Clerkships-PEDIATRICS Flashcards

1
Q

1) mongolian spot. comprised of? 2) pale pink vascular macules in nuchal area or face 3) firm yellow-white pustules/papules on an erythematous base, perhaps seen on DOL 2; what would you find on bx? 4) cherry hemangioma

A

1) arrested melanocytes 2) nevus simplex 3) erythema toxicum; eosinophils 4) raised, palpable

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2
Q

2 ddx for papules on the face in neonate 2 distinguishing features

A

baby acne (not present on day 1 of life) milia

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3
Q

Etiology of neonatal acne!

A

Maternal hormones! (not p. acnes)

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4
Q

What is this rash called? How is it characterized? Tx and why?

A

Nevus sebaceous, an area of alopecia with orange colored nodular skin,

tx by removing before adolescence bc of malignant transformation risk

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5
Q

What is the cradle cap? tx and definition (looks like impetigo but it’s not)

A

Seborrheic dermatitis, “thick yellow/white oily scale on an erythematous base.”

tx, clean with shampoo

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6
Q

What two things are mandatory on neonatal screens?

Timing of the px of each?

A

PKU, Galactosemia (can cross placenta!)

PKU longer time to show up, galactosemia present right away.

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7
Q

Days of jaundice, levels; dx? NBS?

1, 14, .5

2-3, 10, .5 (normal stool and feeds)

7, 12, .5 (dry mucous membranes)

14, 12, .4 (otherwise healthy, regained birth weight)

A

1) Hemolytic, DAT- if +
2) physiologic jaundice of newborn, should resolve by day 5
3) breast FEEDING jaundice (def?)
4) breast MILK jaundice (def?)

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8
Q

Other kinds of jaundice:

1) Dark urine, pale stools
2) Rando INHERITED causes of indirect
3) Rando INHERITED causes of direct
4) Random non-inherited cuases of DIRECT

A

1) Cholestatic/biliary atresia
2) Gilbert’s (less enzyme), Criggler Najjar type 1 (abscent enzyme UDP-glucuronyl-tranferase)
3) Rotor’s, Dubin Johnson
4) sepsis, hypothyroidism, galactosemia, CF, choledochal cyst

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9
Q

What is given to sickle patients to prevent encapsulated infxn?

A

Penicillin

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10
Q

Postpericardiotomy syndrome

A

pericardial effusion 2/2 autoimmune response occurring 1-6 weeks postoperatively following surgery for congenital heart disease.

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11
Q

Foreign body in the vagina

A

common in pre-pubertal girls. The foreign body should be removed before CPS is contacted, if warranted.

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12
Q

Wheezing that improves with neck extension and unaffected by bronchodilators. Etiology?

A

Tracheal compression by a vascular right (ex. double aortic arch, right sided aorta, pulmonary sling, etc.)

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13
Q

Night terrors vs nightmares

A

Night terrors: non-REM, crying, screaming, tachycardia, no recollection

Nightmares: REM, no crying, no screaming, no tachy, recollection upon wakening

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14
Q

dx and nbs for baby with bowel loops in thorax

A

pulmonary hypoplasia

deliver baby in a place with ECMO, 3-4 days later correct surgically

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15
Q

Baby is cyanotic but becomes pink when crying.

Other asociated things to look for?

A

Choanal atresia,

CHARGE: coloboma, cognitive, heart defects, retarded growth, ear anomalies, eye anomalies

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16
Q

Gastroschisis vs Omphalocele vs Umbilical Hernia

A

Gastroschisis - lateral, no sac, not assoc. w/ any other anomalies, high AFP

Omphalocele - midline, sac, assoc. w/Beckwith Weidemann syndrome = ear pits, big baby, big tongue, low glucose

UH - HYPOTHYROIDISM, resolves by 2-3 years, if not, surgery

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17
Q

Management of itussusseption vs meconium ileus

A

Barium enema vs gastrograffin enema

(dx and tx)

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18
Q

CF genetics

A

AR!!!!!

