Kulkarni Yellow Book

Question 1

What condition has eczema, thrombocytopenia and immunodeficiency associated with it?

What is the platelet size?

What its inheritance pattern and how is it cured?

Answer 1

Wiscott Aldrich

Small platelets

Inherited X-linked so boys are more affected

Stem cell transplant

Question 2

For a child with HCM who had chest pain twice in the setting of exercise over the past 3 months, what’s the next best step in management?

Answer 2

Beta blockers to decrease heart rate and improve ventricular filling

If the patient had had a documented arrhythmic event, then an AICD - automatic impantable cardioverter defibrillator would be recommended.

Question 3

When a facial palsy involves the ENTIRE right side of a face. Is it central or peripheral?

What then is the most likely etiology if accompanied by malaise and myalgia.

Answer 3

It is peripheral. Lyme disease a cause of PERIPHERAL facial palsy when accompanied by fatigue and myalgia

In central disease, there is forehead sparing.

Question 4

A baby with Beckwith-Wiedemann disorder presents with large tongue, neonatal hypoglycemia and is LGA. Which tumors are they at risk for?

Answer 4

Wilms tumor, hepatoblastoma, rhabdomyosarcoma, neuroblastoma. Routine ultrasounds are recommended. The hypoglycemia that occurs is transient and due only to pancreatic cell hyperplasia NOT any insulin mass

Question 5

What is the Kocher criteria for evaluating a septic hip vs transient synovitis?

Answer 5

Temp > 101.3F
WBC > 12 K
ESR > 40mm/h
Inability to ambulate.

Absence of all four makes the likelihood of septic arthritis 0.2%

Question 6

What is the treatment for transient synovitis?

Answer 6

NSAIDs

Question 7

What is the treatment for transient synovitis?

Answer 7

NSAIDs usually x 7-10 days

Question 8

What is a typical WBC of synovial fluid in a septic joint?

Answer 8

More than 50,000 cells/mm

Question 9

OPEN fractures can be classified using the Gustilo and Anderson classification system to decide on appropriate antibiotic choice.

Answer 9

True. The single most important factor in reducing infection rates is early administration of prophylactic antibiotics within 3 hours.

If the open fracture has a wound LESS than 1 cm with minimal contamination, soft tissue damage and no comminution then IV cefazolin (1st gen cephalosporin) is appropriate.

If the wound is > 1 cm or there is moderate or more soft tissue damage or periosteal stripping or MORE then the appropriate prophylaxis is: IV cefazolin + aminoglyside (gentamicin)

Question 10

Why is enoxaparin preferred to IV heparin?

Answer 10

It is easier to give outpatient. It only requires once or twice daily monitoring of Xa after initiation but IV heparin requires q6h monitoring of PTT.

However, LMWH is only partially reversible with protamine and has a longer onset of action

Question 11

In the management of bronchiolitis, which of the following 2 is recommended by the AAP (chest PT or nebulizer hypertonic saline)?

Answer 11

Nebulized hypertonic saline

Question 12

What is the most helpful way to rule out T1DM and determine Type 2 DM in a new diagnosis of DM?

Answer 12

The absence of pancreatic ISLET cell autoantibodies (e.g IA2, GAD, Zinc transporter 8)

Question 13

A 9 month old boy with L arm abscess, recent otitis media and pneumonia, loose malodorous stools, hepatomegaly with elevated ALT, Thrombocytopenia, mild anemia, neutropenia, FTT, is concerning for

Answer 13

Schwachman diamond which is associated with pancreatic insufficiency. They are at risk long term of MDS and AML.

Treatment for the condition includes GCSF, pancreatic enzyme replacement and stem cell transplant.

Question 14

Tetralogy of fallot spells happen because crying or agitation/stress increases PVR which worsens RV outflow obstruction and causes increased R to L shunting. What is the treatment?

Answer 14

Oxygen, morphine to help with relaxation and phenylephrine to increase SVR. Can also consider fluid bolus to increase RV filling.
Prostaglandins do not have any role in managing tet spells except at the very beginning of life to keep PDA open to minimize impact of severe RVOT obstruction

Question 15

Even if motivated by religious preference, if a family understands the benefit of a treatment like insulin and refuses it for their child, the best action is to

Answer 15

Report it to CPS for medical neglect

Question 16

What test is dilute Russell viper venom used for?

Answer 16

To diagnose antiphospholipid syndrome

Question 17

A 6 wk old is brought to ED for 2 wks of vomiting. She has been tracking along the 50%ile for wt, episodes of emesis are 5-6 times a day occurring 20 to 30 min after feed. Never bloody or bilious and she is in no pain during worries. She has 3-4 stools per day. What’s best next step?

Answer 17

No testing is needed. She has reflux.

Question 18

What do Heinz bodies indicate?

Answer 18

G6PD or oxidative damage to RBCs

Question 19

What is ristocetin cofactor testing used for?

Answer 19

VWD

Question 20

Reactions to contrast are anaphylactoid not IgE mediated. They can have tachycardia, urticaria, bronchospasm, laryngospasm and the reaction can be prevented by using a steroid. A reaction to contrast that includes hypertension is more physiologic and would not be prevented by a steroid.

Answer 20

Repeat.

Question 21

An egg shaped cardiac silhouette on CXR in a neonate with hypoxia suggests transposition of the great arteries (the most common CYANOTIC congenital heart defect) that usually requires the PDA to stay open to oxygen prevent mixing.

Answer 21

Repeat

Question 22

Organophosphate are commonly found in pesticide or fertilizer. The toxidroe associated with them include mnemonic DUMBBBELS (defecation, urination, miosis, bronchorrhea, bronchospasm/cough, bradycardia, emesis, lacrimation/watery eyes, salivation/drooling). Also weakness, paralysis. They are cholinesterase inhibitors and lead to increase acetylcholine activation in synapses. It should be treatment with anticholinergic like atropine.

Answer 22

Repeat

Question 23

What is Sturge Weber syndrome and what is it associated with?

Answer 23

Neurocutaneous disorder associated with port wine stain (vascular malformation of face) with leptomeningeal angiomas of brain and eye. If the port wine includes the ophthalmic branch (upper branch) of the trigeminal nerve then they have a 50% risk of glaucoma and 10-35% risk of brain involvement.

Question 24

What is Sturge Weber syndrome and what is it associated with?

Answer 24

Neurocutaneous disorder associated with port wine stain (vascular malformation of face) with leptomeningeal angiomas of brain and eye. If the port wine includes the ophthalmic branch (upper branch) of the trigeminal nerve then they have a 50% risk of glaucoma and 10-35% risk of brain involvement.

Question 25

What genetic disease is associated with cardiac rhabdomyosarcomas?

Answer 25

Tuberous sclerosis

Question 26

In Williams syndrome, what electrolyte abnormality can be seen?

Answer 26

Hypercalcemia

Question 27

What bacterial cause of osteomyelitis is a gram negative coccobacillus?

Answer 27

Kingella Kingae - can be a/w mouth ulcers.

Prior to vaccination, Hib which was the same morphology, was more commonly implicated.

Question 28

A 7 year old with a doughnut shaped mass protruding from the urethra with erythema and a small amount of bleeding (that falsely appeared vaginal prior to exam) has what?
How is it treated?

Answer 28

Urethral prolapse
Treatment: sitz bath and estrogen cream
Most common aged 4-8yrs

Question 29

Enterococcus is resistant to: cephalosporins, often to bactrim, and is not treated with gentamicin motherly. Best treated with ____

Answer 29

Ampicillin

Question 30

In a patient with acute bone or soft tissue infection concern in the lower extremity, what study should be obtained first?

Answer 30

Plain X-rays

Question 31

What is the empiric treatment for erythema migrans?

Answer 31

Amoxicillin or doxycycline for 10-14 days for early localized disease

Or 14-28 days for early disseminated and late disease (depending on the specific extracutaneous disease).

You can do antibody testing in patients who lack the characteristic rash.

Question 32

What is a normal CRP range?

Answer 32

0.8-1.0mg/dL or 8-10mg/L

Question 33

What are the classification for determining degree of envenomation from a snake bite and at what level would anti-venom be considered?

Answer 33

None/dry bite: only snake puncture wounds, no surrounding erythema, no systemic systems or lab abnormalities.

Mild: puncture wounds with local erythema, edema, ecchymosis or pain. No systemic or lab abnormalities

Moderate: puncture wounds with progression of edema or erythema but not involving whole extremity. Systemic
Symptoms: n/v, metallic taste, oral paresthesias, tachycardia, tachypnea, mild hypotension. Abnormal coagulation labs (elevated PT time, low platelets).

Severe: puncture wounds, significant erythema, edema, ecchymosis of extremity, blisters and necrosis. Systemic symptoms: n/v, metallic taste, oral paresthesias, tachycardia, tachypnea, mild hypotension +/- serious bleeding. Labs: abnormal coagulation labs (elevated PT time and low platelets)

Consider antivenom in patients with moderate to severe envenomation.

Question 34

A patient with recent diagnosis of sinusitis who was on amoxicillin develops fever, headache, left arm weakness, AMS, and vomiting? What has happened and what is the right antibiotic choice?

What is the classic triad?

Answer 34

The patient has developed a brain abscess. The right treatment is ceftriaxone and flagyl for common causes (strep, staph, anaerobes, gram negatives). Gentamicin and cefazolin (1st gen cephalosporin) are not used because they have poor CNS penetration.

Triad: fever, headache, and focal neurological deficits

Question 35

Peritonsillar abscesses are more common than RPAs.

RPAs can spread to the mediastinum as a complication.

Both abscesses are usually polymicrobial.

