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210 Cards in this Set
- Front
- Back
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A mass or growth caused by excessively multiplying cells.
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Tumor
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What are the four cancer cell characteristics?
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Lack of differentiation
Loss of contact inhibition Unregulated growth Cellular immortality |
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Histologically, where does cancer arise from between children and adults?
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Childhood cancer often arises from embryonal tissue. Adult cancers typically arise from epithelial tissue (exposed to the environment).
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This is the first known genetic link in cancer.
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Retinoblastoma gene
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True/False. Lifestyle factors can be a cause of childhood cancers.
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False. Lifestyle factors are NOT a cause of childhood cancer.
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Pain, alteration in sensation, and CNS changes are associated with (solid tumors/hematologic cancer).
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Solid tumors
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What are some common tests for the diagnostic evaluation of childhood cancer?
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CBC, Chem 10 (presenting involvement: electrolytes are "all out of whack"), AST/ALT, LDH (can be elevated), UA (to make sure they are well hydrated).
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This is the most common form of childhood cancer.
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Leukemia
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What is a hallmark sign of childhood leukemia?
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Unilateral bone pain (so severe it wakes the child at night)
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Which lymphoma is more common in teenagers?
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Hodgkin's lymphoma is more common in children 15-19 years old.
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A 17 year-old boy arrives in the clinic complaining of pain in his armpit and neck. Knowing what you do about childhood cancer, what do you suspect you may need to test him for?
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Hodgkin's lymphoma (slide 20, Overview of Child with Cancer)
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What is the diagnostic confirmation for Hodgkin's disease?
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REED-STERNBERG CELLS!
(Should remember this from Dr. Murphy! She really stressed this!) |
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This is the most common solid tumor in children.
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Brain tumors (60% infratentorial, 40% supratentorial)
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What is a hallmark sign of brain tumor?
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Headaches in the morning (change in ICP, often relieved by getting up and/or vomiting)
Also: Lethargy, N/V, personality or academic changes |
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A child is brought into the clinic, and his mother states he has been complaining of a headache in the mornings, he has become more irritable, and his grades have begun to fall. Upon physical examination, you note nystagmus of the eyes. You present these findings to the oncoming resident, and he orders an LP. What do you say?
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"Uh. Back off, dude. If this kid is exhibiting s/s of BRAIN TUMOR, then he needs an MRI first to determine whether he has increased ICP. If you stick a needle in his back with increased ICP, you risk brain herniation."
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Drooping eyelids, black eyes, and elevated catecholamine levels in the blood are classic s/s of what childhood cancer?
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Neuroblastoma (slide 29-- Cancer)
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What are the two classes of bone tumors?
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Osteosarcoma and Ewing's Sarcoma (slide 31-- Cancer ppt)
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Between osteosarcoma and Ewing's sarcoma, which occurs more commonly at the end of long bones?
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Osteosarcoma (slide 31-- Cancer)
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A "moth-eaten" appearance of a bone in an X-ray is usually characteristic of what disorder?
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Ewing's sarcoma (slide 32-- Cancer)
Note: "sunburst pattern" occurs in Osteosarcoma |
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A malignant renal and intraabdominal tumor of childhood is:
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Wilm's tumor
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What is the most common presenting sign of Wilm's tumor?
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Painless swelling or mass within the abdomen (slide 34-- Cancer ppt)
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This is a malignant tumor of undifferentiated mesenchymal cells in muscles.
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Rhabdomyosarcoma (slide 37-- Cancer)
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A physical finding found in retinoblastoma is ____, or a lack of normal red reflex a light shined in the eye has a whitish glow.
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Leukocoria (slide 40-- Cancer ppt)
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Metabolic abnormalities due to rapid release of intracellular contents during lysis of malignant cells.
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Tumor lysis syndrome (slide 53-- Cancer ppt)
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What is a nursing intervention in dealing with tumor lysis syndrome?
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Frequent blood work to monitor serum chemistries, and aggressive IV fluids with strict I&Os.
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The renal system reaches functional maturation around __ years of age.
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2
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Bladder capacity at an adult level is usually achieved by age ___.
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1
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True/False. The expected urine output/kg of body weight decreases as the child's age increases.
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True. Ex: Infants typically put out 2cc/kg/hr. A child can put out anywhere from .5-1cc/kg/hr.
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True/False. A red flag is if a child is putting out less than .25 mL/kg/hr.
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False. If a child is putting out less than 0.5mL/kg/hr, this is a red flag.
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A mother, whose son is due for urinalysis this morning, arrives late in your clinic stating, "Even though I told my son not to use the bathroom, he went ahead anyway (what an idiot). Don't worry, though. I had him chug about three things of Gatorade, so he should be good to go again now." What is your response?
A) Provide her with a sterile cup and instruct her in the "clean catch" technique so that she may explain it to her son. B) Provide the child with water so as to dilute the glucose concentration of the urine brought on by excess Gatorade consumption. C) Inform her that only an initial, first-thing-in-the-morning evacuation specimen is viable, and tell her she must return tomorrow D) Inform her that the excess fluid intake may skew the results of the urinalysis, and to return tomorrow. |
D.
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Which of the following is NOT consistent with renal problems in children?
A) Diaper rash B) Bowed legs C) Abdominal mass D) Increased bowel sounds |
D) Increased bowel sounds
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Which of the following statements is FALSE regarding bladder extrophy (select all that apply)?
A) The only treatment for this condition is surgical repair B) It is caused by a midline closure defect in utero C) It is impossible to diagnose prenatally D) Usual complications are UTI or superficial infection E) All male patients have concomitant genital malformations, like epispadias |
C) It is possible to diagnose this condition prenatally
AND E) Not all male patients have penile defects |
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Which position is recommended in patients with bladder exostrophy?
