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EH Reviews > EH - Pediatrics > Flashcards

EH - Pediatrics Flashcards

1
Q

Baby presents with HR = 130, acrocyanotic, moves all extremities, grimaces to stimulation, crying – APGAR score?

A

Pulse = 2, Appearance = 1, Grimace = 1, Activity = 2, Respiration = 2 … Score = 8

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2
Q

APGAR stands for …

A

Appearance, Pulse, Grimace, Activity, Respiration

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3
Q

Full Grimace in APGAR score is …

A

Withdrawing from stimulation

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4
Q

What does APGAR tell you?

A

1 minute = how baby tolerated labor, 5 minutes = how baby is tolerating stimulation + resuscitation

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5
Q

What does APGAR not tell you?

A

Not predictive of baby’s outcome (brain damage, mental development); Should not direct treatment

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6
Q

Baby’s R arm appears extended and IR – diagnosis?

A

Erb’s palsy

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7
Q

Best treatment for Erb’s palsy?

A

Neurosurgery if doesn’t resolve after 3 months

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8
Q

Best treatment for neonatal clavicle fracture?

A

No treatment needed – fracture will resolve because bones in children are malleable

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9
Q

Infant presents with abnormally-shaped head; Edema appears to cross suture lines – diagnosis?

A

Caput

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10
Q

Quality of edema in caput?

A

Pitting; Crosses suture lines

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11
Q

Infant presents with abnormally-shaped head; Palpation shows fluctuant edema that does not cross suture lines – diagnosis?

A

Cephale hematoma

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12
Q

Quality of edema in Cephale hematoma ?

A

Does not cross suture lines

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13
Q

Infant presents with rash that appears blue, slate-gray; Located on lower back, thigh – diagnosis?

A

Mongolian spots

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14
Q

Composition of Mongolian spots?

A

Melanocytes

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15
Q

Infant presents with rash that appears pale, pink, vascular; Located on face, nuchal region – diagnosis?

A

Nevus simplex

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16
Q

Alternate name for nevus simplex?

A

Salmon patch

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17
Q

Infant presents with rash that appears as firm white papules; Present on Day of Life #1 – diagnosis?

A

Milia

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18
Q

Composition of Milia?

A

Filled with keratin

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19
Q

What can milia be confused for?

A

Neonatal acne

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20
Q

What distinguishes neonatal acne from milia?

A

Time of onset … Milia = Day of Life #1; Neonatal acne = Weeks of Life #1-2

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21
Q

Infant presents with rash that appears as firm yellow-white pustules/papules with erythematous base; Present on Day of Life #2 – diagnosis?

A

Erythema toxicum

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22
Q

Composition of Erythema toxicum?

A

Filled with eosinophils

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23
Q

Infant presents with rash that appears sharply-demarcated, bright red, raised – diagnosis?

A

Hemangioma

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24
Q

Different in PE findings between hemangioma and nevus simplex?

A

Hemangioma = palpable; Nevus simplex = non-palpable

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25
Q

Infant presents with rash that is hairless, nodular, orange – diagnosis?

A

Nevus sebaceous

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26
Q

Prognosis for nevus sebaceous?

A

Removal due to malignant transformation risk

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27
Q

Alternate name for seborrheic dermatitis that presents on infant’s scalp?

A

Cradle cap

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28
Q

Best treatment for cradle cap in infants?

A

Antifungal

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29
Q

Which 2 conditions are always included in neonatal screen?

A

Galactosemia, PKU

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30
Q

Etiology of PKU?

A

Deficiency in phenylalanine hydroxylase

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31
Q

Clinical presentation of PKU?

A

Silvery hair, Musty odor

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32
Q

Etiology of Galactosemia?

A

Deficiency in G1P-uridyl transferase

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33
Q

Clinical presentation of Galactosemia?

A

Jaundice, hepatomegaly, cataracts

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34
Q

3 do male presents with jaundice; Labs show T. Bili = 10, D. Bili = 0.3 – diagnosis?

A

Physiologic jaundice

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35
Q

Physiologic jaundice resolves by Day ___

A

5

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36
Q

Etiology of physiologic jaundice?

A

Infant’s liver is not mature enough to conjugate all bilirubin

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37
Q

7 do male presents with jaundice; Labs shows T. Bili = 12, D. Bili = 0.5; PE shows failure to thrive, dry MM – diagnosis?

A

Breastfeeding jaundice

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38
Q

Distinguishing clinical feature of Breastfeeding jaundice?

A

Infant appears dehydrated

… No breastfeeding enough

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39
Q

When is jaundice a cause for concern?

A

Present on Day of Life #1; T. Bili > 12; D. Bili > 2

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40
Q

Next best test for infant who presents on Day of Life #1 with elevated total + indirect bilirubin?

A

Coomb’s Test

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41
Q

7 do male presents with jaundice; Urine is dark, stools are pale; Labs show T. Bili = 12, D. Bili = 8, elevated LFTs – diagnosis?

A

Biliary atresia

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42
Q

Biliary atresia represents a ___ bilirubinemia

A

Direct

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43
Q

Best treatment for biliary atresia?

A

Surgical emergency

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44
Q

Why is biliary atresia considered a surgical emergency?

A

Will cause liver failure if left untreated

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45
Q

Infant presents with direct hyperbilirubinemia, NML LFTs – diagnosis?

A

Sepsis, Hypothyroidism, Cystic Fibrosis

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46
Q

2 hereditary causes of indirect hyperbilirubinemia?

A

Crigler-Najjar, Gilbert

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47
Q

Etiology of Gilbert Syndrome?

A

Decreased in glucuronyl transferase

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48
Q

Etiology of Crigler-Najjar?