Peritonsillar abscesses greater than 1 cm need surg intervention

Answer 35

All true.

Question 36

What does CHARGE syndrome stand for?

Answer 36

Coloboma of the eye, heart anomalies, choanal atresia, retardation, genital and ear anomalies.

You can distinguish this from DiGeorge because there’s eye involvement in only one of them

Question 37

What are the findings in DiGeorge syndrome?

Answer 37

Thymic aplasia/hypoplasia, parathyroid aplasia or hypoplasia - leading to hypopara, cardiac defects, developmental delay, facial features (bulbous nose etc).

Question 38

What coagulation study should be severely elevated in hemophilia A (the severe type) and what is the treatment?

Answer 38

PTT should be elevated and the treatment is Factor 8.

Question 39

A child with acute kidney injury, micoangiopathic hemolytic anemia and thrombocytopenia.

What infection is most likely responsible?

When does HUS develop relative to primary infection with strep?

Answer 39

Shiga toxin producing E Coli (STEC) - 90% of case. Also strep pneumoniae and HIV are other acquired causes.

Hereditary causes are usually due to complement gene mutations or inborn errors of Cobalamin C.

Develops 3-13 days after the primary infection with strep

Question 40

A polycyclic rash with central clearing that spares the palms and soles of the feet and can present with fevers, facial and actual edema with antibiotics as a common trigger is …

Answer 40

Serum sickness like reaction. Management includes antihistamines and NSAIDs. If severe case, can consider steroids.

Question 41

What is the most common autosomal dominant form of hereditary pancreatitis?

Answer 41

It’s PRSS1

Question 42

What genes are associated with Alagille syndrome?

Answer 42

JAG1 and NOTCH2

Question 43

A patient with asthma who goes from having a respiratory alkalosis and metabolic acidosis to a hyperbaric respiratory acidosis suggests you need to prepare to get…

Answer 43

An advanced airway

Question 44

A 1 yr old with history of FTT presents with a femur fracture in the ED and the xray shows osteopenia. What should be checked?

Answer 44

Serum and urine electrolytes to rule out Fanconi syndrome (proximal renal tubular acidosis)

Question 45

What is the empiric treatment for PID? Usually caused by Gonorrhea, chlamydia or anaerobes?

Answer 45

Options are Doxycycline and cefoxitin/cefotetan OR
Clindamycin and gentamicin
OR (Unasyn + Doxycycline)

Only for mild PID: azithromycin +/-metronidazole

Floroquinolones are not appropriate due to resistant gonorrhea.

Question 46

A sexually active teen patient with 4 days of knee and ankle joint swelling, conjunctivitis and sacroilitis with normal WBC, normal ESR and mildly elevated CRP without recent diarrhea or urinary symptoms is concerning for…

Answer 46

Reactive arthritis which is likely due to chlamydia trachomatis. Had he had diarrhea, it would have been due yersinia, campylobacter, salmonella, or shigella.

Question 47

What is wet wrap therapy?

Answer 47

Medium potency corticosteroids or emollients followed by two layers of gauze or two layers of cotton pajamas. For gauze or PJs - inner layer is wet and outer layer is dry.

Question 48

A hemodynamically unstable patient with mid-gut malrotation needs what emergently?

Answer 48

Fluid resuscitation and then emergent surgical exploration

Question 49

What heart rate threshold should prompt concern for rentrang SVT?

Answer 49

Older child: above 180bpm
Infant: above 220bpm

Question 50

A patient with moderate acute asthma exacerbation experiences a transient drop in oxygen 30 minutes into treatment with albuterol starting. What’s the next step in management?

Answer 50

Give supplemental oxygen, this hypoxemia comes from V/Q mismatch due to systemic absorption of beta agonist which causes pulmonary vasodilation to previously poorly ventilated areas of the lung. It is transient and oxygen responsive with no new fatigue, or altered mental status from hypercarbia.

Question 51

Parotitis due to a sialolith can be managed with…

Answer 51

If no pus or concern for infection then sialologogues like lemon, or glandular massage posterior to anterior on the SAME side that is affected.

Question 52

What popular class of drugs is contraindicated in asthma patients?

Answer 52

Beta blockers like propranolol

Question 53

What popular class of drugs is contraindicated in asthma patients?

Answer 53

Beta blockers like propranolol

Question 54

The presence of what physical exam findings rule against testicular torsion?

Answer 54

Negative Doppler, normal testicular lie, normal cremasteric reflex

Question 55

Epipidymitis in a non sexually active male who is not at risk of UTI is most likely viral

Answer 55

Supportive care

Question 56

In a sexually active male, UTI due to G/C is treated with?

If they have insertive anal sex, they are at increased risk for GNRs and could be treated with?

Answer 56

Ceftriaxone/Azithromycin or ceftriaxone/doxycycline for G/C

For GNRs, levofloxacin

Question 57

A 4 yr old male is admitted for his fifth admission to manage constipation in 2 years. He passed meconium at 30 hours of life. Has occasional abdominal pain and has been compliant with all meds. What does he have?

Answer 57

Less severe Hirschprung’s disease

Question 58

A 3 yr old male is admitted for pneumonia. He has had recurrent otitis media and sinusitis and this is his 3rd admission for pneumonia. He does not have tonsils on exam. What is his condition? How is the diagnosis confirmed?

Answer 58

His condition is X-linked agammaglobuniemia and the diagnosis is confirmed by a mutation in the gene responsible for BTK kinase so B-cells and thus immunoglobulins are missing. The adenoids and tonsils are B-cell rich.

Question 59

A 3 yr old male is admitted for pneumonia. He has had recurrent otitis media and sinusitis and this is his 3rd admission for pneumonia. He does not have tonsils on exam. What is his condition? How is the diagnosis confirmed?

Answer 59

His condition is X-linked agammaglobuniemia and the diagnosis is confirmed by a mutation in the gene responsible for BTK kinase so B-cells and thus immunoglobulins are missing. The adenoids and tonsils are B-cell rich.

Question 60

What condition is a dihydrorhodamine assay useful to diagnose?

Answer 60

It is useful to diagnose CGD in patients with recurrent pneumonias and skin infections. Patients typically have hepatomegaly, splenomegaly, or lymphadenitis

Question 61

Hypoaldosteronism is associated with what electrolyte derangements? …

Answer 61

Hyponatremia, hyperkalemia, acidosis.
For classic CAH: males can have a normal exam or darkened scrotum and enlarged phallus. Females can have clitoral enlargement or labial fusion.

Question 62

A torn lingual frenulum in a non ambulatory infant (e.g. 8 week old) should prompt concern for…

Answer 62

NAT and if the child is irritable, consider a head CT

Question 63

How is nephrotic syndrome defined?

Answer 63

> 300mg/dL of urinary protein, or loss of more than 3g in 24hrs

Question 64

A patient with history of obliterative bronchiolitis, bronchiectasis, allergic rhinitis and chronic diarrhea who is underweight and has sinus tenderness and prudent rhinorrhea is concerning for

Answer 64

Selective IgA deficiency

Question 65

If a patient ingests lighter fluid (hydrocarbon), they are at risk of aspiration pneumontis and need to be observed. Only if fever persists for more than 48 hrs should bacterial superinfection be considered.

Answer 65

True.

Question 66

A patient with acute asthma exacerbation who suddenly on hospital day 3 develops a new oxygen requirement with bilateral crackles and wheeze on exam is concerning for…

Answer 66

Pulmonary edema and could benefit from a one time diuretic.

Question 67

For acute bacterial cervical lymphadenitis, is there any specific sized abscess that should prompt image guided aspiration or surgical drainage?

Answer 67

No! They should first fail 2nd or third line antibiotics after 48-72hrs before intervention. E.g. if only on augmentin, add MRSA coverage.

Question 68

What are the indications to remove a central line in the setting of CLABSI?

Answer 68

Line is broken irreparably, patient is significantly ill appearing, infection is disseminated, cannot clear bacteremia after 48-72h, or evidence of fungal disease

Question 69

A 2 week old on newborn screen has elevated TSH, the newborn is well appearing. What could most likely give a false positive result?

Answer 69

Maternal history of graves. TSH does not cross the placenta but maternal antibodies from graves can.

Question 70

According to IDSA, abscesses that lack systemic signs and aren’t in an immunocompromised person should be managed with …

Answer 70

I&D

Question 71

HyperIgE is a recurrent infection syndrome that is a rare autosomal
Dominant condition where patients have recurrent skin and pulmonary infection (chronic dermatitis, upper airway infections, sinusitis and AOM) an and eczema due to impairment in JAK STAT pathway. Abnormalities in osteoclastogenesis and osteopenia lead to skeletal and dental anomalies

Answer 71

True

Question 72

What is the gold standard test for myocarditis?

Answer 72

Endomyocardial biopsy NOT echocardiogram

Question 73

A 2 yr old child admitted with respiratory distress who has history of constipation, frequent bouts of coughing, failure to thrive and whose CXR shows nearly opacified L Lung that responds well to chest PT, antibiotics and supplemental
Oxygen should be evaluated for…

Answer 73

Cystic fibrosis

Question 74

A 5 year old girl who has presented with 3 bouts of not feeling well and emesis after a night of not eating well with low blood glucose of 45 is concerning for?

What laboratory abnormalities should be found?

Answer 74

Ketotic hypoglycemia of childhood

Labs should show high ketones, high fatty acids, high amino acids, high cortisol and growth hormone. LOW insulin

Question 75

Benign mature teratomas (dermoid cysts) can be associated with malignant transformation (rarely), hypotension and fever (if they burst), anti NMDA receptor encephalitis, and ovarian torsion.

Answer 75

True. They are NOT associated with Addison disease.

