

The PNP is the primary care provider for a preterm infant (born at 31 weeks' gestation). The infant had no complications other than a minor ventricular hemorrhage at birth. The infant is 4 months' chronologic age and progressing well. What type of respiratory syncytial virus (RSV) prophylaxis should the PNP consider at today's visit? A) RSV prophylaxis in six monthly doses, if the local RSV season is approaching B) Nothing, because the infant did not have bronchopulmonary dysplasia at birth C) Nothing, if the RSV season has already begun D) RSV prophylaxis in three monthly doses if the local RSV season is approaching

a

The PNP sees a 4-week-old neonate for a well-child visit. The parents report that the infant seems to eat well but does not gain weight and has frequent, greasy-looking stools. The PNP suspects that the neonate might have: A) Cystic fibrosis B) Failure to thrive C) Gastroenteritis D) Intussusception

a

The common practice using "time outs" with young children is direct application of: a. operant conditioning b. classical conditioning c. separation-individuation d. maturational reinforcement

a

The family history should include: a. the health status of the paternal grandparents b. the living conditions of the family c. the work status of the parents d. school information

a

The first step in the process of developing an IEP for a child with disabilities is to: A) Perform a comprehensive assessment of the child by a multidisciplinary team B) Perform a battery of psychological tests that are valid and reliable C) Perform a complete history and physical examination to identify organic causes D) Provide government funds to the child and family to supplement income

a

The leading cause of death for children 1-18 years of age in the United States is: a. Accidents b Homicide c. Cancer d. Congenital anomalies

a

The most common hematological presentation of leukemia in children is anemia along with which of the following? a. neutropenia and thrombocytopenia b. leukocytosis and monocytosis c. neutropenia and blast cells on peripheral smear d. monocytosis and blast cells on peripheral smear

a

The most common temperamental profile is: a. easy b. difficult c. slow-to-warm-up d. intermediate

a

The most likely weight of 1yo child whose weight at birth was 6.5lb would be: a. 19-20lbs b. 13-14lbs c. 25-26lbs d. Impossible to estimate

a

The most likely weight of a 1yo child whose weight at birth was 6.5lbs would be what? a. 19-20lbs b. 13-14lbs c. 25-26lbs d. impossible to estimate

a

The normal motor development of a 2-month-old infant includes: A) Grasping a rattle and lifting the head and shoulder off the bed when in the prone position B) Briefly fixating on a face or object and grasping an object when placed in the palm of the hand C) Reaching for objects, transferring objects from one hand to the other, and lack of head lag when pulled to a sitting position D) Bearing weight on the forearms when in the prone position, rolling from the prone to the supine position, and bearing weight when standing

a

The nurse practitioner role was initially established to: a. improve access to care and partially solve physician shortage b. reduce the nursing shortage and improve access to care c. improve working conditions of nurse while improving access to care d. improving nursing's image through expansion of the role

a

The parents of a 6 year old reports that the child has been allergic to most fruits since early life. Which history question should be asked FIRST? a. what were the child's symptoms? b. how many different fruits is the child allergic to? c. has the child had any previous testing? d. how old was the child with the first reaction?

a

The parents of a child with cystic fibrosis are considering another pregnancy. They want to know what their chances are of having another child with cystic fibrosis. The PNP explains that cystic fibrosis is an autosomal recessive disorder and that each conception of carrier parents has a: a. 25% chance of being affected b. 50% chance of being affected c. 75% chance of being affected d. 100% chance of being affected

a

The stage of cognitive development that Piaget described as characteristic of the way preschoolers think is the: a. preoperational stage b. mental combinations stage c. tertiary circular function stage d. sensorimotor stage

a

The time of ovulation is usually: a. about 14 days before onset of the next menstrual period b. about 14 days after the onset of the previous menstrual period c. during the menstrual period d. about 7 days after the onset of the menstrual period

a

What is the probability of a couple having a child with cystic fibrosis (CF) if the mother carries the △F508 gene and the father does not? A) 0% B) 100% C) 25% D) 50%

a

When asked at a prenatal visit by the mother, "How should I feed my infant—breast or bottle?" How should the PNP reply? A) "Breastfeeding is the best way to feed the infant." B) "A combination of breast and bottle is best." C) "Formula is an easy way to offer adequate nutrition." D) "Feed the infant whichever way you want."

a

When assessing the heart of a healthy 4-year-old child, the PNP would expect to find: A) A visible apical pulse or point of maximal impulse B) Sinus tachycardia C) S2 heart sounds louder than S1 heart sounds at the apex D) Long, low-pitched heart sounds

a

Which BEST represents the description of Tanner stage 3 in an adolescent female? a. areola and breast enlarges with no separation of contours, presence of pubic hair over the middle of the pubic bone c. areola and breast enlarges with no separation of contours, appearance of fine, downy pubic hair along the labia d. distinctive projection of the areola, appearance of fine, downy pubic hair along the labia

a

Which component of identity is likely to develop first? a. physical b. vocational c. moral d. ideological

a

Which diagnostic study warrants the MOST attention when evaluating a child with autism? a. audiologic evaluation b. EEG to rule out seizure disorder c. state-mandated metabolic screening d. brain imaging

a

Which immunization statement applies to a 3 year old who completed chemotherapy 2 months ago for acute lymphocytic leukemia (ALL)? a. the child should not receive immunizations containing live viruses b. serum immunity should be evaluated prior to administration of vaccine c. a repeat of all recommended immunizations is necessary d. a repeat of live virus vaccines is warranted

a

Which of the following drugs is important in symptom management and the prevention of complications in Kawasaki's disease? a. aspirin b. corticosteroids c. acetaminophen d. penicillin

a

Which of the following explanations can help parents of preschool-aged children distinguish night terrors from nightmares? A) Nightmares are scary dreams followed by complete awakening B) The child does remember night terrors and talks about them in the morning C) Night terrors usually occur during the second half of the night D) The child does not remember nightmares in the morning

a

Which of the following is accurate about transmission of an autosomal recessive trait, such as the defective gene of cystic fibrosis? a. 25% of children born to two carriers of the gene mutation will be affected by the disease b. All male offspring born to two carriers of the gene mutation will be affected by the disease, while none of the female offspring will be affected c. Half of the female offspring born to two carriers of the gene mutation will be carriers of the gene mutation and half of the male offspring will be affected by the disease d. 50% of all offspring born to two carriers of the gene mutation will be affected by the disease

a

lab results reveal a hypochromic, microcytic anemia in a 3yo child. Your differential diagnosis must include: a. lead poisoning b. pernicious anemia c. hemophilia d. folic acid deficiency

a

standards of practice are: a. authoritative statements used to measure quality b. used to measure outcome but are not authoritative c. designed for legal purposes d. not designed for legal purposes and cannot be used to measure quality

a

20-month-old Ava is in for fussiness. The PNP diagnoses her with teething. At what age can the PNP educate Ava's mom that all of her primary teeth should be erupted? a. 2 years old b. 3 years old c. 12 years old

a *stated at live review

The PNP is making a genogram of Haley's family. What is the minimum number of generations that a genogram includes? a. 3 b. 4 c. 2

a pg. 21

The PNP is assessing a 6-year-old male and notes a murmur at the right upper sternal border. What structure of the heart is the PNP auscultating? a. Aortic b. Pulmonic c. Ventricle

a pg. 63

11yo Mark is diagnosed with constitutional growth delay. Appropriate management includes: a. starting him on low dose testosterone therapy now b. counseling regarding delayed onset of puberty c. thyroxine replacement d. nutritional counseling

b

13. Which of the following statements is not true regarding the transmission of chickenpox? a. Susceptible individuals can contract chickenpox from patients with varicella zoster (shingles) b. Children with chickenpox are infectious only during the period of time when skin lesions are present c. Children with chickenpox are no longer infectious once crusting of skin lesions has occurred d. Varicella-zoster immune globulin (VZIG) should be administered to susceptible immunocompromised individuals who are exposed to a patient with varicella zoster infection

b

14. A well-appearing, well dressed 11mo old has a long philtrum, midface hypoplasia, microcephaly, mild developmental delay, & myopia. The mother denies drinking alcohol during the pregnancy. What is the next best step? a. Refer the mother-child to child protective services b. Refer the child to early intervention c. Refer the child to cardiology d. Refer the mother to alcoholics anonymous

b

15. The most appropriate agent for use in treating varicella zoster infection in an immunocompromised host is: a. Ganciclovir b. Acyclovir c. Cetriaxone d. Chloramphenicol

b

17. Which of the following is not a complication of mumps? a. Meningitis b. Pneumonia c. Oophoritis d. Pancreatitis

b

18. A pathognomonic skin finding in children with chronic adrenal insufficiency (Addison's) is: a. Purple striae b. Increased pigmentation in the axilla, groin, areola, hand creases, & in surgical scars c. Dry, thickened skin d. Increased perspiration

b

18. What recommendation would you make to a parent whose son has been diagnosed with mumps and wants to know when he can return to child-care? a. He can return once he becomes afebrile and can tolerate eating b. He can return 9 days after onset of symptoms c. He can return when he is well enough participate in activities d. He can return after a minimum of 5 days of antibiotic therapy

b

2. Which of the following physical stigmata are common in newborns with Down syndrome? a. Microcephaly, large ears & mouth, flattened philtrum b. Hypotonia, large appearing tongue & small mouth, upward slant to eyes c. Fair mottled skin, large hands & feet, broad stocky neck d. Funnel or pigeon-breasted chest, Brushfield spots, extra digits

b

5. Infants younger than 6mo of age with pertussis frequently require hospitalization to manage: a. Fever, cough, dehydration b. Coughing paroxysms, apnea, cyanosis, feeding difficulties c. Coughing paroxysms, dehydration, renal failure d. Seizure, fever, pneumonia

b

A 10-month-old infant is assessed for ocular alignment with the corneal light reflex test. The PNP is testing for: A) Anisometropia B) Strabismus C) Functional loss of vision D) Hyperopia

b

A 12-month-old infant is at the clinic for a scheduled well-child visit. The mother expresses concern that the infant awakens in the middle of the night screaming. The mother refuses to let the infant cry because the crying wakes up siblings, so she rocks the infant back to sleep. In addition to telling the parents that the infant's nighttime awakening has become a habit, the PNP should offer what other advice? A) The infant should be allowed to stay up late so he or she will be tired and sleep longer at night B) Rocking is reinforcing the habit. The parents may comfort the infant but should not pick up, rock, or make eye contact with the infant when the infant awakens at night C) The parents should offer a security blanket or toy at bedtime and use a night light D) The parents should arrange for the siblings to spend a few nights with relatives or friends and then should allow the infant to cry long enough to fall back asleep

b

A 13-year-old female patient is being evaluated by the pediatric nurse practitioner for allergic rhinitis. During the visit, the patient discloses that she is considering have sexual intercourse with her boyfriend. Later in the visit, she mentions that she has been feeling "depressed" recently. Which of the following should be the pediatric nurse practitioner's first priority in caring for this patient? a. Evaluating the patient further to determine the best contraceptive method for this patient b. Eliciting more details about the depression, including evaluation for suicidal thoughts or plans c. Managing the symptoms of allergic rhinitis at this visit and scheduling a follow-up visit to address the other issues d. Referring the patient to an adolescent medicine specialist

b

A 15-year-old adolescent comes to the school-based clinic with the complaint of nausea in the morning and breast tenderness. Menses are 5 days late. It is not abnormal for her to be late. A pregnancy test is performed and is positive. The PNP advises the adolescent to first: A) Discuss the situation with her parents B) Discuss the results with the adolescent to determine what this means to her C) Consult with an obstetric physician or adolescent clinic D) Repeat the pregnancy test in a week

b

A 15-year-old girl is being evaluated for possible delayed puberty. There is a documented history of Tanner stage 2 breast development and Tanner stage 1 pubic development at age 9.5 years. What current findings would support the diagnosis of delayed puberty? A) Family history of abnormal puberty B) Palpable breast buds with areolar enlargement C) Dark, coarse, curly pubic hair spreading over the mons D) Weight at 5th percentile

b

A 2-year-old child is brought to the clinic for a well-child visit. The mother expresses concern about the child's language development. Which of the following limitations would be an indication that this child has a language delay? A) The child can name two pictures B) The child has a vocabulary of 20 words C) The child's speech is halfway understandable D) The child can put two words together

b

A 2-year-old child is examined as part of a well-child visit. The mother's main concern is bowing of the child's legs, which is evident on examination. The PNP: A) Assures the mother that this is normal development B) Refers the child to an orthopedic clinic for evaluation C) Obtains a detailed family history for genu varum D) Suggests that the child may need bracing

b

A 3-year-old child is brought to the clinic with noisy respirations. Which of the following signs or symptoms would be an indication for immediate referral and hospitalization? A) Mild restlessness B) Stridor at rest C) Fever of 102°F D) Slightly elevated white blood cell count

b

A 3-year-old child is brought to the office for the first time. The child is adopted, and little is known about the prenatal and birth history. A diagnosis of fetal alcohol effects (FAE) is suspected. The physical findings that lead the PNP to suspect this diagnosis are: A) Carious teeth, hyperactivity, toe walking, and macrocephaly B) Growth retardation, thin or wide lips, flat midface, and finger anomalies C) Abnormal hair pattern, cherubic lips, temper tantrums, and protuberant belly D) Balance problems, irritability, multiple scars on the arms and legs, and microcephaly

b

A 4-month-old infant is brought to the office for a well-child visit. While giving the infant's history, the grandmother states that she dreaded coming to the office today because the infant "cried for hours" after the first set of immunizations. The immunization record reads as follows: Birth Hep B Age 2 months DTP/Hib, Hep B, Prevnar, and IPV The following immunizations should be given today: A) DTaP, Hib, and MMR B) DT, Hib, Hep B, and IPV C) DTaP, Hib, Prevnar, Hep B, and IPV D) DTP/Hib and IPV

b

A 4-year-old child is brought to the clinic with ulcers on the tongue and oral mucosa. There are vesicles on the palms, soles, and interdigital areas. The PNP diagnoses: A) Infectious mononucleosis B) Hand-foot-and-mouth disease C) Rubeola D) Herpangina

b

A 5-year-old child is brought to a community health clinic for a physical examination and immunizations before starting kindergarten. The father says he is unsure whether the child had chickenpox. The immunization record reads as follows: Age 1 month Hep B Age 2 months DTaP, Hib, Prevnar, and IPV Age 4 months DTaP, Hep B, Hib, Prevnar, and IPV Age 6 months DTaP, Hep B, Prevnar, and Hib Age 15 months Hib, Prevnar, and MMR Age 18 months DTaP and IPV What would be the most appropriate action? A) Order a serum varicella titer B) Administer DTaP, IPV, MMR, and Var C) Administer one dose of Var now and another dose in 1 month D) Administer DTaP, IPV, and MMR at this visit and one dose of Var in 1 month

b

A 9-year-old child is brought to the clinic for joint pain, a rash on the trunk, and a "racing heart." The child looks ill, and the skin is hot to the touch. The child had a sore throat about 3 weeks before this illness but recovered without medical treatment. The PNP orders a: A) Immunofluorescent stain to detect ANA antibodies. B) Antistreptolysin O (ASO) titer C) Monospot test D) CBC

b

A 9-year-old child is brought to the clinic for the evaluation and treatment of a rash. While examining the child, the PNP detects a speech dysfluency. The most appropriate plan of treatment should include: A) Treating the rash and scheduling a well-child visit to address the speech problem B) Treating the rash and making a referral for speech, language, and hearing evaluation with a speech pathologist C) Treating the rash and making no referral because it is too late for speech therapy to be beneficial D) Using a clinical screening tool to determine whether a language disorder exists

b

A foster mother phones the office because her 10-year-old child has knocked out a permanent tooth. The PNP instructs the foster mother to: A) Rinse the tooth in warm water, and call the dentist B) Place the tooth back in the socket, and call the dentist immediately C) Take the child and the tooth to the dentist tomorrow D) Take the child to the hospital emergency room immediately

b

A pelvic exam should not be performed on which of the following adolescents? a. a 14yo who is sexually active b. a 15yo who has just started menarche c. a 17yo who is having irregular menses d. an 18yo healthy female

b

A preschool child who says that the sky is blue because it is his favorite color is illustrating the concept of: a. symbolic thinking b. egocentrism c. centration d. imaginary audience

b

A single, 15-year-old mother who attends high school brings a 3-month-old infant to the clinic. The infant seems to be healthy and thriving, but the mother is vague when reporting the infant's feeding and sleeping habits. To get more accurate information about the specifics of the infant's routine and care, the PNP should: A) Make a referral to a home nursing agency B) Ask about the day care arrangements C) Ask the mother if she has a learning disability D) Make a referral to a social service agency

b

An 18-month-old is seen in the emergency room with a second-degree "glove distribution" burn. A more detailed history is needed because of the concern for: A) Staphylococcal scalded skin syndrome B) Immersion injury caused by child abuse C) Possible contact with a caustic material D) Accidental burn from an iron

b

Diagnostic studies included in the routine screening of the child with developmental delays of unknown etiology include chromosomal karyotyping, deoxyribonucleic studies (for fragile X syndrome), and: A) Cystometrography B) Tests to detect urine and plasma amino acids C) Microscopic urinalysis D) Tests to detect serum antinuclear antibodies (ANAs)

b

Foods containing high levels of iron appropriate to suggest for a 2 yo with iron deficiency anemia include a. almonds, brown rice, peanut butter b. brown rice, Cheerios, kidney beans c. pancakes, peanut butter, Cheerios d. pancakes, broccoli, almonds

b

In addition to specific academic skill deficits, learning disabilities are commonly associated with which of the following characteristics? a. perceptual-motor impairments, normal motor function b. perceptual-motor impairments, impulsiveness c. perceptual-motor impairments, down syndrome d. perceptual-motor impairments, lack of impulsiveness

b

Infants who have been identified as IUGR are prone to developing hypoglycemia due to: a. decreased metabolic rate b. low levels of glycogen stored c. become acidotic d. a prone to develop sepsis

b

It is early fall, and an 18-month-old child with a history of asthma is brought to the office because of an acute exacerbation. The PNP reviews the child's immunization record with the mother. The child's breathing improves after a nebulizer treatment. While giving the history, the mother states that the child gets a rash after eating eggs. The immunization record reads as follows: Birth Hep B Age 2 months DTaP, IPV, Hib, Prevnar, and Hep B Age 6 months DTaP, IPV, Hib, and Prevnar Age 10 months DTaP, Hib, Prevnar, and Hep B The following immunizations should be given today: A) DTaP, IPV, Hib, MMR, Var, and flu vaccine B) DTaP, IPV, Hib, Prevnar, MMR, and Var C) None, because the child is acutely ill D) DTaP, IPV, Hib, and Var

b

Most stage-based theories of development focus primarily: a. the continuity of development b. the discontinuity of development c. persistance of inherent personality characteristics d. the influence of context on development

b

Newborn screening for hypothyroidsm is done by measuring: a. thyroid stimulating hormone (TSH) b. Thyroxine (T4) and TSH c. Triiodothyronine (T3) d. T4 binding globulin (TBG)

b

Nurse practitioners can best assist teens in reducing behaviors that present health risks while socializing with peers by a. maintaining awareness of local social events for teens b. incorporating conversations with teens regarding safe sex, substance use, and body art with regular health visits c. discussing safe sex, substance use, and opportunities for body piercing and tattoos with teens in the presence of their parents d. discouraging teens to participate in group activities without adult supervision

b

Precocious puberty is defined as sexual development beginning before the youngest acceptable age. Which of the following statements is true regarding precocious puberty? A) The intellectual, emotional, psychosocial, and psychosexual development of these children far exceeds their sexual maturity rating B) Short stature in adulthood may result from the rapid skeletal maturation attributable to the early secretion of sex hormones C) The sexually precocious child rarely encounters psychosocial difficulties D) Precocious puberty is not usually idiopathic in cause

b

Preventative health guidelines include references to: a. immunizations, health screening, disease prophylaxis, education, and infection control b. immunizations, counseling, health screening, disease prophylaxis, and education c. health screening, disease prophylaxis, counseling, and CPR d. health screening, disease prophylaxis, education, immunizations, and CPR

b

Quality improvement activities include: a. patient satisfaction surveys only b. peer review, patient satisfaction surveys, chart audits c. defining four practice domains d. systems to decrease risk of injury to patients

b

RSV affects infants and young children and presents with: A) Sore throat, rash, and cough B) Apnea spells, poor feeding, and wheezing C) Sore throat, wheezing, and poor feeding D) Rash, lymphadenopathy, and cough

b

Significant progression of a 20 degree scoliotic curve is most likely to occur in a female who is a. 10 years, Tanner 3, Risser sign of 3 b. 11 years, Tanner 2, Risser sign of 2 c. 13 years, Tanner 4, Risser sign of 4 d. 15 years, Tanner 4, Risser sign of 5

b

The 1st physical sign indicating the onset of female puberty is: a. sparsely distributed fine, pale pubic hairs b. breast buds c. menarche d. peak height velocity

b

The APRN Consensus Model is: a. mandate from the NCSBN that defines advanced practice nursing b. a proposed regulatory model for advanced practice nursing c. a proposal for federal legislation for advanced practice nursing d. approved only by the american nurses association

b

The PNP examines a 12-year-old child with a dry, unproductive cough; a low-grade fever; and copious amounts of sputum. On physical examination, coarse breath sounds and moist rales are heard in the upper part of the lungs. The PNP makes the diagnosis of bronchitis and treats with: A) A decongestant and ibuprofen B) Amoxicillin and a cough suppressant C) An albuterol inhaler and acetaminophen D) An antihistamine; a cough suppressant, such as dextromethorphan hydrobromide; and use of a vaporizer

b

The PNP is examining a 2-year-old child with a history of vomiting, diarrhea, and fever for the past 24 hours. The physical examination reveals a tender abdomen. The PNP should: A) Reassure the parents that the child has gastroenteritis B) Obtain a more definitive history and physical examination C) Send a stool specimen for culture of ova and parasites D) Treat with clear fluids, and call the parents in 24 hours

b

The PNP suspects that a sexually active adolescent has pityriasis rosea. Based on the differential diagnosis, the PNP screens for: A) Chlamydia B) Secondary syphilis C) Erysipelas D) Molluscum contagiosum

b

The intervention currently advised for a child with 4 episodes of acute otitis media in the past 5 months is a. prophylactic antibiotics b. myringotomy and tympanostomy c. adenoidectomy and tonsillectomy d. observation

b

The most appropriate analgesia for a 4yo with post operative tonsillectomy pain would include a. ibuprofen b. acetaminophen and oxycodone (Roxicet) c. Ketorolac d. aspirin and oxycodone (Percodan).

b

The most important aspect of bruising in relation to possible maltreatment or nonaccidental trauma is: A) Dating of the bruise B) The history of the cause of the bruise C) The location of the bruise D) The size of the bruise

b

The pediatric nurse practitioner is evaluating a one-month-old infant male with a unilateral undescended testicle (cryptorchidism). The patient was born at term after an uncomplicated pregnancy and physical examination reveals no other abnormalities. The pediatric nurse practitioner should: a. Refer the patient to pediatric surgery urgently for orchiopexy b. Refer the patient to pediatric surgery if testis remains undescended at 6 months of age c. Inform the parents that orchiopexy is indicated only if they are concerned about cosmetic appearance of an undescended testicle d. Refer the patient to pediatric surgery only if the testis remains undescended at 24 months of age

b

The pediatric nurse practitioner is seeing a 13-year-old female patient with Tanner stage 4 breast and pubic hair development who has not had menarche. The pediatric nurse practitioner suspects: a. Precocious puberty b. Normal puberty c. Androgen insensitivity d. Ovarian tumor

b

The siblings of a child who develops a serious illness, injury, or disability: a. Should be disciplined for verbalizing feelings of resentment and anger toward the affected sibling or parents b. Often develop behavior and adjustment problems due to disruptions in the family routine when a sibling is seriously ill or injured c. Should not be involved in the care and treatment of the affected sibling d. Should be removed from their usual activities in order to spend more time with the rest of the family

b

Tommy is in for his 4mo well check. He was born preterm with a birth weight of 2.0 kg. The appropriate immunizations to give him today would be: a. DTaP, Hib, IPV, HepB-3 b. DTaP, Hib, IPV, PCV 7 c. DTaP, Hib, Hep B-3, PCV 7 d. Hold off on immunizations until he reaches his term due date

b

Vomitus that is bilious suggest: a. obstruction proximal to the pylorus b. obstruction below the ampulla of Vater c. Pyloric stenosis d. peptic ulcer disease

b

What is the % of risk an autosomal dominant gene is being passed on to each offspring? a. 25 b. 50 c. 100 d. none

b

When approaching adolescents about sensitive issues, such as drug use and sex, an effective interviewing approach is to: A) Introduce the topics early in the history B) Begin by asking about their friends' activities C) Let the adolescent know that the parents are concerned D) Avoid promising confidentiality

b

Which behavior would you expect to decrease during the preschool years? a. rough-and-tumble play b. instrumental aggression c. hostile aggression d. cooperative play

b

Which is the MOST accurate to convey when counseling a family about the effects of congenital cytomegalovirus (CMV) infection on hearing? a. half of symptomatic infants will have conductive hearing loss b. hearing loss may be progressive after the newborn period c. asymptomatic infants are free of hearing loss d. infection acquired from breast milk is associated with hearing loss

b

Which of the following best demonstrates the oral behavior of a 12 month old in relation to readiness for feeding? a. begins chewing meat with rotary mouth movements b. controls bite of soft cookie c. controls liquids taken from a cup d. sucks in anticipation of the spoon

b

Which of the following do not meet the criteria for a selective screening for hyperlipidemia? A) A 16-year-old adolescent who is adopted, who smokes, and who has no known family history B) An 8-year-old child with a small restrictive ventricular septal defect C) A 10-year-old child whose father had a balloon angioplasty at age 49 years D) A 12-year-old child with BMI of 28

b

Which of the following ongoing assessments have no specific indication for individuals which Turner's syndrome? a. Cardiac monitoring b. vision screening c. tanner staging d. thyroid screening

b

Which of the following situations does not necessarily warrant immediate mental health assessment and/or referral? a. a 13yo girl who has been "down" for the last mo with varied somatic complaints b. a 9yo boy whose parents recently separated and filed for a divorce and seems to be doing well c. a 16yo girl who has a hx of long standing depression but seems to be doing well in school d. a 15yo boy who expresses suicidal thoughts

b

While examining a 2-month-old, the PNP notices leukocoria. This is the most common physical finding associated with: A) Neuroblastoma B) Retinoblastoma C) Retrolental fibroplasia D) Congenital cataracts

b

10. You are examining a child who has fever, coryza, cough, conjunctivitis, malaise, & anorexia. During the oral examination, you observe red eruptions with white centers on the buccal mucosa. What are these eruptions called? a. Pastia's spots b. Rubelola spots c. Koplik's spots d. Strawberry spots

c

12. Congenital HIV infection: a. Is diagnosed through finding maternal antibodies in infant serum b. Does not respond to antiretroviral therapy c. May be latent for years before clinical signs develop d. Does not include lymphadenopathy as a physical finding

c

14. A child with chickenpox and temperature of 102F should receive which medication for fever? a. Aspirin b. Amoxicillin c. Acetaminophen d. Acyclovir

c

15. An 18mo old child exposed to HIV in utero had negative HIV DNA at 2 weeks and 8 weeks. What is indicated at the 18-month visit? a. No further testing is needed b. HIV DNA should be repeated c. Enzyme immunoassay for antibody to HIV-1 d. CBC with diff & immunoglobulins

c

17. Which of the following is the most common type of congenital bleeding disorder? a. Hemophilia A b. Hemophilia b c. Von Willebrand Disease d. Idiopathic thrombocytopenia purpura

c

25. Muscle spasms associated with tetanus are aggravated by which of the following? a. Fever b. Tetanus immunoglobulin c. External stimuli d. NSAID

c

A 10 yo obese child whose family history is unknown has a total cholesterol (TC) of 205 when first screened for hyperlipidemia. The MOST appropriate course of action is to a. repeat TC level in 2-4 weeks b. repeat TC level after 3 months on a low-fat diet c. perform a lipoprotein analysis now d. perform a lipoprotein analysis after 3 months on a low-fat diet

c

A 10-year-old child has been referred for evaluation of scoliosis, which was identified in a school screening program. On physical examination the PNP finds a curvature of the spine when it is anteriorly flexed from the trunk. There is slight shoulder asymmetry, with prominence of the scapula. The curvature is at 10 degrees. The PNP should: A) Refer the child to an orthopedist for further evaluation B) Inform the parents that the child is going through a growth spurt and schedule an appointment for further evaluation in 1 year C) Consult with the clinic physician D) Order x-ray films of the spine

c

A 10-year-old child is brought to the clinic for what appear to be nongenital warts on the hand. The PNP treats the warts with: A) Referral to a dermatologist for laser treatment of the lesions B) Cryosurgery and referral to a dermatologist C) Topical salicylic acid applied twice a day for several weeks D) Podophyllum resin

c

A 14-year-old adolescent comes to the school-based clinic for a physical examination. During the interview the adolescent claims to be a member of a gang. What response would be appropriate in the initial discussion with this adolescent? A) "Can you tell me if you are currently using drugs?" B) "Can you tell me who else belongs to your gang?" C) "Tell me more about your relationship with your family and close friends." D) "Have you ever been arrested?"

c

A 14-year-old adolescent has a second-degree burn along the hairline from using a curling iron. The lesions are erythematous and blistering. The adolescent complains of pain. The PNP advises: A) Icing the involved area to decrease pain and beginning a prophylactic antibiotic B) Applying silver sulfadiazine cream and icing the involved area to decrease pain C) Taking ibuprofen for pain and applying silver sulfadiazine cream D) Taking prophylactic antibiotics and ibuprofen for pain

c

A 14-year-old adolescent has been diagnosed with early hypothyroidism based on increased TSH and decreased T4 levels. The PNP consults with the physician and in discussing the management decides to: A) Increase the dietary intake of iodized salt B) Refer to an endocrinologist C) Treat with levothyroxine D) Recheck levels in 2 months

c

A 17-year-old adolescent who is at the clinic for a "football physical" relates to the PNP that he and a girlfriend have had sex two times this past month. The adolescent is concerned about preventing pregnancy and protection from STDs. This was his first sexual experience, and he has questions about condoms but does not want his parents to know that he is sexually active. The PNP offers the following information: A) "Use natural condoms because they are easier to apply." B) "Use a petroleum-based lubricant when applying a condom." C) "Use a latex condom with spermicide and lubricant." D) "Condoms have a long half-life, so once purchased, they last for over 2 years."

c

A 2-month-old infant with spina bifida and shunted hydrocephalus has a history of increased gagging with feedings, spitting up, intermittent stridor, and failure to thrive. The most likely explanation is: A) Tethered cord B) Shunt malfunction C) Arnold-Chiari deformity type II D) Esophageal structure

c

A 20mo old child is reported to have been "shaking" for a short period. The parent reports that the child had a fever of 102F before the episode but seems to have returned to normal. Which intervention should be undertaken first? a. refer child to the ED b. refer child to neuro c. conduct an exam of child d. have a parent bring the child back for F/U in 1 mo

c

A 3 year old, who attends daycare, has diarrhea that began with three days of low grade fever and foul smelling watery stools. One month later, he continues to have loose stools and now has abdominal distention. The most probable causative organism is a. rotavirus b. Shigella toxicum c. Giardia lamblia d. Staphylococcal enterococcus

c

A 3-year-old child is brought to the clinic with painful sores in the mouth. On inspection the PNP notes two to five pin-sized vesicles covered with a yellow-gray membrane on the child's lips and in the mouth. The PNP diagnoses: A) Epstein-Barr virus B) GABHS infection C) Aphthous stomatitis D) Herpangina

c

A 5-month-old infant is brought to the office for a routine well-child visit. The infant is healthy today and has no history of allergies or reactions to previous immunizations. The PNP checks the immunization record and finds the following: Birth Hep B Age 1 month Hep B Age 2 months DTaP, IPV, and Hib Today the infant should receive the following immunizations: A) DTaP, IPV, Hib, and Var B) DTaP, IPV, Hib, Prevnar, and Hep B C) DTaP, IPV, Hib, Prevnar D) DTaP, OPV, and Hib

c

A 5-year-old child is at the clinic for a routine well-child visit before beginning kindergarten. The mother reports the child's list of chores as follows: clean own room, make own bed, wash and dry own clothing, take out the trash, and help wash the dishes. If the chores are not completed, the child is grounded from other activities, such as playing with friends or watching television. The mother states that the child frequently must be grounded. How should the PNP respond? A) Tell the mother to make a chart so the child can remember to do the chores and record their completion and to continue grounding the child from activities when necessary B) Suggest use of natural consequences (e.g., having no clean clothes to wear if the laundry does not get done) as an additional way to discipline C) Perform a complete physical assessment of the child, as well as a parenting assessment D) Tell the mother she is expecting too much from the child and should reduce the number of chores

c

A 7-year-old child is brought to the clinic for a rash that has been present for 24 hours. The child was "a little droopy about 3 days ago" but had no fever or other symptoms. The immunizations are up-to-date. The child now has a "slapped cheek" appearance, with a lacy, erythematous rash on the torso and upper arms. The rash blanches. The PNP discusses with the mother the diagnosis of: A) A coxsackievirus and explains that the rash will disappear within a week and no treatment is necessary B) Measles, which is highly contagious, and explains that the child should be taken home and kept away from siblings C) Human parvovirus B19, or fifth disease, for which there is no treatment D) Roseola and explains that time is the best treatment and the rash will fade in about a week

c

A 9mo old infant boy is seen with a 2 day hx of diarrhea. He had 3-4 wet diapers in the past 24hrs and his anterior fontanel is slightly depressed. Capillary refill is WNL. What % of dehydration does this infant have? a. 3% b. 5% c. 8% d. 10%

c

A child with hemophilia falls off a bike, hurting the knee. The child is brought to the emergency room because the mother notices swelling of the affected joint and the child is complaining of pain. What is the highest priority in this child's care? A) Applying ice to the affected knee B) Obtaining a radiograph of the affected knee C) Administering factor VIII concentrate D) Splinting the affecting knee

c

A mother calls the office because her 2.5-year-old has a fever of 101°F (38.2°C). The child is playing and taking plenty of fluids. The PNP advises the mother: A) To dress the child warmly to prevent chilling B) An appointment is needed to determine the cause of the fever C) A fever can actually be a good thing as long as the child is comfortable D) To treat the fever with acetaminophen or ibuprofen if it is greater than 100.1°F

c

A mother is asking the PNP about puberty in her daughter. The PNP advises the mother that: A) Papanicolaou testing should begin at age 16 years B) Pubic hair development precedes breast budding C) Menses occur about 2 years after thelarche D) The adolescent growth spurt begins after pubic hair development

c

A parent brings a 1-week-old neonate into the clinic. The mother is concerned that the infant's testicles do not seem "even." The PNP notes that the cremasteric reflex is absent and the right testicle cannot be palpated in the scrotum. The PNP should: A) Not allow the neonate to be discharged from the hospital B) Order a sonogram C) Consult with the physician D) Refer the neonate to the urology clinic

c

A pregnant woman who has had no prenatal care comes to the hospital in active labor. After delivery, the enzyme-linked immunosorbent assay (ELISA) and Western blot laboratory studies performed upon admission reveal that the mother is HIV positive. The priority for the PNP caring for the neonate in the nursery is to start: A) PCP prophylaxis with TMP/SMX B) AZT the day of discharge C) AZT within 24 hours of birth D) Dapsone orally within 48 hours of birth

c

A previously healthy 4 year old has had the following immunizations: 6 MONTHS: DTaP/HIB, IPV, Hep B 15 MONTHS: DTap/HIB, IPV, Hep B, MMR ,Varicella At this visit the most appropriate recommendation is a. DTAP/HIB, IPV, Hep B, PCV 7 b. DTaP, HIB, Hep B, MMR c. DTaP, IPV, Hep B, MMR d. DTaP, IPV, PCV 7

c

A well-child examination has been completed on a 1-year-old child who appeared slightly pale. The results of the routine CBC are as follows: hemoglobin, 7.8 mcg/dL; mean corpuscular volume, decreased; and red cell distribution width, elevated. The remainder of the CBC is normal. What would be the most likely cause of this child's anemia? A) Thalassemia B) Megaloblastic anemia C) Iron deficiency D) Lead poisoning

c

According to Erikson, the major psychosocial task of adolescence is the achievement of: a. autonomy b. industry c. identity d. generativity

c

An 11-year-old girl is brought to the office for an annual well-child visit. When discussing the onset of puberty with the preadolescent and the mother, which information would the PNP provide? A) "Pubic hair develops before breast buds." B) "Girls have their greatest linear growth after menses." C) "The average time from breast buds to menarche is 1.5 to 2.5 years." D) "The average age of onset for menarche is 10 to 12 years."

