EOR Topics to Review Flashcards
1
Q
Best way to CONFIRM lactose intolerance diagnosis
A
Acidic stool pH testing OR hydrogen breath testing > although lactose intolerance is usually a clinical diagnosis
2
Q
Presentation, diagnosis and management of intestinal malrotation
A
presentation = mild abdominal sx > tenderness, distention, bilious vomiting often seen with a congenital diaphragmatic hernia +/- signs of congenital heart defects, omphalocele
Diagnosis = plain abdominal XR if HDS to r/o perf, followed by upper GI series with contrast to CONFIRM diagnosis
Treatment = always surgical (ladd procedure if concomitant volvulus)
3
Q
MC vitamin deficiency in infants who are exclusively breastfed?
A
Vitamin D
***folate intake through breastmilk is adequate, and iron stores last for the first 4-6 months of life
4
Q
Celiac screening and confirmative tests
A
Screening = tTG-IgA antibodies
If antibodies + > confirm with duodenal biopsy, (+) for complete loss of intestinal villi
5
Q
4 H’s of scurvy (vitamin C deficiency) presentation
A
Hemorrhage
- Petechiae, gingival bleeding
Hyperkeratosis
- Rough skin, loose teeth, poor wound healing
Hypochondriasis
- Irritability, emotional changes
Hematologic abnormalities
- Easy bruising
6
Q
What antibiotics can increase risk of development of pyloric stenosis?
A
Macrolides (erythromycin or azithro) taken during pregnancy or before 2 weeks of age
7
Q
Are indirect or direct hernias due to congenital defects?
A
Indirect > go INto the scrotum
8
Q
GERD management in infants
A
Reassurance if < 1 y/o as it usually self resolves by 12 months
- Encourage to thicken feeds, avoid overfeeding, and frequent positional changes
If pharmacologic therapy is indicated, PPIs are acceptable in moderate to severe cases and mild cases can be treated with H2A antagonists like pepcid
9
Q
Ingestion of which of the following FBs warrants immediate surgical intervention?
A) Battery
B) Coin
C) Marble
D) Puzzle piece
A
A – can cause erosive changes to the esophagus
10
Q
Timeline for reflex appearance and disappearance
A
Moro (startle):
- Appears at birth
- Disappears 3-6 months
Asymmetric tonic neck reflex:
- Appears at birth
- Disappears at 1-3 months
Trunk incurvation (Galant):
- Appears at birth
- Disappears at 5-6 months
Palmar grasp:
- Appears at birth
- Disappears at 5-6 months
Rooting:
- Appears at birth
- Disappears at 2-3 months
Parachute:
- Appears at 8-9 months of age
- Persists throughout life
11
Q
Landmarks for when an infant should double and triple their weight
A
Double by 4 months
Triple by 1 year
***infants should also regain any weight lost during the first few days of life by 10-14 days old
***breastfed infants tend to gain weight more rapidly in the first 3-4 months of life VS. formula fed gain weight more rapidly after 4 months
12
Q
Physical exam findings for down syndrome
A
- Upward slanting eyes
- Flat nasal bridge
- Epicanthal folds
- Widely separated first and second toes
- Increased skin creases on feet
- Single transverse palmar crease on hand
- Short fifth finger that curves inward
13
Q
Empiric meningitis treatment
A
< 1 month: cefotaxime + ampicillin OR gentamicin + ampicillin
1 month - 18 years: vanco + CTX/cefotaxime
14
Q
Car seat recommendations
A
Use rear facing car seats in back seat until highest weight or height allowed by manufacturer
***start using vehicle seatbelts around 8-12 y/o
15
Q
Turner syndrome presentation
A
- Short
- Primary amenorrhea
- Absence of secondary sex characteristics
- Shield chest
- Widely spaced nipples
- Webbed neck
- Low set hairline
16
Q
6 month developmental milestones
A
Social-emotional:
- Knows familiar people
- Looks at self in mirror
- Laughs
Language/communication:
- Cooing
- Makes sounds back when you talk to them
- Turns head towards sound of voices
Cognitive:
- Opens mouth when they see a breast or bottle if hungry
- Looks at hands with interest
Motor:
- Rolls from tummy to back
- Pushes up with straight arms when on tummy
- Leans on hands to support themself when sitting
17
Q
MC presentation of osteosarcoma
A
- Chronic localized pain after minor trauma
- MC areas affected: distal femur, proximal tibia, proximal humerus, middle and proximal femur
- On XR: soft tissue mass with ill defined borders, periosteal reaction and bone destruction
***does not have to be a/w B symptoms
18
Q
MC pattern of scoliosis
A
R thoracic, L lumbar curvature
19
Q
Osteosarcoma versus osteochondroma on imaging
A
Osteosarcoma = soft tissue mass with indistinct borders
Osteochondroma = originates in the physis and presents as a palpable mass with well circumscribed borders and NO bone destruction or periosteal reaction
20
Q
What measures can help prevent the development of severe forms of RSV?
