NU664A Exam 2

What radiographic finding is diagnostic for croup?

*Steeple sign* (Subglottic airway narrowing at the cricoid cartilage)

How to handle picky eaters

-Toddlers may appear picky when it's just a decreased appetite due to slower growth rate *Rule #1:* Parents decide what, when, where to eat. Kids decide if and how to eat. *Rule #2:* Don't react when child refuses to eat. *Rule #3:* Limit dairy to max of 20oz/day, NO juice

Typical portion size for a toddler

1 tablespoon per year or 1/3 or 1/4 of an adult portion

School aged children should grow this many inches per year per year.

2.5

Two to three-word sentences should be expected when a child is how many years old?

24 to 30 months of age

In this age range the child typically sleeps eight to 12 hours and is gradually eliminating NAPs.

3 to 5 years of age

Routine blood pressure measurement starts at what age

3 years old

The PNP is examining a school-age child who complains of frequent stomach pain and headache. The patient reports that the child misses several days of school each month. The child has a normal exam. Before proceeding with further diagnostic tests, what will the NP initially ask the parent?

About the timing of the symptoms each day and during the week.

puberty before this age in females is considered precocious

Age 8

A child is diagnosed with community acquired pneumonia and will be treated as an outpatient. Which antibiotic will the PNP choose?

Amoxicillin

A school-aged child has had nasal discharge and a daytime cough but no fever for 12 days without improvement in symptoms. The child has not had antibiotics recently and there is no significant antibiotic resistance in the local community. What is the appropriate treatment for this child?

Amoxicillin 45mg/kg/day (treatment of acute rhinosinusitis (ARS) based on duration of symptoms without clinical improvement in symptoms)

Sharp pain in the right lower quadrant with fever emphasis and rebound tenderness.

Appendicitis

Your next patient is a 12-year-old adolescent presenting with her mother for her well-child visit. The mother expresses that her child thought she wanted to be a nurse but now has changed her career path to a fighter pilot and asks whether there is something wrong with her daughter. What would you discuss with the mother as the PNP?

As a young adolescent, your daughter is exhibiting a normal growth pattern for her cognitive development.

During a well child school age exam, the primary PNP learns that the child has been having angry episodes at school. The NP observes the child to appear withdrawn and sad. Which action is appropriate?

Ask the child and parent about stressors at home.

9 year old well visit - developmental characteristics

At this age, children have heroes who they look up to, and they develop close friendships.

What is the drug of choice for treating pertussis?

Azithromycin 10mg/kg x 5days

This measurement is helpful in distinguishing obesity from a large body frame in an adolescent concerned about weight.

BMI

The parent of a 3-month old reports that the infant arches and gags while feeding and spits up undigested formula frequently. The infant's weight gain has dropped to the 5th percentile from the 12th percentile. What is the best course of treatment for this infant?

Begin a trial of extensively hydrolyzed protein formula for 2-4 weeks.

A school-aged child has had abdominal pain for 3 months that occurs once or twice weekly and is associated with a headache and difficulty sleeping, often causing the child to stay home from school. The child does not have vomiting or diarrhea and is gaining weight normally. The physical exam is normal. What is included in the initial diagnostic work-up for this child?

CBC, ESR, amylase, lipase, UA, and abdominal ultrasound

complications of ulcerative colitis

Cancer of the colon and possible colectomy. Intestinal perforation and hemorrhage Liver disease and sepsis

5 year old feeling like something might be in his eye. No visual changes had occurred, normal EOM, no known injury. You decide to complete fluorescein staining to the affected eye because you suspect

Corneal abrasion

Fluorescein staining could be used to detect this.

Corneal abrasion

A child has developed her second perirectal abscess in two months, she should be evaluated for this.

Crohn's disease

Confirming the diagnosis that newborn chlamydia conjunctivitis would be best done by obtaining this.

Culture of conjunctival scrapings

The parent of a16 yo tells the PNP that the teen was recently caught smoking an electronic cigarette (e-cigarette). What will the NP tell this parent?

E-cigarette use may be a risk factor for later substance abuse.

PNP is counseling the parent of an overweight school age child about improving overall fitness. What would the NP include?

Encourage the child to begin by engaging in swimming or cycling.

Acute sudden onset high fever, severe sore throat, muffled voice drooling, choking sensation restless with hyper extension of neck.

Epiglottitis

A two month old infant is spitting up after feeds gaining weight well fussy at times in is taking 4 to 6 ounces every three to four hours, he is most likely suffering from this.

GERD

3 year old w/ hx of blepharitis and his mother asks whether there is anything she can do to prevent this from occurring again. What would you suggest as the PNP?

Good handwashing and daily eye lid and lash scrub with diluted baby shampoo should prevent this from reoccurring.

Concurrent otitis media and conjunctivitis is likely due to which organism.

Haemophilus Influenza

Helps with the prevention of epiglottitis

Hib Vaccine

A 2-day old in the hospital nursery has still not passed meconium. This raises a red flag for this condition.

Hirschsprung's disease

12 day old concerned about breathing. Feeding stops breathing for 10 seconds. Eats well never appeared pale/cyanotic, and has never become limp during any of these episodes. What would the PNP discuss w/ the parents?

I know this can be concerning. This can be a normal variant for infants.

cranky, anorexia, nausea, vomiting, growing discomfort, constipation, palpable bulge.

Incarcerated hernia

A child is diagnosed with Crohn's disease. What are likely complications for this child?

Intestinal obstruction with scarring and strictures are the major complications of Crohn's disease.

Greater incidence in males healthy infant with sudden six cycles cycle of inconsolable screaming flexing of the leg colicky abdominal pain periods of sleepiness between episodes.

