WorksheetsPCT E2
Total questions: 25
Worksheet time: 1hrs 15mins
Which of the following is an incorrect reason for increased pediatric ADE/ADRs?
Greater Vd
Poor metabolism
Increased elimination
Altered protein binding
Where do the majority of pediatric medication errors occur?
Dispensing
Preparation
Administration
Prescribing
Which of the following increase the chances that a pediatric patient will have an off-label medication?
>28 days old
Greater severity of illness
Undergoing a surgical procedure
All-cause inpatient mortality
Which of the following is not a contraindication to a pediatric patient receiving a live vaccine:
Receiving 30 mg predisone qd for 3 weeks
Primary immunodeficiency
Receiving infliximab for a GI condition
recent stem cell transplant
Select all of the following that are live vaccines:
MMR
Varicella
injected influenza
inhaled influenza
oral rotavirus
What is true of the MMR+V vaccine(s) for pediatric patients?
It is a toxoid and therefore contraindicated in asplenic patients
It has a higher rate of febrile seizures so it should be given separate for at least the first dose
Due to being an encapsulated bacteria, it isn't advised in asplenic patients
The fever should be pre-treated with acetaminophen 1000 mg 30-60 minutes before the vaccine
You're in the delivery room and the nurse evaluating the baby reports an APGAR of 7. Is this a good score?
Yes although 9 is goal
Yes, the baby was napping during delivery and needs some time to wake up. Consider IV caffeine citrate
No, the baby is not alert enough. Treat with po caffeine
No, goal is 1-3
A Caucasian male baby is being delivered by C-section at 36 weeks gestation. The mother has previous history of hyaline membrane disease with another child. What treatment is necessary to avoid neonatal RDS?
Steroids IM 2-4 doses + Vitamin A and surfactant
IV Caffeine citrate + vitamin K and folate
intrathecal penicillin benzathine
Infrasurf + Curasurf
(True/False) Newborns with hyaline membrane disease will go through a honeymoon period where they will clinically improve before declining again.
True
False
ER is a 3 day old, 26 week gestation, 750 gram Caucasian male in the NICU. They are expressing periods of apnea lasting 20 seconds. Sepsis, obstruction, hyaline membrane disease/neonatal RDS, and neurologic abnormalities are ruled out. They are on fluids maintaining hydration. What do you start them on?
Caffeine citrate 20 mg/kg IV loading dose plus 5 mg/kg q24h started 24h after LD. Monitor heart and resp rate, blood gas, and apneic spells
Theophylline 3 mg IV qd. Maintain levels 5-15 mcg/ml. Monitor resp and heart rate.
Nothing, apnea is common for neonates
Ceftriaxone 1g + ampicillin 4g given over 24 hours
What is the purpose of CFTR?
Reducing the salt content of sweat for palatability
Regulating Cl and bicarb transport in airway epithelium and ductal epithelium
Preventing the secretion of Cl, causing the overproduction of mucus
Deleting phenylalanine 508 in mutated tumor cells
What is true of cystic fibrosis damage to the pancreas?
Poor regulation of Cl and bicarb causes precipitation of enzymes that damage pancreatic cells
Cystic fibrosis induces the production of autoantibodies that attack the pancreas
Cystic fibrosis causes higher nutrient requirements that predisposes patients to type 1 diabetes
Pancreatic damage is a possibility but not a concern for cystic fibrosis patients
What is typically the first symptom of cystic fibrosis?
Sweat present on newborns tastes excessively salty
Urine has a sweet taste, hinting at poor kidney function
Meconium ileus, the blockage of the neonate's first stool
The absence of type 2 pneumocytes that would produce surfactant
Select all of the following that are diagnostic tools for cystic fibrosis:
Elevated IRT in the blood
CFTR mutations
Sweat test
Hyperplasia of the vas deferens
Which of the following would support the prediction of a patent ductus arteriosus?
