AMEDEX MIX Flashcards
The following are absolute contraindications to ACE inhibitors: • History of angioedema regardless of cause (even if not due to ACE inhibitor) • Pregnancy (due to harm to fetus) • Bilateral renal artery stenosis. Previous __________________ to ACE inhibitors
allergic reaction
Relative contraindications are: •
Aortic stenosis •
Hypertrophic cardiomyopathy
A dry cough is a common adverse effect of ACE inhibitors and a main cause of ______________ and abandonment of treatment
non-compliance
neither pre- existing cough nor ACE inhibitor-induced _____________is not a contraindication to their use.
cough
The clinical history is suggestive of laryngomalacia. Laryngomalacia is
congenital softening of the tissues of the larynx above the vocal cords. This is the most
common cause of —————- in infancy.
noisy breathing
Acute asthma makes breathing difficult, and wheeze is audible in
_____________
any body position
Asthma is an extremely rare possibility in a ____________ neonate.
2-week-old
Croup (laryngotracheobronchitis) is most commonly caused by _____________ virus type 1
infection.
para-influenza
It is characterized by a seal barking cough and inspiratory stridor.
Croup (laryngotracheobronchitis
Croup affects
mainly children aged 6 month to __ years.
3
Acute bronchiolitis is an acute viral
infection of the lower respiratory tract, typically affecting infants (≤24 months) and is
characterized by __________, wheezing, and inspiratory fine
respiratory distress
It is primarily caused by respiratory syncytial virus (RSV). Treatment is supportive with oxygen and
___________.
hydration
Prognosis is generally excellent; however, some chidlren may develop apnea or
respiratory failure.
Acute bronchiolitis
Epiglottitis is a rapidly progressive bacterial infection of the
epiglottis and surrounding tissues that may lead to sudden _____________ and death.
respiratory obstruction
Symptoms include severe sore throat, dysphagia, high fever, drooling, and inspiratory stridor.
Epiglottitis
Treatment includes airway protection and antibiotics.
Epiglottitis
Lipomas are common benign tumors of mature fat cells that can be seen in
any site of the body containing ___________.
fatty tissue
They are not premalignant. Although they
frequently occur in the subcutaneous fat tissue, it is not uncommon to see ________in the deeper
layers such as beneath the fascia or within muscles.
lipomas
As there is very little fat in the scrotum lipomas almost never occur there, but fat deposition within the ____________ may be seen.
spermatic cord
Unlike lipomas, ___________ of the scrotum are common.
epidermoid cysts
Lipomas are usually freely
mobile and not attached to the overlying skin; however in areas such as the back of the neck or
the trunk, where the skin has less mobility, they could be less mobile or even ___________.
immobile
The
most characteristic physical feature of a lipoma is the lobulated contour, which can reliably
differentiate it from an epidermoid cyst and its
____________________.
smooth contour
The clinical picture of headache worse in the morning, and by sneezing,
coughing and bending forward is suggestive of a space-occupying lesion in the brain that can
be either a __________
tumor or abscess
Considering the age of the patient, history of heavy smoking and
the cough, this patient has __________cancer with high certainty.
lung
Lung cancer is one of the three
primary cancers that tend to metastasize to the _________(21%).
brain
The other two are melanomas
40%) and breast cancer (9%
metastasize to the brain
With this history and chest X-ray findings, the lesion is most
likely to be a metastatic brain lesion from a __________________.
primary lung cancer
Metastatic brain tumors are
the most common form of __________tumors.
brain
Of all brain tumors, more than a half are ______________.
metastatic
In patients with systemic malignancies, ____________metastases occur in 10- 30% of adults and 6-10% of
children.
brain
With the high probability of an underlying lung cancer in this patient, this
tumor is more likely to be _________________
metastatic than primary.
The clinical picture and the age of the child is mostly consistent with oppositional defiant disorder (ODD) as the diagnosis. ODD is a disruptive behavior disorder in children and teenagers characterized by patterns of unruly and argumentative behavior and ________toward authority figures.
attitudes
This pattern is often considered by parents simply as stubbornness, emotionalism and strong will.
oppositional defiant disorder
ODD manifests with a constant extremely negative, defiant and hostile behavior leading to disruption of the social, school, and home life for at least ___________
6 months
Children with ODD often direct their anger and resentment toward their parent, teachers, and other authority figures; however, they can have such problems with their _________as well
peers
They are often uncooperative, vindictive, and easily annoyed.
