CLINICALPeds EOR Exam_Rosh_SmartyPance Flashcards

Question 1

Q

SmartyPance

what is most common cause of acute bronchiolitis in children?

Answer

A

RSV

esp in fall and winter months

Question 2

Q

SmartyPance

how is acute bronchiolitis treated?

Answer

A

supportive:

humidified O2
antipyretics
beta agonist
nebulized racemic epi
steroids

Question 3

Q

SmartyPance

what is the only treatment demonstrated to improve bronchiolitis?

Question 4

Q

SmartyPance

what are hospitalization criteria for acute bronchiolitis?

Answer

A

If O2 sat <95-96%

if age <3 months

if RR>70

if child has nasal flaring or retractions

if CXR shows atelectasis

Question 5

Q

SmartyPance

what are common s/s of acute bronchiolitis?

Answer

A

tachypnea
respiratory distress
wheezing

Question 6

Q

SmartyPance

what is the most common cause of lower respiratory tract infection in children worldwide?

Answer

A

Respiratory
Syncytial
Virus

(virtually all children get it by age 3)

Question 7

Q

SmartyPance

what is the leading cause of pneumonia and bronchiolitis?

Answer

A

Respiratory
Syncytial
Virus

Question 8

Q

SmartyPance

s/s of RSV?

Answer

A

rhinorrhea
wheezing/coughing (persists for months)
low grade fever
nasal flaring/retractions
nail bed cyanosis

Question 9

Q

SmartyPance

how is RSV diagnosed?

Answer

A

nasal washing, RSV antigen test

CXR can show diffuse infiltrates

(in real life, it’s diagnosed clinically, maybe with nasal swab)

Question 10

Q

SmartyPance

how is RSV treated?

Answer

A

supportive measures:

albuterol via nebulizer
antipyretics
humidified O2
steroids (controversial)
resolves in 5-7 days

Question 11

Q

SmartyPance

what kids get vaccinations for RSV?

Answer

A

kids with lung issues, born premature (<30 weeks), immunocompromised

once per month for five months, start in Nov.

Question 12

Q

(Rosh Review)

what ages of children most often present with retropharyngeal abscesses?

Question 13

Q

(Rosh Review)

what are the two most common causes of retropharyngeal abscesses?

Answer

A

Strep pyogenes

Staph aureus

Question 14

Q

(Rosh Review)

presentation of a child with retropharyngeal abscess?

Answer

A

fever
odynophagia (painful swallowing)
stridor
drooling
torticollis

Question 15

Q

(Rosh Review)

what specific type of position and imaging is required for diagnosis of retropharyngeal abscess?

Answer

A

Xray
on INSPIRATION
with neck EXTENSION

(if xray is positive, get CT of neck with contrast)

Question 16

Q

(Rosh Review)

What is the plan for children with retropharyngeal abscess?

Answer

A

hospitalization
otolaryngologist consult

IV abx would likely include ampicillin-sulbactam or clindamycin

Question 17

Q

(Rosh Review)

what is the involuntary compulsive use of obscenities seen in Tourette’s syndrome?

Answer

A

coprolalia (a type of tic)

Question 18

Q

(Rosh Review)

three descriptors of candidal diaper dermatitis

Answer

A

beefy red plaques
satellite lesions
inguinal folds are involved

Question 19

Q

(Rosh Review)

treatment of choice for candidal diaper dermatitis

Answer

A

nystatin ointment

apply 2-3 x/daily, continue until rash has fully resolved for 48 hrs

Question 20

Q

(Rosh Review)

define complex febrile seizures (three factors)

Answer

A

multiple szs occur during the same febrile illness,
szs are prolonged (>15 minutes)
szs have a focal component

(not all criteria required to dx complex febrile sz)

Question 21

Q

(Rosh Review)

seizures lasting under 15 minutes are _______

Answer

A

…associated with simple febrile seizures

when multiple szs occur w/in same febrile illness, szs are classified as complex

Question 22

Q

(Rosh Review)

what is first-line therapy while baby is in the hospital with bronchiolitis, RSV?

