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
2
Q
APGAR stands for …
A
Appearance, Pulse, Grimace, Activity, Respiration
3
Q
Full Grimace in APGAR score is …
A
Withdrawing from stimulation
4
Q
What does APGAR tell you?
A
1 minute = how baby tolerated labor, 5 minutes = how baby is tolerating stimulation + resuscitation
5
Q
What does APGAR not tell you?
A
Not predictive of baby’s outcome (brain damage, mental development); Should not direct treatment
6
Q
Baby’s R arm appears extended and IR – diagnosis?
A
Erb’s palsy
7
Q
Best treatment for Erb’s palsy?
A
Neurosurgery if doesn’t resolve after 3 months
8
Q
Best treatment for neonatal clavicle fracture?
A
No treatment needed – fracture will resolve because bones in children are malleable
9
Q
Infant presents with abnormally-shaped head; Edema appears to cross suture lines – diagnosis?
A
Caput
10
Q
Quality of edema in caput?
A
Pitting; Crosses suture lines
11
Q
Infant presents with abnormally-shaped head; Palpation shows fluctuant edema that does not cross suture lines – diagnosis?
A
Cephale hematoma
12
Q
Quality of edema in Cephale hematoma ?
A
Does not cross suture lines
13
Q
Infant presents with rash that appears blue, slate-gray; Located on lower back, thigh – diagnosis?
A
Mongolian spots
14
Q
Composition of Mongolian spots?
A
Melanocytes
15
Q
Infant presents with rash that appears pale, pink, vascular; Located on face, nuchal region – diagnosis?
A
Nevus simplex
16
Q
Alternate name for nevus simplex?
A
Salmon patch
17
Q
Infant presents with rash that appears as firm white papules; Present on Day of Life #1 – diagnosis?
A
Milia
18
Q
Composition of Milia?
A
Filled with keratin
19
Q
What can milia be confused for?
A
Neonatal acne
20
Q
What distinguishes neonatal acne from milia?
A
Time of onset … Milia = Day of Life #1; Neonatal acne = Weeks of Life #1-2
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
22
Q
Composition of Erythema toxicum?
A
Filled with eosinophils
23
Q
Infant presents with rash that appears sharply-demarcated, bright red, raised – diagnosis?
A
Hemangioma
24
Q
Different in PE findings between hemangioma and nevus simplex?
A
Hemangioma = palpable; Nevus simplex = non-palpable
25
Infant presents with rash that is hairless, nodular, orange – diagnosis?
Nevus sebaceous
26
Prognosis for nevus sebaceous?
Removal due to malignant transformation risk
27
Alternate name for seborrheic dermatitis that presents on infant’s scalp?
Cradle cap
28
Best treatment for cradle cap in infants?
Antifungal
29
Which 2 conditions are always included in neonatal screen?
Galactosemia, PKU
30
Etiology of PKU?
Deficiency in phenylalanine hydroxylase
31
Clinical presentation of PKU?
Silvery hair, Musty odor
32
Etiology of Galactosemia?
Deficiency in G1P-uridyl transferase
33
Clinical presentation of Galactosemia?
Jaundice, hepatomegaly, cataracts
34
3 do male presents with jaundice; Labs show T. Bili = 10, D. Bili = 0.3 – diagnosis?
Physiologic jaundice
35
Physiologic jaundice resolves by Day \_\_\_
5
36
Etiology of physiologic jaundice?
Infant’s liver is not mature enough to conjugate all bilirubin
37
7 do male presents with jaundice; Labs shows T. Bili = 12, D. Bili = 0.5; PE shows failure to thrive, dry MM – diagnosis?
Breastfeeding jaundice
38
Distinguishing clinical feature of Breastfeeding jaundice?
Infant appears dehydrated
... No breastfeeding enough
39
When is jaundice a cause for concern?
Present on Day of Life #1; T. Bili \> 12; D. Bili \> 2
40
Next best test for infant who presents on Day of Life #1 with elevated total + indirect bilirubin?
Coomb’s Test
41
7 do male presents with jaundice; Urine is dark, stools are pale; Labs show T. Bili = 12, D. Bili = 8, elevated LFTs – diagnosis?
Biliary atresia
42
Biliary atresia represents a ___ bilirubinemia
Direct
43
Best treatment for biliary atresia?
Surgical emergency
44
Why is biliary atresia considered a surgical emergency?
Will cause liver failure if left untreated
45
Infant presents with direct hyperbilirubinemia, NML LFTs – diagnosis?
Sepsis, Hypothyroidism, Cystic Fibrosis
46
2 hereditary causes of indirect hyperbilirubinemia?
Crigler-Najjar, Gilbert
47
Etiology of Gilbert Syndrome?
Decreased in glucuronyl transferase
48
Etiology of Crigler-Najjar?
Total deficiency in glucuronyl transferase
49
2 hereditary causes of direct hyperbilirubinemia?
Rotor, Dubin-Johnson
50
Why is indirect hyperbilirubinemia concerning in infants?