ODD
They usually defy the rules, have anger outburst, blame others for their mistakes, seek revenge, and disturb others on purpose.
ODD
Since the child is unlikely to understand that he has a problem, seeking treatment is often from the parents’ side
ODD
A careful history is essential because many other childhood conditions may have some shared features with ____
ODD
It is important to differentiate whether the abnormal in the behavioral pattern is due to ODD or simply a response to a _____situation.
temporary
The international Classification of Diseases 10th Revision (ICD-10) classifies ODD as a mild form of ________disorder
conduct
It has been estimated that up to 60% of patients with ODD will develop _________disorder
conduct
Treatment is necessary at earlier stages to prevent it from developing into a more serious conduct disorder (most important), mental health disorder, or criminal behavior.
ODD
Treatment entails a combination of behavioral therapy, family therapy and at occasions, medications.
ODD
In more than 50% of patients with ADHD, _____is also part of the clinical picture
ODD
There is strong evidence suggesting that ODD and ____overlap and many medications that are used to treat _________may also be efficacious in treatment of ODD too.
ADHD
A few studies have reported the positive effects of psychostimulants or atomoxetine in the treatment of ODD associated with ______
ADHD
Patients with ODD and conduct disorder with severe aggression may well respond to risperidone, with or without ___________
psychostimulants
Mood regulators, alpha2 agonists, and antidepressants may also have a as second-line role in treatment of ___________and its comorbidities
ODD
Of the options, risperidone, is the only option that can be used if pharmacotherapy is considered.
ODD
Mood stabilizers such as sodium valproate (option B) or olanzapine (option A), and antidepressants such as SSRIs (option C) are second-line options.
ODD
There is no evidence supporting carbamazepine (option E) as a pharmacological treatment for __________
ODD
___________ is congenital softening of the tissues of the larynx above the vocal cords
Laryngomalacia
This is the most common cause of noisy breathing in infancy.
Laryngomalacia
In _________, the laryngeal structure is malformed and floppy, causing the tissues to fall over the airway opening and partially block it.
Laryngomalacia
symptoms are usually present at birth, and can become more obvious within the first few weeks of life.
Laryngomalacia
Symptoms of laryngomalacia include: Noisy breathing - an audible wheeze when a baby ________.
inhales
It is often worse when the baby is agitated, feeding, crying or sleeping on his back High pitched sound Difficulty feeding (in severe cases) •
laryngomalacia
Poor weight gain (in severe cases) • Choking while feeding (in severe cases) (Option A)
laryngomalacia
___________ makes breathing difficult, and wheeze is audible in any position.
Acute asthma
__________is an extremely rare possibility in a 2-week-old neonate.
Asthma
Croup (laryngotracheobronchitis) is most commonly caused by _____________________infection.
para-influenza virus type 1
Croup is characterized by a distinctive seal barking cough and _______________
inspiratory stridor
Croup affects mainly children aged ________________
6 month to 3 years.
Acute bronchiolitis is an acute viral infection of the lower respiratory tract, typically affecting infants younger than 12 months of age, and is characterized by respiratory distress, __________.
wheezing
It is primarily caused by respiratory syncytial virus (RSV).
Acute bronchiolitis
Treatment is supportive with oxygen and hydration
Acute bronchiolitis
Prognosis is generally excellent; however, some children may develop apnea or respiratory failure.
Acute bronchiolitis
Epiglottitis is a rapidly progressive bacterial infection of the epiglottis and surrounding tissues that may lead to sudden _______________ and death
respiratory obstruction
Symptoms include severe sore throat, dysphagia, high fever, drooling, and inspiratory stridor.