Answer

A

supportive care is first line therapy while in hospital, which includes suctioning of nares with saline

Question 23

Q

(Rosh Review)

what is the difference between croup and bacterial tracheitis?

Answer

A

bacterial tracheitis is croup that worsens despite treatment
high fever develops
airway compromise risk is higher
(this is usually caused by Staph aureus)

Question 24

Q

(Rosh Review)

slippage of femoral head on femoral neck

Answer

A

slipped capital femoral epiphysis (SCFE)

Question 25

Q

(Rosh Review)

presentation of acute slipped capital femoral epiphysis

Answer

A

pain in hip, groin, knee
gait abnormalities
decreased ROM
pain dull (chronic) or sharp (acute)
limited flexion of hip
LIMP

Question 26

Q

(Rosh Review + SmartyPance)

what is treatment of slipped capital femoral epiphysis?

Answer

A

casting, surgery (fixation with screw), or both

(SmartyPance: PROPHYLACTIC SCREW FIXATION of the contralateral hip may be considered for patients, as there is a risk of the disease in the contralateral hip later in life - usually for patients < 10 or > 16 years of age)

Question 27

Q

(Rosh Review)

complications of slipped capital femoral epiphysis

Answer

A

avascular necrosis of femoral head

osteonecrosis

Question 28

Q

(SmartyPance)

how is diagnosis of slipped capital femoral epiphysis made?

Answer

A

radiography

AP and frog-leg lateral of right and left hip
- lateral radiograph is the best way to identify a subtle slip

Question 29

Q

(Didactic)

name three causes of microcephaly

Answer

A

Down’s, Fetal Alcohol Syndrome, Zika

Question 30

Q

(SmartyPance)
define Downs Syndrome
what is special about it?

Answer

A

chromosome 21 disorder causing developmental and intellectual delays

MC chromosomal disorder
MC cause of mental retardation

Question 31

Q

(SmartyPance)

RF for Downs:

Answer

A

advanced maternal age

1: 1500 in women <20 yrs
1: 25 in women >45 yrs

Question 32

Q

(SmartyPance)

three comorbidities common with Down’s

Answer

A

ALL
early-onset Alzheimer’s
atlantoaxial instability

Question 33

Q

(SmartyPance)

Dx for Down’s:

Answer

A

PRENATAL:

first trimester U/S
amniocentesis
chorionic villus sampling (CVS)
quadruple screen

POSTNATAL:
- clinical identification of dysmorphic features

Question 34

Q

(SmartyPance)

treatment for Down’s

Answer

A

prenatal genetic counseling

supportive management of affected body systems

Question 35

Q

(SmartyPance)

what is Turner Syndrome?

Answer

A

genetic disorder caused by a missing X chromosome in females
(45X0)

Question 36

Q

(SmartyPance)

how is Turner Syndrome diagnosed?

Answer

A

physical exam

pt hx

Question 37

Q

(SmartyPance)

what is the test of choice for suspected Turner Syndrome?

Answer

A

karyotype analysis
(may identify 45X0)

Question 38

Q

(SmartyPance)

what is treatment of Turner Syndrome?

Answer

A

growth hormone therapy

sex hormone replacement therapy

Question 39

Q

(RoshReview)

what is the name of the disease caused by the measles virus?

Question 40

Q

(SmartyPance)

How is measles diagnosis made?

Answer

A

clinically:

hx of fever at least 3 days
at least one of the 3 C’s (cough, coryza, conjunctivitis)

maybe also Koplik’s spots
maybe you get labs and find measles IgM antibodies or isolation of measles virus RNA from resp specimens

Question 41

Q

(SmartyPance)

what is the treatment for measles?