Indirect bilirubin can cross the BBB … causing kernicterus
51
Where does indirect bilirubin preferentially deposit in the brain?
Basal ganglia, CN nuclei
52
Best treatment for extreme hyperbilirubinemia (20+)?
Plasma exchange
53
Best treatment for moderate hyperbilirubinemia?
Phototherapy
54
Role of phototherapy in moderate hyperbilirubinemia?
Isomerizes indirect hyperbilirubinemia … more easily excreted
55
Best treatment for diaphragmatic hernia causing respiratory distress?
Surgical repair 3-5 dyas after delivery
56
What other conditions should we look for in an infant with transesophageal fistula?
VACTERL … Vertebral, Cardiac, Limbs, Renal
57
Additional conditions associated with choanal atresia?
CHARGE … Coloboma, Heart defects, growth Retardation, GU anomalies, Ear anomalies
58
Infant born at 32 weeks presents with dyspnea, nasal flaring; CXR shows ground glass opacities with air bronchograms and atelectasis – diagnosis?
RDS
59
Best test for prenatal diagnosis of RDS?
L:S ratio
60
L:S ratio of ___ is associated with higher likelihood of developing RDS
\< 2
61
Pathophysiology of RDS?
Lack of surfactant
62
Best treatment for RDS?
Surfactant
63
Indication for theophylline in NICU?
Difficulty with respiratory drive
64
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?
TTN
65
Buzzwords associated with CXR in setting of TTN?
Perihilar streaking; Air-trapping
66
What accounts for perihilar streaking in setting of TTN?
Retained fluid in fissures
67
Etiology of TTN?
Retained fluid
68
Risk factor for TTN?
C-section
69
Infant born at 41 weeks; Born after rupture of membranes that yielded green-brown fluid – diagnosis?
Meconium aspiration syndrome
70
Next best step for baby with suspected Meconium aspiration syndrome?
Suction before stimulation
71
Complications of Meconium aspiration syndrome?
Pneumonia pneumonitis; Pulmonary artery HTN
72
2 characteristics of gastroschisis?
Lateral to midline; No soft tissue sac
73
Best test for prenatal diagnosis of gastroschisis?
Elevated maternal AFP
74
2 characteristics of omphalocele?
Midline; Soft tissue sac
75
Which additional conditions are associated with omphalocele?
Down Syndrome, Beckwith-Weidman Syndrome
76
3 aspects of clinical presentation of infants with Beckwith-Weidman Syndrome?
Large baby, Macroglossia, Ear pits
77
Which additional conditions are associated with umbilical hernia?
Hypothyroidism
78
Infant who presents with macroglossia + umbilical hernia – diagnosis?
Hypothyroidism
79
Best treatment for umbilical hernia children?
Monitor for self-resolution by 2-3 yo, then consider surgery
80
4 wo infant presents with non-bilious vomiting; PE shows palpable olive – diagnosis?
Congenital Pyloric Stenosis
81
Best treatment for Congenital Pyloric Stenosis?
Myotomy
82
Metabolic abnormality associated with Congenital Pyloric Stenosis?
Hypochloric, hypokalemic metabolic alkalosis
83
2 wo infant presents with bilious vomiting; Pregnancy complicated by polyhydramnios – diagnosis?
Duodenal atresia
84
Classic appearance of Duodenal atresia on abdominal XR?
Double bubble
85
Condition associated with Duodenal atresia?
Down Syndrome
86
1 wo infant presents with bilious vomiting, abdominal distention; Draws up legs to chest during PE – diagnosis?
Malrotation
87
3 do infant has still not passed meconium – which 2 conditions are on differential?
Cystic fibrosis, Hirschsprung disease
88
5 do male born at 33 weeks develops bloody diarrhea – diagnosis?
Necrotizing enterocolitis
89
Classic appearance of Necrotizing enterocolitis on abdominal XR?
Pneumatosis intestinalis
90
Best treatment for Necrotizing enterocolitis?
Bowel rest, IV ABX, Parental nutrition
91
Risk factor for necrotizing enterocolitis?
Prematurity
92
2 mo infant presents with red current jelly stool, abdominal pain; PE shows sausage-shaped mass in RUQ – diagnosis?
Intussusception
93
Diagnostic and therapeutic test for Intussusception?
Barium enema
94
Next best test for male infant whose testes are not located in scrotum or inguinal canal?
US
95
Condition associated with cryptorchidism?
Prune Belly Syndrome
96
When do infants with cryptorchidism typically require surgery?
12 months
97
Newborn male presents with urethral opening located on ventral surface of penis?
Hypospadias
98
What is contraindicated in male infants with hypospadias?
Circumcision
99
Newborn child presents with ambiguous genitalia; 1 month later develops hyponatremia, vomiting, hyperkalemia, acidosis – diagnosis?
21alpha hydroxylase deficiency
100
Definitive test for 21 hydroxylase deficiency?
17-OH progesterone
101
Best treatment for 21 hydroxylase deficiency?