Question 76

Benign mature teratomas (dermoid cysts) can be associated with malignant transformation (rarely), hypotension and fever (if they burst), anti NMDA receptor encephalitis, and ovarian torsion.

Answer 76

True. They are NOT associated with Addison disease.

Question 77

A coombs test only has value in assessing RBCs.

Answer 77

True

Question 78

A coombs test only has value in assessing RBCs.

Answer 78

True

Question 79

Prior to treating ITP with corticosteroids, a peripheral smear should be obtained to rule out leukemia or aplastic anemia.

Answer 79

True

Question 80

In acute migraine management, what drugs would be helpful?

Answer 80

IV toradol, IV prochlorperazine (and a Triptan)

(NOT Promethazine which causes tissue damage)

Question 81

In acute migraine management, what drugs would be helpful?

Answer 81

IV toradol, IV prochlorperazine (and a Triptan)

(NOT Promethazine which causes tissue damage)

Question 82

In a child with suspected JIA who is stable, what is the best next step?

Answer 82

Consult a rheumatologist. Don’t do MRI on own.

Question 83

In a child with suspected JIA who is stable, what is the best next step?

Answer 83

Consult a rheumatologist. Don’t do MRI on own.

Question 84

To diagnose Cushing syndrome (clinical manifestations of round face, supraclavicular fat pads, abdominal striae) you need 2 of 3 first line tests to be abnormal. The tests are

Answer 84

24 hour urinary free cortisol, late night salivary cortisol and overnight dexamethasone suppression test

Question 85

A patient with gross hematuria episodes in the setting of illness (eg strep pharyngitis) including past hematuria episodes with illness is concerning for…
What is the expected C3 and C4 level?

Answer 85

IgA neuropathy. C3 and c4 should be normal.

Question 86

In post infectious glomerulonephritis like post strep GN, what should be the trend of C3 and C4?

Answer 86

C3 should be low and C4 should be normal

Question 87

In a patient with repeated migraines worsened by stress from school, one option is to give non-pharmacologic interventions including

Answer 87

Relaxation training with bio behavioral feedback

Question 88

A 17 yr old healthy male has had recurrent oral ulcers (white-gray base, erythematous halo), genital lesions (including past ones with scarring), sometimes associated with fever. He also report difficulty seeing some items at school. What dx does he have? What’s the treatment?

Answer 88

He has Behcet’s disease and treatment includes colchicine, steroids, azathioprine, and TNF alpha inhibitors. The illness is common in young males. The criteria requires 3 of these 6 symptoms:
Oral apthosis, genital ulcers, skin involvement (Acneiform, erythema nodosum, necrotic folliculitis), ocular involvement, neurologic signs, vascular signs.

Question 89

A 4 yr old boy who has had itching, scaling, and hair loss on his R scalp for several weeks develops tactile fever and swollen, red purulent pustules in the region of alopecia. What does he have and what is the treatment?

Answer 89

He has tinea capitis with kerion (intense T-cell mediated hypersensitivity to the dermatophyte). He needs systemic antifungals (oral griseofulvin, terbinafine, fluconazole). There can be bacterial co-infection.

Question 90

A 2wk old full term male presents to the ED with jaundice with unconjugated hyperbili of 16. He has been eating well and has normal greenish-brown stools. No evidence of hemolysis. What disease does he have and what is the treatment?

Answer 90

He has Crigler Najjar (Type 2) less severe version which is marked by decreased function of the bilirubin conjugation enzyme as opposed to its abscence (Type 1). He should be treated with phenobarbital.

Question 91

What is the treatment for splenic sequestration?

Answer 91

It’s IV crystalloid given to address the hypovolemia cause by the large spleen size. Then after, a simple pRBC transfusion can help (NOT exchange). Surgical intervention is reserved only for those who fail medical mgmt (requiring continued transfusion support, persistent hypersplenism, or repeated episodes of splenic sequestration).

Question 92

In any child with prolonged febrile illness and a neck mass that is not responding to antibiotics, Kawasaki disease should be considered.

Answer 92

yes

Question 93

In sick euthyroid syndrome, what proteins are usually low?

Answer 93

The binding proteins: Thyroxine-binding globulin protein and transthyretin (TTR)

Question 94

In sick euthyroid syndrome, what proteins are usually low?

Answer 94

The binding proteins: Thyroxine-binding globulin protein and transthyretin (TTR)

Question 95

In sick euthyroid…

Answer 95

T3 is low and then T4 is low. Also, TSH is initially LOW and then can rise to well above the normal range.

However reverse T3, the inactive form of thyroid hormone, is always high.

Question 96

In sick euthyroid syndrome…

Answer 96

T3 is low and then T4 is low. Also, TSH is initially LOW and then can rise to well above the normal range.

However reverse T3, the inactive form of thyroid hormone, is always high.

Question 97

What is the biggest risk factor for ovarian torsion?

Answer 97

An ovarian mass including an ovarian cyst is the biggest risk factor for torsion

Question 98

What is first line treatment for infantile spasms?

Answer 98

ACTH, corticosteroids, and vigabatrin

Question 99

What is the baseline work up for tuberous sclerosis?

Answer 99

Brain MRI, echocardiogram and renal ultrasound because the risks are angiofibromas, retinal hematomas, cortical dysplasia, cardiac rhabdomyomas, and renal cysts

Question 100

What is the recommended management when more than one magnet is swallowed? (Including magnetic beads)

Answer 100

If in the esophagus or stomach, then immediate endoscopy. If in the small or large bowel, then can use serial radiographs with or without total bowel clean out

Question 101

What is stage 2 HTN?

Answer 101

Greater than the 95th percentile + 12 mmHg or once aged 13 or older, greater than or equal to 140/90

Question 102

What is stage 1 HTN,

Answer 102

Greater than the 95th percentile to less than the 95th percentile + 12 mmHg or 130/80 to 139/89 or once aged 13 or above, from 130/80 to 139/89

Question 103

What is the definition of acute severe hypertension?

Answer 103

A blood pressure 30mmHg or more above 95th percentile or greater than 180/120 in an adolescent

Question 104

What is a complication of acute inhalant abuse?

Answer 104

Sudden sniffing death - surge of catecholamines leading to CV collapse.

FYI: Non-acute, more long term use can be associated with peripheral neuropathy, toxic leukoenceohalopathy, megaloblastic anemia, and subacute combined degeneration syndrome.

Question 105

A 2 mo old male who presents with poor weight gain, feeding difficulties since birth, moderate head lag and poor suck reflex with birth history notable for hypotonia and undescended testicles is concerning for…

Answer 105

Prader-Willi syndrome. The polyhydramnios from impaired swallowing of amniotic fluid.

Question 106

A 9 yr old with bilateral sensorineural hearing loss, recurrent left lateral neck swelling concerning for abscess with an enhancing tract to the left palatine tonsil is concerning for…

Answer 106

Branchial cleft anomaly and given the sensorineural hearing loss, needs a renal ultrasound to rule out the autosomal dominant condition, branchio-otorenal syndrome (BOR). In BOR, they usually have two of 5 features, branchial cleft anomalies, hearing loss, preauricular pits, pinna abnormalities and renal malformation.

Question 107

In a patient with T1DM for years, who begins requiring less subcutaneous insulin, has fatigue, weight loss, and low-normal blood pressure (99/65) as a 16 yr old is concerning for…

Answer 107

adrenal insufficiency and once the patient has more than 1 autoimmune disease should be considered for autoimmune polyglandular syndrome.

Question 108

A woman with history of migraine with aura who has abnormal uterine bleeding has symptomatic anemia with a Hgb 6.5. pRBC transfusion is ordered. what is the next best treatment for her?

Answer 108

Progestin-only oral contraceptive because she can’t have estrogen if she has migraine with aura.

If she had no hx of migraines then if she could tolerate PO, combination oral OCPs would be best and if she could not tolerate PO, then IV estrogen.

Question 109

In a patient with hypertensive emergency (or hypertensive crisis) usually with BP > 30mmHg above the 95th percentile or >180/120 in an adolescent, what is the best next step in treatment and what is the goal?

Answer 109

Short acting anti-hypertensive (esmolol, hydralazine, labetalol, clonidine, isradipine) given oral if patient can’t take IV or if a more SEVERE complication (i.e. emergency/crisis) has occurred. The goal is GRADUAL BP reduction with BP decreased by no more than 25% of goal in first 8 hours and then normalize slowly over first 24-48hrs.

Question 110

Idiopathic intracranial hypertension has been linked to several medicines including…
treatment is…

Answer 110

minocycline, excess vit A corticosteroids, growth hormone.
Work-up includes head imaging to rule out other causes, then LP. Treatment is diamox (acetazolamide) which can have adverse effects of metabolic acidosis, paresthesias, and metallic taste when drinking carbonated drinks. Lasix is 2nd line treatment.

Question 111

When and how often does the CDC require a check of my state’s PDMP (prescription drug monitoring program) when prescribing an opioid.

Answer 111

Prior to every new prescription and once every 3 months for chronic prescriptions.

Question 112

A teen with known T1DM is admitted with DKA. What is the most likely cause?

Answer 112

Insulin nonadherence. NOT increased needs in puberty.

Question 113

What is the treatment for torsion of the testicular appendage? What would doppler look like in this case?

Answer 113

Warm compresses, NSAIDs and decreased activity. Doppler would usually be normal.

Question 114

Alcohol, infections (such as Hep A), drug reactions, and autoimmune disorders often lead to a conjugated hyperbilirubinemia

Answer 114

Yes

Question 115

For central cathethers, larger diameter cathether size relative to vein size and multiple lumen cathethers have a higher risk of thrombosis due to stagnated blood flow around the cathether.