c

An 18-month-old child is being evaluated in the clinic for falling with increasing frequency and loss of speaking ability. The PNP considers: A) Urine amino acid screening B) Referral to a physical therapist C) Referral to a pediatric neurologist and MRI of the brain D) Chromosomal studies for Tay-Sachs disease

c

An 18yo female college freshman, Bailey, presents to college health with an 8hr hx of abdominal pain that began in the periumbilical area and then localized to the RLQ. She has been on OCPs for teh past 6mo. Bailey denies a medical hx of UTIs, pregnancy, STDs, or chronic illness. Upon her physical exam, she is guarding on the RLQ with generalized tenderness and no masses. Her temp is 99.6 and her vitals are normal. Which of the following is the most suggestive of Bailey's diagnosis? a. Leukocytosis b. Hematemesis c. + psoas sign d. Vomiting before the onset of pain

c

An 8yo afebrile child presents with a ST. Upon examination, you note that his tonsils are 4+ without exudate. Differential diagnosis includes: a. normal b. strep throat c. hodgkin disease d. phayngitis

c

Children born with cleft lip/palate are prone to: A) GER B) Pyloric stenosis C) Milk bottle caries D) Nasal allergies

c

Children do not generally exhibit a fear of strangers until after about? a. 2mo b. 4mo c. 6mo d. 2yo

c

Children with Down syndrome have 15 to 20 times incidence of developing which of the following as compared to other children? a. asthma b. neuroblastoma c. leukemia d. diabetes

c

During a well-child visit you teach parents that an infant may first transfer an object from hand to hand at: a. 2mo b. 4mo c. 7mo d. 9mo

c

In counseling a parent regarding possible lead poisoning in the child, the PNP states that the most common source of lead is: A) Drinking water B) Soil C) Lead-based paint D) Batteries

c

In providing anticipatory guidance to the parents of a 5-year-old child with diabetes, the PNP should teach them to recognize the symptoms of sweating, hunger, drowsiness, and confusion. These are all symptoms of: A) Diabetic ketoacidosis B) The dawn phenomenon C) Hypoglycemia D) The Somogyi phenomenon

c

In the health care system the major perceived barrier to use of a PNP's services in a primary health care setting is: A) Lack of quality of service provided B) Organized nursing C) Organized medicine D) Lack of consumer confidence

c

In the health care system the major perceived barrier to use of an PNP's services in a primary health care setting is: A) Lack of consumer confidence B) Lack of quality of service provided C) Organized medicine D) Organized nursing

c

In what Tanner stage for girls would the PNP expect to see enlargement of the breasts and areolae, as well as curly, coarse pubic hair? A) Tanner 4 B) Tanner 2 C) Tanner 3 D) Tanner 5

c

Mom informs you that she and her 6mo infant are traveling to a place where measles is endemic. Your best response to her is: a. She should not take her baby with her b. Reassure her that her baby has passive immunity c. Give baby a MMR or monovalent measles injection d. Give baby gamma globulin prior to the trip

c

Standards for well child care and health promotion are set forth by the: a. Task Force on Preventative Services, US Department of Health and Human services b. American Academy of Family Physicians c. American Academy of pediatrics d. Healthy People 2010 and 2020

c

The PNP has recently read a report, published by the Committee on the Quality of Health Care in America, about medical errors in office practice. Which of the following suggestions should the PNP make to the managed care administration to decrease medical errors in the clinical area? A) Require that health care providers tell the patient one time the medications being prescribed B) Encourage health care providers to dictate all chart entries C) Stress the need for health care providers to write legibly D) Advocate keeping electronic medical records

c

The PNP is concerned that a child may have A. lumbricoides (roundworm). Which of the following symptoms would lead the PNP to this diagnosis? A) Fever and runny nose B) Nausea and vomiting C) No symptoms D) Vomiting and rash

c

The PNP is examining a sexually active 17-year-old boy who admits to having unprotected sex over the last several weeks. Appropriate care for this patient includes: A) Evaluation of immunization status, hepatitis B screening panel, HIV screen, and penile smear for gonorrhea B) Complete blood count and penile smear for gonorrhea C) Physical examination, STD history and screening tests, immunization update, anticipatory guidance regarding responsible and safe sexual behavior, and recheck in 6 months D) No tests because the patient is asymptomatic, anticipatory guidance, and recheck in 6 months

c

The PNP is performing a well-child examination on an 8-year-old child with a previous diagnosis of precocious puberty. The patient is Tanner stage III for breast development and pubic hair growth, with height and weight in the 95th percentiles. The patient has missed 6 months of her hormone therapy. The mother states that the child often complains of abdominal cramping, and the mother has noticed an increased vaginal discharge. The remainder of the examination is normal. Addressing the abdominal pain should include: A) Evaluation for a UTI B) Guidance regarding the appropriate dietary intake of fruits, fiber, and water to prevent constipation C) Anticipatory guidance regarding the importance of complying with drug therapy and the likelihood of the onset of menses D) A referral to a gastroenterologist for evaluation

c

The PNP should consider referring for a more comprehensive developmental evaluation a child who: A) Has explosive temper tantrums at age 19 months B) Does not speak by age 15 months C) Has lost the ability to perform previously attained developmental milestones D) Has consistently tracked in the 5th percentile for growth since birth

c

The anterior fontanel usually closes by: a. 2mo b. 6mo c. 18mo d. 24mo

c

The concept of health promotion consists of efforts to prevent rather than to cure disease or disability. This description best describes: a. tertiary prevention b. secondary prevention c. primary prevention d. morbidity prevention

c

The first nurse practitioner program was designed to: A) Provide emergency care to children in Colorado B) Provide limited access to health care for low-income children in Colorado C) Provide increased access to health care for children in Colorado D) Manage severely ill children at Colorado General Hospital

c

The first nurse practitioner program was designed to: A) Manage severely ill children at Colorado General Hospital B) Provide limited access to health care for low-income children in Colorado C) Provide increased access to health care for children in Colorado D) Provide emergency care to children in Colorado

c

The mother of a 10-year-old girl is concerned that the child has been sexually molested. Upon genital examination of a prepubescent girl after penile penetration, the PNP would expect to find: A) Permanent tears of the vaginal wall B) An intact hymen C) Normal-appearing genitalia D) A wide-open vaginal orifice

c

Title V of the Social Security Act of 1935 was amended in 1981 and 1986 to expand coverage for children with special health care needs under: A) The Supplemental Security Income (SSI) Program for the Aged, Blind, and Disabled B) Title XIX of the Social Security Act C) The Maternal and Child Health Services Block D) The U.S. Public Health Service

c

What advice would the PNP give a parent about fruit juice during the 4-month well child visit? A) "Offer any juice except orange juice now." B) "Begin to offer orange juice now." C) "Do not offer the infant fruit juice now." D) "Begin to offer juice to the infant now."

c

What is considered minimal weight gain in a normal newborn after discharge from the hospital? a. 10gms/day b. 20gms/day c. 30gms/day d. 40 gms.day

c

What is the American Academy of Pediatrics' recommendation for routine skin testing for TB in a child with no risk factors who lives in a low prevalence area of the country? A) Test at age 3 months, 1 year, and yearly thereafter B) PPD should be performed yearly C) Routine skin testing is not indicated in this group D) Test at age 1 year, entrance to kindergarten, and high school

c

What suggestions would the PNP offer a father calling because his 3-month-old infant is passing hard stools? A) "Add honey to a 4-oz bottle of water." B) "Time will take care of the problem." C) "Offer the infant a little extra water with added pasteurized apple or prune juice." D) "Hold the infant upright so that gravity can help the stool pass."

c

Which criteria is essential for the diagnosis of obsessive-compulsive disorder (OCD) for children? a. behaviors occur up to an hour a day b. behaviors are purposeless c. presence of repetitive thoughts, images, or processes d. child recognizes the actions are excessive

c

Which developmental theory best explains the multifactorial etiology of failure to thrive? a. organismic-maturational theory b. social learning theory c. transactional theory d. psychoanalytic theory

c

Which institution legally defines the scope of practice for pediatric nurse practitioners? a. graduate schools b. certification board c. state legislation d. NP membership organiation

c

Which of the follow parental characteristics is associated with an increased risk of child maltreatment (abuse)? a. Older parents b. Immigrant parents c. History of childhood abuse/neglect for the parent d. Wealthy parents

c

Which of the following findings would be helpful in distinguishing obesity vs. large body frame in an adolescent who is concerned with her weight? a. tricep skinfold measurement b. weight-for-height ratio c. body mass index d. percent of ideal body weight

c

20. Prader-Willi syndrome is a congenital genetic disorder characterized by: a. Failure to thrive b. 100% detection rate with chromosome analysis for a 15q deletion c. emergence of spasticity during toddler years d. voracious appetite & development of obesity

d

20. Which of the following describes a characteristic rash associated with which disease? Initially erythematous and macular, becoming maculopapular and petechial. The rash first appears on the wrists & ankles, spreading proximally to the trunk. The palms and soles are often involved. a. Lyme disease b. Roseola c. Rubeola (measles) d. Rocky mountain spotted fever

d

26. The following is not a characteristic feature of DiGeorge syndrome: a. Hypertelorism b. Cleft palate c. Cardiac defect d. Frontal bossing

d

3. a 2mo infant, with hx of sacral myelomeningocele repair, has an increase in head circumference from the 75th to the 95th percentile. What is the most appropriate first action? a. Order a stat head CT scan b. Refer to neurosurgery for management c. Recheck it at the next well-child visit d. Recheck & replot the child's head circumference

d

7.5yo Jimmy presents to your clinic with inspiratory stridor, drooling, and a temp of 105F. He insists on sitting up during the exam. What is your diagnosis? a. foreign body aspiration b. reactive airway disease c. croup d. epiglottitis

d

9yo Jon has recently been diagnosed with mild intermittent asthma. Which of the following is not a routine part of his management? a. spirometry eval b. metered dose inhaler technique demonstration c. environmental triggers & control methods review d. allergy skin testing

d

9yo Tom is in the clinic for a "cold" that lasted for 10 days. He has no complaints of breathing problems. A physical exam reveals temp of 100F, edematous cervical lymph nodes, mucopurulent drainage from the middle meatus, erythematous pharynx & malodorous breath. Tom's management should include: a. culture of nasal drainage b. radiograph of the sinuses c. measurement of erythrocyte sedimentation rate d. use of an antibiotic

d

A 10-year-old child is brought to the clinic after jumping over a rusty fence and receiving a puncture wound to the buttocks. Immunizations are up to date with last tetanus given when child was 4 years old. The PNP cleanses the wound and: A) Administers a tetanus vaccine and prescribes penicillin for 14 days B) Starts prophylactic antibiotics C) Applies a sterile dressing D) Administers tetanus vaccine and educates family regarding signs of wound infection

d

A 10-year-old child was seen in the clinic 5 days before for a routine sports physical examination. The child's blood cholesterol level was 186 mg/dL. The most appropriate intervention by the PNP would be to: A) Screen other members of the family for hyperlipidemia B) Implement a diet plan of less than 20% of fat in total daily calories C) Counsel the child and family regarding a healthy diet and exercise and perform another blood cholesterol test in 3 to 5 years D) Repeat the total cholesterol test and obtain lipoprotein analysis

d

A 13-year-old adolescent is brought to the office because of a partial-thickness burn on the leg caused by a campfire. The immunization record reads as follows: Age 3 mo-DTP, OPV, & Hib Age 7 mo-DTP, OPV, & Hib Age 10 mo-DTP, OPV, & Hib Age 20 mo- DTP, Hib, & MMR Age 5 years-DTP and OPV The following immunizations should be administered today: A) Td, IPV, and Var (if there is no history of disease) B) None (because a tetanus-containing vaccine was administered within the last 10 years) C) Td, Hep B, and MMR D) Td, MMR, Hep B, and Var (if there is no history of disease)

d

A 13-year-old is in the clinic for her yearly checkup and asks the PNP when she will start her menstrual periods. Her breast and pubic hair development are Tanner stage II and her height is at the 25th percentile. The best response to her is: A) "You need to be seen by an endocrinologist immediately." B) "Looks like you are going to be a late bloomer." C) "You will probably begin in the next 6 months." D) "Tell me more about your concerns."

d

A 17-year-old adolescent comes to the clinic because of weight loss, irritability, insatiable hunger, and heat intolerance. The PNP screens for hyperthyroidism. In the patient with hyperthyroidism: A) The TSH level is normal, and the T4 level is elevated. B) The TSH and the T4 levels are elevated. C) The TSH level is normal, and the T4 level is below normal. D) The TSH level is below normal, and the T4 level is elevated.

d

A 2-month-old infant is brought to the clinic because of continued vomiting. Because the PNP suspects GER, time has been arranged for the visit to include a feeding. During the feeding the PNP observes the infant for: A) Calm, attentive feeding position B) Head moving back and forth and searching C) Disinterest in the bottle D) Back arching and crying

d

A 2-year-old child is screened for lead poisoning. The blood level is 16 mg/dL. The PNP discusses nutritional needs, including a diet high in: A) Protein and calcium B) Vitamin C and iron C) Fat and Zinc D) Calcium and iron

d

A 2-year-old child screened for lead poisoning has a lead level of 14 mcg/dL. The intervention provided by the PNP should include: A) A long bone x-ray film for lead B) A low-calcium diet C) Referral to the health department for environmental investigation D) A high-calcium diet

d

A 3-year-old child is brought to the clinic for a well-child visit. The mother reports that the child has recently begun waking up in the middle of the night screaming and appearing frightened and requests information on how to deal with nightmares. The PNP responds: A) Anxious parents tend to have fearful, anxious children B) The mother should ignore the behavior and not go to the child's room C) The mother should not allow the child to relive the nightmare D) The mother should listen to the child's nightmare and reassure the child

d

A 3-year-old child with sickle cell disease is brought to the clinic for a well-child visit. What is an appropriate intervention to decrease the child's risk of infection? A) Obtain a CBC with differential and platelet count every 6 months B) Obtain a yearly Hgb electrophoresis and administer the pneumococcal vaccine annually C) Prescribe penicillin 20 mg/kg and administer Hib at this visit D) Continue penicillin prophylaxis 20 mg/kg and administer the pneumococcal vaccine at this visit

d

A 4 year old with close contact 10 days ago to a school classmate, now hospitalized with meningococcemia, currently has no symptoms and a normal physical exam. No other cases have been reported in the community. Appropriate management would include a. oral rifampin prophylaxis b. nasopharyngeal culture c. meningococcal vaccine d. reassurance

d

A 4-year-old is seen in the office for a preschool physical. The past history is significant for hospitalization for Kawasaki's disease and treatment with intravenous immune globulin (IG) 2 months ago. The immunization record indicates that the child needs a DTaP, polio, and MMR at this time. What immunizations should the PNP administer today? A) DTaP, OPV, and MMR at this visit, and instruct the parent to schedule a return visit in 8 weeks B) MMR only at this visit C) None, give immunizations at the school physical next year D) DTaP and IPV, and instruct the parent to schedule an appointment in 1 month for the MMR

d

A 7-year-old child with no record of prior immunizations received initial immunizations including Td, IPV, MMR, Var, and Hep B today. When should the child return for the second set of immunizations? A) In 6 months B) In 2 weeks C) In 1 year D) In 2 months

d

A CBC is ordered for a 10yo female. Results indicate decr MCHC & decr MCV. Differential diagnosis should include: a. sickle cell anemia b. vitamin B12 deficiency anemia c. Pernicious anemia d. iron deficiency anemia

d

A mother of a 16mo old toddler announces that she is giving her child skim milk. You tell her she should switch to whole milk because: a. skim milk is not easily digested b. Skim milk does not have enough calcium c. Skim milk has too little protein d. Skim milk does not contain enough essential fatty acids

d

A teenager sustains a puncture wound in the sole of a foot after stepping on a protruding nail. The most appropriate INITIAL management of this injury would be a. debridement of epidermal edges b. wound probing for retained material c. initiation of prophylactic antibiotics d. superficial irrigation of the wound

d

Adolescent girls are especially prone to developing which of these disorders: a. hirsutism b. hypothyroidism c. folate deficiency anemia d. iron deficiency anema

d

After sinusitis dx, two days later, Tom is back in the clinic because now he has a "swollen eye". Redness, inflammation, and impaired extraocular movement of his right eye are observed. Which action is most appropriate form the choices below: a. reassure mom that this is common & benign b. treat for bacterial conjunctivitis c. order anti-inflammatory eye drops d. refer tom immediately

d

An 11-year-old child is concerned about breast size. About 6 months ago when her breast development began, she noticed that her breasts were different sizes. The PNP responds: A) "This is abnormal and you need to see a specialist." B) "Menarche will appear soon." C) "A mammogram is needed." D) "The breasts will become closer to the same size within a few years."

d

An 18-month-old child is brought to the clinic with a rash and temperature of 103ºF for the past 5 days. The child has bilateral conjunctivitis; dry, cracked lips; and strawberry-like tongue. Cervical lymph adenopathy and a heart murmur are noted on physical examination. The PNP should: A) Order a CBC B) Order an ECG C) Refer the child to the infectious disease clinic D) Consult with the physician

d

An 18-month-old child is brought to the office for irritability, nightmares, and generally being tired for the past few nights. The child has had an upper respiratory tract infection for which the grandmother has administered an over-the-counter medication for rhinorrhea. The child is afebrile and alert, with obvious clear rhinorrhea. The PNP: A) Orders sinus radiologic studies B) Prescribes amoxicillin C) Suggests that the mother administer acetaminophen D) Discusses side effects of decongestants and antihistamines

d

Early reflexive responses that are not r/t survival include all but: a. babinski b. moro c. swimming d. rooting

d

Herpes Zoster is characterized by clustered vesicles and a. is transmitted via respiratory secretions b. is reactivated on exposure to a siblings chicken pox c. results frequently in post herpatic neuralgia d. often develops along the trigeminal nerver

d

In a child with chronic sinusitis, the most accurate method of identifying abnormalities is: a. dark room transillumination of the sinuses b. percussion of the paranasal sinuses c. AP, lateral, and occipitomental sinus radiographs d. CT scan of the sinuses

d

In counseling an adolescent vegetarian, the PNP discusses the need to ensure adequate intake of: A) Niacin, thiamine, iron, and calcium B) Vitamin C, calcium, iron, and zinc C) Calcium, vitamin D, thiamine, and iron D) Calcium, zinc, iron, vitamin B12, and vitamin D

d

Jasmine, a 5-month-old infant is in the clinic for a well child visit and is sleeping in her mother's arms. What should the PNP do first? a. Examine the ears, since this is uncomfortable for the infant. b. Quickly give any needed immunizations. c. Begin with assessment of the head and proceed from head to toe. d. auscultate the heart & lungs while the infant is sleeping.

d

Most states require that a battery of screening tests be performed on the blood of neonates, usually after the neonate has taken formula or breast milk. Many of the diseases being screened for are rare. The most common disease screened for is: A) Phenylketonuria B) Galactosemia C) Maple syrup urine disease D) Hypothyroidism

d

Routine pediatric office developmental testing is conducted to: A) Diagnose children with mental retardation B) Diagnose children with learning disabilities C) Determine the child's school readiness D) Identify children who may require formal evaluation

d

The PNP notes anal fissures on the physical examination of a 2-year-old child. There is no history of constipation. The PNP is concerned about: A) Ulcerative colitis B) Crohn's disease C) A foreign body D) Sexual abuse

d

The PNP sees a 6-week-old, HIV-exposed neonate in the clinic. The mother received ZDV starting in the second trimester of pregnancy and intravenous ZDV during labor. The infant was started on oral ZDV after birth. The most accurate test to determine whether the infant is HIV positive is: A) Ribonucleic acid (RNA) PCR B) ELISA C) Western blot D) Deoxyribonucleic acid (DNA) polymerase chain reaction (PCR)

d

The parents of a son with hemophilia are considering another pregnancy. The mother has been identified as a carrier of the hemophilia gene. What chance does each female offspring have of having hemophilia. a. 100% b. 50% c. 25% d. none

d

The past history should include a. family history b. social hx c. symptom analysis d. hospitalization

d

The pediatric nurse practitioner evaluates an injured pediatric patient and suspects that the patient's injuries were caused by abuse. The pediatric nurse practitioner should: a. Report the suspected abuse only if the patient's family is acting suspiciously b. Report the suspected abuse to the appropriate state agency c. Report the suspected abuse to the appropriate state agency only if the physician agrees d. Document his/her concerns in the patient chart without reporting the suspected abuse

d

Which counseling for parents of a 2 year old with an elevated lead level, would be effective in decreasing lead exposure? a. avoid kerosene heaters b. dry dusting c. sweeping d. high efficiency particulate air (HEPA) filters for vacuuming

d

Which hepatitis virus vaccines are available and approved for use in children? A) Hepatitis A and C B) Hepatitis B and C C) Hepatitis A, B, and C D) Hepatitis A and B

d

Which is the correct order for introduction of solid foods to an infant? a. fruits, cereal, vegetables, & meats b. cereal, meats, vegetables, fruits c. fruits, cereal, meats, and vegetables d. cereal, vegetables, fruits, meats

d

Which of the following approaches to cultural differences between healthcare providers and patients/families is most effective? a. Encourage patients and families to conform to the "majority culture" when interacting with the health care system b. Urge parents to follow the advice of healthcare providers over that of extended family members c. Contact the appropriate child protective agency if a family is non-compliant with medical care due to cultural differences d. Utilize knowledge of the family's cultural beliefs and practices in meeting the patient's medical needs

d

Which of the following children does not need PCP prophylaxis? A) An HIV-exposed newborn B) A 9-month-old, HIV-positive infant with a CD4 lymphocyte count of 1600 (no immune suppression) C) A 3-year-old, HIV-positive child with a CD4 lymphocyte count of 1000 (no immune suppression) and a history of PCP D) A 3-year-old, HIV-positive child with a CD4 lymphocyte count of 600 (moderate immune suppression)

d

Which of the following genetic disorders can be detected by cytogenic testing? A) Huntington's chorea B) Sickle cell anemia C) Tay-Sachs disease D) Down's syndrome

d

Which of the following infant reflexes should not disappear by 6mo of age? a. moro b. rooting c. tonic neck d. plantar grasp

d

Which of the following is accurate about the emancipated minor? a. The adolescent patient who disagrees with a parent/guardian about medical treatment can be treated as an emancipated minor b. All 50 states have identical legal statutes with regard to the emancipated minor. c. The emancipated minor may not legally consent to medical care involving reproductive health issues d. The emancipated minor may legally consent to all types of medical care

d

Which of the following tests is not an appropriate test for development dysplasia of the hip in an 18mo infant? a. allis sign b. skinfold symmetry c. galeazzi sign d. ortolani maneuver

d

Which of the following topics is not appropriate to include when providing anticipatory guidance to the parent of an 18mo old? a. temper tantrums b. toilet training c. dental care d. stranger anxiety

d

Which of the following types of headaches requires immediate referral to a physician? a. acute recurrent b. chronic nonprogressive c. acute d. chronic progressive

d

What is the primary method of preventing and controlling the incidence of bacterial meningitis in infants and children: a. keeping infanct and young children away from crowded places b. administering antimeningitis vaccines during outbreaks c. immediately isolating all children suspected of having meningitis d. routinely giving infancts H. flu vaccine

d.

most common disease that is screened for on newborn screen

hypothyroidism

characterstics of Tay Sachs

hypotonia cherry red spot on retina transluscent delicate pink coloring to skin

what other clinical findings associated with precocious puberty?

multiple café au lait spots

meningitis, oophoritis, pancreatitis are all complications of

mumps

13. an infant presents with cataracts, congetinal glaucoma, congenital heart disease, hepatosplenomegaly, thrombocytopenia, blueberry muffin rash, & growth retardation. What is the most likely diagnosis? a. Cytomegalovirus b. Taxoplasmosis c. Rubella syndrome d. Syphilis

c

29. Which of the following would be included in patient education regarding lyme disease? a. Educate caretakers regarding complications, including hypertension and renal calculi due to immobility b. Avoid use of aspirin-containing products for fever control due to association with increased risk for Reye's syndrome c. Protective clothing and tick repellent should be worn in heavily wooded areas d. Educate caretakers regarding natural history of the illness, and specific follow up needed after infection with Rickettsia rickettsii

c

A 13yo adolescent comes to the school based clinic with a headache that began this morning before school. The headache is described as unilateral and increasing in intensity. What type of HA is it? a. cluster b. tension c. migraine d. sinus

c

A PNP is following a child placed in foster care. The most common health problem of children in foster care is: A) Parasitic infection B) Neurological disorders C) Respiratory disease D) Growth failure

c

A parent asks at what age separation anxiety is most often expected. You explain to the parent that separation anxiety usually occurs at: A) 12 to 18 months of age with peaking at 24 to 26 months B) 9 to 15 months of age with peaking at 20 to 22 months C) 3 to 9 months of age with peaking at 18 to 20 months D) 1 to 6 months of age with peaking at 9 to 12 months

c

At a routine health maintenance visit, an 11-year-old patient with Tourette Syndrome informs the nurse practitioner that he is struggling both socially and academically at school. His parents have spoken with his teacher at school, but the problems have continued. He confides that he often goes to the school nurse's office with vague complaints to avoid some of his regular school day. The pediatric nurse practitioner's next action should be to: a. Refer the patient to a neurologist so that medications can be started for symptom management b. Refer the patient for psychological counseling c. Establish communication with the school nurse to enlist his/her assistance in advocating for the patient at school d. Tell the patient to try harder to control his symptoms while at school

c

Individuals living with an infant who has been diagnosed with pertussis should receive: A) A cephalosporin B) Pertussis immune globulin C) Erythromycin prophylactic D) The pertussis vaccine

c

The PNP is evaluating a postterm (42 weeks' gestation) neonate in the nursery. On the physical examination the PNP would expect to find: A) Excessive vernix caseosa B) Smooth soles of the feet C) Cracked, peeling skin D) An elevated weight/length ratio

c

young infants with CP often show

hypotonia in the first weeks of life

psoriasis test and TX

tests--> VDRL r/o secondary syphilis KOH to rule out fungal infections **Auspitz sign--> lift corner of scale, droplets of blood + sign for psoriasis TX- refer to derm -reduce hypertrophy of lesion, limit sun exposure, apply topical steroids (hydrocortisone, triamcinolone), apply mineral oil and moisturizers at least BID to decrease dryness)

While nighttime control lags behind daytime control by 1 year, when does physiologic and psychological readiness begin for toilet training? a. 1.5 to 2.5 years old b. 3 years old c. 1 years old

a pg. 43

Beta thalassemia

Cooleys anemia--> increased but ineffective erythropoiesis, shortened red cell life span S&S -pale skin or mucous membranes, weakness -characteristic facies--> frontal bossing, exposure of frontal teeth, prominence of malar eminences, depression of bridge nose, exposure of upper incisors -splenomegaly, mild jaundice, growth retardation Tests CBC with red cell indices - Hgb decreased, hypochromia, microcytosis, low mean corpuscular volume, anisocytosis (unequal sz of RBC), target cells, retic count increased Hemoglobulin electrophoresis--> HgB A present or increased -refer to hematologist

Fracture

S&S -Edema, erythema, eccymosis, pain, obvious angulation, bony point tenderness, decreased ROM Management--> immobilize, pain management, ROM exercise, refer to ortho

Enuresis S&S and tests

S&S -bewetting or daytime urine leakage -odor of urine on clothing and or/bedding -may have withdrawl/isolation from peers, diminished self-esteem Hypospadias, epispadis, labial fusion, dribbling of urine during examine Tests--> UA/Urine cx, renal ultrasound/ VCUG

Transient toxic synovitis of the hip

Self-limiting inflammation of hip joint -Occurs most often in 3-12yrs old S&S -painful limp or hip (groin) pain with acute or insidious onsent, usually unilateral, often preceded by an URI -range of motion of hip causes spasm and pain, particularly with internal rotation -no obvious signs on inspection or with palpation Dx- radiographs normal or slightly widened joint space medially -US useful for effusion -Slightly or normal WBC count Tx -Hospitalize child if high fever or severe sx, to differentiate between transient synovitis and septic arthritis -Analgesics (ibuprofen) 5 days -bed rest/non wt bearing -benign self limiting illness

HPV

Series of 3 Starts as early as 9 years Ends at 26 years For males and females Second dose given 1 month after 1st. Third given 6 months after initial. *****have kids sit for at least 15 minutes after getting shot to due to syncope******

Testicular torsion

Torsion of the spermatic cord; can result in gangrene of testes (emergency) S&S -acute, painful swelling of scrotum, N/V, minimal fever, if any, lack of urinary symptoms is the norm -enlarges, highly tender testis, scrotum on involved side of edematous, warm, erythematous, resistant to move, -lifting testis does not relieve pain (Prehns sign) -solid mass may be visualized with transillumination Management- immediate referral for surgery

diagnostic criteria for Giles de la Tourette syndrome includes which of the following

must have both motor and vocal tics

pulmonic stenosis xray findings

normal

12. Fifth disease is usually: a. Seen in age 5-14yo children b. Transmitted via the deer tick c. Treated with oral erythromycin d. Characterized by prolonged coughing episodes

a

Irritable bowel syndrome

Chronic disorder w/ a range of symptoms, including abd pain, altered bowel habits (diarrhea or constipation), bloating, fecal urgency, and a feeling of incompetence -TX -Diarrhea predominant- consider fructose and lactose elimination from diet for 2-3 weeks; antidiarrheal agents and antispasmodic agents -Constipation- increased dietary, soluble fiber (5+age in years=daily dose in grams) stool softener Miralax

Genum Valgum (knock-knee)

Deformity in which the knees are abnormally close and space between the ankles is increased -normal alignment about 8yrs of age Further evaluation w/ radiographs necessary if--> genum valgum is present after 7yrs of age, unilateral involvement

Adrenocortical insufficiency

Inadequate production and secretion of adrenal hormones cause by failure of adrenals to secrete glucocorticoids, mineralocorticoids, and adrenal androgen (primary adrenal insufficiency, Addisons) or deficient secretion of ACTH from pituitary (secondary) -secondary adrenal insufficiency--> hypopituitarism, cessation of glucocorticoid therapy prolonged large-dose administration of glucocorticoids S&S -adrenal crisis--> hypotension, shock, muscle weakness, wt loss, confusion, fever, fatigue, n/v, diarrhea, dehydration, salt craving, hypoglycemia, increased skin pigmentation -monitor for steroid excess--> decrease height and weight; monitor for insufficient glucocorticoid tx ( HA, wt loss, nausea, hypotension); monitor blood glucose level, ACTH, sodium and K -avoid abrupt withdrawal of corticosteroids to avoid adrenal crisis

Excessive growth

Variation from average pattern of growth in linear height with height >2SD above the mean; excess height for age -Normal variation in growth, familial/genetic -Endocrine disorders--> infant of a diabetic mother, -GH excess due to pituitary adenoma--> characteristics tall, soft tissue growth, prominent mandible, supraorbital ridge, large nose, space b/w teeth, HTN, heart failure, large hands and feet, thickened bones, overgrowth of joints of extremities -Labs--> low adrenocorticotropic hormone (ACTH), FSH low and LH, high or normal GH -precocious puberty--> androgen or estrogen excess prior to puberty from CNS disorder (early development of pubic hair ) causes early secondary sex characteristics with testicular enlargement and spermatogenesis in boys , menarche and mature ova in girls -in boys before age 9 and girls breast development before 8yrs old, pubic hair before 9yrs, or menses before 9.5 yrs -Elevated LH and FSH -Marfan syndrome, Klienfelters syndroms in males, fragile X

A previously healthy 10mo has vomiting, intermittent periods of intense crying, and the passage or red stool. Which would be considered FIRST in child? a. refer to emergency dept b. obtain an abdominal x-ray c. obtain a complete blood count d. schedule surgical appointment for tomorrow.

a.

A 7-year-old child with factor IX-deficient hemophilia falls off the slide at recess and hits his head on the ground. Since returning home from school, the child has complained of headache and dizziness. What actions should the PNP take first? A) Order magnetic resonance imaging, and then perform a complete neurologic examination B) Administer factor IX concentrate C) Perform a complete neurological evaluation to rule out CNS injury D) Order a computed tomography (CT) scan of the head

b

The PNP is assessing a new patient who was diagnosed with Turner's Syndrome in utero. Which of the following findings is not a typical finding of Turner's Syndrome? a. Lymphedema b. Tall stature c. Webbed neck

b pg. 23

A 5-year-old child is at the clinic for a routine well-child visit before beginning kindergarten. The mother reports the child's list of chores as follows: clean own room, make own bed, wash and dry own clothing, take out the trash, and help wash the dishes. If the chores are not completed, the child is grounded from other activities, such as playing with friends or watching television. The mother states that the child frequently must be grounded. How should the PNP respond? A) Suggest use of natural consequences (e.g., having no clean clothes to wear if the laundry does not get done) as an additional way to discipline B) Tell the mother she is expecting too much from the child and should reduce the number of chores C) Perform a complete physical assessment of the child, as well as a parenting assessment D) Tell the mother to make a chart so the child can remember to do the chores and record their completion and to continue grounding the child from activities when necessary

c

A 6-month-old infant is brought to the clinic for a well-child visit. On physical examination, increased tone and lower leg scissoring are noted. The PNP recognizes this as a probable sign of: A) Muscular dystrophy B) Down's syndrome C) Cerebral palsy D) Fragile X syndrome

c

Myoclonic seizures

(generalized seizure) Brief 1-2 sec, sudden muscle contractions/jerks -both sides of the body are involved but may involve only one area of body -may occur as isolated events or in clusters uncontrollable, may be no alteration in consciousness

CN X vagus

(mixed) Motor Fibres: Under conscious control Stimulates voluntary muscles that effect swallowing, coughing and speech. Under unconscious control Stimulates the contraction and relaxation of smooth muscle in the gastrointestinal tract (GI, also called the alimentary canal) Can trigger reduction (slowing) of heart-rate Stimulates secretion of digestive fluids Sensory Fibres: Monitors blood pressure Monitors levels of oxygen and carbon dioxide in blood Sensations of touch, pain and temperature from thoat area Sensations from visceral organs in thorax and abdomen

CN VII facial

(mixed) Sensory fibres are concerned with taste via the taste buds at the front of the tongue. Motor fibres control secretion of tears via the lacrimal glands and saliva via the sublingual salivary glandsas well as facial expressions via some of the muscles of facial expression.

CN XI accessory

(mixed, mainly motor) Arises from two roots, cranial and spinal. Cranial parts: Controls swallowing movements because nerve fibres (from the cranial root of cranial nerve XI) join the vagus nerve to form the recurrent laryngeal nerve which supplies the internal laryngeal muscles. Spinal Parts: Governs movement of the head and shoulders by supplying the sternocleidomastoid and trapezius muscles in the (anterior and posterior) regions of the neck.

corneal abrasian

- most heal within 24-48hrs, f/u in 24 hrs, restain to evaluate abrasion, refer to optho if not better. -broad spectrum optho ointment- erythromycin and bacitracin

GABHS

-EKG changes---> Long PR interval (mitral valve effects) tx with penicillin V, or amox

Toddler Developmental Warning Signs

1 year: not pointing and gesturing, no pulling to stand, not imitating sounds. 18 mo: does not use spoon, does not make eye contact. 2 years: not walking up stairs, not using 2-3 word sentences, not noticing cars and animals, not initiating self stimulation behaviors. 4 years: engages in head banging or rocking and is not toilet trained.

Requirements for IV abx orbital/preseptal cellulitis

1. suspected orbital cellulitis 2. younger than 1yr 3. s/s of sepsis 4. immunocompromised 5. no improvement after 48 hrs of outpt management

Formal operational thought Jean Piaget (cognitive development)

11-15yrs ability to abstract -capable of complex problem solving -reality based -logical conclusions

MMR vaccine

12-15 months and 4-6yrs -can give as early as 6 months -avoid PPD 4-6 weeks -live vaccine

Anterior fontanel closed

12-18 months

Weight gain during months 6-12 months

12-20 oz

What are the five stages of Erickson's theory?

1: Infancy (birth to 1 year)- Trust vs Mistrust 2: Toddler ( 1 to 3 ears)- autonomy vs shame and doubt 3: Preschool (3 to 6 years)- initiative vs guilt 4: School age ( 6 to 12 years)- industry vs inferiority 5: Adolescents ( 12 to 18 years)- identity vs role confusion

What are the five stages of Freud's theory?

1: Infancy- Oral Stage 2: Toddler (1.5 years to 3 years)- Anal Stage 3: Preschool ( 3 to 6 years)- Phallic stage [love of opposite sex, oedipal complex/ ego development] 4: School age (6 to 12 years)- Latency sage [sexual drive repressed, socialization occurs super ego and morality development] 5: Adolescence ( 12 to 18 years)- Genital stage

Head control

4 months, f 6 months of age, 0 head lag when pulled up from supine to sitting position, if present may indicate cerebral palsy

Posterior fontanel closed

6-8 weeks

what is the appropriate amount of ORT for 7% dehdration

600-700cc over 4hrs

Testes

95% of term males have fully descended testes. Most fully descended by 3 months of age. Refer if not descended by

precocious puvertal development is defined as dev of secondary sex char before age

9yr in boys and menses in girls before 9.5yr

what percent of Factor VIII/IX is associated with severe hemophilia A and B

<1

Very low birth weight

<= 1500g

Cat-Scratch Fever

A benign self limited form of lymphadenitis following contact w/ an infected cat as a result of a cat bite or scratch or contact w/ cat saliva on broken skin or the conjunctiva of the eye -supportive tx, may be unresponsive to abx** -can last 2-4 months

Lead poisoning

A chronic disease caused by accumulation of toxic amounts of lead in the body, CDC defines lead poisoning as a whole blood lead level >5 Sources of lead exposure -Lead-based paint in older homes built prior to 1976 esp houses built in 1950s -lead-contaminated soil and dust from automobile emissions -lead-contaminated drinking water -lead containing folk remedies, cosmetics -lead based pain on imported items, including toys -Children b/w 1 and 3 yrs old age at greatest risk

Hernia

Abnormal protrusion of abdominal tissue/structures through umbilical ring in umbilical hernia or external inguinal ring in inguinal hernia -Umbilical--> due to imperfect closure or weakness of umbilical ring (resolve by 2 yrs old) if not closed by 5 yrs old refer to surgeon -Monitor umbilical hernias -Inguinal- failed closure of processus vaginalis -Silk sign + when palpation of spermatic cord over the pubic tubercle, transillumination reveal presence of bowel Refer for surgical correction S&S - intermittent or constant bulge of abd wall or inguinal region that may worsen with crying or straining -Inguinal incarcerated--> cranky, anorexia, N/V/ groin discomfort, constipation Strangulated- area becomes tender, swollen and progressively reddened

Roseola S&S

Abrupt onset of high fever (102-105) lasting 3-5 days -appearance of rash (discrete 3-5mm pink-red macules and papules commonly found on the trunk and spreads to arms and neck will less involvement of face and legs ) follows resolution of fever - associated sx are irritability and swelling of eyelids -Tympanic membrane inflammation -Febrile sz most common complication -Diagnosed on the basis of classic presentation Tx- supportive -avoid acetylsalicylic acid (ASA) *appearance of rash is sign of recovery

Progres towards AIDS labs

Absolute CD4 lymphocyte count: NOrmal >800 cells CD4 lymphocytes percentage of WBC risk when <20% Viral load ideally should be <5000 copies or 0 or undetectabl

Roseola

Acute high fever and appearance of rash with simultaneous decrease in fever -Cause by human herpesvirus 6 (HHV-6 or HH-7) -Period of infectivity is though to be during the febrile episode prior to the appearance of the rash -Common in 6-24 months of age -One attack confers lifelong immunity

Sickle cell disease Management/tx

Administer all immunizations as recommended, including pneumococcal, meningococcal, and annual influenza -Should also receive polysaccharide pneumococcal vaccine (PPV)) every 5-10yrs as recommended -prophylactic penicillin- initiated by 2 months of age and continue until at least 5 yr old -Seek medical attention with fever -Any fever greater than 101.5 (38.5), require immediate eval--> CBC, clood culture, and a dose of broad spectrum antibiotics (ceftriaxone) Education/Prevention--> factors that may precipitate painful events--> dehydration, fever, hypoxia, exposure to extreme temperatures

What is the Denver II? What age is it used for?