A

Total deficiency in glucuronyl transferase

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49
Q

2 hereditary causes of direct hyperbilirubinemia?

A

Rotor, Dubin-Johnson

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50
Q

Why is indirect hyperbilirubinemia concerning in infants?

A

Indirect bilirubin can cross the BBB … causing kernicterus

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51
Q

Where does indirect bilirubin preferentially deposit in the brain?

A

Basal ganglia, CN nuclei

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52
Q

Best treatment for extreme hyperbilirubinemia (20+)?

A

Plasma exchange

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53
Q

Best treatment for moderate hyperbilirubinemia?

A

Phototherapy

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54
Q

Role of phototherapy in moderate hyperbilirubinemia?

A

Isomerizes indirect hyperbilirubinemia … more easily excreted

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55
Q

Best treatment for diaphragmatic hernia causing respiratory distress?

A

Surgical repair 3-5 dyas after delivery

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56
Q

What other conditions should we look for in an infant with transesophageal fistula?

A

VACTERL … Vertebral, Cardiac, Limbs, Renal

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57
Q

Additional conditions associated with choanal atresia?

A

CHARGE … Coloboma, Heart defects, growth Retardation, GU anomalies, Ear anomalies

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58
Q

Infant born at 32 weeks presents with dyspnea, nasal flaring; CXR shows ground glass opacities with air bronchograms and atelectasis – diagnosis?

A

RDS

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59
Q

Best test for prenatal diagnosis of RDS?

A

L:S ratio

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60
Q

L:S ratio of ___ is associated with higher likelihood of developing RDS

A

< 2

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61
Q

Pathophysiology of RDS?

A

Lack of surfactant

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62
Q

Best treatment for RDS?

A

Surfactant

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63
Q

Indication for theophylline in NICU?

A

Difficulty with respiratory drive

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64
Q

Infant born at 38 weeks presents as large for gestational age; Born via C-section to diabetic mother; Patient was dyspneic and grunting after delivery – diagnosis?

A

TTN

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65
Q

Buzzwords associated with CXR in setting of TTN?

A

Perihilar streaking; Air-trapping

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66
Q

What accounts for perihilar streaking in setting of TTN?

A

Retained fluid in fissures

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67
Q

Etiology of TTN?

A

Retained fluid

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68
Q

Risk factor for TTN?

A

C-section

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69
Q

Infant born at 41 weeks; Born after rupture of membranes that yielded green-brown fluid – diagnosis?

A

Meconium aspiration syndrome

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70
Q

Next best step for baby with suspected Meconium aspiration syndrome?

A

Suction before stimulation

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71
Q

Complications of Meconium aspiration syndrome?

A

Pneumonia pneumonitis; Pulmonary artery HTN

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72
Q

2 characteristics of gastroschisis?

A

Lateral to midline; No soft tissue sac

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73
Q

Best test for prenatal diagnosis of gastroschisis?

A

Elevated maternal AFP

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74
Q

2 characteristics of omphalocele?

A

Midline; Soft tissue sac

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75
Q

Which additional conditions are associated with omphalocele?

A

Down Syndrome, Beckwith-Weidman Syndrome

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76
Q

3 aspects of clinical presentation of infants with Beckwith-Weidman Syndrome?

A

Large baby, Macroglossia, Ear pits

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77
Q

Which additional conditions are associated with umbilical hernia?

A

Hypothyroidism

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78
Q

Infant who presents with macroglossia + umbilical hernia – diagnosis?

A

Hypothyroidism

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79
Q

Best treatment for umbilical hernia children?

A

Monitor for self-resolution by 2-3 yo, then consider surgery

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80
Q

4 wo infant presents with non-bilious vomiting; PE shows palpable olive – diagnosis?

A

Congenital Pyloric Stenosis

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81
Q

Best treatment for Congenital Pyloric Stenosis?

A

Myotomy

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82
Q

Metabolic abnormality associated with Congenital Pyloric Stenosis?

A

Hypochloric, hypokalemic metabolic alkalosis

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83
Q

2 wo infant presents with bilious vomiting; Pregnancy complicated by polyhydramnios – diagnosis?

A

Duodenal atresia

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84
Q

Classic appearance of Duodenal atresia on abdominal XR?

A

Double bubble

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85
Q

Condition associated with Duodenal atresia?

A

Down Syndrome

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86
Q

1 wo infant presents with bilious vomiting, abdominal distention; Draws up legs to chest during PE – diagnosis?

A

Malrotation

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87
Q

3 do infant has still not passed meconium – which 2 conditions are on differential?

A

Cystic fibrosis, Hirschsprung disease

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88
Q

5 do male born at 33 weeks develops bloody diarrhea – diagnosis?

A

Necrotizing enterocolitis

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89
Q

Classic appearance of Necrotizing enterocolitis on abdominal XR?

A

Pneumatosis intestinalis

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90
Q

Best treatment for Necrotizing enterocolitis?

A

Bowel rest, IV ABX, Parental nutrition

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91
Q

Risk factor for necrotizing enterocolitis?

A

Prematurity

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92
Q

2 mo infant presents with red current jelly stool, abdominal pain; PE shows sausage-shaped mass in RUQ – diagnosis?

A

Intussusception

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93
Q

Diagnostic and therapeutic test for Intussusception?

A

Barium enema

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94
Q

Next best test for male infant whose testes are not located in scrotum or inguinal canal?

A

US

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95
Q

Condition associated with cryptorchidism?

A

Prune Belly Syndrome

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96
Q

When do infants with cryptorchidism typically require surgery?

A

12 months

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97
Q

Newborn male presents with urethral opening located on ventral surface of penis?

A

Hypospadias

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98
Q

What is contraindicated in male infants with hypospadias?

