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Primary PNP > PNP-PC Part 2 > Flashcards

PNP-PC Part 2 Flashcards

1
Q

If a child’s 0.9 g/dl, hematocrit is 32%, and serum ferritin is 25 mcg/L, what should her iron supplementation start at?

A

3 to 6 mg/kg/day of elemental iron until her hemoglobin (Hgb) reaches above 11 g/d

Once hemoglobin normalized, continue 2 to 3 mg/kg/day of elemental iron for 4 months

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2
Q

_________ ensures that NPs are qualified to provide safe health care, meet professional standards and minimal levels of acceptable performance, and comply with federal and state laws relating to NPs

privileging or credentialing

A

Credentialing

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3
Q

most definitive tools for confirming intussusception

A

Radiography and barium enema

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4
Q

which anemia is normocytic and normochromic

A

Anemia of chronic disease

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5
Q

microcytic and hypochromic anemias

A

iron-deficiency anemia
thalassemia
lead poisoning anemia

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6
Q

Which two vaccines should not be given to those allergic to streptomycin, neomycin, and polymyxin B?

A

IPV (polio)

Varicella

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7
Q

Which vaccines should not be given to immunocompromised patients as these are live vaccines that can cause them to become severely ill?

A

MMR

Varicella

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8
Q

Which vaccine should be not given to people who are allergic to eggs?

A

Influenza

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9
Q

A 12-month-old infant is brought to the nurse practitioner’s (NP) office because her left foot is turned inward. What is her probably condition?

A

Clubfoot

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10
Q

What are the necessary abilities to be able to give informed consent?

A

reason, differentiate, and communicate

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11
Q

Patchy infiltrates and pleural effusion on chest x-ray suggestive of pneumonia

A

Escherichia coli

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12
Q

lobar consolidation rather than patchy infiltrate on chest x-ray suggestive of pneumonia

A

Klebsiella and Streptococcus pneumoniae

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13
Q

diffuse interstitial, infiltrates that are apical or in the upper lobe on chest-ray suggestive of pneumonia

A

Pneumocystis pneumonia

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14
Q

You meet your new patient, Ali, in the exam room. You see that Ali has drawn a picture of her mother that includes a face, body, legs, arms, and hair. Based on this behavior, how old do you suppose Ali is?

A

4 years old

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15
Q

the leading cause of death among infant

A

Developmental and genetic disorders

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16
Q

Sudden head extension produced by light drop of head

A

Moro

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17
Q

Week of gestation that moro reflex appears

A

34-36 weeks

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18
Q

When does moro reflex resolve

A

5-6 months

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19
Q

Rotation of infant’s head to one side for 15 seconds

A

Asymmetric tonic neck reflex

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20
Q

When does asymmetric tonic neck reflex appear

A

38-40 weeks

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21
Q

When does asymmetric tonic neck reflex resolve

A

2-3 months

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22
Q

Scratching the skin of infant’s back from shoulder downwards, 2-3 cm lateral to spinous processes

A

Tunk incurvation/

Galant

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23
Q

Week gestation that trunk incurvation/Galant reflex appear

A

38-40 weeks

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24
Q

when does trunk incervation/galant resolve

A

1-2 months

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25
Q

placing index finger in palm of infant

A

palmar grasp

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26
Q

week gestation that palmar grasp appears

A

38-40 weeks

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27
Q

when does palmar grasp resolve

A

5-6 months

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28
Q

pressing tumb against sole just behind the toes in the foot

A

plantar grasp

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29
Q

week gestation that plantar grasp reflex appears

A

38-40 weeks

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30
Q

when does plantar grasp resolve

A

9-10 months

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31
Q

infant’s head turns toward cheek that is stroked to suck

A

rooting

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32
Q

week gestation that rooting reflex appears

A

38-40 weeks

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33
Q

when does the rooting reflex resolve

A

2-3 months

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34
Q

arms and legs extend in protective fashion when suspected in prone

A

parachute reflex

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35
Q

when does parachute reflex appear

A

8-9 months

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36
Q

when does parachute reflex resolve

A

it persists

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37
Q

In supine position with hip and knee flexed at 90 degrees, the patient has pain with extension at the knee

A

Kernig sign

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38
Q

While in supine position, patient flexes lower extremities during passive flexion of neck

A

Brudzinski sign

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39
Q

Headaches in occipital or consistently localized could mean what?

