4

Question 1

Kawasaki labs

Answer 1

CBC: high WBC, normo anemia, elevated platelets 2 week+

blood cx, elevated liver enzymes, low albumin, elevated ESR, sterile pyuria on UA (cath may not show WBCs)

Question 2

requirements for dx of Kawasaki

Answer 2

high fever for at least 5 days PLUS 4/5 of the following:
Changes in oral mucosa
Extremity changes (redness/swelling)
Unilateral cervical lymphadenopathy
Rash
Conjunctivitis
PLUS no other apparent cause for presentation

Question 3

developmental milestones

Answer 3

http://www.med-u.org/the-library/developmental-milestones

Question 4

Juvenile idiopathic arthritis (JIA) criteria

Answer 4

must be less than 16 years of age and have arthritis in at least one joint for more than six weeks. criteria for one category).

Question 5

JIA subtypes

Answer 5

Systemic (includes constitutional symptoms such as fever and rash);
Oligoarthritis (previously called pauciarticular, this type of oligoarthritis typically affects the knee; onset of the arthritis is acute, and it is associated with an asymptomatic iridocyclitis);
Polyarthritis (rheumatoid factor positive and rheumatoid factor negative);
Psoriatic arthritis;
Enthesitis-related arthritis; and
“Other arthritis” (has overlapping features with multiple categories or does not meet full criteria for one category).

Question 6

septic arthritis orgs in kids

Answer 6

Staphylococcus aureus
Streptococcus (neonate: group B; infant and older child: Group A and Streptococcus pneumoniae)
Haemophilus influenzae type b (in unimmunized children)
Neisseria gonorrhea (adolescents)
Kingella kingae (in children less than 4 years)

Question 7

Pediatric ibuprofen dosing

Answer 7

Pediatric dose: 10 mg/kg every 6-8 hrs PO (maximum dose = 40mg/kg/24 hr PO)
Concentration of oral suspension: 100 mg/5 mL (20 mg/1 mL)

Question 8

Most practice guidelines for fever evaluation would recommend routinely sending a urinalysis and culture in what age group of kids/gender?

Answer 8

Males less than 6 months old (less than 12 months old if uncircumcised)
Females less than 12 months old.

Question 9

Bacterial meningitis in immunized children 2 months to 12 years of age is usually due to ?
In younger infants, ? need to be considered

Answer 9

S. pneumoniae or N. meningitidis, but the incidence of invasive pneumococcal disease is diminishing with routine vaccination.

gram negatives such as E. coli and organisms like GBS (Strep agalactiae)

Question 10

Meningitis may present with classic signs including ?

Alternatively, non-specific findings may predominate, including:

Answer 10

increasing lethargy and irritability as well as signs of meningeal irritation (often referred to as nuchal rigidity or meningismus).

Fever (in 90-95% of cases, Anorexia and poor feeding, symptoms of a URI, Myalgias, Tachycardia

Question 11

meningitis antibiotics

Answer 11

third-generation cephalosporin and vancomycin, and then tailoring antibiotics based on sensitivities, for a total of 7-14 days.

Question 12

Complications of bacterial meningitis include:

While it is unusual for treated meningitis to be fatal, morbidity such as ? are known complications.

Answer 12

Stroke
Subdural effusions
Syndrome of inappropriate anti-diuretic hormone (SIADH) secretion.

developmental delays, seizures, and hearing loss

Question 13

3 Ps of McCune-Albright syndrome

Answer 13

Precocious puberty
Pigmentation (cafe au lait spots)
Polyostotic fibrous dysplasia

Question 14

craniopharyngiomas

Answer 14

calcified intracranial tumors in the supersellar region

may present with bitemporal hemianopsia and pit hormone deficiencies: diabetes insipid us, GH deficiency

Question 15

Howell-Jolly bodies suggest..

Answer 15

functional asplenia in a SCD pt as they are nuclear remnants of RBCs typically removed by a functional spleen

Question 16

SIDS happens in what ages?

peaks when?