A

Circumcision

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99
Q

Newborn child presents with ambiguous genitalia; 1 month later develops hyponatremia, vomiting, hyperkalemia, acidosis – diagnosis?

A

21alpha hydroxylase deficiency

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100
Q

Definitive test for 21 hydroxylase deficiency?

A

17-OH progesterone

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101
Q

Best treatment for 21 hydroxylase deficiency?

A

Replacement of Aldosterone + Cortisol

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102
Q

Newborn with midline mass; Lack of urination for first several days of life – diagnosis?

A

Posterior urethral valves

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103
Q

Best treatment for Posterior urethral valves?

A

Catheterization + Surgical correction

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104
Q

2 infant complications associated with mothers who have pre-existent DM?

A

Small L colon, caudal regression

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105
Q

Best treatment for neonatal hypoglycemia < 40 mg/dL?

A

Breastfeed

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106
Q

Best treatment for neonatal hypoglycemia < 20 mg/dL?

A

IV glucose

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107
Q

Infants of DM mothers have increased risk of … (even if not premature)

A

RDS

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108
Q

What accounts for increased risk of RDS in infants born to mothers with DM?

A

Insulin inhibits release of surfactant … (normally stimulated by a surge of cortisol)

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109
Q

Anytime an infant age ___ develops fever, it is cause for concern

A

< 1 mo

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110
Q

Important test to order for infant > 1 mo who develops a fever?

A

LP … to rule out meningitis

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111
Q

Most common pathogens responsible for neonatal sepsis?

A

GBS, E. coli, Listeria

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112
Q

Best empiric treatment for neonatal sepsis?

A

Ampicillin + Gentamycin

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113
Q

When should empiric treatment for neonatal sepsis be discontinued?

A

Blood cultures are (-) for 48 hours

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114
Q

TORCH infection that presents as maculopapular rash on palms + soles?

A

Syphilis

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115
Q

TORCH infection that presents as hydrocephalus, intracranial calcifications, chorioretinitis?

A

Toxoplasmosis

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116
Q

TORCH infection that presents as deafness, heart defect, cataracts, extramedullary hematopoiesis?

A

Rubella

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117
Q

TORCH infection that presents as microcephaly, periventricular calcifications, deafness, thrombocytopenia, petechia?

A

CMV

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118
Q

TORCH infection that presents as limb hypoplasia, cutaneous scars, cataracts, cortical atrophy, chorioretinitis?

A

Varicella

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119
Q

When should infants receive IgG for varicella … based on maternal infection timing?

A

5 days before delivery … 2 days after delivery

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120
Q

Infants who present with red + tearing conjunctiva during days of life 1-3 – which type of conjunctivitis?

A

Chemical … (silver nitrate)

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121
Q

Infants who present with purulent conjunctiva during days of life 3-5 – which type of conjunctivitis?

A

Gonorrhea

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122
Q

Infants who present with mucoid conjunctiva – which type of conjunctivitis?

A

Chlamydia

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123
Q

Complication of chlamydia conjunctivitis?

A

Chlamydia PNA

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124
Q

Typical IQ of patients with Down Syndrome?

A

Moderate mental retardation

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125
Q

Infant presents with rocker-bottom feet, microcephaly – diagnosis?

A

Edward Syndrome

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126
Q

Infant presents with holoprosencephaly, cleft lip/palate – diagnosis?

A

Patau Syndrome

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127
Q

14 yo female presents with lack of secondary sex characteristics, high FSH – diagnosis?

A

Turner Syndrome

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128
Q

Anomalies associated with Turner Syndrome?

A

Coarctation of aorta, horseshoe kidney

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129
Q

Best treatment for Turner Syndrome?

A

Estrogen replacement

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130
Q

16 yo male presents with hypogonadism, gynecomastia, mild mental retardation – diagnosis?

A

Klinefelter Syndrome

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131
Q

Klinefelter Syndrome is associated with increased risk of …

A

Gonadal malignancy

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132
Q

Patient presents with bird-like facies, hypomandibulosis, glossoproptosis, cleft palate – diagnosis?

A

Pierre-Robin sequence

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133
Q

Patient presents with broad + square face, self-mutation – diagnosis?

A

Smith McGuinness

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134
Q

Most common overall cause of MR?

A

Fetal ETOH Syndrome

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135
Q

Most common cause of MR in males?

A

Fragile X

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136
Q

AD condition, associated with advanced paternal age; PE shows deafness, white forelock – diagnosis?

A

Wardenberg Syndrome

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137
Q

Patient presents with multiple infections; PE shows absent tonsils – diagnosis?

A

X-linked agammaglobulinemia (Bruton)

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138
Q

Lab values seen in setting of X-linked agammaglobulinemia (Bruton)?

A

No B cells; Low levels of all Ig

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139
Q

Low levels of all Ig that presents in adolescents and young adults – diagnosis?

A

Combined Immunodeficiency

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140
Q

Labs seen in setting of Combined Immunodeficiency?

A

Low levels of all Ig, NML B cells

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141
Q

Combined Immunodeficiency is associated with increased risk of …

A

Lymphoma

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142
Q

What is the most common B cell deficit?

A

IgA deficiency

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143
Q

Infant presents with seizures, truncus arteriosus, micrognathia – diagnosis?

A

DiGeorge Syndrome

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144
Q

Which type of infections are children with DiGeorge Syndrome susceptible to?

A

Fungal, Viral … things that T cells take care of

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145
Q

Patient presents with absent tonsils, absent thymus; Labs show severe lymphopenia – diagnosis?

A

SCID … Severe Combined Immunodeficiency

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146
Q

Inheritance pattern of SCID?

A

X-linked; AR

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147
Q

Best treatment for SCID?

A

Bone marrow transplant

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148
Q

Child presents with inguinal lymphadenopathy; PE shows multiple MRSA skin abscesses – diagnosis?

