Library Tutorials

Question 0

Common first line meds for:
Partial seizures 
Generalized seizures except absence 
Absence seizure 
Infantile spasms

Answer 0

Partial seizures - carbamazepine or clobazam
Generalized seizures except absence - valproic acid or a benzo
Absence seizure - ethosuximide or valproic acid
Infantile spasms - vigabatrin

Question 1

ABCDS for c-spine X-rays

Answer 1

Alignment (4 lines - ant and post cervical, spinal lamellar, spinous process)
Bones (inspect spines, bodies, facet joints)
Count (7), Curvature
Dens, Discs
Soft tissues (on lateral, soft tissues above glottis should be no wider than 1/2 vertebral body width; below glottis, less than full vertebral body width)

Question 2

Finding in mouth assoc with measles

4 Cs of measles

Where does the rash start?

Answer 2

Koplik spots

Cough, coryza, conjunctivitis, Koplik spots

Hair line, then moves down

Question 3

Erythema infectiosum (fifth disease) caused by?

Risk if infected when pregnant?

Where does rash start?

Answer 3

Parvovirus b19

Hydrops fetalis

Stats on face, then extensor surfaces

Question 4

Roseola infantum (exanthum subitum) cause?

Rash starts where?

Answer 4

Human herpes virus 6

Rash in rosettes appear as fever resolves, mainly on trunk

Question 5

A child with any two of the following factors has a 30% risk of having a febrile seizure at some point

Answer 5

1 first-degree relative with febrile seizures
2 second-degree relative with febrile seizures
3 devel delay
4 delayed neonatal discharge
5 day care attendance

Question 6

Typical febrile seizure: characteristics

Sex preference for febrile seizure?

When to CT scan or to do EEG?

Antipyretics? Antiepileptic meds?

Answer 6

Generalized
F

CT/EEG very rarely useful in DDx of febrile seizures

Antipyretics not helpful in reducing risk of febrile seizure. Antiepileptics may slightly reduce recurrence rate but at the cost of cognitive and behavioral side fx (limited usefulness)

Question 7

A child with none of the factors below has a12% risk of febrile seizure recurrence. Having all 5 gives a recurrence risk of 80%.

Answer 7

1 FamHx of febrile seizures
2 FamHx of epilepsy
3 age <14 months at first seizure
4 atypical febrile seizure
5 day care attendance

Question 8

Line drawn across posterior superior iliac crests intersects what?

Order of 3 vials for CSF analysis

Answer 8

L4 spinous process

Lumbar puncture in kids usually done betw L4-L5
Can also be done L3-L4 or L5-S1 if necessary

1 Culture and gram stain (least handled), 2 glucose and protein, 3 cell count (least blood)

Question 9

Usual UTI Tx

Answer 9

Ampi/Tobra QDAY

Question 10

Long bone sections, from middle to articular surface

Answer 10

Diaphysis-metaphysis-physis-epiphysis

Question 11

SH1?
SH2?
SH3?

Answer 11

SH1: Complete separation of physis and epiphysis from metaphysis (usually shear force); excellent Px

SH2: # through most of physis and piece of adjoining metaphysis (oblique deforming forces); good Px (articular surface OK)

SH3: # through entire epiphysis and part of physis; part of epiphysis and physis separates from metaphysis; moderate risk (art surface disrupted, fragment unstable, blood supply to fragment may be compromised)

Question 12

SH4?

SH5?

Answer 12

SH4 = SH2 + SH3 (through epiphysis and part of metaphysis; entire fragment separates with physis intact in segment; significant risk (worse Px than SH1-3 - need ortho)

SH5: crush injury of growth plate, freq results in fusion of metaphysis to epiphysis (stops growing) - worst Px of all categories

SH1 & 5 difficult to see on X-ray

Question 13

Which bug causes strep throat (streptococcal pharyngitis)? Clinical manifestations?

Answer 13

GAS

Sore throat, fever, abdo pain, nausea, vomit, palatal petechiae, dysphagia, headache (NO cough, rhinitis, conjunctivitis, hoarseness, diarrhea)

Question 14

How long to Tx strep throat? With what drugs?

Answer 14

10 days

Pen V
[BiCillin C-R (long acting combo of penicillins; 1inj lasts 10d)] - used less
Erythromycin if allergic