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19
Q

cryptorchidism tx

A

if testes don’t descend within 1 year (reduces cancer risk; detection, not prevetion)

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20
Q

Midline suprapubic mass with anuria early in life. dx, tx,

A

(distended bladder is the mass here)

posterior urethral valves

NBS is catheterization for relief

surgery for correction

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21
Q

congenital adrenal hyperplasia (21-hydroxylase def.)

px, path, labs, dx, tx

A
  • ambiguous genitalia at birth
  • 21 hydroxylase deficiency (AR)
  • hyponatremia, hyperkalemia
  • 17 hydroxy-progesterone
  • hydrocortisone (replace cortisol), fludrocortisone (replaces aldosterone)
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22
Q

more medical name for osgood schlaughtters

A

traction apophysitis

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23
Q

IgA def vs Wiskott-Aldrich syndrome vs X-linked bruton’s agammaglobulinemia vs hyper IgM

Transfusion rxn/anaphylaxis?

Recurrent URI?

Giardia?

Serum levels?

A

IgA: yes, yes, yes, obv

WAS: (thrombocytopenia, otitis media, eczema)

Bruton’s: NO, yes, NO, no levels

hyper IgM: NO, yes, yes, high M, low G&A

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24
Q

intussusseption dxx,tx?

A

U/S targetoid mass

tx: air-contrast enema (dx and tx)

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25
Q

Most common symptoms of polycythemia of the newborn

A

Respiratory distress, cyanosis/tachypnea (decreased pulm perfusion 2/2 increased viscosity of blood), poor feeding, hypoglycemia, hypocalcemia, neurologic (seizures, jitteriness, irritability, lethargy)

tx: hydration and exchange transfusion

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26
Q

Fever >101.2 in neonate, <28 days old

A

sepsis until proven otherwise,

order everything

tx. amp/gent

GBS, listeria, E coli

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27
Q

Gonorrhea vs Chlamidia conjunctivitis neonate

A

Gonorrhea: DOL 3-5, purulent dcg, tx. ceftriaxone, topical erythromycin

Chlamidia: mucopurulent, DOL 7-14, tx oral erythromycin, chlamydial pneumonia concern

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28
Q

Most common cause of unilateral lymphadenopathy

A

Staph aureus

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29
Q

Lead posoning screenings?

A

Do screenings frequently. Try to do it before 5 years of age. If there’s more suspicion, do a SERUM lead and go from there.

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30
Q

How to potty train if child isn’t interested?

A

Stop potty training attempts for several months and allow the child to become interested.

If interested, then use positive reward techniques and regular scheduling.

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31
Q

The most common predisposing factor for acute bacterial sinusitis

A

Viral URI

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32
Q

Fluctuant, cervical lymphadenitis/lymphadenopathy 2 most causative agents and tx?

A

Staph/strep

DICLOXACILLIN

Cephalexin and clindamycin work as well

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33
Q

Congenital syphillis presentation and tx

A

HSM

Jaundice

Cutaneous Lesions

Anemia

Rhinorrhea

(metaphyseal dystrophy, periostitis)

TREAT: penicillin G

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34
Q

Most common causes of viral meningitis?

A

Echovirus, coxackievirus

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35
Q

Child falls on a pencil or a stick in his mouth. What can result? What is the mechanism? Time till onset?

vs.

postictal condition that usually rapidly improves with restoration of function within 24 hours

A

Stroke 2/2

Internal carotid artery dissection/thrombosis

onset can be up to 24 hours later

postictal (Todd’s) paralysis

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36
Q

Kid with ADD symptoms but also poor eye contact, poor language development

A

UNDETECTED HEARING DISORDER! DON’T MISS IT!

could be absence seizures

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37
Q

Most common cause of diarrhea in children? Some others?