A
Breastfeeding and vitamin D supplementation prenatally
21
Q
Croup treatment
A
Mild (no signs of respiratory distress or stridor) = dexamethasone ONLY
Moderate to severe = dex plus nebulized epinephrine
22
Q
Preferred diet for cystic fibrosis
A
High fat, high energy with fat soluble (A, D, E and K) vitamin supplementation
***high fat bc they have poor pancreatic enzyme activity and ability to absorb fats
23
Q
What are the cyanotic congenital heart defects?
A
Tetralogy of Fallot
Tricuspid atresia
Transposition of great arteries
Total anomalous pulmonary venous return
Truncus arteriosus
Hypoplastic left heart syndrome
24
Q
Suspected candida diaper dermatitis diagnostic method of choice?
A
KOH prep
25
Cleft palate risk factors
- Maternal use of phenytoin, depakote, topiramate, MTX
- Maternal tobacco use
- Folate deficiencies
26
Skeletal deformities a/w Marfan syndrome
Scoliosis (MC)
Arachnodactyly (very long and thin fingers)
Dolichostenomelia (long limbs and trunk length)
Pectus excavatum
27
When do you start screening audiometry in average risk children?
4 years old
***start at 2 y/o if risk factors for decreased hearing
***after starting at age 4, kids should undergo routine screening at 6 and 8 years old
28
Treatment of hypophosphatemic rickets
calcitriol 20 ng/kg/day + phosphate 40 mg/kg/day
29
Kawasaki treatment
Mainstay = IVIG
Also want to give concurrent low dose aspirin to decrease incidence of developing coronary aneurysm
30
Diaper dermatitis treatment
Zinc oxide taste + nystatin (for candida coverage if suspected -- rash will involve skin folds)
31
Mainstay of vWD treatment
Moderate = desmopressin (increases vWF and factor VII levels)
32
GERD treatment in infants
No pharamcologic therapy in kids < 13 mo old UNLESS biopsy shows esophagitis or pt has poor weight gain
If > 13 months OR biopsy evidence/poor weight gain > start with 2 week trial of PPI
33
Simple diaper dermatitis ______ the inguinal folds
Spares -- consider candida if inguinal folds are involved
34
Diaper dermatitis treatment (uncomplicated)
Zinc oxide barrier paste, add on nystatin if suspected candida involvement
35
Best initial treatment for enuresis
Motivational therapy
36
Thrush is more a/w albuterol/inhaled CS use
ICS -- instruct patients on an ICS to wash out their mouth after use
37
Guttate psoriasis etiology
Post streptococcal infection most commonly
38
Guttate psoriasis versus drug reaction presentation
Guttate = discrete, drop like inflammatory papules and plaques with a thin adherent scale
Drug reaction = less discrete lesions
39
Which viral exanthem is a/w postauricular lymph node involvement?