A

Underlying pathology

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40
Q 
Worse in the morning upon awakening
Nocturnal awakening
Projective vomiting without nausea
Seizures
Fever
VP shunt, hydrocephaly

Primary or Secondary Headache

A

Secondary headache

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41
Q

Commonly bilateral in young children, in adolescents, and young adults

Gradual in onset, crescendo pattern; pulsating; moderate to severe intensity; aggravated by routine physical activity

Patient prefers to rest in a dark, quiet room

2-72 hour duration

Nausea, vomiting, photophobia, phonophobia, aura (visual, but can involve other senses)

A

Migraine

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42
Q

Bilateral

Pressure/tightness that waxes and wanes

Patient may remain active or may need to rest

Variable duration

A

Tension-Type Headache

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43
Q

Always unilateral, usually begins around eye/temple

Pain begins quickly, reaches crescendo within minutes; pain is deep, continuous, excruciating, and explosive in quality

Patient remains pain

Duration: 30 minutes to 3 hours

Ipsilateral lacrimation and redness of eyes; stuffy nose; rhinorrhea; pallor; sweating; Horner syndrome; focal neurologic symptoms rare; sensitivity to alcohol

A

Trigeminal autonomic cephaloagia

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44
Q

Which is the most common migraine-type?

With or without aura

A

Without aura

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45
Q

What is the standard of care for migraine management?

A

Lifestyle modification and behavioral factors

  • Adequate sleep
  • Eating routine meals, not skipping
  • Adequate exercise and physical activity
  • Adequate hydration (at least 64 ounces of water/day)
  • Limit screentime
  • Avoid triggers or stressors
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46
Q

What is acute migraine medication management?

A

NSAIDs, acetaminophen, triptans, antiemetics

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47
Q

What are the approved migraine medications from the FDA?

A

Almotriptan, rizatriptan, sumatriptan/naproxen, zolmitriptan

TRIPTANS

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48
Q

What is the preventative medication for migraines?

A

Topiramate 25-100 mg/d for 12 years and up

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49
Q

Sudden and stereotyped alternation in motor activity, sensation, behavior, or consciousness due to abnormal electrical discharge of neurons

A

Seizure

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50
Q

Chronic neurological condition characterized by recurrent seizures (2 or more >24 hours apart) which are not provoked by systemic or acute neurologic insults

A

Epilepsy

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51
Q

Carbamazepine/Tegretol and valproic acid/Depakote can cause which side effects

A

Bone marrow suppression

Liver damage

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52
Q

Phenytoin/Dilantin can cause what side effects

A

Gingival hypertrophy

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53
Q

Oxcarbazepine/Trileptal can cause what side effects

A

Significant hyponatremia

Stevens-Johnson syndrome

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54
Q

What is the common age for febrile seizures?

A

6 months to 5 years

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55
Q

Bried, generalized seizures and associated with concurrent febrile illness

A

Simple febrile convulsion

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56
Q

Which antibiotics should you want to prescribe with caution with antiepileptics drugs?

A

Erythromycin, Azithromycin, Doxycycline

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57
Q

Prolonged (>15 minutes) seizure, focal, or repeated episodes within 24 hours that are associated with fever

Usually genetic predisposition

A

Complex febrile convulsion

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58
Q

Treatment for simple febrile seizure

A

Reduce fever with ibuprofen (>6 months) or acetaminophen

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59
Q

Manifested by both motor and phonic tics with onset during childhood

A

Tourette Syndrome

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60
Q

Coprolalia

A

Obscene words tic

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61
Q

Echolalia

A

Repetition of words tic

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62
Q

Palilalia

A

Repetition of phrase or word with increasing rapidity tic

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63
Q

Management for tics

A

Educating patient and family, teachers

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64
Q

Non-epileptic, paroxysmal event; occurs between ages 6 months and 4 years

Peak age 18 months

Start with provoking factors (frustration, anger, fright) and minor trauma (crying or emotionally upset) leading to a noiseless state of expiration (silent scream) with color change and eventually loss of consciousness and tone (briefly)

A

Breath-holding spells

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65
Q

What should be ruled out for breath-holding spells?

A

Iron-deficiency anemia (serum ferritin level)

66
Q

Upper trunk nerve injury to C5 and C6 nerve roots from stretching of brachial plexus

Occurs usually unilaterally, weakness of deltoid and infraspinatus muscles and biceps

A

Neonatal brachial plexus palsy (Erb’s)

67
Q

Upper arm adducted and internally rotated, forearm extended, hand/wrist movement preserved

A

Neonatal brachial plexus palsy (Erb’s)

68
Q

Who would you refer a patient to for neonatal brachial plexus palsy (Erb’s)?