A) Supine B) Prone C) Lateral D) Trendelenburg |
A) Supine
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Urethral defect with an abnormal location of urethral meatus.
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Hypospadias/Epispadias
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Which of the following is contraindicated in children who have undergone hypospadias/epispadias surgical correction?
A) Immersion baths B) Double-diapering C) Anti-spasmotics D) Catheter irrigation |
A) Immersion baths
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This is a condition in which urine from the bladder flows back up the ureters.
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Vesicoureteral Reflux
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UTI/VUR antibiotics are most effective when taken:
A) In the morning B) In mid-afternoon C) In the evening D) At bedtime |
D) At bedtime, because urinary stasis occurs overnight
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True/False. UTIs are more common in females than males during infancy.
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False. UTIs are more common in males younger than 1 year of age. After 1 year of age, however, UTIs are more common in females.
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True/False. Secondary enuresis occurs in a child who has previously exhibited bladder control over a period of at least 3-6 consecutive months.
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False. PRIMARY enuresis.
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Which of the following children warrants further referral?
A) A 23 month old who consistently fails toilet training B) A 6-month old producing 6 wet diapers/24 hrs C) A 7-year old experiencing nocturnal enuresis D) A 3-year-old experiencing encopresis |
C) Nocturesis usually stops by age 6. Beyond 6 years, it should be evaluated by a physician.
Encopresis is a normal finding in toddlers. Infants generally produce 6-8 heavy diapers/day. A 23 month old may not have full bladder/bowel control yet. |
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Which of the following is NOT consistent with nephrotic syndrome?
A) Hyperalbuminemia B) Proteinuria C) Hyperlipidemia D) Edema |
A) Nephrotic syndrome is characterized by hyPOalbuminemia
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Which of the following is a treatment for nephrotic syndrome (select all that apply)?
A) Elimination of salt from diet B) Corticosteroids C) Diuretics D) Fluid restriction E) IV albumin |
B, C, E.
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What is the most common cause of acute renal failure in children?
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Hemolytic-uremic syndrome
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Which of the following is associated with ingestion of bacterial toxins, chemicals, or viruses?
A) Hydronephrosis B) Acute glomerulonephritis C) Hemolytic-uremic syndrome D) Urinary tract infection |
C) Hemolytic-uremic syndrome
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If the potassium level is too high in children with acute renal failure, what drug is often administered?
A) Kayexalate B) Spirinolactone C) Furosemide D) Digoxin |
A) Kayexalate
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What is the primary manifestation of acute renal failure?
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Oliguria
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True/False. Acute renal failure is permanent and irreversible.
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False. CHRONIC renal failure is considered permanent and irreversible.
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Optimum protein intake in children is approximately ___g/kg of body weight.
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2.5 g/kg
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Which of the following should a nurse be aware of in administering erythropoietin (select all that apply)?
A) CBC/WBC B) Blood pressure C) Serum creatinine/ferritin levels D) ESR E) Alpha glucosidase |
B and C.
Hypertension is an adverse effect of erythropoietin. Serum creatinine/ferritin levels may also be altered. |
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Which of the following statements by the mother of a child with end stage renal disease indicates a need for further teaching?
A) He requires a growth hormone shot into his shoulder 6-7 days per week. B) I will need to make sure he consumes extra servings of dairy per day C) He is not allowed to consume much protein, so I'll need to supplement his diet with iron in other ways D) His condition will not improve unless he receives a kidney transplant |
A) Is incorrect. Growth hormone supplements are given SQ, not IM.
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Which of the following is true regarding dialysis treatments?
A) Peritoneal dialysis is more applicable for children under 10 B) Dietary restrictions are lifted during hemodialysis exchanges C) Risk for infection in hemodialysis is greater than in peritoneal dialysis D) If bloodwork is needed, it may be retrieved from the AV graft site |
B. Dietary restrictions are usually lifted during the exchanges.
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True/False. Phimosis is normal in the newborn.
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True.
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Which of the following statements by the parent of a child with circumcision indicates a need for further instruction?
A) I will alert my physician if he has not voided in 6-8 hours after the procedure B) Some bleeding is expected, but if he bleeds a lot, I will apply pressure to the site and call my doctor C) I will apply petroleum jelly generously around the plastibell to ensure the site is adequately moisturized D) I should avoid immersing him in water until the site is healed |
C) is FALSE. If a plastibell is used in circumcision, petroleum jelly should NOT be used.
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One or both testes fail to descend through the inguinal canal into the scrotum.
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Cryptorchidism
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The testes should normally descend by how old?
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6-9 months of gestation
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If testes remain undescended, an orchiopexy may be done at ___ years of age.
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2-3 years of age
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Which of the following is NOT true regarding cryptorchidism?
A) If left untreated, this can lead to infertility B) Growth hormone is often administered as treatment C) Corrective surgery cannot be performed until 2-3 years of age D) Risk of testicular cancer is 35-50 times greater with this disorder |
B) Growth hormone is NOT a viable treatment for cryptorchidism. HcG (human chorionic gonadotropin) is used as treatment.
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Fluid in scrotal sac: ____
Swelling of scrotal sac: ___ |
Hydrocele; variocele
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True/False. Variocele is usually self-limiting and benign, and often resolves on its own.
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FALSE. Variocele is not benign, and can result in infertility.
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In performing a newborn assessment, you note a mass on one side of the scrotum with bluish discoloration and a worm-like cord beneath the skin. Based on your knowledge of male genital disorders, what do you suspect?