A

Rotavirus (watery)

Norwalk (second most common)

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38
Q

MSK manifestation of Down’s

A

Atlanto-axial instability

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39
Q

Omphalocele, microcephaly, clenched hand, rocker bottom feet, hammertoe

Severe mental retardation, holoprosencephaly, microcephaly, cleft lip/palate

A

Edward’s Syndrome 18

Patau’s Syndrome 13

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40
Q

Breast milk vs formula

A

Breast milk

WHEY is dominant, more LONG-chain fatty acids, less iron but better absorbed, more lactose

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41
Q

14 yo boy, always been below 5th percentile for height, both parents are super tall and were late bloomers. dx? bone age vs actual age? prognosis for kid?

Same story, but both parents are super short. ???

Comment on bone age in obese ppl. Why?

A

Constitutional growth delay, bone age less than actual age (bones “have more room to grow), kid can attain height

Familial Short Stature, bone age=real age (bones “don’t have any more room to grow”), kid is doomed

Bone age>actual age, fat=estrogen

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42
Q

Most common leukemia in children? Dx?

A

ALL (acute lymphoblastic leukemia); +25% lymphoblasts in bone marrow

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43
Q

Spondylolisthesis

A

Developmental disorder in which a vertebrae makes a forward slip (L5 over S1 usually).

Palpable “step off” at lumbosacral area.

Cauda equina type symptoms

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44
Q

Easy bruisability and petechiae usually following a viral infection, px in early childhood

A

ITP

All labs normal except for thrombocytopenia

45
Q

Isolated appearance of axillary hair before the age of six, resulting from premature androgen secretion of the adrenal glands. tx?

pubic hair before the age of 8. tx?

A

premature adrenarche

benign, no clinical significance

premature pubarche, requires thorough eval, as it may be due to a CNS disorder

46
Q

Which newborn brachial palsy is accompanied by horner’s symptoms?

A

Klumpke’s (C7-8, T1)

47
Q

Give 3 contraindications to breastfeeding?

A

Active drug abuse,

TB,

HIV

48
Q

1) CLASSIC TRIAD OF TOXOPLASMOSIS
2) SYPHILIS
3) RUBELLA
4) HSV

A

1) CHORIORETINITIS, HYDROCEPHALUS, INTRACRANIAL CALCIFICATIONS
2) fever, osteitis, osteochondritis, mucocutaneous lesions, lymphadenopathy, hepatomegaly, rhinitis
3) microcephaly, microphthalmia, meningoencephalitis, sensorineural deafness, PDA, ASD, congenital glaucoma/cataract
4) encephalitis, chorioretinitis, NO MICROCEPHALY/MICROPHTALMIA

49
Q

Cri-du-chat syndrome is due to what? Px?

A

5p deletion

microcephaly, hypotonia, short stature, cat-like cry

50
Q

Long term neurologic sequelae of bacterial meningitis (that can prevent kids from reaching developmental milestones, etc.)

A

hearing loss

loss of neurons in dentate gyrus

seizures

mental retardation

spasticity or paresis

51
Q

tx for exacerbation of lung dz 2/2 CF? which organism

A

penicillin/cephalosporin+aminoglycoside

covers pseudomonas

(ex. ceftazidime+gentamicin)

52
Q

Gastric residues?

Bloody diarrhea with eosinophils, fam hx of atopy

A

NEC

milk protein intolerance

53
Q

Distinguish TTNB from HMD

A

HMD has fine granularity on CXR

54
Q

To Screen for dystrophies? To confirm dx?