Answer

A

SUPPORTIVE
- anti-inflammatories

ISOLATION
- 1 week after onset of rash

**vaccination is highly effective

Question 42

Q

(RoshReview)

how does the measles rash spread?

Answer

A

red maculopapular eruption rash begins in forehead, behind ears, on upper neck ——> spreading to torso, extremities

Question 43

Q

(RoshReview)

what is first line abx treatment for epiglottitis?

Answer

A

CEFTRIAXONE - OR -
cefotaxime plus vancomycin

(this covers H.influenzae and GAS)

Question 44

Q

(RoshReview)

when are antibiotics administered for epiglottitis patients?

Answer

A

only after pt’s airway has been protected through intubation

Question 45

Q

(RoshReview)

what the finding on lateral neck XR for epiglottitis?

Answer

A

thumbprint sign

Question 46

Q

(RoshReview)

what is NOW the MC cause of acute epiglottitis in pediatric population?

Answer

A

Group A Strep

before vaccination, H. influenzae type b was most common

Question 47

Q

(SmartyPance)

how do we diagnose epiglottitis?

Answer

A

first, secure the airway, then

CULTURE

Question 48

Q

(RoshReview)

How do we treat pertussis?

Answer

A

oral macrolide antibiotics:

erythromycin
azithromycin, or
clarithromycin

everyone in the house gets this treatment too, as prophylaxis!!

Question 49

Q

(RoshReview)

How is pertussis definitively diagnosed?

Answer

A

isolating the organism from a nasopharyngeal culture

Question 50

Q

(RoshReview)

what is the pattern of spread of the rubeola rash?

Answer

A

centrifugal

begins on head, spreads down face to trunk and extremities

Question 51

Q

(PPP)

how do we diagnose acne vulgaris? (mild, moderate severe)

Answer

A

mild: comedones, sm amts of papules &/or pustules
moderate: comedones, lgr amts of papules &/or pustules
severe: nodular (>5mm) or cystic acne

Question 52

Q

(PPP 609)

How do we treat mild acne vulgaris?

Answer

A

MILD: TOPICALLY

azelaic acid
salicylic acid
benzoyl peroxide
retinoids
tretinoin
topical abx like Clindamycin or Erythromycin

Question 53

Q

(PPP 609)

how do we treat SEVERE acne vulgaris?

Answer

A

severe (refractory nodular acne): oral isotretinoin

Question 54

Q

(PPP 609)

How do we treat moderate acne vulgaris?

Answer

A

moderate:  
topically (as with MILD), 
add oral abx (i.e. minocycline or doxycycline)
     or 
          spironolactone

Question 55

Q

(PPP)

how do we treat mild acne vulgaris?

Answer

A

mild: topically
- azelaic acid, salicylic acid, benzoyl peroxide, retinoids, tretinoin or topical antibiotics
- topical abx –> i.e. clindamycin or erythromycin

Question 56

Q

(PPP 612)

how do we diagnose androgenetic alopecia?

Answer

A

clinically

- dermoscopy maybe…look for miniaturized hair and brown perihlar casts

Question 57

Q

(PPP 612)

how do we treat androgenetic alopecia?

Answer

A

Topically, orally, or transplant

Topical: minoxidil, needs 4-6 month trial (widens blood vessels, allowing more blood O2 & nutrients to promote anagen/growth phase

Oral: 5-alpha reductase type 2 inhibitor (inhibits the conversion of testosterone to dihydrotestosterone)

Transplant: effective, works if pt has sufficient # of donor plugs

Question 58

Q

(PPP 616)

How do we diagnose erythema infectiosum?

Answer

A

clinically

(can also look for parvoviris-specific IgM via serology)

Question 59

Q

(PPP 616)

How do we treat erythema infectiosum?

Answer

A

supportive
- anti-inflammatories (acetaminophen or NSAIDs)

it’s a self-limited disease

Question 60

Q

(PPP 617)

How do we diagnose HFMD?