Rubella
40
Epistaxis treatment algorithm
Anterior: consistent compression for 5-10 minutes > topical vasoconstriction with oxymetazoline > cauterization if you can identify source > nasal packing
41
Otitis externa treatment if auditory canal edema causes complete vs. partial occlusion
Complete: Wick placement + subsequent administration of otic solution (antibiotic + glucocorticoid)
Partial: ciprofloxacin + HCT otic drops
42
Fetal alcohol syndrome presentation
- Smooth philtrum
- Short palpebral fissures
- Thin vermillion border
- CNS abnormalities: learning disabilities, cognitive impairment, seizures, microcephaly
- Growth restriction
- Decreased interpupillary distance
- Strabismus
- Hearing loss
- Epicanthal folds
43
Tinea capitis treatment of choice
Oral griseofulvin or terbinafine x6-8 weeks
***Topicals are not sufficient b/c they do not penetrate the hair follicles
44
Pityriasis rosea treatment
Reassurance > typically a self limiting condition
45
Which viral exanthem is highly teratogenic if caught during pregnancy>
Rubella
46
Best SSRI for MDD in kids/teens?
Fluoxetine/Prozac
47
Complex partial versus simple seizure presentation
Complex = focal, prolonged, period of impaired awareness
48
Complex partial seizure treatments
First line = Keppra
49
MCC of conductive HL in kids?
Otitis media
50
Common MOI for tibial shaft fracture/toddler fracture
torsion or twisting of the leg, i.e. pulling child out of a car seat and leg gets caught
51
Fractures that indicate high likelihood of abuse
Metaphyseal corner fractures of extremities
Posterior rib
Scapula
Sternum
Spinous process
52
Strabismus cover test findings for eso/exotropia
Esotropia → covering unaffected eye causes affected eye to deviate outward
Exotropia → covering unaffected eye causes affected eye to deviate inward
53
Hyaline membrane disease presentation and mgmt
Preterm infants in respiratory distress with EXPIRATORY GRUNTING
Mgmt: early intubation to allow for intratracheal surfactant administration (can also trial nasal CPAP if pt is stable)
54
Nephrotic syndrome first line treatment
Trial of corticosteroids (ideally prednisone)
55
What tool is used to screen for autism and at what age?
Modified checklist for autism in toddlers (MCHAT) at age 18-24 months
56
Whooping cough treatment of choice
Azithromycin or clarithromycin if > 14 mo (azithro ONLY if < 1 mo) for 14 days
57
Herpetic gingivostomatitis presentation
Ulcerative lesions of gingiva and mucous membranes + perioral vesicular lesions > appear yellow after rupturing and are surrounded by red halos
***tx = acyclovir (caused by HSV-1) + supportive care with hydration and pain control
58
Timeline of rubella versus rubeola (aka measles)
Rubella = rash that starts on face and spreads to body 14-17 days after exposure, petechiae on soft palate (Forchheimer spots)
Rubeola (measles) = rash preceded by 2-3 days of cough, conjunctivitis, corzya then rash development that starts on face and spreads to body, Koplik spots (pinpoint gray spots on BUCCAL mucosa)
59
What are the TORCH infections?
Congenital infections
Toxoplasmosis
Other
Rubella - blueberry muffin rash, infantile glaucoma, cardiac abnormalities
Cytomegalovirus - SNHL
HSV
***Other = hepatitis, HSV, syphilis
60
Mumps causative organism
Paramyxoviridae (viral)
61
What are Pastia lines?
Linear petechiae over antecubital fossa and axillary folds a/w rash seen in Scarlet fever
62
Congenital toxoplasmosis presentation
- Roughly 70% are asymptomatic
- Classic triad: chorioretinitis (MC long term complication -- painless blurred vision), intracranial calcifications, hydrocephalus
- Jaundice
- Thrombocytopenia, anemia
- Fever
- Hepatosplenomegaly
63
Congenital toxoplasmosis treatment
Pyrimethamine, sulfadiazine, and folinic acid x1 year + prednisone IF CSF fluid protein > 1 g/dL
64
Which exanthem is characterized by very high fever x3 days followed by a rash?
