Laboratory 03: Integrated Management of Childhood Disease (IMCI) - FOCUS ON DISEASES

Question 1

What are the treatment options for cough or difficulty breathing in a sick child?

Answer 1

(A) Soothe the throat, relieve the cough with a safe remedy
(B) Safe remedies to recommend:
1. Breastmilk for exclusively breastfed infants
2. Tamarind, calamansi, ginger
(C) Harmful remedies to discourage:
1. Codeine cough syrup
2. Other cough syrups
3. Oral and nasal decongestants

Question 2

Explain the assessment process when assessing if the child have a cough or difficulty breathing.

Answer 2

(A) If NO: Proceed to the next symptom.
(B) If YES, ask: For how long?

Question 3

How do you assess cough or difficulty breathing?

Answer 3

LOOK, LISTEN, FEEL:
(A) Count the breaths in one minute.
(B) Look for chest indrawing.
(C) Look and listen for stridor.

Question 4

What should you do if the child is fast breathing?

Answer 4

Fast breathing is defined as:
(A) For 2 months to 12 months: 50 breaths/min or more
(B) For 12 months to 5 years: 40 breaths/min or more

Question 5

How do you classify the child’s illness?

Answer 5

Classify the illness using the color-coded classification table for cough or difficulty breathing.

Question 6

What are the signs that indicate the need to classify as SEVERE PNEUMONIA or VERY SEVERE DISEASE?

Answer 6

(A) Any general danger sign
(B) Chest indrawing
(C) Stridor in a calm child

Question 7

What is the treatment for SEVERE PNEUMONIA or VERY SEVERE DISEASE?

Answer 7

(A) First dose of an appropriate antibiotic
(B) Urgent referral to the hospital

Question 8

What are the signs that indicate PNEUMONIA?

Answer 8

Fast breathing

Question 9

What is the treatment for PNEUMONIA?

Answer 9

(A) Give an appropriate oral antibiotic for 5 days
(B) Soothe the throat and relieve the cough with a safe remedy
(C) Advise the mother when to return immediately
(D) Follow-up in 2 days

Question 10

What are the signs that indicate NO PNEUMONIA (COUGH OR COLD)?

Answer 10

No signs of pneumonia or very severe disease

Question 11

What is the treatment for NO PNEUMONIA (COUGH OR COLD)?

Answer 11

(A) If coughing for more than 30 days, refer for assessment
(B) Soothe the throat and relieve the cough with a safe remedy
(C) Advise the mother when to return immediately
(D) Follow-up in 5 days if not improving

Question 12

What is the treatment for PNEUMONIA OR VERY SEVERE DISEASE when the child is under ages 6 to 12 months old?

Answer 12

(A) Cotrimoxazole 1/2 tablet (80mg TMP, 400mg SMX) 2x daily for 5 days
(B) Amoxycillin 1/2 teaspoon (125mg/5ml) 3x daily for 5 days

Question 13

What is the treatment for PNEUMONIA OR VERY SEVERE DISEASE when the child is under ages 12 months old to 5 years old?

Answer 13

(A) Cotrimoxazole 1 tablet (80mg TMP, 400mg SMX) 2x daily for 5 days
(B) Amoxycillin 1 1/2 teaspoons (125mg/5ml) 3x daily for 5 days

Question 14

What is the Vitamin A supplementation for SEVERE PNEUMONIA or VERY SEVERE DISEASE based on age?

Answer 14

6 to 12 months:
(A) 100,000 IU: 1 capsule
(B) 200,000 IU: 1/2 capsule

12 months to 5 years:
(A) 100,000 IU: 2 capsules
(B) 200,000 IU: 1 capsule

Question 15

What do you do when the child shows NO symptoms of diarrhea?

Answer 15

(A) Classify the child’s illness using the color-coded classification tables for diarrhea.
(B) Ask about the next main symptoms: fever, ear problems, and check for malnutrition, anemia, immunization status, and other problems.

Question 16

What do you do when the child shows YES symptoms of diarrhea?

Answer 16

A) Ask:

How long has the child had diarrhea?
Is there blood in the stool?

Question 17

How do you assess the child’s general condition during diarrhea?

Answer 17

(A) Look for signs such as:

Is the child lethargic or unconscious?
Is the child restless or irritable?

Question 18

What do you check when assessing the child for signs of dehydration during diarrhea?

