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#1 Prep Pearls > Board Vitals #2 > Flashcards

Board Vitals #2 Flashcards

1
Q

White mass behind tympanic membrane, no history of ear infections. Conductive hearing loss on audiogram.
Dx

A

Congenital choleastoma
Tx with surgical excision or risk hearing loss
Tell apart from acquired given neg history

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2
Q

What is the risk for devo of T1DM in the sibling of affected individual?
Affected parent?

A

Risk is 5% in siblings
6% if parent has it
50% in identical twins

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3
Q

What are other diseases associated with T1DM?

A

Autoimmune thyroid with 25% risk
5% risk of celiacs
RF = Vit D deficiency, cereal induction before 3 months

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4
Q

What is benign neonatal sleep myoclonus?

A

Seen more common in preterm infants, no seizure and see focal or multifocal myoclonic jerks during non-REM sleep with normal EEG, no neuro abnormalities

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5
Q

Teen with irregular patches of missing hair with short broken hair shafts of different lengths, see perifollicular involvement and the hair shafts are incompletely keritanized
Dx?
Associations?
Tx?

A

Trichtillomania
Behavior therapy
Associated with OCD, anxiety, may need SSRIs or stimulants

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6
Q

Patient with broken hair shafts with erythematous and scaly patch on head.
Dx and tx?

A

Tinea capitis

Tx is 6-8 weeks of oral griseofulvin or 2-4 weeks of oral itraconazole or terbinafine

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7
Q

How can minors become emancipated?

A

Joining military, getting married

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8
Q

Patient started on amoxicillin a few days ago, developed a erythematous itchy rash on trunk, arms, hands and soles. Cause of rash and treatment

A

Drug eruptions; delayed T cell mediated type IV immune response
different from viral xanthem bc on palms and soles also see low grade fever and eosinophilia

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9
Q

Patient present with fever, swollen LN, joint pain and hives. Recently started on new AED.

A

Serum sickness

type III hypersensitivity; antiB-antiG immune complex deposition

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10
Q

When can kids sit in front seat?

A

When they turn 13 years old. No specific weight recommendation and really should be over 4ft 9in

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11
Q

3 yo patient with limping and left knee swelling but no pain and now decreased ROM. No fevers. On exam swollen knee, pain with ROM. ESR is 40 and aspirated fluid is neg for organisms.
Dx and complications?

A

Juvenile idopathic arthritis

Common complication is uveitis–> lead to blindness; should see optho regularly.

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12
Q

Patient presents with UTI, they are 2 years old. This is third UTI. You get renal US and a it shows reflux to renal pelvis with dilation of ureter and distension of collecting system of right kidney.
What grade is reflux and what is this concerning for?

A

Patient with grave IV or V (only ones that show up on US, lower grades don’t show up on US).
Pt with vesicourethral reflux and needs to be on prophylaxsis

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13
Q

Patient with MRI showing downward displacement of cerebellum from small posterior fossa into cervical or occipital encephalocele

A

Chiari III malformation

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14
Q

Abnormal cerebllar tonsils displaced below foramen magnum. Pt with occipital HA, neck pain and gait abnormalities. Also having nystagmus and dysarthria

A

Chiari I malformation; can be associated with syringomyelia

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15
Q

Fluid filled cavity lined with gliotic tissue and confined to spinal cord. No involvement of central canal

A

Syringomelia

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16
Q

Patient ingests rat killer. He has BL intracranial hemorrhage and prolonged PT.
What happened and what is tx?

A

rodenticide ingestion (anticoagulation by inhibiting Vit K dependent coag factors)
Tx for symptomatic patients are FFP for emergent reversal.
If not as severe/asymptomatic then use Vitamin K

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17
Q

What do we give to reverse Heparin urgently?

A

FFP for symptoms and give Protamine for asymptomatic urgent reversal

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18
Q

Pathophys of CF and inheritance.

