4.Pediatric Flashcards
1
Q
Nephrotic vs Nephritic syndromes ??
A
2
Q
Catch up schedule for varicella vaccine:
A
● Less than 7 year old; 2 doses with 3 months apart
●More than 7 year old; 2 doses with 1 month apart **MCQ
3
Q
Case of child with meningitis, what you will give for close contact ( his brother & sister ) as prophylaxis?
A
Ciprofloxacin one dose
Note :
- Rifampicin - 4 doses orally
Or
- Ciprofloxacin- Single oral dose
Or
- Ceftriaxone - Single IM dose
UpToDate
4
Q
Types of vaccines…
A
Killed»_space;
(I Killed A Dragon By my High Power)
I = IPV
A = hepatitis A
D = DTaP
B = hepatitis B
H = Hib
P = PCV
LIVE ATTENUATED (I live in a Very Big ROOM)
V= Varicella
B= BCG
R= Rota
O= OPV
M= MUMPS,MEASLES, RUBELLA (MMR)
Note; yellow fever & influenza are live attenuated vaccines
5
Q
How to give hepatitis B vaccine ?
A
Intramuscular
Note :
Route of Administration:
• Live vaccines: Subcutanous
• Killed vaccines: Intramusular
• BCG: Intradermal
• Oral: polio, rota
By Dr.Safedr
6
Q
Vaccine for 9 months old
• A-DTaP , HiB , Oral polio
• B-Meniniogococcus , measles
• C-MMR , Meningiococcus
• D-Pneucoccal , Hepatits B
A
Answer is : C
See below when to give vaccines
7
Q
Mother is hepatitis B positive • Baby weight is 1.6 kg
• A-Give Hep B vaccine
• B-Wait till weight reached 2 kg and then give vaccine
• c-Check the hepatitis B status for the baby
• D-Give both Hep vaccine and hepatitis B
immunoglobulin
A
Answer is D
If mother HB –ve; Wait until; Baby be 1 month Or Baby reach 2 kg or at time of discharge
●If mother HB +ve; Give HBV vaccine and HBV Ig (Regardless of the weight)
8
Q
optimal time to give PCV vaccines after
Spleenoectomy..
A
• A- 2 weeks
Note ; vaccination against encapsulated bacterial
like pneumococcal or meningococcal should be given
2 weeks at least before splenectomy or 2 weeks after splenectomy
By Dr.Safder
9
Q
Which vaccines are absolute contraindicated in pt with HIV ?
A
OPV and BCG
And lived attenuated vaccines are contraindicated in immunocompromised patients
10
Q
Duration of Dtap vaccine is
A
10 years
11
Q
Absolute contraindications for DTP vaccine ..
A
Progressive encephalopathy within 7 days from
previous DTP vaccines
12
Q
Specific Contraindications for vaccines
A
●Contraindicated in Intussusception; Rota
●Contraindicated in egg allergy; yellow fever
●Contraindicated in gelatin and neomycin allergy; varicella and MMR ●Contraindicated in lactating mother; small pox and yellow fever
●DTP Contraindications: 3 D’s; Developmental delay, Dysmorphic features, Neurological system Disorder (encephalopathy within 7 days or uncontrolled seizure)
Immunodeficiency:
□SCID (bacteria, viral and fungal infections), All vaccine are contraindicated
□ X linked aggamaglublmemua; only live vaccines are contraindicated
□Chronic granulomatosis disease; only live bacterial vaccine is contraindicated (BCG, Typhoid, plague)
□IgA deficiency; most common, Protozoal infections and chronic diarrhea from giardiasis; can receive all types of vaccine
□Complement deficiency; can receive all types of vaccine
13
Q
Regarding contraindicated vaccine in HIV patient:
A
●if CD4 more than 200; Only OPV, BCG vaccines are contraindicated
●if CD4 less than 200 (AIDS); All live attenuated vaccines are contraindicated
14
Q
Varicella vaccine is given
A
2 doses within 3 months apart
Remember:
Live vaccine: If not given at the same time → You should wait 4 weeks to give another live vaccine
— Minimal interval between same vaccine is 4 weeks Except;
●Hepatitis A: 6 months
●Meningiococcus: 8 weeks
●Varicella vaccine: 3 months
15
Q
In Sickle cell diseae, splenectomy, nephrotic syndrome, you give
A
Pneumococcal vaccine,
Menegiococcal vaccine, HiB
16
Q
Catch up schedule for varicella vaccine:
A
In children less that 13years: 2 doses with 3 months
apart •
In children above13 years: 2 doses with 4 weeks
apart
By Dr.Safder
17
Q
Contraindications for yellow fever vaccine
A
Allergy to • Egg • Chicken protein • Gelatin
18
Q
contraindication for
varicella vaccines
A
Allergy to neomycin or gelatin are contraindications to
MMR and varicella
19
Q
One month boy came for vaccine. His older
sister (6 years old) had renal transplant and now
is on immunosuppressive medication. Which
vaccine is contraindicated for the boy?