A

Chronic granulomatous disease

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149
Q

Diagnostic test for Chronic granulomatous disease?

A

Nitrotetrazolium blue

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150
Q

18 mo female presents with recurrent ear infections, eczema, petechiae – diagnosis?

A

Wiskott-Aldrich Syndrome

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151
Q

Lab results seen in setting of Wiskott-Aldrich Syndrome?

A

High IgE + IgA; Low IgG + IgM

wAtEr

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152
Q

Which event typically leads to diagnosis of Wiskott-Aldrich Syndrome?

A

Prolonged bleeding after circumcision … due to severe thrombocytopenia

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153
Q

Why do infants typically lose up to 7% of their birth weight during Week 1 of life?

A

Excess urination

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154
Q

When should infants regain their birth weight?

A

2 wo

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155
Q

When should infants double their birth weight?

A

6 mo

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156
Q

When should infants triple their birth weight?

A

12 mo

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157
Q

When should infants increase their birth height by 50%?

A

1 yo

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158
Q

When should infants double their birth height?

A

4 yo

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159
Q

2 fetal contraindications to breastfeeding?

A

Galactosemia, PKU

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160
Q

5 maternal contraindications to breastfeeding?

A

HIV, TB, Chemotherapy, Radioactive iodine, Maternal ETOH use

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161
Q

Is Hepatitis C considered a contraindication to breastfeeding?

A

No

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162
Q

Dominant protein in breastmilk?

A

Whey

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163
Q

Dominant fatty acid in breastmilk?

A

Long-chain FA

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164
Q

Does breastmilk or formula contain more lactose?

A

Breastmilk

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165
Q

Does breastmilk or formula contain more iron?

A

Formula contains more Fe … BUT breastmilk has greater bioavailability

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166
Q

14 yo male presents in < 5% for height + weight; Parents are above-average height – diagnosis?

A

Constitutional growth delay

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167
Q

Typical bone age seen in Constitutional growth delay?

A

Bone age < Real age

168
Q

Prognosis for Constitutional growth delay?

A

Patient is likely to achieve NML height

169
Q

14 yo male presents in < 5% for height + weight; Parents are below-average height – diagnosis?

A

Familial short stature

170
Q

Typical bone age seen in Familial short stature?

A

Bone age = Real age

171
Q

Prognosis for Familial short stature?

A

Patient is likely to be short when older

172
Q

14 yo male presents with height in 50th percentile, weight in 97th percentile – diagnosis?

A

Obesity

173
Q

Typical bone age seen in obesity?

A

Bone age > Real age

174
Q

What accounts for Bone age > Real age in setting of obesity?

A

Excess estrogen exposure … Estrogen matures bone, closes epophyseal plates more quickly

175
Q

5 causes of advanced bone age?

A

Obesity, Precocious puberty, Hyperthyroidism, Neoplasm of ovaries/test, CAH

176
Q

14 yo male presents with height < 5%; Height was tracking along 50th percentile until about 2 years ago – diagnosis?

A

Pathologic short stature

177
Q

Name the primitive reflex – head is extended, arms + legs flex?

A

Moro

178
Q

Name the primitive reflex – hand grasp when finger is placed in palm?

A

Palmar grasp

179
Q

Name the primitive reflex – head turns to side after ipsilateral cheek is rubbed?

A

Rooting

180
Q

Name the primitive reflex – hip flexion after dorsal foot stimulation?

A

Stepping

181
Q

Name the primitive reflex – contralateral arm flexion + ipsilateral arm extension when neck is turned to side?

A

Fencing

182
Q

Name the primitive reflex – arms extended after fall is stimulated?

A

Parachute

183
Q

Most primitive reflexes disappear by age …

A

6 months

184
Q

Which primitive reflex persists after 6 months?

A

Parachute … never disappears

185
Q

Where in CNS do primitive reflexes originate?

A

Brainstem + Vestibular nuclei

186
Q

Age of development – creep + crawl?

A

6 mo

187
Q

Age of development – roll?

A

6 mo

188
Q

Age of development – sit up?

A

6 mo

189
Q

Age of development – skip?

A

5 yo

190
Q

Age of development – copy a triangle?

A

5 yo

191
Q

Age of development – walk without support?

A

15 mo

192
Q

Age of development – walk up stairs with alternating feet?

A

30 mo

193
Q

Age of development – copy cross and square?

A

4 yo

194
Q

Age of development – hop on 1 foot?

A

4 yo

195
Q

Age of development – throw a ball overhead?

A

4 yo

196
Q

Age of development – sit without support?

A

9 mo

197
Q

Age of development – pincer grasp?

A

9 mo

198
Q

Age of development – walk downstairs?

A

3 yo

199
Q

Age of development – copy a circle?

A

3 yo

200
Q

Age of development – half of speech is comprehensible?

A

2 yo

201
Q

Age of development – begins to speak in 2-3 word sentences?

A

2 yo

202
Q

Age of development – social smile?

A

2 mo

203
Q

Urinary continence is considered pathologic at what age?

A

5+ yo

204
Q

Most common cause of pathologic urinary incontinence?

A

UTI

205
Q

First step of workup for urinary incontinence?

A

UA

206
Q

First treatment for urinary incontinence?

A

Behavioral modifications

207
Q

Fecal continence is considered pathologic at what age?

A

4+ yo

208
Q

Most common cause of pathologic fecal incontinence?

A

Constipation

209
Q

Which immunizations are due at birth?

A

Hep B

210
Q

Infant born to mother with Hepatitis B should receive?

A

Hep B vaccine + IgG

211
Q

Which immunizations are due at 2 mo?