A

Defective transmembrane conductance regulator protein; chloride channel found in exocrine tissues. Get loss of Na in sweat = hypoNa
Auto Recessive

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19
Q

How is CF screened in newborn screen?

A

Screen for immunoreactive trypsinogen then do follow up testing for genetics and sweat chloride later

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20
Q

Cause of Duchennes

A

X linked disorder; muslce degeneration; dystrophin gene is mutated leading to muscle degeneration and see devo delay, intellectual impairment and elevated serum Cr.

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21
Q

What is the classic presentation of PCOS

A

hyperadrnogenism (hirsutism and acne) oligomenorrhea or amenorrhea, polycystic ovaries and LH elevated to FSH: 3:1

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22
Q

What neonates should get the VZV immune globulin

A

Mom with symptoms 5 days before or 2 days after birth OR hospitalized premature infants >28 wks in mom’s w/o immunity OR
<28 weeks that weight less 1000g no matter what

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23
Q

Cause of congenital diaphragmatic hernia

A

embryologic defect around 6-7 weeks gestation

more common in teen mom, smoking

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24
Q

What electrolyte abnormalities are seen with salicylate toxicity?

A

Anion Gap metabolic acidosis with respiratory alkalosis (increased RR)
Hypoglycemia
Hypokalemia
Tx alkalinize urine with sodium bicarb

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25
Q

What are SIRS criteria in peds?

A
  1. Temp >38.5 or < 36
  2. Pulse >2 SD above norm
  3. RR >2 SD above norm
  4. Leukocyte abnormalities
    * 2/4 must be met and one must be either temp or leuks
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26
Q

Whats the most important initial therapy for Peds in septic shock?

A

FLUIDS; 60ml/kg and then antibiotics

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27
Q

What type of imaging is best to assess for retropharngyeal abscess?

A

Full extension during inspiration

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28
Q

Patient with single oval red plaque on chest that became scaly. In teens, no other symptoms. What may happen next?

A

Pityriasis rosea; can progress to similar legions concentrated on trunk in christmas tree distribution

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29
Q

Tx for bulemia

A

CBT and fluoxetine

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30
Q

This bug causes diarrhea, rash, pharyngeal or conjuctival erythema, rhinorrhea and fevers. See outbreaks in NICUs, daycares and lots of different buts in this family.

A

Enterovirus

see Coxsackie A and B

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31
Q

Delayed cord separation and omphalitis and nonpustular lesions are associated with this immune defect

A

LAD; leukocyte adhesion defect; neutrophils don’t adhere to vascular endothelium due to defects in integrin CD18 (key for neutrophil

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32
Q

Male patient who is 2 yo, recurrent s.pneumo and H.influenza as well as S. aureas infections. No Ig’s on testing

A

Agammaglobulinemia from mutation in Btk gene on chrom Xq22; arrest B cell devo at pre-B cell state.
X linked more common than AR form

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33
Q

2 week old infant with low set ears and flat nasal bridge present with tachypnea, crackles, puffy hands and feet and poor eating. Femoral pulses are barely palpable when compared to radial.
Dx and treatement

A

Coarct in setting of Turners

prostaglandin E1 to keep the PDA open until surgery can be done and give inotropic meds.

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34
Q

Serum sickness is a ____ hypersensitivity from ____.

See arthralgias as well as uticaria and fever 1-3 weeks after starting drug

A

Type III
Immune complex deposition
type III = C for immune Complex

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35
Q

How do we treat hypernatremic dehydration?

A

restore intravascular volume with isotonic fluids until adequate perfusion has been restored. Then you can use D5 0.2NS at a constant rate. Goal is not to drop Na by more than 12 in 24 hours to minimize risk of cerebral edema

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36
Q

parent interview form to screen for developmental and behavioral problems that need to be evaled. Works for kids 0-8 and only 10 questions

A

PEDS (parents evaluation of developmental status)

good to screen for academic, behaviors, fine motor, ect.)