A) Cryptorchidism B) Testicular torsion C) Hydrocele D) Variocele |
D) Variocele
Note: Hydrocele is simply swelling of the scrotum that may decrease when the child is supine. |
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True/False. Dislocations and sprains are less common in children than in adults.
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True.
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Progressive muscle weakness and wasting, terminal illness.
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Muscular dystrophy
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In muscular dystrophy, muscular weakness is typically seen around ___ years of age.
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3 years
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Turning onto the side or abdomen and flexing the knees to assume the kneeling position, then with the knees pushing the torso to an upright position by walking the hands up the legs.
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Gower's sign
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True/False. Classic Duschenne muscular dystrophy occurs only in boys.
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True.
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True/False. Corticosteroids like prednisone are a cure for muscular dystrophy.
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False. Corticosteroids may slow down the progress of muscular dystrophy, but they are not curative.
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This is the most common permanent physical disability in childhood, characterized by early onset of impaired movement and posture.
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Cerebral palsy
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What is the single most important risk factor of cerebral palsy?
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Premature delivery
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True/False. Cerebral palsy is considered a progressive muscle disorder.
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False. Cerebral palsy is a non-progressive muscle disorder, in that it does not get worse over time.
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True/False. Use of walkers is discouraged in children with cerebral palsy.
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True! The risk for injury is great!
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What are some physical s/s of cerebral palsy?
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Poor head control after 3 months of age
Stiff or rigid arms or legs Pushing away or arching of the back Floppy/limp body posturing Cannot sit up w/out support at 8 months of age Using only one side of the body or only arms to crawl Clenched fists after 3 months of age |
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A fractured femur from a car bumper, thoracic trauma from the hood, and head injury from the subsequent fall is also known as:
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Waddell's triad
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Remember the 5 Ps of vascular impairment?
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Pain
Pulse Pallor Paresthesia Paralysis |
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Byrant's traction is used to treat what in children under 3 years of age (or less than 30 pounds)?
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Developmental dysplasia of the hip or fractured femur
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Most children have surgery for clubfoot when?
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Between 3-12 months of age
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What is the preferred treatment for DDH?
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A Pavlic harness (worn 24 hrs/day)
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This is an avascular necrosis of the femoral head.
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Legg-Calve-Perthes Disease
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The spontaneous displacement of the proximal femoral epiphysis in the posterior and inferior direction.
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Slipped Femoral Capital Epiphysis
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In which age group are you most likely to see slipped femoral capital epiphysis (SFCE)?
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Adolescents
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Which of the following statements is FALSE regarding slipped femoral capital epiphysis?
A) The use of assisted devices like wheelchairs are required until the patient recovers (3-4 months) B) Incidences of SFCE are higher in adolescents and males C) Some s/s of SFCE are shortening of the lower extremity or limping on the affected side D) Diagnosis is typically made by X-ray |
A) Wheelchairs are NOT recommended, as they may cause further slippage of the epiphysis.
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True/False. Osteogenesis imperfecta is often mistaken for child abuse.
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True.
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Which of the following drugs are NOT indicated in the treatment of juvenile rheumatoid arthritis?
A) Methotrexate B) NSAIDs C) Corticosteroids D) Aspirin |
D) Aspirin
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What is the purpose of prostaglandins in fever?
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Prostaglandin production increases the body's temperature set point.
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The time from onset of nonspecific symptoms such as fever, malaise, and fatigue to more specific symptoms.
A) Incubation B) Prodrome C) Illness D) Convalescence |
B) Prodrome (p. 448)
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Test used to measure item produced in the liver and is present during episodes of acute inflammation or infection.
A) ESR B) CBC C) CRP D) UA |
C) C-Reactive protein is usually used to diagnose bacterial infections.
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True/False. Acetaminophen is only for use in children older than 6 months of age.
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FALSE. Ibuprofen is only for children older than 6 months of age. (p. 461)
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A child arrives in your clinic with an erythematous rash on his cheeks that resembles a sunburn. Upon palpation, you note it feels like sandpaper. What do you suspect?
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Scarlet Fever (p. 465)
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How do the oral s/s of scarlet fever progress?
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Early in the illness the tongue develops a thick coat with a strawberry appearance. The tongue will later lose the coating and become bright red. (p. 465)
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A pseudomembrane is most commonly associated with what immunologic disorder?
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Diptheria (p 465)
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In treating pertussis in a 3 week old, which of the following drugs is indicated?
A) Azithromycin B) Erythromycin C) Clindamycin D) Gentamycin |
A) For infants older than 1 month of age, marolide drugs like erythromycin , clarithromycin, and azithromycin are the DOC. For YOUNGER infants, azithromycin should be used and erythromycin and clarithromycin AVOIDED (p. 467).
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Rash or skin eruption.
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Exanthem
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Which of the following is NOT considered a viral exanthem?
A) Rubeola B) Rubella C) Varicella D) Pertussis E) Fifth disease |
D) Pertussis is NOT considered a viral exanthem.
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Which of the following symptoms is not associated with Rubella (German measles)?
A) Lymphadenopathy B) Polyarthralgia C) Sesquamation of the hands and soles of feet D) Encephalitis |
C) Desquamation is minimal in Rubella (p. 469)
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Which of the following is FALSE regarding measles?
A) Koplik spots often show up on the mucous membranes B) The disease is communicable 1-2 days after the onset of rash C) The maculopapular rash generally proceeds in a cephalocaudal fashion D) Treatment is mainly supportive, but Vitamin A has been used |
B) is FALSE.
Rubeola (measles) is communicable 1-2 days BEFORE the onset of symptoms (3-5 days BEFORE the onset of rash), up until 4-6 days after the rash has appeared. (p. 469) |
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A mother of a child with measles asks you when it is safe to return her child to daycare. What is your response?