Replacement of Aldosterone + Cortisol
102
Newborn with midline mass; Lack of urination for first several days of life – diagnosis?
Posterior urethral valves
103
Best treatment for Posterior urethral valves?
Catheterization + Surgical correction
104
2 infant complications associated with mothers who have pre-existent DM?
Small L colon, caudal regression
105
Best treatment for neonatal hypoglycemia \< 40 mg/dL?
Breastfeed
106
Best treatment for neonatal hypoglycemia \< 20 mg/dL?
IV glucose
107
Infants of DM mothers have increased risk of … (even if not premature)
RDS
108
What accounts for increased risk of RDS in infants born to mothers with DM?
Insulin inhibits release of surfactant … (normally stimulated by a surge of cortisol)
109
Anytime an infant age ___ develops fever, it is cause for concern
\< 1 mo
110
Important test to order for infant \> 1 mo who develops a fever?
LP … to rule out meningitis
111
Most common pathogens responsible for neonatal sepsis?
GBS, E. coli, Listeria
112
Best empiric treatment for neonatal sepsis?
Ampicillin + Gentamycin
113
When should empiric treatment for neonatal sepsis be discontinued?
Blood cultures are (-) for 48 hours
114
TORCH infection that presents as maculopapular rash on palms + soles?
Syphilis
115
TORCH infection that presents as hydrocephalus, intracranial calcifications, chorioretinitis?
Toxoplasmosis
116
TORCH infection that presents as deafness, heart defect, cataracts, extramedullary hematopoiesis?
Rubella
117
TORCH infection that presents as microcephaly, periventricular calcifications, deafness, thrombocytopenia, petechia?
CMV
118
TORCH infection that presents as limb hypoplasia, cutaneous scars, cataracts, cortical atrophy, chorioretinitis?
Varicella
119
When should infants receive IgG for varicella … based on maternal infection timing?
5 days before delivery … 2 days after delivery
120
Infants who present with red + tearing conjunctiva during days of life 1-3 – which type of conjunctivitis?
Chemical … (silver nitrate)
121
Infants who present with purulent conjunctiva during days of life 3-5 – which type of conjunctivitis?
Gonorrhea
122
Infants who present with mucoid conjunctiva – which type of conjunctivitis?
Chlamydia
123
Complication of chlamydia conjunctivitis?
Chlamydia PNA
124
Typical IQ of patients with Down Syndrome?
Moderate mental retardation
125
Infant presents with rocker-bottom feet, microcephaly – diagnosis?
Edward Syndrome
126
Infant presents with holoprosencephaly, cleft lip/palate – diagnosis?
Patau Syndrome
127
14 yo female presents with lack of secondary sex characteristics, high FSH – diagnosis?
Turner Syndrome
128
Anomalies associated with Turner Syndrome?
Coarctation of aorta, horseshoe kidney
129
Best treatment for Turner Syndrome?
Estrogen replacement
130
16 yo male presents with hypogonadism, gynecomastia, mild mental retardation – diagnosis?
Klinefelter Syndrome
131
Klinefelter Syndrome is associated with increased risk of …
Gonadal malignancy
132
Patient presents with bird-like facies, hypomandibulosis, glossoproptosis, cleft palate – diagnosis?
Pierre-Robin sequence
133
Patient presents with broad + square face, self-mutation – diagnosis?
Smith McGuinness
134
Most common overall cause of MR?
Fetal ETOH Syndrome
135
Most common cause of MR in males?
Fragile X
136
AD condition, associated with advanced paternal age; PE shows deafness, white forelock – diagnosis?
Wardenberg Syndrome
137
Patient presents with multiple infections; PE shows absent tonsils – diagnosis?
X-linked agammaglobulinemia (Bruton)
138
Lab values seen in setting of X-linked agammaglobulinemia (Bruton)?
No B cells; Low levels of all Ig
139
Low levels of all Ig that presents in adolescents and young adults – diagnosis?
Combined Immunodeficiency
140
Labs seen in setting of Combined Immunodeficiency?
Low levels of all Ig, NML B cells
141
Combined Immunodeficiency is associated with increased risk of …
Lymphoma
142
What is the most common B cell deficit?
IgA deficiency
143
Infant presents with seizures, truncus arteriosus, micrognathia – diagnosis?
DiGeorge Syndrome
144
Which type of infections are children with DiGeorge Syndrome susceptible to?
Fungal, Viral … things that T cells take care of
145
Patient presents with absent tonsils, absent thymus; Labs show severe lymphopenia – diagnosis?
SCID … Severe Combined Immunodeficiency
146
Inheritance pattern of SCID?
X-linked; AR
147
Best treatment for SCID?
Bone marrow transplant
148
Child presents with inguinal lymphadenopathy; PE shows multiple MRSA skin abscesses – diagnosis?
Chronic granulomatous disease
149
Diagnostic test for Chronic granulomatous disease?
Nitrotetrazolium blue
150
18 mo female presents with recurrent ear infections, eczema, petechiae – diagnosis?