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37
Q

What are the CHAT and M-CHAT used for?

A

screen for autism
Modified Checklist for Autism in Toddlers
M-CHAT: 16-48 months
CHAT; 18-24 months

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38
Q

What is the Ages and Stages or ASQ used for

A

parent completed for communication, gross motor, fine motor, problem solving and personal adaptive skills for 4-60 months

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39
Q

What three things are seen in septo-optic dysplasia?

A
  1. optic nerve hypoplasia
  2. midline devo defects (dysgenesis or absence of septum pelludicum, thinning of corpus collosum)
  3. Hypopit (see GH deficiency as most common)
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40
Q

Constellation of findings in MEN2B

A

Medullary thyroid carcinoma
Marfanoid
Mucosal neuromas and distinct face~ large lips and ganglioneuromatosis
Pheochromocytoma

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41
Q

Findings in MEN1

A

Hyperparathyroid
Islet cell tumor
Pituitary tumors

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42
Q

Findings in MEN 2A

A

Medullary thyroid
Pheochromocytoma
Parathyroid adenoma

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43
Q

In preterm infant what is most common cause of hyponatremia?

A

From excessive renal loss of sodium

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44
Q

Most common inherited risk factor for thrombosis

A

Factor V Leiden
aids in clotting of injured vessels
mutation causes resistance to activated protein C (key for regulating amount of clotting)
Dx by DNA blood test to see if hetero (5-7 fold increase of thrmobosis) or homozygous (25-50 times increase)

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45
Q

What happens as a result of scorpion sting?

A

Catecholamine surge; see tachycardia, hypertension, hyperthermia, tachypnea

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46
Q

A complete series of Hep B vaccines requires ___ doses.

A dose does not count if the infant is

A

3 doses

<2.0kg

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47
Q

Patient with asthma symptoms LESS than ___ days per week and ___ nights per month have intermittent asthma

A

2

2

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48
Q

Patient with asthma more than 2x per week but less than once a day, flares affect activity. Night flares occur >2x/month but not weekly with lung function 80% or more of normal

A

Mild persistant asthma

Tx with low dose ICS

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49
Q

Symptoms of asthma daily, flares last several days and disrupt activity and frequent night time wakenings with lung function 60-80% normal

A

Moderate persistant asthma

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50
Q

Daily and frequent asthma symptoms, disrupt sleep and lung function <60% of normal

A

Severe persistant

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51
Q

Most common urea cycle defect with elevated ammonia and low citrulline, somnolence, temp instability, vomiting and seizures.

A

Ornithine transcarbomylase deficiency
X linked
usually nitrogen and ammonia–>urea cycle-> urea and excreted but doesn’t happen bc ornithine transcarbomylase is deficent

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52
Q 
Urea cycle defect present with:
\_\_\_\_\_ anion gap
\_\_\_\_blood glucose
\_\_\_\_ketones
\_\_\_\_plasma ammonia
A

NORMAL anion gap
NORMAL blood glucose
NORMAL ketones
ELEVATED ammonia

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53
Q

Organic acidemias present with
____ ammonia
____ketones
____glucose

A

ELEVATED ammonia
ELEVATED ketones
LOW glucose

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54
Q

Patient is AA, 10 yo and coming in with fever, rash and swollen LN. Mom says he has joint pain and on exam rash looks like erythema nodosum. Eyes are red and injected and you note a cough on exam, mom says this has been going on for months
CXR with BL hilar lymphadenopathy.