A
OPV ( oral polio )
●OPV should not be given if there is a family member with immunocompromised conditions (can be disseminated by fecal-oral route to other individual)
20
Q
any immunosuppressed patients with a contact
with chicken pox should
A
receive varicella zoster
immunoglobulin
21
Q
Patient is known nephrotic and he finished steroid
just now and wants MMR vaccine
A
Ask her to come back after 4 weeks
Remember:
Live vaccine after stopping;
●Steroid, MMF, cyclosporine; 4 weeks
●Chemotherapy, cyclophosphamide; 3 months
●Bood transfusion; 6 months
●IVIG; 11 months
22
Q
Live Vaccine should be delayed (especially MMR or
varicella)
A
3-11 month after IVIG
• 6 months after PRBC
• 7 months after FFP or platelets
• Immediately after packer RBC blood products
Note : Recent blood transfusion is not a reason to delay
killed vaccine like hepatitis A.
23
Q
Patient with chronic respiratory disorder should
receive
A
Influenza • Pneumococcal
24
Q
Catch up vaccine for 6 years old that didn’t receive any vaccination ..
A
DTP , varicella , MMR , pneumococcal, IPV , hepatitis B , HIB
EXCEPT ROTA !!
Catch up vaccines • For all children below 7 years • Need catch up all vaccine except rota vaccine if he is
above 8 months • Need to catch up for all bacterial vaccine
For children above 7 years will need catch up for all
viral vaccine except Rota • No need for bacterial vaccines except DT • Nesseria and pneumococcal only in high-risk patients
(SCA and nephrotic syndrome)
By Dr,Safder
25
• A mother is unvaccinated, and she is concerned
about tetanus neonatorum
Give mother DtAp at 28 weeks of geastion
By Dr,Safder ;
CDC recommends that pregnant women should
receive a single dose of DTaP between 27 to 36
weeks • It can 2 weeks for babies to develop antibodies if
mother vaccinated during pregnancy
26
The best way to decrease asthma exacerbation is
Receive influenzas virus vaccines
27
When to give live vaccines in pt on chemotherapy ?
given wither 2 weeks
before starting chemotherapy or after 3 months from
stopping chemotherapy
28
Indications of influenza vaccine ?
• Pregnant woman
• Immunodeficiency
• Children on aspirin
• Children below 5 years
• Resident of healthcare facilities
29
Regarding live vaccine in pregnant taking anti-TNF;
- In 2nd trimester; delay 6 months
●In 3rd trimester; delay 12 months
30
Most common cause of infective endocarditis in children in general is …
Answer is ; staph aureus >> normal heart
Streptococcus virdans >> patients with underlying congenital heart disease or valve disease
Staph epidermis>> patient with prosthetic heart valve , 12 months post insertion, Staph aureus more than 12 months post insertion.
By Dr,Safder
31
Best empirical regimen for child with infective endocarditis & prosthetic valve is ..
Vancomycin to cover MRSA
Or
gentamycin and rifampicin or cefipime .
32
Child with infective endocarditis in native valve what is empirical antibiotic..
vancomycin
33
Most important investigation in case of child with infective endocarditis is
Blood culture
Diagnosed by blood culture (should be repeated 3 times and best timing for culture during fever)
34
Diagnosis is of infective endocarditis is ..
By Modified Duke Clinical criteria
• 2 major
• Or
• 1 major and 3 minor
• Or
• 5 minor
35
Endocarditis prophylaxis in :
• before dental procedure
المزرق Unrepaired Cyanotic congenital heart disease e,g. TOF •
صاحب التاریخ المسبق Previous history of infective endocarditits •
المصطنع With prosthesis except for peacmaker •
• After heart surgery if there is:
• 1- prosthesis (except pace maker)
• 2- residual VSD or ASD
• 3-Shunt
المرتجع( Cardiac transplant surgery with valve regurgitation •
• Respiratory procedures
• Procedures in infected skin , soft tissues or musculoskeletal system
• GIT or genitourinary procedures if there onging infection olny
36
How to prevent IE ?