A

Hep B, Rotavirus, DTAP, HIB, Strep pneumonia, Polio

212
Q

Which immunizations are due at 4 mo?

A

Rotavirus, DTAP, HIB, Strep pneumoniae, Polio

213
Q

Which immunizations are due at 6 mo?

A

Rotavirus, DTAP, HIB, PCV, IPV + Flu (then yearly)

214
Q

Contraindications to flu vaccine?

A

Egg allergy

215
Q

Which immunizations are due at 12 mo … (not before because live attenuated)?

A

Varicella, Hep A, MMR

216
Q

Contraindications to MMR?

A

Allergy to neomycin

217
Q

Which immunizations are due at 2 yo?

A

Hep A, DTAP

218
Q

Which immunizations are due at 12 yo?

A

TDAP boosters, Meningitis, HPV

219
Q

2 benign murmurs in children?

A

Stills murmur, Venous hum

220
Q

2 characteristics of murmurs that always signify pathology?

A

Murmur > 2/6 intensity; Diastolic murmur

221
Q

Best first step of workup for pathologic murmur?

A

ECHO

222
Q

Newborn is cyanotic at birth; Oxygen does not improve cyanosis – diagnosis?

A

Transposition of great vessels

223
Q

RF for Transposition of great vessels?

A

Maternal DM

224
Q

Murmur associated with Transposition of great vessels?

A

None

225
Q

Best immediately treatment for Transposition of great vessels?

A

Prostaglandins to ensure patency of ductus arteriosus

226
Q

Murmur associated with Tetralogy of Fallot?

A

VSD … systolic ejection murmur

227
Q

Best treatment for Tetralogy of Fallot?

A

Supplemental O2 … eventual surgical correction

228
Q

Murmur associated with Epstein anomaly?

A

Holosystolic murmur that is worse during inspiration

229
Q

What does “murmur that worsens on inspiration” tell us?

A

R-sided murmur

230
Q

Which arrhythmia is associated with Epstein anomaly?

A

Wolf-Parkinson White

231
Q

Infant presents with cyanosis at birth; PE shows holosystolic murmur; Depends on VSD or ASD for life; EKG shows L ventribular hypertrophy – diagnosis?

A

Tricuspid atresia

232
Q

Structural heart defect associated with Tricuspid atresia?

A

LV hypertrophy … blood shunts through ASD/VSD, away from R heart, into L heart

233
Q

Heart defect associated with DiGeorge Syndrome?

A

Truncus arteriosus

234
Q

Most common congenital heart lesion?

A

VSD

235
Q

Description of murmur heard with VSD?

A

Harsh, holosystolic murmur – heard best at L lower sternal border

236
Q

When should VSD be treated (instead of observed)?

A

VSD is unclosed by 2 yo; Failure to thrive; Pulmonary HTN

237
Q

Is louder murmur in VSD better or worse?

A

Louder = better … small hole makes more noise

238
Q

Loud S1 with fixed + split S2 – diagnosis?

A

ASD

239
Q

Heart defect associated with Down Syndrome?

A

Endocardial cushion defect

240
Q

Description of endocardial cushion murmur?

A

Fixed + split S2 (ASD); Loud systolic ejection murmur (VSD)

241
Q

Continuous machine-like murmur with bounding pulses – diagnosis?

A

PDA

242
Q

2 conditions associated with PDA?

A

Prematurity, Congenital Rubella infection

243
Q

Best treatment for PDA?

A

Indomethacin

244
Q

Most common heart defect heard in baby with Turner’s Syndrome?

A

Aortic coarctation

245
Q

Classic CXR finding for Aortic coarctation?

A

Figure 3 sign

246
Q

Murmur of HCM is nearly identical to murmur of …

A

Aortic stenosis … (except HCM gets softer with squat; AS gets louder with squat)

247
Q

HCM murmurs occur during …

A

Systole

248
Q

How do HCM murmurs change with preload?

A

HCM = worse with increase in preload; AS = better with increase in preload

249
Q

Best treatment for HCM?

A

B blockers; Can’t clear medically on sports physical

250
Q

Medical tool for HCM ablation?

A

ETOH

251
Q

7 yo female presents with vague CP, arthralgias, rash – diagnosis?

A

Rheumatic fever

252
Q

EKG change associated with Rheumatic fever?

A

PR prolongation

253
Q

Best treatment for Rheumatic fever?

A

Penicillin

254
Q

Complication of Rheumatic fever?

A

Mitral stenosis

255
Q

Signs of cystic fibrosis at birth?

A

Rectal prolapse, Meconium ileus

256
Q

Inheritance pattern of cystic fibrosis?

A

AR

257
Q

CF results from genetic mutation on Chromosome ___

A

7

258
Q

Child with asthma has symptoms 2x per week; PFTs appear NML – diagnosis?

A

Mild, Intermittent

259
Q

Best treatment for Mild, Intermittent asthma?

A

SABA

260
Q

Child with asthma has symptoms 4x per week + night cough; PFTs appear NML – diagnosis?

A

Mild, Persistent

261
Q

What distinguishes Mild vs. Moderate asthma?

A

Mild = normal PFTs

262
Q

Best treatment for Mild, Persistent asthma?

A

SABA + ICS

263
Q

Child with asthma has symptoms daily + night cough x2 per week; PFTs show low FEV1 – diagnosis?

A

Moderate

264
Q

Best treatment for Moderate asthma?

A

SABA + ICS + LABA

265
Q

Example of LABA used in treatment for Moderate asthma?

A

Salmeterol

266
Q

Child with asthma has symptoms daily + night cough x4 per week; PFTs show extremely low FEV1 – diagnosis?

A

Severe

267
Q

Best treatment for Severe asthma?