A

Physical Therapy for passive ROM

69
Q

Heterogenous group of conditions involving permanent non-progressive central motor dysfunction that affect muscle tone, posture, and movements

A

Cerebral Palsy

70
Q

Non-degenerative, non-progressive, chronic motor disorder

A

Cerebral Palsy

71
Q

Muscle stiffening and tightness
Muscles cannot relax on their own
Can be hemiplegic or global

A

Spastic CP

72
Q

Involuntary, purposeless movements

A

Athetoid CP

73
Q

Affects balance and coordination

A

Ataxic CP

74
Q

What is management referrals should be made for cerebral palsy patients?

A

Neurology
Nutrition
Auditory/Speech
Vision

75
Q

Many anti-seizures medications are _________

A

Teratogenic

76
Q

Genetic disorder of nervous system that primarily affects development and growth of nerve cell tissues; tumors grow on nerves and cause skin changes and bone deformities

A

Neurofibromatosis type-1

77
Q

Multiple hyperpigmented skin macules (cafe au last spots), axillary or inguinal freckling, multiple skin neurofibromas, and iris hamartomas (Lisch nodules)

A

Neurofibromatosis type-1

78
Q

Genetic disorder resulting in the development of bilateral acoustic neuromas; pressure on vestibulocochlear or facial nerve; typical first appearance in adolescent or early 20s

A

Neurofibromatosis type-2

79
Q

Impaired/loss of hearing, tinnitus, unsteadiness, or facial weakness

A

Neurofibromatosis type-2

80
Q

Raised, pigmented hamartomas of the iris

A

Lisch nodules

81
Q

Lisch nodules are characteristic of Neurofibromatosis type 1 or Neurofibromatosis type 2?

A

Neurofibromatosis type 1

82
Q

Cognitive impairment is associated with Neurofibromatosis type 1 or type 2?

A

Type 1

83
Q

6 or more cafe au lait macules > 5 mm (0.5 cm) in greatest diameter in prepubertal children and >15 mm (1.5 cm) in postpubertal individuals
2 or more neurofibromas of any type or 1 plexiform neurofibroma
Axillary or inguinal freckling
Optic glioma
2 or more Lisch nodules
Distinctive bony lesions (sphenoid dysplasia or medullary narrowing and cortical thickening)
1st degree relative with disease

A

Neurofibromatosis type 1

84
Q

Bilateral 8th nerve masses seen on neuroimaging
OR
1st-degree relative
Multiple spinal tumors (schwannomas, meningiomas)
Cutaneous schwannomas
Sporadic vestibular schwannoma in individuals younger than 30
Solitary meningioma or non-vestibular schwannoma in individual younger than 25

A

Neurofibromatosis type 2

85
Q

Neurofibromatosis type 1 management

A

Monitor for hypertension (renal involvement)
Monitor for enlargement of plexiform
Examining skin routinely to see if there are new lesions
Yearly eye exam
Observing skeletal system for any changes

86
Q

Ashleaf spots, adenoma sebaceum, shagreen patches, forehead fibrosis plague

Seizures, cognitive delay, learning disabilities

A

Tuberous Sclerosis Complex

87
Q

Management for tuberous sclerosis complex

A

Monitor for seizures
Brain MRI every 1 to 3 years (up to 25 years old)
Neuropsychiatric assessment for aggressive behaviors
Annual skin examination
Periodic dental and oral inspections or examinations
Baseline echocardiography (repeat 1-3 years) and electrocardiography(every 3-5 years) for those <3 years

88
Q

Diagnosis for tuberous sclerosis complex

A

2 major clinical features
or
1 major and 2 minor

89
Q

Diagnosis for possible tuberous sclerosis complex

A

1 major or

2 or more clinical

90
Q

Headache, nausea/vomiting, neck pain, light sensitivity, noise sensitivity
Vision problem, hearing problems/tinnitus, balance problems, dizziness
Confusion, difficulty concentrating, difficulty remembering, answers questions slowly, repeat questions
Irritable, more emotional than usual, sadness, nervous/anxious
Drowsiness/fatigue, trouble falling asleep, sleeping too much, sleeping too little

A

Concussion

91
Q

Most common cause of head trauma in infants and toddlers

A

Fall and non-accidental trauma

92
Q

Most common cause of head trauma in young children

A

Falls and bicycles

93
Q

Most common cause of head trauma in adolescents

A

MVA, sport-related injuries, assaults

94
Q

Treatment for minor head trauma

A

Observation in ED, clinic, or home
Physical rest for 24-48 hours followed by a gradual and progressive return to non-contact, supervised physical activity
Athletes should follow return to play protocol
Acetaminophen or Tylenol can be used briefly