A

Sarcoidosis
seen 8-15yo in kids, more in AA
Dx with CXR, labs (CBC, CMP with elevated Ca, TB test, PFT and eye exam with uveitis)
Gold standard dx is biopsy of lesion

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55
Q

Patient with flu like illness, HSP, hilar lymphadenopathy, pulmonary nodules, cavitary lung disease, joint pain.
Pt in Ohio

A

Histoplasmosis
-also see calcifications on CXR
Tx: amphotericin or fluconazole or ketoconazole

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56
Q

Patient recently started on AED about one month ago now has high fevers, swollen LN, rash and body aches. Mucosal membranes are not involved

A

Drug induced hypersensitivity syndrome

Seen in AEDs and sulfas

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57
Q

Mom noticed left sided mass in abdomen while giving a bath to 3 yo. Elevated BP on exam, normal HR. Most likely malignancy

A

Wilms
most common abdominal malignancy in kids.
RCC not until teens!
Tx with nephrectomy; good prognosis with favorable histology

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58
Q

Hemihypertrophy is associated with..

A

Beckwidth weidemann
Klippel Trenaunay
Russell Silver syndrome and Denys-Drash

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59
Q

Symptoms associated with accidental Ca Channel blocker

Tx

A

Hypotension, bradycardia and usually normal mentation. EKG with PR prolongation and hyperglycemia 2/2 decreased insulin release
Tx IV Calcium and glucagon (to improve inotropy and chronotropy) and IV fluids

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60
Q

Patients with CSF glucose <40 are most often associated with

A

bacterial meningitis

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61
Q

Ciprofloxacin is a FQ that works by_____
Best to treat _____
Can’t use with____

A

FQs work by inhibiting DNA gyrase and topiosomerase (enZ needed for DNA synthesis)
Use for gram negatives (like UTIs) and PSA
can’t use with zinc, calcium of mag (cations) bc decreases absorption. can’t use with antacids
SE are upset stomach, tendonopathy, HA

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62
Q

Necrotizing encephalopathy; mitochondrial disorder. Lesions in brain stem, thalamus, basal ganglia and cerebellum. Presents in infancy/early childhood with devo delay, ataxia, dystonia, seizures, lactic acidosis

A

Leigh disease; progressive

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63
Q

Infants double their birth weight by ____

They triple their birth weight by ___-

A

double by 4 months

triple by 12 months

64
Q

Infants double their birth length by ____

A

3 years

grow apx 2 inches or 5cm per year from age 4 until puberty

65
Q

Moro reflex is gone by ___

A

3 months

66
Q

Rooting reflex gone by __-

A

4 months

67
Q

Palmar or grasp reflex gone by ___

A

6 months

68
Q

You suspect a patient has constitutional growth delay.What do you see on their FSH, LH and bone age

A

Low FSH, LH

Bone age is less than actual age

69
Q

What are radiographic signs and murmurs you hear with coarct?

A

XRAY with notching of ribs (figure 3 sign) abnormal contour of the aortic arch (double bulge superior and inferior of aortic knob)
Hear a systolic ejection click

70
Q

How do electrolyte abnormalities result in refeeding syndrome?

A

See HypoMag, HypoCal, Hypophos and HypoKalemia from increased uptake of K into cells once eating again from insulin
EKG shows depression of ST, decrease in T wave and increase in U waves

71
Q

Deficiency leads to nystagmus, opthalmoplegia, ataxia and confusion with peripheral neuropathy

A

Vit B1 deficiency or thiamine deficiency

Wernicke Dorsakoff

72
Q

Deficiency leads to sore throat with redness and swelling of mucosa, chelitis, stomatitis, glossitis and normocytic normochromic anemia with seborrhea

A

Vit B2 or riboflavin deficiency

73
Q

Deficiency leads to dermatitis, diarrhea, dementia and death

A

B3 or niacin

74
Q

SLE diagnosed by 4 of 11 of these criteria

A 
Malar rash
dischoid lupus rash
Photosensitivity
Oral or nasal mucocutaneous ulcers
non-erosive arthritis
Nephritis
Encephalopathy
Pleuritis
pericarditis
Cytopenia
\+ANA
Immunologic: + antidsDNA or antiSmith
75
Q

occur through the growth plate. These injuries may present with normal radiographs and the diagnosis is often made clinically when tenderness is palpated over the growth plate.