Answer 115

yes. Similarly, peripherally inserted cathethers have a higher risk of thrombosis because they are in smaller veins.

Question 116

A 10 yr old with 10 seconds of syncope without prodromal symptoms with immediate return to baseline thereafter while playing basketball suggests what cause and what studies would be beneficial?

Answer 116

Cardiac cause. Obtain EKG, Echocardiogram, and cardiac monitoring.

FYI ask about chest pain or palpitations before event. FHx sudden cardiac death under the age of 50 or a FHx congenital deafness which could be associated with long QT syndrome.

Question 117

What is the inheritance pattern of Duchenne Muscular dystrophy?

Answer 117

X-linked recessive

Question 118

In orbital cellulitis, patients under 9 yrs old, with non-frontal sinus involvement and small medial subperiosteal abscesses can be managed medically. Corticosteroids are not routinely recommended.

Answer 118

Yes.

Question 119

A patient is considered having failed the first IVIG for KD treatment only if they have a fever after ___ hours. What should be used to manage their fevers before 36 hrs

Answer 119

36 hours. Use tylenol to avoid using ibuprofen when they are on aspirin.

Question 120

For a patient who has failed outpatient keflex management of a cellulitis and is showing systemic signs, what is the best next step in management?

Answer 120

Admit them and broaden to MRSA coverage (e.g. vancomycin)

Question 121

What does liver biopsy show when caused by drug (e.g. acetaminophen) injury?

Answer 121

Lobular inflammation with focal necrosis

Question 122

What does focal nodular hyperplasia, a benign tumor of the liver more common in women aged 20-40 look like on liver biopsy?

Answer 122

Proliferation of hyperplastic hepatocytes surrounding a central stellate scar

Question 123

By what age have most kids received 3 tetanus vaccines?

For dirty wounds (e.g. animal bite), when should a tetanus booster vaccine be given? For clean, minor wounds?

Answer 123

Age 6 months. Usually DTaP is given at 2 mo, 4 mo, 6 mo, 15 mo, 4-6 yrs.

Dirty wounds or major wound: When a shot has not been received in 5 years.

Clean, minor wound: Booster indicated if not received in 10 years.

Question 124

When is rabies post exposure prophylaxis indicated?

Answer 124

For any wild animals or any animal that cannot be observed for 10 days to see if it develops symptoms, the rabies vaccine AND rabies immunoglobulin is indicated.

For domesticated animals that can be observed for 10 days, no PEP is recommended unless animal develops symptoms.

Question 125

What is a risk factor for hospital acquired pneumonia (which develops after more than 48 hours in the hospital)?

Answer 125

Aspiration risk, neurologic impairment, gastric feeding tubes, antibiotic exposure in past 90 days.

Question 126

In a patient who is seizing with hypoxia to 89%, what is the best next step in management?

Answer 126

Supplemental oxygen FIRST. Then can abort seizure. Stabilize airway, breathing, circulation first.

Question 127

When do the frontal sinuses develop?

Answer 127

Age 7

Question 128

What is the gold standard imaging choice for Pott’s puffy tumor (frontal bone osteomyelitis usually in the setting of frontal sinusitis)

Answer 128

MRI is the GOLD standard.

While contrast enhanced CT is good for the sinuses and bone detail, the MRI is better for assessing the extent of the brain infection

Question 129

What is the initial shock amount for a shockable rhythm (V Fib or V Tach)?

Answer 129

2J/kg

Question 130

What do you expect to find on BAL and bronchoscopy of a child with recurrent aspiration pneumonias?

Answer 130

Lipid-laden macrophages

Question 131

An adolescent who started fluoxetine 1 week ago and 2 days ago developed a cough for which he started taking cough medicine presents with fever (T100.6F), HR 120, BP 132/82, DTRs 2+ biceps, 3+ patellar and clonus in ankles with agitation is concerning for…

Answer 131

Serotonin syndrome (from the SSRI and from dextrometorphan which is also a serotonin reuptake inhibitor).

Treatment is stop offending agents, supportive (IV fluids, supplemental oxygen, and if needed, benzodiazepenes for agitation).

Question 132

What is the antibiotic treatment for acute epiglottitis?

Answer 132

anti staphylococcal agent (e.g. vancomycin) AND a 3rd gen cephalosporin (ceftriaxone)

Question 133

A 3 day old infant comes to the ED with hypoglycemia, hepatomegaly, and lethargy. The UA is positive for ketones and reducing substances, what does the patient have?

Answer 133

Galactosemia – likely due to inability to process galactose. Galactose is present in human and cow’s milk so infant with the condition present in first few days of life with liver dysfunction (HSM, or jaundice), FTT, cataracts, and risk of serious infections most common of which is E. Coli sepsis.

Question 134

What imaging study is the gold standard for diagnosing SMA syndrome?

Answer 134

MR arteriography (MRA)

Question 135

In a drowning case with patient who presents unresponsive with hypothermia, what is the preferred intervention?

Answer 135

Warmed fluids at 42 degrees celsius (between 40 and 45 deg celsius is ideal). NOT in the 30s.

Question 136

For neonates with HSV encephalitis with CSF PCR positive, what is the treatment?

Answer 136

IV acyclovir for 21 days followed by 6 months of oral suppressive therapy.

Question 137

For neonates with HSV SEM disease only, what is the treatment?

Answer 137

14 days of IV treatment followed by 6 months of oral suppressive therapy.

Question 138

What is Duke’s criteria for diagnosing bacterial endocarditis?

Answer 138

Major criteria:

1) 2 separate positive blood cultures for a HACEK (H. paraflu, H. aphrophilus, H.paraphrophilus, actinobacillus actinomycetemcomitans, cardiobacterium, Eikenella corrodens, or Kingella) organism, strep viridans, or coxiella
2) positive echo

Minor criteria:
1) predisposing heart condition or IV drug use
2) fever (T>38C)
3) vascular phenomenon (arterial emboli, septic pulm infarct, mycotic aneursym, intracranial hemorrhages, conjunctival hemorrhages, janeway lesions)
4) immunologic phenomena (glomerulonephritis, osler nodes, roth spots, rheumatoid factor)
5) positive blood culture that does not meet major criteria.

Diagnosis:
2 major criteria OR 1 major + 3 minor criteria OR 5 minor criteria.

Question 139

What are the strongest predictors of poor outcome in a submersion?

Answer 139

Submersion duration greater than 5 min
Initial blood gas pH less than 7.1
Resuscitation time of more than 25 min

Question 140

What is a normal CSF glucose?

Answer 140

50-80 or greater than 2/3 blood sugar level

Question 141

What are the most common oragnisms isolated in suppurative odontogenic infections?

Answer 141

Usually polymicrobial including bacteroides, streptococcus, peptostreptococcus, actinomyces and fusobacterium.

NOT staph

Question 142

When would a third generation cephalosporin alone be sufficient monotherapy in a febrile neonate?

Answer 142

Ceftriaxone would be sufficient monotherapy greater than 28 days so 29-60 day old.

Question 143

Above what age can the urea breath test be used to diagnose H. pylori?

Answer 143

At age 6 and above.

Question 144

A mid to late systolic click with a high-pitched late systolic murmur is consistent with…

Answer 144

mitral valve prolapse (typically congenital but symptoms may not present until adolescence)

Question 145

In a patient presenting with somolence, vomiting, tachycardia hypertension and tachypnea after a house fire, what is she at risk for?

What is the reversal agent?

Answer 145

Carbon monoxide and cyanide poisoning.

For cyanide, the reversal agent is hydroxocobalamin. It can cause reddish urine. For carbon monoxide, it’s 100% oxygen via a non-rebreather.

Question 146

Remember that in acute on chronic respiratory acidosis in a patient with epilepsy with myotonic dystrophy who is newly somnolent on a new dose of valproic acid for example, you should expect to see pH with acidemia, pCO2 notably elevated. Bicarb level may be upper level of normal due to the acute resp failure.

Answer 146

yes

Question 147

What is the reversal agent for acute dystonic reaction to haloperidol, reglan, or prochloperazine?

Answer 147

Benadryl or benztropine. The dystonic reaction results from drugs that block dopamine

Question 148

Organic acidemias present in newborns usually with…

Answer 148

hyperammonemia and metabolic acidosis

Question 149

Urea cycle defects in newborns usually present with…

Answer 149

hyperammonemia and respiratory alkalosis. OTC deficiency, the most common one is inherited in X-linked manner so more common in males.

Question 150

POTS requires what for diagnosis?

Answer 150

Heart rate change of 30 points with no orthostatic hypotension.

Question 151

What’s a good way in infants to estimate BSA involved in burn?

Answer 151

18% head
18% each for anterior and posterior thorax so 36% together
9% each arm
14 % each leg

Parkland formula for fluid needs over first 24 hrs. (Percent BSA involved x wt in kg x 4). First half given over first 8 hrs to aim for UOP 1-2ml/kg/hr.

ONLY Severe burns should be included NOT superficial burns.

If they are NPO, you ADD the above result to their maintenance fluid rate.

Question 152

What is the estimated caloric intake need by age for the first 2 years of life?

Answer 152

0-2 months - 100-110kcal/kg/day
3-5 months 85-95 kcal/kg/day
6-8 months 80-85 kcal/kg/day
9-11 months 80 kcal/kg/day
12-24 months 83kcal/kg/day

Question 153

For children with FTT, the formula for calculating caloric intake needed for catch up growth is:

Answer 153

(IBW*Estimated Caloric Intake for Age)/Current weight

So for a 10 month old infant who weighs 8 kg with IBW 10kg, the result (10kg x 80kcal/kg/day)/8kg = 100kcal/kg/day

Question 154

What is the preferred mangement for mild to moderate dehydration with decreased urine output (2 diaper per day) but normal HR, BP and cap refill.