Roseola (fever lasts 3-5 days THEN rash subsequently develops on trunk/neck then spreads to face)
65
MC complication of mumps
Orchitis
66
Pinworms causative organism
Enterobius vermicularis
Tx = albendazole or mebendazole
67
Congenital CMV presentation
- Petechiae
- Hepatosplenomegaly
- Jaundice
- Small size for gestational age
- Microcephaly
- SNHL!!! (common sequelae)
- Labs: elevated LFTs, TCP, hemolytic anemia, elevated bili (direct and indirect)
68
"dew drop on a rose petal" rash appearance is a/w which exanthem?
Varicella/chicken pox
Tx if healthy and < 12 y/o = supportive care
Tx if unvaccinated and > 12 y/o, pregnant or immunocompromised = acyclovir
MC complication = soft tissue infection
69
Erythema infectiosum presentation and timeline VS. rubella
Erythema infectiosum: Fever, nausea, diarrhea, coryza > THEN erythematous malar rash 2-5 days later
Rubella: posterior cervical and posterior auricular lymphadenopathy, rash initially starts on face then spreads to the rest of the body
70
Rocky Mountain Spotted Fever presentation and treatment
Early sx nonspecific: HA, malaise, myalgias, arthralgias, N/V
3-5 days later: blanching, erythematous macular rash on wrists and ankles ? spreads to trunk and can become petechial (presence on hands and soles highly characteristic of later RMSF)
Tx = doxycycline even in children
71
Treatment of amoxicillin induced rash secondary to EBV infection
Supportive care with acetaminophen (pref if known ibuprofen allergy) or NSAIDs
Dexamethasone if impending airway obstruction present
72
Is it safe to give influenza vaccine to pts with egg allergies?
Yes, no documented reactions of anaphylaxis even in pts with known egg allergies
Single dose of live attenuated vaccine (intransal) indicated if pt has had previous flu shots
2 doses of inactivated influenza vaccine (IM) if pt has never had flu shot before
73
Herpes diagnostic test of choice
Depends on clinical presentation:
- Suspicious lesions/vesicles present WITHOUT any crusting -- PCR, viral culture is gold standard
- Suspicious lesions/vesicles present WITH overlying crust/unable to get fluid out -- serologic testing is method of choice
***Tzanck would show (+) multinucleated giant cells but is no longer the test of choice b/c it has low specificity and sensitivity, can't distinguish between HSV1 and 2
74
Pertussis diagnostic method of choice
PCR on nasopharyngeal swab/specimen
75
Blanchable erythematous macular rash on wrists and ankles
RMSF > treat with doxy!
76
Viral exanthem a/w transient aplastic crisis
Erythema infectiosum (parvovirus destroys RBC progenitor cells)
77
Chronic lichen planus presentation
Pruritic flat topped lesions with fine white lines on the surface and violaceous lesions at sites of trauma (+ Koebner phenomenon)
78
Erythema multiforme versus RMSF presentation
Both with targetoid lesions on palms and soles of feet (though later development of RMSF); multiforme with 3 areas of color change (dusky central area, dark red inflammatory zone surrounded by a pale edematous ring); RMSF with more prodromal symptoms (HA, malaise, fever, etc.)
79
What type of HSR are drug eruptions?
Type IV (delayed)
80
Treatment of allergic contact dermatitis
Topical corticosteroids x2-3 weeks
81
T or F: You should do patch testing for poison ivy or poison sumac
FALSE -- could initiate a severe reaction
82
What part of the head are the earliest sites of hair loss noted in androgenic alopecia?
Vertex (crown area) -- proceeds to an M shape or widow's peak
83
Common wart presentation and treatment
Exophytic, dome shaped papules often on fingers, dorsal surface of hand, knees or elbows
Tx: salicylic acid
84
Molluscum treatment of choice if refractory to observation?