A

Type I fractures

76
Q

occurs through the growth plate and metaphysis. The most common physeal fractures.

A

Type II fractures

77
Q

occur through the growth plate and epiphysis. These injuries are intra-articular and the diagnosis is made radiographically based on the appearance of an epiphyseal fragment not associated with a metaphyseal fracture.

A

Type III fractures

78
Q

are also intra-articular and occur through the growth plate, metaphysis and epiphysis.

A

Type IV fractures

79
Q

occur when there is a crush injury of the growth plate. The prognosis is poor because growth arrest and partial physeal closure are common.

A

Type V fractures

80
Q

Patient is 14 years old, he is shorter than classmates by quite a bit. His labs are normal, his bone age is that of 12 year old. Dad says he was a late bloomer himself

A

Constitutional growth delay
normal labs
bone age is delayed and have relative with same

81
Q

Patient is much shorter than classmates. Has normal bone age, normal growth velocity. Mom is 5’0 and dad is 5’3

A

familial short stature

82
Q

One week old infant in NICU, mom delivered at 35 weeks, had diarrhea shortly before delivery. Infant with fever, tachycardia, tachypnea. CSF with catalase+ oxidase- gram + bacilli. On vanc and gent, any changes to management?

A 
Switch to ampicillin, stop vanc
Dx listeria (mom with diarrhea illness)
83
Q

Management for labial adhesions

A

watch and wait; resolves 80% of time w/i a year

Can do estrogen cream with 90% effective rate and preferred medication

84
Q

Hereditary angioedema is ____ inherited.
C4 levels are ____
Due to deficiency of ____

A

Auto Dominant
Low C4
Absent C1 inhibitor
Tx with Bradykinin receptor antagonist

85
Q

3 month old with swelling of left jaw, labs with elevated WBC and ESR as well as elevated alk phos. XRAY with mandibular subperiosteal bone hyperplasia and soft tissue swelling

A

Caffey disease
infantile cortical hyperostosis
Auto Dominant
presents by 6 mo resolves 2 years old, mandible often involved and see cortical thickening

86
Q

At what age do we ‘okay’ OTC cough and cold medicine for kids

A

6 years old

kids less than 2 we see tachycardia, seizures and even death

87
Q

What symptoms are present in neonatal lupus?

A

annular facial rash, thrombocytopenia, elevated AST/ALT, low C4, +ANA
Check EKG; may see 3rd degree heart block from autoantibodies damaging cardiac muscle during devo

88
Q

What two food borne bacteria cause rapid onset vomiting after food ingestions

A

Likely TOXIN mediated

Staph aureus or Bacillus

89
Q

What bacteria are more likely to cause food borne illness where diarrhea dominates and occurs one to several days from exposure

A

Enterotoxigenic E coli, salmonella

90
Q

What is althletes heart?

A

Cardiac hypertrophy from increased wall thickness and LA enlargement, adaptive mechanism to constant forces of exercise. Is reversible
(HCM has LV outflow tract obstruction, decreased LV volumen)

91
Q

What causes a hypercyanotic ‘Tet’ spell?

A

Sudden increase in resistance to blood flow across pulmonary outflow tract–> get elevation of RV pressures and increase in R–> L flow at VSD.
it’s due to spasm of RV outflow tract leading to increased pulmonary flow (R–>L shunting of deoxy blood)

92
Q

How do you manage a Tet spell?

