Infectious Disease

Question 1

Rheumatic Fever treatment

Answer 1

anti-inflammatory medication (aspirin), eradication of the streptococcal infection (penicillin), and treatment of carditis or heart failure. There is no role for intravenous immunoglobulin in ARF. In cases of severe rheumatic carditis, the addition of glucocorticoids is believed to have therapeutic benefit, but contemporary studies are lacking, and it is not the current standard of care.

Question 2

Most accurate ways to take temperature

Answer 2

rectal> oral >axillary

Question 3

Problematic fever

Answer 3

greater than 41.7C

Question 4

OI

Answer 4

OI = (FiO2 × mean airway pressure × 100)/PaO2. In the PALICC definition, mild ARDS is defined as an OI of 4 to 8, moderate as 8 to 16, and severe as greater than 16

Question 5

Organism most likely to cause Lemierre syndrome

Answer 5

Fusobacterium Necrophorum

Question 6

Hib vaccination schedule

Answer 6

2.4.6 months and booster at 12-15 months

Repeat series for any child who has undergone BMT, 6 months after treatment complete

Question 7

Subdural hemorrhages

Answer 7

• crescent shaped
• associated with tears of bridging veins
• trauma: shaken baby

Question 8

Epidural Hemerrhages

Answer 8

• lenticular (oval) lesion on CT
• associated with middle me I’ve always artery tear
• associated with temporal bone trauma
• period of Lucidity before LOC
• can lead to uncal herniation and 3rd nerve palsy- marked by ipsilateral dilated and in reactive pupil

Question 9

Goal caloric intake for infant with congestive heart failure

Answer 9

140 kcal/kg/d

Question 10

Puberty courses

Answer 10

Girls 8-12 years old
Breast development- pubic hair- peak height velocity- menarche

• menarche typically occurs 2-2.5 years after breast development (between SMR 3-4)
• precocious puberty : before 8 years old in girls
• delayed puberty: no breast development by 13 or no menarche by 16

Boys 9-13 years old
Testicular enlargement- pubic hair- inc penile length- peak height velocity

• delayed puberty: no testicular enlargement by 14
• precocious puberty: before age 9

Question 11

Type 2 diabetes management

Answer 11

Initiate insulin therapy with blood glucose over 250 or HgA1c greater than 8.5 at diagnosis . Also consider with ketosis

Consider metformin if below insulin thresholds

Question 12

Features of Guillan-Barre Syndrome

Answer 12

symmetric ascending paralysis that can evolve over hours to weeks and at times is preceded by nonspecific reports of back and leg pain. Patients will have weakness with areflexia and lack of a sensory level (distinguishing it clinically from other postinfectious autoimmune processes such as transverse myelitis)
- treat with IvIg or plasmapheresis

Question 13

Parkland formula for fluid replacement after burns

Answer 13

4 mL/kg × weight (kg) × body surface area affected (%)
The rule of nines divides the body into multiples of 9% as follows:

Abdomen/chest and back, 18% each
Anterior and posterior lower extremities, 9% each
Anterior and posterior upper extremities, 4.5% each
Anterior and posterior head, 4.5% each
Genitals, 1%

Question 14

True/ False: Florinated toothpaste is not recommended

Answer 14

True. Patients should begin brushing with fluorinated toothpaste at first tooth eruption

Question 15

hemoptysis plus other system findings

Answer 15

think systemic vasculitis (eg. Wegners with hemoptysis plus renal findings plus anemia and thrombocytopenia)

Question 16

Lab diagnosis of West Nile Virus

Answer 16

Serology for IgM antibodies on CSF or blood

Question 17

ADHD meds that can cause hypertension

Answer 17

Stimulants and atomoxetine

Question 18

Wolf-Hirschhorn Syndrome

Answer 18

4p deletion
commonly presents with unusual facies, prenatal and postnatal growth deficiency, significant developmental delays, hypotonia, hearing loss, antibody deficiencies, cardiac defects, urinary tract anomalies, central nervous system malformations, and epilepsy or electroencephalographic abnormalities.

“Greek warrior helmet nose”

Typical craniofacial dysmorphology seen in 4p− deletion includes microcephaly, “Greek warrior” helmet nose, high anterior hairline with prominent glabella, hypertelorism, epicanthus, high-arched eyebrows, downturned mouth, small jaw, and small ears with bilateral ear pits.

Question 19

Who should be screened for ROP

Answer 19

born less than 30 weeks or less than 1500 grams

Begin screening at 31 weeks CGA or 4 weeks chronologic age

Question 20

spasmus nutans

Answer 20

characterized by a clinical triad of dysconjugate pendular nystagmus, torticollis, and head bobbing.

Question 21

skin lesion that can complicated severe protein- energy malnutrition

Answer 21

ecthyma gangrenous- primary pathogen pseudomonas gangrenosum

Question 22

toxo infection treatment

Answer 22

do not need to treat healthy, asympotommatic patient but may require treatment in future if they become immunocompromised

Question 23

MELAS

Answer 23

(mitochondrial encephalomyopathy with lactic acidosis and stroke-like episodes) is a mitochondrial disorder that presents with childhood onset of myopathy, seizures, recurrent headaches and vomiting, sensorineural hearing loss, early signs of diabetes mellitus, stroke-like episodes associated with periods of regression, and laboratory evidence of lactic acidosis both in serum and cerebrospinal fluid.

Question 24

DTAP/ Tdap schedule

Answer 24

DTaP contains several diphtheria and tetanus toxoids as well as acellular pertussis. Children should receive 5 doses of DTaP prior to the age of 7 years. Typically the first dose is given at 2 months but can be given as early as 6 weeks. The following doses are typically given at 4 months, 6 months, 15 months, 18 months, and between 4 and 6 years of age. If a child does not receive vaccines on a typical schedule, the minimum intervals between doses are as follows:

Between first and second doses: 4 weeks
Between second and third doses: 4 weeks
Between third and fourth doses: 6 months
Between fourth and fifth doses: 6 months
Tdap, which should be used for children aged 7 years and older, contains 2 tetanus toxoids, a reduced amount of diphtheria toxoid, and acellular pertussis. It is recommended that children receive 1 dose as a booster between 11 and 12 years of age.

Question 25

Triad of findings in Prune Belly

Answer 25

intra-abdominal testes, abnormality of urinary tract, deficiency of the abdominal musculature

Question 26

Most common cause of CAH

Answer 26

21 hydroxylase defiency