Amoxicillin or Ampicillin
procedure my cause bacteremia:
-dental or tonsillectomy (mouth) -surgery involving respiratory system. -SKIN procedures
-I&D of infected tissue.
37
What are indications of cardiac surgery in case of ( infective endocarditis) IE ?
In patients with
• Fungal endocarditrs
• Severe valve regurgitation
• Dehiscence of prosthesis valve
• Myocardial abscess
• Mycotic anuresym
By Dr.Safder
See below by Rayan
38
Best initial investigation for detection of infective endocarditis..
TTE ( Trans- thoracic echo ) >> to detect vegetation,valve damage , abscess formation
39
Janeway lesions vs Osler nodes in IE ..
40
Most sensitive test for infective endocarditis?
TEE ( trans esophageal Echo ) >> done when TTE is negative with high suspension of IE , can detect small vegetation <2mm !
41
What is the diagnostic criteria for Kawasaki disease ?
-Fever >5 days
- four of the following:
1)Bilateral conjunctival injection
2)Mouth involvement (erythematous mouth and pharynx, strawberry
tongue, red/cracked lips)
3)Cervical lymphadenopathy
4)Changes in extremities (edema, erythema)
5)Rash
6)Exclusion of other diseases with similar findings
42
The best indicator for POOR response to IVIG in Kawasaki disease is
High CRP
43
Best test to asses coronary artery in Kawasaki disease is
Echo >> look for coronary artery aneurysm!! As common complication!
44
Pathophysiology of Kawasaki disease is
Vasculitis of unknown etiology
45
Treatment of Kawasaki disease is
1. High dose of IVIG
2. **Aspirin **started with high ant inflammatory dose
dose (6-80 mg per kg per day) then decrease to
antiplatelet dose for 6-8 weeks.
46
Patient came with pharyngitis, rash begins in the groin,
axillae, neck, antecubital fossa; Pastia’s lines + may be
accentuated in flexural areas 24 h, sandpaper rash
becomes generalized with perioral sparing, non-pruritic,
non- painful, blanchable treatment is
penicillin for 10 days
If allergic to penicillin, then consider macrolide or
sulpha drugs.
Dx is Scarlet fever
47
What do you suspect to find in Lab in Scarlet Fever ?
High Antistreptolysin O ( ASO ) titer
48
Complications of scarlet fever ?
Rheumatic fever
Post streptococcal GN
pyogenic complications : Adenitis , otitis , sinusitis and abscess
49
Etiology of scarlet fever ..
Group A streptococcus
50
A child came with fever , sore throat. On
examination there is hyperaemia. You start him on
antibiotic but after 2 days rapid test came and was
negative. You should
• A-Continue antibiotic for total 10 days
• B-Stop antibiotic
Stop antibiotic
no need to give antibiotic for patients with
pharyngitis unless There is positive confirmation of bacterial infection by
rapid test or culture .
51
A child came with pharyngitis and confirmed to have
group A streptococcus and you start him on
antibiotic. What you should do for household
contacts
Nothing
No need to treat or to test the contact of patients
with pharyngitis group A streptococcus unless they
have clinical symptoms like fever , sore throat. ( first line prophylaxis is *cephalexin * first generation cephalosporins)
52
Q1.Most common age for intussispcion is
Q2.Most common site ?
Q1.3m -3 years
Q2 : ileocolic *uptodate
53
3 years old with crying , red currant jelly stool ,
vomiting,
1. Dx ?
2. What you will fined in physical examination ?
3. Complications?
4.fist step in Mx ?
5.best INTIAL test to dx ? What you find ?
6.best Conformity test ( diagnostic & theraputic) ?
1. Intussusception
2.palpable mass in RLQ( sausage shaped )
3.bowel ischemia >>perforation
4.Nasogastric decompression & fluid resuscitation
5.intial test > abdominal US > shows target sign ( doughnut sign ) , psudokidney sign
6.Baruim or air enema ( shows a claw sign ) 🦅
54
Management of intussusception in stable vs unstable pt ?