Wiskott-Aldrich Syndrome
151
Lab results seen in setting of Wiskott-Aldrich Syndrome?
High IgE + IgA; Low IgG + IgM
wAtEr
152
Which event typically leads to diagnosis of Wiskott-Aldrich Syndrome?
Prolonged bleeding after circumcision … due to severe thrombocytopenia
153
Why do infants typically lose up to 7% of their birth weight during Week 1 of life?
Excess urination
154
When should infants regain their birth weight?
2 wo
155
When should infants double their birth weight?
6 mo
156
When should infants triple their birth weight?
12 mo
157
When should infants increase their birth height by 50%?
1 yo
158
When should infants double their birth height?
4 yo
159
2 fetal contraindications to breastfeeding?
Galactosemia, PKU
160
5 maternal contraindications to breastfeeding?
HIV, TB, Chemotherapy, Radioactive iodine, Maternal ETOH use
161
Is Hepatitis C considered a contraindication to breastfeeding?
No
162
Dominant protein in breastmilk?
Whey
163
Dominant fatty acid in breastmilk?
Long-chain FA
164
Does breastmilk or formula contain more lactose?
Breastmilk
165
Does breastmilk or formula contain more iron?
Formula contains more Fe … BUT breastmilk has greater bioavailability
166
14 yo male presents in \< 5% for height + weight; Parents are above-average height – diagnosis?
Constitutional growth delay
167
Typical bone age seen in Constitutional growth delay?
Bone age \< Real age
168
Prognosis for Constitutional growth delay?
Patient is likely to achieve NML height
169
14 yo male presents in \< 5% for height + weight; Parents are below-average height – diagnosis?
Familial short stature
170
Typical bone age seen in Familial short stature?
Bone age = Real age
171
Prognosis for Familial short stature?
Patient is likely to be short when older
172
14 yo male presents with height in 50th percentile, weight in 97th percentile – diagnosis?
Obesity
173
Typical bone age seen in obesity?
Bone age \> Real age
174
What accounts for Bone age \> Real age in setting of obesity?
Excess estrogen exposure … Estrogen matures bone, closes epophyseal plates more quickly
175
5 causes of advanced bone age?
Obesity, Precocious puberty, Hyperthyroidism, Neoplasm of ovaries/test, CAH
176
14 yo male presents with height \< 5%; Height was tracking along 50th percentile until about 2 years ago – diagnosis?
Pathologic short stature
177
Name the primitive reflex – head is extended, arms + legs flex?
Moro
178
Name the primitive reflex – hand grasp when finger is placed in palm?
Palmar grasp
179
Name the primitive reflex – head turns to side after ipsilateral cheek is rubbed?
Rooting
180
Name the primitive reflex – hip flexion after dorsal foot stimulation?
Stepping
181
Name the primitive reflex – contralateral arm flexion + ipsilateral arm extension when neck is turned to side?
Fencing
182
Name the primitive reflex – arms extended after fall is stimulated?
Parachute
183
Most primitive reflexes disappear by age …
6 months
184
Which primitive reflex persists after 6 months?
Parachute … never disappears
185
Where in CNS do primitive reflexes originate?
Brainstem + Vestibular nuclei
186
Age of development – creep + crawl?
6 mo
187
Age of development – roll?
6 mo
188
Age of development – sit up?
6 mo
189
Age of development – skip?
5 yo
190
Age of development – copy a triangle?
5 yo
191
Age of development – walk without support?
15 mo
192
Age of development – walk up stairs with alternating feet?
30 mo
193
Age of development – copy cross and square?
4 yo
194
Age of development – hop on 1 foot?
4 yo
195
Age of development – throw a ball overhead?
4 yo
196
Age of development – sit without support?
9 mo
197
Age of development – pincer grasp?
9 mo
198
Age of development – walk downstairs?
3 yo
199
Age of development – copy a circle?
3 yo
200
Age of development – half of speech is comprehensible?
2 yo
201
Age of development – begins to speak in 2-3 word sentences?
2 yo
202
Age of development – social smile?
2 mo
203
Urinary continence is considered pathologic at what age?
5+ yo
204
Most common cause of pathologic urinary incontinence?
UTI
205
First step of workup for urinary incontinence?
UA
206
First treatment for urinary incontinence?
Behavioral modifications
207
Fecal continence is considered pathologic at what age?
4+ yo
208
Most common cause of pathologic fecal incontinence?
Constipation
209
Which immunizations are due at birth?
Hep B
210
Infant born to mother with Hepatitis B should receive?
Hep B vaccine + IgG
211
Which immunizations are due at 2 mo?
Hep B, Rotavirus, DTAP, HIB, Strep pneumonia, Polio
212
Which immunizations are due at 4 mo?
Rotavirus, DTAP, HIB, Strep pneumoniae, Polio
213
Which immunizations are due at 6 mo?
Rotavirus, DTAP, HIB, PCV, IPV + Flu (then yearly)
214
Contraindications to flu vaccine?
Egg allergy
215
Which immunizations are due at 12 mo … (not before because live attenuated)?