Age: birth to 6 years Denver II is a generalized assessment tool ( not an intelligence test)

Hepatitis A

An enteral virus transmitted via the oral fecal route Common source of outbreaks from contaminated food and water. Shellfish is also source of infection. Symptoms mainfest 2-6wks after infection. Blood and stools are infectious during the 2-6wk incubation period. Most children are anicteric so the infection goes unnoticed. Chronic carrier state does not exist, mortality is low

Legg-Calve-Perthes Disease

Aseptic or avascular necrosis of the femoral head -generally slightly shorter stature/delayed bone age compared to peers S&S -insidious onset of limp with knee pain that is activity related and resolves with rest -pain also in groin or lateral hip (pain migrates from hip to knee, downward) -pain less acute -afebrile -limited passive internal rotation and abduction of hip joint -may be resisted by mild spasm or guarding -hip flexion contracture and leg muscle atrophy in long-standing cases DX- radiographs studies NEED--> show disease progression and sphericity of femoral head Tx -Goal is to restore ROM while maintaining femoral head within acetabulum -Observation only if ROM preserved (children <8yr old or involvement of less than one-half of femoral head) -Aggressive treatment (Refer to Ortho)--> indicated when more than one-half of femoral head involved and in children >8yrs old. Educate family that LCPD lasts 1-3 yrs and potentially serious if not treated properly

the following diagnostic finding is consistent with x-linked agammaglobulinemia

B cells - decreased

When to start Iron for BF

BF babies >6 months start 1mg/kg/day of Iron -by 4-6 months maternal irons stores are depleted so need replacement

Partial Seizures

Begin with an electrical discharge in one limited area of the brain (one hemisphere)

Milia

Benign and common condition of small, yellow-white 1-2mm sized inclusion cysts filled w/ cheesy keratinous material on face of newborn -caused by superficial keratinous material accumulated w/in developing pilosebaceous follicle -numerous firm, pearly white-yellow, papular cysts on the cheeks, forehead, and nose, predominantly on face -oral counterpart is yellow, papular lesions on hard palate known as Epstein pearls -condition resolves spontaneously w/o treatment within a few weeks as lesions exfoliate

Salmon patch (vascular lesion) Nevus simplex

Benign, flat, light or red to orange vascular birthmark on head or face - caused by overgrowth of blood vessels w/in dermis skin layer -single or multiple irregular light red to orange macular lesions on eyelids, nape of neck, glabella, and or occiput -lesions gradually fade and disappear spontaneously with time, eyelid lesions fade first (resolve completely in 3-6months) nape of neck lesions fade but may persist to adulthood - other lesions may resolve completely by 7yrs of age

Port-Wine Stain (Nevus Flammeus)

Benign, permanent, flat, dark red to purple vascular lesion, predominantly on head and face -caused by proliferation of dilated capillaries in the dermis -lesions covering entire half of face or bilateral may be associated with Sturge Weber syndrome -lesions on extremities may be associated w/ hypertrophy of soft tissue and bone -lesions on the back especially crossing the midline, may be associated w/ defects in the spinal cord vertebrae -may appear pink in infancy and gradually become darker -lesions never fades and become thickened and raised in adulthood -uncertainty about diagnosis--> pediatric opthalmology examine and ultrasound 5 month old - refer to derm to rule out Sturge-Weber syndrome -watercolor resistant cosmetics to camouflaged

What is a bone age scan?

Bone scan: is an x-ray of tarsals and carpals to determine the extent of ossification to show the estimated bone age of a child (left wrist)

AOM 3rd line therapy

Ceftriaxone 50mg/kg 2 doses IM, 48hrs apart w/ an option for a 3rd dose and tympanocentesis to figure out pathogen

child has developed her 2nd perirectal abcess in 6mo - what should she be evaluated for?

Chrohns disease

Genital Herpes Simplex virus

Clusters of painful lesions of the genital tract, perineum, mouth, lips, and pharynx Type 2--> primary source of genital herpes, affecting skin below the waist Type 1--> sites include face and skin above waist S&S -painful genital lesions, burning with urination, tender, swollen lymph nodes, fever, malaise -vesicular/ulcerated lesions -cervical friability, d/c -lymphadenopathy ***BF not recommended Tests--> tissue cx, or PCR Management Primary episodes--> Acyclovir 200mg PO 5x/daily for 7-10 days or 400mg TID per day for 7-10 days -initiation of tx w/in 6 days of onset of lesions may reduce duration and severity of symptoms -acyclovir less effective in tx of recurrent vs primary episodes

Hearing loss (conductive)

Conductive loss- normal bone conduction and reduced air conduction due to obstruction of transmission of sound waves through external auditory canal and middle ear to inner ear -Weber and Rhine test- abnormal Rhine test- tap and put on mastoid bone- stops vibrating then against air **air conduction >bone conduction NORMAL - due to OME, OM, cerumen impaction, foreign body, perforated or damaged ear drum, cholesteatoma, otosclerosis

Venus hum

Continuous humming murmur, RUSB Heard best in sitting position and disappears in supine also stops by turning neck to side

Hand-foot-mouth disease

Coxsackie A16 virus incubation 4-6 days spontaneous resolution in 1 week - vesicular lesions appear as blanching red lesions on ANTERIOR PILLARS, palms, and soles -sm vesicles erode to ulcers on buccal mucosa, hard palate, tonsils and tongue -fever (low grade), dysphagia -tx- supportive care

DiGeorge

Defect of the parathyroid, thymus, and conotruncal region of the heart. Increased risk for infection due to absent thymus. lateral displacement of inner acanthi short palpebral fissures. short philtrum micrognathia ear anomalies aortic arch anomalies hypoparathyroidism with hypocalcemia will cause seizures in infants. cognitive and behavioral problems. *significant neonatal morbidity and mortality associated with heart defects.

Glomerulonephritis

Disease characterized by diffuse inflammatory changes in the glomeruli; immune-mediated response Primary acute form- poststreptococcal glomerulonephritis (most common) Primary chronic form--> seen with IgA nephropathy S&S- Acute disease--> gross hematuria, decreased urine output, edema facial (periorbital), dark urine (poststreptococcal), HTN, CVA tenderness chronic--> fatigue, FTT Diagnosis- UA (cast RBS, leukocytes, casts indicate glomerular inflmmation), protein, pH low Tx--> supportive HTN/ reliev edema, fluid restriction, diuretics, vasodilators -Penicillin (throat or skin infection persists)

diabetes mellitus Type 2

Due to insulin resistance (in muscle, fat, and liver) as well as progressive beta-cell failure -mild to moderate polyuria and polydipsia, wt loss, hx of high caloric intake and sedentary lifestyle, + fam hx of type 2DM of maternal gestational diabetes Labs--> hyperglycemia, glycosuria (urinary or blood ketones), random blood glucose >200, or fasting BG >126 (on 2 occasions), elevated glycosylated hgb A1c >6.5% (3month average) - overweight >85% for age and sex; weight for height >85% S&S of insulin resistance--> HTN, acanthrosis nigricans, dyslipidemia, polycystic ovary syndrome, or small for gestational age -Need wt loss of 5-7% of body wt can improve glycemic goals and decrease risk of long term complications.

Lymes dx disgnosis and tx

Dx- ELISA test for detection of Borrelia Burgdorferi -western blot test confirms Tx- <7yrs old AMoxicillin >7yrs Doxycycline

which of the following is most likely to be the etiologic cause of meningitis in the newborn

E. coli

Obstructive Defects

Ejection clicks are due to turbulence Referred or radiated found noted.

Hypothyroidism tests

Elevated TSH and low T4 for primary hypothyroidism Acquired hypothyoidism secondary to pituitary or hypothalamic disorders - low free unbound thyroxine (free T4), usually normal TSH, and low thyroxine binding globulin -abnormal pituitary function tests -refer to endocrinologist -levothyroxine administered on an empty stomach approximately 30-60 minutes before breakfast for max absorption -do not mix with formula or breast milk, and iron may interfere with absorption

Constipation (encoporesis)

Encoporesis- (involuntary fecal soiling) chronic with-holding leads to impaction and soiling; eventually loses urge to stool and results in megacolon 4-7yrs old M>F -Soiled underwear, may appear to be diarrhea, may occur daily -May have impacted stool and/or large, dilated rectal vault, normal tone, abd distention with sausage shaped mass in L pelvis or midline

Functional abd pain

Episodic or continuous abd pain that occurs at least weekly for at least 2 weeks where there us no evidence of an inflammatory, anatomic, metabolic or oncological process to explain the childs symptoms -Nature of pain--> onset crampy or dull ache, no radiation, pain usually periumbilical, nothing relieves the pain, interferes with activities, no night wakening, unrelated to meals Certain personality traits--> maladaptive coping skills, anxiety, internalization of feelings, protective parents Labs--> CBC, ESR, CRP, Guaiac stool, UA/cx, ova and parasites Management -Emphasize to child and parents that pain is real, work up should reassure child is healthy -reinforce normal behavior, go to school -decrease hectic lifestyle and hurried meals -try to identify source of stress -keep pain diary to identify situations associated with symptoms

Hyperthyroidism

Excessive production and secretion of thyroid hormone by thyroid gland resulting in increased basal metabolism, goiter, autonomic nervous system, and problems with water and electrolyte metabolism Graves disease--> body produces thyroid-stimulating immunoglobulins, which stimulates TSH receptors in thyroid gland, causing overproduction of TH

Infectious Mononucleosis S&S

Fever (101-104), malaise, fatigue, HA, rhinitis, cough, abd pain, N/V, severe sore throat, difficulty swallowing, - rash +/- with administration of ampicillin derivatives -tender enlarged lymph nodes, **posterior cervical chain -Exudate tonsillitis with patchy white or gray exudates -inflamed pharynx; possible petechiae at junction of hard and soft palate -+/- hepatosplenomegaly -tender, enlarged anterior and posterior cervical nodes

Marcostomia

Fish mouth fetal alcohol syndrome mucopolysaccharidoses

TET

Four Defects: VSD, PS, RVH, overriding aorta **Loud systolic ejection murmur at the M-LUSB.** ECG: Right axis deviation, RVH ***Xray: Boot shaped heart*** no cardiomegaly or markings. * TET spell: Hypercyanotic episode*

Febrile seizures

Generalized tonic or tonic-clonic sz that occur consequence of an abrupt and steep rise in body temperature in young children Simple febrile sz--> duration 15 minutes, no focal features Complex febrile sz--> duration 15 minutes, focal features or postictal present Management -Fever control for temperature >101 -sponge baths with tepid water are not recommended because they are ineffective and risk the possibility of increasing temperature through shivering -tylenol/ibuprofen

2-3 months olds

Good head control Smiles and coo's Grasp and shake rattle

ASD

Grade 2-3 systolic ejection murmor LUSB ECG shows Right ventricular hypertrophy. Xray: Cardiomegaly, increased pulmonary vascular markings.

Coarctation of the Aorta

Grade 2-3 systolic ejection murmur with radiation to the left inter scapular area. May have an ejection click at the apex and RUSB. ECG: RVH progressing to LVH ***Xray: cardiomegaly, pulmonary venous congestion, Rib notching due to collateral circulation****

Short stature

Growth adequacy determined by consideration of both growth rate and absolute height; severe form of short stature defined as height <3 standard deviations below the mean -Normal growth variations--> familial or genetic normal variant of average growth pattern that is familial, racial, or genetic; child continuously small and remains small as adult -usually small at birth <3% but consistent with family pattern -constitutional delay of growth with delayed growth pattern resulting in delayed physical maturity but normal final adult height**** -usually normal size at birth with declining height and weight <5% between 1 and 3 yrs -non-endocrine causes short stature--> syndromes--> Turners syndrome, Noonan syndrome, Prader-willi syndrome, laurence-moon and bardet-biedl Growth hormone deciencies--> failure to grow, HA, delayed dental development, visual field defects, polyuria, polydipsia, delayed sexual maturation, CNS abn, hx of trauma, infection, radiation to CNS

SVT

HR greater than 220 in infants and 180 in children, narrow QRS complex with hidden P waves

Head circumference and chest

Head circumference 2 cm larger than chest during 1st year 1st year- equal childhood- chest 5-7cm larger than head

Macrocephaly

Head circumference larger than 2 standard deviations

Malabsorption

Impaired intestinal absorption of nutrient and electrolytes S&S -FTT, adequate or increased intake per dietary hx, severe/chronic diarrhea, bulky foul, pale, steatorrhea stools, abd distention Findings -Lactose intolerance- persistent diarrhea after infectious diarrhea w/ normal growth -CF- recurrent pulm infection,saly taste to skin, nasal polyps, rectal prolapse, FFT -Celiac disease- vomiting abd pain, irritability, anoerxia, protuberant abd, FFT, noted around 6 months w/ introduction to solids Test -Stool--> Hemoccult, ova and parasite (Giardia antigen), pH reducing substances, Sudan stain for fat, stool for pancreatic elastase, 3-day quantitative fecal fat UA,Urine cx, CBC, celiac screen, sweat test -Refer to gastro

GERD

In the infant- result of immaturity of lower esophageal sphincter; normal physiologic process. Occurs during periods of transient relaxation of the lower esophageal sphincter -resolves as child becomes more upright and starts solids Physiologic GER -effortless, painless, sitting up of varying amounts, often w/in 40 minutes of eating, no choking or color changes, normal growth, feeding hx may indicate excessive intake, burp head during vomiting may indicate incomplete burping GERD -cause FTT, esophagitis causing irritability, anemia, and guaiac positive stools or hematemesis, dysphagia, aspiration, sandifer syndrome (abnormal positiong

Sigmund Freud

Infancy: Oral Stage Toddler 1.5-3yr: Anal Stage Preschool 3-6yr: Phallic Stage ( love of opposite sex, gender roles ( Oedipal complex) School Age 6-12yr: Latency phase Adolescence 12-18yr: Genital stage

Hepatitis A

Inflammation of the liver -most common form in children -Transmission--> fecal-oral route, raw shellfish, contaminated water -Incubation 5-50 days, can infect others up to 2 weeks before onset of illness and 1 week after S&S--> infants and young children asymptomatic or nonspecific symptoms (N/V/D) no jaundice -Self limiting disease-several weeks to occasionally 6 months; no chronic or carrier state TX -HAV immunoglobulin (IG) available to decrease course of disease in early stages or prevention in exposed individuals **Defer measles or MMR vaccine for 3 months following administration of immunoglobulin -reduce protein, No tylenol

which of the following is a common cuae of acquired coronary artery disease during childhood?

Kawasaki disease

Autistic

Language delay and marked abnormal or impaired development in social interaction usually noted within the first year of life. Greatly restrictive repertoire of activity and interest.

Transient Tics

Lasts less than 1 yr -often begin in school-age children and can be intensified by anxiety, fatigue, or excitement -support and education for child and family

Pyloric Stenosis

Males more affected. Most common in White ppl. Breast feeding delays presentation. Presents usually 3wks-4mo's. **Projectile non bilious vomititing** Poor weight gain Visible peristaltic waves Palpable mass (olive) after vomititng. Labs: Abd US, Upper GI commonly shows **String Sign** Surgical referral.

Retinoblastoma

Malignant intraocular tumor S&S -squinting, eyes turned inward or outward, painful red eye -leukocoria (yellow-white pupillary reflex) -strabismus, hyphema may be present

Hepatitis

Manifestation of symptoms may either be mild or self limiting, profound and life threatening. Most common types in pediatrics are A.B,C

Iron deficiency anemia S&S

Mild anemia- usually asymptomatic/ normal pe Moderate anemia--> fatigue, irritability, delayed motor development, decreased attentiveness, shorter attention span, poor school performance, **eating nonnutrient substances such as ice, plaster, clay, paint, fabric (pica) PE--> pallor, tachycardia, systolic murmur, hepatomegaly, CHF

conjunctivitis (chlamydia)

Mild mucopurulent discharge for a few days to several weeks (5th-14 days), min lid edema, conjunctival hyperemia, +/- concomitant pneumonia(afebrile, repetitive cough with rales and tachypnea) Tx- oral erythromycin

OME tx

Most cases resolve w/o abx Referral to otolaryngologist if persists longer than 3 months or associated hearing loss (conductive hearing loss rhine test tuning fork) -decongestants and antihistamines NOT recommended except if allergy symptoms persist -f/u every 3-4 weeks

Bacterial vaginosis

Not an actual infection but classified as sexually transmitted disease -results from replacement of normal vaginal flora (lactobacillus) with high concentrations of anaerobes S&S -profuse vaginal d/c with fishy odor, may be asymptomatic -vaginal/cervical d/c, thin, white/gray, malodorous, adherent to vaginal wall -itching, swelling, redness of external genitalia tests--> vaginal secretions- pH >4.5, KOH mixed with vaginal discharge releases fishy odor (whiff test) - Saline mount--> Clue cells found Tx - Metronidazole (flagyl) 500mg PO twice per day for 7 days or 2g orally in single dose with 2nd dose in 48 hrs -alternative tx -clindamycin cream 2% one full applicator at bedtime for 7 days Education--> avoid douching, common reoccurrence, increase risk for PID, pregnancy risk for chorioamnionitis and premature delivery

Trichomoniasis

Often associated with gonorrhea and chlamydia -not reportable S&S -females asymptomatic in 25-50% all cases -vaginal d/c, vulvovaginal irritation and itching, dysuria, urinary frequency, abd pain, dyspareunia -risk or preterm birth or low wt infants -males usually asymptomatic, mild dysuria, itching -vaginal d/c--> frothy, light yellow to gray green musty odor with a pH >4.5 -vaginitis, cervicitis, punctate hemorrhage known as strawberry cervix, erythema, edema, pruritis of external genitalia Test- wet mount of vaginal secretions or spun urine sediment--> presence of motile trichomonads Tx -metronidazole--> adolescent- 2g PO or 375 mg BID per days for 7 days Avoid alcohol during tx and for 24 hrs after

Breastfeeding or formula should continue

Oral Rehydration therapy Moderate 50ml/hr Severe 100ml/hr

Combined Hormonal contraceptives

Oral contraceptives -prevents ovulation -increase viscosity of cervical mucus, inhibiting sprem penetration -alters endometrium to resist implantation Drug interactions--> may reduce OCP effectiveness, antibiotics, antifungals, anticonvulsants, antacids Drugs thant enhance--> ascrobic acid, co-trimoxazole Absolute contraindications--> hx of clotting disorder, impaired liver fx, abn vaginal bleeding, preganacy, estrogen dependent carcinoma Relative contrainfication--> severe HTN, migraines, chronic diseases, rheumatology disorders

Blue Sclera

Osteogenensis imperfecta

Perorbital cellulitis

Outpt management with IM ceftriaxone, with oral abx 1st line abx- amoxicillin with clavulante amd cefixime

Dysmenorrhea

Pain during menstrual cycle; usually 1-2 days; cramping discomfort felt mid-to-lower abd Secondary dysmenorrhea--> underlying pelvi pathology (congenital anomalies, cervical stenosis or strictures, cysts, tumors or ovary or uterus, endometriosis, PID)

HTN

Persistent blood pressure greater than 95% on three separate occasions. Headaches, Visual problems, Dizziness, Resp distress, Irritability, nosebleed. CXR PA/Lateral Plasma adolosterone Morning and evening cortisol levels UA, BMP, CBC, cholesterol, trigylceride ECG **** refer to pediatric cardiologist****

Poliomyelitis

Polio- caused by enterovirus -Preventable by the IPV vaccine -Spread by fecal-oral route and droplet, virus persists in throat for about 1 week and sheds in feces for several weeks S&S fever, myalgia, sore throat, and HS for 2-6 days -GI prodrome -decreased tone and motor fx/tendon reflexes of affected limb -inability to speak w/out frequent pauses -meningeal signs -respiratory compromis Dx- EV isolated from feces, throat, urine, or CSF in cell cx -Medical referral

Trisomy 21 Down's

Presence of a 3rd 21st chromosome increased parental age increases risk Physical: Microcephaly, flattened nose, wide set eyes ( hypertelorism), protruding tongue, inner epicanthal folds, upward slanting eyes, short broad hands, single palmar crease, hypotonia, brush fields spots ( spots on iris), delayed growth Seizures, congenital heart defects, endocrine issues, esophageal/duodenal atresia, hearing and vision impairment, obesity, leukemia, early dementia.

GERD

Present in 85% of premies H.Pylori should be suspected in children of color. S/S: Choking, coughing, wheezing, weight loss, irritability, recurrent vomiting, heartburn, sore throat, OM, dental erosions. Labs: CBC, UA, Stool, abd US to r/o pyloric stenosis. Mgmt: small frequent feedings, burp frequently, continue breast feeding, weighted AR formula, one tablespoon of rice cereal per ounce, elevate head of bead, MEDS: H2 blockers; Zantac and Pepcid PPI; Prilosec Follow up and monitor growth.

Periorbital cellulitis

Preseptal- inflammation/infection of the skin and subcutaneous tissues surrounding the eye -acute onset of unilateral eyelid swelling, warmth, swelling, and tenderness of overlying skin, eye and vision normal

Appendicitis

Psoas sign--> pain with R thigh extension Obturator sign--> pain with internal rotation of the R thigh McBurneys point tenderness--> one-thrid the distance from the anterior superior iliac spine to the umbilicus

Neo freudian: Erik Erikson

Psychosocial development Infancy--> Trust vs mistrus Toddler--> Autonomy vs shame and doubt Preschool--> Initiative vs guilt School age--> industry vs inferiority Adolesence--> identity vs role confusion Young adult--> intimacy vs isolation

9-10 months

Pulls to stand Pincer grasp Understands No

Total Anomalous Pulmonary Venous Connection

Pulmonary veins do not enter LA but are connected either directly or indirectly to RA, if veins return below the diaphragm emergency surgery

Aortic heart sound

R upper sternal border (best heard)

steven jonson syndrome

Referral to derm -sudden onset of prodromal state- fever, malaise, weakness then skin rash develops in 2-3 days similar to erythema multiforme minor -Hypersensitivity cause by exposure to enterovirus, mycoplasma pneumoniae, Herpes simplex, barbiturates, sulfa and penicillin drugs, or foods

When should the initial weight loss of an infant be regained?

Regained weight loss should be within 7 to 14 days

Primitive Reflexes

Rooting- Gone by 3-4mo Sucking- Gone by 3-4 mo Moro- gone by 3-4 mo Grasp- gone by 3-6 mo Pacing Stepping- gone by 1-2 months Tonic neck- gone by 3 months Babinski's- gone by 12months or when walking.

Chlamydia S&S

S&S -often asymptomatic for months to years -abd/ pelvic pain, dysuria/burning Genital tract infection -may be normal exam -erythema of external genitalia, vaginal/penile d/c yellowish to watery, tenderness on bimanuel examination

atopic dermatitis (eczema) TX

Secondary infections--> oral abx (Bactrim, cefadroxil, cephalexin, clindamycin) Topical abx for localized infections (mupirocin) -Reduce and prevent nocturnal pruritsis with oral antipruritics (hydroxyzine, benadryl, nonsedating histamines during the day) -Topical steroids to reduce inflammation, immune response, and pruritis (hydrocortisone or triamcinolone) ***long term use can cause hyperglycemia, bladder dysfumction -hydrate skin w/ luke warm baths - avoid harsh soaps, perfumes, or lotions -apply cream emollients and lubricants at least BID (hold moisture in) -Maintain cool temps to reduce sweating, increase humidity during cold weathers

Toxic synovitis

Self limiting inflammation of the hip, most likely due to a viral or immune cause - occurs most often in 2-6yrs olds, but also up to 15yrs old S&S -painful limp -unilateral involvement -internal rotation of hip causes spasm*** -no redness, warmth, or swelling Normal radiographs -self-limiting, analgesics and bed rest if needed

Varicella

Series of 12 between 12months and 12 years Minimum of 3 months apart. ***prefer to give one month apart form MMR

Hep A

Series of 2 1 year to 2 years 6months apart

Measles, Mumps, Rubella MMR

Series of 2 1 yr and 12 yrs Can given as early as 6months if parent is traveling to an endemic area. Will still need primary series when time though.****

Meningococcal Vaccine

Series of 2 11yr and 12yr 1 Booster at 16yrs.

PCV13 Prevnar

Series of 3 2-4-6 Months 1 booster at 12Months

Polio IPV

Series of 4 2-4-6 months 6 years

Truncus arteriosus

Single arterial trunk that did not divide completely in utero; single vessel provides flow to both pulmonary and systemic circulation, overrides ventricles and receives blood from them through a ventricular septal defect

Milestones by Age 2-5 Months

Smiles and Coos Watches a person's face Follows people and objects with eyes Laughs aloud Lifts head/chest when on stomach*** Hold head steady when pulled to sit*** Grasps rattle placed in hand Startles to loud noise

Complex partial sz

Start in a limited area of the brain, typically the temporal or frontal lobes, and spread to other parts of the brain with a variety of clinical expressions -Impairment of consciousness for 30 seconds to approximately 2 minutes or longer -Cognitive symptomatology--> abrupt alteration in mental state, involves disruption of time relationships and memory -Affective symptomatology--> inexplicable feelings (fear, dread, w/o obvious cause) -Somatosensory disturbances--> distortions of perception or hallucinations, may involve odd taste or smell with visual disturbances Automatisms--> semi purposeful perseverative movements, may involve walking, sucking, lip pursing, or picking at clothing

Intermittent asthma

Symptoms < 2 days/week -0 night time awakening >5yr old <2 night time awakening -no interference with activity -<2 days/ wk use of SABA -requiring 0-1 use of oral corticosteroids for asthma exacerbations -SABA as needed

Moderate persistent asthma

Symptoms daily -nighttime awakenings 3-4x/month, >5yrs old 1xwk but not nightly -SABA use daily -some limitation with activity Step 3: lmedium dose ICS + LABA (Salmeterol)

Severe persistent asthma

Symptoms throughout the day -nighttime awakening >1x/week, >5yrs old 7x/week -SABA use several times per day -extremely limited w/ activity Step 4-6: med-high dose ICS + LABA (+ PO steroids) + montlukast

Pharyngitis (bacterial) tx

TX--> oral penicillin V/amox (50mg/kg daily), erythromycin or 1st generation cephlasporin for penicillin allergy 2nd line of tx- macrolides, cephlasporins, or clinda Complications-->peritonsillar or retropharyngeal abscess or cellulitis -acute rheumatic fever if untreated (prevented if tx w/in 9 days of initial complaints of sore throat)

Intussusception

Telescoping of one part of the intestine into one another. Cause is unknown but may be due to adenovirus. More common in males Most cases before 2yrs age. Acute colicky pain, BILIOUS vomiting, progressive lethargy, currant jelly stool, sausage shaped mass in RUQ, progressive distention/tenderness. If not reduced perforation and shock will occur. ***Radiograph and barium enema to dx and reduce. Will need surgery if enema does not reduce. Will be fatal if not treated.

When should the infants weight be tripled?

The infant's weight should be tripled by 1 year of age.

How many pounds should the school age child gain?

The school age child should gain 5 to 7 pounds annually.

6-12 years

Visual acuity reaches 20/20

How much vitamin D should a breastfeed infant receive?

Vit D supplements [400 international units (IU) per day] at 2 months of age to adolescence

What is the recommended vitamin supplements for infants that are breastfeed?

Vitamin D Iron

Fissures at lip corners

Vitamin deficiency riboflavin deficiency Cheilosis

Language milestones 18-23 months

Vocab of 50 words, pronunciation often unclear -asl for common foods by name -makes animal sounds, such as moo -starts to combine words such as- more milk -begins to use pronouns such as- mine -use 2-word phrases "I go" or "I like"

Lead poisoning testing

Whole blood lead level test *<5--> if high risk, retest in 6 months, if low risk no further testing *5-14--> at risk for lead poisoning, early f/u within 3 months--> if f/u is 15-19 or higher 3 months apart, retest every 1-2 months until results <15 for at least 6 months, then every 6-9 *15-19--> f/u in 2 months, if >15 retest every 1-2 months until results <15 for at least 6 months, then every 3 months until child is 36 months old include nutritional counseling *Blood level >20 refer for further medical evaluation, interventions, and f/u -levels 20-44 may need pharmacological tx

Generalized seizures

Widespread electrical discharge of both hemispheres of the brain, usually WITH LOC

Glucose-6-phosphate dehydrogenase (G6PD) Deficiency

X-linked or autosomal recessive genetic disorder causing hemolytic anemia -decreases the ability to deal with oxidative stress and results in hemolysis May be induced by-->aspirin, sulfonamides, antimalarials, nitrofurans -->fava beans, ingestion or exposure to pollen from the beans flower, infection S&S -develop 24-48 hrs after ingestion of substance having oxidant properties--> weakness, pale appearance, sever case had blood in urine, yellow discoloration of skin, white of eyes, and gums -hyperbilirubinemia in infants Red blood cell indices- heinz bodies present, fragmented cells and blister cells Management--> avoidance of foods and drugs that causes hemolysis

11. A newborn or infant with birth length <50% and microphallus should be suspected of having: a. Growth hormone deficiency b. Congenital hypothyroidism c. Primordial short stature d. Down syndrome

a

4. Although relatively rare in the U.S., diphtheria can occur among under-immunized children. Which of the following clusters of signs, symptoms, and physicals findings would suggest diphtheria in a child presenting with upper respiratory complaints? a. Low grade fever, sore throat, nasal discharge, grayish-white pseudo-membrane in his/her throat b. Abrupt onset of high fever, severe sore throat, nasal discharge, and grayish-white pseudo-membrane in his/her throat c. Low grade fever, abrupt onset of severe sore throat with difficulty swallowing and drooling d. Abrupt onset of high fever, severe sore throat, with difficulty swallowing & drooling

a

A 4-year-old child is examined in the clinic. The parents report that the child has limited language skills and does not speak in three-word sentences. The PNP is interested in further assessing the child and chooses the following: A) Denver Articulating Screening Examination (DASE) B) Denver II C) Clinical Adaptive Test/Clinical Linguistics Auditory Milestone Scale (CAT/CLAMS) D) Vineland Social Maturity

a

A 5-year-old child with a gross motor deficit is brought to the office for a preschool physical examination. The child's language skills are normal. The parents ask about potential learning difficulties. The PNP stresses the importance of being vigilant and involved with school to optimize the child's success. The PNP also informs the parents that: A) The child's language skills are a strength because language performance is the skill most highly correlated with school success B) It is impossible to predict learning issues at this age C) The child is at minimal risk for learning problems because the fine motor development is normal D) The child is at high risk for learning problems secondary to the gross motor condition

a

A mother brings her 2-year-old child to the clinic for a well-child visit. The mother's chief complaint is the child's rebellious behavior. The mother says that she has tried time-out, yelling, and spanking but nothing has worked. The child has never slept through the night and still gets a bottle in the middle of the night. In the examination room the PNP observes as the child repeatedly gets into the mother's purse when she is not paying attention, despite the mother telling the child "no." Based on the history and observation, the PNP suggests that: A) The child needs to have limits and boundaries set consistently and the mother could benefit from parenting classes B) The child is normal; this rebelliousness is only a phase and will improve with time C) The child exhibits behavior atypical of 2-year-old children and immediate referral to a child psychologist is necessary D) The child shows signs of attention deficit-hyperactivity disorder, and referral to a specialist may be necessary.

a

A newborn is brought to the office for a 2-week well-baby exam. The PNP notes that the infant's head circumference is 2 SDs below the norm. A neurologist evaluated the child in the newborn nursery but detected the abnormal circumference without significant findings. The baby is otherwise growing well. What is the most appropriate recommendation? a. F/U in 2 weeks, including measurement of the head circumference b. refer the patient to a neurologist. c. order skull x-ray films & MRI d. do nothing.

a

The PNP is seeing an 8-hour old infant. The infant's mother was HBsAG positive. The PNP expects to order which of the following? a. Hepatitis B immune globulin .5ml b. HBsAG antibodies c. Intravenous fluids

a pg. 17 Within 12 hours of birth, infant should receive Hep B vaccine and HBIG. After the child completes the HepB series obtain HBsAG and antibodies to HBsAG.

When assessing the length and weight of a toddler and preschooler, when should measurements be taken? a. Every visit up to 2 years old, then annually b. Every visit up to 3 years old, then annually c. Every visit up to 4 years old, then annually

a pg. 39 Also, head circumference should be measured each visit until 2 years old.