Answer 16

1 mo to 1 yr

peaks 2-4 mos

Question 17

1 wk hx of leg pain +low grade fever +hepatosplenomegaly +petechia on face/chest think?
next step?

Answer 17

ALL

CBC with platelets and differential

Question 18

Most of the s/s of ALL result from either

Answer 18

replacement of normal bone marrow components with clonal proliferation of a single lymphoblast that has undergone malignant transformation, or from infiltrates of extramedullary sites by these malignant lymphoid cells.

Question 19

ALL has a peak incidence at age ? and occurs more frequently in what gender

Answer 19

2 to 4 years

boys, children with certain chromosomal abnormalities, such as Down syndrome and Fanconi anemia

Question 20

nickname of ALL

Answer 20

the “great imitator” because of its nonspecific symptoms, including anorexia, irritability, lethargy, pallor, bleeding, petechiae, leg and joint pain, lymphadenopathy, and fever.

Question 21

ddx ALL

Answer 21

idiopathic thrombocytopenic purpura (ITP), aplastic anemia, mononucleosis, juvenile idiopathic arthritis, and leukemoid reaction

Question 22

use ? to dx ALL from other diagnoses

Answer 22

bone marrow biopsy: a minimum of 25% blasts confirms the diagnosis (normal marrow contains less than 5% blasts)

Question 23

ALL translocations with poor outcomes

Answer 23

t(4;11)

t(9;22) : Philadelphia chromosome in pts with pre-B ALL

Question 24

why does ALL workup include an LP? CXR?

Answer 24

to examine the CNS for early leukemic involvement; a higher number of blasts in the CSF are associated with a worse prognosis.
CXR is performed to detect a mediastinal mass.

Question 25

ALL induction therapy

Answer 25

prednisone, vincristine, and asparaginase, produces remission within 4 weeks in approximately 98% of children with non–high-risk ALL

Question 26

Intrathecal therapy (± craniospinal irradiation) has decreased the incidence of ? as a primary site of relapse from 50% to approximately 3% to 6%

Answer 26

CNS leukemia

Question 27

ALL Maintenance therapy

Answer 27

methotrexate and 6-mercaptopurine, vincristine, and prednisone is given for 2 to 3 years to prevent relapse; therapy is discontinued for children who remain in complete remission for 2 to 3 years

Question 28

how is ALL survival rate changing?

Answer 28

The 5-year survival rate for childhood ALL has steadily improved over the last 40 years and now is greater than 80%

Question 29

late effects of ALL

Answer 29

neuropsychological deficits, seizures, and endocrine disturbances (ie, growth hormone deficiency) related to CNS prophylaxis; spermatogenesis dysfunction related to cyclophosphamide; delayed sexual maturation in boys who received irradiation of gonadal tissue due to leukemic invasion of the testes; leukoencephalopathy and neurodevelopmental problems (especially in post–CNS radiation patients); and secondary malignancies.

Question 30

ALL vs JIA on CBC

Answer 30

The leukocyte and platelet counts are normal to increased in JIA,

Question 31

causes of splenomegaly

Answer 31

infection (EBV, CMV, bac sepsis, endocarditis), hemolysis (SCD), malignancy (leukemia, lymphoma), storage disease (Gaucher), systemic inflammatory disease (SLE, JIA), congestion (portal HTN)

Question 32

HSP

Answer 32

(also known as anaphylactoid purpura) is a self-limited, IgA-mediated, small vessel vasculitis that typically involves the skin, GI tract, joints, and kidneys.
most commonly diagnosed form of vasculitis in children (about 50% of cases)
use of steroids in treatment is controversial

Question 33

idiopathic thrombocytopenic purpura (ITP) is caused by ?

Answer 33

the binding of an antiplatelet antibody to the platelet surface, leading to removal and destruction of platelets in the spleen and liver. It is the most common cause of isolated thrombocytopenia in otherwise healthy children.