Varicella, Hep A, MMR
216
Contraindications to MMR?
Allergy to neomycin
217
Which immunizations are due at 2 yo?
Hep A, DTAP
218
Which immunizations are due at 12 yo?
TDAP boosters, Meningitis, HPV
219
2 benign murmurs in children?
Stills murmur, Venous hum
220
2 characteristics of murmurs that always signify pathology?
Murmur \> 2/6 intensity; Diastolic murmur
221
Best first step of workup for pathologic murmur?
ECHO
222
Newborn is cyanotic at birth; Oxygen does not improve cyanosis – diagnosis?
Transposition of great vessels
223
RF for Transposition of great vessels?
Maternal DM
224
Murmur associated with Transposition of great vessels?
None
225
Best immediately treatment for Transposition of great vessels?
Prostaglandins to ensure patency of ductus arteriosus
226
Murmur associated with Tetralogy of Fallot?
VSD … systolic ejection murmur
227
Best treatment for Tetralogy of Fallot?
Supplemental O2 … eventual surgical correction
228
Murmur associated with Epstein anomaly?
Holosystolic murmur that is worse during inspiration
229
What does “murmur that worsens on inspiration” tell us?
R-sided murmur
230
Which arrhythmia is associated with Epstein anomaly?
Wolf-Parkinson White
231
Infant presents with cyanosis at birth; PE shows holosystolic murmur; Depends on VSD or ASD for life; EKG shows L ventribular hypertrophy – diagnosis?
Tricuspid atresia
232
Structural heart defect associated with Tricuspid atresia?
LV hypertrophy … blood shunts through ASD/VSD, away from R heart, into L heart
233
Heart defect associated with DiGeorge Syndrome?
Truncus arteriosus
234
Most common congenital heart lesion?
VSD
235
Description of murmur heard with VSD?
Harsh, holosystolic murmur – heard best at L lower sternal border
236
When should VSD be treated (instead of observed)?
VSD is unclosed by 2 yo; Failure to thrive; Pulmonary HTN
237
Is louder murmur in VSD better or worse?
Louder = better … small hole makes more noise
238
Loud S1 with fixed + split S2 – diagnosis?
ASD
239
Heart defect associated with Down Syndrome?
Endocardial cushion defect
240
Description of endocardial cushion murmur?
Fixed + split S2 (ASD); Loud systolic ejection murmur (VSD)
241
Continuous machine-like murmur with bounding pulses – diagnosis?
PDA
242
2 conditions associated with PDA?
Prematurity, Congenital Rubella infection
243
Best treatment for PDA?
Indomethacin
244
Most common heart defect heard in baby with Turner’s Syndrome?
Aortic coarctation
245
Classic CXR finding for Aortic coarctation?
Figure 3 sign
246
Murmur of HCM is nearly identical to murmur of …
Aortic stenosis … (except HCM gets softer with squat; AS gets louder with squat)
247
HCM murmurs occur during …
Systole
248
How do HCM murmurs change with preload?
HCM = worse with increase in preload; AS = better with increase in preload
249
Best treatment for HCM?
B blockers; Can’t clear medically on sports physical
250
Medical tool for HCM ablation?
ETOH
251
7 yo female presents with vague CP, arthralgias, rash – diagnosis?
Rheumatic fever
252
EKG change associated with Rheumatic fever?
PR prolongation
253
Best treatment for Rheumatic fever?
Penicillin
254
Complication of Rheumatic fever?
Mitral stenosis
255
Signs of cystic fibrosis at birth?
Rectal prolapse, Meconium ileus
256
Inheritance pattern of cystic fibrosis?
AR
257
CF results from genetic mutation on Chromosome \_\_\_
7
258
Child with asthma has symptoms 2x per week; PFTs appear NML – diagnosis?
Mild, Intermittent
259
Best treatment for Mild, Intermittent asthma?
SABA
260
Child with asthma has symptoms 4x per week + night cough; PFTs appear NML – diagnosis?
Mild, Persistent
261
What distinguishes Mild vs. Moderate asthma?
Mild = normal PFTs
262
Best treatment for Mild, Persistent asthma?
SABA + ICS
263
Child with asthma has symptoms daily + night cough x2 per week; PFTs show low FEV1 – diagnosis?
Moderate
264
Best treatment for Moderate asthma?
SABA + ICS + LABA
265
Example of LABA used in treatment for Moderate asthma?
Salmeterol
266
Child with asthma has symptoms daily + night cough x4 per week; PFTs show extremely low FEV1 – diagnosis?
Severe
267
Best treatment for Severe asthma?
SABA + ICS + LABA + Oral corticosteroids / Leukotriene modifying agent
268
If PCO2 normalizes in the setting of asthma exacerbation – good/bad?
Bad … PCO2 should be getting lower with hyperventilation; Increased PCO2 indicated respiratory muscle fatigue
269
Best treatment for increasing PCO2 in setting of asthma exacerbation?
Intubation
270
Best test to monitor DKA?