A) Your child may safely return to daycare after he has completed his treatment of antibiotics B) Your child may return to daycare once his blood titers come back negative C) Your child may return to daycare when his WBC count has returned to normal D) Your child may return to daycare about a week after the rash has appeared |
D) Air-borne precautions are required for measles until 4-6 days after the onset of rash. After this point, the virus is no longer considered communicable (p. 469)
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A mother of a child with chicken pox asks when it is safe for her son to return to school. What is your response?
A) Your son may return to school when all of his lesions have crusted over B) Your son may return to school when all of his lesions have healed C) Your son may return to school approximately 2-3 days after onset of his rash D) Your son may return to school when he is no longer exhibiting a fever |
A) Children may return to school once lesions have crusted (3-7 days after the onset of rash) (p. 470)
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A child arrives in your clinic exhibiting pinkish red, flat, and raised spots on his skin that blanch when touched. What do you suspect?
A) Rubella B) Varicella C) Roseola D) Rubeola |
C) Roseola (p. 471)
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Football-shaped vesicles with erythematous rims and vesicles on the tongue and oral mucosa are s/s associated with what immunologic disorder?
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Hand, foot, and mouth disease (herpangina) (p. 473)
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What is the DOC for Lyme disease in children older than 8 years old?
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Doxycycline
(Children younger than 8 should receive amoxicillin) (p. 479) |
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You admit a 6 year old patient with Rocky Mountain Spotted Fever. The medical resident has made his rounds, and had prescribed doxycycline to your patient. What is your next course of action?
A) Educate the resident that antibiotics are not indicated in this patient, as RMSF is not a bacterial infection B) Educate the resident that doxycycline is not indicated in this patient, as it is not used in patients under age 8 due to risk of teeth staining C) Educate the resident that this patient does not require treatment until he is in the acute phase of RMSF D) Carry out the resident's orders without question |
D) Carry out the resident's orders.
Due to the life-threatening nature of RMSF, the American Academy of Pediatrics has identified doxycycline as the drug of choice for treating presumed or confirmed RMSF in children of ANY age! (p. 481) |
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The tissue that forms the lip usually fuses by what week of gestation?
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5-6 (p. 708)
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Cleft lip is usually corrected by what age? Cleft palate?
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Cleft lip is usually repaired around age 2-3 months.
Cleft palate is usually repaired by 9-18 months. (p. 708) |
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Which of the following is NOT considered a risk factor for cleft palate?
A) Maternal smoking B) Intrauterine growth retardation (IUGR) C) Advanced maternal age D) Use of anticonvulsants or steroids during pregnancy E) Prenatal infection |
B) IUGR is NOT associated with cleft palate. (p. 708)
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What is the idea position to place an infant in postoperatively following cleft palate or cleft lip repair (select all that apply)?
A) Supine B) Prone C) Side-lying D) Prone with hips elevated E) Lateral recumbent |
A, C. (p. 709)
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True/False. Breastfeeding is not indicated in children with cleft lip.
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False. The contour of the breast against the lip may allow for a better seal to be maintained for adequate sucking. (p. 709)
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This is a gastrointestinal anomaly in which the esophagus and trachea do not separate normally during embryonic development.
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Esophageal atresia/Tracheoesophageal fistula. (p. 710)
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A congenitally interrupted esophagus where the proximal and distal ends do not communicate; the upper esophageal segment ends in a blind pouch and the lower segment ends a variable distance above the diaphragm.
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Esophageal atresia (p. 710)
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What are the three C's associated with esophageal fistula?
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Choking
Coughing Cyanosis |
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This is the first sign of esophageal atresia.
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POLYHYDRAMNIOS.
This is because the fetus cannot swallow and absorb amniotic fluid in utero, leading to accumulation. (p. 710) |
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In performing a newborn assessment, you note copious, frothy bubbles of mucus in the mouth and nose accompanied by drooling. What do you suspect?
A) Rheumatic fever B) Condomylata C) Tracheoesophageal fistula D) Gastroschisis E) Cleft palate |
C) The hallmark sign of tracheoesophageal fistula is bubbling/frothing at the nose and mouth. (Think about it this way-- air, mucous, and regurge is mixing.) (p. 710)
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Which of the following orders should you question in a child with esophageal atresia or tracheoesophageal fistula?
A) Oxygen and suctioning PRN B) HOB elevated at 30-45 degrees C) NG tube irrigation PRN D) Strict I&O E) NG at low continuous suction |
C) Tube irrigation is CONTRAINDICATED in trach patients as this increases risk of aspiration. (p. 710)
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Which of the following are indicated in a child with gastroschesis or oomphalocele (select all that apply)?
A) Strict sterile technique B) OG tube at low suction C) Saran wrap dressing D) Radiant warmer E) Gauze irrigated in distilled water |
A, B, C, D. (p. 712)
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Surgical intervention for a high type of anorectal malformation involves:
A) Corrective surgery preceded by a colostomy B) Corrective surgery to repair the fistula C) Corrective surgery to create an anal opening D) Repositioning the rectal pouch into the anus |
A) Surgery for a HIGH type of defect involves a colostomy in the newborn period, with corrective surgery performed ins tages to allow for growth.
All of the other options are associated with a low type of anomaly. (p. 713) |
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What is the hallmark sign of an imperforate anus?
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No passage of meconium stool within the first 24 hours of life. (p. 713)
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Which of the following is NOT indicated in the treatment of an imperforate anus?
A) Mineral oil applied with cotton ball B) Colostomy C) Barrier cream D) Gastric decompression E) Excessive use of baby wipes and soap water |
E. (p. 714)
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This is the result of an incomplete fusion of the omphalomesenteric duct during embryonic development.