Answer 18

(A) Look for sunken eyes.
(B) Offer the child fluids:
Is the child unable to drink or drinking poorly?
Is the child drinking eagerly and thirsty?

(C) Pinch the skin on the abdomen and check if it returns:
Very slowly (longer than 2 seconds)?
Slowly?

Question 19

What do you do after assessing the child for diarrhea?

Answer 19

(A) Classify the child’s illness using the color-coded classification for diarrhea.
(B) Ask about the next main symptoms: fever, ear problems, and check for malnutrition, anemia, immunization status, and other problems.

Question 20

How do you classify a child with two of the following signs:

(A) Lethargic or unconscious
(B) Sunken eyes
(C) Not able to drink or drinking poorly
(D) Skin pinch goes back very slowly?

Answer 20

Severe Dehydration (Pink).

Question 21

What is the treatment for severe dehydration?

Answer 21

(A) If no other severe classification:
Give fluid for severe dehydration (Plan C).

(B) If the child has another severe classification:
Refer urgently to the hospital and give frequent sips of ORS on the way.

Question 22

How do you classify a child with two of the following signs:

(A) Restless, irritable
(B) Sunken eyes
(C) Drinks eagerly, thirsty
(D) Skin pinch goes back slowly?

Answer 22

Some Dehydration (Yellow)

Question 23

What is the treatment for some dehydration?

Answer 23

(A) Give fluid, zinc supplements, and food for some dehydration (Plan B).
(B) If the child has another severe classification:
(C) Refer urgently to the hospital with mother giving frequent sips of ORS on the way.
(D) Advise the mother when to return immediately and follow up in 5 days if not improving.

Question 24

What is the treatment for no dehydration?

Answer 24

(A) Give fluid, zinc supplements, and food to treat diarrhea at home (Plan A).
(B) Advise the mother when to return immediately and follow up in 5 days if not improving.

Question 24

What do you do if there are not enough signs to classify as severe or some dehydration?

Answer 24

No Dehydration: If there are not enough signs to classify as severe or some dehydration, classify the child as No Dehydration (Green).

Question 25

What do you do if the child has diarrhea lasting 14 days or more?

Answer 25

Classify the child under Persistent Diarrhea (Yellow)

Question 26

What is the treatment for persistent diarrhea?

Answer 26

(A) Treat dehydration before referral unless the child has another severe classification. (B) Give multivitamins and minerals (including zinc) for 14 days. (C) Follow up in 5 days.

Question 27

What should you do if blood is found in the stool?

Answer 27

Classify the child under Dysentery: If there is blood in the stool, classify as Dysentery (Yellow).

Question 28

What is the treatment for dysentry?

Answer 28

(A) Refer to the hospital. (B) Give ciprofloxacin for 3 days. (C) Follow up in 3 days.

Question 29

What do you do if the child has severe persistent diarrhea (pink)?

Answer 29

(A) Treat dehydration before referral unless the child has another severe classification. (B) Refer to hospital

Question 30

What should the nurse ask or assess for when the child has suspected measles?

Answer 30

(A) Does the child have a fever? (by history or feels hot or temperature 37.5 C or above) (B) Travel history to malaria prone places

Question 31

What if the child has been confirmed that he has measles?

Answer 31

If YES: Ask: (A) For how long? (B) If more than 7 days, has fever been present every day? (C) Has the child had measles within the last 3 months? Look and feel: (A) Look or feel for stiff neck (B) Look for runny nose

Question 32

Does the child show signs of measles?

Answer 32

Signs of Measles: (A) Generalized rash (B) Cough (C) Runny nose (D) Red eyes If the child has measles now or within the last 3 months, check for: (A) Mouth ulcers: Are they deep and extensive? (B) Pus draining from the eye (C) Clouding of the cornea

Question 33

How do you classify a child with any general danger sign or a stiff neck?

Answer 33

Very Severe Febrile Disease (Pink)

Question 34

What is the treatment for Very Severe Febrile Disease?

Answer 34

(A) Give first dose of artesunate or quinine for severe malaria. (B) Give first dose of an appropriate antibiotic. (C) Treat the child to prevent low blood sugar. (D) Give one dose of paracetamol in clinic for high fever (38.5°C or above). (E) Refer URGENTLY to hospital

Question 35

How do you classify a child with a positive malaria test?