Answer

A

clinically

- you could do a culture for cocksackievirus-specific immunoglobulin A

Question 61

Q

(PPP 617)

How do we treat HFMD?

Answer

A

supportive

antipyretics (acetaminophen, ibuprofen)
hydration
topical lidocaine

Question 62

Q

(PPP 620)

how do we diagnose impetigo?

Answer

A

clinically

can do gram stain and wound culture if you wish

Question 63

Q

(PPP 620)

How do we treat EXTENSIVE impetigo?

Answer

A

EXTENSIVE: systemic abx like cephalexin or dicloxacillin (a PCN) or macrolides

Question 64

Q

(PPP 620)

how do we treat COMMUNITY-ACQUIRED MRSA impetigo?

Answer

A

COMMUNITY-ACQUIRED MRSA:
 - doxycycline
 - clindamycin
or
- TMP-SMX

Answer 62

A

MILD:  
mupirocin tid x10 days, 
or bacitracin, 
or retapamulin, 
wash with soap & water

Answer 63

A

rash, due to
defective skin barrier
susceptible to drying, 
leading to pruritus & inflammation
"the itch that rashes"

Answer 64

A

eczema + allergic rhinitis + asthma

Answer 65

A

clinically

increased IgE supports dx

Answer 66

A

1 - topical corticosteroids, first line. Also, antihistamines for itching. Wet dressings. (treat secondary infections w/ abx)

2 - topical calcineurin inhibitors (alternatives to steroids): tacrolimus, pimecrolimus

3 - systemic: phototherapy, cyclosporine, azathioprine, mycophenolate mofetil, methotrexate, dupilumab

Answer 67

A

clinically

can do PATCH TESTING to id potential allergens
histology not needed, but will show spongiosis (intercellular edema in epidermis)

Answer 68

A

AVOIDANCE - id and avoidance of irrititnts

CORTICOSTEROIDS: topical corticosteroids, first line trtmt
- severe rxn? add oral corticosteroids

CALCINEURIN INHIBITORS: topical calcineurin inhibitors - tacrolimus or pimecrolimus

Answer 69

A

head 18%
back 18%
chest 18%

each leg 14%
each arm 9%

Answer 70

A

patient’s palm = 1%

Answer 71

A

monitor ABCs
fluid replacement
1% silver sulfadiazine

MILD:
soap & water
drain & debride bullae
cover w/ silver sulfadiazine

MODERATE/SEVERE:
cover w/ dry dressing
admit

Answer 72

A

ABG
CBC
CMP
CK
U/A
carboxyhemoglobin

Answer 73

A

kids with >10% total BSA GET FLUIDS

LR 3mL x wt (kg) x %BSA
“half given in 1st 8 hrs, then 16 hrs”

Answer 74

A

adverse cutaneous rxn in response to admin of a drug, usually w/in past 6 weeks

Answer 75

A

skin reactions

Answer 76

A

penicillin (amoxicillin, ampicillin)
TMP-SMX (bactrim)
allopurinol
NSAIDs
CCBs
sulfonamides
anticonvulsants

Answer 77

A

clinically

- a biopsy may help

Answer 78

A

topical metronidazole (AVOID STEROIDS)
mild, first line, topical alone:
       - pimecrolimus 0.1%
       - erythromycin solution q12 hrs
       - metronidazole 0.75% gel q12 hr
        - Clindamycin lotion q12 hours

moderate:
- topical + oral abx

Oral ABX: Doxycycline if necessary - no gels, solutions, or lotions on eye

Answer 79

A

TYPE IV HYPERSENSITIVITY RXN
affecting skin and mucous membranes

an acute, self-limited, sometimes recurring skin condition that affects extremities and mucosa