Answer 154

Oral rehydration of 50-100ml/kg over 4 hours.

Question 155

What does right to left shunting refer to?

Answer 155

When deoxygenated blood enters the arterial circulation WITHOUT participating in gas exchange due to anatomic or physiologic shunts.

Question 156

A patient with Crohn’s who develops a PE and hypoxemia has hypoxemia from what mechanism?

Answer 156

V/Q mismatch because the PE causes over-perfusion of the non-embolized parts of the lung.

Question 157

How do you calculate IBW from a growth chart.

Answer 157

McLaren method (growth chart): first plot the child’s height. Then, from the plotted height, first move horizontally to the 50%ile line for HEIGHT, then drop down to from that point to the 50%ile line for weight and tht gives you IBW

Question 158

How do you calculate IBW from a BMI?

Answer 158

It’s IBW =
[BMI at 50%ile for age] x ((height in meters)^2)

Question 159

For a child with a dog bite to the head that CT shows is associated with a small skull fracture, besides tetanus status, what is important to treat with?

Answer 159

Ceftriaxone and flagyl (metronidazole).

Amp-sulbactam or amox-clavulanate is only acceptable for bites involving other parts of the body

Question 160

What testing can be considered in low-risk patients with BRUE who may be developing URI symptoms?

Answer 160

Pertussis testing

Question 161

What are alarm signs for underlying disease with constipation?

Answer 161

No meconium passage in first 2 days of life
Constipation in 1st month of life
Ribbon stools
Bloody stools w/o anal fissures
bilious emesis
Fhx of hirschprung’s disease

Ddx: Hirshprung’s disease vs celiac vs hypothyroidism vs tethered cord vs cystic fibrosis vs anatomic malformations or botulism and others.

Question 162

What is the right 1st line management for a black widow spider bite which is associated with neurotoxic symptoms (muscle cramping, rigidity, tenderness) and autonomic symptoms (diaphoresis, tachycardia, hypertension, nausea/vomiting)?

Answer 162

Opiates. If opiates don’t work then benzodiazepines can be adjunctive.

Anti-venom is not usually available and is reserved for those with severe envenomation that is not responsive to initial treatment.

Question 163

In a patient with severe asthma with several exacerbations in the past year and already on high dose ICS therapy that they are taking appropriately who is noted to have high IgE levels, what is the best next step?

Answer 163

Immunomodulator therapy

Question 164

If a patient has beta blocker toxicity with hypotension and significant bradycardia, what is the first line of treatment?

Answer 164

Normal saline bolus and atropine.

For a refractory patient with other symptoms: you could consider epinephrine and glucagon

Question 165

In a CF patient in a flare who develops hemoptysis, what medications should be stopped?

Answer 165

Hypertonic saline neb and inhaled dornase alpha

Question 166

In a CF flare, what empiric antibiotics should be used if concerned for pseudomonas?

Answer 166

Dual therapy:
Zosyn, Ceftazidime (don’t use if staph is also a concern), imipenem or meropenem, Ticarcillin-clavulanate

PLUS

ciprofloxacin, levofloxacin, amikacin or colistin.

Question 167

Primary hyperparathyroidism is seen in…

Answer 167

MEN 1 > MEN 2

Question 168

Pseudohypercalcemia occurs when…

Answer 168

Serum calcium levels are elevated BUT ionized calcium levels are normal.

It is most often cause by additional carrier proteins like in multiple myeloma, MGUS, excessive IgM. It can also occur in heat related illness.

Question 169

How do you calculate the FeCa which can help in familial hypocalciuric hypercalcemia (FHH)

Answer 169

FeCa = (Urine Ca x Serum Creatinine)/(Serum Ca x Urine Creatinine). If the FeCa is greater than 0.01, FHH is unlikely

Question 170

Activated charcoal is not great for ingestions of heavy metals (iron, lead), lithium, alcohols and caustic agents like bleach because they are not well absorbed. It’s good for extended release medications or chemicals with extensive enterohepatic recirculation like…

Answer 170

Aspirin

Charcoal is most effective when given within 1 hour of ingestion.

Question 171

What drug classes are most likely to cause SIADH?

Answer 171

anti-epileptics, anti-depressants, anti-psychotics, cytotoxic drugs, some pain medications.

SIADH is associated with a euvolemic hyponatremia. (Water loading also causes euvolemic hyponatremia but the diff is the Urine Na would be low)

Question 172

When can pseudohyponatremia be seen?

Answer 172

It is the result of high lipid or high protein states.

POsm = 2*Na + BUN/2.8 + Glu/18 (Normal is 280-295)

Question 173

What is hypertonic hyponatremia?

Answer 173

This is seen in high glucose states

Question 174

What interventions in severe asthma exacerbation, when given early, decrease NEED for hospitalization?

Answer 174

1) Early administration of 2-3 doses of ipatroprium along with albuterol
2) Steroids in 1st hr
3) IV magnesium

What DOES NOT decrease need for hospitalization? cont albuterol

Question 175

What is the mnemonic for Jones criteria in acute rheumatic fever?

Answer 175

JONES CAFE PAL
Joints (migratory polyarthritis), O looks like heart so carditis, Nodules (subcutaneous), Erythema marginatum, Syndeham chorea

Minor:
CRP elv, arthralgia, Fever, ESR elev
PR prolonged, anamnesis of rheumatism (past infections), leukocytosis

Need 2 major criteria OR one major + 2 minor criteria plus evidence of past GAS infection (throat cx, NAAT, anti-DNAse B, anti-streptolysin O). If Chorea present, doesn’t require GAS evidence.

Question 176

A patient with multiple intracranial injuries with sudden increase in urine output could have developed ____

Answer 176

Central DI (known mechanism), SIADH, OR CSW (no known mechanism). Central DI results from deficiency of ADH which leads to polyuria and serum hypernatremia.

Treatment for central DI is desmopressin.

Of note, SIADH and CSW would cause hyponatremia but in CSW, the pt is hypovolemic and in SIADH, the patient is euvolemic.

Question 177

In a child who is splinted for a supracondylar fracture who is showing signs of compartment syndrome, what is the best next step?

Answer 177

Remove constrictive dressings then the surgeon can measure compartment pressure.

Question 178

How is the urine anion gap usually calculated and how can it help distinguish GI from renal losses?

Answer 178

in GI losses, the urine anion gap is negative but in urine losses, the urine anion gap is positive (unchanged from baseline). In urine losses, you lose bicarbonate without losing cations. In GI losses, you also lose cations.

UAG = Cations (Urine Na + Urine K) - Anions (Urine Cl). Normal range is 20-90.

Question 179

If you are starting D10 for neonatal hypoglycemia, what rate should you pick?

Answer 179

5 to 8 mg/kg per minute and titrate to maintain euglycemia

Question 180

In a patient with history of NEC who presents with symptoms of SIBO (abd distension, foul-smelling stools, difficulty advancing enteral feeds), as well as confusion/AMS, what could be causing the AMS?

Answer 180

D-lactic acidosis

Question 181

For new moms with opioid use disorder who are stabiized on methadone or buprenorphine, have not relapsed in the past 90 days, consent to discussing their treatment progress with a counselor, and do not have a contraindication to breastfeeding, they are advised TO BREASTFEED. Decreases NAS.

Answer 181

Yes

Question 182

Contraindications to breastfeeding:

Answer 182

Infant galactosemia
Maternal: HIV without ART and viral suppression
HTLV
Illicit drug use
Ebola

These moms should temp not nurse OR pump:
HSV with active breast lesions - unaffected breast ok
Certain meds or radioactive drugs
Untreated brucellosis
Monkeypox

A mom with active TB or chickenpox can pump & feed but not nurse

Question 183

A gram negative rod in the respiratory tract should be suspicious for…

Answer 183

P. aeruginosa

Question 184

Physically aggressive behavior is normal in a 2-3 year old

Answer 184

yes

Question 185

Glycopyrollate is an anti-cholinergic medication that is contraindicated in what population?

Answer 185

Those with increased intraocular pressure

Question 186

All infants who are exposed to HIV during birth should received ART. The # of drugs and duration is dependent on mom’s ART regimen and if she achieved viral suppression.

Answer 186

If mom was on ART and had viral suppression in pregnancy, infant only needs zidovudine x 4 weeks. If mom had a high viral load in pregnancy, requires 3 drug regimen.

Infants should be tested by Nucleid acid/PCR for HIV only at 14-21 days, 1-2 months and again at 4-6 months. Do not use cord blood.

Question 187

To make a diagnosis of conduct disorder, there has to be at least…

Answer 187

3 or more incidents in the past 12 months and at least one in the past 6 months.

Question 188

Per NRP guidelines, at least 1 qualified person whose sole responsibility is a newborn should attend a delivery but if there’s any risk factor (including meconium staining, prematurity, pre-E, IUGR, emergency c/s, breech or abnormal presentation, chorio) then at least 2 qualified people should be at the delivery.

Answer 188

yes

Question 189

At 2 min of life in a neonatal resuscitation, an infant’s oxygen level is 68% and by 10 min is over 90%. What helps this transition and are these numbers normal?

Answer 189

Yes, these are normal. Infants go from a sat of 60% to >90% at 10 minutes of life. The drop in pulmonary vascular resistance helps with this transition.

Question 190

For peri-stomal G-tube leakage where optimizing nutrition and medical status, barrier creams and skin protectants have already been completed, what is the best next step?

Why does the leakage occur?

Answer 190

Best next step is pulling out the G-tube for a few days to give the tract some time to get a little smaller and then re-inserting the tube.

