Last Minute Flashcards
What is the average growth length (growth velocity) per year after 2 years of age (later childhood)?
5cm
How much does the head circumference increase per month in the 1st year?
1/m
When does the head grow the fastest?
First 60 days
.5/wk
Child with enlarged head > 98th percentile, similar to the father, no symptoms and normal cognitive function, head imaging study showed prominent subarachnoid space especially in the frontal region
Benign familial macrocephaly
Anterior displacement of the occiput on one side and the frontal region on the ipsilateral side and the ear is more anterior on the side of occipital flattening (parallelogram)
Positional plagiocephaly
Anterior displacement of the occiput on one side and frontal bossing on the contralateral side and the ear is displaced more posteriorly (trapezoid)
Posterior plagiocephaly (craniosynostosis)
The most common type of craniosynostosis
Long narrow head (scaphocephaly), which is an early closure of the sagittal sutures
Infant born to HBsAg positive mom what should be given?
Hepatitis B and HepB immunoglobulin in the first 12 h
Encephalopathy within 7 days of administration is an absolute contraindication in which vaccine?
Dtap
If you give only MMR vaccine, how long should you wait to do PPD test?
4-6 weeks
The child who received MMR vaccine 2 weeks ago Rubella is now having pain in the hip joints. Which component of the vaccine is responsible for this reaction?
Rubella
2-month-old child with complement component deficiency. What are the vaccines that should be given at the 2-months well visit?
Routine 2 months vaccines plus meningococcal vaccine
Visual acuity for a newborn is
20/400
Newborn with a mother who is HIV positive
Breastfeeding is contraindicated (except in resource-limited settings)
What is the latest age for first tooth eruption?
18 months (after that, dental consult)
Child with a capillary lead level of > 5 μg/ dL. What is the next best step?
Obtain venous sample
Gestational age of screening for group B Streptococcus (GBS)
35–37 weeks gestation
Birth weight less than 2500 g
Low birth weight
Birth weight less than 1500 g
Very low birth weight (VLBW)
Birth weight less than 1000 g
Extremely low birth weight (ELBW)
Uteroplacental insufficiency is associated with what type of deceleration?
Late deceleration
A neonate is born to a mother with chorioamnionitis. The neonate is alert with good tone, no respiratory distress, and vital signs are normal. What is the next best step?
Obtain blood culture, complete blood cell count, and start ampicillin and gentamicin
Newborn with one side of the body pink and the other side pale, with a sharp line in-between, no other symptoms
Harlequin color change
Children younger than 9 years of age, never been vaccinated for influenza before; how many doses should they receive during the first instance of influenza vaccination?
2 doses 1 month apart
neonate is born with severely thickened skin with large, shiny plates of hyperkeratotic scales. Deep, erythematous fissures separate the scales and contraction abnormalities of the eyes (severe ectropion), ears, mouth, and appendages
Harlequin ichthyosis (autosomal recessive)
When is surfactant recommended to be used prophylactically after resuscitation in extremely premature neonates to protect the immature lungs?
< 27 weeks gestation (some institutions give surfactant as rescue therapy)
An 8-week-old who was born at 27 weeks was intubated for several weeks and now has chronic hypoxemia, tachypnea, wheezing, along with longstanding respiratory insufficiency. Chest radiograph showed: Decreased lung volumes, areas of atelectasis, hyperinflation, and pulmonary edema
Bronchopulmonary dysplasia
Full-term infant presents with tachypnea, cyanosis only in the lower body, loud second heart sound. Chest radiograph shows clear lungs and decreased vascular markings
Persistent pulmonary hypertension of the newborn
post-term newborn has respiratory distress. The amniotic fluid was stained with meconium, and the point of maximal cardiac impulse is displaced
Pneumothorax
A 2-week-old preterm infant born at 26 weeks gestation started having more gastric residuals, abdominal distension, blood in stool, abdominal wall erythema. KUB shows pneumatosis intestinalis and gas in the portal vein
Necrotizing enterocolitis
condition specific for the infant of diabetic mother
Small left colon syndrome
An abdominal wall defect with uncovered abdominal contents noted right of the umbilicus is
Gastroschisis—not associated with genetic abnormalities
An abdominal wall defect covered with a membrane that is often associated with genetic syndromes is
Omphalocele
A full-term newborn with missing right index, middle, and ring fingers
Amniotic band syndrome
Very small for gestational age (SGA) infant, mother with multiple drug abuse during pregnancy, including alcohol, cigarette smoking, cocaine, marijuana. Which substance is most responsible for SGA?