A

Increase pulm vasc resistance decrease systemic resistance
Increase blood flow to lungs, decrease blood to body
Legs to chest, sucrose, morphine, fluid bolus, phenlyephrine to decrease PVR and increase SVR

93
Q

Adrenoleukodystrophy is _____linked, associated with…

The mutation is _____ and what do we see on MRI

A

X linked perixosomal disorder
very long chain fatty acid levels
Due to mutation in the ABCD1 gene
MRI with demylenation in cerebral white matter

94
Q

LAD type I is inherited _____
It’s a defect in in ____
Leads to these findings

A

Auto Recessive
Beta-2 integrin
See impaired wound healing, omphalitis, delayed cord separation, skin and resp tract infections.
Absent CD18 on flow cytometry

95
Q

Overweight is BMI >_____

Obese is BMI >____

A

BMI >85%

BMI >95%

96
Q

16yo male with vesicular rash on neck. 20 vesicles, burning pain 4 days before.

A

Herpes gladiotorum

HSV-1; seen in wrestlers; see on face, neck and arms

97
Q

MCC of septic arthritis in kids

A

staph aureus

Tx with anit-staph, must irrigate and try to get culture may need to cover for MRSA

98
Q

Based on PECARN; what are 6 rules for low risk head trauma in kids <2yo

A

normal mentation,normal behavior, no LOC, no severe mech of injury, no nontrontal scalp hematoma, no evidency of skull fx
Can observe for several hrs w/o imaging
MRI over CT if needed for less radiation

99
Q

MCC of sensorineural hearing loss is…

A

Auto Recessive disorder of Connexin 26 mutation (accounts for 1/2 of hereditary hearing loss)

100
Q

Most common cause of infectious hearing loss

A

CMV; leads to partial hearing loss

101
Q

What decreases risk of initial stroke in SS patients that are high risk?

A

chronic transfusion

102
Q

What is treatment for lithium toxicity?

A

Iv hydration

Dialysis if severe levels

103
Q

What are three phases of pertussis?

A

Stage I: Catarrhal phse 1-2 weeks with low fever, coryza and mild cough
Stage II: Paroxysmal phase 2-8 weeks with paroxysms of intense cough and whoop + post tussive emesis
Stage III: Convalescent phase: slow improvement

104
Q

Gram neg coccobacillus that causes severe cough
What lab abnormalities do we see
What is tx?

A

Bordatella pertussis
Absolute lymphocytosis even >50,000 lymph/micoL
Tx macrolides (azithro, clarithro and erythro)

105
Q

Group of disorders with smooth surface of cerebral cortex and mutation of DCX on chrom X

A

Lissencephaly; group of disorders

Seizures, microcephaly, need feeding tube, shortened life expectancy and hypotonia

106
Q

Patient with itchy, palpable rash on butt and thighs, abdominal pain, joint pain and hematuria.
DX
Tx
Where is intussusception located?

A 
HSP; systemic small vessel vasculitis
Palpable purpuric rash, ab pain, hematuria and joint pain
follows URI
Can have ileo-ileal intussusception 
No thrombocytopenia or coagulopathy
107
Q

Study a group of similar individuals with similar exposure to see if develop disease over time

A

Cohort

Me and my cohorts are in this together, but sometimes we change

108
Q

Analyze a known outcome by looking back to assess for exposure

A

Case control

Case = have cases or disease

109
Q

What are the four stages to pediatric weight management in obese children?

A

1: Prevention plus
2. Structured weight management
3. Comprehensive multidisciplinary eval
4. Tertiary care intervention

110
Q

Most common CV disease risk factor in peds is

A

dyslipidemia

111
Q

MMR should be delayed ____ after receiving IVIG

A

11 months

Bc passive transferred IgG may prevent viral replication needed to induce immunity

112
Q

enhances recovery btwn bouts of exercise but can cause dehydration, cramps and GI upset

A

Creatinine

113
Q

Cardiac abnormalties seen in anorexic patients

A

Increased risk of MVP; hear midsystolic click with late systolic murmur
Bradycardia and AV block, ST depression, T wave inversion and long QT

114
Q

Most common TE fistula

A

Type C esophageal atresia with distal TE fistula

Seen in VACTERL

115
Q

Abdominla pain, hematuria, hyperchloremic hypokalemic metabolic acidosis, urine pH >5.5 and kidney stones