Leakage can occur due to infection, gastric hypersecretion, excessive cleaning w/hydrogen peroxide, buried bumper syndrome, torsion of tube or lack of bolster.

Question 191

Neonates with brachial plexus injury should be referred to OT or PT. Up to 20-30% of these injuries can have persistent deficits. If they have not regained normal function by 1 month, they should be…

Answer 191

referred for surgical evaluation at a subspecialty center.

Question 192

What symptoms are associated with Vitamin C deficiency?

Answer 192

Poor wound healing, corkscrew hair, gingival swelling, ecchymosis, perifollicular hemorrhages (Esp on lower extremities), hemoarthrosis koilonychia (flat, thing nails often with concavity), bony lesions or brittle bones, ocular hemorrhages

Question 193

What are the symptoms of zinc deficiency?

Answer 193

Alopecia, dermatitis, particularly affecting the perineum, chin, cheeks, acral surfaces

Question 194

What are the symptoms of Vitamin A deficiency?

Answer 194

Corkscrew hair, follicular hyperkeratosis, and Bitot spots (build up of keratin in the conjunctiva).

Question 195

What are the symptoms of copper deficiency?

Answer 195

Kinked hair, skin depigmentation, myelopathy presenting as a sensory ataxia.

Question 196

What are the symptoms of iron deficiency?

Answer 196

Pallor, onychomadesis (periodic shedding of the nails), koilonychia

Question 197

What is the best treatment for a patient with abdominal migraine?

Answer 197

Aerobic exercise, CBT and supportive medical optimization

Question 198

11% down from BW in a 3-day old baby born by C/S who has adequate urine output and maternal supply is okay and requires no changes.

Answer 198

Yes

Question 199

What is the LEAST common complication of IO access?

Answer 199

First of all, IOs in general have very few complications (<1%). The LEAST common complication is bone injury, deformity, or growth arrest due to growth plate destruction. This includes epiphyseal injury

Question 200

A patient with CP, R hemiparesis and R hip subluxation was admitted after varus derotation osteotomy. 4 days into admission, pain is well controlled on oxycodone and diazepam and you begin discharge planning, What is an appropriate next step? (It’s not stopping meds).

Answer 200

Have pt and family seen by PT/OT

Question 201

How long should an IO site be used for?

Answer 201

No longer than 24 hours

Question 202

What are the stages of pressure ulcers?

Answer 202

Stage 1 - Non blanching skin erythema with intact skin: red, blue, purplish, may itch, feel warm or burn. The skin does not blanch

Stage II - erythema with partial loss of the skin to the superficial dermis - can be shiny, moist, shallow open ulcer.
(treatment debridement with normal saline cleanser or sterile water).

Stage III - full thickness tissue loss that exposes subcutaneous fat

Stage IV - exposed tendon, fascia, ligament, cartilage, MUSCLE or BONE.

All wounds require more frequent repositioning (every 2 hours), pressure reduction surfaces and adequate intake of zinc, vit C, iron, vit A, protein.

Antibiotics are used if there is concern for infection

Question 203

If a nurse reaches out about a patient transfer from another hospital that uses different connectors for a patient on a specialty feeding formula as well as TPN by PICC that she cannot connect the patient’s TPN properly, what is the best next step?

Answer 203

come and make sure all the lines and tubes are appropriately connected. Make sure you have good lighting etc to avoid medical misconnection which can lead to sepsis or emboli.

Question 204

What are the AAP guidelines for criteria for hospitalization in eating disorder pts?

Answer 204

acute food refusal, HR less than 50 during the day or 40 at night, SBP <90, <75% IBW, orthostatic tachycardia (>20 beats diff), orthostatic hypotension, hypothermia (<96F or 35.6C), syncope, electrolyte abnormalities. Failure of outpatient mgmt. Uncontrolled binging and purging. EKG abnormalities.

Question 205

What are some of the screenings that patients with Down syndrome or T21 need?

Answer 205

Echocardiogram after birth to r/o AV canal defects
Yearly eye exam to rule out cataracts.

These don’t require screening but can also be present duodenal or anorectal atresia, atlanto-axial instability

Question 206

Which patients benefit from post-pyloric feeds?

Answer 206

Patients with severe reflux, risk of aspiration, gastroparesis, or gastric outlet obstruction

Question 207

Long term use of TPN can be associated with _____

Answer 207

cholestasis with biliary sludging and steatosis, nephropathy, metabolic bone disease,

Question 208

The most common complication of NGT placement and that should be suspected in a pt with an NGT recently placed with persistent coughing is…

Answer 208

pulmonary insertion of the tube. confirmation of placement by abd XR or gastric pH is acceptable but auscultation alone is not.

Question 209

Oppositional defiant disorder is characterized by defiant, disobedient behaviors towards authority figures. The diagnosis can be made with following criteria

Answer 209

under 5 years: episodes on most days for 6 month
over 5 yrs: weekly episodes for 6 months

CBT and parent training are most effective. Reserve meds for refractory patients. Prior to puberty, it is more common in boys but after puberty, there is no sex disparity.

Question 210

In newborns born with CDH, they should be immediately intubated and thereafter received positive pressure ventilation. Bag valve mask is contraindicated because it will just further distend the stomach.

Answer 210

YES. You can decompress the stomach with an NGT or OGT but priority is to secure the airway with intubation because the GI contents in the thoracic cavity may make it too difficult for the pt to generate the negative intrathoracic pressure needed to breathe.

Question 211

What are some meds that can be associated with QT prolongation?

Answer 211

Tacrolimus, ondansetron, azithromycin. Macrolides, fluoroquinolones, azoles, antipsychotics, antidepressants, opioids.

Risk of QT prolongation is torsade de pointes and the treatment is magnesium (should correct hypokalemia before Mg administered).

Question 212

In a 4yr old patient with a tracheostomy tube and vent dependence whose trach tube is dislodged and becomes agitated with turning his head side to side and develops retractions, vitals are HR 183, RR 65, sat 96% on blow-by oxygen, with blood tinged tracheal secretions but the tracheal stoma otherwise appears intact, what is the best next step?

Answer 212

First confirm there is good oxygenation and then reposition head and attempt tube re-insertion after. If that doesn’t work, can try inserting a smaller tube.

Question 213

A “seizure” episode with arching of the back, head, and neck, bilateral arm stiffening, pelvic thrusting and eyes tightly closed shut even in a patient with known seizure disorder is concerning for …
What is the best next step?

Answer 213

PNES (psychogenic non-epileptic seizures) particularly because pelvis thrusting, eyes resistant to opening and lack of post-ictal period are characteristic of PNES

obtain VEEG

Question 214

Antibiotics (Can be oral) are recommended after abscess I&D for infants under 12 months of age regardless of disease severity

Answer 214

yes

Question 215

Which cardiology patients need antibiotic prophylaxis to prevent infective endocarditis prior to procedures?

Answer 215

Unrepaired CYANOTIC CHD, completely repaired CHD with prostethic material or device for 6 months after procedure, repaired CHD with residual defects at site or adjacent to the site of a prostethic patch or prosthetic device.

Question 216

A 4 yr old healthy patient is persistently agitated for 15 min after undergoing a sedated tooth extraction where halothane was used in the OR. What labs would be most helpful?

Answer 216

While this is likely emergence delirium which is a benign condition that lasts 15-20 min and may need pain control/sedatives to manage, it is critically important to rule out hypercarbia, hypoxia, or hypoglycemia immediately post-op so ABG and POC glucose would be best.

Question 217

In a neonate like a premie who is intubated, IV epinephrine by UVC is far more effective than ETT administered epinephrine.

Answer 217

True.

Question 218

In a patient with Treacher-Collins (with micrognathia) causing unsuccessful intubation attempts, what’s the best next step?

Answer 218

Try a supraglottic airway aka an LMA. Contraindication to an LMA is active vomiting

Question 219

A patient diagnosed with functional neurologic disorder (or conversion disorder) who is admitted can benefit from what prior to discharge?

Answer 219

Inpatient psychology consultation

Question 220

An infant is born by C/S to a mom with a lesion suspicious for HSV infection on presentation to L&D, what are next steps?

Answer 220

The infant should immediately (at 24 hours of life) have HSV surface cultures, blood PCR and CSF PCR sent regardless of delivery method if this is a primary infection in mom then IV acylovir should be started in the infant while awaiting results.

If this is a recurrent infection, blood PCR and HSV surface cultures can be sent and you can observe the infant off acyclovir if the infant remains asymptomatic.

Mode of delivery reduces but does not eliminate risk so it should not influence plan.

Question 221

What test is most important to obtain prior to starting a typical or atypical antipsychotic?

Answer 221

EKG - assess for QT prolongation

Question 222

What is the greatest risk factor of depression in a child with chronic illness whose parent is also depressed?

Answer 222

Parental depression

Question 223

If a preterm infant (<37 weeks) or LBW (<2500g) infant fails a car seat tolerance test (within 24-48h of discharge time), what’s the appropriate next step

Answer 223

Rpt screen in 24 hrs or Discharge in a car bed

Failure is apnea >20 seconds, bradycardia <80 bpm or desat <90 in the span of 90-120min CSTS.

Question 224

If an admitted patient is agitated, and verbal de-escalation techniques are not working, what is the best next step BEFORE physical restraints?

Answer 224

Medical restraint with haldol and reassess in 15 min. you are not trying to achieve sedation.

Question 225

What oral medications besides baclofen can be used for generalized spasticity?

Answer 225

Clonazepam, tizanidine and dantrolene.

Botulism toxin should NOT be used for generalized spasticity, it is first line only for focal spasticity.

