PEDS Exam 1

Question 1

health equity vs health equality

Answer 1

health equity: pts are given the resources they need to get better
health equality: everyone gets the same care

Question 2

infant pain assessment - FLACC

Answer 2

face
legs
activity
cry
consolability

Question 3

infant (0-12mo) - physical growth

Answer 3

• double weight by 6mo, triple by 1yr
• posterior fontanelle closes at 2mo
• anterior fontanelle closes at 18mo

Question 4

infant (0-12mo) - gross & fine motor, sensory, vocalization

Answer 4

1mo: lift head, grasp reflex, poor vision, calms to voice, makes comfort sounds
3mo: raise chest when prone, brings objects to mouth, follows objects, coo/squeal
4mo: rolls side to side
6-8mo: sit, pincer grasp, visually pursue dropped object, imitate sounds
8-10mo: crawl, object permanence, comprehend “no”
1yr: pull to stand, “cruise,” release object into cup, 4 words plus “mama” & “dada”

Question 5

infant (0-12mo) - developmental theories

Answer 5

trust vs. mistrust (rely on caregivers to meet their needs)
sensorimotor

Question 6

infant (0-12mo) - nutrition

Answer 6

• breastmilk for 6-12mo, may need vit d supplementation
• iron fortified formula
• no honey
• whole milk at 1yr

Question 7

colic baby vs failure to thrive

Answer 7

Colic
- crying for >3hrs/day, >3days/week, >3weeks
- still growing/gaining weight as expected
- unknown cause, disappears at 3mo
FTT
- inadequate growth

Question 8

toddler (12-36mo) & preschool (3-5yr) - gross motor

Answer 8

• walk at 15mo

Question 9

toddler (12-36mo) & preschool (3-5yr) - language

Answer 9

• 18mo: >10 words
• 3yr: 2-4 word sentences
• 4yr: lots of questions

Question 10

toddler (12-36mo) & preschool (3-5yr) - socialization

Answer 10

• 15mo: imitates
• 24mo: parallel play
• 4yr: play w friends
• 5yr: eager to please

Question 11

toddler (12-36mo) & preschool (3-5yr) - developmental theories

Answer 11

(1-3) autonomy vs shame & doubt
(3-6) initiative vs guilt
preoperational: magical thinking, egocentrism

Question 12

toddler (12-36mo) & preschool (3-5yr) - nutrition

Answer 12

• caloric needs decrease, infants need more calories than preschooler
• picky eating *food jags

Question 13

toddler (12-36mo) & preschool (3-5yr) - other milestones

Answer 13

• primary dentition at 30mo
• bowel/bladder control at 30mo (3-4 at nighttime)

Question 14

toddler (12-36mo) & preschool (3-5yr) - parent education

Answer 14

• carseat/booster seat until 80lbs (~12yr)
• leading cause of death: MVA, drowning, suffocation, burns, chokin

Question 15

school age (6-12) - growth & dev

Answer 15

• growth slows but is steady
• growth spurt 10-12 in F, ~12 in M

Question 16

school age (6-12) - developmental theories

Answer 16

industry vs inferiority *peers are important
concrete operational; can see other POV

Question 17

school age (6-12) - puberty

Answer 17

• breast dev is 1st sign of puberty in females
• prepubertal weight gain, pubic hair growth, growth/changes in genitals are early signs in males

Question 18

school age (6-12) - injury prevention

Answer 18

• MVA most common cause of death

Question 19

school age (6-12) - screenings

Answer 19

• hyperlipidemia 9-11
• scoliosis 10-12

Question 20

adolescence (early 10-13, middle 14-17, late 18-21) - developmental theories

Answer 20

early: identity vs role confusion
late: intimacy vs isolation
formal operational

Question 21

adolescence (early 10-13, middle 14-17, late 18-21) - sexual health

Answer 21

1/2 of all STIs are found in adolescents

Question 22

adolescence (early 10-13, middle 14-17, late 18-21) - other important topics

Answer 22

• teens are less likely to report sexual abuse/assault
• drinking and driving is leading cause of death
• emancipation/confidentiality when treating substance abuse, STI, pregnancy

Question 23

respiratory a&p

Answer 23

• child resp tract is shorter & narrower
• NBs are obligatory nose & belly breathers
• 15 sec apnea is normal
• higher metabolic rate = higher O2 demand

Question 24

upper airway infectious disorders - otitis media

Answer 24

• s/s earache, pulling at ears, buldging red or opaque TM, yellow purulent fluid
• tx with abx

Question 25

upper airway infectious disorders - otitis media w effusion

Answer 25

- fluid collection in middle ear *buldging - can present as hearing loss

Question 26

upper airway infectious disorders - otitis externa

Answer 26

- inflammation of external ear canal

Question 27

upper airway infectious disorders - sinusitis

Answer 27

- pres: cold-like s/s for 7-14 days, facial pain, HA, fever, postnasal drip, bad breath, N/V, yellow/green nasasl discharge, swelling around eyes - intervention: supportive care, internasal steroid, antihistamine, abx, saline nasal drops, sinus rinse