A

CK levels

Muscle biopsy

55
Q

Sturge-Weber (3 characterisstics), (4 more presentations), xray findings, tx (3)

A

Generalized seizures, mental retardation, portwine (nevus flammeus) along trigeminal [2/2 congenital unilateral cavernous hemangioma]

hemianopia, hemiparesis, hemisensory disturbance, ipsilateral glaucoma

2+ years old, xray shows gyriform intracranial calcifications that resemble a tramline

tx aimed at reducing intraocular pressure and reducing seizures, lazer therapy to remove skin lesions

56
Q

Treatment for the following: wonder drug (levitiracetam)

1) Absence
2) Trigeminal Neuralgia
3) Myoclonic (helmet), Atonic
4) Febrile Seizures
5) Seizure abortive measure heirarchy (all IV)
6) Wes Syndrome of infantile spasms

A

levitiracetam

1) ethosuximide
2) carbamazepine
3) valproic acid
4) acetaminophen (tx source)
5) lorazepam, phenytoin, phenobarbital, midazolam+propofol
6) ACTH

57
Q

Define:

Complex vs. Simple

Generalized vs Partial

Seizures vs Epilepsy

A

+LOC vs -LOC

Whole body vs Specific symptoms (loss of tone?)

One episode vs life long with “focus” of neuroconductive abnormality pathway

58
Q

how to distinguish seizures from syncope

A

SEIZURES WILL HAVE A POST-ICTAL STATE, in which patient slowly regains consciousness

59
Q

Atonic vs myoclonic vs absence seizures

loss of tone? loss of conciousness?

A

atonic and myoclonic both DO NOT have LOC (simple)

atonic has LOT while myoclonic is jerky

absence has LOC but no LOT

60
Q

Patient has infantile spasms, not febrile,

Dx?

Tx?

Hypopigmented spots shown with what test. what’s the name?

A

interictal EEG showing hypsarrythmia

tx ACTH

ash leaf spots, dx with woods lamp, seen in tuberous sclerosis. tx is supportive

61
Q

Loud S1, fixed split S2, gets tired in gym class

PDA assoc. with what infection

A

ASD

Cogenital rubella syndrome

62
Q

1) Super high fever, 3 days later resolves and now there’s a rash on the trunk and legs
2) Fever, Slapped cheeks
3) 2 weeks post sore throat, fine maculo-pap rash that starts on top and spreads down (tx?)
4) cough, fever, runny nose, rash top down, gray spots on the buccal mucosa (tx?)
5) sore throat, joint pain, fever, pinpoint rash on face that moves down, rose spots on palate

A

1) Roseola (HHV-6)
2) Erythema Infectiosum (Parvovirus B19)
3) Scarlet Fever (group A strep pyogenes) (PCN)
4) Measles (vitamin A) [koplik spots]
5) rubella (paramyxovirus)

63
Q

Scabies tx

Impetigo tx

A

Primethrin

topical muciprocin

64
Q

1) Most common meningitis bugs overall? Tx?
2) Young and immune suppressed? Tx?
3) Brain surg w/ instruments?
4) 2 Randos and (tx?)

A

1) Strep pneumo, H flu, Neisseiria meningitidis (encapsulated). Tx. IV Ceftriaxone + vancomycin + steroids
2) GBS, strep pneumo, Listeria, tx add ampicillin
3) Staph tx vanco
4) TB (ripe+steroids) , lyme (IV ceftriaxone)

65
Q

Retropharyngeal abcess

vs

Peritonsillar abcess

A

Can’t turn head, can lead to mediastinitis (retropharyngeal space communicates directly with mediastinum). tx I&D, strong abx

“hot potato voice”, deviated uvula tx I&D, strong abx

66
Q

Croup

Epiglottitis

Bronchiolitis

Pertussis

A

Parainfluenza, barking cough, steeple sign, racemic epi

H Flu, thumb sign, intubate in OR, ceftriaxone/vanc

RSV, wheezy cough/runny nose, swab, nebs, NO STEROIDS, rare: pavalizumab

Bordatella pertussis, whooping, lymphocytosis, erythromycin for patient and close contacts

67
Q

2 most common surgeries for Sickle cell patients

study to assess risk?