Question 226

A newborn with rash, cataracts and extramedullary hematopoeisis is concerning for…

Answer 226

congenital rubella

Question 227

A newborn with rash, bone deformities and interstitial keratitis is concerning for…

Answer 227

congenital syphilis

Question 228

A newborn with rash, macrocephaly (with intracranial calcifications), and chorioretinitis is concerning for…

Answer 228

toxoplasmosis

Question 229

A patient with a pressure ulcer should not be prescribed vitamin C and zinc until…
Blood levels for vitamin C and zinc should be obtained before and during supplementation.

Answer 229

After 1 week of trying other interventions and not noting healing.

Yes.

Question 230

What are the greatest risk factors for cardiac arrest during procedural sedation?

Answer 230

Age less than 1 year old (particularly less than 6 months) and ASA class > II.

Patients who are less than 3 months or ASA III or more should be sedsted by an intensivist or anesthesiologist NOT a hospitalist. Examples of patients with an ASA class III illness (a patient with severe or uncontrolled systemic disease) e.g. asthma w/exacerbation, poorly controlled epilepsy, insulin-dependent DM, morbid obesity

Question 231

For bag valve mask ventilation, what are some things that are true…

Answer 231

continuous flow of oxygen can be provided passively through the reservoir portion of a self-inflating bag.

in patients with poor lung compliance, the normal pressure pop-off valve that release at 35-45cm H20 may need to be CLOSED/overriden to allow higher pressures to pop open the lungs.

Question 232

For an arterial blood puncture

Answer 232

1) you should assess for collateral circulation by occluding both radial and ulnar arteries until fingers are pale then release just the ulnar pressure point.
2) sterile technique is needed if getting blood cultures, otherwise clean technique is okay.
3) the vessel may not feel pulsatile in infants.
4) enter at 90 degrees
5) overlying infection is a contraindication

Question 233

A patient with eating disorder is likely to have:

Answer 233

Heme: cytopenias
GI: delayed gastic emptying, dysmotility, high cholesterol, pancreatitis, elevated LFTs, constipation
Electrolytes: Low k, low Na, low phos

Question 234

When discussing advanced are directive, you should NOT discuss financial burden and cost of providing care up front. Instead, include a discussion of unnecessary therapies that prolong life.

Answer 234

true

Question 235

For patients with bulimia, pharmacotherapy along with what pharmacotherapy is recommended?

Answer 235

SSRI specifically fluoxetine is 1st line to minimize binging and purging behavior. The other SSRIs are 2nd line.

Of note bupropion has been associated with seizures in bulimia patients and is contraindicated in them.

Question 236

A sacral dimple that you cannot see the base of, if within 2.5cm of anus with no hypertrichosis, hemangioma or caudal appendage (tail or pseudotail) does not need further imaging.

Answer 236

Yes

Question 237

How frequently should botulinum toxin injections for sialorrhea be performed?

How frequently can you increase glycopyrollate?

Answer 237

Botulinum toxin injections should be repeated only once every 3-6 months

Glycopyrollate can be increased every 5-7 days until you reach treatment effect

Question 238

An infant who turned blue and choked immediately on trying breastfeeding is concerning for bilateral choanal atresia. Of note, 2/3 of cases are unilateral. What test can be done to confirm diagnosis?

Answer 238

Inability to pass the suction catheter deeper than 3.2cm in the affected nare (no connection between NP and larynx).

Question 239

In a patient with NEC who undergoes extensive bowel resection, what is associated with the best prognosis of achieving full enteral autonomy?

Answer 239

Residual bowel length greater than 50cm (specifically patients with bowel length less than 20cm are unlikely to achieve independence from TPN).

other factors that are positive but less impactful: preservation of IC valve and having the ileum which has the highest ability to adapt post resection.

Question 240

In which newborns should a DSD (disorder of sexual development) be considered?

Answer 240

bilateral undescended testicles, severe hypospadias, uniliateral undecscended testicle with hypospadias or with micropenis (<1.9cm).

If concerned about CAH, you should get serum electrolytes, 17 OHP, and karyotype.

Question 241

How long is appropriate to wait for a unilateral undescended testicle?

Answer 241

4-6 months. The testicle is unlikely to descend after 6 months of age.

Question 242

A child with SLE who was recently started on high dose pulse steroids and develops neuropsychiatric symptoms is most likely to have them from…

Answer 242

Lupus! Steroid induced psychosis usually occurs with prolonged exposure to high dose steroids.

Question 243

A 17 yr old patient with a PEG in place that flushes and develops emesis as well as a 10kg weight loss over the past 3 months, with soft mild upper abdominal distension should first get a …

Answer 243

PEG contrast study to rule out gastric outlet obstruction from the PEG. This can be addressed by just repositioning the PEG if present.

Question 244

If a mom is HepBsAg negative and baby is greater than 2kg, Hep B vax should be given within first 24 hours. If mom is HepBsAg positive, HepB vax and HBIG should be given within first 12 HOL. If mom is HepBsAg unknown, Hep B vax should be given within 12 HOL and HBIG can be held up to max 7 days until results return.

Answer 244

Yes

Question 245

A patient who has recently undergone gastric fundoplication and experiences tachycardia and hypoglycemia in the post-op period about 1 hour after her feeds is experiencing…____. why? what is the way to address it?

Answer 245

Dumping syndrome where gastric contents (due to smaller volume) are delivered more quickly to the small intestine and the undigested carbs in the small intestine leads to a hyperinsulinemic response. The treatment is to add complex carbs like cornstarch to the formula. You could also slow the feeds or switch to continuous feeds.

Question 246

In an infant born at >= 35 weeks, you can start PPV at 21% FiO2 but for younger infants, you may start at 30% FiO2. If the HR does not improve to >100bpm then you should consider transition to chest compressions 3:1.

Answer 246

True

Question 247

What are the most common symptoms of somatic symptom disorder and what is the best treatment for it?

Answer 247

Most common symptoms: abdominal pain, headache.

Best Treatment: CBT

A thorough medical evaluation is important but unnecessary, invasive testing does not help

Question 248

Dex gel should be followed by feeding for neonatal hypoglycemia

Answer 248

yes

Question 249

A FT newborn baby with tremors, hypertonicity, high pitched cry, exaggerated sucking and some colostrum regurgitation on blanket is concerning for maternal history of…

Answer 249

Anti-depressant use. The syndrome is called poor neonatal adaptation syndrome.

Question 250

What are neonates with in utero exposure to marijuana likely to show?

Answer 250

Low birthweight. Marijuana does not cause neonatal withdrawal symptoms.

Question 251

A patient with epilepsy who is admitted for replacing a dislodged G-tube becomes febrile, tachycardic, diaphoretic, with dystonic posturing. What is occurring? What is the best management for both preventing and aborting symptoms?

Answer 251

Paroxysmal sympathetic hyperactivity or dysautonomia.

Clonidine.

For abortive therapies only: morphine, lorazepam.
For preventive therapy only: gabapentin, baclofen

Question 252

How does phototherapy reduce jaundice?

Answer 252

Light changes the conformation of bilirubin to lumirubin which can then be excreted in both the urine and bile without being conjugated.

Question 253

How does bilirubin metabolism usually work in the body?

Answer 253

Bilirubin is transported bound to albumin to the liver. In the liver, UGT enzyme, converts the unconjugated bilirubin taken up by the hepatocytes to conjugated bilirubin which can then be excreted in bile.

Question 254

What is an intervention that can improve lumbar puncture success rate?

Answer 254

ultrasound guided LP - can occur in ED.

Hydration and diff position don’t necessarily improve odds.

Question 255

What are typical colostrum volumes in the first 24-48hrs of life and in the 48-72hr timeframe?

Answer 255

24-48 hrs: 5-15ml
48-72hrs: 15-30ml

Question 256

Who is home BiPAP (not CPAP) usually recommended for?

Answer 256

Patients with central apnea, hypoventilation

Question 257

For healthy children, the leading cause of OSA is adenotonsillar hypertrophy so T&A is the main treatment.

For children with craniofacial anomalies, T&A usually won’t work so PPV via CPAP is recommended. Most children only tolerate nasal interfaces with home CPAP but chronic use of these nasal masks or pillows can lead to midface hypoplasia in kids due to maxillary bone pressure. Solution is to have the interface be loose fitting and occasionally rotate with between face mask and nasal interfaces

Answer 257

Yes

Question 258

What is the appropriate testing for a child with congenital syphilis?

Answer 258

serum RPR or VDRL
CBCd
CSF VDRL, cell count, protein
Other studies per provider discretion (LFTs, CXR, long bone XRs, HUS, Ophto exam)

usually concurrent maternal testing recommended. (Moms who received PCN at least 4 wks before delivery and were documented to be negative after are viewed as adequately treated. Baby in these cases should only be treated if their RPR/VDRL titters are more than 4-fold greater than mom.

Treatment is IV PCN G for 10 days.

Question 259

What testing can distinguish a false positive RPR?

Answer 259

Maternal treponemal test such as fluorescent treponema antibody (FTA-ABS)

Question 260

A standardized format for VERBAL handoffs has been shown to reduce patient safety events

Answer 260

yes

Question 261

What are the different types of variables?

Answer 261

Continuous data - numerical scale where separation between each # is same amount (e.g. age)

Nominal or categorical data - unrelated categories (e.g. race variable)
Dichotomous variable - nominal data with only 2 categories

Ordinal - data is categorical but has a clear order of lowest to highest

Question 262

When delivering bad news, it is better to say something like I have some “unexpected” news to deliver –ie. not make a judgement about the diagnosis.