1.Stable >> simple intussisciotion ( no features of perforation or strangulation ) non surgical reduction by :
- Pneumatic reduction > inflate co2
- Baruim or air enema> reduction ( TT OF CHOICE )
2. Unstable or complicated intussisciption >> strangulated or perforated as tachycardia, severe abdominal pain , fever , high WBC ,guarding >> surgical reduction ( open laparotomy )
55
• 5 year came with vomiting and abdominal pain • On examination tenderness in right iliac fossa • CBC :High WBC
1. Dx ?
2. How to dx ?
3 Best initial test for dx ?
4. Best diagnostic test ?
5. Epidemiology?
6. Complications?
7. What is the clinical scoring system used in child with appendicitis?
8. Management?
1. Dx ? Acute appendicitis
2. How to dx ? Clinically
3 Best initial test for dx in children ? US >> increase diameter of appendix + thickness of wall + peri appindecal fluid + Fecolith
4. Best diagnostic test ? Ct scan to exclude complications &Dx
5. Epidemiology? Peak incidence10-19 y * AMBOSS , note : Uncommon in children below 3 years !
6. Complications?
- Appendicular mass
- appendicular abscess
- perforation
- peritonitis
What is the clinical scoring system used in child with appendicitis?
PAS ( pediatric appendicitis score ) >>
>= 7 points >> high risk for appendicitis
<=3 points > low risk
Note : The Alvarado score does not have adequate accuracy for the diagnosis of appendicitis in children.!! Remember Alvarado is ADULT ! 🧔🏽* UpToDate
8. Management? Appendectomy
56
• A 5 weeks old and came with non-bilious vomiting.
On examinations there is a mass at epigastric area
1. Dx ?
2. Clinical features ?
3. What is the gold Standard for diagnosis this condition?
4. What is the most common electrolyte abnormalities associated with this condition?
5. Management?
1. Dx ? Congenital pyloric stenosis
2. Clinical features ?
- Non-bilious postprandial emesis at 2–12 weeks of life, then
becoming progressively projectile
- Palpable pylorus in RUQ or epigastric region (“olive”); and visible or palpable gastric peristalsis (feeding test→ All of this after the mom feeds baby)
3. What is the gold Standard for diagnosis this condition?
Abdominal US: shows hypertrophic pylorus
4. What is the most common electrolyte abnormalities associated with this condition?
Hypochloremic Hypokalemic
metabolic alkalosis with paradoxical Aciduria
5. Management?
1-IVF: NS is the best (stomach loss contain high Na+ content)
2-Laparoscopic or open pyloromyotomy → opening in pylorus muscle without cutting mucosa to relive pressure (Ramstedt procedure)
57
A child came with history of vomiting and diarrhoea. He
had history of eating from a restaurant 8 hours ago • Most likely cause
• A-Salmonella
• B-Staphy aureus
• C-Shegella
• D-Cambylobacter
Staphylococcus aureus ( incubation period 1-8h )
58
9 months old baby boy came to your clinic • You noticed that his weight is not increasing from the age
of 6 months
1.what is the diagnosis ?
2. Best INITIAL test for dx ?
3.best DIAGNOSTIC test ? What is the findings?
4.which is consider DIAGNOSTIC in this condition ?
5. classic presentation of this condition ?
6. Associated with which of other medical conditions?
7. Which foods should be avoided in this condition?
8.what is the skin lesion most commonly associated with this condition? Treatment ?
9.which is will decrease by gluten free diet ?
10. Management?
1.what is the diagnosis ?
Celiac disease (gluten-sensitive enteropathy
2. Best INITIAL test for dx ? Tissue transglutaminase antibody
3.best DIAGNOSTIC test ? What is the findings? Duodenal biopsy (subtotal vilious atrophy)
4.which is consider DIAGNOSTIC in this condition ? Gluten free diet
5. Classical presentation; Most show symptoms between 9 and 24 months ,
chronic diarrhea, failure to thrive, abdominal distention, and muscle wasting and loss of SC fatt .
6. Associated with which of other medical conditions? Common in Down ,, Tuner , DM type 1 , hashimoto
thyroiditis , IgA deficiency
7. Which foods should be avoided in this condition?
- Wheat القمح
- Rye الشليم
- Barley الشعير
- Oats الشوفان
8.what is the skin lesion most commonly associated with this condition? Treatment ? Dermatitis herpetiformis ، Dapsone
9.which is will decrease by gluten free diet ? Intestinal lymphoma
10. Management? Therapy : Gluten-free diet and Lactose-free diet
59
1 year old child came with vomiting , diarrhoea and
greenish stool.