Question 28

upper airway infectious disorders - pharyngitis

Answer 28

- causative agents: virus, bacteria, fungi - dx: nasal/throat swab intervention: supportive care, abx for strep

Question 29

upper airway infectious disorders - tonsilitis

Answer 29

- pres: sore throat, enlarged tonsils - may be red/covered in exudate, difficulty swallowing, halitosis - tonsillectomy post-op care: side-lying or prone, gentle oral assment, avoid coughing, using a straw, & blowing nose - s/s of post-op hemorrhage: restlessness, tachycardia, frequent swallowing

Question 30

upper airway infectious disorders - croup

Answer 30

- pres: "barky" cough, stridor, resp distress, hoarseness - dx: x-ray may show "steeple sign" (narrowing of larynx), clinical signs - intervention: admin meds; beta-adrenergic (racemic epinephrine) corticosteroids (dexamethasone), monitor resp status, cool mist & cold night air, O2, hydration

Question 31

upper airway infectious disorders - epiglottitis

Answer 31

- inflammation of larynx & epiglottis *life threatening - pres: 4Ds; drooling, dysphagia, dysphonia, distressed inspiratory air mvmt) - dx: x-ray shows narrow airway, inverted thumb - considerations: do not inspect mouth w/o intubation supplies

Question 32

lower airway infectious disorders - bronchiolitis

Answer 32

- causative agents/patho: caused by viruses that trigger inflammation of bronchioles (RSV most common), inflammation partially occludes airway causing wheezing & allowing less O2 to enter lungs - pres: cold sx, nasal congestion, fever, cough, decreased appetite, rapid breathing, wheezing, presistent cough, difficulty feeding intervention: supplemental O2 (humidified), hydration, suctioning

Question 33

lower airway infectious disorders - pneumonia

Answer 33

- causative agents/patho: virus, bacteria, mycoplasma, fungus, aspiration; bacteria cause fluid accumulation (consolidation) viral causes impaired gas exchange - pres: viral - flu & RSV, retractions, tachypnea, fever, cough, crackles, wheezing, CXR hyperinflation or consolidation bacterial - recent hx of URI, fever/chills, decreased breath sounds, retractions, tachypnea, CXR consolidation - intervention: supportive care (viral), supplemental O2, abx (bacterial), pneumococcal vaccine

Question 34

upper airway noninfectious disorders - esophageal atresia & tracheoesophageal fistula

Answer 34

- pres: resp distress within minutes, day, or weeks of birth, excessive oral secretions, cyanosis, abdominal distension - dx: prenatal US, polyhydramnios (excessive amniotic fluid) - intervention: prep for surgery, constant oral suction, supplemental O2, monitor ABGs & resp status

Question 35

upper airway noninfectious disorders - laryngomalacia

Answer 35

- pres: inspiratory stridor within first 2 weeks of life, crowing noise w resp, normal VS & O2 - dx: flexible laryngoscopy - intervention: sx usually resolve by age 2 w/o intervention

Question 36

upper airway noninfectious disorders - subglottic stenosis

Answer 36

- pres: stridor, increased work of breathing - dx: narrowing of airway as a result of intubation - intervention: oral/IV/inhaled epi, prep for surgery, supplemental O2

Question 37

upper airway noninfectious disorders - apnea

Answer 37

NB - risk factors: gestational age, maternal drug use, thermal instability, prematurity, infection, insufficient O2, metabolic/CNS disorder - intervention: CPAP, BiPAP Obstructive - risk factors: enlarged tonsils, craniofacial abnormalities - intervention: CPAP, tonsillectomy

Question 38

lower airway noninfectious disorders - resp distress syndrome

Answer 38

- underdeveloped lungs in NB - patho: deficient surfactant - pres: s/s of resp distress within minutes of birth - dx: "ground glass" (cloudiness) on CXR - intervention: CPAP, admin surfactant

Question 39

lower airway noninfectious disorders - cystic fibrosis

Answer 39

- autosomal recessive disorder of exocrine glands - patho: excessive mucus production in lungs that leads to infection - dx: prenatal DNA testing - intervention: med admin - dornase alfa (things mucus)

Question 40

lower airway noninfectious disorders - asthma

Answer 40

- chronic obstructive inflammatory disorder - patho: narrowing, mucus - risk factors: genetics, environment - pres: cough (worse at night), SOB, wheezing, hx of allergies, hyperresonance - dx: hx & physical, pulmonary function test (ages 5+)

Question 41

lower airway noninfectious disorders - foreign body aspiration

Answer 41

- pres: coughing, wheezing, stridor, gagging, cyanosis - dx: hx & clinical s/s, CXR, CT, MRI - intervention: assess resp status, child assume position of comfort, prep for removal of object, monitor, abx, cool mist

Question 42

lower airway noninfectious disorders - pneumothorax

Answer 42

- patho: air enters chest w inspiration, but cannot exit w expiration - accumulation of air compresses lung - dx: CXR & clinical pres (decreased or absent breath sounds unilaterally) - intervention: O2, needle aspiration/chest tube placement