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Meckel Diverticulum (p. 714)
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Which of the following would you NOT expect to see in a patient with Meckel Diverticulum?
A) Anemia B) Scaphoid abdomen C) Colicky abdominal pain D) Guarding E Bleeding |
B) Scaphoid abdomen is NOT expected in this patient.
Patients with M.D. typically have hypoactive bowel sounds and abdominal distention (p. 714) |
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“Double diapering” is commonly used in children with what condition?
A) Hypo/epispadias B) Bladder extrophy C) UTI D) Hydronephrosis E) Penile adhesions |
A) Hypo/epispadias (p. 764), usually following surgical repair
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Dilation of the pelvis and calyces of the kidney is called:
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Hydronephrosis (p. 767)
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Which of the following is not associated with hydronephrosis?
A) Elevated levels of serum alpha-fetoprotein B) Maternal oligo or polyhydramnios C) FTT D) Hematuria E) High urine specific gravity |
E) Elevated urine specific gravity is not associated with hydronephrosis
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A mother of a child with nephrotic syndrome states that he has just completed his round of steroids and can’t start school until he has his flu shot. What is your response?
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You must delay administering live vaccines until at least 2 weeks after the steroid regimen ends (due to immunosuppression) (p. 774).
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Why should NSAIDs be avoided in children with questionable renal function?
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NSAIDs may cause a further decrease of the glomerular filtration rate (p. 775)
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What are the three features of hemolytic-uremic syndrome?
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“ART”
Anemia Renal failure (acute) Thrombocytopenia (p. 776) |
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Name some nephrotoxic drugs in children.
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Aminoglycosides
Sulfonamides Vancomycin NSAIDs (p. 777) |
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Which of the following are considered medical emergencies (select all that apply)?
A) Hydrocele B) Cryptorchidism C) Paraphimosis D) Testicular torsion E) Epididymitis |
C, D (p. 789-790)
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Bladder capacity is about how big in the newborn? What is the expected urin OP?
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30 mL (p. 751); 0.5-2mL/kg/hour
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What is used to stimulate production of gonadal steroids to precipitate testicular descent?
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HcG!!! (p. 753)
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When is Desmopressin best administered (what time of day)?
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At bedtime. Also, alternate nares (p. 753).
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In this condition, a midline closure defect occurs during the embryonic period of gestation, leaving the bladder open and exposed outside the abdomen.
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Bladder exostrophy (p. 762)
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What is the most common cause of pancreatitis?
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Abdominal trauma, drugs, and alcohol (though the latter are unlikely in children) (p. 741)
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For which of the following procedures is bed rest necessary?
A) Myelography B) Ultrasound C) Computed tomography (CT) D) Magnetic resonance imaging (MRI) E) Fluoroscopy |
A) Myelography (p. 799)
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____ is a normal intracellular plasma membrane protein in the muscle, which is absent in Duchenne muscular dystrophy.
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Dystrophin (p. 800)
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When does the neural tube close in gestation?
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3rd and 4th week (p. 805)
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Prenatal screening of alpha-fetoprotein is primarily used to diagnose what?
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Neural tube defects (p. 805)
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The less serious form of spina bifida cystica, which occurs when meninges herniate through a defect in the vertebrae.
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Meningocele (p. 806)
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The most severe form of neural tube defect.
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Myelomeningocele (p. 806)
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Which of the following is NOT indicated in a child with myelomeningocele?
A) Saline or antibiotic-soaked gauze to keep the sac moist B) Warm blankets to maintain thermoregulation C) Prone position to promote downward flow of urine D) Plastic wrap below the sac to prevent feces from contacting the lesion |
B) Blankets are avoided, as they may exert too much pressure on the sac. (p. 808)
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True/False. Duchenne muscular dystrophy is universally fatal.
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True. (p. 811)
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Which of the following is NOT indicated in muscular dystrophy?
A) Corticosteroids B) Frequent periods of bed rest C) Calcium supplements D) Ankle-foot orthoses |
B) Long periods of bed rest may contribute to further weakness. (p. 815)
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In which type of spinal muscular atrophy are the legs weaker than the arms, or the lower legs weaker than the thighs?
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Type 2 SMA (p. 815)
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Which of the following is characterized by symmetric weakness that is more proximal than distal and greater in the legs than arms?
A) Cerebral palsy B) Duchenne muscular dystrophy C) Spinal cord injury D) Spinal muscular atrophy |
D) Spinal muscular atrophy (p. 815)
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____ is caused by abnormal development of, or damage to, the motor areas of the brain, resulting in a neurologic lesion.
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Cerebral palsy (p. 817)
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What is the most common form of cerebral palsy?
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Spastic
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In this form of cerebral palsy, the infant is limp and flaccid with uncontrolled, slow, worm-like writing or twisting movements. Dysarthria or drooling may be present.
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Athetoid/dyskinetic (p. 819)—note: this is characterized by abnormal involuntary movements
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An autoimmune disease in which the acetylcholine receptor at the neuromuscular unction is affected, resulting in progressive weakness sand fatigue of the skeletal muscles.
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Myasthenia gravis (p. 825)
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True/False. There is no cure for myasthenia gravis.
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True. (p. 825)
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The Tensilon test is commonly associated with what neuromuscular disorder?
A) Cerebral Palsy B) Cystic Fibrosis C) Guillain-Barre D) Myasthenia Gravis |
D) Myasthenia gravis (p. 825)
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What is an effective technique for assessing the level of paralysis in the child with Guillain-Barre syndrome?
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Tickling! (p. 824)
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An autoimmune disease that results in inflammation of the muscles or associated tissues.