1.Which is most important in management ?
2. What is most likely diagnosis ?
3. Most common cause of this condition?
4. What are DDX ?
5. When to give antimicrobials ?
6. Complications of dehydration + Management see below ?
1.Hydration
2.Gastroenteritis
3.most common cause is viral
4. DDx viral , bacterial & parasitic Gastroenteritis * see pic below
5.generally NOT indicated unless :
- C difficile → stop antibiotic & start metronidazole
Giardia → metronidazole
Cryptosporidium → metronidazole or Nitazoxanide
Cholera → tetracycline and doxycycline
Shigella → ciprofloxacin** Q
• Antidiarrheal and antiemetics are not usually needed
• Probiotics have no rule
6. Complications of Diarrhea:
1) Dehydration:death
2) Metabolic Acidosis and electrolyte imbalance → arrhythmia
3) RF
4) Abdominal distention then paralytic iliues( due to hypokalemia)
5) Sepsis if bacterial
6) Malabsorption
7) Nutritional complications
60
10 years old girl came with history right upper quadrant
and fever. Laboratory test confirmed amoebic liver
abscess
• Best action is ..
Oral metronidazole for 7-10 days
If not respond to medical treatment do surgically
- note; For amebic liver abscess • Metronidazole or Tinidazole followed by Diloxanide
furoate.
If complicated liver abscess >> Image-guided needle aspiration.
61
A 15-year-old girl presents with lower abdominal
pain, diarrhea and fever. She has mucus and blood
mixed with her stool.
1.The most likely organism is??
2.diagnosis ?
3 Best initial test ?
4. Best DIAGNOSTIC test is ?
5. Treatment ?
1. Entamoeba histolytica, a protozoan causes Amebiasis, Infection typically occurs following travel to endemic regions *** keyword
2. Dx is : intestinal amebiasis ( Amebic dysentery) * mucus & bloody diarrhea + abdominal pain + fever
3. Microscopic identification of cysts or trophozytes in fresh stool (best initial)
4. Serology (PCR or ELISA ): The best
5. Metronidazole is usually given first, followed by Paromomycin .
62
2 months old found to have deep jaundice and pale
stool. He looks healthy and growing well
• Which is the most likely cause ?
- DDx of obstructive jaundice?
- what is the gallbladder ghost triad ?
- complication if untreated?
- Which is the most likely cause ? Biliary atresia
- DDx of obstructive jaundice?
1-Structural: Billary atresia Cholodochal cysts
• 2-Metabolic: galactosemia , tyrosenimia , alpha 1
antitrypsin
• 3-Infection: TORCH , hepatitis
• 4-Hypothyroidsm
- what is the gallbladder ghost triad ? See pic
- complication if untreated? > Early biliary liver cirrhosis !!!
63
2 months old found to have deep jaundice and pale
stool. He looks healthy and growing well
• Which is the most likely cause ?
- DDx of obstructive jaundice?
- what is the gallbladder ghost triad ?
- complication if untreated?
- treatment?
- The best way to distinguish biliary atresia from neonatal hepatitis ?
- what is the best test for diagnosis ?
- Which is the most likely cause ? Biliary atresia
- DDx of obstructive jaundice?
1-Structural: Billary atresia Cholodochal cysts
• 2-Metabolic: galactosemia , tyrosenimia , alpha 1
antitrypsin
• 3-Infection: TORCH , hepatitis
• 4-Hypothyroidsm
- what is the gallbladder ghost triad ? See pic
- complication if untreated? > Early biliary liver cirrhosis !!!
- treatment >> hepatoportoenterostomy): a connection is created between the liver and the small intestine to allow for bile drainage.
In case of liver cirrhosis >>liver transplantation!
- The best way to distinguish biliary atresia from neonatal hepatitis ? Hepatobiliary scan
- Intraopertaive cholangiogram is the best for billary atresia
64
• A child with obstructive jaundice and there is family
history in his siblings
1. Most likely diagnosis ? Definition ?
2. Classical triad of this disease ?
3. Types of this lesion ? **picture below
4. Causes of familial cholestasis ?
5. INTIAL imaging modality of choice ?
6. How to CONFIRM diagnosis ?
7. What is the method of choice for preoperative for this condition ?
8. Treatment of this condition?
9. Possible complications ?
1. Cholodochal cysts = Biliary cyst = premalignant extrahepatic or/and Intra hepatic cystic dialatation of biliary tree .