Anion Gap
271
Diagnostic criteria for T1DM?
Fasting BG \> 126; Any BG \> 200; BG \> 200 after 75g 2-hour glucose challenge test
272
2 yo male; T = 105, rash later appears on trunk, arms, legs – diagnosis?
Roseola
273
Alternate name for Roseola?
HHV-6
274
Parvovirus infection is most concerning in which 2 groups of patients?
Sickle Cell, Pregnant females
275
Consequence of Parvovirus during pregnancy?
Hydrops fetalis
276
Consequence of Parvovirus in patients with Sickle Cell Disease?
Aplastic anemia
277
2 aspects of clinical presentation for Scarlet Fever?
Desquamating rash, Strawberry tongue
278
Best treatment for Scarlet Fever?
Penicillin
279
Value of penicillin treatment in Scarlet Fever?
Prevents rheumatic fever, but not post-streptococcal glomerulonephritis
280
Koplik spots are associated with …
Measles
281
Best treatment for Measles?
Vitamin A
282
Sore throat, joint pain, fever; PE shows pinpoint rash that spreads down from head – diagnosis?
Rubella
283
Best treatment for Lyme Disease in children \< 8 yo?
Amoxicillin
284
Best treatment for Lyme Disease in children \> 8 yo?
Doxycycline
285
Best treatment for Rickettsia?
Always doxycycline … no matter the age
286
Best treatment for Scabies?
Permethrin for patient + household
287
Best treatment for impetigo?
Topical mupirocin
288
Best treatment for Scaled Skin Syndrome?
IV ABX
289
Most common pathogens responsible for meningitis overall?
Strep pneumoniae, H. influenzae, N. meningitidis
290
Pathogen responsible for meningitis in people with HX of brain surgery and instrumentation?
Staph aureus
291
First 3 steps of workup for patients with meningitis?
Start IV ABX, Check ICP (on CT), Lumbar puncture
292
Best treatment for Lyme Disease causing meningitis?
IV ceftriaxone
293
Most sensitive test to confirm AOM?
Lack of TM mobility during insufflation
294
Best treatment for AOM?
Amoxicillin
295
Best treatment for otitis externa?
Topical ciprofloxacin
296
Complication of otitis externa is invasion of which bone?
Temporal
297
Child presents with exudative pharyngitis; PE shows tender cervical LN, T = 102 – first step in workup?
Rapid Strep test
298
Next step of workup in patient with (-) strep test, but index of clinical suspicion is high?
Culture
299
2 DOC for treatment of strep?
Penicillin, Erythromycin
300
Child with untreated strep throat later presents with muffled voice; Refuses to turn head during PE – diagnosis?
Retropharyngeal abscess
301
Best treatment for Retropharyngeal abscess?
I&D, ABX
302
Complication of Retropharyngeal abscess?
Mediastinum
303
Child with untreated strep throat later presents with muffled voice; PE shows deviated uvula – diagnosis?
Peritonsillar abscess
304
Best treatment for Peritonsillar abscess?
I&D, ABX
305
Indication for tonsillectomy in children?
5+ episodes of strep throat for 2 years; 3+ episodes of strep throat for 3 years
306
Effect of Infectious Mononucleosis treatment with penicillin … (thinking it’s strep throat)?
Rash
307
Diagnostic test for Infectious Mononucleosis?
Heterophile antibody monospot
308
Appearance of blood smear in Infectious Mononucleosis?
Atypical lymphocytes
309
Best treatment for Infectious Mononucleosis?
Supportive care
310
Best treatment for croup?
Inhaled racemic epinephrine, then steroids
311
Most common pathogen responsible for epiglottitis?
Haemophilus influenzae
312
Most common pathogen responsible for epiglottitis in children who have been vaccinated?
Strep pneumoniae, Strep pyogenes, Staph aureus
313
Next best step of workup for epiglottitis?
Intubation in OR … (NOT in ER, due to risk for epiglottis collapse)
314
3 aspects of clinical presentation for Acute bronchitis?
Rhinorrhea + cough with Sputum, Low-grade temp, NO abnormal findings on lung exam (egophony, crackles)
315
Best treatment for Acute bronchitis?
Symptomatic care
316
Most common cause of PNA in infants \<1 mo?
GBS, E. coli, Listeria
317
Most common cause of PNA in infants 1-3 mo?
RSV, Chlamydia, Parainfluenza, Strep pneumonia
318
Specific PE finding associated with Chlamydia PNA?
Staccato cough
319
Specific lab finding associated with Chlamydia PNA?
Eosinophilia
320
Most common cause of PNA in infants 6 mo – 5 yo?
Viral
321
Most common cause of PNA in infants \> 5 yo?
Mycoplasma pneumoniae, Strep pneumonia
322
Best treatment for RVS bronchiolitis?
Nebulizer treatments … steroids won’t help
323
CXR findings for RVS bronchiolitis?
Hyperinflation; Atelectasis without consolidation
324
Specific lab finding associated with pertussis?