Plaque

a scaly, elevated lesion, the classic lesion of psoriasis

post operative T&A pain analgesia

acetaminophen and codeine

Kawasaki disease signs and symptoms

acute phase- lasts about 10 days Preceding URI sx, diarrhea, vomiting, abd pain, irritability, persistent high fever for 5 days, reddened eyes, red tongue and throat, redness and/or swelling of hands and feet, rash, swollen lymph nodes, fast and/or irregular pulse, arthritis or arthralgia involving multiple joints

sinusitis

acute, subacute, or chronic inflammation of mucosal lining in one or more paranasal sinuses Acute- symptoms for 10-30 days Chronic-persistent symptoms >30 days **sinuses not well formed under 9yrs of age

medicare part b covers

all medically necessary services

boggy nasal mucous membrane with serous drainage suggests

allergic rhinitis

A newborn infant who was recently tested and failed the evoked optoacoustic emissions audiometry (EOAE) prior to discharge should be reffered for:

auditory branstem response

A macrobiotic diet can best be described as a diet containing: A) No animal foods, including milk and eggs B) Whole grains, vegetables, fruits, and white meat of fish C) Grains, fruits, vegetables, and milk but no eggs, meat, poultry, or seafood D) Grains, fruits, vegetables, milk, eggs, fish, and fowl but no red meat

b

A white instead of red reflex upon eye exam of a 1yo child would suggest: a. an accommodation error b. retinoblastoma c. papilledema d. retinal detachment

b

The PNP is assessing a neonate in the nursery. The cremasteric reflex is absent, and the right testicle cannot be palpated in the scrotum. The PNP should: A) Order a sonogram B) Consult with the physician C) Refer the neonate to the urology clinic D) Not allow the neonate to be discharged from the hospital

b

The PNP is examining a 16-year-old adolescent with painful vesicular skin lesions. The most likely diagnosis is: A) Molluscum contagiosum B) Herpes infection C) Coxsackievirus infection D) Impetigo

b

The first sign of puberty in girls is usually: A) Pubic hair growth B) Thelarche C) Menarche D) Acne

b

The pediatric nurse practitioner suspects autism spectrum disorder in a 2-year-old patient. The nurse practitioner should: a. Refer the patient for further neurodevelopmental evaluation if symptoms persist at the 3-year-old health maintenance visit b. Promptly refer the patient for further detailed neurodevelopmental evaluation c. Recommend that the patient receive no further immunizations d. Assist the family in locating a long-term placement facility

b

The risk factor that is MOST predictive of suicide in an adolescent patient is a. major mood disorder b. previous suicide attempt c. substance and alcohol abuse d. family history of suicide

b

When performing a preemployment physical on a 16-year-old adolescent in an urban health care center the PNP learns that the patient's girlfriend was recently treated for a vaginal infection. Based on this information, the PNP should: A) Contact the primary care provider of the adolescent's sexual partner for further information B) Obtain a urine specimen to rule out chlamydial infection C) Treat immediately with doxycycline D) Do no further workup because the patient is asymptomatic

b

Which of the following methods is best for diagnosing obesity? A) Skinfold measurements B) BMI C) Weight for height measurements D) Mother is obese

b

While examining a 3-year-old child for a well-child visit, labial adhesions are noted. The PNP discusses with the mother: A) Concern of sexual abuse B) Proper hygiene C) Causes of UTI D) Surgical treatment of the adhesions

b

While examining a 3-year-old child for a well-child visit, labial adhesions are noted. The PNP discusses with the mother: A) Surgical treatment of the adhesions B) Proper hygiene C) Concern of sexual abuse D) Causes of UTI

b

What would the PNP determine Jamie's APGAR score to be when he presents with normal color all over, heart rate of 120 bpm, pulls away with stimulation, respiratory rate of 42, spontaneous movement? a. 14 b. 10 c. 8

b pg. 26

The PNP is performing a newborn assessment. Which posture is considered normal? a. Arms and legs flexed with minimal movement, hips adducted b. Partially flexed abducted hips, flexed knees, arms adducted, elbows flexed, fists clenched c. Arms and legs with floppy tone, hips relaxed

b pg. 28

Which newborn skin disorder is often referred to as "prickly heat" and is the result of an obstructed eccrine gland? a. Milia b. Miliaria c. Erythema toxicum

b pg. 28 Miliaria= Milia with "R" (redness)

The PNP notices junctional nevi on a child. If this skin condition is noted in large numbers, what condition should be suspected? a. Eczema b. Tuberous sclerosis c. Erythema toxicum

b pg. 28 Other conditions associated: Xeroderma pigmentosus, generalized neurofibromatosis

According to Freud, what age does a child to become orally aggressive and start biting their playmates? a. 6 months old b. 7 to 18 months old c. 18 to 24 months old

b pg. 8

The PNP expects a toddler to be in which psychosocial stage? a. Trust vs. Mistrust b. Autonomy vs. Shame and Doubt c. Industry vs. Inferiority

b pg. 8

what is the most consistent fiding with meningitis in the neonate

bulging fontanel

A 13-month-old child is brought to the clinic for a routine visit. The child is healthy today and has no history of allergies or previous reactions to immunizations. The PNP checks the immunization record and finds the following: Age 2 months DTaP, IPV, Hib, Prevnar, and Hep B Age 5 months DTaP, IPV, Hib, Prevnar, and Hep B Age 8 months DTaP and Hib The PNP should give the child the following immunizations today: A) DTaP and IPV B) MMR and Var (a return visit should be scheduled for 1 month later so that Hep B can be administered) C) Hep B, MMR, IPV, HIB, Prevnar, and Var D) Hep B and MMR (a return visit should be scheduled for 1 month later so that Var can be administered)

c

An 18-month-old child is examined because of a cough and runny nose lasting 7 days. The nasal discharge is yellow-green. The mother has been using over-the-counter cold medications every 6 hours. There is no fever, and the child's appetite, activity, and elimination are as usual. The mother had the same symptoms and was put on an antibiotic for a sinus infection. She is concerned that the child has the same infection. The most appropriate step for the PNP to take is to: A) Prescribe an appropriate antibiotic to treat the sinus infection B) Order a Water's view sinus x-ray film to rule out acute sinusitis C) Reassure the mother that the child probably has a viral infection, and provide instructions regarding supportive care D) Inform the mother that no treatment is necessary, but suggest that she bring the child in if symptoms do not improve within 4 weeks

c

An 18yo female college freshman, Bailey, presents to college health with an 8hr hx of abdominal pain that began in the periumbilical area and then localized to the RLQ. She has been on OCPs for teh past 6mo. Bailey denies a medical hx of UTIs, pregnancy, STDs, or chronic illness. Upon her physical exam, she is guarding on the RLQ with generalized tenderness and no masses. Her temp is 99.6 and her vitals are normal. Based on this H&P, which of the following is the most likely diagnosis for Bailey? a. Mittelschmerz b. Ectopic pregnancy c. Appendicitis d. Gastroenteritis

c

An 18yo female college freshman, Bailey, presents to college health with an 8hr hx of abdominal pain that began in the periumbilical area and then localized to the RLQ. She has been on OCPs for teh past 6mo. Bailey denies a medical hx of UTIs, pregnancy, STDs, or chronic illness. Upon her physical exam, she is guarding on the RLQ with generalized tenderness and no masses. Her temp is 99.6 and her vitals are normal. Which of the following is the least helpful in the eval of abdominal pain in this client? a. urinalysis b. CBC c. Temperature d. Pregnancy test

c

Gynecomastia in a male may not be a finding in which of the following? a. normal pubertal development b. steroid usage c. hyperthyroidism d. testicular tumor

c

The PNP is examining a full-term neonate with jaundice at age 15 hours. The bilirubin level is 13 mg/L. The mother tested positive for group B streptococcus, but antibiotics were not administered during labor because there was not enough time. There were no other complications during birth. The infant is breastfeeding well. Currently the only other significant finding on the infant's examination is a large cephalohematoma. The least likely cause of jaundice is: A) Sepsis B) Rh or ABO incompatibility C) Physiologic jaundice D) Hemolysis

c

The PNP is managing care for a 5-year-old child with growth failure. After a complete history is taken and a physical examination is performed, the mostrelevant and cost-effective screening tests to obtain are: A) Tests to determine total protein level, bone x-ray films to determine bone age, urinalysis, and CBC B) Bone x-ray films to determine bone age, CBC, urinalysis, and tests to determine potassium and chloride levels C) Bone x-ray films to determine bone age; CBC; T4, TSH, and liver profile tests D) Tests to determine insulin-like growth factor (IGF-1) levels, CBC, and urinalysis

c

The PNP is meeting with the parents of a 7-year-old child with type 1 diabetes to discuss blood glucose levels. A suggested blood glucose level for a 7-year-old child with diabetes is between: A) 80 and 120 mg/dL B) 100 and 200 mg/dL C) 80 and 180 mg/dL D) 70 and 150 mg/dL

c

The PNP is performing a neonatal examination in the nursery. A pustular type of eruption is noted on the neonate's face and trunk; some of the lesions are transient. The PNP diagnoses: A) Streptococcal infection B) Staphylococcal infection C) Erythema toxicum D) Herpes infection

c

The mother brings a 4-month-old infant to the office for a well-child visit. The infant received a hepatitis B (Hep B) immunization in the hospital at birth and another Hep B in the office at age 1 month but has received no other immunizations. The infant lives with the mother and grandfather. The grandfather is asthmatic and is taking steroids. What immunizations should the infant be given today? A) Hep B, DTaP, and Hib B) DTaP, Hib, and OPV C) DTaP, Hib, Prevnar, and IPV D) Hep B, DTaP, Hib, and IPV

c

Which of the following observations demonstrates the function of the oculomotor nerve? a. the child frowns during the examination b. the child offers appropriate verbal responses to the nurse practitioner during the examination c. the child visually tracks the parent's movements around the room during the examination d. the child sticks out the tongue during the examination

c

Which of the following statements is true regarding childhood obesity? A) The most common problem associated with childhood obesity is diabetes B) If one parent is obese and the other is of normal size, 9% of their children will become obese C) The older the obese child is, the more likely it is that he or she will become an obese adult D) Endocrine causes of obesity are common

c

Which of the following language skills does the PNP expect 15 month old Emerson to demonstrate? a. 2-word sentences b. 30 to 50 word vocabulary c. Point to body parts

c pg. 10 15-18 months old should be able to demonstrate. 2-word sentences at 18-22 months. 30 to 50 word vocabulary at 22 to 24 months old.

The PNP is seeing 7-year-old George who is behind on his vaccines. Which of the following vaccines can he receive? a. Hib Conjugate Vaccine b. Rotavirus c. Tdap

c pg. 18 Hib is not recommend for children older than 5 years old.

The PNP is performing a sports physical on a 14-year-old male. The PNP notes an enlarged scrotum and testes and elongated penis. Using Tanner staging, what stage of maturity is this patient currently in? a. Tanner stage 1 b. Tanner stage 2 c. Tanner stage 3

c pg. 58

12-year-old Mary is concerned because she has not experience menarche like her friends. Upon exam, the PNP notes the breast enlargement without a separate nipple contour. Which Tanner stage does menarche usually occur? a. Tanner stage 2 b. Tanner stage 5 c. Tanner stage 4

c pg. 59 Menarche occurs between development stages 3 to 4, but most often at stage 4

James is in for his 4-month check up. His mom asks if she needs to provide iron supplementation even though James is exclusively breastfed. What does the PNP educate? a. James will not need iron supplements unless he is anemic. b. James should already be on iron supplements 1mg/kg/day. c. James should start iron-fortified foods at 6 months old.

c pg. 6

The PNP is assessing the need for fluoride supplements in her rural town. She knows that supplementation is not required for the first 6 months of life. When is the local water supply considered deficient. a. <.8 parts per million/ppm b. <.6 parts per million/ppm c. <.3 parts per million/ppm

c pg. 6

glucagon should be used to treat

chdilren with severe hypoglycemia

most advanced type of play is?

cooperative

4. a 2 week old presents with mucopurulent eye discharge with injection and edema of the conjunctiva. The 15yr old mother had no prenatal care. What is the most likely organism? a. Staphylococcus aureus b. Gonococcus c. C. pneumoniae d. C. trachomatis

d

A 13-year-old Tanner stage III/IV female adolescent who competitively runs cross-country track is scheduled for an annual sports physical examination. The adolescent complains of mild abdominal cramps and backache. When asked about voiding difficulties, the adolescent reports frequency symptoms. The dipstick screening reveals yellow urine, +1 blood, and no protein, leukocytes, and nitrites on the reagent strip. This morning the adolescent started having some dark vaginal discharge. The physical examination is otherwise within normal limits. The blood pressure was 110/78. Which of the following would be appropriate management? A) Obtain a culture and microscopic urinalysis, and start the patient on antibiotics, confirming improvement in 24 to 48 hours; perform repeat urinalysis or culture in 14 days B) Reassure the adolescent and the family that transient hematuria can be related to vigorous exercise, urinary tract infection (UTI), or menarche C) Obtain a urinalysis and complete blood cell count, and order tests to determine electrolyte levels, blood urea nitrogen, creatinine level, and creatinine clearance D) Obtain urinalysis and culture, and explain that these problems may be transient and related to exercise

d

A 15-year-old adolescent has pallor and fatigue. The CBC results are consistent with iron-deficiency anemia. What would be appropriate information to give this adolescent? A) Antacids increase the absorption of iron B) Dairy foods are good sources of dietary iron C) Juices fortified with vitamin C inhibit the absorption of nonheme iron D) Tannin-containing products, such as tea, inhibit the absorption of nonheme iron

d

A 5-day-old neonate, diagnosed with trisomy 21, was noted to have an elevated thyroid-stimulating hormone (TSH) level. The neonatal screening was performed at age 3 days. What should the PNP do next? A) Reassure the mother that an elevated TSH at age 3 days is common and that no further treatment is necessary B) Repeat the test because it was not performed at the appropriate time C) Repeat the test when the child is age 3 weeks because this is the appropriate time D) Repeat the test and inform the mother that children with Down's syndrome have a high rate of hypothyroid disease

d

A mantoux test in a child with no risk factors is considered positive with a reaction of: a. at least 5mm induration b. at least 8mm induration c. at least 10mm induration d. at least 15mm induration

d

A number of the PNP's adolescent patients are using natural herbal remedies. What general advice should the PNP give these patients? A) "Herbs are drugs even though they are marketed as being grown naturally." B) "Interactions between different types of herbal remedies are rare." C) "Herbs are safe because they are natural." D) "Let's look for evidence-based resources to check out the herbal remedies that you are interested in trying."

d

A parent asks for suggestions in helping a 6-year-old child who wets the bed. What intervention would the PNP recommend for this child diagnosed with primary nocturnal enuresis? A) Use a "wet night" calendar to mark the dates of wetting accidents B) Allow the child to take care of changing wet clothes and linens C) Criticize the child when a wetting accident has occurred D) Praise any progress made by the child

d

Higher-functioning adolescents with autism are at increased risk for: a. significant phobias b. panic attacks c. substance abuse d. obsessive-compulsive disorder

d

Providing reassurance of "normalcy" during the course of an exam would be most important for: a. preschool children b. young school aged children c. older school aged children d. adolescents

d

The father of a 2-year-old child calls the office, requesting help in managing bedtime resistance. The PNP suggests that children should be expected to: A) Set their own bedtime based on their internal time clock B) Put themselves to sleep somewhere other than their own bed and then be carried to bed once asleep C) Make ongoing requests, requiring the parent to come to the room and meet those demands D) Protest going to bed but parents should be consistent in expecting the child to stay in bed

d

The mother of a 2-year-old child calls the office with concerns about temper tantrums. She asks if screaming, falling on the floor, and kicking are normal behaviors. The PNP explains A) "The child is expressing a need for independence." B) "The child is trying to get attention." C) "The child is probably spoiled and needs a spanking." D) "The child cannot yet express frustrations verbally."

d

Peritonsillar abscess

deep infection in the space between the soft palate and tonsil -high fever with severe sore throat, bad breath -unilateral enlargement of tonsils, bulging medially w/ anterior pillar prominence, uvula displace due to edematous and erythematous to soft palate, extreme tonsillar tenderness on palpation -Immediate referral to ENT

ASD exam finding

grade II to VI systolic ejection murmur at the left upper sternal border

AOM 1st line treatment

high dose amoxicillin 80-90mg/kg/day for 10 days -if rash may use cefuroxime, cefpodoxime, and cefdinir

p value of 0.1

high value would indicate the proposed protocol did not produce the desired results in 1 in 10 tests 0.001 indicates 1 in 1000 tests

VSD is associated with

holostystolic thrill felt at left lower sternal border

Venous hum

humming continuous murmur usually heard best at the upper R sternal border in sitting position with marked decrease of murmur with change in head position (turn head sideways) or disappearance of murmur in supine position -result of blood flow returning through SVC to the heart with gravity acceleration

increasing infant head circumference would lead you to suspect

hydrocephalus metaboli/genetic disorder benign familial macrocephaly

Rett's

in females neurodegenerative developmental regression following a period of normal functioning through the first 5 months of life. Lack of gain in developmental milestones CNS irritability and withdrawl symptoms stereotypic hand movements delayed head growth seizures scoliosis hypertonicity.

In 1964 the NP program was started at the Univeristy of Colorado

in order to makeup for shortfall of pediatricians. initially oriented towards outpatient care

a pathognomonic skin finding in children with chronic adrenal insufficiency (Addisons) is

increased pigmentation in the axilla, groin, areola, hand creases and surgical scars

Orbital cellulitis

infection of soft tissue of the orbit posterior to the orbital septum. -Primary etiology is an extension of a bacterial sinusitis -insidious onset of unilateral eyelid swelling, orbital pain, HA, decreased vision, fever, lid edema and redness not extending onto the eyebrow, proptosis, chemosis, decreased ocular mobility, decreased visual acuity -Hospitalization

Appendicitis

inflammation of appendix, if untreated gangrene and perforation may develop in 36 hours, More common in males 10-30yrs. Begins with vague colicky umbilical pain that moves to RLQ. **Psoas Sign: pain with right thigh extension** Rebond tenderness. **Obturator sign: pain with internal rotation of right thigh** McBurney point: tenderness one third the distance from the anterior superior iliac spine to umbilicus. Pain worsens with cough. N/V with sense of constipation...low grade fever. Labs: elevated WBC, elevated ESR, US and CT is dx. Surgical treatment.

Hepatitis

inflammation of the liver -Physical findings--> possible hepatosplenomegaly RUQ tenderness, if jaundiced may develop dark urine and light stools, scleral icterus Tests -elevated liver enzymes (ALT, AST), elevated serum bilirubin, elevated erythrocyte sedimentation rate (HAV) Tx -supportive, good nutrition, decreased activity, monitor hydration and chronic state -report to state health department Prevention - HAV--> 2 vaccines recommended for children >age 12 months; Hep A vaccine should be given to previously unvaccinated individuals prior to travel to affected areas; HAV vaccine can also be given as postexposure prophylaxis, for children <12 months, immunocompromised persons, persons w/ chronic liver disease, and persons who are allergic to the vaccine or a vaccine component HAV IG should be used -HBV vaccine 3 series ( birth, 1-2 months, 4-6 months)

what is the most important frequent post meningitis seqeulae in older infant and children?

language delays/disorders

cyst

large raised lesions filled with serous fluid, blood, and pus.

the most common type of skull fracture in children with an excellent prognosis is

linear

septicemia in the newborn period is ost likely caused by which organism

listeria

what is common xray result findings with Strep Pneumoniae & H. flu?

lobar consolidation or hilar adenopathy

which is usually elevated with viral infections

lymphocytes

how would your rate a burn if 5% of the body surface is burned involving the epidermis and upper part of the dermis

major 1st and 2nd degree burns

example of pleiotropic genetic disorder?

marfans

congenital HIV infection

may be latent for years before clinical signs develop

a preschool boy whose parents have separated and are beginning divorce procedures?

may think that he caused the divorce by misbehaving

what are common charactstic findings of children and infants with hyperadrenocorticism

moon facies delayed onset of secondary sex char buffalo type adiposity of face, neck and trunk

Erythema Toxicum

most common newborn rash. usually appears between day 2-5 after birth, blotchy red spots on skin with overlying white or yellow papillose or pustules. Will resolve by 14th day.

true statements regarding tourette's

most sever tic disorder more common in males mean age onset b/n 6&7

aspiration, antibiotic treatment for 4-6wks, surger if abscess is present is diagnostic workup and management for a child with what ?

osteomyletitis

the major trend In health policy research today is

outcome studies

what would you suspect to occur with appendicitis?

pain not relieved with ambulation

Area of percentage of Burns

palm is 1%.

Conjunctivitis (bacterial)

purulent discharge 2nd-5th days Tx- opth erythromycin, polymixin-bacitracin, and tobramycin, warm compresses

erythema toxicum wrights stained smear findings

pustules that identifies presence of eosinophils

Hemangiomas

raised soft red lumps on skin more common in premies. usually begins to shrink and fade around 6 months,

electroencephalogram use in seizures

records the electrical activity of the brain helping to precisely classify seizures.

Genotype

refers to diagnostic characterisitics Like gene markers, DNA, etc....

ascaris lumboicides (roundworm) Is prevalent where?

rural south

antimicrobials will improve which diarrhea cuased by

shigella

why do toddlers need whole milk instead of skim?

skim milk does not contain enough fatty acids

the cover/uncover test is used for detecting?

strabismus

Palmer grasp

strongest 1-2 months, disappears by 3months

deep crease on medial border of foot, atrophy of calf muscles and small foot with limit dorsiflexion are findings associated with

talipes equinovarus congenita

CT scan & MRI use in seizures

used for exploring possible causes of seizures such as brain hemorrhages, mass occupying lesions or tumors but are not at all useful in classifying seizures

Port Wine stain

vascular birthmark malformation consisting of superficial and eep dilated capillaries in the skin. permanent. rule out Sturge Webber

Introduction of foods

vegetables -->fruits-->meats **egg whites more allergic to in egg

which of the following is the most common type of congenital bleeding disorder

von willebrand disease

22-24 months

walks up and down stairs stacks 6-7 blocks 30-50 word vocal

Conjunctivitis Viral

watery or thick stringy mucoid Tx- artificial tear drops for lubrication, chronic conjunctivitis for allergies refer to optho for topical steroids

erythema toxicum presents with

yellow white lesions on redish pink base may be blotchy palms and soles are spared

further assessment of 4yr with limited language skills

Denver articulation screen exam

Daycare exclusion

E.Coli and Shigella require two negative stool cultures prior to returning to day care.

Tetralogy of Fallot

-Cyanotic -Combination of 4- pulmonary stenosis, VSD, overriding aorta, and RVH -loud SEM, middle to left upper sternal border -TET spells--> hypercyanotic spells--> sleep knee chect position, squat while playing

What are the three primary growth and development domains?

1: physical domain 2: Cognitive domain 3: Psychosocial domain

Chest pain- non cardiac

- sharp, stabbing pain along two or more contiguous costochondrial joints -pain exacerbated by deep breathing or coughing -may occur at rest or with activity -short duration (sec to mins) -hx of recent URI, asthma, pain after eating, recurrent injury, or trauma to chest Findings--> reproducible pain with palpation at costosternal junctions, localized inflammation of a costochondral joint, benign physical exam Tx- education, ibuprofen, activity restrictions until inflammatory conditions resolve

Bronchiolitis tx

- supportive care, suction -Bronchodilators (albuterol), epinephrine, and corticosteroids not recommended -Prevention--> synagis (palivizumab vaccine) indicated for high risk children in 1st yr of life -infants born at <29wks gestation -infants born at >29 wks gestation w/ chronic lung disease of prematurity, CHD -Does 15mg/kg IM given, in 5 monthly doses beginning in November -2nd yr of life guidelines for children with CLD and CHD, CF, Down syndrome

Cutis marmorata

- transient mottling of the neonates skin w/ a lacy, bluish apearance -physiologic response of uneven blood flow that results from constriction of sm blood vessels while other dilate -persistence after neonatal period found w/ Down syndrome -50% of these patients have one or more congenital skin conditions including glaucoma, hemangioma, and vascular malformations -Keep at stable temperature, reduce exposure to cold enviroment

precocious puberty

--> androgen or estrogen excess prior to puberty from CNS disorder (early development of pubic hair ) causes early secondary sex characteristics with testicular enlargement and spermatogenesis in boys , menarche and mature ova in girls -in boys before age 9 and girls breast development before 8yrs old, pubic hair before 9yrs, or menses before 9.5 yrs -Elevated LH and FSH

Physiologic hyperbilirubinemia unconjugated bili

--> indirect bili 5-7, usually peaks within 3-5 days, resolves by 10 days, higher incidence among preterm and low birth weight infants, occurs in 13% of BF infants within 1st wk of life

Mumps

-A systemic, viral infection disease charaterized by swelling of the parotid glands =caused by RNA paramyxovirus - infected individuals is contagious for as many as 7 days prior to and as long as 9 days after onset of symptoms S&S - parotitis, malaise, fever, orchitis, oophoritis (inflammation of ovary), aseptic meningitis -swelling of salivary glands, listlessness, scrotal swelling and pain Tx- isolation and supportive care, soft or liquid diet -may return to school when all symptoms have resolved or 9 days after onset of symptoms -report case to health department

Tibial torsion

-Abnormal bowing of the tibia S&S -toeing-in appearance of childs legs when walking/running -tripping and falling may be noticed -increased rotation of affected leg, flat feet, increased lumbar lordosis Tx- observation, have spontaneous correction w/ growth

Foreign body aspiration

-Abrupt onset of violent cough, with gagging, choking, stridor, wheezing, and possible cyanosis -unilateral wheezing and localized decreased breath sounds on side of aspiration -persistent cough, voice changes, stridor, dyspnea, sputum production, and emesis -high index of suspicion rigid bronchoscopy indicated for diagnostic (ENT referral) -do not perform blind finger sweep -antibiotics if evidence of pna or bronchitis

Prevention of bacterial endocarditis based on AHA guidelines

-Abx prophylaxis w/ dental procedures is recommended only for patients w/ cardiac conditions associated w/ the highest risk 1. prosthetic cardiac valave 2. previous endocarditis 3. CHD- unrepaired cyanotic cyanotic CHD including those with pallative shiunts and conduits, completely repaired CHD w/ prothetic material or device during the 1st 6 months after the procedure, repaired CHD with residual defects at the site of adjacent to the site of a prosthetic patch or prosthetic device 4. Cardiac transplantation recipients with cardiac valvular disease

Coarctation of the aorta

-Acyanotic -congenital narrowing of the aorta, usually distal to the origin of the L subclavian artery, opposite the area of the ductus arteriosus -unequal pulses ( decreased lower extremity pulses vs higher) -upper extremity BP (systolic) 10mm Hg or more higher than lower extremity BP - causes obstruction to LV (increases afterload) -ejection murmur (click), R upper sternal border, venous congestion

Jones criteria for rheumatic fever- Minor manifestations

-Arthralgia, w/o objective evidence of inflammation -fever usually at least 39C -elevated acute phase reactants (ESR, CRP, leukocyte count, elevated or rising antitreptolysin-O ASO titer) -prolonged PR interval on EKG

Jones criteria for rheumatic fever- Major manifestations

-Carditis--> valbulitis evident by new murmur (apical systolic murmur of MR), myocarditis (tachycardia), pericarditis (distant heart sounds, friction rub, chest pain) -Polyarthritis--> several joints may be intermittently involved, ranging from vague arthralgia to fluid swelling, heat, and redness. Most frequently larger joints (knees, hips, ankles, elbows, wrists) -Chorea-->purposeless, involuntary, rapid movements of trunk and/or extremities, muscle weakness and emotional lability -Erythema marginatum--> macular, non pruritic rash w/ irregular geometric morphology; areas have pale centers and rounded margins, lesions most commonly located on trunk and proximal limbs (never on face) -Subcutaneous nodules--> firm, painless nodules over the extensor surfaces of certain joints, particularly elbows, knuckles, knees, ankles, occiput, and vertebrae, skin overlying nodules is not inflamed and moves freely

iron deficiency anemia Management/tx

-Children should routinely be screened between the ages of 9 and 12 months -chlid at risk between 1 and 5 yrs Nutritional counseling -Supplemental iron drops or iron fortified cereal by 4-5 months of age -If not BF, use iron fortified infant formula until 1 yr of age -No cows milk before 1yr of age, then limit 18-24 oz per day -Prescribe 2-3mg/kg/day elemental iron in 1-2 doses/day prohpylaxis in low-birth-wt infants Oral iron medication -Prescribe elemental iron 3-6mg/kg/day in 1-3 doses until hgb normal, then 2-3 mg/kg/day for 4 months to replace iron stores. -Best absorbed on empty stomach -Failure to respond--> persistent or unrecognized blood loss, impaired GI absorption, failure of administrating medication ***can take 4-6 months to see iron levels increase

Transposition of the Great Arteries (TGA)

-Cyanotic -Aorta arises from RV; Pulmonary artery from the LV, have PDA at birth, usually create/enlarge atrial septal opening to allow for unrestricted mixing until surgery. -holosystolic, II-V murmur, systolic, +thrill, RVH, increase pressure backing into R side

Mono

-Epstein-Barr virus -Posterior cervical lymphadenopathy splenomegaly -fever -pharyngitis -malaise,anoerxia, myalgia *rash appears with amox (pronounce rash if given) Labs -leukocytosis, neutropenia -+ heterophil and monospot -early rise in IgM EBV -permanent rise in IgG EBV 3month no contact sport

PDA (patent ductus arteriosus)

-Failure of the ductus arteriosus to close after birth, allowing blood to flow from the aorta into the pulmonary (lung) artery (less vascular resistance after lungs inflate reverses fetal blood flow through DA) Indomethacin drug therapy or heart surgery to prevent CHF, emboli. -May have no cyanosis. - machine like murmur, cardiomegaly, LVH, increase PVR, remains open prostagladins help close -may keep open due to cyanotic lesion

Constipation causes

-Functional -Encoporesis -Anatomic abnormalities, rectal abnormalities -Intrinsic motor disorder-Hirschprung disease , Down syndrome -Metabolic- Hypothyroidism

Denver II

-Generalized assessment tool -Framework for looking at child evaluates children from birth to 6years in four skill areas: personal-social, fine motor, language and gross motor. Test is not always valid with a range of ethnicities. Adjust for prematurity.

Bronchitis symptoms

-Inflammation of the larger lower airways, excess mucus is present due to poor clearance or increased production, cough is prominent -acute bronchitis often follows a URI -chronic bronchitis symptoms persist for more than 2 weeks, chronic bronchitis rarely an isolated entity -Cough is hallmark symptoms--> initially dry and brassy but may become productive as illness progresses -sputum may become purulent, reflects leukocyte migration and not bacterial -swallowing sputum may result in nausea -retrosternal pain common if cough persists -brassy cough -coarse, bronchial breath sounds -fever may be low grade or absent

Tinea corporis (ringworm of body)

-Lesions are scaly plaques of varying sizes (annular) from less than 5mm-3cm w/ mild erythematous active borders -lesions spread peripherally as they heal centrally -lesions may be singular or severl Tx -topical antifungal meds--> ketoconazole, for 8 weeks -tx w/ oral giseofulvin for extensive recurrent and unresponsive condition -wash clothing touching affected area after each use

Pigeon toed Metatarsus Adductus/ Metatarsus Varus

-Medial deviation of the forefoot on the hind foot Pigeon toed, toeing in gait in older child Tx- supple deformity (adductus) parents stretch forfoot in all planes of motion w/ each diaper change for 4-6 months -Rigid deformity (varus)- serial casting or bracing in the first yr of life *refer

burns classification based on extent of affected area

-Minor burns-less than 10% of body surface if burn is superficial and less than 2% if burn is partial thickness -Major burn-10% or more of body surface if burn is superficial and 2% or more if burn is partial thickness -Major burn- hands, feet, face, eyes, ears, and perineal burns always considered major burns regardless of surface area

Tic disorders

-Symptoms appear before 18 yrs -exacerbated by stress -some degree of voluntary control may be present -Typically subsides during sleep Simple Tics--> movements present that resemble nervous habits, facial twitches, head shaking, eye blinking, shoulder shrugging, or throat clearing

Turner syndrome XO Karyotype

-To amke diagnosis the female must have the characteristic features of TS with the complete or partial absence of the second X sex chromosome with or without mosaicism of the cell line S&S -female with unexplained growth failure or pubertal delay -edema of hands and feet, webbed neck, L side cardiac anomalies, esp COARC, or HPLH -low hairline and high-arched palate, low set ears with small mandible, chronic OM, short statures -Marked elevated FSH, cubitus valgus (medical deformity in which the forearm is angled away from the body to a greater degree than normal when fully extended) -nail hypoplasia **Lymphedema neonatal (resolved by 2yr) -Widely spaced oten inverted nipples with "shield" shaped chest'-HTN and aortic murmur -Annually from age 4 and onward Ta, TSH due to high rate of autoimmune thyroid disease (thyroiditis, hypothyroid, hashimoto)

Impetigo treatment

-Topical antibiotics for areas with little involvement (limited) w/ mupirocin -Oral abx for numerous lesions- Cephalexin (Keflex) treats both staph and strep -Exclude from school and other public programs for 48 hrs b/c of high communicability

Constipation Tx

-Xray abd- examine for stool Infants >6 months of age= prune juice; malt soup extract to 3 tsps BID for max of 3 days Bowel training for encopresis-- sit on toilet for 1 minute per yr of age BID per day; dont expect bowel movement every sitting. Institute reward system for positive reinforcement If impacted--> Day 1--> mineral enema to soften stool -No impaction or day 2--> sodium phosphate enema one time per day for 2-3 days -Oral meds for disimpaction, Miralax 3350, 1-1.5g/kg/day for 3 days -After intestines emptied--> keep stool soft to prevent reoccurrence of withholding cycle- Miralax 3350 1g/kg/day -Prevent pain cycle- emphasize to child medication will prevent painful stool Goal--> soft bowel movement every day or every other day without encopresis

cataracts

-abnormal, uniform, progressive opacity of the eye seen in children with co-morbid syndromes (cloudy) - Down syndrome, DM, Marfan syndrome, and atopic dermatitis -hazy corneas

psoriasis

-acquired chronic, relapsing inflammatory condition characterized by erythematous plaques w/ silver-gray scales -Psoriasis vulgaris--> predominantly on elbows and knees -Psoriasis guttate--> small patches on trunk, upper arms and thighs (associated w/ strep infection) -*fam hx -due to overproduction and too rapid migration of epithelial cells to skin surface; cells migrate 3-4 days vs usual 28days -Nail plates may be thicker and show signs of pits, ridges, "oil spots", which are yellow discolorations of the nail plate (oncholysis)

Motor milestones 3-6 months

-actively moves arms (reaches and swipes) when sees an object of interest -grasps object voluntarily -plays with his own hands and feet -watches/plays with hands/toys at midline -transfers toys from hand to hand -when on stomach, lifts head and chest with weight on hands -holds head upright and steady -rolls from stomach to back and back to stomach

gonococcal conjunctivitis

-copious purulent -IV pen G or IM ceftriaxone co treat with chlamydia-->erythromycin or oral tetracycline, azithromycin, erythromycin, doxycycline

Simple partial sz

-activity restricted to 1 side of body but may spread to other parts -usually lasts less than 2 minutes, NO LOSS of consciousness and no postictal state -Motor- part of body or entire side (arm, leg, Jacksonian march, postural, vocalization) -Sensory- visual, auditory, olfactory, paresthesias, visual hallucinations Autonomic- result in changes in parts of the nervous system that automatically control bodily functions (tachycardia, pallor, sweating, flushing)

Erythema multiforme minor

-acute condition of the skin involving hypersensitivity reaction characterized by multimorphology skin and mucous membrane eruptions; lasts 2-3 weeks w/ spontaneous resolution -Hypersensitivity cause by exposure to enterovirus, mycoplasma pneumoniae, Herpes simplex, barbiturates, sulfa and penicillin drugs, or foods -pruritus and pain at site of lesions, erythema and edema w/ lesions progressing from macules to papules, vesicles, bullae, and petechiae -lesions predominately on hands, elbows, knees, ankles, feet, eyes, lips, oral mucous membranes, tongue, oral cavity -lesions develop in crops over period 1-2wks with each crop lasting 1 week -targetoid bulls eye lesions may be present, a necrotic vesicular center, a pale middle macular ring and an outer erythematous peripheral ring TX- antihistamines, maintain hydration, mouthwashes for oral lesions (lidocaine)

ASD (atrioventricular septal defect)

-acyanotic atrial and ventricular septal defects allow excessive pulmonary blood flow to occur. Common in Down syndrome -elevated pulmonary vascular resistance could affect R heart fx - heard L upper sternal border - L to R shunt- enlarge R due to more blood flow

Hirschsprung disease

-affects the large intestine (colon) causes problem with passing stool. Present at birth as a result of missing nerve cells in the muscles of the colon. Stretch megacolon. -hx of failure to have bowel movement w/out aid of laxative or enema, no meconium at birth -ribbon-like stools, small, complaints of no stooling -tight empty rectum in presence of palpable abd stool mass, may be explosion of stool on withdrawal of examining finger -stool may be guaiac +, abnormal bowel sounds; abdominal distention, FTT -refer GI

obstructive lung disease

-airflow rates are reduced, lung volumes, issues with exhaling-->air trapping= decrease rates FEV1 (normal FEV1 80%), hyperresonance Narrowed airways result in resistance to airflow during breathing. Examples are asthma, bronchiectasis, COPD, and cystic fibrosis.