2.classical triad ; abdominal pain , pliable abdominal mass , jaundice
3. 6 types see picture ( Type 1 cholodochal cyst can run in families and associated with familiar adeomatosis polyps , Type 5 cholodchal cyst can associate with caroli
disease. ( multiple saccular or cystic dilations of the intrahepatic ducts), If assocated with congential hepatic fibrosis: caroli
syndrome
- causes : Progressive familial intrahepatic cholestasis • Caroli syndrome • Allagile syndrome
5. INTIAL modality = ultrasound
6. To confirm dx = by Cholangiography
7. Preoperative = MRCP
8. Treated by = Cholecystectomy & Roux-en Y hepaticojejunostomy
9. Complications ;
- Cholangitis
- Pancreatitis
-MALIGNANCY; 😱 😱 😱 risk for Cholangiocarcinoma is 20-30 x higher !!!
Note ; even if pt is asymptomatic!! They have to do surgery !!
.
65
Patient with chronic abdominal pain • Which of following indicate organic cause
• A-Before sleeping time
• B-Pain before awakening
• C-Pain during daytime
Answer is B
Signs for organic abdominal pain
• Awake patient from sleep
• Weight loss
• Vomiting
• Growth failure
• Delayed puberty
• Pain away from umbilicus
• Diarrhea
66
Child came with fever and icterus and recent history
of travelling •
1. Most likely cause
• A-Hepatitis A
• B-Hepatitis B
• C-Hepatitis C
2. DDX ? See pic
3. How to confirm dx ?
4. Is there vaccine for it ?
5. What type of viruses is ?
6. Treatment?
7. How to prevent ?
1. Answer is Hepatitis A * keyword is Hx of traveling to endemic area .
3. How to confirm dx ? Serology >> +Ve antiHAV IgM + -ve antiHAV IgG→ acute HAV infection.
4. Is there vaccine for it ? Yes ,HAV vaccine in childhoods& given as booster prophylaxis for endemic area .
5. What type of viruses is ? RNA Virus,note all are RNA viruses EXCEPT HBV is DsDNA
6. Treatment ; supportive , self limited disease .
7. Prevention; Hygiene practices & HAV vaccine
67
Challenge yourself 🦅
Interpret these findings in serology for hepatitis;
Remember;
1. Look at HBs Antigen first >> if positive so infected !
2. Look at Anti HB c >> for acute or chronic infection > if positive , look at IgM if positive so it’s acute !
3. Look at Anti HBs >> if positive so immune , if it negative so not immune
68
Second challenge 🦅
What do you think ??
Chronic HBV infection
See below a great mnemonic 🫡❤️🔥
69
child presented with convulsion after blood
diarrhea:
• A- salmonella
• B- shigella
Answer is : Shigella
Remember;
Shegilla can cause febrile seizure
• Shegella can cause electrolyte disturbance leading to
seizures
• known to affect CNS and lead to seizures
• Shegella can affect CNS directly lead to encephalopathy
(Ekiri syndrome)
• Cambylobacter jejuni related to Gullian Barre syndrome
70
A child known Gasrtoespohageal reflux and his
symptoms are uncontrolled and biopsy showed eosniphic
oseophagitits
1• Which of the following is an excepted finding
• A-Obesity
• B-Snoring
• C-excessive chewing
2. Other associated diseases?
3. What is the best diagnostic test ?
1.Excessive chewing
2. With allergic disease like atopic
dermatitis or asthma
3. endoscopy and biopsy
71
About child milestones he can articulate word and knows color asking about age :
A.2
B. 3
C. 5
D. 6
The correct answer: B
72
About newborn with microcephaly and hepatosplenomegaly, investigations showing low hgb, wbc, platelets, elevated alt and ast, asking about what to do next :
A. US abdomen
B. Congenital infection screening
C. Chromosomal analysis
Congenital infection screening
Most likely is TORCH infection ( congenital rubella syndrome )
73
An infant boy underwent an ultrasound which shows bilateral hydronephrosis and a thickened bladder wall.