Curettage and cantharidin (topical blistering agent that causes a small blister to develop without any scarring)
85
Rash described as "like a sunburn" but without any sun exposure should make you think
Staphylococcal scalded skin syndrome (SSSS)
86
SSSS treatment
Empiricic antibiotics with IV oxacillin or nafcillin (2nd gen cephalosporin or vanco if pt has PCN allergy)
87
SSJs skin biopsy findings
Full thickness keratinocyte epidermal necrosis
88
Plantar wart prevention
Careful sanitation and hygiene (warts are infectious)
Avoid deliberate manipulation of warts
Avoid sharing footwear, nail files, razors
***Warts caused by HPV 1 (on soles of feet) -- first line treatment is salicylic acid
89
Burn presentation based on classification
Superficial: painful, dry, red and blanches with pressure
Superficial partial: painful to temperature/air/touch, blisters, moist, red and weeping, blanchable
Deep partial: painful with deep pressure only, blisters and is easily unroofed, wet or waxy dry, variable color
Full: painful with deep pressure only, waxy white to leathery gray to charred and black, dry and inelastic, no blanching
90
Acutane monthly labs include
- Pregnancy test
Side effects: hyperlipidemia, hepatotoxicity, IBD, ankylosis hyperostosis, depression
91
TORCH infection a/w decreased hearing, infantile glaucoma, and cardiac disease
Rubella
92
Foreign body aspiration management
Complete obstruction (pt cyanotic, unable to speak, respiratory distress) -- chest compressions or back blows/Heimlich (if pt >/= 1 y/o)
Partial obstruction (no distress or cyanosis, pt otherwise stable) -- proceed with laryngoscopy or rigid bronchoscopy to remove FB
93
Causative pathogen and presentation of bacterial tracheitis versus croup
Bacterial tracheitis (staph aureus) -- looks like croup but children will appear toxic on PE, tachypnea and high grade fever
Croup (parainfluenza virus) -- non-toxic appearing, normal RR, low grade fever
94
What is the Samter triad?
- Nasal polyps
- Asthma
- Aspirin hypersensitivity
95
Management of severe versus nonsevere bronchiolitis
Severe = persistently increased RR, nasal flaring, retractions, accessory muscle use, grunting, O2 < 95%, apnea, acute resp failure
- Tx: hospital admission for monitoring and treatment (i.e. HFNC, LFNC, etc., IVF)
Non-severe = all other cases of bronchiolitis that do not fit these criteria
- Tx: close monitoring at home w/ adequate hydration, frequent nasal suctioning, inhalation of humidified air, strict return precautions
96
What intervention can decrease the risk of developing bronchiolitis in PREMATURE infants?
Palivizumab (series of injections) for kids < 6 months
***RSV vaccine not available for kids atm
97
Asthma classification
Mild intermittent: night sx 1x a week, but NOT nightly
Severe persistent: night sx often 7x per week
98
What would be the step up inhaler if a pt is uncontrolled with prn albuterol and fluticasone-salmeterol 250/50 mcg BID?