A

SABA + ICS + LABA + Oral corticosteroids / Leukotriene modifying agent

268
Q

If PCO2 normalizes in the setting of asthma exacerbation – good/bad?

A

Bad … PCO2 should be getting lower with hyperventilation; Increased PCO2 indicated respiratory muscle fatigue

269
Q

Best treatment for increasing PCO2 in setting of asthma exacerbation?

A

Intubation

270
Q

Best test to monitor DKA?

A

Anion Gap

271
Q

Diagnostic criteria for T1DM?

A

Fasting BG > 126; Any BG > 200; BG > 200 after 75g 2-hour glucose challenge test

272
Q

2 yo male; T = 105, rash later appears on trunk, arms, legs – diagnosis?

A

Roseola

273
Q

Alternate name for Roseola?

A

HHV-6

274
Q

Parvovirus infection is most concerning in which 2 groups of patients?

A

Sickle Cell, Pregnant females

275
Q

Consequence of Parvovirus during pregnancy?

A

Hydrops fetalis

276
Q

Consequence of Parvovirus in patients with Sickle Cell Disease?

A

Aplastic anemia

277
Q

2 aspects of clinical presentation for Scarlet Fever?

A

Desquamating rash, Strawberry tongue

278
Q

Best treatment for Scarlet Fever?

A

Penicillin

279
Q

Value of penicillin treatment in Scarlet Fever?

A

Prevents rheumatic fever, but not post-streptococcal glomerulonephritis

280
Q

Koplik spots are associated with …

A

Measles

281
Q

Best treatment for Measles?

A

Vitamin A

282
Q

Sore throat, joint pain, fever; PE shows pinpoint rash that spreads down from head – diagnosis?

A

Rubella

283
Q

Best treatment for Lyme Disease in children < 8 yo?

A

Amoxicillin

284
Q

Best treatment for Lyme Disease in children > 8 yo?

A

Doxycycline

285
Q

Best treatment for Rickettsia?

A

Always doxycycline … no matter the age

286
Q

Best treatment for Scabies?

A

Permethrin for patient + household

287
Q

Best treatment for impetigo?

A

Topical mupirocin

288
Q

Best treatment for Scaled Skin Syndrome?

A

IV ABX

289
Q

Most common pathogens responsible for meningitis overall?

A

Strep pneumoniae, H. influenzae, N. meningitidis

290
Q

Pathogen responsible for meningitis in people with HX of brain surgery and instrumentation?

A

Staph aureus

291
Q

First 3 steps of workup for patients with meningitis?

A

Start IV ABX, Check ICP (on CT), Lumbar puncture

292
Q

Best treatment for Lyme Disease causing meningitis?

A

IV ceftriaxone

293
Q

Most sensitive test to confirm AOM?

A

Lack of TM mobility during insufflation

294
Q

Best treatment for AOM?

A

Amoxicillin

295
Q

Best treatment for otitis externa?

A

Topical ciprofloxacin

296
Q

Complication of otitis externa is invasion of which bone?

A

Temporal

297
Q

Child presents with exudative pharyngitis; PE shows tender cervical LN, T = 102 – first step in workup?

A

Rapid Strep test

298
Q

Next step of workup in patient with (-) strep test, but index of clinical suspicion is high?

A

Culture

299
Q

2 DOC for treatment of strep?

A

Penicillin, Erythromycin

300
Q

Child with untreated strep throat later presents with muffled voice; Refuses to turn head during PE – diagnosis?

A

Retropharyngeal abscess

301
Q

Best treatment for Retropharyngeal abscess?

A

I&D, ABX

302
Q

Complication of Retropharyngeal abscess?

A

Mediastinum

303
Q

Child with untreated strep throat later presents with muffled voice; PE shows deviated uvula – diagnosis?

A

Peritonsillar abscess

304
Q

Best treatment for Peritonsillar abscess?

A

I&D, ABX

305
Q

Indication for tonsillectomy in children?

A

5+ episodes of strep throat for 2 years; 3+ episodes of strep throat for 3 years

306
Q

Effect of Infectious Mononucleosis treatment with penicillin … (thinking it’s strep throat)?

A

Rash

307
Q

Diagnostic test for Infectious Mononucleosis?

A

Heterophile antibody monospot

308
Q

Appearance of blood smear in Infectious Mononucleosis?

A

Atypical lymphocytes

309
Q

Best treatment for Infectious Mononucleosis?

A

Supportive care

310
Q

Best treatment for croup?

A

Inhaled racemic epinephrine, then steroids

311
Q

Most common pathogen responsible for epiglottitis?

A

Haemophilus influenzae

312
Q

Most common pathogen responsible for epiglottitis in children who have been vaccinated?

A

Strep pneumoniae, Strep pyogenes, Staph aureus

313
Q

Next best step of workup for epiglottitis?

A

Intubation in OR … (NOT in ER, due to risk for epiglottis collapse)

314
Q

3 aspects of clinical presentation for Acute bronchitis?

A

Rhinorrhea + cough with Sputum, Low-grade temp, NO abnormal findings on lung exam (egophony, crackles)

315
Q

Best treatment for Acute bronchitis?

A

Symptomatic care

316
Q

Most common cause of PNA in infants <1 mo?

A

GBS, E. coli, Listeria

317
Q

Most common cause of PNA in infants 1-3 mo?

A

RSV, Chlamydia, Parainfluenza, Strep pneumonia

318
Q

Specific PE finding associated with Chlamydia PNA?

A

Staccato cough

319
Q

Specific lab finding associated with Chlamydia PNA?

A

Eosinophilia

320
Q

Most common cause of PNA in infants 6 mo – 5 yo?

A

Viral

321
Q

Most common cause of PNA in infants > 5 yo?

A

Mycoplasma pneumoniae, Strep pneumonia

322
Q

Best treatment for RVS bronchiolitis?