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Dermatomyositis (p. 826)
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What is the purpose of corticosteroids in the treatment of dermatomyositis?
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To prevent complications of painful calcium deposits under the skin, as well as joint contractures. (p. 826)
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Botulism is commonly associated with children under the age of one eating what?
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Honey or corn syrup (p. 826)
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Myelinization is complete by ___ years of age.
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2! (p. 832)
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True/False. Intrauteral rickets occurs when the fetus’ hips are flexed, abducted, and externally rotated, with the knees also flexed and the lower limbs inwardly rotated.
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False. This is called internal tibial torsion, and usually resolves independently some time in the second or third year of life. (p. 833)
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True/False. If a cast is lined with Gore-Tex, it requires petaling to prevent skin breakdown at the edge.
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False. Gore-Tex does not require petaling. (p. 843)
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Which of the following is NOT a sign of compartment syndrome?
A) Extreme pain B) Pain with passive range of motion C) Proximal extremity pallor D) Inability to move digits E) Loss of pulses |
C) DISTAL extremity pallor is associated with compartment syndrome (p. 845)
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Inversion of the heel in clubfoot is called?
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Talipes varus
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Plantar flexion of the foot in which the heel is raised and would not strike the ground in a standing position.
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Talipes equinus
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Plantar flexion of the forefoot on the hindfoot.
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Cavus
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Scissor crossing of the legs with plantar flexion is associated with what neuromuscular disorder?
|
Cerebral palsy (p. 820)
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A genetic bone disorder that results in low bone mass, increased fragility of the bones, and other connective tissue problems such as joint hypermobility, resulting in instability of the joints.
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Osteogenesis Imperfecta (p. 851)
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True/False. Osteogenesis imperfecta Type A involves the presence of dentinogenesis.
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False. A and B exist depending on the (A) absence or (B) presence of dentinogenesis imperfecta (p. 852)
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Older children with DDH may take this position when the leg is raised. This is when the pelvis/hip drops.
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Trendelenburg position (p. 855)
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True/False. Maternal T-cells cross the placenta and are involved in cellular immunity.
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False. Maternal T cells do NOT cross the placenta, so the fetal thymus begins production of T cells early in gestation, and the newborn demonstrates a relative lymphocytosis compared with the adult, probably due to increased amounts of T-cell lymphocytes. (p. 946)
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By ___ years of age, IgG levels should reach the adult levels in children.
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By 1 year of age, IgG is 70% of the adult level, and by 8 years of age it should reach the adult level (p. 946).
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What is ANA?
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Antinuclear antibody. It is a common test for the presence of autoantibodies that react against cellular nuclear material. Associated usually with SLE and JIA (p. 951)
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Which of the following are considered warning signs of primary immunodeficiency (select all that apply)?
A) Positive allergy skin testing before 1 year of age B) Two or more episodes of pneumonia or severe sinusitis in 1 year C) Elevated ESR on two separate occasions within 1 year D) Persistent oral thrush or skin candidiasis after 1 year of age E) Two or more episodes of acute otitis media in 1 year F) Failure to thrive in infant |
B, D, F.
B) Two or more episodes of pneumonia or severe sinusitis in 1 year (p. 951) A, C) Are unrelated to primary immunodeficiency D) Persistent oral thrust or skin candidiasis after 1 year (p. 951) E) FOUR or more new episodes of acute otitis media in one year. F) Failure to thrive is correct (p. 951) |
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A colleague’s patient has a history IgG hypogammaglobulinemia and requires administration of IVIG in the morning. In reconstituting the IVIG, your colleague adds diluent to the powder and shakes up the mixture before placing it in the refrigerator. Which of the following statements is MOST important in addressing her process?
A) It is fine that you refrigerate the mixture, but before you administer IVIG you must bring it to room temperature B) IVIG is not a feasible treatment for IgG subclass deficiency, and can cause severe anaphylactic reaction in these patients. C) The IVIG needs to be reprepared, as shaking the mixture may cause the immunoglobulin protein to degrade D) It is imperative that you monitor vital signs and infuse the IVIG slowly, monitoring the infusion site for any signs of infiltration |
C) The IVIG needs to be reprepared, as shaking the mixture may cause the immunoglobulin protein to degrade
A) Is correct, but it is not the MOST correct answer. B) is incorrect. IgA deficiency has no specific gammaglobulin treatment available, but IgG subclass deficiency patients can respond to administration of IVIG. D) are universal precautions with just about any IV infusion, but it is not specific to IVIG administration |
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An episode of prolonged bleeding, such as after circumcision, may be the first sign of ____:
A) Severe Combined Immune Deficiency B) Systemic Lupus Erythematosus C) Hypogammaglobulinemia D) Wiskott-Aldrich Syndrome |
D) Wiskott-Aldrich Syndrome (p. 956)
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True/False. Boys with Wiskott-Aldrich syndrome often have worsening eczema over time.
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True! (p. 956)
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___ is characterized by absent T-cell and B-cell function.
A) Severe Combined Immune Deficiency B) Systemic Lupus Erythematosus C) Hypogammaglobulinemia D) Wiskott-Aldrich Syndrome |
A) Severe Combined Immune Deficiency (SCID)
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You have arrived on the unit and are assigned a patient for the day. After report, which of the following should be addressed FIRST in a child with Severe Combined Immune Deficiency (SCID)?
A) The father and mother do not wash their hands upon entering their son’s room. B) Prophylactic antibiotics are 30 minutes past due, and your patient has yet to order breakfast. C) The night-shift nurse states that the patient developed severe diarrhea overnight and may require a fluid bolus if he does not drink enough fluids. D) The patient has white patches on his oral mucous membranes and is complaining of mouth pain. E) The patient has a maculopapular rash on his palms and the soles of his feet. |
E) A maculopapular rash is an indication that GRAFT-VERSUS-HOST disease is developing, which is a life-threatening condition followed by a bone marrow or stem cell transplant (a treatment in SCID). This needs to be addressed FIRST!