High IL-6 and high PaO2
Low PGE2 and high PaO2
High PGE2 and low PaO2
Low PGE2 and low PaO2
Select all of the following that would be more characteristic of complex febrile seizures:
>15 minutes or more than one occurrence within 24 hours
Generalized electrical activity in one side of the brain
Focal, limited electrical hyperactivity
Can start as a stare or localized jerking
What is a false statement regarding the use of mucolytics for CF treatment?
Many agents require the use of a bronchodilator
Includes Mucomyst, Pulmozyme, Hypersal, etc.
Many have a high risk of bronchoconstriction
Variety of MOAs include cleaving sulfide bonds and destroying products of neutrophil degradation
What is the purpose of adding amikacin liposome as an inhaled antibiotic to a CF regimen?
None, amikacin is contraindicated in cystic fibrosis
Targeting Mycobacteroides avium complex, supported by CONVERT
Bronchodilation by increasing cAMP
Targeting Mycobacterium tuberculosis
Which of the following are true statements regarding microbiology in cystic fibrosis?
Staph aureus infection is common, but prophylaxis will increase Pseudomonas infection
Pseudomonas aeruginosa is used as a predictor of mortality and morbidity
Burkholderia cepacia is linked to unpredictable rapid declines in lung function
Achromobacter are a microbe of major concern, being pan-resistant and causing accelerated lung function decline
Most infections will require combination therapy
You're part of a team initiating the CFTR modulator Orkambi (lumacaftor/ivacaftor) in an 18 year old with the homozygous F508del mutation. Which of the following wouldn't be a consideration for this patient?
Chest tightness as a side effect may lead to Orkambi discontinuation
Their other medications will have to be monitored and adjusted for CYP 3A4 interactions
The drug should be taken with a low fat meal and baby aspirin to prevent flushing
The drug will likely improve lung function, quality of life, and weight gain while decreasing Pseudomonas risk and pulmonary exacerbations
ML is an 8 yr African American male presenting for a vaso-occlusive pain crisis precipitated by fluctuating weather and dehydration. He has significant swelling in his arms and hands and 9/10 pain. The patient is writhing, distressed, and struggles to stay still. How do you treat ML?
IV Fluids and tenecteplase to dissolve the clot
ibuprofen and acetaminophen/hydrocodone
ketorolac and acetaminophen/codeine
IV ketorolac + morphine bolus and PCA
What were the findings of the PROPS I/II trials in regards to antibiotic prophylaxis in sickle cell patients?
Start on oral penicillin by 4 months and stop at 5 years
Start on daily IV amoxicillin by 4 months and stop at 5 years
Antibiotic prophylaxis is not warranted in sickle cell patients due to full immunocompetency
Start on nebulized amikacin liposomal daily for Pseudomonas coverage
A sickle cell patient is admitted for acute chest syndrome, the leading cause of mortality for sickle cell patients. CXR finds partial left atelectasis and pulmonary infiltrates. Which of the following wouldn't be a necessary intervention?
Incentive spirometry, albuterol +- PEP
RBC transfusion
Broad spectrum antibiotics without confirmatory cultures - vancomycin, azithromycin, ceftriaxone, etc.
IV fluid boluses regardless of hydration status
PA is a 4 month old baby being seen for vaccines today. She was given DTaP at 2 months of age as planned, but was given another dose at 3 months of age when it should have been withheld until 4 months. The parent wants to know if they should still get a DTaP today or if the dose at 3 months is acceptable.
Yes, reducing the interval between vaccines still provides full immunity
No, reducing the interval between vaccine doses should be considered as incomplete and should be repeated
No, reducing the interval between vaccine doses increases inflammatory response and predisposes PA to a febrile seizure
No, children shouldn't get DTaP
AC is a premature neonate (28 wks gestation) born to an HBsAg negative mother. He has since done well but is only at 1800 grams. Should they receive the hepatitis B vaccine?
No, the HBV vaccine shouldn't be given to premies <2000 grams
No, the vaccine shouldn't be given until 1 year of age
Yes, either at one month old or at discharge
Yes but only when they reach 2500 grams and 1 month old