A

Type 1 RTA

116
Q

Patient who is 2 presents with anemia, pallor. PE notable for HSP and smear showing target cells with Heinz bodies on smear and microcytic hypochromic anemia

A

Hemoglobin H

3 alpha alleles affected; two unstable hemoglobins present in blood: barts and H with high affinity for O2

117
Q

Treatment for Hemogobin H

A

Transfusion and chelation

118
Q

Female 15 yo with weight gain, hair loss, irregular periods adn BL symmetric goiter likely to have these antibodies present

A

Anti-thyroid peroxidase antiB

Hashimotos

119
Q

When should a child with pertussis be admitted to the hospital?

A

Increase WOB, PNA, inability to feed, cyanosis, apnea and age < 4 months

120
Q

Patient is 6yo with ADHD and progressive paralysis as well as adrenal insufficiency.
Dx?
Inheritance?
Cause

A

Adrenoleukodistrophy
X link recessive
Peroxisomal disorder with elevated Very long chain FA and elevated ACTH

121
Q

Patient is in teens, has night blidness, short 4th toe, ichthiyosis (scaling of skin) hearing loss and peripheral neuropathy leading to ataxia

A

Refsum syndrome
Auto REcessive
peroxisomal disorder from phytanoyl CoA hydroxylase deficiency

122
Q

2 year old with devo delay, self aggressive behaviors and hand biting, chorea movements. Labs with elevated uric acid

A

Lesch Nyhan syndrome
X link recessive
Deficient HGPRT leading to build up of purines then uric acid

123
Q

Maple syrup urine disease is due to

A

deficient branched chain alpha ketoacid dehydrogenase

124
Q

Activated charcoal is good for AAA and A

not for MLL

A

Asa, Acetaminophen, Anticholinergics and Asthma (theophyline) stuff in tables
NOT for MLL (metals, liquids, lithium)

125
Q

How do we manage severe hyperammonemia/lethargy/vomiting/low tone in patient with urea cycle defect disorder?

A

Temporarily limit protein intake and increase carbs and lipids to prevent further muscle breakdown; avoid catabolism

126
Q

MCC of epididymitis in males not sexually active

A

Mycoplasma pneumoniae adn enterovirus

See scrotal swelling, pain relieved with elevation and dysuria

127
Q

3 day old born at home presents with right eye swelling, purulent discharge. What is most concerning diagnosis?
How do we definitively diagnose and what is treatment?

A

Neisseria gonorrhea conjuctivitis– can lead to ulceration
Dx with culture
Tx single dose 3rd gen cephalosporin

128
Q

When do we screen for T2DM?

A

Overweight and 10 years or older or have started puberty with at least one RF:

  • T2DM in 1st or 2nd degree family member
  • Member of high risk racial/ethnic group: Native american, latino, AA, Asian, Pacific island
  • Maternal Hx of DM or gestational DM
  • Signs of insulin resistance
129
Q

What is the screen for T2DM?

A

Fasting oral glucose OR

HA1C or oral glucose tolerance test; should be done q3 if qualifty for screening

130
Q

Takes turns in a game, seperates easily from parents, dresses and undresses self and name a friend

A

3 year old

131
Q

Uses 2-3 word sentances, do simple puzzles with 3-4 pieces, copy a cirlce, climbs and pedals tricycle

A

3 year old

132
Q

Can hop on one foot, use scissors and draw person with 3 body parts

A

4 year old

133
Q

Knows first and last name, would rather play with other kids then alone

A

4 year old

134
Q

Walk on tip toes, throw a ball overhead and kick a ball

A

2 year old

135
Q

Build 4 block tower, follows 2 step command, points to 10 pictures and 50% of language is understandable

A

2 year old

136
Q

Newborn with 2/6 midsystolic murmur heard at the LUSB radiates to axillae and back