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What is the preferred test for HIV in infants older than 1 month of age?
A) PCR B) ELISA C) Western Blot D) CD4 Counts |
A) Polymerase chain reaction test is positive in infants older than 1 month of age. PCR is the preferred test to determine HIV infection in infants and to exclude HIV infection as early as possible. (p. 959)
Note: The ELISA test is positive in infants of HIV-infected mothers because of transplacentally received antibodies. These antibodies may persist and remain detectable up to 24 months of age, making the ELISA test less accurate at detective HIV infection in infants and toddlers than the PCR (p. 959). |
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Which of the following type of juvenile idiopathic arthritis involves four or fewer joints and is the most common type?
A) Pauciarticular B) Polyarticular C) Systemic |
A) Pauciarticular. Note: Nonjoint manifestations include eye inflammation, malaise, poor appetite, and poor weight gain (p. 964).
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For which of the types of juvenile idiopathic arthritis is there fever and rash in addition to joint involvement?
A) Pauciarticular B) Polyarticular C) Systemic |
C) Systemic (p. 964).
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C) Systemic (p. 964).
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6 months (p. 966)
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The bladder reaches adult capacity by how old? The renal system reaches functional maturity by how old?
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1 year; 2 years
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You are caring for a 5-month-old boy with an undescended left testis. Which of the following would you identify as indicative of TRUE cryptorchidism?
A) Testis cannot be "milked" down inguinal canal B) Testis can briefly be brought into scrotum C) Fluid detected in scrotal sac D) Venous varicosity detected along the spermatic cord |
A) Testis cannot be "milked" down inguinal canal
A retractile testis is one that may be brought into the scrotum, remains for a time, and then retracts back up the inguinal canal. This should not be confused with true cryptorchidism! (p. 789) C) Fluid in the scrotal sac is a hydrocele. D) A venous varicosity along the spermatic cord is a varicocele. |
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Which of the following are consistent with hydronephrosis (select all that apply)?
A) Proteinuria B) Hematuria C) Flank pain D) Foul smelling urine E) Abdominal mass |
B, E.
Proteinuria is associated with nephrotic syndrome. Flank pain and foul smelling urine are associated with obstructive uropathy or vesicoureteral reflux. |
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|
A hallmark finding of Duchenne muscular dystrophy is the presence of:
|
The Gower's sign-- the child cannot rise from the floor in standard fashion because of increasing weakness. (p. 813)
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Pseudohypertrophy of the calves is associated with what condition?
A) Myasthenia gravis B) Guillain-Barre C) Duchenne muscular dystrophy D) Cerebral palsy |
C) Duchenne muscular dystrophy (p. 811)
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|
True/False. In spinal muscular atrophy, the distal muscles are more affected than the proximal muscles.
|
FALSE. The proximal muscles, those closer to the body's center, are usually more affected than the distal muscles. (p. 815)
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A 7-year-old boy is suspected of having transient synovitis of the hip. Which of the following would the nurse expect to assess? (Select all that apply.)
A) Complaint of acute onset of moderate pain B) Pain worse in the morning on arising C) High fever D) Internally rotated affected extremity E) History of recent otitis media |
A, B, E.
Assessment findings associated with transient synovitis of the hip include a recent upper respiratory tract infection, pharyngitis, and otitis media. Pain onset is acute and sudden, with pain ranging from moderate to severe that is worse in the morning. Temperature will be normal or a low-grade fever may be present. The child holds the affected hip flexed and externally rotated. |
|
|
A self-limiting condition that involves avascular necrosis of the femoral head.
|
Legg-Calve-Perthes disease (p. 860)
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|
Which of the following is NOT associated with Trendelenburg gait?
A) Osteogenesis imperfecta B) Legg-Calve-Perthes disease C) Developmental Dysplasia of the Hip D) Slipped Capital Femoral Epiphysis |
A) Osteogenesis imperfecta is NOT associated with Trendelenburg gait.
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A child is diagnosed with severe combined immunodeficiency syndrome. Which of the following would the nurse expect to find when reviewing the child's history and physical examination?
A) Elevated IgE levels B) Chronic diarrhea C) Worsening eczema D) Weight greater than expected for height |
B) Assessment findings associated with severe combined immune deficiency include chronic diarrhea, failure to thrive, adventitious lung sounds, persistent oral thrush, and low levels of all immunoglobulins. Worsening eczema is associated with Wiskott-Aldrich syndrome.
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Which of the following statements indicates a need for further teaching by the parents of a child with bladder exstrophy?
A) Infection control is very important, so I will always use latex gloves and strict aseptic technique during catheterization B) I am not allowed to immerse my child in water until the condition has been surgically corrected C) I can prevent skin breakdown by using lots of barrier creams on the skin surrounding the area D) I can give my child oxybutynin suppositories to help with bladder spasms |
A) is FALSE. Children with congenital urologic malformations are at high risk for the development of latex allergy. Latex allergy can result in anaphylaxis. Primary prevention of latex allergy is warranted in all children with urologic malformations, so use latex-free gloves, tubes, and catheters in these children (p. 764)
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|
Hydronephrosis often occurs secondary to what other conditions?
|
Obstructive uropathy or vesicoureteral reflux (p. 767).
