1. CARDIOVASCULAR: 5 questions
❖ Congenital heart conditions: medications, assessment findings
➢ Finding: murmur, increased work of breathing, tiring while feeding, turning blue
when crying
Murmur: turbulent blood flow through an abnormal valve, vessel, or
chamber. A chamber can either be innocent or pathological.
Diagnosis- through assessment and listening to the heart sounds,
make sure to document
- What part of the cardiac cycle (systole, diastole)
- Quality (harsh, soft, blowing)
- Pitch
- Intensity (loudness)
- Location (where it is heard the best)
- Radiation
- Presence of a thrill
- Response when patient changes position or exercises
- Systolic Murmur Graded on a scale of I VI (Levine Scale)
- Diastolic Murmurs are graded on a scale of I to IV
- Grading a murmur II to III is subjective based on the loudness
- Grading a murmur a IV/VI must be associated with a thrill, they are usually rare in
pediatric patients
Diagnostic tests- Chest X-ray, EEG, Monitor, transthoracic echocardiogram, CT/MRI,
exercise stress test, and Cardiac catheterization
❖ Kawasaki disease
➢ A prolonged high fever that doesn’t break for longer than 5 days
➢ increases plt count bc dehydration/thick blood
➢ Signs & Symptoms
➢ Phase 1 : Acute Phase - onset of high fever, which can last 5 days - 2 weeks, that
is unresponsive to antipyretics
■ irritability
■ Red Eyes without drainage
■ Bright red, chapped lips
■ red oral mucous membranes with inflammation including the pahrynx
■ Swelling of the hands and feet with red palms
■ Non Blistering Rash
■ Bilateral Joint rash
■ Enlarged Lymph nodes
■ Desquamation of perineum
■ Cervical Lymphadenopathy
■ Cardiac manifestations: Myocarditis, decreased left ventricular, pericardial
effusion
■ Strawberry tongue with white coating or red bumps on the posterior
aspect (red, puffy, and indented taste buds)
■ Vesicular type rash on the trunk
➢ Subacute Phase- resolution of fever and gradual subsiding of other manifestations
■ Irritability
■ Peeling skin around the nails, on the palms and soles
■ Temporary Arthritis
➢ Diagnostic Tests:
■ CBC
■ CRP
■ ESR
■ Blood Albumin
■ Elevated Liver enzymes
■ Lumbar puncture to assess for aseptic meningitis and inflammation
➢ Treatments
■ IVIG
■ IV fluids
■ Aspirin
❖ Digoxin
➢ What do you check before giving digoxin?
■ Take apical pulse
■ Holding for HR under 90
➢ Discharge teaching for where to teach parent to take pulses
■ Brachial- baby
■ Radial- older
■ Give Digoxin One hour before feedins or 1-2 hours after
❖ Prostaglandin
➢ What are they used for?
■ Keeps PDA open (mimics in utero)
❖ SVT
➢ Infant put upside down
➢ ice packs to face
❖ Tetralogy of Fallot
➢ This cardiac defect is associated with VSD, right ventricular hypertrophy, right
ventricular outflow obstruction, and an overriding aorta
➢ knee to chest
➢ Shunt placement until able to undergo primary repair
■ Complete repair within the first year of life
2. RESPIRATORY: 6 questions
❖ Cystic fibrosis
➢ pancreas & lungs
➢ high vitamin intake & high protein/low fat
➢ have to take pancrelipase every time they eat
➢ both parents have to be carriers
■ likelihood high
➢ life expectancy ~ 30 years
➢ chest vest - loosens secretions IN THE MORNING MOST IMPORTANT
➢ can’t be around other CF patients -spreads pseudomonas aeruginosa
■ essentially a death sentence
➢ lung function tests (LFTs)
➢ sweat test for diagnosis (high sodium sweat indicates CF)
❖ Viral respiratory illness: bronchiolitis, RSV, pneumonia – diagnosis and treatment,
assessment findings
➢ bronchiolitis
■ diagnosis
■ treatment
● symptom treatment
● suction
■ assessment findings
● congestion
● rhinorrhea
● fever
● cough
● wheezing
● retractions
➢ RSV (Respiratory Syncytial Virus)
■ diagnosis
■ treatment
● symptom treatment
● SUCTION
■ education
● suction before feeds
■ assessment findings
➢ Respiratory syncytial virus (RSV) accounts for the majority of lower respiratory tract
infections in young children. Infants with RSV infections must be observed closely for
signs of increased respiratory distress
➢ pneumonia
■ diagnosis
■ treatment
■ assessment findings
❖ Asthma – peak flow, normal findings
➢ peak flow
■ green 80-100
■ yellow 50-80
■ red 0-50
➢ learn inhaler types
➢ education
■ trigger education (allergies, smoking, cold weather, etc)
■ rinse mouth and mouth piece
● thrush development
■ use spacer
3. GI: 6 questions
❖ Hirschsprung’s disease
➢ top or bottom part is stenosed
➢ S&S
■ no meconium within 48 hrs
■ projectile vomiting
➢ NEC secondary
■ antibiotic treatment
❖ GERD
➢ hiccups
➢ vomiting
➢ education
■ frequent burping
■ small frequent meals
■ sitting up for 30 mins after eating
❖ Surgical emergencies: appendicitis
❖ Esophageal atresia
➢ aspiration!!
➢ NPO
3. INTAKE AND OUTPUT: 3 questions
❖ Calculating intake and output
➢ diaper weighs 1 g = 1 mL
3. GU: 7 questions
❖ Glomerulonephritis
➢ strep main cause
➢ pees blood
➢ treatment
■ IV fluids
❖ Hypospadias
➢ the urethral opening is on the bottom?
❖ Circumcision
➢ infection
➢ bleeding
❖ Testicular torsion
➢ abdominal pain/nausea get ultrasounded for this
➢ straight to OR once confirmed
➢ once having it, more likely to have it again
❖ Acute and chronic renal failure
➢
3. ENDOCRINE: 7 questions
❖ Hypothyroidism
➢ Synthroid
■ 1 hr before or 2 hr after feeding
➢ Hashimotos- goiter development secondary to hypothyroidism
➢ exophthalmos
❖ Growth hormone
❖ Type 1 DM
➢ bed wetting
➢ hypoglycemia in babies
■ lethargy
❖ Proper insulin administration
➢ NPH/reg mix
3. MUSCULOSKELETAL: 3 questions
❖ Hip dysplasia
➢ barlow test
■ opens legs to hear clicking
➢ one leg longer than other
➢ one foot straight up, other laying sideways
➢ skin folds aren’t equal
➢ treatment
■ pavlik harness
● 3 mos
■ surgery
● spica cast
❖ Torticollis
➢ tightening of muscles on one side of the neck causing child to favor one side
❖ Ortolani/Barlow signs
➢ hip clicking??
3. DERMATOLOGY: 5 questions
❖ Roseola
➢ red cheeks and nose
❖ Thrush
❖ Scabies
➢ mites under the skin
➢ very contagious
➢ lines
➢ itchy
❖ Impetigo
➢ Honeycomb rash
➢ skin slough
➢ contagious
➢ contact
❖ Urticaria
➢ hives
➢ parent education
■ socks on hands at night
■ PO benadryl treatment
3. CHROMOSOMAL ABNORMALITIES: 7 questions
❖ Down syndrome
➢ hand creases
❖ Newborn screening tests
➢ CF, PKU, sickle cell,
❖ Inherited disorders: pattern of inheritance
3. MED CALC: 1 question
❖ Dimensional analysis
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