95
Q

Treatment for moderate head trauma

A

Admit for prolonged observation in ED

96
Q

Indications for neuroimaging with head trauma/TBI

A 
Age <2
Recurrent vomiting
Loss of consciousness
Severe mechanism of injury
Worsening headache
Amnesia
Glasgow Coma Scale <15
Suspicion for skull fracture
Non-frontal skull hematoma
97
Q

Typical symptoms of migraine headache in 14 year old usually include recurrence and:

A. Unilateral forehead pain, nausea, photophobia
B. Bilateral temporal pain, cyclical vomiting, and vertigo
C. Unilateral forehead pain, ataxia, and photophobia
D. Bilateral forehead pain, nausea, and an aura

A

Unilateral forehead pain, nausea, and photophobia

98
Q

How is bone age measured on a radiograph?

A

Left hand and wrist

99
Q

Growth spurts start at which tanner stage in girls?

A

Tanner 2

100
Q

Growth spurts start at which tanner stage in boys?

A

tanner 3

101
Q

When does long bone growth stop?

A

~2 years after menarche or damage to the epiphysis

102
Q

What are unique bone fractures in childhood?

A

Buckle fracture

Greenstick fracture

103
Q

Growth plate injuries

A

Salter fractures

104
Q

Salter fractures cause?

A

Growth arrest leading to shortening or angular deformity

105
Q

Trendelenburg gait signals

A

weakness of hip abductors

106
Q

Gower sign signals

A

weak hip extensors and abductors

107
Q

Trendelenburg gait and Gower sign are common in which condition

A

Duchene Muscular Dystrophy

108
Q

Equine gait

A

toe-walking or toe-to-heel

109
Q

Equine gait is common with which conditions

A

Heel cord contracture

Limited dorsiflexion

110
Q

Radial head subluxation/annular ligament displacement

Commonly occurs in age 1-4 years

A

Nursemaid’s Elbow

111
Q

Nursemaid’s Elbow reduction maneuvers

A

Hyper-pronation

Supination/flexion

112
Q

Support child’s arm at elbow, place moderate pressure with finger on radial head, examiner grips distal forearm with other hand and hyper-pronates forearm until click felt over radial head when reduced

A

Hyper-pronation

113
Q

Supports child’s arm at the elbow, exerts moderate pressure on radial head, apply gentle traction, supinate forearm fully and flex elbow

A

Supination/flexion

114
Q

Evaluations for scoloisis

A

Adams forward bend test
Scoliometer
Radiographs

115
Q

Differences in shoulder/scapula height
Waist, truncal, or rib asymmetry
Asymmetry in distance that arms hands
S- or C- shape curve of the spine

A

Scoliosis

116
Q

Red flags for scoliosis

A

Cutaneous lesion over spine
Weakness, atrophy, abnormal reflexes
Progressively worsening low back pain

117
Q

When is observation ok for scoliosis

A

Cobb angle less than 20 degrees

118
Q

When is bracing necessary for scoliosis

A

Cobb angle between 20-40 degrees

119
Q

When is surgery necessary for scoliosis

A

Cobb angle greater than 50 degrees

120
Q

Acute/gradual onset
Sharp, darting, dull pain
Point tenderness of costal cartilages along sternal border
coughing, sneezing, deep inspiration, movements can exacerbate pain

A

Costochondritis

121
Q

Maneuvers to evaluate costochondritis

A

Horizontal arm traction/Crowing rooster

122
Q

Management for costochondritis

A

NSAIDs

123
Q

Idiopathic avascular necrosis of hip

A

Legg-Calve-Perthes Disease

124
Q

Peak age incidence for Legg-Calve-Perthes Disease

A

5-7 years

125
Q

Acute/chronic onset
Unilateral pain that is activity related
Insidious onset limp with groin, thigh, or knee pain
Pain with weight-bearing
Decreased abduction, internal rotation of hip

A

Legg-Calve-Perthes Disease

126
Q

Which x-ray should you order for Legg-Calve-Perthes disease

A

AP and lateral pelvis

127
Q

AP and lateral pelvis x-ray for Legg-Calve-Perthes disease

A

Cresent sign

128
Q

Management for Legg-Calve-Perthes DIsease

A

Non-weight bearing

Referral to orthopedist

129
Q

Femoral neck displaces at physis causing bone impingement

A

Slipped Capital Femoral Epiphysis (SCFE)

130
Q

Peak age incidence for Slipped Capital Femoral Epiphysis (SCFE)

A

10-14 years

131
Q 
Knee, groin, and thigh pain
Limping
**Obesity (boys), delayed puberty
External rotation fo thigh when hip is flexed
Limited *abduction/extension
A

Slipped Capital Femoral Epiphysis (SCFE)

132
Q

What type of Salter-Harris fracture is Slipped Capital Femoral Epiphysis (SCFE)?