1. Diagnosis ?
2. What is the highest yield diagnostic investigation?
3. Indications for it ?
1. Vesicoureteral reflex
2MCUG= micturating cystourethrogram = VCUG = voiding
3; dx of vesicoureteral reflex & urethral stricture,recurrent UTIs ,suspected obestruction as bilateral Hydronephrosis,bladder trauma or rupture
74
Newborn with Down syndrome features asking how to confirm diagnosis ?
Postnatal diagnostic test > for Newborn >> confirm by Chromosomal analysis
75
Child know asthmatic uncontrolled , history of bad smell stool
1. What is most likely diagnosis?
2.what investigation to do next?
1.Cystic fibrosis
2. Sweat chloride test ( best initial test ) , diagnostic test is genetic study
76
child had a fall from a 1 story high building and direct trauma to the head, presents with hemotympanium. No loss of consciousness, no vomiting, neurological exam normal. Ear: Ruptured tympanic membrane with intact external auditory canal. Most likely bone fracture:
A. Mastoid
B. Maxillary
C. Basal skull
D. Orbital
Answer is ; Basal skull fracture
Note ; early sign for basal skull fracture after head trauma is hemotympanuim , other signs will be delayed takes hours to days to appear e.g racon eyes & CSF rhinorrhea
77
Baby sitting in tripod position, can change his position from supine and prone and vice versa, immature pincer grasp, his age in months ?
2
4
6
9
9 months
Remember;
Raking ( palmar grasp ) >>6months
Immature pincer grasp >>9 months
Mature pincer grasp >> 12months
78
Newborn who has passed no stool, and has bilious vomitus .During rectal examination, rectum was empty, however the stool eventually squeezes out of the rectum. Diagnosis?
A: hirschprung's disease
B. Pyloric stenosis
C intususpeption
A
79
#August
وجى سؤال كيف المفروض يكون هدفك فطول الطفل .. كان طول امه ١٥٥ و ابوه ١٧٥ ، مع انه ال bone age اقل من عمره الحقيقي اتوقع كان ١١ : وكان ضمن الخيارات 165 - 180
155-164
180-190
كان عمر الطفل 11
و bone age اقل من عمره بسنه
80
1 months came with history of stridor that
improving in supine position
1.Diagnosis?
2. Best diagnostic test?
1. Laryngiomalcia
2. flexible laryngoscope
81
Best screening test for TB for children below 2 years is ;
PPD & chest x ray
By Dr.Safder
82
Best screening test for TB for children ABOVE 2 years is
IGRA ( Interferon gamma release assays ) and chest X ray
By Dr.Safder
83
Active vs Latent TB is :
84
the most common cause for
bilateral nalasl poyps in chidren
Cystic fibrosis
85
most common initital
presntation of cystic fibrosis in neonate
Meconim illius
86
What’s the most common side effect of DTP
vaccine?
erythema over the injection site
87
#August
A child came to you with Café au lait spots in
face and neck.
1. Which of the following features
can strengthen your diagnosis?
2. What is the most likely diagnosis?
3. What is the type of inheritance?
1. Axillary freckling
2. Neurofibromatosis type 1
3. Autosomal dominant
88
#August
A child came to you with Café au lait spots in
face and neck.
1. Which of the following features
can strengthen your diagnosis?
2. What is the most likely diagnosis?
3. What is the type of inheritance?
1. Axillary freckling
2. Neurofibromatosis type 1
3. Autosomal dominant
89
#August
The most common eye manifestation in sturge
weber syndrome ?
Glaucoma
Pathology; episcleral angiogram >> increase IOP > early onset of glaucoma * AMBOSS
90
Calcaute fluid required to give for 11 months old
boy , 10 KG, and deficit 5% of his body fluid?
1500
Explanations ;
1. Maintenance= 10*100 = 1000
2• Deficit : weight * deficit * 10= 10*5*10=500
3• Total : 1000 +500 = 1500 ml
91
Pediatric pt has referral from the village with typical
unusual facial characteristics, short stature, heart defects
present at birth, bleeding problems, developmental delays,
and malformations of the bones of the rib cage
1 .What is the most likely diagnosis ?
2. DDx ?
1. Noonan syndrome
2. Turner syndrome
92
#Milestones
A child can sit, have immature pincer grasp and crawl, age in months?
9 months
See table below ** very important **
Reference ; Nelson Essentials of pediatric
93
#Milestones
Part 1
94
#Milestones
Part 2