Epiglottitis
Treatment includes airway protection and antibiotics
Epiglottitis
While expiratory stridor indicates an obstruction in the lower trachea, inspiratory stridor suggests obstruction above the ____________.
glottis
______________ discharge in female children should always be taken seriously and investigated promptly
Blood-stained vaginal
One exception is vaginal bleeding in the first week of birth in female neonates that is caused by withdrawal from maternal ________upon birth.
estrogen
Causes of vaginal bleeding in children include the following: • Vaginal foreign body • Severe vulvovaginitis • Trauma (including straddle injury and sexual abuse) • Excoriation associated with threadworms Onset of first menstruation Hematuria • ________prolapse (an inflamed “doughnut” of tissue is visible at the urethral meatus Of the above
Urethral
_____________ is the most common cause of bloody vaginal discharge.
a vaginal foreign body
The foreign body is often toilet t papers. Foreign body in the vagina causes offensive purulent vaginal discharge that _________frequently despite successful initial management with antibiotic unless the foreign body is removed.
recurs
It can also cause vaginal bleeding. Children with suspected vaginal foreign body should be rereferred to pediatrics specialist for ______________________.
removal of the foreign body
Monilial (candida) vulvovaginitis is almost never seen in prepubertal girls except as an association with ______________
nappy rash
Atrophic vulvovaginitis is a less common condition in prepubertal girls and if present should raise suspicion against _____________.
lichen sclerosus
Even in case of atrophic vaginitis, itching and _______________ would be the expected presentation
mucoid discharge
Infection with chlamydia, gonorrhea and trichomonas can cause offensive bloody vaginal discharge. These infections in children are highly suggestive of _________________
sexual abuse
For every child with vaginal discharge associated with unusual features such as persistent and significant discharge or __________in the discharge, sexual abuse should be considered as a possibility and approached appropriately.
blood
Although sexual abuse should also be considered and thought of in such situation, the most likely cause of such presentation remains a vaginal foreign body, unless investigations establish the presence of chlamydia, gonorrhea or ___________, in which case sexual abuse is almost always the cause.
trichomonas
Infection with threadworm may vulvovaginitis, in which case, ___________is the most prominent symptom
itching
The earliest sign of Perthes disease is an intermittent limp, especially after exertion, with mild or intermittent pain in the anterior part of the ________.
thigh
____________ is the most common cause of a limp in the 4-to 10-year-old age group.
Perthes disease
The classic presentation of Perthes disease has been described as a ‘_________________.
painless limp’
The child may present with limited range of motion of the affected extremity. The most common symptom is persistent pain
Perthes disease
Hip pain may develop and is a result of necrosis of the involved bone
Perthes disease
This pain may be referred to the medial aspect of the ipsilateral knee or to the lateral thigh.
Perthes disease
The quadriceps muscles and adjacent thigh soft tissues may atrophy, and the hip may develop adduction flexion contracture.
Perthes disease
The patient may have an antalgic gait with limited hip motion, or a Trendelenburg gate (abductor lurch).
Perthes disease
Pain may be present with passive range of motion and limited hip movement, especially internal rotation and abduction.
Perthes disease
Laboratory studies including a full blood count, ESR and CRP are usually normal and are often ordered to exclude other possible causes of hip pain and limp such as septic arthritis, transient synovitis, or juvenile rheumatoid arthritis
Perthes disease
In most cases X-rays are normal early in the course of the disease but are used serially to assess the progression of the disease
Perthes disease
Stage 1 - Cessation of femoral epiphyseal growth • Stage 2 - Subchondral fracture Stage 3 - Resorption Stage 4 - Reossification Stage 5 - Healed or residual stage
Perthes disease
A bone scan can be used to evaluate the site for avascular necrosis (AVN). Early radiographic findings in acute phase can be a nonspecific effusion of the joint evident by slight widening of the joint space.
Perthes disease
Other early findings may include decreased bone density around the joint and a bulging joint capsule. The acute phase often lasts 1-2 weeks. Decreasing bone density in and around the joint is noted after a few weeks.
Perthes disease
Once Perthes disease is suspected, the child should be urgently referred to orthopedic specialist for management and treatment
Perthes disease
In the meanwhile, limited movement and reducing the weight from the hip joint should be encouraged to prevent or minimize further damage of the femoral head.
Perthes disease
For this purpose, crutches are prescribed and encouraged to use.
Perthes disease
Treatment goals in ___________ are: • Eliminating hip irritability • Restoring and maintaining good range of motion in the hip Preventing femoral epiphyseal collapse
Perthes disease
Having a spherical femoral head when the hip heals Initial therapy includes protecting the hip joint and making it non-weightbearing
Perthes disease
This can be achieved by maintaining the femur abducted and internally rotated to keep it held well inside the rounded portion of the acetabulum.