A

Nebulizer treatments … steroids won’t help

323
Q

CXR findings for RVS bronchiolitis?

A

Hyperinflation; Atelectasis without consolidation

324
Q

Specific lab finding associated with pertussis?

A

High lymphocytes

325
Q

Best treatment for pertussis (in patient + family + daycare)?

A

Macrolides

326
Q

Febrile UTI in children – diagnosis?

A

Pyelonephritis

327
Q

Anatomic risk factor for UTI in children?

A

Vesicoureteral reflux

328
Q

Next step of treatment for children diagnosed with Vesicoureteral reflux?

A

Prophylactic ABX

329
Q

Diagnostic test for UTI?

A

UA

330
Q

Best strategy obtaining clean-catch in infants … (normally impossible)?

A

Catheterization

331
Q

Which 2 GU conditions in children require US?

A

Febrile UTI, pyelonephritis

332
Q

2 DOC for treatment of UTI in children?

A

TMP-SMX, Nitrofurantoin

333
Q

Best treatment for pyelonephritis?

A

IV ABX for 2 weeks

334
Q

Indication for VUCG in children with UTI?

A

After first UTI in males; After first UTI in very young females (< 5yo); After 2nd UTI in females < 5 yo

335
Q

Most common cause overall of child with limp?

A

Trauma

336
Q

Infant presents with asymmetric gluteal folds on exam – diagnosis?

A

Hip dysplasia

337
Q

Epidemiology of hip dysplasia in infants?

A

Firstborn females, breech delivery, (+) FHX

338
Q

Next for workup of hip dysplasia after hearing “clunk” on exam?

A

Hip US

339
Q

5 yo male presents with painless limp, progressing in pain in thigh – diagnosis?

A

Legg-Calve Perthes Syndrome

340
Q

Etiology of Legg-Calve Perthes Syndrome?

A

Avascular necrosis of femoral head

341
Q

5 yo male presents with limp; PE shows hip effusion; Labs show high ESR; HX reveals recent URI – diagnosis?

A

Transient synovitis

342
Q

Best treatment for Transient synovitis?

A

Supportive care

343
Q

14 yo lanky male presents with knee pain; PE shows decreased hip ROM – diagnosis?

A

Slipped capital femoral epiphysis (SCFE)

344
Q

Best treatment for SCFE?

A

Surgical correction

345
Q

Why is surgical correction needed for SCFE?

A

Complication = osteonecrosis

346
Q

12 yo female presents with HX of daily fever; PE shows salmon-colored rash; Swelling of R knee and L knee – diagnosis?

A

Juvenile RA

347
Q

Best treatment for Juvenile RA?

A

NSAIDs, then Methotrexate, then steroids

348
Q

1 factor that indicates good prognosis in Juvenile RA?

A

(+) ANA

349
Q

1 factor that indicates bad prognosis in Juvenile RA?

A

(+) RF

350
Q

2 yo female presents with daily fevers; PE shows desquamating rash on perineum, swelling of hands/feet, conjunctivitis, unilateral cervical lymph node – diagnosis?

A

Kawasaki Syndrome

351
Q

Best treatment for Kawasaki Syndrome?

A

High-dose ASA, IVIG

352
Q

2 lab findings associated with Kawasaki Syndrome?

A

Thrombocytosis, Sterile pyuria

353
Q

Best first test for Kawasaki Syndrome?

A

ECHO + EKG

354
Q

2 main bone tumors seen in pediatric patients?

A

Osteosarcoma, Ewing Sarcoma

355
Q

Onion skinning - Osteosarcoma, Ewing Sarcoma?

A

Ewing Sarcoma

356
Q

Sunburst appearance, Codman’s triangle - Osteosarcoma, Ewing Sarcoma?

A

Osteosarcoma

357
Q

Child presents with diffuse bone pain, pallor, recurrent infections – diagnosis?

A

Leukemia

358
Q

African American / Mediterranean child with PMHX of Sickle Cell Anemia presents with swollen, painful hands + feet – diagnosis?

A

Dactylitis … vaso-occlusive pain crisis

359
Q

African American / Mediterranean child with PMHX of Sickle Cell Anemia presents with point tenderness over femur, fever, malaise – diagnosis?

A

Osteomyelitis (salmonella)

360
Q

What has occurred in children with Sickle Cell Anemia who present with Howell Jolly bodies on blood smear?

A

Auto-splenectomy

361
Q

African American / Mediterranean child with PMHX of Sickle Cell Anemia presents with decreased reticulocytes + sudden drop in HCT – diagnosis?

A

Aplastic crisis … Parvovirus B19 infection

362
Q

African American / Mediterranean child with PMHX of Sickle Cell Anemia presents with recurrent RUQ after meals – diagnosis?

A

Cholelithiasis with pigmented gallstones

363
Q

African American / Mediterranean child with PMHX of Sickle Cell Anemia presents with respiratory distress, need for tonsillectomy – diagnosis?

A

Waldeyer ring lymphoid hyperplasia

364
Q

African American / Mediterranean child with PMHX of Sickle Cell Anemia presents with proteinuria, increased creatinine, recurrent UTI – diagnosis?

A

Kidney infarct

365
Q

Most common cause of sepsis in children with Sickle Cell Anemia?

A

Strep pneumoniae

366
Q

Most common cause of death in children with Sickle Cell Anemia?

A

Acute chest syndrome

367
Q

Best treatment for Acute chest syndrome in children with Sickle Cell Anemia?

A

Exchange transfusion

368
Q

Best treatment for CVA in children with Sickle Cell Anemia?

A

Exchange transfusion … (not TPA!)

369
Q

Best tool for assessing risk for CVA in children with Sickle Cell Anemia?