A

Chole

Tonsillectomy (hyperplasia happens in sickle)

transcranial doppler

68
Q

Blackfan Diamond

Fanconi’s Anemia

Lead Poisoning

A

Triphalangeal thumbs, pale baby, increased RBC ADA

tx. corticosteroid, stem cell transplant, transfusions

Absent thumbs, cafe-au-lait, microcephaly

tx. corticosteroids, stem cell txpt, androgens

Hyper baby, basophilic stippling

69
Q

Brain tumors in kids. Two most common.

(infratentorial!)

A

Pilocytic astrocytoma, resect, good prognosis

Medulloblastoma, increased ICP bc it blocks 4th ventricle, vermis, bad prognosis

70
Q

tx ALL?

What causes mediastinal mass w/resp distress

A

chemo + intrathecal mtx

non-hodgkins lymphoma. tx surgical excision and radiation

71
Q

Infant born to an HIV-positive mother. NBS?

A

Course of Zidovudine

72
Q

Metabolic derangement from immobilization?

A

“immobilization hypercalcemia” from sedentary-ness after a fracture, etc.

montior with serum calcium and urine calcium:creatinine ratios (greater than .2 is hypercalciuria)

treatment with mobilization, calcitonin in extreme cases

73
Q

Tx of hydrocele?

A

Observation, usually spontaneously resolve after 1 year of life

74
Q

Encephalofacial angiomatosis

A

another name for Sturge Weber syndrome

leptomeningeal angiomas

unilateral port-wine nevus

hemiparesis

75
Q

Distinguish calcifications caused by CMV vs toxoplasmosis. Mnemonic

A

cmV - periVentricular

toXoplasmosis - scattered throughout the corteX

76
Q

Infant with hemiparesis looking away from the paralyzed side.

Pathophys?

A

Acute Infantile hemiplegia

thomboocclusion of the middle cerebral artery

77
Q

Which “brain bleed” happens with shaken baby syndrome

A

SubDURAL hematoma (rupture of bridiging veins)

78
Q

Analgesia for circumcision?

A

Penile block

Topical Lidocaine

Subcutaneous Ring Block

79
Q

Parinaud Syndrome

A

Pineocytoma

Lid retraction, loss of vertical gaze, loss of pupilary light reflex, and convergence-regtraction nystagmus (eyes jerk back into orbit upon attempted upward gaze)

80
Q

Isoniazid MOA?

A

Inhibits pyridoxine utilization, therefore consider supplementing Vit B6 in children undergoing tuberculosis treatment.

Recall that B6 def. leads to peripheral neuropathy

81
Q

What is prune belly syndrome?

Features?

A

Urinary tract abnormalities, renal malformation, oligohydramnios, pulmonary hypoplasia, club feet, wrinkled abdomen, dilated urinary tract, intra-abdominal testes

82
Q

1) Dolichocephaly
2) Brachycephaly

A

1) Long, thin head
2) Broad head

83
Q

Acute disseminated encephalomyelitis

path?

timing?

features?

imaging?

tx?

A
  • autoimmune demyelinating condition seen in children less than 10 years of age
  • follows viral URI
  • fever, emesis, weakness, headache
  • MRI shows disseminated focal white matter lesions
  • corticosteroids
84
Q

tx for newborn galactosemia?

A

switch to soy-based or casein-based and avoid galactose

85
Q

Anaphylactoid purpura

A

Same thing as Henoch-Schonlein Purpura

86
Q

Hartnup disease

Path?

Features?

Treatment?

A

Intestinal malabsorption of tryptophan and other neutral amino acids

Red Scaly rash, emotional lability, episodic cerebellar ataxia, developmental delay

Treat with nicotinamide replenishment

87
Q

Cure for salycilate poisoning

A

NaCO3, acetazolamide, hemodialysis if extreme

88
Q

Which of the following has karytype abnormalities? Gastroschisis or Omphalocele? Which ones?

A

Omphalocele

the three Trisomies

89
Q

Antidote for phenothiazine poisoning? Symptoms of this?