High lymphocytes
325
Best treatment for pertussis (in patient + family + daycare)?
Macrolides
326
Febrile UTI in children – diagnosis?
Pyelonephritis
327
Anatomic risk factor for UTI in children?
Vesicoureteral reflux
328
Next step of treatment for children diagnosed with Vesicoureteral reflux?
Prophylactic ABX
329
Diagnostic test for UTI?
UA
330
Best strategy obtaining clean-catch in infants … (normally impossible)?
Catheterization
331
Which 2 GU conditions in children require US?
Febrile UTI, pyelonephritis
332
2 DOC for treatment of UTI in children?
TMP-SMX, Nitrofurantoin
333
Best treatment for pyelonephritis?
IV ABX for 2 weeks
334
Indication for VUCG in children with UTI?
After first UTI in males; After first UTI in very young females (\< 5yo); After 2nd UTI in females \< 5 yo
335
Most common cause overall of child with limp?
Trauma
336
Infant presents with asymmetric gluteal folds on exam – diagnosis?
Hip dysplasia
337
Epidemiology of hip dysplasia in infants?
Firstborn females, breech delivery, (+) FHX
338
Next for workup of hip dysplasia after hearing “clunk” on exam?
Hip US
339
5 yo male presents with painless limp, progressing in pain in thigh – diagnosis?
Legg-Calve Perthes Syndrome
340
Etiology of Legg-Calve Perthes Syndrome?
Avascular necrosis of femoral head
341
5 yo male presents with limp; PE shows hip effusion; Labs show high ESR; HX reveals recent URI – diagnosis?
Transient synovitis
342
Best treatment for Transient synovitis?
Supportive care
343
14 yo lanky male presents with knee pain; PE shows decreased hip ROM – diagnosis?
Slipped capital femoral epiphysis (SCFE)
344
Best treatment for SCFE?
Surgical correction
345
Why is surgical correction needed for SCFE?
Complication = osteonecrosis
346
12 yo female presents with HX of daily fever; PE shows salmon-colored rash; Swelling of R knee and L knee – diagnosis?
Juvenile RA
347
Best treatment for Juvenile RA?
NSAIDs, then Methotrexate, then steroids
348
1 factor that indicates good prognosis in Juvenile RA?
(+) ANA
349
1 factor that indicates bad prognosis in Juvenile RA?
(+) RF
350
2 yo female presents with daily fevers; PE shows desquamating rash on perineum, swelling of hands/feet, conjunctivitis, unilateral cervical lymph node – diagnosis?
Kawasaki Syndrome
351
Best treatment for Kawasaki Syndrome?
High-dose ASA, IVIG
352
2 lab findings associated with Kawasaki Syndrome?
Thrombocytosis, Sterile pyuria
353
Best first test for Kawasaki Syndrome?
ECHO + EKG
354
2 main bone tumors seen in pediatric patients?
Osteosarcoma, Ewing Sarcoma
355
Onion skinning - Osteosarcoma, Ewing Sarcoma?
Ewing Sarcoma
356
Sunburst appearance, Codman’s triangle - Osteosarcoma, Ewing Sarcoma?
Osteosarcoma
357
Child presents with diffuse bone pain, pallor, recurrent infections – diagnosis?
Leukemia
358
African American / Mediterranean child with PMHX of Sickle Cell Anemia presents with swollen, painful hands + feet – diagnosis?
Dactylitis … vaso-occlusive pain crisis
359
African American / Mediterranean child with PMHX of Sickle Cell Anemia presents with point tenderness over femur, fever, malaise – diagnosis?
Osteomyelitis (salmonella)
360
What has occurred in children with Sickle Cell Anemia who present with Howell Jolly bodies on blood smear?
Auto-splenectomy
361
African American / Mediterranean child with PMHX of Sickle Cell Anemia presents with decreased reticulocytes + sudden drop in HCT – diagnosis?
Aplastic crisis … Parvovirus B19 infection
362
African American / Mediterranean child with PMHX of Sickle Cell Anemia presents with recurrent RUQ after meals – diagnosis?
Cholelithiasis with pigmented gallstones
363
African American / Mediterranean child with PMHX of Sickle Cell Anemia presents with respiratory distress, need for tonsillectomy – diagnosis?
Waldeyer ring lymphoid hyperplasia
364
African American / Mediterranean child with PMHX of Sickle Cell Anemia presents with proteinuria, increased creatinine, recurrent UTI – diagnosis?
Kidney infarct
365
Most common cause of sepsis in children with Sickle Cell Anemia?
Strep pneumoniae
366
Most common cause of death in children with Sickle Cell Anemia?
Acute chest syndrome
367
Best treatment for Acute chest syndrome in children with Sickle Cell Anemia?
Exchange transfusion
368
Best treatment for CVA in children with Sickle Cell Anemia?
Exchange transfusion … (not TPA!)
369
Best tool for assessing risk for CVA in children with Sickle Cell Anemia?
Transcranial Doppler US
370
Vaccinations needed for children with Sickle Cell Anemia?
