final exam Flashcards
A child has mild persistent asthma. Appropriate daily medication should include - A cough suppressant Correct! - A low-dose inhaled corticosteroid - Short-acting beta-2 agonist - An oral systemic corticosteroid
A LOW DOSE INHALED CORTICOSTEROID
A child with mild persistent asthma should be on an inhaled low-dose corticosteroid. Short-term oral corticosteroids may be needed during an exacerbation but should not be used daily. Cough suppressants are not recommended in children.
Rachel, age 16 years, has had her asthma well controlled by using a beta-adrenergic metered dose inhaler. For the last month or so, she has had her sleep interrupted with wheezing. She thinks this happens almost every night lately. What is the appropriate intervention?
Prescribe an inhaled steroid.
Prescribe a cough suppressant for night time use only
Prescribe a longer-acting bronchodilator
Prescribe a short course of steroid therapy
PRESCRIBE AN INHALED STEROID
If an asthmatic develops persistent symptoms an inhaled steroid should be prescribed and used in conjunction with the beta-1 adrenergic metered-dose inhaler.
Tyrell has arrived at the urgent care clinic with wheezing. He has a history of asthma and has been prescribed Flovent in the past but since he was well all summer he ran out of his med. He is 14 years old and weight 60 kg. His PEF is < 40% and he is using accessory muscles to breathe. His SaO2 is 86. Choose your next steps:
Face mask ventilation with nebulized SABA and Ipratropium
Start an IV for corticosteroids
Transfer to acute care area
O2 to achieve SaO2 > 90%
O2 to achieve SaO2>90%
High-dose inhaled SABA by nebulizer or MDI plus valved holding chamber
60 mg po prednisone
O2 to achiever SaO2.90%
4 puffs of Flovent (inhaled corticosteroid) for double dose
Repeat in 20 minutes
O2 to achieve SaO2>90%
High-dose inhaled SABA/IPRATROPIUM by nebulizer or MDI plus valved holding chamber
60 mg po prednisone
A 6-year-old child with asthma is brought to the clinic because the parents have noticed daily wheezing for the past month requiring daily use of his SABA, and he has had a few night-time awakenings with wheezing as well. The PNP recognizes that this may indicate the child has: Severe persistent asthma Mild persistent asthma. Moderate persistent asthma. Intermittent asthma.
Moderate Persistent Asthma
Choose the words that best complete the following sentence:
The majority of children with asthma develop symptoms between ages 3 and 6 years. Common symptoms of asthma include: Chonic cough, recurrent __________________, Recurrent ___________________, and recurrent ________________.
Wheezing, sick days, respiratory syncytial virus (RSV).
Sneezing, flu symptoms, bronchitis.
Wheezing, bronchitis, pneumonia
Lung obstruction, bronchitis, nosebleed
Wheezing, Bronchitis, Pneumonia
_______________medications limit the underlying airway inflammation that contributes to asthma symptoms and are taken ______________.
Quick-relief; daily.
Quick relief, as needed.
Long-term control; twice a week.
Long-term control; daily.
Long-term control; daily
You have been Ava’s PCP since she was 5 years-old. At that time, Ava had aczema and coughing and wheezing. Ava’s mother has asthma and, through history taking and exam, you diagnosed asthma in Ava, too. You have examined Ava frequently to adjust medications, but now she is stable. She consistently takes her medication and uses her Flovent inhaler daily. Her mother diligently keeps the house clean, especially the bedroom Ava shares with her sister. You are ready to step down Ava’s medication therapy, according to the National Heart, Lung, and Blood Institute’s step wise approach. How often should you examine Ava during this step-down period?
Every month
Every three months
Every year
Every six months
EVERY 3 MONTHS
Asthma is highly variable over time. See patients:
Every 2-6 weeks while gaining control
Every 1-6 months to monitor control
Every 3 months if step down in therapy is anticipated.”
A 3-year-old boy presents to the emergency department with fever 103, drooling, hoarse cry, inspiratory retractions, stridor, and holding his head in a sniffing position. He is taken to the operating room for control of the airway. What is the likely etiology? Staphylococcus aureus Haemophilus influenzae Streptococcus pneumoniae Parainfluenza virus
Haemophilus influenzae
The child is showing symptoms and signs of epiglottitis which is an emergent condition. Progression to total airway obstruction may occur and result in respiratory arrest. Transfer him to an acute care are ASAP keeping him as calm and comfortable as possible.
The incidence has decreased significantly since the advent of the Haemophilus influenzae type B (HiB) vaccination but patients are still susceptible to the non typeable Haemophilus influenzae and not all children are vaccinated.
5 month old (27 weeks gestation at birth) with fever, coryza, cough,increased work of breathing, and scattered rales.
Influenza A pneumonia
A 5-year-old girl with fever, tachypnea, and lobar infiltrate. She has been taking amoxicillin for 6 days and is getting worse. Her chest xray shows empyema
Pneumococcal pneumonia
A 14 year-old girl with low-grade fever, cough of 3 weeks’ duration, and new onset of wheezing. Her medical history is negative.
Mycoplasma pneumonia
Common organisms causing pneumonia in newborn infants are:
Group B streptococci, gram-negative enteric bacilli, Chlamydia trachomatis
Haemophilus influenzae, Staphylococcus pneumonia, herpes simplex
Staphylococcus aureus, pseudomonas, group A beta-hemolytic streptococcus
Mycoplasma, Staphylococcus pneumoniae, Haemophilus influenzae
Group B streptococci, gram-negative enteric bacilli, Chlamydia trachomatis
Manuel, a 9-month-old infant, has been hospitalized with laboratory-confirmed pertussis. Which of the following would be appropriate components of the management plan?
Treatment with erythromycin, prophylaxis of close contacts, report to state health department.
Antibiotic treatment with Augmentin, immediate booster immunization with DTaP, oxygen as needed.
Cough management with Robitussin DM, treatment with pertussis antitoxin, intensive care observation.
Prophylactic treatment of close family members, antibiotics to control secondary pneumonia, liquid diet until coughing subsides.
Treatment with erythromycin, prophylaxis of close contacts, report to state health department.
The antibiotic of choice for a school-age child with suspected Mycoplasma pneumoniae would be: A cephalosporin Amoxicillin Penicillin A macrolide
A macrolide
Which of the following statements is true about chalazions?
Chalazions are more common in children with eczema.
Chalazions are caused by acute localized inflammation of one or more sebaceous glands of the eyelids, causing painful furuncle.
Chalazions should be treated with either erythromycin or sulfacetamide 10% eye ointment.
Chalazion is a chronic sterile inflammation of the eyelid resulting from a lipogranuloma of the Meibomian glands.
Chalazion is a chronic sterile inflammation of the eyelid resulting from a lipogranuloma of the Meibomian gland