Answer 80

A

target iris lesions, dull “violet” red

Answer 81

A

blanching

lack of itchiness

Answer 82

A

clinical hx

phys exam

Answer 83

A

remove the offending agent

IV fluids if needed
magic mouthwash
systemic steroids if it’s severe

Answer 84

A

Major: widespread skin lesions, affects 2+ mucosal sites

Minor: limited region of skin affected, 1 type of mucosa affected (usually oral)

Answer 85

A

pruritic scalp, body, or groin

small white specs on hair shaft

Answer 86

A

launder potential fomites in water >131 F

permitherin topical drug of choice

 - capitis?  permitherin shampoo x 10 minutes
 - pubis?  permitherin lotion x 8 hrs

Answer 87

A

papulosquamous inflammatory dermatosis

of unknown etiology,
probably autoimmune in origin

Answer 88

A

the 5 P's:
purple
papule
polygonal
pruritis
planer

Answer 89

A

topical steroids

Answer 90

A

S-shaped or linear burrows on skin

often on web spaces of hands, wrists, waist
severe itching, worse at night

Answer 91

A

> 2 months old?
topical permethrin 5%
apply to entire body and wash after 8-14 hrs, repeat in 1 week

Answer 92

A

sulfur 5%-10% ointment

Answer 93

A

oral ivermectin

Answer 94

A

no, pruritus may persist for 2-4 weeks after treatment

Answer 95

A

rare
serious hypersensitivity complex
affects skin and mucous membranes
reaction to meds or infection

MC caused by anticonvulsants and sulfa drugs

Answer 96

A

3-10% OF THE BODY

Answer 97

A

skin biopsy show necrotic epithelium

ddx includes erythema multiforme, viral exanthems, drug rash

Answer 98

A

stop all offending medications

early admit to burn unit
manage fluids/electrolytes/nutrition, airway, eye care

Answer 99

A

scrape and KOH prep

(dermatophytes = long branching fungal hyphae with septations

candidiasis = budding yeast, pseudohyphae

tinea versicolor = short hyphae and clusters of spores (“spaghetti and meatballs”)

Answer 100

A

Oral griseofulvin (Drug of Choice): 20–25 mg/kg/24 h (max 1 g/24 h) once daily or divided b.i.d. of microsize griseofulvin for 6–8 weeks.

In addition, topical therapy of 2.5% selenium sulfide or ketoconazole shampoo twice weekly suppresses viable spores. Laboratory monitoring is not needed.

Systemic therapy warranted to penetrate the hair shaft

Answer 101

A

Topical azole antifungals (1% clotrimazole, 2% ketoconazole)
or
1% terbinafine cream applied twice daily for 2–4 weeks.

Answer 102

A

A rare, life-threatening skin condition that is usually caused by a reaction to drugs

TOXIC EPIDERMAL NECROLYSIS IS >30% OF THE BODY
(very similar to Steven-Johnson)

Answer 103

A

The difference is the AGE of the individuals (in toxic epidermal necrolysis older patients vs. SJS younger patient)
and
percentage of the body affected (in TEN > 30% of body surface area affected vs. SJS < 10% of body surface area affected)

Answer 104

A

biopsy

necrotic epithelium

Answer 105

A

admit to burn unit with supportive care;

consult ophthalmology if eyes affected;

cyclosporine
and
possibly plasma exchange for severe cases

Answer 106

A

von Willebrand disease (VWD)

Answer 107

A

type 1 is qualitative or quantitative defect in von Willebrand factor, a protein necessary for platelet adhesion function

Answer 108

A

bleeding time is increased

PTT is normal or may be increased

Answer 109

A

twisting of spermatic cord, most commonly due to an anatomical defect, can result in ischemia of testicle

abnormal anchoring of testicle w/in tunica vaginalis, which allows it to move freely in scrotum (bell clapper deformity)

Answer 110

A

absence of cremaster reflex (most sensitive PE finding)

others:

negative Prehn’s sign (lifting of testicle will not relieve pain)
sudden severe pain, swelling, n/v, TTP
blue dot sign = tender nodule 2-3 mm in diameter on upper pole of testicle