Fluticasone-salmeterol 500/50 mcg BID
99
Chronic cough with brown, foul-smelling sputum in Cf patients should make you think
Bronchiectasis -- confirm with lung CT (+) for dilated airways, bronchial thickening, and reduced bronchi wall tapering
100
Bronchiolitis timeline
Initial sx 2-4 days of mild cough, congestion, fever followed by dev of lower respiratory infections (progressive cough, wheezing, poor feeding)
101
Nasal suctioning as treatment is most a/w
Mild/nonsevere bronchiolitis management
102
Innocent murmur characteristics
- Grade 2 or less intensity
- Short systolic duration
- Minimal radiation
- Musical or vibratory quality
- Soften in intensity when sitting or standing versus when supine
103
Tetralogy of Fallot cardiac changes
THINK: RAPS
Right ventricular hypertrophy
Aorta overriding ventricular septum
Pulmonary outflow tract obstruction
Septal defect (VSD)
104
Clinical diagnosis criteria for Kawasaki disease
Fever of 5 days duration with any four of the following:
- B/l nonexudative conjunctivitis
- Oral changes (strawberry tongue or cracked, erythematous lips)
- Peripheral extremity changes (erythema and/or edema, periungual desquamation)
- Polymorphous rash
- Cervical lymphadenopathy
105
Tetralogy of Fallot murmur description
Harsh systolic crescendo decrescendo heard best at left sternal border (also a/w palpable thrill and prominent RV impulse)
106
MC valvular complication of rheumatic heart disease
Mitral regurg (pansystolic murmur)
107
Cervical venous hum murmur findings
Heard best over L or R upper sternal borders, infraclavicular or supraclavicular -- continuous murmur accentuated by head extension while seated
108
MCC of aortic stenosis in peds
Bicuspid aortic valve
109
Aortic stenosis murmur description
Systolic crescendo decrescendo murmur at R second intercostal space w/ radiation to the neck, ejection click, and visible apical hyperactivity
110
MC endocarditis pathogen in peds
Staph aureus
111
Acute rheumatic fever diagnostic criteria
Need 2 major OR 1 major, 1 minor
Major criteria: erythema marginatum, subcutaneous nodules, polyarthritis, carditis, Sydenham chorea
Minor criteria: fever, elevated ESR/CRP, arthralgia, prolonged PR
112
Best initial test to order when working up etiology of short stature
Bone age determination
113
DKA lab findings
BG > 200
Anion gap metabolic acidosis (pH < 7/3) or serum bicarb < 15 mEq/L
- normal AG in kids is 8-16
Ketonemia/ketonuria
114
Congenital adrenal hyperplasia management
Hydrocortisone, fludrocortisone, and sodium chloride
Presents with clitoral enlargement, common urethral-vaginal orifice and labial fusion d/t CYP21A2 mutation > causes deficiency of 21-hydroxylase (required to convert 17-OHP to 11-deoxycortisol) > androgen buildup in 46XX patients
115
BMI classification for obesity in kids
BMI >/= 95th percentile for age and sex
116
Foods that can contribute to IDA in infants
Intro of unmodified cow/s milk before 1 y/o
117
Age to start routine screenings for:
- BP
- Lipids
BP: 3 y/o
Lipids: between 9-11, sooner (age 2 in high risk kids)
118
Cyanotic congenital heart defects
- Tetralogy of Fallot
- Transposition of great vessels
- Tricuspid atresia
- Truncus arteriosus
- Total anomalous pulmonary venous return
All start with T's!
119
When do you do prophylactic penicillin for rheumatic heart disease?
If valvular disease (most likely MR) is present
Prophy: penicillin IM every 21-28 days until age 21
120
Congenital heart defects a/w recurrent respiratory infection
Ventricular and atrial septal defects
121
AOM with ruptured TM treatment
Oral amoxicillin or augmentin x10 days
122
AOM indications for immediate use of antibiotics
Patients < 6 months old
Kids 6 mo to 2 y/o with bilateral or unilateral AOM
Children >/= 2 y/o and are toxic-appearing
***First line abx = amoxicillin
123
Acute mastoiditis treatment
Uncomplicated: IV antimicrobial therapy and myringotomy
Complicated: IV antimicrobial + myringotomy + mastoidectomy
124
MCC of viral conjunctivitis
Adenovirus
125
Causes of perennial (year round) allergic rhinitis
Pet dander, household mites, dust, air pollution
126
Treatment of chlamydial conjunctivitis in neonates versus gonococcal
Chlamydial (neonates < 1 month + conjunctival infection) = oral erythromycin
***also want to check labs for presence of gonococcal infection
Gonococcal = IV CTX
127
Infection of which sinus MC leads to preseptal cellulitis?