Answer 262

Yes

Question 263

On a receiver operator curve, the y-axis represents sensitivity and the x-axis represents “1-specificity or the false positive rate”

Answer 263

Yes

Question 264

A leadership organizing principle called GRPI represents goals, roles, procedures/processes, and interpersonal relationships suggests addressing these issues in this order and requires conflict to be dealt with in the open.

Answer 264

Yes

Question 265

You do not need a separate consent from an adolescent to screen specifically for HIV when screening for STIs.

Answer 265

Yes

Question 266

When designing a new curriculum, the first step is to identify the method currently being used and the ideal approach from the literature. The next step is to perform a needs assessment. 3rd step is to identify goals/objectives of the curriculum. The 4th step is to identify educational strategies that will be most effective. The 5th step is implementation of the curriculum which helps to identify potential barriers and the last step is to perform evaluation.

Answer 266

Yes

Question 267

To set up the sensitivity/specificity calculation 2x2, what is at the top (columns - disease positive or not), rows (test positive or not)

Answer 267

Yes

Question 268

What is the equation for sensitivity?

Answer 268

TP/TP+FN - true positive rate, given that you have the disease, how likely is the test to be positive

Question 269

What is the equation for specificity?

Answer 269

TN/TN+FP - True negative, given that you are negative, how likely is the test to identify you as negative

Question 270

What is the equation for positive predictive value?

Answer 270

TP/TP+FP, Given a positive test, how likely are you to have the disease.

Question 271

What is negative predictive value?

Answer 271

TN/TN+FN, Given a negative test, how likely are you to not have the disease?

Question 272

From simplest to most complex, Bloom’s taxonomy is remember, understand, apply, analyze, evaluate, create

Answer 272

True

Question 273

What are Kotter’s 8 steps of change management?

Answer 273

1 - create a sense of urgency
2 - pull together the guiding team which should include members with credibility, communication skills, analytical skills, authority, and leadership skills
3 - Develop the change vision/strategy to achieve the change
4 - communicate the vision to help others understand and buy into it
5 - empower others to work collectively to make the vision a reality
6 - produce short term wins that are visible and unambiguous
7 - don’t let up after the first successes
8 - create a new culture over time with improved action and behaviors

Question 274

11What are examples of social determinants of health?

Answer 274

age and conditions in the environments that people are born, live, learn, work and play that affect health outcomes and quality of life. Examples are: access to healthcare or transportation or food, quality of housing conditions, language, literacy, quality of education

Question 275

What statistical tests are appropriate at what times?

Answer 275

2 categorical variables - chi-square test

When the independent variable (Aka exposure/explanatory variable is continuous, regression is used

When the explanatory variable is categorical and the response variable is continuous, multiple tests are options. If both groups of data belong to the same individual, paired t-tests can be used.

Question 276

What is relative risk?

Answer 276

Ratio of risk in exposed group/ratio of risk in the unexposed (untreated) group

Question 277

What is absolute risk?

Answer 277

The difference between risk in the exposed group and risk in the untreated/unexposed group

Question 278

What is the odds ratio?

Answer 278

The ratio between those who do and do not have the disease,

Question 279

What is omission bias?

Answer 279

The tendency to favor inaction over action (watchful waiting over starting antibiotics)

Question 280

What is visceral bias?

Answer 280

When a clinician’s feelings about a patient/family impact the diagnoses that are covered (e.g. assuming a parent who is a smoker doesn’t correctly use child’s asthma meds)

Question 281

What is aggregate bias?

Answer 281

Believing that aggregate data does not apply to your specific patient (e.g. not using evidence-based guidelines when patient meets inclusion criteria)

Question 282

What is health in all policies?

Answer 282

It references improved health as a shared goal across all areas of government. It’s strategy that focuses on the goal of improving health and health equity by addressing health in all areas of government…such that legislators need to consider the downstream impact to health of ALL individuals, not just children though health may not be the primary focus of the legislation.

Question 283

What are the rough PTX thresholds by hour for 37 weeker

Answer 283

Goes up by ~3 per day until 72 hrs when it goes up by 2 and then from 96hrs onward, plateaus

24 hrs - 12 (11.7)
48 hrs - 15 (15.4)
72 hrs - 18 (18.1)
96 hrs - 20 (20) - plateaus at 96hrs
120 hrs - 20 (20.2)

Question 284

In a linear regression, r2, represents the percentage difference accounted explained by the independent variable.

Answer 284

True

Question 285

On a run chart, the astronomical point is the point that is distinctively different than all the others,

A shift is 6 or more consecutive points all above or all below the median.

A trend is 5 or more consecutive points all going up or all going down

Answer 285

Yes

Question 286

The Joint Commission requires that a patient’s race/ethnicity, preferred language and any communication needs NEED to be documented in the chart

Answer 286

yes

Question 287

Prior to using an interpreter, it is best practice for the provider to prepare the interpreter for what will be discussed in the encounter.

Answer 287

yes

Question 288

If a patient with Anorexia Nervosa is of age of consent and willingly checks in and asks a physician to withhold treatment related information from them, which ethical principle are they exercising?

Answer 288

Therapeutic privilege

Question 289

Positive predictive value and negative predictive value can ONLY be calculated if prevalence is known meaning you cannot calculate them in a case control study or pre-selected group of patients that does not represented the general population.

Answer 289

Yes

Question 290

In a statistical process control chart where there is a center line, an upper bound and a lower bound, a common cause variation is due to random variability in data and is represented by the center line. A shift is thought to have occured if the data after invention has at least 8 points all above or all below the center line. If that’s the case, that’s a “special-cause variation”. The effect can be explained (if it starts at the time of or just after the intervention) or unexplained if it precedes the intervention.

Answer 290

Yes

Question 291

How is assessment different from evaluation?

Answer 291

Evaluation tests what has been learned and happens at the end of an identified period of learning (e.g board exam after fellowship or grade after med student rotation). It identifies weaknesses and is judgmental in that it has an associated score.

Assessment is a diagnostic, ongoing process that identifies how learning is going and areas to improve. It happens DURING learning.

Question 292

A meta-analysis requires homogeneity of the studies (not the type) but in data collection so the data can be pooled for statistical analysis.

Limited outcome data or selective reporting can limit the validity of a meta-analysis meaning if data for non-significant results is mentioned but isn’t adequately reported in some included studies.

Answer 292

True

Question 293

What’s a good acronym for the types of waste in lean methodology?

Answer 293

DOWNTIME
Defects - errors that don’t produce desired outcome - misdiagnosis, med errors

Overproduction - doing/creating more than needed

Waiting - delay in service provided

Not using talent

Transportation - unnecessary movement of materials or patients in system

Inventory - extra supplies that may not be used, may expire or take up space

Motion - unnecessary movement by employees in system

Extra-processing - performing additional tasks or making existing tasks more complex than necessary

Question 294

For a patient in septic shock who needs oxygen, the best way to maximize the patient’s fraction of inspired oxygen (FiO2) is to place them on a non-rebreather

Answer 294

Yes. Nasal cannula and facemask do not provide sufficient FiO2.

Question 295

Failure mode and effects analysis is a proactive method to PREVENT errors due to a new system before they occur.

Answer 295

Yes

Question 296

What is “just culture”

Answer 296

Just culture is an approach that focuses on addressing systems issues that lead to patient harm and improving those systems in a way that reduces an individual’s likelihood to perform an unsafe task.

Question 297

In just culture, what is a lapse? what is a slip?

Answer 297

Lapse is forgetting to do something that was intended - forgot to prep skin with chlorhexidine for LP

Slip is inadvertently performing a task incorrectly (e.g. pouring salt instead of sugar in coffee)`

Question 298

Even during the COVID-19 pandemic, the AAP said a family member should be at the bedside.

Answer 298

Yes

Question 299

In newborn metabolic screening, sensitivity is more important that specificity and it is ok to include a disease that is present at birth even if it is latent in childhood and does not present until adulthood.

Answer 299

Yes

Question 300

What are the 4 components of healthcare access?

Answer 300

coverage - insurance status/access to health facilities, service - usual source of care for screening and treatment, timeliness - ability to receive healthcare when needed, workforce - access to capable and qualified healthcare providers

Question 301

What is 360 feedback?

Answer 301

Feedback from multiple perspectives (attendings, peers, nurses, and patient families)

Question 302

What is formative feedback?

Answer 302

It is given during or after a particular encounter or task, with the goal of helping the learner make timely adjustments to improve their performance in that area

Question 303

what is summative feedback?

Answer 303

comprehensive assessment of a learner’s performance that happens at the end of a course or clinical rotation

Question 304

The reportable pressure injuries to CMS as a hospital aquired infections are…

Answer 304

Stage 3 (full-thickness loss with fat tissue visible)
Stage 4 (full thickness skin and tissue loss with exposed fascia, muscle, bone/cartilage, tendon, ligament)

Question 305

In multiple choice testing, test questions with which of the following DO NOT or all of the following except wording tend to have lower validity and reliability

Answer 305

yes

Question 306

Validity is the degree to which a test measures the learning outcomes it is intended to measure

Reliability is the degree to which a test CONSISTENTLY measures a learning outcome

Answer 306

yes

Question 307

How long can opiate withdrawal symptoms be seen after birth?

Answer 307

5 days

Question 308

If a baby with NAS with increasing morphine needs has a mother who insists on signing them out AMA, what is the best next step?

Answer 308

Notify CPS

Question 309

What is the most common reason for unplanned hospital readmission in the pediatric population in 30 days?

Answer 309

complications from surgical procedures most commonly pain or dehydration. E.g. as many as 1 in 4 adolescents is readmitted after a T&A and nearly all (98%) of appendectomy readmissions are thought to be preventable. Ensuring post op patients have adequate