Answer 111

A

ultrasound
and
radionuclide study (gold standard)

Answer 112

A

surgical emergency

repair both testes w/in 4-6 hrs

Answer 113

A

1 - bulging of TM
2 - other signs of acute inflammation
    - marked erythema
    - fever
     - pain
     - middle ear effusion
3 - loss of landmarks
4 - limited mobility of TM with pneumotoscopy (key finding)

Answer 114

A

1st line: amox
2nd line: augmentin (amox + clavulanic acid)
*if PCN allergy, use azithromcin, erythromycin, TMP-SMX

<2 y/o, treat 10 days
>2 y/o, treat 5-7 days

Answer 115

A

viral

adenovirus most common virus

Answer 116

A

1st line: PCN
*use azithromycin if PCN-allergic

(GAS pharyngotonsilitis complication –> rheumatic fever, post-strep glomerulonephritis)

Answer 117

A

suportive

Answer 118

A

symptomatic
avoid sports for 3 weeks from symptom onset (4 weeks for strenuous contact sports)

*amox or ampicillin may cause a rash

Answer 119

A

clotrimazole
miconazole
nystatin

Answer 120

A

preferred regimen:
intramuscular ceftriaxone (250 mg)
azithromycin as second agent

Answer 121

A

acute onset
unilateral or bilateral erythema of conjunctiva
copious watery discharge
tender preauricular lymphadenopathy
scant mucoid discharge

(MC cause = adenovirus, highly contagious)

Answer 122

A

eye lavage w/ normal saline bid 7-14 days
antihistamine drops
warm to cool compresses

Answer 123

A

purulent (yellow) discharge from both eyes, but may be unilateral
glued shut eyes
crusting
worse in morning

Answer 124

A

S. pneumo

S. aureus

Answer 125

A

1 - gentamicin/tobramycin aminoglycoside
2 - erythromycin ointment (chlamydia eyes for newborns)
3 - trimethoprm and polymyxin B for corneal or conjunctiva involvement
4 - ciprofloxacin

contact users need to treat for pseudomonas and get FQ’s (cipro)

Answer 126

A

Kesselbach’s Plexus (epistaxis is usually anterior)

Answer 127

A

most are ANTERIOR (Kiesselbach’s Plexus) and stop with direct pressure, leaning forward

otherwise - anterior nasal packing w/ CEPHALOSPORIN - or - petroleum jelly inside nostril bid 4-5 days

Answer 128

A

(posterior bleed, less frequent, Woodruff Plexus)

posterior balloon packing
high risk for complications

Answer 129

A

r/o HTN or hypercoagulable disorder

Answer 130

A

congenital failure of the duodenal lumen to recanalize during fetal development

(often seen in infants with Down syndrome and is associated with a number of congenital anomalies including biliary atresia, as well as cardiac and renal malformations)

Answer 131

A

Nasogastric or orogastric tube placement is the first step in management prior to surgical intervention

Answer 132

A

Desmopressin,

while not curative, will relieve symptoms

Answer 133

A

RECTAL BIOPSY

rectal biopsy showing the absence of ganglion cells in both the submucosal and muscular layers of the involved bowel is the most appropriate diagnostic study for Hirschsprung disease

Answer 134

A

low dose inhaled corticosteroid

Low dose inhaled corticosteroids are the preferred treatment for mild persistent asthma

Answer 135

A

surfactant deficiency

(Hyaline membrane disease (Resp distress syndrome) results from alveoli collapse due to lack of adequate lung surfactant and immature lungs)

Answer 136

A

ASA and IVIG

(Patients with Kawasaki’s disease present with fever, bilateral conjunctival injection, pharyngeal erythema, edema of the hands and feet, rash, and LAD. Tx of choice is high-dose aspirin and IV immunoglobulin)

Answer 137

A

double-bubble sign

(Duodenal atresia presents within the first day of life with bilious vomiting without abdominal distention . A double-bubble sign is noted on abdominal xray film. Treatment of choice is a duodenoduodenostomy.)