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|
True/False. Grade II-V Vesicoureteral Reflux require surgical intervention.
|
False. Grade III, IV, and V usually require surgery. Grade I and II VUR cases usually resolve spontaneously (p. 768)
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A mother arrives in the clinic with her 5-year old, stating that his urine has been “really dark, almost tea-colored” lately. Upon taking his history, you discover that the boy had a fever in the past few weeks and “he had a sore throat and was throwing up a lot.” What do you suspect?
A) Scarlet fever B) Acute nephritic syndrome C) Hemolytic-uremic syndrome D) Acute poststreptococcal glomerulonephritis |
D) APSGN is caused by an antibody-antigen reaction secondary to an infection with a nephritogenic strain of group A beta-hemolytic streptococcus (p. 775)
Hemolytic-uremic syndrome is also characterized by present illness and sometimes vomiting, but risk factors usually include ingestion of ground beef, visits to a water park or to a petting zoo, or use of antidiarrheal medications or antibiotics. |
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|
What is the most common cause of acute renal failure in children?
|
Hypovolemia!
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|
|
Muscular weakness in children with muscular dystrophy usually occurs around what age?
|
3 years (p. 811)
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|
|
True/False. Classic Duchenne muscular dystrophy occurs only in boys.
|
True (p. 811).
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|
Surgery for clubfoot occurs most commonly between age ___ and ___.
|
Between 3 and 12 months of age.
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|
Which of the following s/s is NOT associated with DDH?
A) Asymmetric gluteal folds B) Unequal leg length C) Trendelenburg gait D) Limited adduction |
D) Limited ABDUCTION is associated with DDH (p. 855)
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|
A child arrives in your clinic with no previous healthcare. The mother states he has a history of nosebleeds, sweating, thin skin, and frequent fractures. What do you suspect?
|
Osteogenesis imperfecta is characterized by frequent fractures, thin skin, hyperextensible ligaments, epistaxis, blue sclera, easy bruising, excess diaphoresis, and mild hyperpyrexia.
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|
Which of the following is NOT considered a bleeding disorder?
A) Sickle cell anemia B) Thalassemia C) von Willebrand disease D) Wiskott-Aldrich Syndrome E) Henoch-Schonlein Purpura |
D) Wiskott-Aldrich Syndrome is an X-linked genetic disorder that results in immunodeficiency, eczema, and thrombocytopenia (p. 956).
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|
Which of the following is NOT considered a tier-two precaution?
A) Handwashing B) Gloves C) Mask D) Eye protection |
A) Handwashing is considered a standard precaution, and therefore only tier-one.
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|
The nurse is assisting with lab testing to measure the type of protein produced in the liver that is present during episodes of acute inflammation. Which of the following tests is the nurse performing?
A) complete blood count B) erythrocyte sedimentation rate C) C-reactive protein D) blood culture and sensitivity |
c. C-reactive protein. C-reactive protein measures the type of protein produced in the liver that is present during episodes of acute inflammation.
Complete blood count evaluates white blood cell count. Erythrocyte sedimentation rate determines the presence of inflammation or infection. Blood culture and sensitivity detects the presence of bacteria or yeast and what antibiotics they are sensitive to. |
|
|
Cleft palate is more common in (boys/girls). Cleft lip is more common in (boys/girls).
|
Cleft palate is more common in girls. Cleft lip, boys.
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|
A neonate arrives in the ICU with a pending diagnosis of diaphragmatic hernia by a surgical resident. His orders state that the infant needs to have an OG tube placed immediately and connected to low intermittent suction. You insert the tube, but are unable to get any residual when you attempt to check placement. Upon ordering an X-ray, the technician states that the tube appears to be coiled in the upper esophagus. What do you suspect?
|
This typically occurs in esophageal atresia, which is a congenitally interrupted esophagus where the proximal end and distal ends do not connect.
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|
Your neonatal patient has increasing abdominal distension and, for the past several diapers, has produced ribbon-like stools. What do you suspect?
A) Intussusception B) Rectal atresia C) Crohn’s disease D) Hirschprung Disease |
B) Rectal atresia
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|
Which condition is characterized by painless rectal bleeding caused by ulceration of the mucosa?
A) Hirschprung Disease B) Inguinal hernia C) Meckel diverticulum D) Imperforate anus |
C) Meckel diverticulum
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|
Which of the following is not recommended in patients with constipation?
A) Rectal stimulation B) High fiber diet C) Stool softeners D) Bowel cleansing |
A) Persistent rectal stimulation is avoided because it may result in anal fissures and increase pain that may trigger stool withholding.
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REVIEW QUESTION! A child weighing 27 kg comes into the ER severely dehydrated. Calculate his maintenance fluid requirements.
|
10 * 100 = 1000
10 * 50 = 500 7 * 20 = 140 = 1640cc/24 hr |
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|
What is the first known genetic link in cancer?
|
Retinoblastoma gene (slide 10—Cancer)
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|
Which leukemia is the most common type?
|
Acute lymphoblastic leukemia (ALL) = 80%
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|
True/False. Bone marrow transplant is used in ALL in first remission.
|
FALSE. Bone marrow transplant is used in AML in first remission (due to low prognosis), and ALL in second remission.
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|
The majority of brain tumors are (supratentorial/infratentorial).
|
60% are infratentorial, occurring in the posterior third of the brain (primarily in the cerebellum or brainstem).
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|
Drooping eyelids and black eyes are commonly associated with what type of cancer?
|
Neuroblastoma. Note: This commonly occurs during infancy with the median age of diagnosis of 19 months.
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|
(Osteosarcoma/Ewing’s sarcoma) typically arises from the marrow spaces of the bone and commonly involves metastasis.
|
Ewing’s sarcoma arises from the marrow spaces of the bone and commonly involves metastasis. Osteosarcoma arises from the osseous tissue in the bone.
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