Intussusception

The mother of a 12-year-old female asks whether there are any changes in diet for her daughter now that she has started her period. How would you respond as the PNP?

It is a good idea to increase iron and calcium in her daily diet.

2 week old infant with complaint of rash near left upper eyelid several vesicular lesions on his left upper eyelid. What would you discuss with the mother as the PNP?

It is important that you go to the children's hospital emergency department now because your child needs an immediate referral to a pediatric ophthalmologist.

You are seeing an adolescent who has tall stature, arachnodactyly, laxity of joints, pectus excavatum and an abnormal echocardiogram. You suspect this adolescent has this diagnosis.

Marfan syndrome

10 and a half year old Melissa is noted, to have the appearance of breast buds you can tell her to express expect this in approximately two years it was.

Menstrual Cycle

Your next patient is a 2-month-old male presenting with frequent vomiting per his mother's report. She is upset and concerned that something is "really wrong' with her baby. Which of the following is most suggestive of GER?

Mother reports he takes 7-8 ounces of formula every 2 to three hours.

Which of the following clinical histories would most indicate pyloric stenosis?

Nonbilious progressively more forceful vomiting after each feed.

§A 12yo is brought into the clinic for an urgent visit after having ingested 10 diazepam tablets. Following the initial emergent care and stabilization of the child, the most important aspect of your management is:

Obtaining a psychiatric consultation

When you rotate the thigh and it produces pain in the right lower quadrant of a patient with appendicitis what is this sign called.

Obturator sign

A school-age child who has an abrupt onset of sore throat, nausea, headache, and a temperature of 102.3 F. An examination reveals petechiae on the soft palate, beefy-red tonsils with yellow exudate, and scarlatiniform rash. A rapid antigen detection test (RADT) is negative, what is the next step in the management for this child?

Perform a follow-up throat culture

The PNP is examining a 15 yo female who reports having her first period at age 13. She states that she has had five periods in the last year, with the last one 2-month prior. She participates in basketball at school.

Perform biometric screening to determine lean body mass.

6 year old hx of cough for 10 days, Fever 101.5 F in the past 24 hrs. Decrease appetite and complain of abdominal pain. Breathing faster than normal . Given the information, what is the most likely dx?

Pneumonia

A 13-year-old female who started menarche at 11 years of age presents today with complaint of monthly menstrual pain that is persistent and not improving. She has not taken any medications to relieve the pain. What is your diagnosis and next plan of care?

Primary dysmenorrhea and start NSAIDS with a follow-up in 1-3 months.

Your next patient is a 13-year-old male presenting with his mother for a well-child visit. His mother expresses concern about the high-risk behaviors that she has read about in adolescence and asks whether there is any way to reduce his chance of risky behavior. How would the PNP respond?

Providing your son with a close family and being active in his extra-curricular activities are protective factors that are known to reduce risk-taking behavior in the growing adolescent.

4-month-old w/1-week hx of nasal congestion and occasional cough. Prior evening Temp 102F refused to breastfeed and had coughing and noisy labored breathing. On exam ill-appearing infant who is lethargic w/ tachypnea, wheezing, and intercostal retractions. Does not attend daycare but has a 3-year-old sibling who is in daycare and who recently had a "cold". Considering the clinical presentation what is the most likely cause of the infant's illness?

RSV bronchiolitis

During a well child examination of a 2-year old child, the PNP palpates a unilateral, smooth, firm abdominal mass which does not cross the midline. What is the next course of action that the PNP should take?

Refer the child to a pediatric oncologist for further workup immediately.

PNP performs the vision screen on a four month old and notes the presence of convergence and accommodation with esotropia of the 1eft eye. What will the NP do?

Refer the infant to a pediatric ophthalmologist

A 10 month old has been diagnosed with gastroenteritis he attends a child care facility, you should check to see if he has had this vaccination.

Rotavirus

Your next patient is a 15-year-old female here for her well-child visit. Her mother asks about risk factors for teen pregnancy. The PNP discusses these reasons:

Sexually active with several partners

In this tanner stage see they use standard stage here sexual maturation age hair is adult in character, but doesn't cover the entire pubic area.

Tanner Stage 4

An adolescent is diagnosed with functional abdominal pain (FAP). The child's symptoms worsen during stressful events, especially with school anxiety. What will an important part of treatment of this child?

Teaching about the brain-gut interaction causing symptoms

The mother of a 4-year-old male complains that her child wants dresses and dolls and says that he is a girl when asked. As the PNP, what should you tell the mother?

These may be signs of gender dysphoria.

PNP is performing a well child examination or three year old parent reports that the child has recently begun masturbating what will the PNP counsel with this parent?

To teach the child about privacy and hand hygiene.

testicular torsion

a sharp pain in the scrotum caused by twisting of the vas deferens and blood vessels leading into the testicle

This can occur in patients with an untreated streptococcal infection of the upper respiratory tract.

acute rheumatic fever

Adolescence man I wasn't engaging in risky behavior are displaying a form of this.

egocentrism

This has a decreasing incidence from H influenza with the use of the HIV vaccine by 99% in children younger than I thought, but can still a current even with a complete set of vaccines.

epiglottitis

Sneezing, discomfort and unilateral purulent it malodorous or bloody nasal discharge is a sign of.

nasal foreign body

When reviewing techniques to reduce fear in the children in your clinic, you recall that the age group w/ imaginary play is

preschoolers

The greatest imminent risk in a patient with hyphema.

rebleed

acute painful swelling of scrotum nausea anorexia vomiting minimal fever.

testicular torsion