Answer 35

Malaria (Yellow)

Question 36

What is the treatment for Malaria?

Answer 36

(A) Give the recommended first-line oral antimalarial. (B) Give one dose of paracetamol in clinic for high fever (38.5°C or above). (C) Give appropriate antibiotic treatment for an identified bacterial cause of fever. (D) Advise the mother when to return immediately. (E) Follow-up in 3 days if fever persists. (F) If fever is present every day for more than 7 days, refer for assessment.

Question 37

How do you classify a child with a negative malaria test but another identified cause of fever?

Answer 37

(A) Fever: No Malaria (Green)

Question 38

What is the treatment for Fever: No Malaria?

Answer 38

(A) Give one dose of paracetamol in clinic for high fever (38.5°C or above). (B) Give appropriate antibiotic treatment for an identified bacterial cause of fever. (C) Advise the mother when to return immediately. (D) Follow-up in 3 days if fever persists. (E) If fever is present every day for more than 7 days, refer for assessment.

Question 39

What is the treatment for Very Severe Febrile Disease?

Answer 39

(A) Give first dose of an appropriate antibiotic. (B) Treat the child to prevent low blood sugar. (C) Give one dose of paracetamol in clinic for high fever (38.5°C or above). (D) Refer URGENTLY to hospital.

Question 39

How do you classify a child with a very severe febrile disease?

Answer 39

Very Severe Febrile Disease (Pink)

Question 40

How do you classify a child with no general danger signs and no stiff neck?

Answer 40

Fever (Green)

Question 41

What is the treatment for Fever?

Answer 41

(A) Give one dose of paracetamol in clinic for high fever (38.5°C or above). (B) Give appropriate antibiotic treatment for any identified bacterial cause of fever. (C) Advise the mother when to return immediately. (D) Follow-up in 2 days if fever persists. (E) If fever is present every day for more than 7 days, refer for assessment.

Question 42

How do you classify a child with any general danger sign, clouding of the cornea, or deep and extensive mouth ulcers?

Answer 42

Severe Complicated Measles (Pink)

Question 43

What is the treatment for Severe Complicated Measles?

Answer 43

(A) Give Vitamin A treatment. (B) Give first dose of an appropriate antibiotic. (C) If clouding of the cornea or pus draining from the eye, apply tetracycline eye ointment. (D) Refer URGENTLY to hospital.

Question 44

How do you classify a child with measles and pus draining from the eye or mouth ulcers?

Answer 44

Measles with Eye or Mouth Complications (Yellow)

Question 45

What is the treatment for Measles with Eye or Mouth Complications?

Answer 45

(A) Give Vitamin A treatment. (B) If pus draining from the eye, treat with tetracycline eye ointment. (C) If mouth ulcers, treat with gentian violet. (D) Follow-up in 3 days.

Question 46

How do you assess a child for an ear problem?

Answer 46

(A) Ask if the child has an ear infection. (B) Ask if there is ear pain. (C) Ask if there is ear discharge and for how long. (D) Look for pus draining from the ear. (E) Feel for tender swelling behind the ear.

Question 46

How do you classify a child with tender swelling behind the ear?

Answer 46

Mastoiditis (Pink)

Question 47

What is the treatment for mastoiditis?

Answer 47

(A) Give the first dose of an appropriate antibiotic. (B) Give the first dose of paracetamol for pain. (C) Refer URGENTLY to the hospital.

Question 48

How do you classify a child with pus draining from the ear for less than 14 days or ear pain?

Answer 48

Acute Ear Infection (Yellow)

Question 49

What is the treatment for acute ear infection?

Answer 49

(A) Give an antibiotic for 5 days. (B) Give paracetamol for pain. (C) Dry the ear by wicking. (D) Follow-up in 5 days.

Question 50

. How do you classify a child with pus draining from the ear for 14 days or more?

Answer 50

Chronic Ear Infection (Yellow)

Question 51

What is the treatment for chronic ear infection?

Answer 51

(A) Dry the ear by wicking. (B) Treat with topical quinolone eardrops for 14 days. (C) Follow-up in 5 days.

Question 52

How do you classify a child with no ear pain and no pus seen draining from the ear?

Answer 52

No Ear Infection (Green)

Question 53

What physical sign should you look for to assess severe acute malnutrition?

Answer 53

Edema in both feet

Question 54

What measurements help determine acute malnutrition in children?