Contact dermatitis (allergic)

-allergic response to local contact with an allergen manifested by development of skin eruptions at site of contact -erythema and edema at site of contact, lesions of varying sizes, pruritus, excoriation due to scratching -skin testing to determine allergen hypersensitivities TX -Cool compresses of Burrows solutions to affected area -steroids to reduce inflammations, immune response, and pruritis -short course oral steroids (taper)or topical steroids -oral antibiotics for secondary infection (sulfamethoxazole and trimethoprim) -refer to derm if no improvement in 2 days

Labial adhesions

-benign fusion of labial minora - Usually occurs after 2 months of age S&S -difficulty voiding, general discomfort -enuresis (primary diurnal), pooling of urine behind adhesion after voiding, results in dribbling of urine throughout the day Management--> observation, observe for UTIs -topical application of conjugated estrogen cream; applied sparingly BID for 2-3 weeks results in separation within 8 wks 90% of the cases (overuse may stimulate signs of precocious puberty, such as breast buds, which resolve when cream is discontinued.) -transient hyperpigmentation of labia may occur during tx Following separation--> maintain good hygiene, topical applications of bland cream or petroleum jelly

Capillary hemangioma (strawberry nevus)

-bright red or blue-red nodular tumors of varying sizes and shape with a rubbery and rough surface predominately on head and face -caused by proliferation of capillary endothelial cells, which may be superficial or deep -often not present at birth -grows quickly w/in 2-4 weeks to a red or blue-red protuberant, rubbery nodule plaque, most growth the 1st 6 months, gradual reduction in proliferation usually begins b/w 9 and 12 months with gray areas developing, followed by flattening from center to periphery, a flat or involuntary are of hyperpigmentation often remains following dissolution of the lesion -complication may occur resulting from location and depth of lesion, thrombocytopenia may occur resulting from trapped platelets w/in lesion -lesions resolve spontaneously and completely disappear with age--> 50% are cleared by 5yrs of age, 90% cleared by 10yr -refer to derm evaluation to r/o involvement of vital organs -tx depends on location, oral propranolol protocols in some cases

Chest pain (cardiac)

-can be associated w/ palpations, exertional, radiating, associated w/ nausea, dizziness, fatigue - recent hx of febrile illness, hx of kawasaki, murmur noted of underlying cardiac disease -refer to cards, restriction from activity until seen

Motor milestones 3-4yrs

-can run around obstacles -can stand on one foot for 3-5 sec -stand on tip toes 3-5 seconds -can walk on a line without stepping off -can hop on one foot -rides a tricycle -can jump forward -throws ball overhand or underhand -can build a tower -copies drawing of circle -imitates drawing od cross -cuts paper in half

Asthma

-chronic airway inflammation causes airway hyperresponsiveness to a variety of stimuli, variable airway obstruction -immunohistopathologic features--> inflammatory cell infiltration w/ neutrophils, eosinophils, lymphcytes, mast cell activation and epithelial cell injury -persistent airway inflammation can lead to airway wall remodeling, irreversible changes, and loss of pulmonary fx

Bronchitis tx

-chronic bronchitis- not at distinct entity in children; investigate underlying systemic or pulmonary problem -acute bronchitis, increase fluid intake, antihistamines and cough suppressants, bronchodilators if accompanied by wheezing -Antibiotics are useful if bacterial etiology is suspected and cough is >10 to 14 days duration

Contact irritant dermatitis

-common disorder of genital-perineal area ue to skin breakdown; characterized by erythema, scale, and other lesions such as vesicles -breakdown of skin associated w/ chemical irritants--> soaps, bleach, water softners, skin lotions, diaper cleansing tissues, excessive contact to urine, feces -monilial rash caused by candida albicans (fiery red papular lesions w/in folds and on genitals, may be associated w/ oral thrush) -redness, sores in diaper area, blisters, fiery red rash with satellite lesions -pustules suggest secondary infection TX -secondary infection tx w/ topical antibiotics mupirocin

Kawasaki disease tests/tx

-diagnosis of exclusion -leukocytosis w/ L shift -thrombocytosis in 1st week -ESR and CRP elevated -Echo -EKG changes--> secondary myocarditis ST-t wave changes and prolonged PR interval TX- IVIG and high dose aspirin

Red flags for infant

-does not raise head when laying on stomach by 3 months -does not pick up toy by 6 months -no reactions to noise/voice -does not laugh -does not seek interpersonal contact -does not sit up

Tinea pedis (athletes foot)

-erythematous scaly patches of varying sizes, small vesicles, central clearingg and peripheral spreading, affected areas on foot or toes -lesions on or between toes are scaly w/ mild erythemam interdigital fissures are present, dystophy of toenails may be present w/ yellow discoloration of the nail matrix and periungual debris -Tx--> w/ ketoconazole cream, 8-12 wks, absorbent antifungal cream -tx w/ oral giseofulvin for extensive recurrent and unresponsive condition

Tinea curis (jock itch)

-erythematous, scaly red to brown lesions of varying size with well defined raised borders, sm vesicles, central clearing, and peripheral spreading to the upper thighs, groin, or inguinal folds -painful to touch and with movement -often concurrent with tinea pedis -KOH scrapping of lesion border- confirms hyphae and spores Tx--> topical antifungal ketoconazole, 4-6 wks -tx w/ oral giseofulvin for extensive recurrent and unresponsive condition

cystic fibrosis signs and symptoms

-extremely viscid meconium (newborns), w/ delayed passage -poor growth, FTT, despite normal to increased appetite due to fat malabsorption and maldigestion -recurrent or chronic respiratory infections, dyspnea on exertion -large bulky, foul-smelling, greasy stools -frequent flatulence or abd pain/distension -chronic cough, productive w/ blood streaked mucus -nasal polyps, chronic sinusitis -rectal prolapse -salt-tasting skin -distal sm bowel obstruction -recurrent pancreatitis -wheezing and air trapping w/ increased anterposterior diamete of chest (barrel chest) -male infertility, delayed puberty

TM Tubes

-fitted earplugs with swimming -drainage occurs- tx with- abx otic suspension (fluoroquinolone otic drops 1st line), polymyxin B with neomycin and hydrocortisone

Neonatal hyperbilibrubinemia

-increased amount of bilirubin in the blood; if untreated and bili levels rises can cause encephalopathy (kernicterus) 1. Unconjugated (indirect) types--> caused by overproduction of bilirubin, impaired conjugation, transport or uptake of bilirubin 2. Conjugated bili (direct)--> caused by rare of pathologic conditions (rare in new borns), including biliary obs, infections, drugs, and other metabolic disorders -direct bili >1.5 to 2, jaundice in 1st day of life, total bili >12.9, persistence >1weeks S&S -yellow discoloration of skin, whites of eyes, guns, and oral mucosa -clinical jaundice varies based on bili leve, 5mg/dL appears first on head and progresses down chest/abd as bili increases, usually at leat 15mg/dL when notes on distal extremities -heptaspenomegaly -edema Tests- Coombs test Bilirubin indirected hyperbili- unconjugated bili increased direct hyperbili- conjugated bili increased retic count may be increased with both indirect and direct Management- Indirect unconjugated hyperbili--> hydration and feeding, phototherapy, exchange transfusion Direct (conjugated) hyperbili- tx underlying disease

Molluscum contagiosum

-infectious self-limiting skin condition characterized by waxy, firm papules, predominately on face, axillae, abdomen, and arms -Caused by poxvirus -Incubation period 2-8 weeks but may be up to 6 months -Period of communicability uncertain, may persist as long as lesions are present, spread by direct contact and through autoinoculation

Acute myocardial inflammatory disease

-inflammation of the layers of the heart (myocarditis) -viral infections are the most common etiology -fever or flu like viral illness -suspect myocarditis if onset of congestive heart failure s&s- persistent tachycardia, tachypnea, dyspnea, easy fatigue, poor feeding, gallop rhythm, poor perfusion -refer to cards

Seborrhea Dermatitis

-inflammatory condition usually on sebumrich areas such as scalp ad face Infants-->Cradle crap- areas or underlying erythema w/ yellow crusts and greasy scaling scalp and face-->TX-->shampoo and wash affected area with nonperfumed baby shampoo or baby wash, mineral oil with brushing to loosen crusts prior to washing Adolescents--> dandruff

Scabies

-intense itching -fine gray to skin colored superficial 2-8mm linear curved burrows w/ small papule at proximal end Infants- red/brown papular, vesicular lesions on head, neck, palms, and soles Older children and adolescents- red papular lesions on webs of fingers and folds of wrists, elbows, axillae, waist, buttocks, groin, umbilicus, abd, knees, and ankles Tx -bathe and dry skin, and then treat with topical meds. Permethrin 5% -topical steroids to reduce inflammation, immune response, and pruritus (hydrocortisone) or oral antihistamines Secondary infection- mupirocin topically extensive oral abx cephalexin **treat household and other close contacts, eash clothes, bed linens, towels, and hats w/ hot water and dry in hot fryer -store nonwashable items in plastic bag for 1 wk, do not use -residual pruritus and skin irritation can persist for weeks after successful tx.

3rd degree/full-thickness burns

-involve epidermis, dermis, and dermal appendages - white, brown, to black, swollen, dry, lack full touch, pain, temperature sensitivity,

Acne vulgaris (moderate)

-lesions are more numerous , covering larger areas - all lesions of mild acne and pustules Tx -topical tretinoin, retnoids (reddens skin in sun, apply at night do not use w/ benzoylperoxide), topical benzoyl peroxide -can use topical antibiotics for moderate- clindamycin, add oral abx for persistent and unresponsive cases (tetracycline, doxycycline, minocycline)

Motor milestones at birth to 3 months

-lifts and turns head when on stomach -when on back, will turn head to hear or see something -random movements become more purposeful but are typically large, jerky movements -brings hands to mouth -grasp reflex

Cellulitis

-localized acute infection often precipitated by an insect bite or trauma that penetrates the protective skin barrier -Cause when surface streptococci, Haemophilus influenzae, staphylococcus aureus bacteria invade all skin layers -erythema and edema w/ ill defined, irregular borders, tenderness and warmth, regional lymphadenopathy, fever, chills, and malaise may indicate systemic involvement

Molluscum contagiosum symtoms and TX

-papular pink-white or skin colored lesions, usually on face neck, axillae, abdomen, and arms -lesions may become umbilicated, self limiting but may be present up to 2-3 yrs TX R/o maltreatment is lesions present in genitals -lesions resolve spontaneously w/o tx overtime -topical applications of keratolytics not recommended if near eyes ( tretinoin cream, cantharidin) -Avoid direct exposure of others to lesions -wash hands before and after application of topical medications/ or touching lesions -avoid personal items and siblings sharing baths

atopic dermatitis (eczema)

-periods of remission and exacerbation -pruritus for both, worsens w/ sweating and temperature extremes S&S -acute form in infants usually develops b/w ages 2wks and 6 months w/ 50% of cases resolving by 3 yrs and remainder develop chronic -lesions appear as erythematous scaly patches of skin on face, head, trunk, and extensor, papules, xerotic, oozing/crusting -Chronic form develops w/ poor skin management and personal and family hx of atopy--> skin is hyperpigmented, leathery, and lichenified in the flexor surfaces of the neck, antecubital areas, wrists, popliteal area, ankle, fingers and toes -pustules may be present with secondary infection

Tinea capitis (ringworm of scalp)

-superficial dermatophyte fungal infection of scalp -spreads through direct and indirect contact -occurs more often in hot, humid climates -communicability occurs as long as lesions w/ dermatophytes are present -scaly patches of varying sizes w/ or w.o alopecia and pruritis -pustules, papules w/ areas of honeycomb crusts -tender erythematous areas w/ broken hairs at scalp level leaving a black dot appearance Tx--> oral antifungal meds=Griseofulvin (8wks) monitor liver function tests need baseline and during tx. -Shampoo 2-3 times weeklys w/ selenium sulfide or ketoconazole to reduce spore count and infectivity -avoid sharing personal items

Mastoiditis

-tenderness over mastoid bone w/ or w/out edematous or erythema over bone -fever/irritability, ottorhea (ear d/c) -pinna displaced downward and outward -AOM +/- narrowing of ear canal in posterior superior wall due to pressure from mastoid abscess -Prompt referral to ENT and hospitalization -CT scan, CBC, Bl cx, -abx for 4-6 wks

Erythema toxicum neonatorum

-transient, benign, self limited skin rash w/ lesions of varied morphology; erythematous macules, wheals, vesicles, and pustules -onset usually w/in 1st 24 to 48 hrs of life, occasionally present at birth -lesions usually arise from erythematous base w/ macular erythema fading w/in 2-3 days -occurs predominantly on trunk, may occur anywhere on the body except the soles and palms -spontaneous resolution in 5-7 days -describe and monitor lesions, no tx necessary, refer to derm for eval if no improvement

Motor milestones 6-9 months

-uses index fingers to poke -holds an object in each hand and plays with each -transfers objects from hand to hand --pivots on stomach -pulls themselves to hands and knees -sits w/o help, playing with toys

Viral Pneumonia

-usually children <5yrs -gradual onset, preceding URI -CXR--> interstitial infiltrates and peribronchial cuffing -WBC may or may not be elevated

Toilet Training

1.5-2.5 years old Average daytime control is usually achieved by 2 years Nightime control usually lags one year behind. Do not start in time of stress Do not punish and reward all good efforts

Psychosocial periods of adolescence Early adolescence

11-14yrs importance of peers, feeling "normal", moodiness

Caloric intake of newborns

110-120 cal/kg/day

Preoperational/preconceptual stage Jean Piaget (cognitive development)

2-4yrs -can focus on a single aspect of a stimulation -no cause-and-effect reasoning -egocentrism -development of intuitive thought -difficulty distinguishing fact from fantasy (magical thinking)

erythema toxicum appears and resolves

2-5 days after birth and usually resolves within 14 days of birth

Stage of initiative vs guilt Erik Erikson (psychosocial)

3-6 yrs old

Introduce other foods

4-6 months.

the expected Hgb range for sickle cell anemia is

6.5-9.5

school age weight gain

6lb per year

Concrete thinking Jean Piaget (cognitive development)

7-11 yrs -capable of logical thought -logical operations - Concepts time and money -Classify -Categorize -though process expanded; capable of reversibility -can grasp the concept of conversation -master cause and effect -understand concept of space -capable of deductive reasoning

Caloric intake of 2-10yr

70cal/kg/day

Acquired syphilis

A contagious systemic infectious disease characterized by 3 progressive clinical stages 1. Primary-> painless chancres on skin or mucous membranes at site of exposure that may go unnoticed 2. Secondary--> between 1-2 months after inoculation, characterized by skin rash, copper colored lesions, cutaneous lesion, lymphadenopathy, fever, malaise, sore throat, skin rash, hair loss 3. Latent stage--> no lesions, early latent is less than 1 yr, and late latent is more than 1 yr duration 4. Tertiary stage- multisystem involvement that may occur from years after primary infection, including aoritis or gummatous changes of skin, bone, or viscera Neurosyphilis may occur ay any stage of infection, esp HIV pts ***Crosses placenta- causes congenital syphilis Tests- Microsdope tests--> direct fluorescent antibody tests- presence of spirochetes from scrapings or washings of primary lesions; Definitive diagnosis serologic tests- presumptive dx Nontreponemal tests- rapid plasma reagin (RPR), VDRL, TRUST (toluidine red unheated serum test) Treponemal tests--> fluorescent treponemal antibody absorption (FTA-ABS) and treponema pallidum particle agglutination (TP-PA) greater specifity

Iron deficiency anemia

A microcytic, hypochomic anemia caused by inadequate supply iron, associated with low reticulocyte count and elevated red cell distribution width causative factors -deficient dietary intake, increased demand (growth, cyanotic heart), blood loss, malabsorption -most common between 8 and 18 month of age and adolescents, iron stored enough up to first 4-5 months of age -Hgb falls 2 standard deviations below the mean for age and gender

Malaria

A parasitic infection primarily acquired via mosquito bite that is characterized by high fever, rigors, sweats, and HA -Need prophylactic treatment when traveling to endemic areas

Fifth disease (Slap cheek)

A viral exanthematous illness, erythema infectiosum self limited and resolves w/o sequela -Human parvovirus B19 via direct contact and respiratory droplet -Typically seen in 5-14 yrs old -Most infectious prior to rash, incubation period 4 and 14 days -Not contagious after fever breaks -Diagnosis based on clinical presentation of classic slapped cheek rash with a lacy-reticular exanthem on the extremities and torso -Parvovirus B19Igm antibody confirms current infection or past infection TX--> symptomatic for fever/arthralgias, avoid sunlight as exposure may exacerbate the condition. -period of high infectivity in persons with EI is prior to onset of symptoms, unlikely to be infectious after rash develops. -Can cause still birth or spontaneous abortion

Torticollis

Abnormal position of head and neck, due to unilateral contracture of sternocleidomastoid muscle that may be congenital or acquired or due to atlantoaxial rotary subluxation, which is a displacement of C1 or C2 -20% have developmental dysplesia of the hip S&S -Childs head tilted toward side of contracture -plagiocephaly or asymmetry of face/skull development present with progressive deformity Dx- Cervial radiograph, Hip US rule out DDH management--> refer to PT, surgery recommended persists by 1yr of age, stretching exercises unsuccessful

Cryptorchidism (undescended testes)

Absence of one or both testes in scrotal sac due to failure of normal descent from abdomen during fetal development -common (20-30%) among premie w/ birth wt <1500g - family hx of undescended testes, may be palpable or nonpalpable -Palpable testes may be retractile or ectopic -Nonpalpable testes- may be abdominal or absent - presence or absence of testes should always be documented -Bilateral nonpalpable testes--> karyotyping for chromosomal abn, follicle-stimulating and lutenizing hormone may suggest anorchia Management -routine assessment at well-child visit during 1st year of life, most spontaneous descents occur by 6 months -refer to urologist if undescended by 1 yr Education -Infertility- greater risk in bilateral cryptorchidism ****Testicular malignancy up to 40x increased risk (teach adolescent to check)

Kawasaki Disease

Acute febrile syndrome causing vasculitis ** most common in children under age 2** Most common in Asians DX: must have fever and at least 4 of criteria below: Fever> 5 days, Bilateral conjunctival infection w/o exudate, polymorphous rash (urticarial or pruritic), inflammatory changes of the lips and oral cavity, changes in extremities ( erythema, edema,etc), cervical lymphadenopathy...***strawberry tongue*** Labs: CBC, elevated ESR, positve CRP, ECG shows prolonged PR and QT interval. Mgmt: immediate referral to peds cardiologist, high dose ASA 80-100mg/kg/day until afebrile for 48 hours then 3-5mg/kg/day until peds cardiologist discontinues.

Rubella (german measles) 3 day measles

Acute, mild, contagious, viral disease characterized by an erythematous, maculopapular rash, lymphadenopathy, conjunctivitis, and/or arthralgia, or arthritis -Maternal infection in pregnancy can cause spontaneous abortion, death, or congenital deformities -Clinical case definition--> acute onset of a generalized maculopapular rash, fever >99F, arthralgia/arthritis, lymphadenopathy, conjunctivitis S&S -rash starts on forehead and face and spreads over trunk and extremities during 1st day; facial exanthem fades by 2nd day, disappears by 3rd day -postauricular, suboccipital and posterior cervical lymphadenopathy usually precedes rash, petechia on soft palate and uvula (forchheimer sign), fever Test -positive antirubella IgM in acute serum or a significant rise in serum rubella IgG titers between acute and convalescent phases Management -supportive -out of school for 5 days after onset of rash

Kawasaki primary care

Administration of live virus vaccines (measles and varicella) delayed at least 11 months after IVIG tx -IVIG decreases effectiveness of vaccine -Administration of annual influenza vaccine to pts on long term aspirin therapy -Activity restrictions beyond initial 6-8 wks based on severity of coronary artery involvement

AIDS

Advanced stage of illness with HIV, classifies children according to presence or absence of clinical S&S -No breastfeeding (access for transmission) Baseline labs--> CBC, albumin, total protein, phosphate, calcium, HIV RNA, drug resistance test, lipid panel, UA, measurement of CD4T lymphocyte count can be every 6-12 months S&S--> onset 12-18 months but can be latent for years -influenza like illness (fever, rash, sore throat, lymphadenopathy, and myalgias) for 2-4 weeks -Lymphadenopathy is often the 1st symptoms, FTT, chronic diarrhea or recurrent diarrhea, pneumonia, oral candidiasis, recurrent bacterial infections, chronic parotid swelling, and progressive neurologic deterioration Oppurtunisitic diseases--> Myobacterium avium infection, severe CMV after 6 months old, EBV, VZV, disseminated histoplasmosis, RSV, M tuberculosis and measles (despite vaccinations) -S.pneumoniae, Hib, S aureus, and salmonella are common with AIDS, HIV exposed infants, testing times should be done 14-21 days, 1-2 months, and 4-6 months NAAT must be used -at birth ARV prophylaxis -Treatment with zidovudine to all HIV exposed newborns -at 12-18 months enzyme immunoassay for antibody to HIV1

Tension HA

Affects all ages but more common in adolescence -diffuse, dull pain, mild-moderate intensity, present all day with worsening in the afternoon -occurs most frequently with increased stress -involve the occipital or temporal regions bilaterally and often extend to neck, or may be diffuse -N/V may occur with chronic tension HA, not episodic

What is Piaget's Formal Operational though? What age is it for?

Age: 11 to 15 years A: ability to abstract B: capable of complex problem solving C: reality-based D: logical conclusions

What is Piaget's Preoperational/Preconceptual Stage? What age is it for?

Age: 2 to 4 years A: can focus on a single aspect of a situation B: no cause and effect reasoning C: egocentrism D: development of intuitive thought E: difficulty distinguishing fact from fantasy (magical thinking)

What is Piaget's Intuitive/Preoperational thhinking? What age is it for?

Age: 4 to 7 years A: beginning of causation

What is Piaget's Concrete thinking? What age is it for?

Age: 7 to 11 years A: capable of logical thought B: logical operations

What is Piaget's Sensorimotor stage? What age is it for?

Age: birth to two years A: reflex: inborn B: adapts inborn reflexes to the environment C: object permanence D: sensory abilities improve becomes increasingly aware of the environment E: Trial and error learning F: Simple Problem solving

Newborn Screen's

All 50 states test for PKU, galactosemia, hemoglobinopathies, congenital hypothyroidism.

Urinary Tract infection

Bacterial infection of the urinary tract involving the bladder (cystitis), urethra (urethrisitis), or kidney (pyelonephritis) -Ecoli 80% of the cases in children, other Klebsiella, or enterobacter S&S -Newborns--> irritability, poor feeding, diarrhea, fever, vomiting, wt loss -Infants/preschoolers--> diarrhea, vomiting, fever, poor feeding, strong/foul smelling urine School age--> fever, vomiting, strong/foul-smelling urine, suprapubic or urethral pain, frequency, dysuria, and incontinence -abd examine--> pain, tenderness, guarding -BP may be elevated due to reflux nephropathology

Hemophilia

Bleeding disorder cause by congenital deficiency or absence of clotting factor VIII, or IX -Hemophilia A (factor VIII deficiency) S&S -easy bruising at injection site, prolong bleeding following circumcision, excessive bruising after child begins to walk -mucosal bleeding, prolong bleeding in any part of the body, may have pain at site of the bleed -hemarthrosis (bleeding into joint spaces) -ecchymosis -swelling and pain in joints Diagnostic--> direct assay of plasma factor activity level for hemophilia A and B -activated partial thromboplastin time prolonged (APTT) - PT normal -Bleeding time (not indicative)- normal Managment--> factor replacement therapy

Pertussis (whooping cough)

Bordetella pertussis--> prolonged coughing episodes ending in inspiratory whoop Clinical decision--> is a cough illness lasting 2 weeks w/o apparent cause paroxysms of coughing, inspiratory whoop, or postussive emesis -Patients considered infected until they have received 5 days of antibiotics -No lifelong immunity, protect immunity decreases after 5-10 yrs, booster vaccine is recommended for adolescents S&S -Catarrhal stage- mild URI sx with mild cough for approximately 2 weeks, low grade fever, malaise, rhinorrhea, excessive lacrimation, and conjunctival injection -Paroxysmal stage--> 2nd week of illness, hallmark is paroxysmal cough night and day, if untreated leads to vomiting, sucking, or crying precipitates coughing episodes, poor feeding and poor wt gain -Convalescent stage--> coughing gradually -subside over several weeks to months Tests--> PCR, CXR w/ patient for 2-4wks of cough Culture is the standard for diagnosis

Eating Disorders

Cause is not clear. Peak at 14-18yrs. Mortality is high at 10%. Weight loss Anemia, dry skin, constipation, low vital signs, Lanugo, tooth enamel erosion, ****Russels sigh: Bruised knuckles**** Mgmt: interdisciplinary mgmt, behavior modification, psychotherapy, may need hospitilization. Mild < 20% Mod 20-30% Severe < 30%

Prader willi syndrome

Caused by a failure of expression of the paternally acquired imprinted region on chromosome 15q11-q13 affect neurologic and endocrine systems -uncontrollable appetite and obesity -hypotonia,FTT, feeding problems -temper tantrums and OCD -FISH study Education --> dietary management, high pain tolerance, increased risk for febrile sz, OSA

What is the direction of growth for physical domain?

Cephalo ---- caudal Proximal ---- distal

Sickle cell disease

Chronic hemolytic anemia (constantly breaking down) -Autosomal recessive genetic disorder characterized by Hgb S variant of the beta globulin gene -Occurs in AA, Mediterranean, Indian, and Middle eastern descent Sickle cell anemia Hgb 6.5-9.5 MCV- >80 Retic count- 5-20% Sickle cell trait- one normal hgb A and one sickle form, asymptomatic, can have symptoms if become hypoxic

Inflammatory bowel disease Chrons

Chronic intestinal inflammation w/ 2 specific entities of ulcerative colitis and Chrons disease Chrons--> occurs in any part of the GI tract, terminal ileum typical, inflammation extends through entire thickness of intestinal wall and strictures and fistulae may develop -Chrons--> skip pattern, discrete areas of inflammation interspersed w/ normal mucosa -Diarrhea--> loose w/ blood if colon involved, can have pain but no diarrhea -Wt loss/delayed pubertal maturation -Abd pain located in the RLQ sometimes as fullness or mass; food related Refer to gastro _CBC w/ diff shows microcytic anemia, increased WBC, elevated ESR and CRP, Chem panel shows low K and albumin -Stool studies- stool for calprotectin (released when inflammation is present in the intestine)

Herpangina

Coxsackievirus group A/B -Fever, HA, myalgia (soreness, ache), malaise -sm vesicles or punched-out ulcers, on soft palate ad tonsillar pillars, anterior structures (gingivia, buccal mucosa, and hard palate) -topical relief w/ 1:1 mixture of diohenhydramine combined w/ antacid preparations consisting of magnesium and aluminum hydroxide

Fragile X syndrome

Decreased or absent levels of fragile X mental retardation protein -males are more effective then females since they only have one X chromosome -most common inherited cause of mental retardation phenotype--> long, narrow face, prominent jaw, with high arched palate, dental crowding, malocclusion, chronic OM, strabismus, GI reflux, soft velvet skin, joint hypermobility, scoliosis, clubfoot, poor gross motor coordination, Macro-orchidism (large testicles as early as 5 yrs, poor eye contact with excessive shyness and anxiety -murmur or apical midsytsolic click

Neurofibromatosis Type 1 (Von recklinghausen disease)

Genetic disorder that causes tumor to grow around nerves (esp eye) -often has learning disabilities and or ADHD\-inherited autosomal dominant disorder (present in every generation) S&S 2 or more of the following 1. 6 or more cafe au lait spots measuring more than 5 mm in children or 15mm in adolescents (usually on trunk and flank areas) 2. Freckling in armpirs or groin 3. 2 or more neurofibromas- tumors around or on the peripheral nerves 4. 2 or more growths on the iris of the eye 5. optic glioma (tumor) 6. pheochromocytoma- tumor of the adrenal gland 7. enlargement of liver 8. distinctive osseous lesions (sphenoid wing dysplasia or thinning of long bone cortex, with or without pseudoarthritis) 9. 1st degree realtive with NF1 DX Slit lamp ocular examination to identify ocular abnormalities, cranial MRI, xray of spine, chest, skull, eeg Management--> problems associated with NF1--> constipation, seizures, HA, hyperactivity, learning disabilities, anxiety, and renovascular HTN

which counseling for a parent of a 2yr old with elevated lead level would be effective in decreasing lead exposure?

HEPA filters for vacuuming

Tay sachs disease

Inborn error of metabolism, which causes a deficiency of hexosaminidase A. Results in progressive neurologic degenerative disease -marked by an exaggerated startle response, FTT, loss of normal milestones, spasticity, and developmental regression -Autosomal recessive single gene disorder **Ashkenazi Jewish population (80%), some pennsylvania dutch, louisiana cajun, french canadian S&S -normal development until age 3-6 months, then progressive deterioration -earliest symptom is irritability and increased reaction to sound with emerging spasticity -hypotonia -Vision starts to detriorate by 6 months with blindness at 1 -***Cherry red spot of the macula is due to degeneration of the ganglion cells -macrocephalic -sz activity by 6 months

Cervical lymphadenitis

Infection/inflammation of cervical lymph nodes -complaints of swollen neck or face, fever common, large unilateral cervical mass 2-6cm, overlying erythema present, tenderness on palpation -oral abx-->augmentin, or cephalexin for 10 days, reexamine after 36-48 hrs if no improvement need iv abx.

Meningitis

Inflammation of the meninges -Bacterial pathogens -Highest risk--> children 2 yrs of age and younger have the greatest incidence, with peak occurring at less than 1 yr of age (6-12 months highest risk) S&S -temperature instability, resp distress, irritability, lethargy, poor feeding, vomiting Older infants and children -N/V, irritability, confusion, anorexia, HA, cranial nerve palsy, ataxia, photophobia -Kernigs sign--> flexion of the leg 90 degrees at hip, pain on extension of leg -Brudzinski sign- involuntary flexion of legs when neck is flexed -weakness, numbness, eye movement problems, double vision Behavior change is key! Newborn- bulging fontenel, increase ICP, vomiting Immunizations for preventing meningitis--> Hib, pneumococcal conjugate, and meningococcal 50% have some sequela after survivial- hearing deficits, language disorder, vision impairment, mental retardation, motor problems, sz

Lyme Disease Management

Known tick bite--> single dose abx prophylaxis with doxycycline; children >8yrs of age 4mg/kg/day orally as a single dose -postexposure prophylaxis w/ a single dose of doxycycline may be used for a significant exposure meeting all of the following criteria--> an engorged tick is removed before at least an estimated 36 hr of attachment -prophylaxis is started w/in 72 hrs of tick removal Early disease -Children >8yr of age doxycycline drug of choice 2mg/kg/dose orally twice a day for 14-21 days -Children <8yrs- amoxicillin 20-50mg/kg/day TID for 14-21 days Early disseminated disease -Multiple EM is treated the same as for early localized disease for 21 days -Isolated facial palsy is the same for 21-28 days -Arthritis is the same for 28 days Late disease-IV, hospitalization

Genu Varum (bowleg)

Lateral bowing of the tibia -Considered normal until 36 months -Bowing does not generally increase after 16 months and usually resolves by age 24 months -resolution occurs without tx Further evaluation with radiographs necessary if-->Genum varum is present after 2yrs of age -progressive after 1yr of age -unilateral involvement -appears to be severe -occurs in a high-risk group, obese, AA children with early ambulation

Scoliolis

Lateral curvature of the spine -Positive fam hx in about 70% of cases Inspect in standing position -asymmetry of shoulder height, uneven hip level, waistline uneven, thoracic spinal curvature, rib asymmetry, unequal arm length, asymmetry of scapulae -Adams forward-bending test--> child bends forward 90 degrees or more, keeping knees straight, feet forward, dropping head with arms hanging downward, elbows extended -observe from caudal aspect to detect abnormal prominence of thoracic ribs *Ragiographs evaluate degree of deformity Management -if pain occurs, further eval is needed -Treatment mode depends on severity of curve and childs age -Curve of 25 degrees--> no further evaluation/tx if child skeletally mature, f/u for possible progression if child is still growing, bracing tc -Curve of 40-50 degrees--> likely to increase if curve >50 degrees even after growth complete, surgery likely for thoracic curve >50

Hypothyroidism S&S

Newborns--> hx poor feeding, prolonged physiologic hyperbilirubinemia elevated, increased birth wt, postmature, -prolonged jaundice, growth deceleration, hypothermia, skin mottling, large fontanels, wide sutures, coarse facial features, facial edema, macroglossia, hoarse cry, bradycardia, constipation, hypotomia Infants, children, and adolescents -poor growth, intolerance to cold, poor appetite, constipation, mental and physical sluggishness, developmental delay -low energy level, increased weight for height, delayed puberty -skin cool, pale, dry, hair dry, brittle

innocent murmur characteristics

No cyanosis, normal BP, and equal peripheral pulses in upper and lower -normal heart sounds, normal splitting (not fixed) of 2nd heart sound - no clicks, no radiation -intensity varies with position change (louder when supine) or respiration -low intensity (grade 1-3) -not holosystolic * smaller the opening the louder the murmur

Primary dysmenorrhea

Pain during menstrual cycle; usually 1-2 days; cramping discomfort felt mid-to-lower abd -> no pelvic abnormality, common in adolescents, usually develops 6-12 months after menarche, ovulation is necessary component Management--> mild, heat to abd, exercise, acetaminophen -ibuprofen 400mg PO every 6-8 hrs for 1-3 days; take with milf, food, antacid to avoid GI distress, titrate to max doe 800mg TID -well balanced diet Moderate pain--> Naproxen 500mg PO at onset, then 250mg every 6-8hrs Severe pain--> low-dose combination oral contraceptive (min 3-4 cycles for symptom improvement) -Continuous symptoms after 4 months-->can be used in conjunction with NSAIDs

GERD 3 classes

Physiological--> infrequent, episodic vomiting Functional--> painless, effortless vomiting with no physical sequela Pathological--> frequent vomiting with alteration in physical functioning such as FTT and aspiration pna -usually resolves by 18 months of age

Kawasaki disease diagnostic criteria

Presence of high fever 39C/102F for at least 5 days and 4 out of the 5 clinical features 1. bilateral, painless bulbar conjunctival injection w/o exudate 2. Changes of mucous membranes- dryness and cracking of lips, strawberry tongue, erythema of oropharyngeal mucosa 3. Changes to extremities- acute erythema and/or edema of hands and feet 4. Polymorphus nonvesicular exanthem within 4 or 5 days of fever onset 5. Cervical nonfluctuant lymphadenopathy; at least on lymph node more than 1.5 cm in diameter; usually unilateral -coronary artery abnormalities (usually beyond 10 days of illness onset) with fever and fewer than 5 clinical features is diagnostic

Fifth disease (Slap cheek) S&S

Prodromal symptoms of a mild URI for 2-3 days, precegin the rash 7-10 days, low grade fever, HA, chills, malaise, myalgia, pharyngitis, conjunctivitis, arthralgias, arthritis Rash begins as bilateral erythema on cheeks w/ circumoral pallor (slapped cheek appearance) that spreads to upper arms, legs, trunks, buttocks, hands, and feet -Palms and soles are spared from rash -Lacy-reticular exanthem, slightly raised, appears as facial erythema, begins to diminish -May reappear when skin is exposed to sunlight, temp extremes, or friction -Rash lasts from 2-39 days, average of 11 days -could cause aplastic crisis in younger children

Brain tumors

S&S Infants w/ open sutures -Increased head circumference -irritability -head tilt -loss of developmental milestones -bulging fontanelle -no red reflex in eye Older children -HA--> symptoms usually increase in frequency, becoming more severe in the morning, following by vomiting 85% of children with tumors have abn neurologic or ocular exams within 2-4 months of onset of HA -Gradual loss of movement or feeding in an arm or leg -problems with balance, speech -papilledema once sutures are fused + babinski -Behavioral changes MRI, CT scan

Bacterial infections, common organisms 2nd month

S. pneumoniae and H. influenzae

S2 heart sound

S2—aortic and pulmonary valve closure. Loudest at left upper sternal border.