A

peripheral pulmonary artery stenosis

137
Q

Patient with severe anemia and no PMH. She had a cough, fever, myalgias and malaise two weeks prior and CXR shows bilateral interstitial infiltrates
MCV 86, HgB 5, WBC is 10000 with 50% lymps, PLTS 45, retic is 6% with elevated LDH and elevated bili and direct bili

A

Mycoplasma pneumonia with cold agglutin anemia
IgM antiB from mycoplasma cross react with RBC–> IGM-RBC complex to activate complement cascade
See hemolytic anemia + elevated retic + elevated LDH and low haptoglobin

138
Q

Start on new drug and get fever, rash, elevated LFTs and Creatinine with eosinophilia

A

Drug induced hypersensitivity syndrome

139
Q

Patients with labial hypertrophy (young females) can present with pain, irritation, increased risk of infection. What do they need to do?

A

Increase personal hygiene especially with sports, sex and menses

140
Q

One year old w/ hx of hypotonia and enlarged head comes to ED in setting of URI encephalopathic. Head imaging shows chronic subdurals and retinal hemorrhages but no other NAT signs. What lab can we get to confirm dx?

A

Urinary glutaric acid levels.
Deficiency of riboflavin-dependent glutaryl-CoA dehydrogenase (GCDH) needed to breadkwon lysine, hydroxylisine and tryptophan

141
Q

How do patients with glutaric acidemia type 1 present?

A

Hyperammenomia, ketoacidosis, hypoglycemia, encephalopathic. See retinal and subdural effusions/hemorrhages

142
Q

3 year old with strawberry tongue, diffuse blanchind sandpaper rash with papules spreads from groin to armpits to trunk/ext and spares palms and soles.

A

scarlet fever from Strep pyogenes exotoxin A

143
Q

Patients with ingestion of this have ketosis without acidosis! See CNS depression, from antifreeze/sanitizer

A

Isopropyl alcohol

144
Q

The most common organism in dog bites is

A

Pasteurella multicoda

145
Q

Niemann Pick A is _____inheritance and caused by _____ deficiency
What is seen on BM biopsy

A

auto recessive
sphingomyelinase deficiency
See foamy histiocytes in BM as well as spleen, pulmonary and hepatic sinusoids

146
Q

Patient with feeding difficulties, hypotonia, psychomotor retardation and FTT. Cherry red spot on macula with HSP

A

Niemann Pick A

B has NO hsp and interstitial lung disease

147
Q

Causes of metabolic alkalosis

A

primary hyperaldosteronism

kaliuretic drugs, Bartters syndrome severe K depletion excessive licorice

148
Q

Patient can run, walk backwards, say 6 words, use a spoon and fork, walk up steps, kick a ball

A

18 months

149
Q

At what age can a child scribble spontaneously and stack 4 blocks

A

18 months

150
Q

This type of spider bite leads to itching and necrosis of lesions at 2-12 hrs, varies in severity.
Dx and tx

A

Brown recluse spider
Tx is minor debridement and pain management
BUT can see severe necrosis and renal fail; dont empirically admit and give antiBx can make worse.

151
Q

This AED cause nail hypoplsia, IUGR, epicanthal folds, hypertelorism and devo delay

A

Phentoin

152
Q

This AED causes NTDefect, epicanthal folds and devo delay

A

valproic

153
Q

this AED causes nail hypoplasia, NTDs, microcephaly, epicanthal folds and devo delay

A

Carbamazepine

154
Q

Neonatal thyrotoxicosis presents in moms with untreated ____ disease.
What cardiac SE do we see?

A

Graves; can have hyperthyroid disease

See high output cardiac fail

155
Q

Newborn with triangular face, frontal bossing, moist skin and tachycardia with hyperactivity.

A

Neonatal hyperthyroidism; from untreated Graves and elevated maternal serum TSH receptor antiBs

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