cocaine
Newborn with chorioretinitis, hydrocephalus, and intracranial calcifications
Congenital toxoplasmosis
Newborn with microcephaly, and periventricular calcifications
Congenital cytomegalovirus infection
Newborn with snuffles, continuous nasal secretions, anemia, thrombocytopenia, hepatomegaly, and periostitis
Congenital syphilis
Lithium use during pregnancy is associated with
Ebstein anomaly
A virus that can cause fetal hydrops
Parvovirus B19
After cleaning the wound of dog or cat bite, what is the most appropriate prophylactic antibiotic?
Amoxicillin/clavulanate
Dog or cat bite and allergy to penicillin
Clindamycin plus trimethoprim-sulfamethoxazole
After cleaning the wound of dog or cat bite, what is the most appropriate prophylactic antibiotic?
Amoxicillin/clavulanate
Dog or cat bite and allergy to penicillin
Clindamycin
Significant fall from height according to age
in < 2 years of age > 3 ft is a high risk
n > 2 years of age > 5 ft is a high risk
Ingestion of which agent can cause pinpoint pupils, unresponsiveness, and respiratory depression? And treatment?
Opiate
Naloxone
Child presents with neck spasms, oculogyric crisis, and tongue thrusting after accidental ingestion of promethazine (anti-nausea medication). What is the drug of choice to treat these symptoms?
Diphenhydramine
Healthy child ingests caretaker’s medicine, presents with altered mental status, seizure, drowsiness, lethargy, sinus tachycardia, widened QRS, prolonged QT interval. Likely ingestion?
TCA
Adolescent currently on SSRI treatment for depression presents with confusion, sweating, and myoclonus admits to trying ecstasy at a party. Likely cause of symptoms?
Serotonin syndrome
Child is brought to the ED after ingesting numerous pills of metformin. Possible laboratory finding?
Lactic acidosis
Child presents with nausea, vomiting, abdominal pain 6 h after accidental ingestion of pills, felt better for a short period, then 24 h later presents with metabolic acidosis, shock, hepatic failure, and 6 weeks later develops pyloric and gastrointestinal scarring. What is the most likely ingested substance?
Iron
Adolescent presents with slurred speech, tachypnea, cyanosis, pulmonary edema, renal failure, calcium oxalate crystals in the urine, high-anion gap metabolic acidosis. Likely ingestion?
Ethylene glycol
Child tripped and fell on an outstretched hand presents with tenderness to distal humerus. No obvious fracture on elbow radiograph, although there is a posterior fat pad sign on the lateral view. Most likely diagnosis?
Occult supracondylar fracture
Toddler presents with right arm pain and decreased during play. No falls or trauma reported. Most likely diagnosis
Nursemaid’s elbow (annular ligament arm mobility after being lifted up by the right arm displacement)
A healthy infant with 1 day of intermittent bilious emesis. Stable vital signs on arrival. Next best test?
Upper GI series to rule out malrotation
Toddler presents with sudden onset vomiting and lethargy, bedside point-of-care glucose and venous blood gas are normal with a non-focal neurologic exam, soft abdomen, and no concern for ingestion. Next best test?
Ileocolic US to rule out intussusception
Child has electrical burns to the mouth after chewing on an electrical cord. Next best step?