N. Meningitis, Strep pneumoniae, H. influenzae + Penicillin prophylaxis until 6 yo
371
African American / Mediterranean child with PMHX of Sickle Cell Anemia presents with fatigue – labs show megaloblastic anemia – diagnosis?
Folate deficiency
372
Why are children with Sickle Cell Anemia prone to Folate deficiency?
Increased RBC turnover
373
When is anemia not concerning in children?
Physiologic anemia during first few months of life
374
18 mo child is a picky eater and often drinks cow’s milk – which type of anemia is most common in this child?
Iron deficiency anemia
375
Which finding on iron panel indicates thalassemia?
Very low MCV
376
18 mo child is irritable, drinks lots of goat’s milk; PE shows FTT, glossitis – diagnosis?
Folate deficiency
377
4 mo female presents with triphalangeal thumbs; Labs show NML platelets, HGB = 4, increased ADA, low reticulocytes – diagnosis?
Blackfan-Diamond anemia
378
Best treatment for Blackfan-Diamond anemia?
Corticosteroids + Blood transfusion
379
4 mo female presents with lack of thumbs + radius; Labs show profound anemia – diagnosis?
Fanconi anemia
380
Best treatment for Fanconi anemia?
Corticosteroids + Blood transfusion
381
2 yo female presents with impaired growth, hyperactivity, abdominal pain, constipation – diagnosis?
Lead poisoning
382
Appearance of Lead poisoning on blood smear?
Basophilic stipling
383
Best treatment for mild Lead poisoning in children?
Succimer (oral)
384
Best treatment for severe Lead poisoning in children?
EDTA + Dimercaprol
385
15 yo female presents with heavy menses, petechiae, recurrent epistaxis – Labs show thrombocytopenia, otherwise NML – diagnosis?
ITP
386
15 yo female presents with heavy menses, petechiae, recurrent epistaxis – Labs show NML platelets, prolonged bleeding time – diagnosis?
Von Willebrand Disease
387
7 yo male presents with bruising, hematuria, hemarthrosis; Labs show increased PTT that corrects with mixing studies – diagnosis?
Hemophilia
388
What is the first clotting factor depleted in child with Wilson’s disease with fulminant liver failure?
Factor VII … PT increases first
389
Which 2 clotting factors are NML in setting of liver failure?
Von Willebrand Factor, Factor VIII … both made in endothelial cells
390
Best treatment for HUS?
Dialysis
391
Which treatment is contraindicated in HUS?
Giving platelets + ABX for original bloody diarrhea
392
Best treatment for Henoch-Schonlein Purpura?
Supportive
393
Most common cause of Henoch-Schonlein Purpura?
URI
394
Child presents with new-onset seizures, ataxia, HA that is worse in AM, vomiting for 1 month – diagnosis?
Intracranial tumors
395
Most common brain tumor in children?
Pilocytic astrocytoma
396
Where are most childhood brain cancers located … (in relation to tentorium)?
Infratentorial
397
2nd most common type of brain tumor in children?
Medulloblastoma
398
Histological findings associated with Medulloblastoma?
Small blue cells
399
Complication of Medulloblastoma?
Hydrocephalus … Due to obstruction of 4th ventricle
400
Adolescent presents with height in 5th percentile; PE shows bitemporal hemianopsia; Head CT shows calcifications in sella turcica – diagnosis?
Craniopharyngioma
401
Craniopharyngioma is remnant of …
Rathke’s pouch
402
Child presents with HTN; PE shows asymptomatic abdominal mass – diagnosis?
Wilms tumor … asymptomatic mass!
403
Condition associated with Wilms tumor?
WAGR – Aniridia, GU anomalies, Retardation
404
Best test for Wilms tumor?
Abdominal CT
405
Most common site of metastasis for Wilms tumor?
Lung
406
Best treatment for Wilms tumor?
Resection + CTX/XRT
407
Child presents with tender abdominal mass; PE shows chorea of eyes + leg – diagnosis?
Neuroblastoma
408
Best diagnostic test for Neuroblastoma?
Increased VMA + MTA in urine
409
3 yo female presents with limp, LLE pain; PE shows petechia, pallor, hepatosplenomegaly; Blood smear shows lots of RBC blast – diagnosis?
ALL
410
Best treatment for ALL?
CTX + Intrathecal methotrexate
411
Best diagnostic test for ALL?
Bone marrow biopsy
412
14 yo male presents with enlarged, painless, rubbery lymph nodes; Reports drenching fevers, 10% weight loss – diagnosis?
Hodgkin Lymphoma
413
Best diagnostic test for Hodgkin Lymphoma?
LN biopsy, then staging with CT
414
Best treatment for Hodgkin Lymphoma?
CTX + XRT
415
7 yo female with non-productive cough; PE shows large anterior mediastinal mass – diagnosis?
Non-Hodgkin lymphoma
416
Best diagnostic test for Non-Hodgkin lymphoma?
Biopsy
417
Best treatment for Non-Hodgkin lymphoma?
Surgical excision + XRT
