Practice Qs Info

Question 1

Short-acting beta2-agonist administration frequency

Answer 1

Can be repeated every 20 mins for up to 3 treatments - if child doesn’t respond after steps of asthma action plan, seek medical care

Question 2

VP shunt placement post-op care

Answer 2

Position on unoperated side or supine with HOB flat-30 degrees - HOB too high can cause too-rapid reduction of CSF

Question 3

Pediculosis capitis treatment

Answer 3

Pediculicide shampoo and manual removal of nits
Second treatment in 7-10 days
If ineffective, do not repeat due to risks associated with repeated exposure to strong chemicals - seek medical care with PMD

Wash clothes, towels, linens in hot water and dry in hot dryer of 20 mins
Dry clean non-washable items or seal in plastic bags for 14 days
Vacuum carpets, car seats, rugs, mattresses, upholstered furniture
Soak combs, brushes, hair accessories in pediculicidal products for 1 hour or in boiling water for 10 mins

Question 4

G tube dislodgement

Answer 4

If within 6 weeks of initial placement, must be reinserted by a provider
After 6-12 weeks, can be replaced by trained caregiver or nurse with G tube or foley catheter of comparable size

Question 5

Cleft lip/palate complications

Answer 5

Feeding difficulties
Dental anomalies
Otitis media/hearing difficulties
Psychosocial issues

Question 6

Hypoglycemia treatment

Answer 6

Quick administration of 15-20g of simple carbohydrate (preferably glucose) followed by complex carbohydrate and protein - protein and fat content prolong results and help prevent rebound
Simple glucose carbohydrates = glucose tablets, candies such as Sweet Tarts, Smarties, Pixie Sticks

Injectable glucagon for severe hypoglycemia

Question 7

Common allergy among children with spina bifida

Answer 7

Latex

Children with latex allergies can show associated sensitivity to some foods like bananas, kiwis, avocados, chestnuts

Question 8

Refeeding syndrome

Answer 8

Life-threatening complication of nutritional rehabilitation for anorexia that can occur during the first few weeks if caloric intake is increased too rapidly
Extreme fluid and electrolyte shifts can cause cardiac arrhythmias, heart failure, respiratory failure, skeletal muscle injury, delirium, seizures, and hematologic problems

Question 9

Anorexia - refeeding monitoring

Answer 9

Electrolyte levels
VS
Fluid balance
Cardiac rhythms

Question 10

Delayed bone age

Answer 10

Indicates epiphyseal plates are open and catch-up growth is still possible

Question 11

Advanced bone age

Answer 11

Indicates epiphyseal plates are closer to being fused than is typical for the child’s age, and may not achieve optimal adult height

Question 12

Microwaving breast milk destroys ____

Answer 12

Anti-infective factors and vitamin C

Question 13

Healthcare services that qualify for confidentiality protection for minors

Answer 13

Contraception, pregnancy, HIV/STIs, substance abuse, mental health

Question 14

Lead exposure prevention in old houses (pre-1978)

Answer 14

Wet mop hard surface floors and wipe other hard surfaces with damp cloth once a week
Avoid vacuum cleaners for hard surfaces - can spread dust - use vacuum cleaners with agitators for rugs
Children should not be present during renovation/remodeling - all surfaces should be damp mopped before they return
Avoid continuous renovation
Avoid hot water consumption - dissolves lead more quickly, contains higher levels
Pipes/faucets should be flushed if not used for 6 or more hours - run cold water for 1-2 minutes

Question 15

Phenylketonuria (PKU)

Answer 15

Autosomal recessive trait
Lack of hepatic enzyme phenylalanine hydroxylase, which is necessary to metabolize phenylalanine (essential amino acid), results in phenylalanine build up in the bloodstream - excreted in urine, giving it a musky odor
Extremely elevated serum levels leads to progressive brain damage

Question 16

Phenylketonuria (PKU) screening

Answer 16

Newborn screening is mandatory in all states because cognitive impairment occurs before metabolites can be detected in urine
Should be repeated within 2 weeks

Question 17

Phenylketonuria (PKU) signs

Answer 17

Cognitive impairment
FTT, vomiting, irritability, hyperactivity, erratic behavior
Fair complexion, skin susceptible to dermatologic problems like eczema

Question 18

Phenylketonuria (PKU) treatment

Answer 18

Restriction of dietary protein - no meats, diary products, nuts, legumes, soy products, foods/beverages containing aspartame
Phenylalanine cannot be totally eliminated from diet - is an essential amino acid necessary for growth
Cakes, cookies, candies are restricted to certain amounts - must be weighed and measured

Question 19

JIA complications

Answer 19

Joint contractures, muscle atrophy, osteoporosis, growth delay, uveitis (inflammation of the uvea, need regular vision screenings)

Question 20

Atopic dermatitis treatment

Answer 20

Topical immunomodulators/calcineurin inhibitors (tracrolimus, pimecrolimus) are preferred for long-term use - less adverse effects compared to topical corticosteroids, can be used on face
Pimecrolimus 1% - mild to moderate AD in children 2 years and older - no systemic accumulation or effects
Tacrolimus 0.03% and 0.1% - reserved for severe cases - can cause local burning sensation initially

Question 21

Most common cause of failure to develop speech

Answer 21

Hearing deficit

Question 22

Signs of puberty in females

Answer 22

Breast budding - 10 years
Pubic hair - 11 years
Height spurt - 12 years
Menarche - 13-14 years

Question 23

Signs of puberty in males

Answer 23

Testicular enlargement - 11 years
Pubic hair - 12 years
Height spurt - 13-14 years

Question 24

Early signs of carbon monoxide poisoning

Answer 24

Lightheadedness, nausea, headache

Question 25

Intussusception diagnosis

Answer 25

Barium or water-soluble contrast enema - reduce invagination of the bowel segment

Question 26

Tracheo-esophageal fistula

Answer 26

Communication between the trachea and esophagus
Present with respiratory distress and difficulty managing oral secretions
Should be NPO

Question 27

Babinski reflex

Answer 27

Present until age 18 months - 2 years

Only infant reflex that remains after 4 months of age

Question 28

Amblyopia

Answer 28

“Lazy eye”
Treated by patching healthy eye to make the lazy eye work
Can result in vision loss if not corrected

Question 29

Phenytoin side effects

Answer 29

Gum hyperplasia

Hirsutism

Question 30

Cushing’s triad

Answer 30

Hypertension, bradycardia, irregular/decreased respirations

Question 31

Glasgow coma scale - head injuries

Answer 31

Mild = 13-15
Moderate = 9-12
Severe = ≤8

Question 32

Mononucleosis

Answer 32

Spread through oropharyngeal secretions
Often caused by Epstein-Barr virus (EBV), CMV
Incubation period of 2-6 weeks
Hallmark manifestation = marked fatigue
Splenomegaly - avoid contact sports to prevent splenic rupture

Question 33

Pertussis incubation period

Answer 33

6-20 days

Question 34

Varicella incubation period

Answer 34

10-21 days

Question 35

Tuberculosis treatment

Answer 35

Pyrazinamide, ethambutol, isoniazid, rifampin