Refer to burn surgeon—concern for labial artery bleeding
An 8-week-old who was born at 27 weeks was intubated for several weeks and now has chronic hypoxemia, tachypnea, wheezing, along with longstanding respiratory insufficiency. Chest radiograph showed: Decreased lung volumes, areas of atelectasis, hyperinflation, and pulmonary edema
Bronchopulmonary dysplasia
Meconium-stained amniotic fluid is noted at delivery, and the infant is apneic. What is the next best step?
PPV
An 8-week-old who was born at 27 weeks was intubated for several weeks and now has chronic hypoxemia, tachypnea, wheezing, along with longstanding respiratory insufficiency. Chest radiograph showed: Decreased lung volumes, areas of atelectasis, hyperinflation, and pulmonary edema
Bronchopulmonary dysplasia
n is surfactant recommended to be used prophylactically after resuscitation in extremely premature neonates to protect the immature lungs?
< 27 weeks gestation
Jaundice, hypocalcemia, and hypoglycemia are usually associated with
Polycythemia
Newborn is very quiet, cries very little, and has prolonged jaundice and umbilical hernia
Hypothyroidism
An abdominal wall defect covered with a membrane that is often associated with genetic syndromes is
Omphalocele
An abdominal wall defect with uncovered abdominal contents noted right of the umbilicus is
Gastroschisis
A full-term newborn with missing right index, middle, and ring fingers
Amniotic band syndrome
Which anticonvulsant is associated with fetal hydantoin syndrome?
Phenytoin
Which maternal medication during pregnancy results in a newborn with growth restriction, renal dysgenesis, oligohydramnios, skull ossification defects?
ACE inhibitors
Lithium use during pregnancy is associated with
Ebstein anomaly
Newborn with snuffles, continuous nasal secretions, anemia, thrombocytopenia, hepatomegaly, and periostitis
Congenital syphilis
Which allergy test is preferred in cases of dermatographism, generalized dermatitis, or a clinical history of severe anaphylactic reactions to a given food?
Radioallergosorbent test (RAST) (allergenspecific IgE antibody)
Child currently on diphenhydramine for allergies is scheduled for skin allergy testing. When should diphenhydramine be stopped?
At least 5 days prior to testing
Child currently on cetirizine for allergies is scheduled for skin allergy testing. When should cetirizine be stopped?
At least 7 days prior to testing
Child currently on amitriptyline for migraine headache prophylaxis is scheduled for skin allergy testing. When should amitriptyline be stopped?
At least 2 weeks prior to testing
Induration reaction to TB testing after 72 h is an example of
Type IV
Allergy to contrast media is an example of
Non-IgE mediated
Child received penicillin 10 days ago for the first time, presents with fever, nausea, vomiting, pruritic skin rash (urticaria), angioedema, joint pain, lymphadenopathy, myalgia, and proteinuria
Serum sickness
What is the most common specific autoimmune association with chronic urticaria?
Autoimmune thyroid disease
Sudden onset of lip swelling, abdominal pain, swelling of both feet, non-pruritic erythematous skin rash; one family member has the same condition
Hereditary angioedema
Initial screening test for a patient with suspected hereditary angioedema
C4 level most reliable and cost-effective screening test for HAE
What is the cause of hereditary angioedema (HAE)?
Low levels or decreased function of plasma protein C1 inhibitor (C1-INH). (Autosomal dominant)
The test that can differentiate between various types of hereditary angioedema
C1-INH functional assay
A 6-year-old male with yellow-tan macules located on the upper extremities. Parents notice localized erythema following scratching of the lesions and after taking a hot shower
Mastocytosis—Darier sign: urticaria after stroking lesions
Common diagnostic lab for mastocytosis
Elevated tryptase levels
The most common cardiac lesion associated with trisomy 18
VSD
The most common cardiac lesion associated with Turner syndrome
Bicuspid Aortic Valve
The most common cardiac lesion associated with Williams syndrome
Supravalvar aortic stenosis
The most common cardiac lesion associated with Alagille syndrome
Branch pulmonary stenosis
The most common cardiac lesion associated with Noonan syndrome
Pulmonary stenosis 
The most common cardiac lesion associated with DiGeorge syndrome
TOF
The most common cardiac lesion associated with lithium/SV tachycardia
Ebstein anomaly
Which serologic marker can be positive in rapidly progressive glomerulonephritis?
