exam

Question 1

ASD

Answer 1

• systolic ejection murmur
• heard at LUSB
• right ventricular hypertrophy
• cardiomegaly

Question 2

VSD

Answer 2

• systolic ejection murmur
• holosytolic thrill may be felt at LLSB
• cardiomegaly

Question 3

PDA

Answer 3

• heard at LUSB
• holosystolic “machinery” sound

Question 4

Transposition of Great Arteries

Answer 4

• thrill at LLSB
• x-ray: “egg on a string”

Question 5

TOF

Answer 5

• loud systolic ejection click at middle and LUSB
• Boot shaped heart
• running and then squat

Question 6

Aortic Stenosis

Answer 6

• systolic thrill at RUSB
• systolic ejection click that does not vary with respirations

Question 7

Pulmonic Stenosis

Answer 7

systolic, loudest at LUSB
- ejection click that decreases with inspiration and increases with expiration
- thrill at LUSB radiating to the back and sides

Question 8

Coarctation of Aorta

Answer 8

• systolic ejection murmur with radiation to the left interscapular area
• BP and pulses in LE is less than UE

Question 9

Stills Murmur

Answer 9

musical
- Louder when supine

Question 10

Venous Hum

Answer 10

humming murmur that is best heard in sitting position and disappears when supine
- also disappears when turning head

Question 11

Rheumatic Fever

Answer 11

• needs 2 major or 1 major and 2 minor to diagnose
  Major: carditis, polyarthritis, chorea, erythema marginatum, subcutaneous nodules
  Minor: arthralgia without inflammation, fever >102.2, elevated ESR and CRP, prolonged PR interval on EKG

Question 12

Kawasaki

Answer 12

• at least 4 criteria
• fever for 5 days
• polymorphous rash
• peeling lips
• changes in extremities (edema, peeling skin)
• cervical lymphadenopathy
• bilateral conjunctival injection without exudate

Question 13

Pityriasis Rosea

Answer 13

• common to have a recent URI
• herald patch initially then pruritic rash in christmas tree pattern found on trunk within 1-2 weeks
• sunlight will help heal faster

Question 14

Lyme Dz (diagnostics and management)

Answer 14

• ELISA screening and Western Blot
• under 8yr Amoxicillin or cefuroxime
• over 8 yr Doxycycline

Question 15

PNA in newborns

Answer 15

GBS, chlamydia, E.coli

Question 16

PNA in infants and toddlers

Answer 16

RSV, H. influenzae, S. pneumoniae,

Question 17

PNA in preschool -young adulthood

Answer 17

S. pneumoniae, Mycoplasma, Chlamydia

Question 18

PNA in immunocompromised

Answer 18

pneumocystitis jirovecii or fungi

Question 19

Osgood Schlatter

Answer 19

10-14 yo
pain in tibial tuberacle
enlargement of 1 side
self limiting

Question 20

Toxic Synovitis

Answer 20

3-8 yo
painful limp
unilateral involvement
internal rotation of hip causes spasm
no signs of infection
self limiting

Question 21

Leg-Calve-Perthes

Answer 21

4-10 yo
limp with knee pain and may migrate to groin/lateral hip
limited passive internal rotation and abduction of hip
Observation: less than 6, involvement of < 1/2 femoral involvement, and FROM preserved
Ortho: > 1/2 involvement or older than 6 yo

Question 22

Kernig’s SIgn

Answer 22

sign for Meningitis: flexion of the hip at 90 degrees, pain on extension of the leg

Question 23

Brudzinski’s sign

Answer 23

sign for meningitis: involuntary flexion of the legs with neck is flexed

Question 24

criteria for neurofibromatosis diagnosis

Answer 24

at least 2 of the following:
- 6 or more CLS >5mm in prepubertal child or >15 mm in postpubertal
- 2 or more cutaneous neurofibromas
- axillary or inguinal freckling
- 2 or more iris Lisch nodules
- distinctive osseous lesions
- optic glioma
- autosomal dominant; present in 1 st degree relative

Question 25

Lead poisoning

Answer 25

• <3.5 - follow up blood testing
• 3.5-19: ensure iron sufficiency
• 20-44: consider abd xray, full exam and hx to check for signs and symptoms
• > 45 admit to hospital, chelation therapy

Question 26

Somogyi effect

Answer 26

• hypoglycemic at 3am, then rebounds with hyperglycemia at 7am
• reduce or eliminate bedtime insulin

Question 27

Dawn Phenomenon

Answer 27

sugar gets progressively higher through the night and is elevated at 7 am
- add or increase dose of bedtime insulin