Perthes disease
Most cases are treated conservatively using splinting (e.g. Scottish Rite brace).
Perthes disease
At occasions surgery (osteotomy) may be considered. Surgery does not speed femoral head healing, rather it results in a more spherical oreossification of the femoral head.
Perthes disease
Limb shortening is a potential complication of surgical treatment.
Perthes disease
Although Perthes disease is associated with hip pain and decreased range of motion, the two most severely affected movements are __________________, not external rotation.
abduction and internal rotation
Perthes disease is mostly diagnosed clinically. The imaging modality of choice to help with diagnosis and also assessment of the disease progression is _________, not ultrasound.
X-ray
Osteotomy can be a treatment option depending on the child’s age and the disease severity:more conservative strategies such as bracing are applied as the treatment option of choice where feasible.
Perthes disease
____________ is not an inflammatory condition; therefore, inflammatory markers such as WBC, ESR and CRP are usually negative
Perthes disease
Positivity of such markers points toward an alternative diagnosis such as septic arthritis, rheumatoid arthritis, synovitis, etc.
Perthes disease
Recurrent urinary tract infections (more than 2 times during childhood) can result in renal scarring, hypertension, and _____________________________.
end-stage renal disease
The underlying etiology is vesicoureteral reflux (VUR) -retrograde passage of urine from the bladder into the upper urinary tract
Recurrent urinary tract infections
Dimercaptosuccinic acid scintigraphy (DMSA) scan is the gold standard for diagnosis of _____________ and assessment of renal functions
kidney scarring
_________is indicated in the following conditions: • Clinical suspicion of renal injury • Reduced renal function Suspicion of VUR • Suspicion of obstructive uropathy on ultrasound in older toilet-trained children
DMSA
For this child with recurrent episodes of UTI, a DMSA should be considered as the most diagnostic modality for assessment of renal function and possible _________________
renal scaring
Biopsy provides clues to histopathological abnormalities in kidney associated with certain type of renal diseases such as _______________but not the overall kidney function
glomerulonephritis
Moreover, it is unnecessarily invasive.
Biopsy provides clues to histopathological abnormalities in kidney
Ultrasound is capable of assessing the presence of fluid collections, bladder volume and the size, shape and location of _________________.
kidneys
it gives no clue regarding kidney function or scarring
Ultrasound
Ultrasound is indicated for assessment of children with UTI in the following situations: Concurrent bacteremia Atypical UTI organisms: i.e., Staphylococcus aureus, Pseudomonas UTI <3 years old • Non/inadequate response to 48hrs of IV antibiotics • Abdominal mass • Abnormal voiding Recurrent UTI • First febrile UTI and no prompt follow up assured • Renal impairment Significant ______________________
electrolyte derangement
Elevated levels of urea and creatinine indicated renal impairment but gives no clue for each indivudual kideny or at times kidneys in general because urea and creatinine may be normal in early stages of ___________________________.
pre-renal or post-renal renal failure
normal values do not exclude the presence of abnormalities in only one kidney as the other kidney can _______________.
compensate
Many patients may have normal ranges in the presence of severe damage to one kidney while the other is functional and __________________.
compensating
Abdominal CT scan will visualize the kidneys, adrenal glands and adjacent structure but is not capable of assessment of ____________.
renal function
Intermittent abdominal pain in children is a frequent reason of seeking medical attention by concerned parents. The causes of intermittent abdominal pain are diverse, ranging from benign conditions such as functional abdominal pain to grave diseases such as childhood _________________.
malignancies
______________________obstruction is by far the most common cause of pediatric hydronephrosis, occurring in 1 per 1000-2000 newborns.
ureteropelvic junction (UPJ) UPJ
Widespread use of antenatal ultrasonography and the advent of modern imaging techniques have resulted in earlier and more common diagnosis of the condition.
ureteropelvic junction (UPJ) UPJ
In older children, periodic abdominal pain with vomiting is a common symptom. These symptoms are probably caused by intermittent kinking of the _____________________
ureteropelvic junction (UPJ) UPJ
If obstruction does not resolve, severe hydronephrosis and pelvic distention can follow, presenting with flank pain or even tenderness.
ureteropelvic junction (UPJ) UPJ
Wilms tumor is the most common intra-abdominal malignant tumor of childhood that often presents with a smooth firm abdominal mass that usually _________________
do not cross the midline
Abdominal pain, either constant and vague or intermittent, is another finding.