P-ANCA
Child presents with persistent proteinuria, history of hepatitis B virus infection
Membranous glomerulonephritis
Adolescent presents with proteinuria, hematuria, hypertension, persistent low C3, hyperlipidemia, renal failure
Membranoproliferative glomerulonephritis
How is Meckel diverticulum diagnosed?
T99
What are the 2 most common ectopic tissues found in Meckel diverticulum?
Gastric and pancreatic
A 2-year-old boy, frank rectal bleeding, anemia, no pain, no other symptoms
Meckel diverticulum
What is the treatment of H. pylori infection?
Amoxicillin or metronidazole + clarithromycin + PPI for 2 weeks
Child with recurrent episodes of left lower lobe pneumonia; chest radiographs demonstrated focal consolidation in the same location in all events; between episodes the child is well, active, and playful
Pulmonary sequestration
An infant has difficulty with feeding, stridor, recurrent wheezing, history of recurrent pneumonia. Barium esophagography showed posterior compressions. What is the most likely diagnosis?
Child with fever, chest pain, and productive cough; chest radiograph shows cyst-like lesion close to the mediastinum
Bronchogenic cyst
sore throat with hoarseness; 3 weeks later develops pneumonia
Chlamydophila pneumoniae
History of asthma, recurrent attacks of fever, fatigue, coughing mucus plugs, hemoptysis, eosinophilia, high IgE
Allergic bronchopulmonary aspergillosis
Adolescent had influenza A infection, now is having a very high fever, looks toxic; tachypnea, respiratory distress, and tachycardia; chest radiograph is positive for infiltration, cavities, and pleural effusion
Staphylococcus aureus pneumonia
An infant with cyanosis, the mother is mixing the formula with well water; normal cardiac and pulmonary examination, normal pulse oximetry. Chocolate-colored blood noticed when collecting the blood for testing
Methemoglobinemia
Child with prosthetic mitral valve going for surgery; is SBE prophylaxis indicated?
Yes
Child routine physical exam, systolic murmur with Still’s murmur a vibratory character, best heard in the lower sternal border, varies with changes in respiration and position
Still’s murmur
A 6-year-old with a continuous murmur, lowpitched sound, best heard in the infraclavicular region, disappears when supine and with gentle pressure on the jugular vein
Venous hum
Cyanosis in lower limbs + decreased lung markings
Pulmonary hypertension
Cyanosis + Decreased lung marking
Tricuspid atresia
Cyanosis + Decreased lung marking + murmur
Pulmonary stenosis
Child with recurrent throat clearing, facial grimacing, and grunting, but otherwise acting normal
Tic disorder
Multiple café-au-lait spots, Lisch nodules on ophthalmology exam, and presence of multiple neurofibromas
NF1
Presents with ringing in the ears; imaging shows bilateral vestibular schwannomas
NF2
MRI showing downward displacement of the cerebellar tonsils through the foramen magnum
Arnold–Chiari malformation
Cystic expansion of the fourth ventricle in the posterior fossa, associated with hydrocephalus, cerebellar ataxia, and associated with corpus callosum agenesis
Dandy–Walker syndrome
Triad of infantile spasms, hypsarrhythmia on EEG, developmental regression
West syndrome
A 6-month-old infant having episodes of tonic flexion of trunk, head, and extremities, occurring in clusters
Infantile spasms
An 8-year-old boy is having multiple brief daily episodes of behavioral arrest and eye fluttering with an EEG showing 3 Hz/s spike-and-wave discharges
Absence seizure
This test is very sensitive but not specific for SLE
ANA