Ethmoid
128
Centor Criteria
Age:
- 3 to 14 y/o +1
- 14 to 44 y/o 0
- 45 and older -1
Cough:
- Absent +1
- Present 0
Fever:
- Present +1
- Absent 0
Tonsillar exudate:
- Present +1
- Absent 0
Anterior cervical lymphadenopathy:
- Present +1
- Absent 0
129
MCC viral conjunctivitis
Adenovirus
130
Mastoiditis treatment
Uncomplicated = IV abx and myringotomy
Complicated = IV abx + myringotomy + mastoidectomy
131
Perennial (year round) allergic rhinitis common triggers
- Dust mites
- Air pollution
- Pet dander
132
Treatment of gonococcal versus chlamydial neonatal conjunctivitis?
Gonococcal = CTX
Chlamydial = oral erythromycin (topical therapy ineffective)
133
RPA presentation diagnostics and treatment
Pres: like PTA but with eventual neck stiffness and stridor
Diagnostic: XR shows prevertebral soft tissue swelling
Treatment: secure airway, surgical I&D + empiric antibiotics (MC unasyn or clinda)
134
Allergic rhinitis most effective treatment
Intranasal steroids (can be augmented with 2nd generation antihistamines)
135
Which of the following is true regarding the description of retinal hemorrhages in head trauma due to abuse?
A) Intraretinal hemorrhages may persist for up to 6 months
B) Retinal hemorrhages are present only in abusive head trauma
C) Severity of retinal hemorrhages does not correlate with the degree of neurologic impairment
D) Severity of retinal hemorrhages is associated with the likelihood of abuse
D
A -- usually resolve within 24-48 hours
B -- other causes include MVA, trauma, severe coagulopathy, and sepsis
C -- correlates with BOTH the extent of intracranial injury and neurologic impairment
136
ADHD stimulant MOA (i.e. Adderall, methylphenidate)
Dopamine and norepinephrine reuptake inhibitors
137
Conduct versus oppositional defiant disorder
Conduct = violent towards others, ignores social norms and laws
ODD = no violation of social norms, not harmful to other people or animals
138
Presentation and MCC of atypical pneumonia
Presentation = extrapulmonary sx (sore throat, HA, malaise) + cough and adventitious lung sounds
139
What is a slate gray nevus
Benign hereditary condition where bluish-gray macules appear in the sacrococcygeal area at birth or develop in the first few weeks of life
Spots fade over time and do not necessarily require any treatment
140
Which coagulation factor is deficient in hemophilia A and B?
A = VIII
B = IX
141
1st line treatment for uncomplicated cystitis
First or third generation cephalosporin (cephalexin or cefixime)
142
Where does HSV infection establish latent infection?
Neurons
143
Central clearing in a rash should make you think what kind of infection
Fungal > confirm with a KOH prep
144
Best long term treatment strategy with low relapse rates for enuresis
Alarm therapy
(versus bladder training therapy, desmopressin or oxybutynin)
145
Imaging of choice for bronchiectasis
High dose CT
146
Wright stained smear findings for erythema toxicum
(+) numerous eosinophils and some/occasional neutrophils
147
First line treatment for pediatric patient with new verrucae that is asymptomatic
Reassurance and observation
Can trial topical salicylic acid if patient is symptomatic (hold off on cryotherapy for kids as it is painful)
148
Which of the following would be a valid reason to delay immunization?
A) History of GBS exposure
B) History of premature birth
C) Moderate acute illness without fever
D) Sibling with autism
C -- can vaccinate during MILD illness, even with fever
149
Presentation of irritant versus allergic contact dermatitis
Allergic = localized to area of contact, MC due to nickel, poison ivy, soaps and topical meds
Irritant = caused by prolonged contact with water, detergents, solvents, acids, alkali > scaly plaques, vesicles/bullae
Tx: topical corticosteroids (clobetasol, triamcinolone) x2-3 weeks
150
Prader willi syndrome mutation + MC complication
Mutation = deletion of chromosome 15
MC complication = obesity
151
Which of the following is the most therapeutic approach for AGE treatment in a patient who is no longer vomiting and taking appropriate PO intake?