A

Diphenhydramine

Opisthotonus, oculogyric crises, torticollis, tremors, dysphagia

90
Q

What kind of a patient would have an unresponsive intradermal skin test using Candida Albicans. Explain

A

DiGeorge.

T-cell deficiency (don’t forget hypocalcemia, heart defects, etc., too).

Therefore, you can’t mount the intradermal response to something like candida

91
Q

How to test for EHEC?

A

McConkey Agar

92
Q

hypothalamic harmatoma

A

preceded by laughter (gelastic seizures)

GHrH release leading to acromegaly

93
Q

General example, if you have a negative dipstick, then you’d probably want to do a urine culture.

A

But obviously if the dipstick was positive, then it’s high index of suspticion enough to consider the infection

94
Q

Tanner Stages

(review kaplan behavioral video on this?)

A

Tanner 1 - no pubes?

Tanner 2 - sparse, thin, long pubes

Tanner 3 - pubes begin to curl

Tanner 4 - resembles adult pubes, but incomplete coverage

Tanner 5 - resemlbes adult pubes, but extends on thigh

95
Q

Impaired ocular mobility, diplopia, pain greatest on upward gaze, infraorbital hypoesthesia,

following blunt force trauma

A

Orbital Floor Fracture

96
Q

Kid with SVT, NBS?

A

Adenosine (NOT CAROTID MASSAGE)

97
Q

Distinguish the definitions of primary vs secondary enuresis

Nocturnal vs diurnal

A

Primary - never followed by period of dryness

Secondary - enuresis followed by 6 months of dryness

Nocturnal - only during the nighttime

Diurnal - both night and day

98
Q

Explain the metabolic derangements you’d find and explain the pathophys:

1) 21-hydroxylase def. & addison’s disease
2) Conn’s Syndrome
3) von-Gierke’s disease

A

1) hypOnatremic hypERkalemia; low aldosterone (low cortisol/glucocorticoids as well)
2) hypERnatremic hypERchloremic hypOkalemic metabolic alkalosis; high aldosterone
3) hypO everything; VGD patients have glucose-6 phosphatase def. which lends hyperlipidemia. this reduces the aqueous volume which in turn “factitiously” reduces electrolyte concentrations in the reading (the machine thinks there’s normal volume, but there’s actually less) tai

99
Q

Legg-Calve-Perth’s Disease

SCFE

Transient synovitis of the hip

A

Femoral head necrosis

Common in blacks, knee pain referred to hip, early teens

Post-infectious condition affecting toddlers

100
Q

Wiskott aldrich new mnemonic

A

TEA-TIME

T-cell dysfunction

Hyper IgE, A

Thrombocytopenia

Infection (otitis media)

LOW IgM

Eczema

101
Q

hypsarrythmia

A

multifocal high amplitude spikes and slowing on EEG

(characteristic of West’s infantile spasm syndrome)

tx. ACTH

102
Q

Best treatment to stop carriage of Group A Strep from oropharyngeal secretions

A

Oral Clindamycin or quinolone

103
Q

Hurler’s Syndrome

A

mucopolysaccridosis type I

alpha-L-iduronidase def. leading to deposition of dermatan and heparan sulfate in the skin and excessive excretion in the urine

umbilical hernia, kyphoscoliosis, deafness, cloudy cornea, claw hand

104
Q

General triad of storage diseases

A

HSM

Coarse Facies

Progressive developmental delay

105
Q

What is ebstein anomaly

A

Downward displacement of the tricuspid valve

106
Q

WHICH RASH HAS EOSINOPHILS

A

ERYTHEMA TOXICUM

107
Q

Paraphimosis. path and tx?

A

Foreskin is retracted over the glans and does not return to its original position. Emergency.

NBS: manual reduction of the skin back into place

108
Q

What does ivermectin treat?

A

cutaneous larva migrans (creeping eruption) caused by dog or cat hookworms