A

Transcranial Doppler US

370
Q

Vaccinations needed for children with Sickle Cell Anemia?

A

N. Meningitis, Strep pneumoniae, H. influenzae + Penicillin prophylaxis until 6 yo

371
Q

African American / Mediterranean child with PMHX of Sickle Cell Anemia presents with fatigue – labs show megaloblastic anemia – diagnosis?

A

Folate deficiency

372
Q

Why are children with Sickle Cell Anemia prone to Folate deficiency?

A

Increased RBC turnover

373
Q

When is anemia not concerning in children?

A

Physiologic anemia during first few months of life

374
Q

18 mo child is a picky eater and often drinks cow’s milk – which type of anemia is most common in this child?

A

Iron deficiency anemia

375
Q

Which finding on iron panel indicates thalassemia?

A

Very low MCV

376
Q

18 mo child is irritable, drinks lots of goat’s milk; PE shows FTT, glossitis – diagnosis?

A

Folate deficiency

377
Q

4 mo female presents with triphalangeal thumbs; Labs show NML platelets, HGB = 4, increased ADA, low reticulocytes – diagnosis?

A

Blackfan-Diamond anemia

378
Q

Best treatment for Blackfan-Diamond anemia?

A

Corticosteroids + Blood transfusion

379
Q

4 mo female presents with lack of thumbs + radius; Labs show profound anemia – diagnosis?

A

Fanconi anemia

380
Q

Best treatment for Fanconi anemia?

A

Corticosteroids + Blood transfusion

381
Q

2 yo female presents with impaired growth, hyperactivity, abdominal pain, constipation – diagnosis?

A

Lead poisoning

382
Q

Appearance of Lead poisoning on blood smear?

A

Basophilic stipling

383
Q

Best treatment for mild Lead poisoning in children?

A

Succimer (oral)

384
Q

Best treatment for severe Lead poisoning in children?

A

EDTA + Dimercaprol

385
Q

15 yo female presents with heavy menses, petechiae, recurrent epistaxis – Labs show thrombocytopenia, otherwise NML – diagnosis?

A

ITP

386
Q

15 yo female presents with heavy menses, petechiae, recurrent epistaxis – Labs show NML platelets, prolonged bleeding time – diagnosis?

A

Von Willebrand Disease

387
Q

7 yo male presents with bruising, hematuria, hemarthrosis; Labs show increased PTT that corrects with mixing studies – diagnosis?

A

Hemophilia

388
Q

What is the first clotting factor depleted in child with Wilson’s disease with fulminant liver failure?

A

Factor VII … PT increases first

389
Q

Which 2 clotting factors are NML in setting of liver failure?

A

Von Willebrand Factor, Factor VIII … both made in endothelial cells

390
Q

Best treatment for HUS?

A

Dialysis

391
Q

Which treatment is contraindicated in HUS?

A

Giving platelets + ABX for original bloody diarrhea

392
Q

Best treatment for Henoch-Schonlein Purpura?

A

Supportive

393
Q

Most common cause of Henoch-Schonlein Purpura?

A

URI

394
Q

Child presents with new-onset seizures, ataxia, HA that is worse in AM, vomiting for 1 month – diagnosis?

A

Intracranial tumors

395
Q

Most common brain tumor in children?

A

Pilocytic astrocytoma

396
Q

Where are most childhood brain cancers located … (in relation to tentorium)?

A

Infratentorial

397
Q

2nd most common type of brain tumor in children?

A

Medulloblastoma

398
Q

Histological findings associated with Medulloblastoma?

A

Small blue cells

399
Q

Complication of Medulloblastoma?

A

Hydrocephalus … Due to obstruction of 4th ventricle

400
Q

Adolescent presents with height in 5th percentile; PE shows bitemporal hemianopsia; Head CT shows calcifications in sella turcica – diagnosis?

A

Craniopharyngioma

401
Q

Craniopharyngioma is remnant of …

A

Rathke’s pouch

402
Q

Child presents with HTN; PE shows asymptomatic abdominal mass – diagnosis?

A

Wilms tumor … asymptomatic mass!

403
Q

Condition associated with Wilms tumor?

A

WAGR – Aniridia, GU anomalies, Retardation

404
Q

Best test for Wilms tumor?

A

Abdominal CT

405
Q

Most common site of metastasis for Wilms tumor?

A

Lung

406
Q

Best treatment for Wilms tumor?

A

Resection + CTX/XRT

407
Q

Child presents with tender abdominal mass; PE shows chorea of eyes + leg – diagnosis?

A

Neuroblastoma

408
Q

Best diagnostic test for Neuroblastoma?

A

Increased VMA + MTA in urine

409
Q

3 yo female presents with limp, LLE pain; PE shows petechia, pallor, hepatosplenomegaly; Blood smear shows lots of RBC blast – diagnosis?

A

ALL

410
Q

Best treatment for ALL?

A

CTX + Intrathecal methotrexate

411
Q

Best diagnostic test for ALL?

A

Bone marrow biopsy

412
Q

14 yo male presents with enlarged, painless, rubbery lymph nodes; Reports drenching fevers, 10% weight loss – diagnosis?

A

Hodgkin Lymphoma

413
Q

Best diagnostic test for Hodgkin Lymphoma?

A

LN biopsy, then staging with CT

414
Q

Best treatment for Hodgkin Lymphoma?

A

CTX + XRT

415
Q

7 yo female with non-productive cough; PE shows large anterior mediastinal mass – diagnosis?

A

Non-Hodgkin lymphoma

416
Q

Best diagnostic test for Non-Hodgkin lymphoma?

A

Biopsy

417
Q

Best treatment for Non-Hodgkin lymphoma?

A

Surgical excision + XRT

EH Reviews (4 decks)

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