Answer 138

A

Homocystinuria is a disorder of amino acid metabolism

Answer 139

A

Vit B6

is best treated with high doses of Vitamin B6

Answer 140

A

INTUSSUSCEPTION

Intussusception, telescoping of proximal bowel into distal bowel, is most common in children younger than age 2, who present with abdominal pain and bloody “currant” jelly” stool. On physical examination a sausage-shaped mass is noted in the mid abdomen.

Answer 141

A

CYANOSIS

(The main characteristic of tetralogy of Fallot is cyanosis. Hypercyanotic spells or “tet spells” are paroxysmal episodes in which the cyanosis acutely worsens. Crying, feeding, or defecating can bring on these episodes.)

Answer 142

A

“Atopy refers to the genetic tendency to develop allergic diseases such as allergic rhinitis, asthma and atopic dermatitis (eczema). Atopy is typically associated with heightened immune responses to common allergens, especially inhaled allergens and food allergens.”

(AAAAI)

Answer 143

A

erythromycin

Erythromycin or sulfisoxazole is the treatment of choice for an infant with Chlamydial pneumonia.

Answer 144

A

OLIVE-SIZED MASS IN THE RIGHT UPPER ABDOMEN

(An olive-sized mass may be palpated in the right upper abdomen in pyloric stenosis and if found, is pathognomonic for pyloric stenosis.)

Answer 145

A

CALCULATION OF THE COBB ANGLE
(“The scoliotic curve is measured by the Cobb method using AP and lateral x-ray films of the entire length of the spine.”)

Answer 146

A

INDIRECT LARYNGOSCOPY

“Laryngoscopy is indicated not only for diagnosis, but also removal of the foreign body.”

Answer 147

A

ORBITAL AND SINUS CT SCAN

(“This is the typical presentation of orbital cellulitis. A CT scan of the orbit and sinuses is indicated to check for the presence of a subperiosteal abscess and underlying sinusitis, which is often the cause of orbital cellulitis.”)

Answer 148

A

SUBPERIOSTEAL ABSCESS AND UNDERLYING SINUSITIS

(“This is the typical presentation of orbital cellulitis. A CT scan of the orbit and sinuses is indicated to check for the presence of a subperiosteal abscess and underlying sinusitis, which is often the cause of orbital cellulitis.”)

Answer 149

A

TYMPANOCENTESIS

(“This child has unresponsive acute otitis media having failed two courses of appropriate antibiotic therapy. Tympanocentesis is indicated to identify the causative organism and appropriate antibioticselection.”)

Answer 150

A

COXSACKIEVIRUS

Coxsackievirus presents with small grayish vesicles and punched-out ulcers in the posterior pharynx.

Answer 151

A

NASAL FOREIGN BODY

(“Nasal foreign body typically presents in children under 3 years of age. The symptoms include mucopurulent drainage, epistaxis, foul odor and nasal obstruction.”)

Answer 152

A

nocturnal hypoglycemia, “which stimulates counter-regulatory hormone release resulting in rebound hyperglycemia”

may present with nightmares and night sweats

Answer 153

A

LINDANE (KWELL)

(Lindane (Kwell) is concentrated in the CNS and toxicity from systemic absorption in infants has been reported.)

(why is this in the SmartyPance exam??)

Answer 154

A

“FOLIC ACID AND PENICILLIN V”

(“Patients with sickle cell disease should receive prophylactic penicillin V starting at 2 months of age and folic acid starting at 1 year of age. Ferrous sulfate is not globally recommended for patients with sickle cell disease.”)

Answer 155

A

Tetralogy of Fallot

Answer 156

A

Tetralogy of Fallot

Answer 157

A

1 - R ventricular outflow tract obstruction
2 - RVH
3 - VSD
4 - overriding aorta