Wilms tumor
____________is the most common extracranial malignant tumor of childhood.
Neuroblastoma
The initial presentation is most commonly within the first 2 years of life. The tumor is intraabdominal in two-thirds of cases.
Neuroblastoma
The tumor is intraabdominal in two-thirds of cases
Neuroblastoma
two-thirds originating from adrenal glands. It can also present with a palpable abdominal mass that is non-tender.
Neuroblastoma
While these masses are commonly benign, there are other possibilities that should be taken into account
Childhood cervical masses
____________________ in children are divided in the following broad categories: 1. Congenital 2. Inflammatory/infective 3. Neoplastic
Cervical masses
majority of childhood neck lumps seen in general practice occur as a result of an inflammatory/infective process, other possibilities such as persistent congenital abnormalities and red flag of neoplastic diseases always must be considered
Childhood cervical masses
Cervical masses in the neonatal period and early infancy are often ___________
congenital
Examples are thyroglossal duct cyst, teratomas, sternocleidomastoid tumors of infancy and vascular or lymphatic malformations
infancy are often congenital
Of note, vascular and lymphatic malformations typically grow with the growth of the child. _______________ is most common in infancy and early childhood, with 40-55% of young children found to have palpable cervical lymph nodes.
Reactive lymphadenopathy
Of note, vascular and lymphatic malformations typically grow with the growth of the child. _______________ is most common in infancy and early childhood, with 40-55% of young children found to have palpable cervical lymph nodes.
Reactive lymphadenopathy
Rapidly developed masses are typically inflammatory, including reactive lymphadenopathy, lymphadenitis, or secondary infection of underlying __________________ masses.
congenital or neoplastic
Inflammatory pathology typically resolves within four weeks
Rapidly developed masses
Cervical masses that persist past _______weeks require further evaluation.
six
Rapidly growing masses should be immediately referred if there is a concern that they have the potential to affect the airway or have features suggestive of ___________formation.
abscess
Masses that grow at a slower rate, for months to years, are suggestive of ________________or a slowly enlarging congenital malformation.
benign neoplasms
In terms of associated symptoms, a viral prodrome, fevers, and cervical tenderness are associated features suggestive of ________________________
reactive lymphadenopathy
On physical examination, location, size, consistency, and tenderness give important _________.
clues
Location-wise, ___________masses are more likely congenital and are typically thyroglossal duct cysts or dermoid cysts
midline
Thyroglossal duct cysts will elevate with tongue protrusion or swallowing, while dermoid cysts are tethered to the ______________.
overlying skin
__________masses are potentially malignant and need further evaluation
Thyroid
Lymphadenopathy commonly arises as a lateral lump in the anterior or posterior triangle, and may present an inflammatory or _________process
neoplastic
Lymphadenopathy in the posterior triangle has a higher risk of malignancy, while supraclavicular lymphadenopathy is considered a ____________.
red flag
Other masses of the lateral neck include lymphatic and vascular malformations and ________________
branchial cleft cysts
Reactive lymphadenitis is characterized by a local collection of small, tender, ______________
mobile lumps
The possibility of suppurative lymphadenitis should be considered if there is palpable warmth, fluctuation, induration, or severe ______________.
tenderness
If the mass is firm, irregular, or immobile, ____________should be thought with high suspicion
malignancy
In terms of size, a palpable cervical lymph node less than 1 cm in size can be considered normal in children, while increasing size is associated with a significantly increased risk of _____________
malignancy
______________ greater than 1 cm in size that persist for longer than six weeks or despite antibiotic therapy should be evaluated with medical imaging and a possible tissue biopsy e.g., FNAC
Lymph nodes
The following features are red flags for a neck lump in children, the presence of which warrants a more aggressive approach: • Weight loss • Sustained fever • Night sweats Generalized lymphadenopathy Signs and symptoms of pancytopenia • Mass persisting> 6 weeks • Lymph node> 3 cm • Thyroid mass • Supraclavicular mass Hard, ______________mass Fixed mass
irregular