A

Salter-Harris type I

133
Q

risk factors for Slipped Capital Femoral Epiphysis (SCFE)

A

malnutrition
endocrine disorders
hx of displaced hip
chemotherapy/radiation exposure

134
Q

What radiographs should you order for Slipped Capital Femoral Epiphysis (SCFE)?

A

AP pelvis, frog-leg lateral view

135
Q

Management for Slipped Capital Femoral Epiphysis (SCFE)

A

Placement on crutches or wheelchair

Immediate referral to an orthopedist

136
Q

How to decide if Slipped Capital Femoral Epiphysis (SCFE) is stable or unstable?

A

Ability to weight bear

137
Q

Micro-trauma in deep fibers of patella tendon at its insertion on tibial tuberosity

Painful swelling caused by repetitive stresses (basketball, sports)

Seen after growth spurt

Boys > Girls

A

Osgood-Schlatter Disease

138
Q

Increased pain with activity
Resolves with rest
** Pain can be reproduced with extension of the knee under pressure
Focal swelling and point of tenderness of tibial tuberosity

A

Osgood-Schlatter Disease

139
Q

Classic prominent tibial tubercle above physis

A

Osgood-Schlatter Disease

140
Q

Management for Osgood-Schlatter Disease

A 
Avoid activities that cause pain
Ice/cold therapy
Stretching
Knee immobilizers 
NSAIDs (with limited use due to prolonged nature of disease)
141
Q

Inflammation of joint due to infection (staph and strep most common)

A

Septic Arthritis

142
Q 
Acute onset
Hx of antecedent URI
Knee/hip pain
Redness, swollen, warm
High fever, limp, refusal to bear weight, anorexia, **appears ill
A

Septic Arthritis

143
Q

Confirmation of septic arthritis

A

CT or ultrasound-guided aspiration

144
Q

Management of septic arthritis

A

referral for surgical draiange

IV antibiotic

145
Q

Solid tumor of bone

A

Osteosarcoma

146
Q

Common age for osteosarcoma

A

15-19 years

147
Q 
Local pain, local swelling, and/or tenderness at rumor site
Decreased ROM
Soft tissue mass at end of long bone
Fever
Increased pain with activity, limp
A

Osteosarcoma

148
Q

Stretch or tear in ligaments or other connective tissue

A

Sprains

149
Q

Stretch or tear in muscle or tendon

A

Strains

150
Q

Pain/limp, tenderness to palpation, swelling, discoloration (ecchymosis or erythema)

A

Sprain

151
Q

Minimal stretching of ligament with microscopic tears

Mild swelling and tenderness

No joint instability, patient is able to bear weight and ambulate with minimal pain

A

Grade I sprain

152
Q

More severe injury involving an incomplete tear of ligament

Moderate pain, swelling, tenderness, ecchymosis

Mild to moderate joint instability with some ROM restriction and loss of function; weight-bearing and ambulation are painful

A

Grade II sprain

153
Q

Complete tear of ligament

Severe pain, swelling, tenderness, ecchymosis

Significant mechanical instability, significant loss of function and motion; unable to bear weight/ambulate

A

Grade III sprain

154
Q

PRICE for sprain management

A

Protect with splint/brace; limit weight bearing
Rest for 24-73 hours or until pain resolves
Ice
Compression with elastic bandage to decrease bleeding or swelling until edema is resolved
Elevation at or above heart level

155
Q

When can you start passive ROM and stretching with sprains?

A

After 1-2 days of rest

156
Q

Tennis, cheer

A

sports common with overuse syndrome

157
Q

Fractures suggestive of abuse

A

Ribs, long bone, skull, fingers, clavicle/scapular, vertebral

158
Q

Most common causes of fractures

A

Abuse, sports, falls, MVA, pedestrian/bicycle events

159
Q

Pain, point tenderness, swelling, ecchymosis/erythema, loss of function, obvious deformity

A

Fracture

160
Q

Management for fracture

A 
Immobilization/splinting, compression, ice, elevation
Pain medication (initially narcotic)
Emergent referral to a pediatric orthopedist

Primary PNP (8 decks)

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