Milestones by age 13-18 Months

Scribbles with large crayon Walks alone Feeds self with fingers and begins using spoon 4-10 words Follows simple directions Coordinates use of both hands Responds to name Points to 2 pictures upon request Long jabbering sentences Throw ball overhead

Tourette syndrome

Severe chronic tic disorder, frequently have additional problems such as aggresiveness, social withdrawal, self-harming acts, and sleep disorders -Onset between 2-15 yrs og age with mean age 6-7 -More male than female S&S Simple tics -Complex sequences of coordinated movements (bizarre gait, kicking, jumping, body gyrations, scratching, and seductive or obscene gestures) -Involuntary vocalization occur, ranging from simple to complex noises -Expression is gender influence motor and vocal manifestation more in males behavioral problems such as obsessive compulsive disorder more common in girls Refer to mental health/neurologist

GERD tx

UGI- can be used to rule out anomalies of the GI tract -Conservative therapy -->positioning, postprandial, prone position for 1-2 hrs if infant can be observed; infant seats/swings worsen by increasing intra-abdominal pressure -A 1-2 week trial of hypoallergenic formula may be warranted if vomiting or other symptoms severe enough -Thickening agents such as rice cereal have not been proven to decrease reflux, but may decrease vomiting -Avoid over-feeding, offer small frequent feedings w/ frequent burping -monitor growth chart Medications -PPI infants and younger children metabolize PPIs more rapidly than older children and require higher per-kilogram dosing than older individuals [64-66]. To be most effective, they should be taken 30 minutes prior to the first meal/feeding of the day. Unlike H2RAs, PPIs do not lose efficacy with prolonged use. The PPIs omeprazole, lansoprazole, esomeprazole, and pantoprazole -Side effects include short-term acid rebound after stopping the ***Histamine type 2 receptor antagonists (H2Blocker) — For patients with mild or intermittent symptoms of GERD that do not respond to lifestyle changes, -Ranitidine (Zantac) -Metoclopramide--> severe reflux, black box warning from FDA can cause tardive dyskinesia

Gonorrhea treatment

Uncomplicated (children <8yrs weight <45kg) -Ceftriaxone 125mg IM single dose -concomitant tx for possible chlamydia azithromycin 20mg/kg po single dose Children >8yrs >45kg -Ceftriaxone 125mg IM single dose or cefixime 400mg oral single dose

regular insulin

has a quicker onset of effect and shorter duration than NPH

3 mo rachel cannot remain seated upright without support. At what age will she acquire the seated position with support? a. 7mo b. 9mo c. 12mo d. 14mo

a

A 10-year-old child is examined in the school-based clinic for unilateral chest pain that radiates to the back and abdomen. On physical examination, tenderness over the costochondral junction is noted. The PNP diagnoses that the chest pain is caused by: A) Costochondritis B) Gastric reflux C) Skeletal deformity of rickets D) A fractured rib

a

A 12-month-old child is brought to the clinic for a repeat urinalysis and culture. Results of the urine culture obtained at the 12-month well-child visit were abnormal. There is no previous history of UTI and no fever of unknown origin. The PNP finds that the child is not circumcised and the foreskin does not retract with moderate traction. The parents state that they have not routinely retracted and cleaned under the foreskin. The most appropriate treatment would be to: A) Refer to a urologist for evaluation as soon as possible B) Obtain another clean catch urine specimen, and repeat urine culture C) Forcibly retract the foreskin, obtain a catheterized urine specimen, clean and lubricate the glans penis, and then protract the foreskin D) Because the child has no previous history of UTI, instruct the parents on foreskin care and perform repeat urinalysis in 6 months

a

A 12-year-old child reveals to the PNP during a visit for acne that she may be pregnant. In this community the pregnancy rate among females aged 15 to 19 years is 3 in 100. What is the most important area to explore? A) The possibility of sexual abuse B) The expected date of confinement C) Plans for telling her family D) The source of prenatal care

a

A 12-year-old girl has questions about the potential for her to get much taller. She aspires to be a professional basketball player. On examination she is in Tanner stage IV. Menarche was 1.5 years ago. In considering answers to her questions, it is important to realize which of the following? A) Girls reach peak height velocity immediately before menarche B) She will not reach her peak height velocity until she is in Tanner stage V C) Menarche occurs an average of 2 years after thelarche D) Boys reach peak height velocity at the average age of 15 years

a

A 13yo female is at the clinic for a routine check up. What presenting symptoms might alert the PNP to the presence of a possible genetic disorder? a. <10% on growth chart, Tanner I, and learning difficulties b. Precocious puberty, developmental delays, gifted piano player c. Lactose intolerance, frequent ear infections, speech delays d. Peanut allergy, right-sided weakness, and exhibits bullying behavior

a

A 14-year-old adolescent is brought to the clinic for primary dysmenorrhea. The PNP prescribes: A) Ibuprofen B) Acetaminophen and codeine C) Codeine D) Acetaminophen

a

A 15-month-old child who began treatment for leukemia 3 weeks ago is brought to the clinic by the parents for a previously scheduled well-child visit. The immunizations that are due today include an inactivated poliovirus (IPV) vaccine and the measles, mumps, rubella (MMR) vaccine. What immunizations should be administered? A) Administer IPV today and delay MMR until 1 year after treatment has been completed B) Delay both vaccines until treatment for leukemia is completed C) Administer vaccines as scheduled D) Delay both vaccines until 1 year after treatment for leukemia has been completed

a

A 17-year-old adolescent is seen in the "fast track" of the emergency room with symptoms of respiratory distress, headache, and euphoria. The PNP suspects: A) Glue sniffing B) Overdose of antihistamines C) Alcohol ingestion D) Acetaminophen overdose

a

A 2-week-old infant is brought to the clinic for a well-child visit. During the interview, which of the following questions would be most appropriate to ask the parent? A) Do you have any questions about your car seat and how to use it? B) Is your hot water heater set at 120°F or lower? C) Have you installed safety locks or window guards on all windows? D) Do you use sunscreen to prevent sunburn?

a

A 2-week-old neonate is brought to the clinic with excessive lacrimation of both eyes. The eyes are clear, with no areas of redness, but the corneas appear hazy. The PNP explains to the parents the possible diagnosis and treatment as follows: A) Congenital glaucoma requiring an ophthalmology referral B) Corneal foreign body requiring fluorescein staining and removal C) Chalazion requiring treatment with antibiotic eyedrops D) Allergic conjunctivitis requiring treatment with Benadryl eyedrops

a

A 2-year-old child is brought to the clinic for the first time. The child has microcephaly, age-appropriate weight and height, and developmental functioning below expectations in all categories on the Denver II. The PNP should: A) Refer the child to an early intervention program B) Refer the child to a speech pathologist C) Order chromosomal studies and a CT scan D) Repeat Denver II screening in 1 month

a

A 2.5yo child presents with a dried pea stuck in his nose passed the first turbinate. An appropriate intervention would be: a. Refer to ENT b. NaCl flush c. Attempt removal with forceps d. Close ipsilateral nares and encourage sneezing

a

A 3-year-old is seen in the clinic for a well-child checkup. The mother states she is concerned because the child is a thumb sucker and worries this will cause dental problems. The PNP explains: A) There is no need for concern until the child reaches age 4 to 5 years B) An immediate dental referral is needed to prevent further damage C) Thumb sucking is not a problem until permanent dentition is completed D) A dental referral is needed within the next 6 months

a

Education for parents whose child has sickle cell disease should include that the majority of pain crises are triggered by which of the following? a. no identifying cause b. temperature changes c. cigarette smoke d. stressful situations

a

A 5-year-old child has sudden onset of nonblanching purpuric lesions scattered over the body and petechiae scattered over the neck and shoulders. The mother reports that the child has been healthy, except for a cold a few weeks ago. The child is not taking any medications. Physical examination reveals a healthy, afebrile child with no other significant findings. The laboratory data show a hemoglobin level of 12.5 g/dL, white blood cell count of 6500/mm3, and platelet count of 20,000/mm3. Based on this information, what should the PNP do next? A) Reassure the parents that these findings are consistent with acute idiopathic thrombocytopenia purpura (ITP), and advise a hematology consultation for confirmation B) Refer the child immediately to the pediatric hematology/oncology department of the nearest tertiary care center C) Report the family to the local protective services department as soon as possible because of the possibility of child abuse D) Order additional laboratory tests, including bleeding studies, an autoimmune panel, and an Epstein-Barr titer; more information is needed before a diagnosis can be made

a

A 6-year-old child in foster care is brought to the clinic by the foster parents. They are concerned that the child's immunizations may not be current. The child's history indicates no contraindications to any immunizations. The family has an official immunization record for the child that lists the following: Age 2 months DTP, OPV, Hib, and Hep B Age 4 months DTP, OPV, Hib, and Hep B Age 6 months DTP, OPV, and Hib Age 4 years DTP, OPV, Hib, and Hep B The immunizations recommended for today are as follows: A) MMR and Var B) Td and MMR C) DT, OPV, Hib, and MMR D) DTaP, IPV, Hib, and MMR

a

A 7-year-old child with cerebral palsy is brought to the clinic. The child is unable to walk but is able to use a wheelchair. The child uses the arms and hands to eat and perform self-care tasks. The PNP diagnoses this child with: A) Spastic diplegia B) Spastic quadriplegia C) Athetoid cerebral palsy D) Spastic hemiplegia

a

A mother brings a 1-year-old child with Down's syndrome to the clinic. She is concerned that the child has been congested for 10 days. The child was born at home and has never been seen in this practice. The mother reports that the child is doing well, has no problems, and is still being breastfed. The child has never been examined by a doctor. The PNP's initial plan of care for the child is: A) Treat the congestion, and start immunizations B) Start immunizations, and refer the parents for genetic counseling C) Rule out an ear infection, and refer the child to a physician for a hearing evaluation D) Rule out a heart defect, and refer the child to a physician

a

A new mom calls the PNP on post partum day 5. She reports her newborn wants to nurse for 30min every 2hrs. Which of the following is your best responses? a. This is a very healthy breastfeeding pattern. Be sure to rest when you can. You are doing a great job. b. Your baby is too demanding. If you can continue to feed that often you will spoil your child. c. You are not making enough milk and your baby will need to go to the ER to be evaluated. d. Your baby has an oral fixation and you should offer a pacifier to relieve stress

a

A parent is concerned her young child may have food allergies. "They run in my husband's family." The parent would like to know the most common food allergies. The PNP responds: A) Dairy products, nuts, eggs B) Soy milk, bananas, nuts C) Fish, wheat cereal, eggs D) Beef, oat cereal, wheat cereal

a

A parent reports that her 18mo cries during the entire aerosol asthma treatment with albuterol and budesonide. What is an alternative managment? a. prescribing oral albuterol b. using MDI and Spacer c. using nebulizer when child is sleeping. d. adding montelukast

a

A teen whose diet consists of frequently eating at fast food restaurants is most likely to have deficits of which nutrients? a. iron and calcium b. phosphorous and iron c. calcium and niacin d. phosphorous and niacin

a

Anticipatory guidance for a parent with a child whose venous lead level is 15 mcg/dL should include a. retesting in 2 months along with an evaluation of the living environment b. retesting required every month along with a neurodevelopmental evaluation c. emergent retesting required and evaluation for intravenous chelation d. an abdominal x-ray with bowel decontamination

a

Appropriate anticipatory guidance for the parents of an 8yo girl should not include: a. preparation for an increase in nervous mannerisms & restless activity b. preparation for pubertal changes c. information that friends begin to serve as allies against adults d. information that their daughter will take idols & heros

a

Appropriate interventions for a 3-month-old infant diagnosed with sickle cell anemia include the following: A) Initiate penicillin prophylaxis, and begin folic acid supplementation B) Teach spleen palpation to parents, and administer Pneumovax vaccine C) Administer Pneumovax vaccine, and initiate penicillin prophylaxis D) Begin folic acid supplementation, and administer Pneumovax vaccine

a

As the NP, you are assessing an 8mo infant in an immunization clinic. You know that by 8mo the child should have had which of the following immunizations? a. Hep B (1st & 2nd), all primary DTaP series, two doses of polio b. All DTaP, polio series, MMR c. DTaP (1st & 2nd), MMR (1st), all Hep B series d. Varicella, DTaP (1st), Hep B (1st)

a

At a physical examination for Head Start, a mother reports being concerned about her 4-year-old child's speech. She worries that the child's speech is unclear and that the child is not saying enough words. The PNP explains to the mother that the child should: A) Have a vocabulary of approximately 1500 words B) Have speech that is 100% intelligible to strangers C) Speak in sentences of three to four words D) Not have problems with dysfluency (stuttering)

a

Diagnostic studies considered part of normal screening for the child with developmental delays of unknown etiology include chromosomal studies or karyotyping, deoxyribonucleic acid (DNA) studies to detect fragile X syndrome, and: A) Measurement of urine and plasma amino acid levels B) Microscopic urinalysis C) Cystometrography D) Measurement of serum antinuclear antibody levels

a

what is the most suffegesive of physiologic GER in a two month old?

he drinks 7-8oz every 3 to 4 hrs

Emphasis on promoting healthy behavioral changes for the overweight child should include which of the following? a. establishing family goals b. maintaining family holiday meal rituals c. weighing child daily d. using weight loss as a sign of success

a

In evaluating a 7-year-old child for ADHD, the PNP questions the parents about reported behavior at school. Of the following symptoms, which would be most descriptive of ADHD? A) The child will not listen to direction or when spoken to, submits messy papers with careless mistakes, runs about or climbs excessively, has difficulty sustaining attention, and exhibits intrusive behavior B) The child has a short attention span, has difficulty listening, has difficulty organizing tasks, and interrupts others who are talking C) The child seems to want attention, has a short attention span for schoolwork, talks out of turn, fidgets a lot, and interrupts others D) The child wants attention, makes careless mistakes in schoolwork, has difficulty taking turns, and fidgets a lot

a

The PNP examines a 17-year-old adolescent with fatigue, joint stiffness in the morning, anorexia, weight loss, and a rash across the nose. The rash is bleeding into the cheeks. The PNP suspects systemic lupus erythematosus and orders: A) An ANA B) Electrophoresis C) An ESR D) A CBC and differential count

a

The PNP examines a 4-month-old infant with hypotonia and motor delay since birth. The most significant finding indicating lower motor neuron involvement in this infant would be: A) Lack of deep tendon reflexes B) Hyperactive deep tendon reflexes C) Persistence of a Moro reflex D) Persistence of the tonic neck reflex

a

The PNP is employed by a physician and performs services under direct supervision of the physician; these services provided by the PNP are billed under the physician's name and are called: A) Incidence to service B) Direct billing for service C) Capitation reimbursement D) Salary

a

The PNP is employed by a physician and performs services under direct supervision of the physician; these services provided by the PNP are billed under the physician's name and are called: A) Incidence to service B) Salary C) Direct billing for service D) Capitation reimbursement

a

The PNP is evaluating a 9-year-old child with a 2-week history of heel pain. The onset of pain coincides with the start of football practice. The child does not limp but experiences heel pain with weight bearing and plantar flexion. Laboratory findings rule out an infectious or inflammatory disorder. This presentation is consistent with a diagnosis of: A) Osteochondritis B) Osgood-Schlatter disease C) Legg-Calvé-Perthes disease D) Freiberg's disease

a

The PNP is examining a 14-year-old adolescent with a strained ankle received during football practice. Which of the following is true regarding sports-related injuries? A) Wearing appropriate protective equipment reduces the injury risk B) Rapid growth phases in which muscle growth is greater than bone growth cause increased clumsiness and increase the injury potential C) Children younger than 14 years have twice the injury risk of those aged 14 years and older D) Overuse injuries cause less permanent damage than accidental injuries

a

The PNP is examining a 15-year-old Vietnamese adolescent during a health maintenance visit. The adolescent immigrated to the United States 3 weeks ago. Which of the following screening tests is most important at this visit? A) Mantoux skin test B) Malaria smear C) Microfilaria smear D) Papanicolaou test

a

The PNP is in the nursery to examine a neonate. The results of the neonatal screen are noted in the chart. The T4 level is low, and the TSH level is elevated. The PNP should: A) Consult with the physician, and repeat the tests B) Discharge the neonate, and schedule a follow-up visit in the office in 1 week C) Begin the neonate on thyroxine based on the test results D) Examine the neonate for signs of hypothyroidism

a

The PNP is speaking with a sixth grade class about injury prevention. Which of the following topics would the PNP emphasize? A) Bike safety and wearing a helmet, drowning prevention B) Drowning prevention, substance abuse C) Drinking alcohol and driving, safe sex D) Sniffing glue, smoking prevention

a

The mother of a 2-year-old child is concerned about the child's thumb sucking during the day when not playing and at night while sleeping. The PNP suggests that: A) The parents should ignore the behavior because it is not harmful at this age B) The mother should obtain an orthodontic device for the child's mouth to discourage the sucking behavior C) This is not a problem unless the thumb sucking continues past age 3 years D) The parents should send the child to time-out when caught thumb sucking during the day

a

The mother of a 3.5-year-old child is counseled about the need to maintain a therapeutic level of an antibiotic prescribed to treat otitis media. The PNP informs the mother that the term therapeutic level refers to the: A) Concentration of a drug that is required to elicit the desired clinical response without causing toxic effects B) Lowest concentration of the drug reached between doses C) Amount of drug taken into the body, which is equal to the amount excreted D) Time required for 50% of a dose to be excreted

a

The mother of a 4-month-old infant is planning to return to work. The mother is investigating licensed day care centers and asks about the appropriate ratio of infants to adults. The PNP responds: A) Three infants to one adult B) Eight infants to one adult C) Five infants to one adult D) Four infants to one adult

a

The mother of a newborn brings the baby to the clinic because she is afraid something is wrong with her baby ("his head is so big"). The PNP responds that: a. "this is normal. The head of a newborn is proportionately large to the rest of the body" b. "Yes, this does appear abnormal. I will make an appointment for the baby to be seen by a neurologist." d. "your head appears large so it is probably genetic."

a

The parents of a 5 yo are frustrated by their child's need to select her own clothing, despite weather and safety. The BEST example of a parent statement to the child that wil promote self esteem a. "You must wear shoes and socks, but you can choose between the red or black ones." b. "Go ahead and wear the sandals, but you will be cold." c. "Wear the sandals, but take your shoes and socks in case you change your mind." d. "It is too cold to wear sandals, stay in your room until you decide to put on shoes and socks."

a

The parents of a 6-month-old infant report that the infant is "different" from their previous child. Which of the following behaviors would alert the PNP to a diagnosis of autism? The infant: A) Is extremely passive, with little interaction with others or the environment B) Is cuddly only when held by the mother C) Initiates eye contact only with siblings D) Seems to have normal language skills

a

The parents of an alert, active 4 yo diagnosed with immune thrombocytopenia purpura (ITP) are frustrated because they feel "nothing was done" for their child. Physical exam reveals multiple purpura and petechiae, but no mucocutaneous bleeding. A repeat CBC shows platelets at 45,000/mm^3, mild anemia and no abnormalities of the red or white blood cells. The NEXT step should include a. discussion regarding safety concerns b. recommendation of hospitalization c. initiation of steroid therapy d. referral for IVIG infusion

a

The pediatric nurse practitioner notices that the mother of her 6-year-old patient looks down at the floor when denying concern for domestic violence. During the rest of the conversation, the mother maintains good eye contact with the nurse practitioner. The pediatric nurse practitioner should: a. Ask an open-ended question about domestic violence with the mother in private b. Ask the 6 year-old patient about violence at home c. Tell the mother she appears to be lying about domestic violence d. Assume the mother was distracted by something on the floor while answering the question

a

The role of the APRN has traditionally focused on: a. the delivery of primary health care to all people b. the delivery of acute health care to all people c. chronic care d. the medical model

a

The school counselor refers a 7-year-old child, who is not known to have received any immunizations, to the clinic. The child has no history of varicella. What immunizations are required at this visit? A) Hep B, MMR, Var, Td, and IPV B) Hep B, Var, Td, and IPV C) Hep B, Td, and IPV D) Hep B, MMR, Var, DTaP, and IPV

a

Unintentional injuries are the major cause of death in preschool-aged children. Of the following, which causes the most deaths in preschool-aged children? A) Motor vehicle injury B) Burns C) Drowning D) Poisoning

a

What is the correct sequence of motor development in average infants? a. Reach & miss, sit alone, creep, climb stairs, stand alone b. creep, sit alone, climb stairs, stand alone, reach & miss c. creep, sit alone, climb stairs, reach and miss, stand alone d. sit alone, creep, climb stairs, reach and miss, stand alone

a

When speaking to a fifth grade class about injury prevention, based on the national top five causes for fatal injuries in this age group, which of the following topics would the PNP emphasize? A) Bike safety (wearing a helmet) and drowning prevention B) Drinking alcohol and driving, and safe sex C) Sniffing glue and smoking prevention D) Drowning prevention and substance abuse

a

Which alternative therapy is most likely to be explored by parents of a child with attention deficit hyperactivity disorder (ADHD)? a. eliminations of food additives b. use of multi-vitamin therapy c. elimination of dietary sugar d. visual training

a

Which of the following factors associated with poor health outcomes would be least attributable to lack of health insurance? a. Difficulty accessing health care services due to geographic distance b. Non-compliance with prescribed medications due to cost c. Delay in seeking care for an acute condition due to financial hardship concerns d. Less utilization of preventive health care services

a

Which of the following is the correct sequence for adolescent female development? a. growth acceleration, breast development, pubic hair, menarche, axillary hair b. growth acceleration, pubic hair, breast development, axillary hair, menarche c. breast development, growth acceleration, axillary hair, pubic hair, menarche d. axillary hair, breast development, pubic hair development, menarche, growth acceleration

a

Which of the following parental responses would discourage sibling rivalry? A) Serving as role models by solving conflicts in a nonconfrontational (nonaggressive) manner B) Comparing qualities of the siblings C) Labeling children in negative and positive roles D) Favoring one child over the other

a

Which of the following should be included in the plan of care for preterm infants? a. use of a car seat without a shield harness b. supplemental vitamin D at 4 months for breast fed infants c. immunizations beginning at 2 months corrected age d. evaluation of vision at 3 months

a

Which of the following should be included when educating a family regarding the care of children with atopic dermatitis? a. apply a barrier ointment to the child's face before feeding b. bathe children daily and encourage low humidity in the house c. expect symptom improvement within 1 week after starting probiotics d. investigate and eliminate possible food triggers

a

Which of the following strategies would not be appropriate to include as part of your management of a 9yo boy who is obese? a. referral to nutritionist for weight reduction plan b. increase physical exercise c. behavior modification strategies to deal with stress and/or reinforce treatment plan d. involve family in management program

a

Which should always be included in the evaluation of a child with a suspected learning disorder? a. full history and physical exam b. Denver II developmental assessment c. genetic and chromosomal testing d. intelligence quotient measurement

a

8-month-old Alex is unable to demonstrate hand-to-hand transfer. What diagnosis should the PNP consider exploring? a. Cerebral Palsy b. Duchenne's Muscular Dystrophy c. Syndactyly

a *stated at live review

Macule

a flat discoloration

Klinefelter syndrome is

a genetic disorder involving only males with an extra x chromosome

VSD exam finding

a holosystolic thrill felt at the lower left sternal border

Wheal

a lesion raised above the surface and extending a bit below the epidermis; may times an allergic reaction

PKU, galactosemia, hemoglobinopathies are required newborn screenings in all 50 states. Which of the following is also required for newborn screening in all 50 states? a. Congenital hypothyroidism b. Menke's syndrome c. Trisomy 21

a pg. 31

When educating about what to expect at a 2-year check-up, what laboratory test does the PNP expect to obtain? a. Hematocrit b. Amylase/Lipase c. CMP

a pg. 38 Obtain at 2 years old or between 1 to 5 years old unless otherwise indicated. Lead screening should be done by 2 years old.

The PNP is using standardized testing to assess for developmental delays. Which of the following tests is the gold standard for diagnosis of developmental delay in children until 42 months old? a. Bayley Scales of Infant and Toddler Development b. Ages and stages questionnaire (ASQ) c. Denver II

a pg. 42

The PNP knows that these warning signs refer to which age: does not listen to a story, does not speak in sentences, engages in head banging or rocking, not toilet trained, and/or not able to draw a person. a. 4 years old b. 5 years old c. 6 years old

a pg. 43-44

7-year-old Anne is in today for "stuttering". Anne's mom is concerned because she herself had to go to speech therapy as a child. Stuttering does not appear to keep Anne from speaking. When does the PNP consider referring Anne for a speech evaluation and for management? a. Now b. in 3 months c. in 6 months

a pg. 44 Consider referral for stuttering lasting >6 months, child older than 6, and a child who avoids speaking. There is often a familial link to stuttering.

The PNP knows that school age children have different fears than preschool children. What fears does a school age child have? a. Pain, loss of control, death b. Animals, ghosts, unknown c. Dark, immunizations, change

a pg. 47

When performing well child exams, what age does the PNP begin performing scoliosis screening? a. 9 years old b. 10 years old c. 12 years old

a pg. 47

The PNP knows the average weight gain for school age child slows down. What is the average weight gain? a. 5 to 7 lbs/year b. 3 to 5 lbs/year c. 7 to 9 lbs/year

a pg. 47 Height is 2 to 3 inches/year

Savannah is in for her 9-month well child appointment. She weighs 6.8kg and is 68cm long. Her mom is concerned that she is pale because she is not getting enough iron. How much iron is recommended for a child of Savannah? a. 6.8mg/day b. 10.2mg/day c. 13.6mg/day

a pg. 6 Exclusively breastfed babies should receive 1mg/kg/day of iron after 6 months old.

The PNP is assessing a child with a known congenital heart defect. The PNP auscultates a loud systolic click at the middle and upper left sternal border. Which congenital heart defect does the PNP suspect? a. Tetrology of fallot b. Coarctation of the aorta c. Transposition of the great arteries

a pg. 65 "Boot shaped heart"

The PNP is assessing a 2-week-old patient and notes a machinery type murmur at the left upper sternal border. Which congenital heart defect does the PNP suspect? a. Patent ductus arteriosus b. Atrial septal defect c. Ventricle septal defect

a pg. 65 Can note a holosystolic machinery murmur

Which of the following factors is not usually assoicated with migraine headaches? a. complaints of diffus occipital pain b. positive family history in immediate relatives c. pain relieved by brief sleep d. recurrent abdominal pain

a.

Which of the following would not be assoicated with concussion? a. focal motor signs b. brief loss of consciousness c. headache d. confusion or irritability

a.

standards of practice are

authoritiave statutues used to measure quality

6. Which of the following problems is common in a child with Hurler's syndrome? a. Developmental delay from birth b. Sleep obstructive apnea c. Ectopic lentis d. Congenital heart disease

b

Legg-Calve-Perthes Disease

avascular necrosis of the femoral head -insidious onset of limp with knee pain, may also migrate to groin/lateral hip*** from hip downward to knee -pain less acute and severe than transient synovitis and septic arthritis -painless limp, pain with activity thats relieved with rest -Limited passive internal rotation and abduction of hip joint**** -hip flexion contracture and leg muscle atrophy occur in long standing cases -may be resisted by mild spasm or guarding -need xray <6yrs old and less than 1/3 of femoral head affected observe full ROM is perserved >6 yrs old refer and if more than 1/3 of femoral head affected

Hypertension

average systolic BP and or average diastolic BP greater than or equal to the 95th percentile for gender, age, and height with measurements obtained on at least 3 occasions -At 12yrs or older any BP reading that defines prehypertension includes any reading greater than 120/80 even it is less than the 90th percentile

1. which of the following is a characteristic physical sign of fragile X syndrome in adolescent males? a. Small posteriorly rotated ears b. Macroorchidism c. Hypertonia d. Double hair whirl

b

14. Which of the following is not a precipitating factor for hemolysis in G6PD deficiency? a. Drugs b. Exposure to extreme temps c. Ingestion of fava beans d. Infection

b

24. Which of the following are associated with paralytic poliomyelitis? a. Lacy, erythematous, pruritic rash b. Respiratory compromise, speech disturbances, urinary incontinence c. Abdominal swelling, lympthadenopathy, and jaundice d. Nonspecific abdominal pain, nausea, and vomiting

b

7. Which of the following symptoms are characteristic of rubella? a. Vesicular, crusted lesions & high fever b. Postauricular lymphadenopathy & low grade fever c. Intense pruritus, usually in finger webs, buttocks, thighs, & ankles d. Rough textured maculopapular rash that blanches with pressure

b

8. Although uncommon, a potential sequela of rubella may include: a. Pneumonia & chronic otitis media b. Arthritis, thrombocytopenia & encephalitis c. Oophoritis & infertility d. Arthritis, carditis, and neurological involvement

b

A 10-year-old child is brought to the office because of persistent fever (102ºF) lasting for 5 days. The child complains of a headache and sore throat and was seen twice by different providers in the past 5 days. An earlier rapid antigen-detection test for GABHS was negative, and a viral infection was diagnosed. Physical examination now reveals slightly enlarged anterior cervical lymph nodes and a red throat. A faint, pink, slightly raised rash is present on the abdomen and in the groin area; the remainder of the physical is unremarkable. The most appropriate action is to: A) Treat with penicillin for probable GABHS without performing a throat culture B) Obtain a throat culture C) Order a monospot test D) Reassure the parents and the child that the symptoms are caused by a viral infection and that symptomatic care is all that is needed

b

A 14-month-old child is brought to the office for a well-child visit. The child is healthy today and has no history of allergies or reactions to previous immunizations. The family lives with a grandmother who is currently undergoing chemotherapy for cancer. The PNP reviews the child's immunization record and finds the following: Birth-Hep B Age 2mo-DTaP, IPV, Hib, & Hep B Age 4mo-DTaP, IPV, and Hib Age 6mo-DTaP and Hib Age 9mo-Hep B The PNP should give the child the following immunizations today: A) DTaP, IPV, Hib, and Var B) DTaP, IPV, Hib, MMR, and Var C) DTaP, IPV, Hib, and MMR D) DTaP, IPV, and Hib

b

A 14-year-old Asian-American male is brought to the office for a well-child visit. The adolescent measures 145 cm (57 inches) in height and weighs 46 kg (102 lb). Physical examination reveals underdeveloped genitalia (i.e., Tanner stage 1, testes down, no hernia). Which diagnostic tests would the PNP order initially? A) Thyroid function tests, a bone age determination, and a complete blood cell count B) Tests to determine plasma luteinizing hormone (LH) and follicle-stimulating hormone (FSH) levels and bone age C) Radiographic examination of the spine, tests to determine the plasma FSH level, and thyroid function studies D) Tests to determine the sedimentation rate, FSH, and bone age

b

A 16-year-old adolescent comes to the clinic for a yearly examination. During the discussion of breast self-examination (BSE), the PNP should inform the adolescent that: A) Breast masses that are painless do not require further evaluation B) Asymmetric breast development is common in puberty C) The best time to perform a BSE is during menses D) Palpation of the nipple area is not necessary

b

A 17-year-old adolescent is anticipating marriage after completing high school. The adolescent does not have sickle cell disease and is not a carrier of the trait, but the intended spouse has sickle cell trait. The adolescent asks if it is possible that any of their future children will have sickle cell disease. The adolescent is told that there is a 50% chance that: A) Their children will have sickle cell disease B) Their children will have sickle cell trait C) Only their sons will have sickle cell disease D) Only their sons will have sickle cell trait

b

A 3-year-old child has recently started having breath-holding spells. The parents state that an older sibling "did the same thing" and ask for help. The PNP advises the mother that after a breath-holding event she should: A) Do everything possible to keep the child from feeling any extreme emotions B) Ignore the child's behavior similar to ignoring temper tantrums C) Throw water on the child's face to stimulate breathing D) Stand and watch but do nothing while the breath-holding occurs

b

A 5-year-old child is brought to the clinic because of a "runny nose." The rhinorrhea is clear, and on physical examination the PNP notes that the nasal mucosa is pale, boggy, and edematous. The PNP prescribes: A) Amoxicillin B) Loratadine (Claritin) C) Erythromycin D) Fexofenadine (Allegra)

b

A 5-year-old child is brought to the clinic for drop-foot gait. The child lifts the leg to avoid tripping over the drooping distal foot and toes. The PNP suspects that the child has: A) Duchenne muscular dystrophy B) Chronic sensorimotor neuropathy C) Myasthenia gravis D) Becker muscular dystrophy

b

A 5.5yo asian child has fallen off of her growth curve. The best intervention would be to: a. Suggest infant breakfast drinks b. Incorporate traditional foods in diet c. educate family on need to increase calories & nutrients d. Refer to endocrine clinic for evaluation

b

A 6-month-old infant is brought to the office for a well-child visit. The infant has had several upper respiratory tract infections but is healthy today. The mother states that the infant attends day care 3 days a week. The immunization record reads as follows: Birth Hep B 4 months DTaP, IPV, Hib, and Hep B What immunizations should the infant be given today? A) DTaP, IPV, Hib, Prevnar, and Hep B B) DTaP, IPV, Prevnar, and Hib C) DTaP, OPV, Hib, and Rv D) DTaP, IPV, Hib, and Rv

b

A 6yo child is being evaluated after sustaining seizures. Which of these tests would be most relevant in this screening? a. determination of the levels of anticonvulsant drugs b. electroencephalography c. Denver II screening test d. Electromyography

b

A grandfather brings his 8-month-old grandson to the clinic and states that the infant screams and cries whenever anyone besides the grandfather comes near. The PNP diagnoses stranger anxiety. The grandfather wants to know if he should be concerned. The PNP responds: A) Force the infant to be held by others B) Reassure the parents this is normal and will pass C) Ignore the screaming D) This is not normal, and a referral to a child psychologist may be helpful

b

A 7.5-year-old Hispanic child has prepubertal pigmented pubic hair. No other secondary sex characteristics are noted. The mother is concerned that the child will soon begin menstruating. What advice would the PNP give the mother? A) "Premature sexual development is common in Hispanic girls, and no treatment is required." B) "Premature adrenarche can be a normal variant in Hispanic girls, and no treatment is required, but we will monitor the changes at each annual visit." C) "Central precocious puberty is a normal variant in 10% to 15% of girls." D) "Start talking to your daughter about the menstrual cycle because menarche will occur soon."

b

A 9yo boy presents with a fever of 102F and complaints of leg pains. His mother reports that he had upper respiratory infection with a sore throat approximately two weeks ago, which subsided without therapy. On physical exam, he has tender, swollen knees bilaterally. His heart rate is 120/min and blowing systolic murmur is heard at apex. No murmur was noted on previous well-child visit. The most likely diagnosis is: a. Kawasaki disease b. Rheumatic fever c. Sickle cell anemia d. Viral illness

b

A child is brought to the office with irritability, agitation, muscle pain, and cramping in the large leg muscles. On examination a target lesion consisting of an erythematous ring around a pale center is noted. The child has been playing in the garage and does not recall seeing or being bitten by an insect. The child's face is flushed, and there is some diaphoresis. The PNP suspects: A) An allergic reaction to flea bites B) A black widow spider bite C) A brown recluse spider bite D) Ingestion of weed pods

b

A child just starting to reach for objects placed in front of him is probably around: a. 1mo b. 4mo c. 7mo d. 9mo

b

A dark-skinned 14-year-old adolescent comes to the school-based clinic with symptoms of a nonpruritic rash, with loss of pigment. The PNP diagnoses tinea versicolor and treats with: A) Steroid cream and erythromycin B) Selenium sulfide shampoo and systemic ketoconazole C) Systemic ketoconazole and steroid cream D) Silver sulfadiazine cream and an antihistamine

b

A father accompanies his 4-year-old child to the clinic. Significant past history reveals that the child had lipomyelomeningocele. The father states that there are no specific complaints, but during the history he reports that the child has complained of back pain over the last 3 months. Further evaluation reveals that the frequency of bowel movements has decreased from once daily to three times a week and that the child is "wetter" between catheterizations. The most likely cause is: A) Acute muscle strain B) Tethered cord C) Urinary tract infection D) A diet low in fiber, fruits, and vegetables

b

A mother asks about the term Moro reflex. The PNP explains that the reflex is present in a neonate and disappears or phases out at about age: A) 6 to 8 months B) 3 to 5 months C) 7 to 9 months D) 10 to 12 months

b

A mother of 10mo old infant asks about the progression of solid foods into her baby's diet. From the choices below, you advise her to introduce which food last to her baby's diet? a. egg yolk b. egg white c. fruits d. vegetables

b

A neonate in the neonatal nursery has a spongy area over the parietal region of the skull. The PNP diagnoses craniotabes and: A) Assesses for hydrocephalus B) Assures the mother this is a normal variant C) Obtains a skull x-ray film D) Refers the neonate to a neurologist for evaluation

b

A parent complains that their child awakens crying and agitated during the last half of night sleep. The child is awake and can be comforted. The parent denies this child is experiencing a. sleep terrors b. nightmares c. somniloquy d. sleep starts

b

A pediatric nurse practitioner evaluates an established patient for fever. The nurse practitioner documents the chief complaint (fever), history of present illness (duration, height of fever, associated symptoms, and timing), and a review of systems involving 3 organ systems. Physical examination is documented and includes full vital signs, general appearance, and head/neck/lung/cardiac/abdominal/skin examinations. Final diagnosis is fever with lower respiratory tract infection. The pediatric nurse practitioner should bill for which level of service? a. Detailed b. Expanded problem-focused c. Problem-focused d. Comprehensive

b

An 8-year-old child brought to the office by the parent has a cough, nasal congestion lasting 3 days, and an oral temperature of 99°F. After the PNP has reviewed the history and completed a physical assessment, a viral upper respiratory tract infection is diagnosed. The child has a history of varicella. A review of the immunization record reveals the following: Age 2 months DTP, OPV, and Hib Age 5 months DTP, OPV, and Hib Age 7 months DTP, OPV, and Hib Age 18 months DTP, Hib, and MMR Age 5 years DTP and OPV What is the suggested course of action regarding the child's immunization status? A) Start the Hep B series today, and have the child return in 1 month for the next Hep B B) Start the Hep B series and give MMR; have the child return in 1 month for the next Hep B C) Give no immunizations today because the child has a febrile illness D) Give no immunizations because none are due until age 11 years

b

An 8-year-old child is evaluated for "growing pains." The pains are intermittent and last up to 2 hours. The child awakens at night, and the pain is not specific to joints. The physical examination is normal. The PNP decides to order: A) A monospot test B) A test to determine ESR C) A throat culture D) An x-ray film of the left hand

b

An 8-year-old child is in the clinic because of an inability to lift the right arm. After playing on the rock wall in the playground, the child complained to the mother of arm pain and inability to lift the arm. On examination the PNP notes decreased voluntary control of the right arm, specifically with an inability to lift the arm. There is no obvious deformity of either arm, and the child has full range of motion in the neck and other limbs. The only abnormal finding is slight tenderness in the right shoulder. The clinical presentation is consistent with the diagnosis of: A) Pinched cervical nerve and pseudoparalysis B) Clavicular fracture and pseudoparalysis C) Fracture of the right humerus D) Muscle strain and concurrent weakness

b

An 8.5-year-old child is brought to the clinic for the first time. On physical examination a penile length of 6.2 cm is noted. The differential diagnosis includes precocious puberty. What additional clinical finding is associated with precocious puberty? A) A testicular length of 2.1 cm B) Multiple small café au lait spots (neurofibromatosis) C) A growth spurt of 5 cm/y D) A blood glucose level of 97 mg/dL

b

An example of a genetic disorder occurring because of genomic imprinting is: A) Marfan's syndrome B) Prader-Willi syndrome C) Trisomy 18 D) Down's syndrome

b

Family-centered care is characterized by which of the following? a. Care team acts as the experts and instructs the patient and family in how to properly carry out the care plan b. Collaboration between the care team and patient/family regarding decision-making and clinical care c. Patient/family direct the clinical care team's actions d. All members of the patient's family must agree on a specific care plan before it is implemented

b

Head & chest circumferences should be equal at: a. 6mo b. 1yo c. 2yo d. 3yo

b

In boys, Tanner III is distinguished from Tanner stage II by: a. Penile growth in width b. Penile growth in length c. Fine, downy hair growth at the base of penis d. Adult-like pubic hair that does not extend to the thigh

b

In the management of a child with a neurogenic bladder resulting from myelomeningocele, the most critical long-term goal is: A) Controlling incontinence B) Preventing kidney damage C) Preparing the child for bladder augmentation D) Preventing bladder spasms

b

Jess has recently noticed that a change in his voice, the shape of his body, and pubic and facial hair growth. What is he noticing is the development of: a. primary sexual characteristics b. secondary sexual characteristics c. deciduous sexual characteristics d. laten sexual characteristics

b

Legal authority for prescriptive privileges for PNPs is granted by the: A) Food and Drug Administration B) State Nurse Practice Act C) Nurse practitioner certification boards D) State pharmacy licensing boards

b

Managed care is a term that describes: a. an established system of healthcare delivery that is mandated by the federal government b. a network of providers who contract to provide services for a specific group of enrollees c. a system that does not recognize APRN as a primary provider d. a network of hospitals and nursing homes that provide care to chronically ill people

b

Medical professionals are legally required to report abuse when: A) Appropriate resources are available to investigate B) Abuse is suspected C) Forensic evidence is collected D) Protocols are used to evaluate the report

b

Molly is a 12yo girl who has diffuse stomach pain and acute onset of diarrhea described as frequent urge to defecate. She is passing large amounts of flatus, small amounts of stool, and has rectal tenderness with digital exam. Which lab test will confirm your diagnosis? a. serum albumin & ESR b. abdominal ultrasound c. stool for ova & parasites d. Upper GI

b

On the basis of your exam you determine a child has ADHD: distractibility, impulsivity, lack of attention, accompanied by hyperactivity. Which of the following conditions is a differential diagnosis? a. seizures b. social disturbance c. dyslexia d. cerebral palsy

b

Once a child is started on oral iron therapy for the treatment of iron-deficiency anemia, what changes are evident in the laboratory studies? A) There is an immediate rise in the reticulocyte count, and the hemoglobin level returns to normal in 2 weeks B) There is a rise in the reticulocyte count beginning on the third day, and the hemoglobin level returns to normal in 6 to 10 weeks C) There is a concurrent rise in the hemoglobin level and the reticulocyte count, with both returning to normal in 3 weeks D) There is a rise in the reticulocyte count beginning in 2 weeks, and the hemoglobin level returns to normal in 3 to 6 weeks

b

Recommendations regarding the current management of croup with increased work of breathing include the use of a. nebulized bronchodilators b. oral corticosteroids c. oral antibiotics d. cool mist therapy

b

Role play with equipment during the course of a physical exam would be most beneficial with with of the following age groups? a. toddlers b. preschoolers c. young school aged children d. older school aged children

b

The PNP is evaluating a 10-year-old child with a 12-day history of rash and intermittent fever. The child is alert and febrile (100.8°F) and has an annular, indurated lesion measuring approximately 16 to 20 cm on the posterior lateral thigh. There also are two small papules with 3 to 4 cm of surrounding erythema on the posterior thorax. The child reports feeling tired and "achy," primarily in the legs, but has been pursuing normal activities. The mother reports no known injuries or insect bites. An appropriate approach to treatment should include: A) Admission to the hospital for parenteral ceftriaxone B) Administration of amoxicillin, doxycycline, or erythromycin at the appropriate dose for 14 to 21 days; administration of antipyretics or analgesics; and observation C) Dermatology referral for skin biopsy of the lesion D) Application of warm compresses, administration of antipyretics, and close observation

b

The PNP is examining a 12-year-old female child with enlarged breasts and areolas and curly, dark, coarse pubic hair. The PNP uses Tanner staging and classifies this child as: A) Tanner stage II B) Tanner stage III C) Tanner stage IV D) Tanner stage V

b

The PNP is examining a 2-month-old infant. At delivery, the infant's cord was wrapped around the neck three times. The parents are concerned that the infant is "floppy." On physical examination, the PNP notes that the deep tendon reflexes are increased, there is poor tone, and scissoring of the legs is marked. The PNP: A) Orders chromosomal studies B) Discusses the findings with the staff physician C) Orders a computed tomography (CT) scan D) Orders routine vaccinations and schedules a return visit in 2 months

b

The PNP is obtaining a review of systems on a healthy 8yo girl. It would be important to include: a. the date of last breast self-exam. b. any limitations related to sports participation. c. the last hematocrit and hemoglobin d. the last lead screen

b

The PNP sees a 14-year-old adolescent in the clinic. The adolescent is sexually active and does not want to become pregnant. There is a history of high blood pressure and cardiac problems in the family. The patient states that she does use condoms to prevent STDs. The patient asks the PNP what the best form of birth control to use to prevent pregnancy? A) Diaphragm B) Depo-Provera C) Ovral D) Intrauterine device (IUD)

b

The School Lunch Program; Women, Infants, and Children (WIC) Program; and Food Stamp Program are administered by: A) The Food and Drug Administration B) The U.S. Department of Agriculture C) Social Security Block Grants D) The U.S. Department of Public Health

b

The first step in the process of developing an IEP for a child with disabilities is to: A) Provide government funds to the child and family to supplement income B) Perform a comprehensive assessment of the child by a multidisciplinary team C) Perform a complete history and physical examination to identify organic causes D) Perform a battery of psychologic tests that are valid and reliable

b

The grandmother of a 2-year-old child requests information regarding toilet training readiness. The PNP tells the grandmother that the most important factor in determining readiness to toilet train is that the child: A) Is strong willed and shows an interest in the potty B) Is able to communicate needs and follow directions C) Is not bothered by wet or soiled pants D) Wakes up from naps with soaked diapers

b

The mother of a 3yo states that her son was completely toilet trained at 18mo. The PNP explores further, asking: a. how the mother did the toilet training b. if the child is dry at night and fully trained for urine and stool day and night c. at what age did the mother begin toilet training the other child. d. if the child gets up at night to use the bathroom

b

The mother of a 5-month-old breastfed infant requests information about weaning. The PNP advises the mother: A) Immediately substitute all breastfeedings with formula B) Wean the infant slowly from the breast to the bottle C) Substitute all breastfeedings with formula, and pump breasts frequently to avoid engorgement D) Continue breastfeeding for at least 1 more month

b

The mother of a preschool-aged child is discussing intellectual giftedness and asks the PNP what is the best predictor and most frequently noted indicator of an intellectually gifted child. The PNP responds: A) Ability to entertain self B) Early language development C) Extreme curiosity D) Participation in an early enrichment program

b

The parent of a 7 year old is concerned about the child's dislike of school. It is late fall, and the child has now been absent for 20 days. The FIRST challenge for the parent is to a. obtain psychological counseling b. send the child to school everyday c. determine what the physical illness may be d. have the child catch up on missed school work

b

The parents of a 2 year old are concerned that their child is having temper tantrums in public settings. What is the BEST option? a. The temper tantrum is an indication that the child is tired and needs to go home. b. Make sure to ensure safety while ignoring the child's display of behavior. c. You can pick up the child and take him to a quiet place for a time out. d. In a public place, it is okay to give into the child's desires to maintain peace.