Question 34

ITP treatment

Answer 34

oral corticosteroids, IVIG, RhoGAM

typically until platelet count rises above 20K

Question 35

the most common form of bowel obstruction in children between 6 months and 6 years of age

Answer 35

intussusception

Question 36

diagnosis and treatment of idiopathic intussusception

Answer 36

air or barium enema, requires surgery if unsuccessful

Question 37

Intussusception occurring in HSP is usually ?

diagnosis and treatment?

Answer 37

ileo-ileal, not ileo-colic, and will not be reduced by air or barium enema. Diagnosis requires abdominal ultrasound, and treatment is generally surgical.

Question 38

HSP recurrence

Answer 38

30% recurrence rate

after initial case, follow with UAs, BP and rash evaluation for several months

Question 39

HSP vs ITP

Answer 39

HSP has a normal platelet count, ITP presents with thrombocytopenia

Question 40

VSD murmurs are typically heard later, around ?

why?

Answer 40

2-6 mos

pulmonary vascular pressures reach normal levels by that time (HTN before)

Question 41

widened pulse pressure

conditions that may cause this?

Answer 41

An increase in the difference between systolic and diastolic pressures, resulting in a bounding arterial pulse
fever, hyperthyroidism, anemia, arteriovenous fistulas, and PDA.

Question 42

congenital cardiac defect workup

Answer 42

1. presence of cyanosis via pulse ox and physical exam
2. increased/normal/decreased vascular markings on CXR
3. EKG to determine LVH/RVH or both

Question 43

large VSDs may be accompanied by ?

Answer 43

dyspnea, feeding difficulties, growth failure, and profuse perspiration, and they may lead to recurrent infections and cardiac failure

Question 44

CXR and EKG findings in large VSD

Answer 44

CXR: cardiomegaly with an enlarged left atrium (LA) and ventricle (LV) and increased pulmonary vascular markings. EKG shows biventricular hypertrophy
small VSDs typically normal

Question 45

medical management of VSD

Answer 45

diuretics (eg, furosemide and afterload reduction agents [eg, an ACE-inhibitor]
-adequate caloric intake and may require feeding by nasogastric or gastrostomy tubes

Question 46

Children with ASDs usually have no symptoms but large defects may cause ?

Answer 46

mild growth failure, frequent upper respiratory tract infections, and exercise intolerance

Question 47

the murmur of ASD is from what? heard when/where?
also hear ?
may hear another murmur?

Answer 47

high-volume blood flow from the right ventricle into the normal pulmonary artery; the murmur is not blood flowing across the ASD itself (systolic murmur at the left upper and midsternal borders)

• fixed split S2
• A lower left sternal border diastolic murmur produced by increased flow across the tricuspid valve may be present

Question 48

ASD CXR and EKG findings

Answer 48

CXR: enlarged right atrium, right ventricle, and pulmonary artery and increased pulmonary vascularity
ECG shows RVH and sometimes right-axis deviation

Question 49

ASD complications

Answer 49

well tolerated during childhood but can lead to pulmonary HTN in adulthood or atrial arrhythmias from atrial enlargement

Question 50

Ductus closure in term infants usually occurs within ?

Answer 50

10 to 15 hours of birth and almost always by 2 days of age

Question 51

Closure of the ductus arterioles is delayed in ? infants, perhaps because of ?
Failure of the ductus to close allows shunting of blood from the systemic circulation to the pulmonary circulation, with resultant ?

Answer 51

premature, impaired vasoconstrictor response to increased oxygen tension
myocardial stress, pulmonary vascular congestion, and respiratory difficulty

Question 52

A small PDA usually results in no symptoms but is still closed medically (usually with indomethacin) or surgically (if medical therapy fails or is contraindicated) due to risk of ?

Answer 52

infective endarteritis and paradoxical emboli

Question 53

Closure of a large PDA is done to prevent ?

Answer 53

heart failure and Eisenmenger syndrome

Question 54

treatment of ductus dependent coarctation of the aorta

Answer 54

infusion of prostaglandin E would be required to maintain the patent ductus until definitive repair could be done

Question 55

test that can usually identify the site of the coarctation?

otherwise, what further interventions may be necessary?

Answer 55

ECHO with color doppler

CT, MRI, cardiac catheterization