b. Diet would be to maintain hydration. c. No corticosteroids, use of albuterol is debatable, no antibiotics 23) Which child should not receive a TB skin test? a. I’ve looked this up before. I think it was on one of our quizzes. I’m hoping it comes to me when I see the choices because I couldn’t find it on the CDC site. 24) Which patient LEAST warrants a sweat chloride test? a. Asthma and Cystic fibrosis are a YES for this test. So, don’t pick those. 25) Wheezing; What does it sound like with: a. Asthma – it is common b. Foreign body – wheezing will be unilateral c. Croup -insp stridor, but if wheezing it indicates lower respiratory tract involvement d. Cystic fibrosis – Common. 26) X-ray findings of Croup: a. Perihylar lymphadenopathy – No. TB or sarcoidosis. b. Thumb sign – This is present with epiglottitis c. Steeple sign – Yes. The trachea looks like a steeple on posteroanterior view x-ray with croup d. Hyperinflation – Yes. 27) Mild to moderate acute asthma and albuterol a. Mild asthma gets albuterol but it should be accompanied by a low dose inhaled corticosteroid (ICS). b. Next step is to add a LABA. c. As symptoms advance, finally consider omalizumab and if necessary, can add an oral steroid. 28) Most common congenital heart defect in kids a. VSD 4
29) Chest pain in young children a. Most common in adolescents. b. Almost always musculoskeletal. If there are cardiac or pulmonary issues, rule out with assessment, x-ray, PFTs, etc. 30) Innocent murmurs; Where are they found; What grade are they? a. Usually grade I to III/IV in intensity and localized. b. They change with position changes (standing to laying) c. They vary in loudness visit to visit. d. Fever, anemia, exercise, and anxiety make them louder. e. They are musical or vibratory in quality, sometimes blowing f. Systolic in timing g. May disappear with jugular pressure, Valsalva, or positioning h. EKG and VS are good i. ALL MURMURS GET A CARDIAC REFERRAL 31) Basic info: a. Rheumatic Fever – a complication following a GAS laryngeal infection. i. It results in an autoimmune process that attacks joints, the heart, CNS, and sub-Q tissue. Sydenham chorea can happen (random, jerky body movements). Most effects are minimal in the long term except scarring and fibrosis on heart valves. ii. In the acute phase it will cause fever and arthralgias. b. Kawasaki Disease – Childhood vasculitis i. Symptoms: bilateral conjunctival injections, changes in lips and oral cavity, cervical lymphadenopathy, polymorphous exanthema, changes in extremities (swelling of hands, feet and perianal area). ii. Acute phase with fever. Subacute they are doing better and can last up to one month. Convalescent shows lab value improvements. c. Sickle Cell Anemia – A group of complex disorders. i. Sickle shaped hemoglobin. People of African descent. ii. Multitude of Symptoms: Fatigue, anemia, pain crises, swelling of hands and feet, arthritis, lung and heart injury, leg ulcers, splenic sequestration, liver pooling, bone infarcts, eye damage, and abdominal pain.
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