b

The parents of an adolescent with pectus excavatum and asthma are interested in surgery for their child, in the hopes of improving his asthma. Which would be MOST accurate response? a. the only purpose of surgery is cosmetic b. studies of post-operative cardiac and pulmonary functioning following pectus repair show inconsistent results. c. reduction of lung volume and degree of symptoms correlates well with extent of the deformity d. improvement of asthma after surgery is dependent on the family history

b

The pediatric nurse practitioner is seeing a 9-year-old patient for routine health maintenance whose 40-year-old father recently suffered an acute myocardial infarction. Which of the following screening tests would be most appropriate for the pediatric nurse practitioner to order next? a. Hypercoagulability screening panel b. Fasting lipoprotein levels c. Serum troponin levels d. Brain natriuretic peptide (BNP) levels

b

When discussing issues concerning confidentiality, the NP should tell the adolescent (>18yo) or when under the state age of majority that: a. the parents must have access to all information in the health hx b. parents cannot access information without adolescent's permission c. parents must be present during all encounters d. it is at the discretion of the provider to decide whether to release information

b

When examining 10 yo Bob's teeth, you note that the upper incisors slightly overlap the lower incisors. The second and lower first molars are absent. Your assessment is: a. malocclusion b. delayed mandibular dentition c. normal dentition d. hyperdontia

b

Which of the following is the major cause of death among adolescents and young adults aged 15 to 24 years? A) Homicide B) Motor vehicle-related accidents C) Acquired immunodeficiency syndrome (AIDS) D) Suicide

b

Which of the following is the most important history taking question for sports evaluation? a. has the child ever had head injury? b. has the child ever fainted or lost consciousness during exercise? c. does the child ever get short of breast with exercise? d. has the child ever had prior surgeries?

b

Which of the following statements is most accurate concerning the pediatric nurse practitioner's scope of practice? a. Prescribing medications is not within the pediatric nurse practitioner's scope of practice b. Pediatric nurse practitioners diagnose and treat most common childhood illnesses c. Pediatric nurse practitioners may practice independently without physician oversight in all 50 states d. Pediatric nurse practitioners may only provide routine health maintenance and immunizations

b

Which of the following techniques is most effective in communicating with the shy, 4-5-year-old patient? a. Stand up when speaking with them so that they are looking up at you b. Communicate through the child's transition object (e.g., doll) before addressing them directly c. Establish physical contact early d. Speak only with the patient's adult family members, rather than addressing the child directly

b

malpractice insurance: a. protects an APRN from charges of practicing medicine without a license when they are practicing outside the legal scope of practice b. does not protect an APRN from charges of practicing medicine without a license when they are practicing outside the legal scope of practice c. does not pay for legal defense if the APRN is practicing beyond the legal scope of practice d. is important, but should not be purchase if the facility in which the APRN is employed carries good coverage

b

The PNP knows that these warning signs refer to which age: not making eye contact and does not feed self with spoon. a. 12 months old b. 18 months old c. 24 months old

b pg 43

The PNP orders for 11-year-old Brittany to receive the Tdap, Meningococcal, and Human Papillomavirus Vaccines. Which of the following actions, should the nurse take after administering the vaccines? a. Administer Tylenol b. Have the Brittany sit for 15 minutes c. Educate Brittany to receive a booster of Tdap at 16 years old.

b pg. 19

17-year-old Jeremy is getting ready for college in the fall. He is up-to-date on vaccines except for receives the Meningococcal vaccine. Jeremy asks if he need anymore shots after he receives the Menactra vaccine. The PNP states which of the following? a. "You will need a varicella booster at 18-years-old." b. "You will need a tetanus shot 10 years after your received your first one." c. "You will need a meningococcal vaccine in 4 to 5 years."

b pg. 19 If received after 16 years old, Meningococcal booster not needed.

The PNP understands that which of the following is a genotypic presentation of a genetic disorder? a. Developmental delay b. Trisomy of chromosome analysis c. Microcephaly

b pg. 21 For genotypic characteristics you must perform a lab test. Phenotypic characteristics are physical presentations.

The PNP is assessing a 3-month old patient. He knows that the primitive reflex of palmar should disappear by what age? a. 2 months b. 6 months c. 8 months

b pg. 28 Palmar/Grasp/Plantar should disappear at age 3 to 6 months with average of 4 months.

The PNP is assessing a 4-month old infant. On the eye exam, the PNP notes a deep blue scelra. This discoloration can indicate what disease process? a. Retinoblastoma b. Osteogenesis imperfecta c. Congenital cataracts

b pg. 29

The PNP should consider placing a purified protein derivative test in a child at risk. What ages should the PNP consider this test? a. 1 to 3 years old b. 4 to 6 years old c. 7 to 9 years old

b pg. 39 Only test if indicated and yearly if indicated

The PNP should consider initial cholesterol screening at what age in a child with a family history of high cholesterol, dyslipidemia, or premature cardiovascular disase? a. 12 years old b. 2 years old c. 8 years old

b pg. 39 Only test if indicated by those stated and a biological parent or grandparent with cardiac event prior to 55 years old. Consider testing through out child hood as needed

The PNP is assessing a child's legs. The PNP notes genu varum. What age does the PNP expect this musculoskeletal finding to resolve? a. Infancy b. Toddlerhood c. Preschooler

b pg. 40 Genu varum=bowed legs

The PNP is assessing the gross motor skills of Graham, 4-years-old. Graham is able to walk up and down steps with alternate feet and run. What other finding is would the PNP expect to see from Graham? a. Skips b. Rides bicycle with training wheels c. Jumps rope

b pg. 41 Other 2 options are for 5 years old

The PNP orders a vision test on a child who is 4-years-old. What does she expect the visual acuity to be? a. 20/20 b. 20/30 c. 20/40

b pg. 41 Visual acuity is 20/30 by 5 years old

While nightmares begin around 3 years old, what age does the PNP expect night terrors to occur? a. 9 months to 18 months b. 2 to 6 years old c. 4 to 7 years old

b pg. 43 Should outgrow night terrors. With night terrors, child does not remember. With nightmares, child can describe dream when awake

The PNP knows that a child who is 6 months old or less has nutritional requirements of 120 kcal/kg/day. What would are a child who is 7 months old to 12 months old nutritional requirements? a) 70 to 100 kcal/kg/day b) 100 kcal/kg/day c) 110 kcal/kg/day

b pg. 5

7-year-old Josephine's mom has scheduled a sick appointment because she is concerned that Josephine has stopped growing. What does the PNP educate Josephine's mom that a child of her age should grow? a. 1.5 in/year b. 2.5 in/year c. 3.5 in/year

b pg. 6 Children 3 years old through school age should grow 2.5 inches/year

Savannah is here for her 6-month check up. She is exclusively breastfed and has not started baby foods yet. What nutritional education should the PNP provide? a. Because she is breastfed, Savannah does not need to start baby foods until she is 12 months old. b. Savannah can start iron-fortified foods such as baby oatmeal. c. Savannah can stop her Vitamin D supplement when she starts table foods.

b pg. 6 Exclusively breastfed babies should receive 1mg/kg/day of iron after 6 months old. Ideally iron comes from iron-fortified foods.

The PNP is assessing 4-year-old Bella who states "I'm a doctor, too". The PNP knows that Bella is in which cognitive stage? a. Sensorimotor state b. Preoperational stage c. Trust vs. Mistrust

b pg. 7

The PNP knows that Grant should have his primary central incisor erupt at what age? a. 4 to 6 months old b. 6 to 7 months old c. 7 to 9 months old

b pg. 7

Egocentrism is part of which of Piaget's stages of cognitive domain? a. 1 year old b. 3 years old c. 5 years old

b pg. 7 Children who are 2 to 4 years old experience egocentrism.

gastroesophageal reflux disease is marked by what onset of symptoms

belching hiccoughs dysphagia bitter taste

Mongolian spots

benign flat congenital birth mark with wavy borders and irregular shape. common color is blue usually disappear by puberty.

which cardiac med can cause an asthmatic patient to wheeze

beta blocker

The PNP is seeing 9-month-old Holden who is behind on his vaccines. Which of the following vaccines can he not receive at this time? a. DTaP b. Hepatitis B c. Rotavirus

c pg. 17 Can't be given after 8 months old

26. Classic symptoms associated with malaria include: a. Low grade fever, upper respiratory congestion, cough b. Annular rash, conjunctivitis, headache, arthralgia c. High fever, chills, rigors, sweats, headache d. High fever, jaundice, lethargy, vomiting

c

5. a newborn presents with a large VSD, rocker bottom feet, overlapping second & third fingers, & fourth & fifth fingers with hypotonia. What is the most likely diagnosis? a. Fragile X syndrome b. Down syndrome c. Edwards Syndrome d. Klinefelter's syndrome

c

7. Young infants with cerebral palsy often show: a. Voracious appetite & weight gain b. Increased muscle tone in the first weeks of life c. Hypotonia in the first weeks of life d. Unusually severe reactions to their first immunizations

c

A 10-month-old infant is noted to have cranial and facial asymmetry during a well-child visit. The PNP should: A) Observe the infant, and reevaluate cranial shape at the 1-year well visit B) Refer immediately to a neurologist C) Obtain a cranial radiologic film, CT scan of the skull, or both D) Perform a Denver Developmental Screening Test

c

A 10-year-old child is brought to the office with coughing, abdominal pain, splinting on the right side, fever, headache, and chills. The child appears to be in severe distress. There are decreased breath sounds, crackles, and dullness to percussion in the area of the right middle and right lower lobe. The diagnosis of pneumonia is made. The PNP orders an anteroposterior and lateral view of the chest and: A) Sputum stain B) Blood culture C) Complete blood cell count and blood culture D) Blood gases and pulse oximetry

c

A 12-month-old child is brought to the clinic. On physical examination the PNP notes that the child's right eye drifts to the nasal side of the eye. The PNP explains to the mother that a complication of this condition may be: A) Myopia B) Astigmatism C) Amblyopia D) Strabismus

c

A 12-month-old child is brought to the clinic. On physical examination the PNP notes that the child's right eye drifts to the nasal side of the eye. The PNP explains to the mother that a complication of this condition may be: A) Strabismus B) Astigmatism C) Amblyopia D) Myopia

c

A 12-month-old infant is brought to the office for a well-child visit. The infant is healthy today, has tested positive for HIV, and has no history of allergies or reactions to previous immunizations. The mother is HIV positive. The child's immunization history is as follows: Birth Hep B Age 3 months DTaP, Hib, Prevnar, Hep B, and IPV Age 6 months DTaP, Hib, Prevnar, and IPV Age 9 months DTaP, Hib, Prevnar, and Hep B The PNP should administer the following immunizations today: A) IPV and Var B) MMR and Var C) IPV, HIB, Prevnar D) MMR, Prevnar, HIB

c

A 12-month-old is seen in the clinic for a well-child check-up. The mother expresses concern about the infant's sleep pattern. What is the average daily sleep time in infants at age 12 months? A) 6 to 12 hours B) 12 to 18 hours C) 10 to 15 hours D) 3 to 7 hours

c

A 12-year-old child comes to the school-based clinic complaining of unilateral chest pain that radiates to the back and abdomen. On physical examination, tenderness over the costochondral junction is noted. The chest pain is most likely caused by: A) A fractured rib B) Gastric reflux C) Costochondritis D) Pneumonia

c

A 12-year-old child reveals to the PNP during a visit for acne that she may be pregnant. In this community the pregnancy rate among females aged 15 to 19 years is 3 in 100. What is the most important area to explore? A) The source of prenatal care B) The expected date of confinement C) The possibility of sexual abuse D) Plans for telling her family

c

A 12-year-old girl has questions about the potential for her to get much taller. She aspires to be a professional basketball player. On examination she is in Tanner stage IV. Menarche was 1.5 years ago. In considering answers to her questions, it is important to realize which of the following? A) She will not reach her peak height velocity until she is in Tanner stage V B) Menarche occurs an average of 2 years after thelarche C) Girls reach peak height velocity immediately before menarche D) Boys reach peak height velocity at the average age of 15 years

c

A 13 year old has repeatedly exhibited behaviors of purposeful cruelty to younger children, property destruction, and school truancy. These behaviors fit BEST the diagnostic critera for a. major depressive disorder b. oppositional defiant disorder c. conduct disorder d. dysthymic disorder

c

A 13-month-old child is brought to the office for a well-child visit. The child is healthy today and has no history of allergies or reactions to previous immunizations. The PNP reviews the immunization record and finds the following: Age 5 months DTaP, IPV, Hib, Prevnar, and Hep B The child should receive the following immunizations today: A) DTaP, OPV, Hib, Hep B, MMR, and Var (the child should return in 2 months for DTaP, IPV, and Hib) B) DTaP, IPV, Hib, and Hep B (the child should return in 1 month for MMR and Var) C) DTaP, IPV, Hib, Prevnar, Hep B, MMR, and Var D) MMR and Var (the child should return in 2 months for DTaP, IPV, and Hib)

c

A 15-year-old adolescent is brought to the clinic complaining of chronic nasal congestion and fatigue. The father gave the adolescent an antihistamine that did not help with the congestion. Upon examination a small perforation is noted in the nasal septum. The PNP suspects: A) Foreign body perforation B) Allergic rhinitis C) Chronic use of cocaine D) Nasal septal defect

c

A 16-year-old adolescent comes to the clinic because of a latex allergy. The adolescent is concerned about sexually transmitted diseases (STDs) and using condoms. He states that he and a girlfriend have been "experimenting." The PNP suggests that: A) The girlfriend should use a cervical cap B) The girlfriend should use a diaphragm C) The adolescent boy should use a double condom (i.e., a non-latex condom covered by a latex condom) D) The girlfriend should take oral contraceptives

c

A 16-year-old female adolescent with Down's syndrome, who is healthy and has had no major medical problems, comes to the clinic for a well-child visit. The adolescent has been "mainstreamed" into a regular classroom and is doing well. The physical examination reveals Tanner stage III breast development and pubic hair. Today the PNP should: A) Order cervical spine x-ray films, a vision screen, and echocardiography B) Perform hearing and vision screens, and refer the adolescent to a long-term planning counselor C) Order thyroid and hearing screens, and provide sexuality education D) Provide nutritional counseling, order cervical spine x-ray films, and refer the adolescent to a family support group

c

A 2-week-old neonate is brought to the clinic for a well-child visit. The infant weighed 3.18 kg at birth; today the weight is 2.95 kg. The mother is breastfeeding about every 2 hours; the infant is latching on well and nursing 15 minutes per side. How many calories a day does this infant need for growth? A) 500 Kcal B) 375 Kcal C) 345 Kcal D) 300 Kcal

c

A 2-year-old child is brought to the clinic with periumbilical pain and vomiting that began this morning. The examination is unremarkable with the exception of tenderness noted on abdominal palpation. The differential diagnosis includes appendicitis. What should the PNP do next? A) Order an abdominal x-ray examination, and instruct the parents not to feed the child B) Order ultrasonography, and instruct the parents to feed the child only clear liquids C) Advise "watchful waiting," and instruct the parents regarding the signs and symptoms that indicate a more serious situation D) Order a CBC and differential count, and send the child home with instructions to return if there is a change in symptoms

c

A 3-week-old infant is being breastfed by a new mother. The mother is unsure if the infant is getting enough breast milk. Besides documenting weight gain, what other signs can the mother observe as an indication of adequate breast milk intake? The infant: A) Sleeps 4 to 5 hours between feedings B) Cries vigorously before feedings C) Has 4 stools and 6 wet diapers per day D) Sucks eagerly on a pacifier and chews on hands after feeding

c

A 3-year-old child is brought to the clinic for a well-child visit. The mother requests help with toilet training. The child refuses to use the toilet to have a bowel movement and squats, wearing a diaper, in a secluded corner to pass a stool. The parents offer encouragement through rewards and the "big kid" approach to using the toilet, but nothing seems to help. The PNP should respond that: A) Refusal to use the toilet after age 2 1/2 years is the result of caregivers (parents, day care workers, etc.) putting too much emphasis on toilet training B) All responsibilities, including clean up (with appropriate assistance), should be turned over to the child after wetting or soiling pants C) Autonomy struggles are common at this age. Most children eventually train themselves D) The child should be forced to sit on the toilet every 2 hours for 5 to 10 minutes during the day

c

A 3-year-old child is brought to the office for the first time. The child is adopted, and little is known about the prenatal and birth history. A diagnosis of fetal alcohol effects (FAE) is suspected. The physical findings that lead the PNP to suspect this diagnosis are: A) Carious teeth, hyperactivity, toe walking, and macrocephaly B) Balance problems, irritability, multiple scars on the arms and legs, and microcephaly C) Growth retardation, thin or wide lips, flat midface, and finger anomalies D) Abnormal hair pattern, cherubic lips, temper tantrums, and protuberant belly

c

A 5-year-old who occasionally reverses letters without any other suggestion of learning problems: A) Should be referred to a neurologist immediately B) May need special education classes for dyslexia C) Will probably grow out of this but should be monitored for other signs of difficulty D) Is likely to have school problems with reading and writing

c

A 6-month-old infant is brought to the office for a well-child visit. The history obtained from the mother reveals that the infant has had "cold symptoms" for 1 week. The mother reports that the infant's eating and sleeping habits have not changed and that the infant has not experienced any other symptoms. Physical examination reveals a temperature of 100.9°F (38.3°C) and right otitis media. The immunization record reads as follows: Birth-Hep B Age 1 month-Hep B Age 2 months-DTaP, Hib, Prevnar, and IPV What immunizations should the PNP administer today? A) None (The mother should be instructed to bring the infant back for immunizations in 1 month) B) Because the infant is febrile, only Hep B C) Hep B, DTaP, Hib, Prevnar, and IPV D) Hep B, DTaP, Hib, and OPV

c

A 6-year-old boy is brought to your office for a routine well-child examination. Significant findings in the child's history, reported by his mother, include unspecified "birth trauma" and a 9-year-old brother who has "difficulty in school." The mother also reports that her son cannot "sit still" or play with toys for long periods and notes that he recently had to change schools when the family moved. Physical examination reveals a well-nourished, appropriately dressed 6-year-old boy and no remarkable physical findings. The boy is unable to follow simple commands; he grabs your stethoscope from your neck and then runs around the examination room with it. CT & MRI of child's head reveal nothing out of the ordinary. What is the next step in determining the child's behavior problems? a. refer to specialist b. refer to special education c. determine whether child meets criteria for ADD/ADHD d. recommend behavior modification

c

A 7-month-old infant is brought to the clinic for a well-child visit. The infant has attained the expected developmental milestones for age. The physical examination is normal, and the infant appears to hear well. The mother is concerned that the infant no longer gibbers and imitates sounds as in past months. The PNP responds: A) "We need to administer the Denver II before providing a referral to an audiologist." B) "The child's hearing needs to be checked, and I'll give you a referral to an audiologist." C) "As an infant develops, milestones may come and go as others are emerging or developing. We will watch the infant closely." D) "A change in milestones is of concern; I will refer the infant to a developmental specialist and a neurologist who can rule out cerebral palsy."

c

A MOST concerning cardiac finding in the initial newborn assessment is a. a soft, grade III/IV systolic murmur b. a cuff blood pressure of 65/35 c. decreased femoral pulses d. a regular heart rate of 95 while sleeping

c

A new mother requests that her infant be placed on low-iron formula. She has heard that regular formula causes constipation. The PNP discusses with the mother: A) Changing to low-iron formula and using iron drops as a supplement B) Changing to a soy-based formula, which is low in iron and more easily digested C) The need for the formula to provide adequate iron for normal growth and development D) The importance of not listening to what people who are not professionals say about how to feed and care for the infant

c

A new parent asks why a light is shined in the infant's eyes. The PNP tells the parent that the infant must be checked for a red reflex in each eye to rule out: A) Glaucoma B) Strabismus C) Cataracts D) Amblyopia

c

Adolescents who receive teaching about condoms should also have information about a. the brands least likely to break during intercourse b. the application of petroleum jelly to prevent dry intercourse c. the us of nonoxynol 9 as a lubricant and spermicide d. the use of oil based lubricants as safe lubricants

c

An 18-month-old child is brought to the office for irritability, nightmares, and generally being tired for the past few nights. The child has had an upper respiratory tract infection for which the grandmother has administered an over-the-counter medication for rhinorrhea. The child is afebrile and alert, with obvious clear rhinorrhea. The PNP: A) Orders sinus radiologic studies B) Prescribes amoxicillin C) Discusses side effects of decongestants and antihistamines D) Suggests that the grandmother administer acetaminophen

c

An infant with congenital hypothyroidism is to start treatment with Levothyroxine. When describing the administration of the medication to the parents, it is important to reinforce: A) Evening dosing is preferable to morning dosing B) Cow's milk formula interferes with absorption C) Dosage must be monitored and increased significantly as the child grows D) A crushed tablet should be administered to the infant each morning

c

Diagnostic laboratory testing indicated for metabolic disorders in the newborn period always includes a. glycosylated hemoglobin b. urine electrolytes c. serum amino acids d. serum AST, GGT, ALT

c

During a routine sports physical examination the PNP asks a 13-year-old adolescent whose parents smoke about tobacco use. Which of the following is the best rationale for asking if the adolescent smokes? A) Smoking will inhibit athletic performance B) Children whose parents smoke are less likely to begin to use tobacco C) The average age at which tobacco use begins is 14 years D) The incidence of nicotine dependence is higher in boys

c

For which of the following screening tests should children fast for 12hrs before the test is done? a. total cholesterol b. serum chemistry profile c. serum lipid profile d. hematocrit

c

In addition to a developmental evaluation, which baseline studies should be included for an infant diagnosed with 22q11 deletion syndrome? a. echocardiography, thyroid function and renal ultrasound b. calcium levels, abdominal ultrasound and immunologic screening c. echocardiography, renal ultrasound, and immunologic screening d. thyroid function, calcium levels, and abdominal ultrasound

c

In addition to hypoglycemia, the MOST common complications found in infants born to mothers with diabetes or gestational diabetes include a. LGA, neural tube defects, anemia, and renal vein thrombosis b. SGA, cardiomegaly, polycythemia and hyperthermia c. LGA, cardiomegaly, renal vein thrombosis and polycythemia d. SGA, hepatosplenomegaly, hypotonia, and anemia

c

In addition to screening by checklist of a 17 month old suspected of having autism, what other testing should be included? a. occupational therapy evaluation b. MRI of the brain c. hearing screening d. chromosomal analysis

c

Johnny, 5 yo, is in your clinic for his initial well check. You note he has not received any immunizations. Which of the following is not necessary at his age? a. MMR b. DTaP c. Hib d. Varicella

c

Johnny, a 16yo high school student is in for a sports physical. He is in good health, but is concerned about a "bad" headache he had several weeks ago. He is afraid he might have a brain tumor. You tell him the most common type of headache with onset in adolescents is: a. sinus headache b. vascular headache c. tension headache d. migraine headache

c

Legal authority for APRN practice is granted by: a. federal law b. regulations from the department of health and human services c. state law and regulations d. the board of medicine in most states

c

National certification of PNPs has been offered since the 1970s. The following credentials may identify nurses who have national specialty certification: A) Master of science in nursing (MSN) B) Advance practice nurse (APN) C) Certified (C) D) Nurse practitioner (NP)

c

One of a toddler's greatest fears is: A) Not being accepted by peers B) Not getting enough food C) Separation from parents or caregivers D) Having limits set by caregivers

c

Sally, a 9yo, with moderate persistent asthma, is still having mild symptoms. She uses a short acting inhaled beta 2 agonist 3x/day and cromolyn sodium. You alter this treatment to include which of the following? a. broad spectrum antibiotic b. addition of systemic corticosteroid x5 days c. replace cromolyn with inhaled corticosteroid, and decrease the beta agonist to prn when symptoms subside d. addition of an inhaled anticholinergic

c

Standards for well child care/health promotion are set forth by the: A) Task Force, Preventive Services, Department of Health and Human Services B) American Academy of Family Physicians C) American Academy of Pediatrics (AAP) D) Healthy People 2000/2010 documents

c

The PNP examines a fair-skinned 17-year-old adolescent. The adolescent had a maculopapular, red, scaling rash on the trunk a few weeks ago and now has five scaling lesions that follow a line of cleavage confined to the trunk. The PNP diagnoses: A) Eczema B) Tinea versicolor C) Pityriasis rosea D) Contact dermatitis

c

The PNP is evaluating an 8-year-old child with an eye injury. About 1 hour ago the child was hit in the eye with a foreign body. When the eye is stained with fluorescein, a vertical linear abrasion is visible. The pupils are equal in size and reactive, and a positive red reflex is noted bilaterally. There are no abnormal extraocular movements. No foreign body is visible. An appropriate plan of care for this patient would include the following: A) Instill antibiotic drops, and apply patches over both eyes B) Close both eyes, and apply eye patches C) Apply antibiotic ointment, but do not apply an eye patch D) Instill ophthalmic steroid drops three times a day, but do not apply an eye patch

c

The PNP is examining a 6-month-old exclusively breastfed infant. The infant is growing appropriately. The mother would like to delay introducing solid foods until the infant is at least 12 months of age. The PNP tells the mother the nutrient most likely lacking if solid foods were to be delayed is: A) Vitamin B6 B) Phosphorus C) Iron D) Calcium

c

The PNP is performing a preschool physical examination on a 4-year-old child who is new to the practice. A bifid uvula is noted, and on further examination of the back of the hard palate, the PNP finds an abnormal contour. The PNP decides to: A) Check the child's gag reflex and determine whether the child has tonsils B) Determine whether the child's thyroglossal cranial nerve is intact C) Test the child's speech and hearing D) Test the child's hearing and ability to lateralize sound

c

When considering child abuse or maltreatment, which of the following statements is correct? A) The most common reporters of abuse are primary care providers B) The most common perpetrator of physical abuse is the father C) Abusive deaths are most often caused by biological family members D) Disabled children are safe from abuse and neglect

c

The PNP is returning a phone call to a parent who has questions regarding the use of over-the-counter medications for a 2-year-old child. The mother reports that the child has been running a temperature of 101.2°F with no other symptoms of illness. The mother has been treating the fever by alternating doses of acetaminophen and ibuprofen every 3 to 4 hours. The child is playful and has a normal appetite. Appropriate counseling for this mother should include: A) Continue giving the medicines every 3 to 4 hours at the appropriate dosage for the child's weight until the fever subsides B) Increase the interval of the medications to every 6 hours C) This amount and frequency of antipyretics may be inappropriate and harmful in a child whose only symptom is a low-grade fever D) Stop the medications, because a temperature of 101.2°F in a child with no other symptoms does not necessitate the use of antipyretics

c

The PNP is returning a phone call to a parent who has questions regarding the use of over-the-counter medications for a 2-year-old child. The mother reports that the child has been running a temperature of 101.2°F with no other symptoms of illness. The mother has been treating the fever by alternating doses of acetaminophen and ibuprofen every 3 to 4 hours. The child is playful and has a normal appetite. Appropriate counseling for this mother should include: A) Continue giving the medicines every 3 to 4 hours at the appropriate dosage for the child's weight until the fever subsides B) Increase the interval of the medications to every 6 hours C) This amount and frequency of antipyretics may be inappropriate and harmful in a child whose only symptom is a low-grade fever D) Stop the medications, because a temperature of 101.2°F in a child with no other symptoms does not necessitate the use of antipyretics.

c

The immunization history of a 23 month old is as follows: Immunizations: 9 months: DTaP, HIB, Hep B, IPV, PCV 7 13 months: DTaP, HIB, Hep B, IPV, PCV 7, MMR, Var The most appropriate recommendation is to now administer a. Hep B, IPV, PCV 7 b. DTaP, HIB, Hep B c. DTaP, HIB, Hep B, IPV, PCV 13 d. DTaP, HIB, Hep B, IPV, PCV 7

c

The knowledge base of the APRN is based on: a. medical content b. theoretical content only c. scientific content and theory d. theory and research

c

The most appropriate advice the PNP can give the mother of a 10-month-old who weighs 21 lb concerning the use of car seats is: A) "A child weighing more than 20 pounds may face forward in the car seat." B) "A booster seat should be used when your child has outgrown a convertible car seat but is still too small to fit properly in a vehicle safety belt." C) "Keep using a rear-facing car seat until age 1 year." D) "It is safe to keep your child in a car seat in the front seat of the car as long as there is not a passenger-side airbag."

c

The most common form of reimbursement for services provided by PNPs is: A) Fee charged at 85% of the physician's payment B) Fee charged at 90% of the cost under the physician's billing C) Fee for service D) Same fee as physician, "equal pay for equal service"

c

The most common form of reimbursement for services provided by PNPs is: A) Fee charged at 85% of the physician's payment B) Same fee as physician, "equal pay for equal service" C) Fee for service D) Fee charged at 90% of the cost under the physician's billing

c

The mother is concerned that her 3-year-old child has begun stuttering over the past 4 to 6 weeks. The PNP should: A) Refer the child to a speech therapist and audiologist B) Instruct the mother to remind the child to speak more slowly and clearly when beginning to stutter C) Explain that dysfluency is normal at this age but should be reevaluated if it is persistent or worsens D) Instruct the mother not to make eye contact with the child while the child is speaking to decrease anxiety

c

The mother of a 1-year-old child requests information about the child's speech and language development. The PNP explains that vocabulary acquisition may be slow during certain periods and that a vocabulary spurt is most common between ages: A) 10 and 12 months B) 12 and 14 months C) 16 and 24 months D) 2 and 3 years

c

The mother of a 10-week-old calls the office because the infant is passing hard stools. What suggestions would the PNP offer a mother? A) "Do nothing. Time will take care of the problem." B) "Hold the infant upright so gravity can help the stool pass." C) "Give a little extra water with added pasteurized apple or prune juice." D) "Add honey to a 4-oz bottle of water."

c

The mother of a 2-year-old child requests information regarding toilet training readiness. The PNP tells the mother that the most important factor in determining readiness to toilet train is that the child: A) Is not bothered by wet or soiled pants B) Is strong willed and shows an interest in the potty C) Is able to communicate needs and follow directions D) Wakes up from naps with soaked diapers

c

The mother of a 4-year-old child tells the PNP that her son "plays with himself in front of the TV." The PNP advises the mother to: A) Explain to the child that this is normal behavior, but if it continues, he will have to see a mental health professional B) Send the child to his room with no comment; the PNP should explain to the mother that this is normal behavior C) Explain to the child that masturbation is normal but should be done in private D) Ignore the behavior and make no comment to the child

c

The parent a of 2 week old states that even though the infant was fed Enfamil LIPIL with iron in the hospital, he is now receiving ProSobee LIPIL formula due to concern about allergies in an older child. What is the BEST response? a. the infant should be switched back to the Enfamil because the ProSobee does not contain an adequate amount of iron b. the infant should be maintained on Enfamil until there are obvious signs of allergy such as vomiting and bloody diarrhea c. both formulas contain equal amounts of nutrients including iron d. both formulas contain carbohydrates in the form of lactose

c

When performing a physical examination on a toddler, which of the following body parts would you examine last? a. heart & lungs b. abdomen & genitals c. ears & throat d. hips & extremities

c

The pediatric nurse practitioner is evaluating a well-appearing 18-month-old patient with diarrhea for 6 weeks. The family reports that the patient develops progressively looser stools throughout the day. Dietary history reveals that the patient drinks 12 ounces cow's milk and 24 ounces apple juice daily. Growth and development are within normal limits for age. Stool studies are negative for enteric pathogens and blood. The most likely diagnosis is: a. Malabsorption secondary to cystic fibrosis b. Infectious diarrhea c. Chronic nonspecific diarrhea/toddler's diarrhea d. Milk protein allergy

c

The pediatric nurse practitioner is performing a well-child examination on a developmentally normal infant who recognizes his parents, can sit independently for 1-2 minutes, rolls over from supine or prone starting position, drops one object when another is offered, and babbles one-syllable sounds. This patient is approximately: a. 3 months old b. 9 months old c. 6 months old d. 12 months old

c

The pediatric nurse practitioner notes two irregular areas of blue-gray discoloration over the sacral area of a 4-week-old Hispanic infant. The most likely etiology of this finding is: a. Inflicted injury (abuse) b. Acrocyanosis c. Mongolian spots (congenital dermal melanocytosis) d. Cutis marmorata

c

The pincer grasp is a fine motor skill that involves the ability to pick up a small object such as a raisin or piece of cereal with the thumb and forefinger that usually is mastered around: a. 4mo b. 6mo c. 9mo d. 16mo

c

The test most commonly used to elicit strabismus in infants and children older than 6 months is the: A) Snellen Eye Chart B) Tumbling E Game C) Cover-uncover test D) Allen Picture Cards

c

The underlying emotion of an insecurely attached (avoidant) relationship is: a. ambivalence b. deprivation c. anger d. conditional love

c

Tina, 12yo, presents with a lateral curvature of her spine. Which of the following tests would diagnose scoliosis? a. positive gower sign b. negative gower sign c. positive adam's sign d. negative adam's sign

c

What is the MOST important safety question to ask a 17 yo? a. Are you aware of ways to avoid accidents? b. Do you play violent video games more than 2 hours a day? c. Do you always wear a seat belt when driving or riding in a car? d. Is there a gun anywhere in your house?