A) Antiemetics
B) Antimotility agents
C) Probiotics
D) Zinc supplementation
C
A -- not indicated if taking in fluids PO
B -- potentially prolong exposure to pathogens
D -- not a primary tool in resource rich countries
152
Duodenal atresia presentation
Bilious vomiting without abdominal distension usually within the first day of life
153
Labs a/w Rickets/vitamin D deficiency
Hypophosphatemia, hypocalcemia, and elevated PTH
***Presents with widened costochondral junctions, growth plate widening in wrists and ankles
154
When does surfactant start to get produced?
20 weeks GA
155
Scurvy treatment in kids
100 mg TID x1 week, followed by 100 mg daily x3 weeks
156
When are APGARs performed?
1 and 5 minutes after birth
157
T or F: Large VSDs can cause prominent apical impulses
True -- increased LV activity to compensate for L to R shunt causes hypertrophy and development of apical impulse
158
Presentation of otitis externa versus malignant otitis externa
Malignant otitis externa = febrile and toxic appearing, uncommon complication of acute otitis externa
159
Meckel's diverticulum is what?
Persistence of the omphalomesenteric duct beyond fetal development
Presentation often asymptomatic on PE, can have rectal bleeding > confirm diagnosis with a technetium scan
160
At what level of dehydration do you start to notice clinical signs?
Moderate
161
Do you have focal/localized lobar findings with croup?
No, adventitious findings localized to one or two lobes should raise suspicion for CAP
162
first line antibiotic for uti in kids allergic to amoxicillin
bactrim (otherwise first line is cefixime or CTX)
163
Varicella zoster treatment in kids < 12
Supportive care with acetaminophen
VCV in kids <12 is often self limiting and antivirals are not indicated
164
Cardiac abnormality that presents with LE cyanosis, decreased femoral pulses and 2/6 systolic ejection murmur radiating to the L interscapular area
Coarctation of the aorta
165
Most important nonpharmacologic component of asthma management
Trigger avoidance
166
Tinea corporis versus pityriasis rosea
Tine corporis = scaling annular plaque with central clearing (like a herald patch) but NO additional crops of papules in a linear distribution (this would be seen with pityriasis rosea)
***tinea corporis looks like multiple herald patches
167
Ruptured TM treatment if occurred 2/2 scuba diving or underwater
Ofloxacin drops (aminoglycosides ototoxic)
If spontaneous rupture, ok to f/u in 4 weeks w/o antibiotic use
168
Cause of HCOM in neonates
Mutations in genes for sarcomeric proteins
169
Medication that can help pediatric patients with nausea via pretreatment
Benzos (zofran, aka 5-HT3 receptor antagonists, are used during acute development of N/V)
170
Irrigation of choice with live foreign bodies in ear
Warmed mineral oil, lido (1%), or ethanol (95%)
171
Recommended first line treatment for kids with AOM with perforation
10d course of antibiotic (amox)
If infection persists > ENT consult for tympanostomy
172
Presentation of fetal alcohol syndrome
Growth deficiency
Small head
Thin upper lip
Short philtrum
Short palpebral fissures
173
MCC of anemia in infants 6 to 9 weeks old
Physiologic anemia -- decrease in erythropoiesis d/t increased tissue oxygenation
174
Cause of infantile glaucoma
Congenital rubella
Most concerning risk factor = emigration from resource-limited country
175
How many doses of the influenza vaccine should patients receive in their first season eligible?
2 doses for kids 6 months to 8 years old who are receiving their first influenza vaccine
176
How long should miralax be given for encopresis initially?
For at least 6 months
177
Preferred method to diagnose congenital herpes?
PCR testing of CSF from LP
178
PDA presentation
Continuous machine like systolic murmur with cyanotic episodes during feeding > leads to FTT, respiratory distress, sweating
179
Is TOF a contraindication to closing a PDA?
No
180
Hand foot mouth causative agent
Coxsackie virus
***kids are not contagious and do not have to be excused from school unless feeling unwell clinically
181
Rules for chickenpox school exclusion
5 days from onset of rash or until all lesions have scabbed over
182
Is lichen planus classically painful or painless?
Painless