Answer 54

(A) Weight-for-Height/Length (WFH/L) z-score (B) Mid-Upper Arm Circumference (MUAC)

Question 55

What WFH/L z-score indicates severe acute malnutrition?

Answer 55

Less than -3 z-scores.

Question 56

What MUAC measurement indicates severe acute malnutrition?

Answer 56

Less than 115 mm.

Question 57

What should you check if a child has WFH/L < -3 z-scores or MUAC < 115 mm?

Answer 57

(A) Any medical complications (B) Any general danger signs (C) Any severe classification (D) Pneumonia with chest indrawing

Question 58

What should be done if a child has severe acute malnutrition but no medical complications?

Answer 58

(A) If 6 months or older, offer Ready-to-Use Therapeutic Food (RUTF). (B) If less than 6 months, assess breastfeeding.

Question 59

How do you classify a child with oedema of both feet OR WFH/L less than -3 z-scores OR MUAC less than 115 mm AND any one of the following: (A) Medical complication present (B) Not able to finish RUTF (C) Breastfeeding problem?

Answer 59

Complicated Severe Acute Malnutrition (Pink)

Question 60

What is the management for Complicated Severe Acute Malnutrition?

Answer 60

(A) Give first dose of appropriate antibiotic. (B) Treat the child to prevent low blood sugar. (C) Keep the child warm. (D) Refer URGENTLY to hospital.

Question 61

How do you classify a child with WFH/L less than -3 z-scores OR MUAC less than 115 mm AND able to finish RUTF?

Answer 61

Uncomplicated Severe Acute Malnutrition (Yellow)

Question 62

What is the management for Uncomplicated Severe Acute Malnutrition?

Answer 62

(A) Give oral antibiotics for 5 days. (B) Give Ready-to-Use Therapeutic Food (RUTF) for children aged 6 months or more. (C) Counsel the mother on feeding the child. (D) Assess for possible TB infection. (E) Advise mother when to return immediately. (F) Follow up in 7 days.

Question 63

How do you classify a child with WFH/L between -3 and -2 z-scores OR MUAC between 115 and 125 mm?

Answer 63

Moderate Acute Malnutrition (Yellow)

Question 64

What is the management for Moderate Acute Malnutrition?

Answer 64

(A) Assess the child's feeding and counsel the mother on feeding recommendations. (B) If feeding problem is found, follow up in 7 days. (C) Assess for possible TB infection. (D) Advise mother when to return immediately. (E) Follow-up in 30 days.

Question 65

How do you classify a child with WFH/L -2 z-scores or more OR MUAC 125 mm or more?

Answer 65

No Acute Malnutrition (Green)

Question 66

What should you do for a child classified as No Acute Malnutrition?

Answer 66

(A) If the child is less than 2 years old, assess feeding and counsel the mother according to feeding recommendations. (B) If there is a feeding problem, follow up in 7 days.

Question 67

What does a MUAC measurement of less than 115 mm indicate?

Answer 67

Severe acute malnutrition and threat of death

Question 68

What does a MUAC measurement between 115 mm and 125 mm indicate?

Answer 68

Moderate acute malnutrition

Question 69

What does a MUAC measurement of 125 mm or more indicate?

Answer 69

No malnutrition

Question 70

How should the nurse check for anemia?

Answer 70

(A) Check for palmar pallor? Is it some pallor or severe pallor? (B) Assess for sickle cells anemia if common in their area. (C) If the child has severe acute malnutrition and is receiving RUTF, do not give IRON.

Question 71

What does severe palmar pallor indicate?

Answer 71

Severe Anemia (Pink Classification)

Question 72

What is the management for Severe Anemia?

Answer 72

Refer Urgently to Hospital

Question 73

What does some pallor indicate?

Answer 73

Anemia (Yellow Classification)

Question 74

What is the management for Anemia?

Answer 74

(A) Give iron supplements. (B) Give mebendazole if the child is 1 year or older and has not received a dose in the past 6 months. (C) Advise the mother when to return immediately. (D) Follow-up in 14 days.

Question 75

What does no palmar pallor indicate?

Answer 75

No Anemia (Green Classification)

Question 76

What is the management for No Anemia?

Answer 76

(A) If the child is less than 2 years old, assess feeding and counsel the mother on proper nutrition. (B) If feeding problems are present, follow up in 5 days.