General Pediatrics

Question 1

Cystic neck masses

Answer 1

In general need to be removed because can become infected or blood-filled after hemorrhage

Question 2

Painless midline neck mass that moves with tongue protrusion; may increase in size with URI or inflammation

Answer 2

Thyroglossal duct cyst

** most common congenital cystic lesion **

Question 3

Nontender, fluctuant mass in lateral anterior triangle, may have associated drainage or inflammation

Answer 3

Branchial cleft cyst

Question 4

Soft, smooth, nontender, compressible mass in posterior triangle, +transilluminates

Answer 4

Lymphatic malformation (cystic hygroma)

Question 5

Red or bluish soft mass of variable location, + changes with valsalva

Answer 5

Hemangioma

Question 6

Neck mass just lateral to midline that may have associated stridor, cough, or hoarseness, + changes with valsalva

Answer 6

Laryngocele

Question 7

Supraclavicular mass more noticeable with crying, straining or coughing, increases with valsalva

Answer 7

Cervical lung hernia

Question 8

Suprahyoid, nontender, smooth, rubbery mass

Answer 8

Dermoid cyst

Question 9

Midline mass associated with hypo or hyperthyroidism

Answer 9

Goiter

Question 10

Cystic hygroma

Answer 10

Only lesion that consistently transilluminates

Noonan Syndrome
Down Syndrome
Turner Syndrome

But only need to send testing if other features

Question 11

How many external hemangiomas necessitate search for internal hemangiomas?

Answer 11

> 5

Question 12

Empiric ABX for lymphadenitis

Answer 12

Clindamycin
Augmentin
1st/2nd gen cephalosporin in younger children

Question 13

What is the most common cause of conductive hearing loss

Answer 13

OME

Question 14

Most common non-syndromic sensorineural hearing loss

Answer 14

connexin 26 gene defect (AR)

Question 15

Fainting + Long QT + SNHL

Answer 15

Jervelle Lange-Nielsen (AR)

Question 16

Retinitis pigmentosa + SNHL

Answer 16

Usher Syndrome (AR)

Question 17

Glomerulonephritis + high frequency SNHL

Answer 17

Alport’s Syndome (AR)

Question 18

Pigment defects, different colored eyes, white forelock, SNHL

Answer 18

Waardenburg

Question 19

Goiter + SNHL +/- balance abnormalities

Answer 19

Pendrid Syndrome

Question 20

SNHL + vertigo after trauma

Answer 20

perilymphatic fistula

Question 21

Single best predictor of school success

Answer 21

speech/language skills

Question 22

What type of hearing loss with newborn hearing screen identify

Answer 22

Moderate/severe hearing loss, not mild (<40dB)

Question 23

Universal screening by ___ month, confirm by ___ months, receive early interventions by ___ months

Answer 23

Universal screening by 1 month, confirm by 3 months, receive early interventions by 6 months

Question 24

Air conduction: abnormal

Bone conduction: normal

Answer 24

CHL

Question 25

Air and Bone conduction abnormal

Answer 25

SNHL (w/i 10 dB of each other) and Mixed hearing loss (bone >10 dB better)

Question 26

Normal peak compliance at 0 P, normal volume

Answer 26

Type A = normal

Question 27

Flat tympanogram, normal volume

Answer 27

Type B, likely middle ear effusion

Question 28

Flat tympanogram, low volume

Answer 28

Type B, likely cerumen impaction of probe against canal wall

Question 29

Flat tympanogram, high volume

Answer 29

Type B, TM perf or tympanostomy tubes

Question 30

Peak compliance at negative P, normal P

Answer 30

Type C, retracted TM (URI, Eustachian tube dysfunction)

Question 31

What additional vaccines should children with cochlear implants receive

Answer 31

PPSV-23

Question 32

Typical PCN resistance pattern for organisms causing AOM

Answer 32

S pneumoniae 40% H influenzae 50% M catarrhalis 99%

Question 33

Recurrent AOM

Answer 33

> 3 episodes in 6 months or >4 in 1 year

Question 34

AOM + PCN Allergy (urticaria or anaphylaxis)

Answer 34

Type 1 hypersensitivity Macrolid (1st) Trimethoprim/Sulfamethoxazole or Clindamycin (2nd)

Question 35

AOM + PCN Allergy (non-type 1 hypersensitivity)

Answer 35

Cephalosporin

Question 36

AOM + ... - Amox within last 30 days - conjunctivitis (H flu) - severe diesease on presentation

Answer 36

Rx: Augmentin

Question 37

Percent of children with an effusion after 2 weeks of ABX for AOM

Answer 37

60-70%

Question 38

Most common complication of AOM

Answer 38

TM perforation

Question 39

Most common SERIOUS complication of AOM

Answer 39

Mastoiditis

Question 40

Rx for bullous myringitis

Answer 40

Rx same as routine AOM

Question 41

Indications for PE tubes

Answer 41

- recurrent AOM | - persistent OME associated with high-risk patient or hearing loss

Question 42

What is the most common risk factor for acute bacterial sinusitis

Answer 42

Viral URI (allergic rhinitis #2)

Question 43

Sinus development

Answer 43

Ethmoid/Maxillary: birth 5phenoid: 5 years Frontal > 7 years --> adolescence (clinically significant around 10-11)

Question 44

Gold standard for sinusitis diagnosis

Answer 44

Sinus aspiration **Sinus and nasopharyngeal cultures do not correlate**

Question 45

Pott puffy tumor

Answer 45

osteomyelitis frontal bone

Question 46

Tympanogram with poor compliance and high volume

Answer 46

perforated TM

Question 47

Tympanogram with poor compliance and low volume

Answer 47

Cerumen or against canal wall

Question 48

Tympanogram with poor compliance, normal volume

Answer 48

Effusion or tympanosclerosis

Question 49

Peak compliance at a negative pressure

Answer 49

Eustachian tube dysfunction, early AOM

Question 50

Normal bone conduction, abnormal air conduction

Answer 50

CHL

Question 51

Abnormal air and bone conduction

Answer 51

SNHL (mixed if difference between bone and air is >10dB)