c

What is the appropriate INITIAL intervention if the parent refuses immunizations? a. notification of child protective services of vaccine refusal b. discussion of the community benefit immunization c. validation of the parental concerns regarding individual immunizations d. provision of the "refusal to immunize" form for parental signature

c

What is the most sophisticated and advanced type of play? a. associate b. parallel c. cooperative d. onlooker

c

When approaching adolescents about sensitive issues, such as drug use and sex, an effective interviewing approach is to: A) Introduce the topics early in the history B) Let the adolescent know the parents are concerned C) Begin by asking about their friends' activities D) Avoid promising confidentiality

c

Which adolescent is considered the MOST likely to abuse illicit drugs? a. a 12yo caucasian male who admits to drinking beer once a month b. a 15yo african am male who admits to trying a variety of alcoholic beverages c. a 16yo caucasian male, who dropped out of school, was suspended twice for smoking and has smoked marijuana twice d. a 16 yo african am, male who is an honor student but admits to smoking marijuana occasionally

c

Which of the following findings would be most likely associated with asymmetric intrauterine growth retardation? a. weight, length, & head circumference ranging from 3rd to 5th percentile b. heavy maternal smoking throughout pregnancy c. Weight at 3rd percentile and length at 25th d. Gestational diabetes

c

Which of the following is an example of a fine motor skill achieved by preschool aged children? a. being able to alternate feet b. walking on a balance beam c. holding a glass with one hand d. balancing on one foot

c

Which of the following is most accurate about childhood lead exposure? a. Houses built after 1978 are most likely to have lead-based paint b. Children are less likely than adults to be affected by lead poisoning because their bodies absorb a lower percentage of lead when exposed c. Most pediatric lead poisoning occurs via normal hand-to-mouth behavior in the presence of environmental lead dust d. Children in minority ethnic groups have a lower incidence of lead poisoning than Caucasian children

c

Which of the following is the best written chief complaint? a. 5yo asian female with itchy red rash b. 1 mo with difficulty feeding c. 15yo african american female complaining of lower abdominal pain for 3 days d. 12yo caucasian with itchy eye for 1 week

c

Which of the following is the most appropriate first choice management strategy for a 30mo old child with learning difficulties and ADD/ADHD? a. referral for appropriate education b. referral to an ophthalmologist c. behavior modification d. prescription for Ritalin

c

Which of the following issues or concepts is relevant to the school-aged child? a. operational thinking b. initiative c. concrete operations d. separation-individuation

c

Which of the following vaccines is contraindicated in the immunocompromised pediatric patient? a. Diphtheria, Tetanus, and acellular Pertussis (DTaP) b. Inactivated Influenza c. Measles, Mumps, Rubella (MMR) d. Hepatitis B

c

While examining a 2.5 week old infant, you notice irritability when you lift the infant and an asymmetrical Moro reflex. A spasm of the sternocleidomastoid on the left side is also present. These findings suggest: a. Torticollis b. Genu varum c. Fracture clavicle d. Pierre-Robin syndrome

c

While obtaining a family history, a mother tells the PNP that her maternal grandfather, her mother, herself, her son, and her daughter have von Willebrand disease. The PNP describes this inheritance pattern as: A) Mosaic B) Autosomal recessive C) Autosomal dominant D) X-linked

c

While performing a well child check exam on a 3yo you discover a heart murmur. In your eval, you remember the following about innocent murmurs: a. they are best heard in diastole b. you must radiate to the axilla c. the intensity is no greater than I or II/VI d. There is no variation with changes in position

c

You are performing a newborn physical exam and you notice white specks around the circumference of the iris. You will also have to assess for: a. hypertonicity b. cherry red spot on the macula c. heart murmur d. cleft palate

c

You would expect a school age child to: a. grow 1.5in per year b. grow 0.5in per year c. Gain about 6lb per year d. Gain about 3lb per year

c

early nursing research focused on: a. the response of policy makers to the nursing shortage b. the effectiveness of the NP as a primary care giver c. an effort to demonstrate quality and cost effectiveness of NP d. the role of the NP as physician extender

c

17-year-old Henry is in for a sports physical. Upon assessment, the PNP sees that Henry is tall, Tanner stage 2, and has difficulty in school. The PNP orders a karyotype. What results does he expect? a. X b. XYY c. XXY

c pg. 22 Patient has physical manifestations of Klinefelter's Syndrome

Zach has Trisomy 21. Which of the following findings is not associated with his chromosomal makeup? a. Inner epicanthal folds b. Single palmar crease c. Downward slanting eyes

c pg. 22 Upward slanting eyes are associated with Trisomy 21

The PNP has a concern for Turner's Syndrome when her patient presents with which of the following physical findings? a. Widely-spaced nipples b. Lack of secondary sex characteristics c. Both a and b

c pg. 23

What would the PNP determine Lee's APGAR score to be when he presents with heart rate of 92, normal color with acrocyanosis, pulls away with stimulation, active spontaneous movements, and good cry? a. 14 b. 10 c. 8

c pg. 26

The PNP is assessing 8-week old infant. She knows that many primitive reflexes disappear by age 3 to 4 months. Which of the following primitive reflexes disappear by 3 to 4 months old? a. Rooting b. Moro c. Both a and b

c pg. 28

The PNP is assessing a 2-month old patient. She knows that the primitive reflex of tonic neck should disappear by what age? a. 1 month b. 2 months c. 3 months

c pg. 28

The PNP notices a blue benign, flat area with wavy borders and an irregular shape on the leg while performing an assessment on a 2-week-old patient. What skin variation does the PNP chart? a. Port wine stain b. Strawberry mark c. Mongolian spot

c pg. 28 Often last until 3 to 5 years old/almost always gone by puberty

The PNP is assessing a 1-month old patient. She knows that the primitive reflex of stepping should disappear by what age? a. 4 months b. 3 months c. 2 months

c pg. 28 Stepping/Placing should disappear at 1 to 2 months old

The PNP is assessing a 3-hour old infant. He notes 2 hair whorls. What can this finding be associated with? a. Down Syndrome b. Hydrocephalus c. Poor brain growth

c pg. 29 More than one hair whorl could indicate poor brain growth. Unruly hair with unusual facies, SGA, microcephaly are often seen with Down Syndrome.

The PNP receives a call from the nursery about a 1-hour old patient. The nurse reports that she was unable to pass a suction catheter through the newborns nostrils. What does the PNP suspect? a. Arhinia b. Micrognathia c. Choanal atresia

c pg. 30 Choanal atresia is a narrowing or blockage of the nasal airway by tissue and is present at birth.

The PNP is assessing for developmental dysplasia of the hip in a 4-month old. With the hips flexed at 90 degrees and knees together and the PNP's fingers over the greater trochanters, the PNP abducts the hips and feels the femoral head slips away from the acetabulum. What is the name of this exam finding? a. Ortolani's click b. Babinski reflex c. Barlow's maneuver

c pg. 31 Hard to assess for after 6 months old

The PNP is seeing a 13-day patient with a reported temperature of 102 rectal at home. The PNP obtains blood cultures, a CBC, CMP, CSF cultures, and urine culture. Which organism is the most common cause of infection in an infant this age? a. S. pneumoniae b. H. influenzae c. Group B streptococcus

c pg. 36 S. pneumoniae and H. flu are common causes in the 2nd month of life.

The PNP is assessing the growth chart of a 9-month old patient. She notes that the chest circumference is the same measurement of the head circumference. At what age does the chest start growing faster than the head? a. 3 years old b. 2 years old c. 1 year old

c pg. 39 Chest eventually grows 5 cm>head by the end of preschool years

The PNP is assessing a 4-year-old child's legs for a concerns for genu valgum. She is not concerned with this finding and educated the child's mother that the musculoskeletal finding should resolve by what age? a. Infancy b. Toddlerhood c. Preschooler

c pg. 40 Genu valgum=knock knees

The PNP is assessing the fine motor skills of Leanne, 3-years-old. Leanne is able to build a block tower. What other finding would the PNP expect from Leanne? a. Draw a person with 4 to 6 body parts b. Print letters c. Copy a circle

c pg. 41 Draw person at 4 years old. Prints letters at 5 years old.

At what age does the PNP expect a child to use sentences regularly and know more than 2000 words? a. 3 years old b. 4 years old c. 5 years old

c pg. 42

The PNP is assessing a 6 month old patient. He knows that Tiffany will grow in an orderly manner. How will Tiffany grow? a) Proximal to Distal b) Cephalo to Caudal c) Both A & B

c pg. 5

The PNP is assessing a 17-year-old male with a concern for having "breasts". The PNP asks the patient if he uses marijuana, alcohol, and/or antidepressants. What other substances can cause gynecomastia in this age? a. Growth hormones b. Energy drinks c. Anabolic steroids

c pg. 58

The PNP is seeing Olivia for her 1 week weight check. Olivia lost the expected 10% of weight after birth. When should Olivia be back to her birth weight? a. 5 to 7 days b. 8 to 10 days c. 7 to 14 days

c pg. 6

The PNP is seeing Riley for his 4-month well child appointment. What supplement should all breastfed infants receive at 2-months of age? a. Vitamin A b. Vitamin B c. Vitamin D

c pg. 6 At age 2 months old infants should be started on Vitamin D 400 IU/day.

Oliver is here for his 2-month well child appointment and scheduled immunizations. His mother is a vegetarian and strictly breastfeeds Oliver. What nutritional education should the PNP provide? a. Vitamin A supplements should be started at 400 IU per day b. Vitamin B6 supplements should be given c. Vitamin B12 supplements should be given.

c pg. 6 Infants of strictly breastfed mothers should be given Vitamin B12 to prevent neurological abnormalities.

The PNP assesses a systolic murmur that changes with position. What is the most common innocent murmur that is heard at the left lower sternal border? a. Venous hum b. Machinery hum c. Still's Murmur

c pg. 68 Musical systolic murmur. Due to turbulence in LV outflow. Systolic ejection murmur

6-year-old Addison's mom is concerned that Addison is irrational and not capable of logical thought most times. At what age does, the PNP knows that Addison will enter the cognitive stage of concrete thinking? a. 4 to 5 years old b. 5 to 7 years old c. 7 to 11 years old

c pg. 7

At what age should the PNP expect his patients to demonstrate formal operational thoughts? a. 4 to 7 years old b. 7 to 11 years old c. 11 to 15 years old

c pg. 7

The PNP knows that Grant should have his primary lateral incisor erupt at what age? a. 4 to 6 months old b. 6 to 7 months old c. 7 to 9 months old

c pg. 7

Annabelle was born at 32-weeks gestation. She is now 6-months-old, and her mom wants to know when she will be like a "normal child". The PNP educates Annabelle's mom that corrected gestational age is considered until she is _______ years old. a. 1 b. 1.5 c. 2

c pg. 8

Jackie is in for her 4-month check up. She eats 4 oz of formula every 3 hours. The PNP knows that the calorie count for a child this age is a) 70 to 100 kcal/kg/day b) 100 kcal/kg/day c) 120 kcal/kg/day

c pg.5

Sarah a 13 month old whose parents are very concerned after she experienced a second fevrile seizure. They ask you about the use of medications to prevent any further seizures. Which of the following statements is not true regarding febrile seizure prophylaxis? a. short term antivonsvulsant prophlaxis is not indicated b. prolonged anticonvulsant prophylaxis for preventing recurrent febrile convulsionsis controversial and no longer recommended. c. it may be indicated for children < 12mo with recurrent febrile seizures d. oral diazepam may be used at the onset, and for the duration of the febrile illness to reduce the risk of reoccurance of febrile seizures

c.

secondary sex characterstics are?

change in voice shape of body pubic and facial hair

16. What type of hemorrhage would be expected with severe factor VIII deficiency? a. Severe hemorrhage following moderate to severe trauma b. Gross bleeding following mild to moderate trauma c. Gynecologic hemorrhage d. Spontaneous hemarthosis

d

16yo Sarah makes the following statements to you during a health visit. Which of the following pieces of information should not be kept confidential? a. "I have been sexually active with 3 of my boyfriends" b. I sometimes smoke marijuana c. I want to get pregnant d. Sometimes I feel like ending my life

d

17. A baby is born to a mother with chronic hepatitis B. what is the best treatment approach? a. Administer interferon within 24hrs b. Administer hepatitis B vaccine within 24hrs c. Administer interferon & nucleotide in combination daily d. Administer HBIG & Hepatitis B vaccine within 12 hours

d

17. Which one of the following is not found in children with growth hormone excess? a. Tall stature b. Prominent mandible & supraorbital ridge c. High or normal plasma growth hormone d. Short stature

d

A 13-month-old child is brought to the clinic for a well-child visit. The child is in the 15th percentile for weight and the 50th percentile for height. The head circumference is in the 50th percentile. The child drinks about 23 oz of skim milk per day and drinks about 20 oz of juice per day. How would the PNP guide this parent? A) "The child should not be allowed to drink all that skim milk and juice." B) "The height is at the 50th percentile, but the weight is at the 15th percentile; give the child about 12 oz of whole milk per day and eliminate the juice." C) "The growth is good; continue doing what you are doing" D) "Let's talk about food groups and the child's favorite foods other than milk and juice."

d

A 14-year-old adolescent comes to the school-based clinic with PMS. The PNP advises the adolescent to: A) Limit intake of chocolate, fats, and sodium and increase exercise B) Limit intake of sugar and fat and decrease exercise C) Limit intake of fats and sodium and decrease exercise D) Limit intake of sugars, fats, and sodium and participate in aerobic exercise

d

A 15 year old previously healthy teen is having school problems, feelings of sadness, insomnia, and disinterest in activities previously enjoyed. The parents reported the teen spends hours alone, avoiding social situations. When questioned, the teen denies any desire or plan to hurt himself or others. Which would be the MOST appropriate INITIAL management of this patient? a. prescribe a tricyclic antidepressant b. arrange for home schooling c. refer for immediate inpatient evaluation d. refer for outpatient psychotherapy

d

A 16-year-old adolescent has evidence of weight loss. The PNP notes on the chart documentation of frequent loose stools for 2 weeks. The differential diagnosis includes hyperthyroidism. What additional clinical finding would suggest this diagnosis? A) Dry mouth B) Hypotension C) Coarse hair D) Heat intolerance

d

A 16-year-old female adolescent with Down's syndrome, who is healthy and has had no major medical problems, comes to the clinic for a well-child visit. The adolescent has been "mainstreamed" into a regular classroom and is doing well. The physical examination reveals Tanner stage III breast development and pubic hair. Today the PNP should: A) Provide nutritional counseling, order cervical spine x-ray films, and refer the adolescent to a family support group B) Perform hearing and vision screens, and refer the adolescent to a long-term planning counselor C) Order cervical spine x-ray films, a vision screen, and echocardiography D) Order thyroid and hearing screens, and provide sexuality education

d

A 17-year-old adolescent attended a party and returned home. The grandmother calls the office and is concerned that the adolescent's eyes "look funny." They are puffy, the pupils are slow to react or nonreactive, and tearing is present. With these presenting signs and symptoms the PNP suspects use of: A) Cocaine B) Phencyclidine hydrochloride (PCP) C) Alcohol D) Marijuana

d

A 2-week-old infant comes to clinic accompanied by his 15-year-old mother. The primary goal for this visit is to discuss: A) Available birth control methods B) Establishing fatherhood through the legal system C) Returning to school immediately D) Specific parenting skills by using concrete examples

d

A 3-year-old child is brought to the clinic for a well-child visit. The mother requests help with toilet training. The child refuses to use the toilet to have a bowel movement and squats, wearing a diaper, in a secluded corner to pass a stool. The parents offer encouragement through rewards and the "big kid" approach to using the toilet, but nothing seems to help. The PNP should respond that: A) Refusal to use the toilet after age 2.5 years is the result of caregivers (parents, day care workers, etc.) putting too much emphasis on toilet training B) The child should be forced to sit on the toilet every 2 hours for 5 to 10 minutes during the day C) All responsibilities, including clean up (with appropriate assistance), should be turned over to the child after wetting or soiling pants D) Autonomy struggles are common at this age; most children eventually train themselves

d

A 4-year-old child has had a productive cough with yellow-green sputum but no fever for 7 days. In developing a plan of treatment, the PNP understands the following: A) The production and color of the sputum may indicate a bacterial infection B) Prolonged cough illnesses are often allergic or viral in nature C) A cough that continues up to 14 days after onset is probably a bacterial infection D) Infection and reactive airway disease are common causes of productive cough in children

d

A 4-year-old child is brought to the office for a preschool physical examination. The PNP asks the child to sit on the floor in a cross-legged position and then get up without using the hands. The child is unable to do so and rolls onto all four extremities before standing. The PNP is concerned that the child may have a: A) Developmental problem B) Cognitive deficit C) Neurologic deficit D) Neuromuscular disorder

d

A 4-year-old child with chickenpox has vesicles on the skin of the right eyelid. The child complains of eye pain and blurred vision. The PNP should treat the condition by: A) Applying cool compresses to the eye and lesions B) Prescribing eyedrops containing steroids to decrease inflammation and pain C) Prescribing polyspoium ophthalmic ointment for the secondary bacterial infection D) Immediately referring the child to an ophthalmologist

d

A 5-year-old child is brought to the clinic for immunizations. The child has never had immunizations. What immunizations should the child receive today? A) Tetramune, IPV, MMR, and Varivax (and should return in 6 weeks) B) DPT, IPV, and Varivax (and should return in 8 weeks) C) DTaP, IPV, MMR, Varivax, and Hep B (and should return in 12 weeks) D) DTaP, IPV, MMR, Varivax, and Hep B (and should return in 6 weeks)

d

A 9-year-old child is brought to the clinic for the evaluation and treatment of a rash. While examining the child, the PNP detects a speech dysfluency. The most appropriate plan of treatment should include: A) Treating the rash and scheduling a well child visit to address the speech problem B) Treating the rash and making no referral because it is too late for speech therapy to be beneficial C) Using a clinical screening tool to determine whether a language disorder exists D) Treating the rash and making a referral for speech, language, and hearing evaluation with a speech pathologist

d

A father brings his 9-month-old because the infant has been tugging on the right ear. While examining the ear, the PNP notes that the infant has cranial and facial asymmetry. There is no evidence of otitis media. The PNP should then: A) Refer the child to a neurologist for consultation B) Perform an extensive developmental assessment C) Continue to observe the infant, and recheck cranial shape at the 1-year well child visit D) Consult with a physician and obtain a cranial radiologic film, CT scan of the skull, or both

d

A husband and wife, both aged 42 years, have adopted a 10-month-old infant from Eastern Europe. The infant has been in an orphanage since birth. The infant's family history is unavailable. A physical examination of the infant was required before the infant entered the United States, and the results were documented as "normal.'' The adoptive parents are bringing the child in for the first well-child visit with the PNP today. What initial screening tests should be performed? A) CBC, urinalysis, hepatitis B screen, and screening for fetal alcohol effects (FAE) and fetal alcohol syndrome (FAS) B) Hepatitis B screen, human immunodeficiency virus (HIV) screen, stool test for parasites, and screening for FAE and FAS C) CBC, Mantoux test, and screening for FAE and FAS D) CBC, hepatitis B screen, HIV screen, and screening for FAE and FAS

d

A male with Vitamin D-resistant rickets asks what his chances are of passing his disease to his parents. The PNP answers: a. all sons will be affected by only 25% daughters b. all daughters are affected by only 25% sons c. 50% of all offspring will have the disease d. all daughters will be affected but no sons.

d

A mother brings a 4-year-old child to the clinic for a well-child visit. She is concerned that the child has autism. Atypical behavior traits that appear in autistic children include: A) An intense relationship with the mother during the first year of life B) Obsession with repetitive hand cleansing C) Onset of behaviors noted after the third year of life D) Impairment in reciprocal social interaction

d

An 8-year-old is brought to the clinic with "hard bumps" in the neck area and axillae for the past week. The child has been living with grandparents for the past 6 months and visits a nursing home frequently. The history is negative for other symptoms such as weight loss. Upon exam the nodes are enlarged but painless. The PNP is suspicious of: A) Epstein-Barr virus (EBV) B) Cytomegaly virus (CMV) infection C) Histoplasmosis D) Tuberculosis (TB)

d

A mother brings her 2-year-old child to the clinic for a well-child visit. The mother's chief complaint is the child's rebellious behavior. The mother says that she has tried time-out, yelling, and spanking but nothing has worked. The child has never slept through the night and still gets a bottle in the middle of the night. In the examination room the PNP observes as the child repeatedly gets into the mother's purse when she is not paying attention, despite the mother telling the child "no." Based on the history and observation, the PNP suggests that: A) The child shows signs of attention deficit-hyperactivity disorder and referral to a specialist may be necessary B) The child is normal; this rebelliousness is only a phase and will improve with time C) The child exhibits behavior atypical of 2-year-old children and immediate referral to a child psychologist is necessary D) The child needs to have limits and boundaries set consistently and the mother could benefit from parenting classes

d

A newly delivered mother wants to breastfeed but admits to using marijuana occasionally. She reports last using marijuana over 6 weeks ago. Her drug toxicology screen is positive for marijuana. What would the PNP advise regarding breastfeeding? A) Discourage the mother from using marijuana and recommend not breastfeeding until she stops using marijuana and her toxicology screen is negative B) Recommend breastfeeding C) Tell the mother she is not a good candidate for breastfeeding because her toxicology screen indicates recent use of marijuana D) Discourage the mother from using marijuana, but if she does, instruct her to pump and discard her breast milk for at least 24 hours before resuming breastfeeding

d

According to Erik Erickson, the "cornerstone of vital personality" is the development of: a. Symbiosis b. Autonomy c. Independence d. basic trust

d

An 18yo male comes to see you with a painless mass in the right side of his scrotum. The most likely diagnosis is: a. epididymitis b. testicular torsion c. incarcerated hernia d. hydrocele

d

During a visit to your clinic, Mitch, 2yo, presents large muscular calves & demonstrates difficulty rising from sitting position. Which lab test should you order below? a. serum calcium b. serum magnesium c. serum phosphorus d. serum creatine kinase

d

An important assumption underlying the "family systems theory" is: a. Problems in the family can be traced back to individual family members b. Family dysfunction is best addressed by emphasizing past (rather than current) family dynamics. c. The family is a closed system which does not interact with its environment d. Changes in one part of the family affect all other parts of the family system

d

An infant brought to the clinic is diagnosed with failure to thrive (FTT), persistent growth deficiency of the head, and delayed development. Some unusual facial abnormalities are noted. The mother has a history of consuming large amounts of alcohol. The PNP suspects fetal alcohol syndrome (FAS) and refers the infant: A) For consultation with an endocrinologist B) For consultation with a neurologist C) For a genetic workup D) To a First Steps or Birth to Three Program

d

At a well-child visit the parents report that the child, who is now approximately age 2.5 years, frequently rocks back and forth and has done so since about age 6 months. The physical examination is normal, as is the developmental history. The most likely cause of the rocking behavior is: A) Emotional deprivation B) Cerebral dysfunction C) Autism D) Normal variation

d

At an 18-month-old child's well-child visit the mother states that the child is a picky eater and has 4 oz of milk by bottle at nap time and 8 oz of milk by bottle at bedtime. The rest of the child's fluids are taken by cup. Of the following, what is the most pertinent information for the PNP to obtain? A) The total intake of milk for 24 hours B) The family's financial status C) A list of foods the child refuses D) A 24-hour recall diet

d

At an office visit, the mother of a 15-year-old basketball player reports that the adolescent arrived home from a postgame party and was euphoric, hostile, and hyperactive. The PNP suspects use of: A) Glue B) Marijuana C) Alcohol D) Amphetamines

d

Certification is: a. procedure through which the government appraises and grants certification to the APRN b. Granted by the individual states c. Governed by each state's Board of Nursing d. A process in which a nongovernmental agency or group verifies that an APRN has met certain predetermined standards for specialty practice.

d

In caring for a noncompliant 16-year-old adolescent with diabetes, the PNP can best assess the diabetic control by: A) Measuring the insulin level B) Obtaining a glucose tolerance test C) Monitoring serum glucose levels for 3 consecutive days D) Measuring the hemoglobin A1c level

d

In most cases the PNP is covered by employee professional liability for: A) Off-duty situations, such as athletic physicals not sponsored by the agency B) Off-duty personal liability C) Off-duty coverage for personal injury, such as discussing a patient in public D) Those acts covered as normal work-related services and duties

d

In performing a physical examination on a 9mo old infant, which of the following developmental fears woud not be appropriate for you to consider? a. Stranger anxiety b. Pain c. Separation from parents d. Bodily harm

d

On examination of a 3-month-old infant the PNP is unable to elicit a red reflex in the right eye. Previous examinations failed to note the presence or absence of a red reflex. The PNP's response is to: A) Reassure the parents that this is not a problem because the infant has dark eyes B) Note this finding in the infant's chart and check again in a few months C) Refer the infant to an ophthalmologist to rule out retinal trauma D) Immediately refer the infant to a pediatric ophthalmologist to rule out a congenital cataract or retinoblastoma

d

Scope of practice: a. is identical across the states b. is determined by the federal government c. is mandated by the federal government d. varies from state to state

d

The American Academy of Pediatrics (AAP) recommends that child ASSENT to participate in clinical research requires evidence of which of the following? a. full understanding of the risk and potential benefits of the treatment b. rejection of non-research alternatives c. acceptance of unfamiliar procedures d. deveolpmentally appropriate understanding of the nature of his condition

d

The PNP counsels the mother of an infant about possible sibling rivalry a 2-year-old sibling may exhibit. To decrease sibling rivalry the PNP suggests that the parents should: A) Tell the older child that he or she is no longer a baby and can wait until his or her needs can be met B) Not allow the older child to touch the infant under any circumstances C) Not tolerate any regression on the part of the older child D) Set aside extra time to spend with the older child

d

The PNP is evaluating a 2-year-old child with a 48-hour history of a dry, coarse cough and fever. Upon examination the child appears ill but nontoxic. The child has a harsh, forceful cough with intermittent stridorous breaths after a coughing spasm but no stridor at rest. The parents have been giving the child an expectorant and cough suppressant that have provided little relief. The PNP makes the diagnosis of croup without respiratory distress. Treatment for this child should include: A) Nebulized albuterol and expectorants B) Narcotic cough suppressant as needed, fever management, mist therapy, and rest C) Antibiotic therapy combined with steroids and an expectorant D) Continued use of an expectorant if helpful, oral steroids, mist therapy, and rest

d

The PNP is evaluating a postterm (42 weeks' gestation) neonate in the nursery. On the physical examination the PNP would expect to find: A) An elevated weight/length ratio B) Smooth soles of the feet C) Excessive vernix caseosa D) Cracked, peeling skin

d

The PNP is seeing a 1-month-old infant for routine follow-up. The infant received both the Hep B and the hepatitis B immune globulin (HBIG) vaccines because the mother is hepatitis B surface antigen (HBsAg) positive. At this visit the PNP should: A) Obtain a Hep B core antigen B) Obtain an anti-HBe C) Readminister only the HBIG D) Give the second dose of Hep B

d

The PNP is seeing a 4-year-old Romanian child for an initial checkup. A local couple, whose other two children also come to the clinic for care, recently adopted the child. The child had been living in a state-operated orphanage, and no medical records are available. Today's visit should include the following: A) Physical examination and referral for counseling with a counselor specializing in adoptive families B) Complete physical examination and an attempt to obtain previous medical records C) A discussion of problems and determination of the child's medical needs D) Complete physical examination, a CBC, urinalysis, immunizations (DTaP, IPV, MMR, varicella, and Hep B), HIV, and a PPD test

d

The PNP sees a 6-week-old, HIV-exposed neonate in the clinic. The mother received zidovudine (AZT) starting in the second trimester of pregnancy and intravenous AZT during labor. The neonate was started on oral AZT after birth. As a prophylaxis for Pneumocystis carinii pneumonia (PCP) at this 6-week visit, it would be appropriate in conjunction with the HIV specialist managing the infant to: A) Continue ZDV, and start PCP prophylaxis if the neonate is HIV positive B) Continue ZDV, and start TMP/SMX C) Discontinue ZDV, and start PCP prophylaxis if the neonate is HIV positive D) Discontinue the ZDV, and start trimethoprim/sulfamethoxazole (TMP/SMX, Bactrim)

d

The PNP sees a 7-year-old child for "an ear recheck." Clinical findings include tympanic membranes that are opaque bilaterally, with visible landmarks and light reflexes. A fluid line is visible on examination. The diagnosis of otitis media with effusion is made. Of the following treatment plans, which is the most appropriate? A) Amoxicillin 60 mg/kg three times a day for 10 days (erythromycin if the child is allergic to penicillin) B) Prednisone 10 mg/kg/day for 7 days C) ENT referral D) Observation and recheck in 4 to 6 weeks

d

The PNP teaches new parents that when breastfeeding is well established they can expect baby to have: a. as many as 4 wet diapers each day b. a stool every 3-4hrs c. 1 wet diaper an hour d. 5-6 wet diapers and 2-3 stools each day

d

The diagnostic criteria for autistic disorders includes which of the following? a. speech delay, ataxia, mental retardation b. impairments in social interactions, interpersonal communication, and staring spells c. mental retardation, impairments in social interactions, & stereotypical restricted pattern of interests & activities c. impairments in social interactions, in interpersonal communication, and stereotypical restricted pattern of interest and activities

d

The foster mother of a 16-year-old adolescent calls the office to make an appointment. She suspects that the adolescent is "doing drugs" and wants to secretly test for drugs. Which one of the following responses is most appropriate? A) Explain that such drug testing is unethical B) Tell the foster mother that drug use is rare in 16-year-old adolescents C) Schedule an appointment for the adolescent to be tested D) Schedule separate appointments for the foster mother and the adolescent

d

The grandmother of an 8-month-old infant brings the infant to the clinic for a well-child visit. The infant missed both the 4- and 6-month examinations and is behind on immunizations. The grandmother states that the parents were substance abusers during the prenatal period and are still using drugs and alcohol. At this visit, appropriate care and guidance should include: A) Growth assessment, Denver II screening, and immunizations B) Growth and developmental assessment, referral for genetics evaluation, and scheduling an appointment in 1 month for immunizations C) Complete physical examination, immunizations, and referral to a genetics center for professional developmental evaluation D) Growth and developmental assessment, immunizations, social services referral, and scheduling an appointment in 1 month to update immunizations

d

The most appropriate laboratory tests to obtain for evaluation of a neonate with jaundice presenting in the first 36 hours of life include: A) G6PD assay and an Rh type test B) Direct Coombs' test and G6PD assay C) Total and direct serum bilirubin levels and a reticulocyte count D) Maternal and infant blood group and Rh type tests and a direct Coombs' test

d

The mother of a 2-year-old child is concerned about the child's fear of the dark. The PNP responds that: A) Parents should not allow the child to withdraw from a fearful situation B) Fears that interfere with social development resolve as the child develops C) Young children with fears tend to have phobias as adults D) Fears of this type are a normal developmental process

d

The mother of a 2-year-old child is concerned about the child's thumb sucking during the day when not playing and at night while sleeping. The PNP suggests that: A) This is not a problem unless the thumb sucking continues past age 3 years B) The mother should obtain an orthodontic device for the child's mouth to discourage the sucking behavior C) The parents should send the child to time-out when caught thumb sucking during the day D) The parents should ignore the behavior because it is not harmful at this age

d

The mother of a 4-year-old female patient reports that the child frequently awakens screaming and agitated about 1 hour after falling asleep and does not appear to recognize her mother. The child falls asleep again within 10 minutes and does not recall these events in the morning. The pediatric nurse practitioner should: a. Tell the mother to speak loudly to the child during these episodes to fully awaken her b. Refer the family for counseling c. Refer the patient to a pediatric neurologist d. Reassure the mother that these episodes will likely resolve as the child gets older

d

The mother of a 4-year-old who was adopted at birth asks the PNP when is the most appropriate time to tell the child that he is adopted. The PNP responds: A) Do not offer the information until the child is developmentally ready at about age 10 years B) When the mother feels the child is able to understand the concept of adoption C) Wait until the child is in third grade and can share with other children his adoption story D) Most children by the age of 3 years are old enough to understand the story of adoption

d

Which of the following is not a typical clinical feature of Kawasaki disease? a. Hand and foot edema b. Bilateral non-exudative conjunctivitis c. Risk of coronary artery aneurysms d. Bacterial growth in peripheral blood cultures

d

The mother of an 18-year-old with epilepsy brings her to the clinic for family planning. The PNP discusses the options and recommends: A) An intrauterine device (IUD) B) Levonorgestrel (Norplant) C) Oral contraceptive pills (OCPs) D) Medroxyprogesterone (Depo-Provera)

d

The parents of a 9-year-old with primary enuresis request information regarding treatment options. When discussing alternative treatments for enuresis, the PNP offers pertinent information to help the child and parents make an appropriate decision about which treatment would be best. The family should be told: A) The alarm is the safest therapy, but the relapse rate is about 10% B) Pharmacologic therapy has the lowest relapse rate C) Motivational therapy should be used after pharmacologic treatment D) Treatment should begin with bladder awareness training

d

The pediatric nurse practitioner reads a healthy 10-year-old patient's screening PPD (tuberculin skin test) as positive (12 mm in duration) 48 hours after the PPD was placed. The pediatric nurse practitioner's next action should be to: a. Begin multi-drug therapy for tuberculosis b. Repeat PPD testing in 6 months c. Begin monotherapy with isoniazid (INH) d. Obtain a chest x-ray

d

What should the PNP consider when immunizing a child for measles, mumps, and rubella (MMR) in relationship to a TB skin test? A) Give MMR first, and give the PPD in 1 to 2 weeks B) Give PPD first, and 6 months later give MMR C) PPD and MMR should never be given at the same time D) Give both at the same time, or give MMR and wait 4 to 6 weeks to apply PPD

d

Which POST competition guidance is most helpful for best nutrition practices for the athlete? a. additional protein consumption is needed for tissue repair b. protein supplements will increase muscle size if taken after competition c. fat loading is most important within the first 1-2 hours d. replacement of carbohydrates should optimally occur within 2 hours

d

Which of the following best describes the Denver II? A) It screens fine and gross motor, expressive and receptive language, and cognitive academic skills by direct observation of children aged 2 to 6 years B) It assesses receptive and expressive language based on observation and parental interview of infants and children aged 1 to 36 months C) It assesses receptive and expressive language by interview, observation, and test administration for infants and children from birth to age 36 months D) It is a global screening tool, including personal/social, fine motor/adaptive, and gross motor skills of infants and children from birth to age 6 years

d

Which of the following is the most accurate description of the Dubowitz tool? a. it evaluates the physical condition of the newborn at birth. b. the criteria evaluated are influenced by labor & birth; therefore a second exam may be indicated to pick up any changes in the newborn c. It is a gestational assessment tool that evaluates the infant's newborn reflexes including moro reflex, tonic neck, grasping, rooting, and sucking d. Estimations of gestational age are performed by examining physical characteristics and neuromuscular development of the newborn.

d

Which of the following patients should be referred for further developmental evaluation? a. Term 12-month-old child not walking independently whose older sibling walked at 10 months b. Premature 7-month-old child born at 28 weeks gestation not sitting independently c. Term 12-month-old infant not using single words d. Term 6-month-old infant with poor head control

d

Which of the following primary interventions assists in the prevention of adolescent depression? a. recommending the allocation of social isolation time b. anticipatory guidance that mild depression is normal c. recommending help from professionals rather than friends d. discussing changes associated with adolescence

d

Which of the following statements is most accurate regarding nutrition in the school-age child? a. Most school-age children eat more than the recommended amount of whole grains b. Most school-age children need to increase their average sodium intake for improved nutritional status c. Meals consumed at fast food restaurants are usually more healthful than meals prepared at home d. Consumption of excess sugars, starches and fats in the average school-age child contributes to childhood obesity

d

Which of the following statements is true regarding childhood obesity? A) The most common problem associated with childhood obesity is diabetes B) If one parent is obese and the other is of normal size, 9% of their children will become obese C) Endocrine causes of obesity are common D) The older the obese child is, the more likely it is that he or she will become an obese adult

d

Which of the following statements would be considered subjective data obtained from the client during the review of systems for the skin? a. the skin appears dry & excoriated b. a lesion is noted on the lateral aspect of the right leg c. there is moderate acne on the forehead and back d. the patient denies changes in skin texture

d

Which of the following symptoms are not typical of a child with ADHD? a. easily distracted b. difficulty playing quietly c. doesn't follow directions d. frequently angry & resentful

d

according to Erikson, the major psychological task between 1-2yrs of age is the development of: a. trust b. identity c. industry d. autonomy

d

Plantar grasp

disappears after 8 months

secondary hypothyroidism results from

disease or disorder of the hypothalamus or pituitary gland compromising thyroid function

CN VIII vestibulocochlear

mixed) Motor Fibres Modulate swallowing via supply to muscles of the throat (pharynx) area Parasympathetic control of secretion of saliva (via supply to the parotid salivary glands) Sensory Fibres Monitors blood pressure Monitors levels of oxygen and carbon dioxide in blood Coordination of some muscle activity e.g. in some swallowing muscles Sensations of taste, touch, pain and temperature from posterior third of the tongue and tissues of the soft palate

Perforation of TM

painless ear d/c if infection present tx- oral abx for 14 days plus abx ear drops 3-4x daily for 7 days- not responsive suspect mastoiditis or cholesteatoma -refer to otolayrngologist -most heal w/in 2 weeks -Cotton plugs with petroleum jelly when bathing and hair washing -diving, jumping into water, and underwater swimming forbidden

what causes physiologic jaundice - uncong

reabsorption of bili from intestines

initially erythematous and macular rash becoming maculopapular and petechial. Rash first appears on the wrists and ankles, spreading proximally to trunk

rocky mountain spotted fever

nephrotic syndrome, corticosteroids, obstructive liver disease are all likely to cause

secondary hypercholesterolemia

chances of having another child with Edwards syndrome is

seek genetic conseling for the best answer to this question

angelman syndrome is accompanied by

seizures and uncontrolled movements

what represents an example of a child ASSENT in healthcare research?

verbally refuses then consents to the next day