Mehl. PED file bullets in general that didnt know nr 1 Flashcards
8M + recently convalesced from URTI + now has stridor + fever 101F; Dx? how to make Dx?
usually S. aureus;
Dx w/ bronchoscopy;
8M + recently convalesced from URTI + now has stridor + fever 101F; Tx?
Tx with third-gen cephalosporin + aminopenicillin (e.g., IV flucloxacillin).
8-month-old girl + stridor that improves with neck extension; Dx?
vascular ring
8-month-old girl + stridor that improves when prone or upright; Dx?
laryngomalacia
3F + 2-wk Hx of cough and nasal congestion + snoring loudly past 6 months + P/E shows she breathes predominantly through her mouth + 1/6 holosystolic murmur and loud S2 + CXR shows cardiomegaly + increased pulmonary vascular markings + echo shows RV hypertrophy and mild tricuspid regurg; what is the most appropriate long-term Mx for this patient?
adenoidectomy and tonsillectomy
12M + steatorrhea + recurrent URTIs + new-onset stridor; why the new-onset stridor?
nasal polyps (common in cystic fibrosis); steatorrhea due to exocrine pancreas insufficiency.
7F + painless lateral neck mass over sternocleidomastoid; Dx?
brachial cleft cyst.
Neonate born by forceps delivery + crooked neck + 1.5cm mass palpated in left side of neck; Dx?
“sternomastoid injury.”
7M + one-week Hx of low-grade fever and fatigue + 3-day Hx of rash and swelling starting at ankles and spreading upward + ankles tender + exam shows “several palpable petechiae and confluent purpuric areas over lower extremities”; Dx? Tx?
Henoch-Schonlein purpura.
Can present with tetrad of 1) palpable purpura (and apparently petechiae), 2) IgA nephropathy (red urine), 3) abdominal pain (mesenteric adenitis), and 4) arthralgias; classically following viral infection, however 2CK vignettes will often omit mentioning the infection altogether; self-limiting.
4-month-old girl + asplenia + dextrocardia; which antibiotic should be used for prophylaxis? Dx?
penicillin (most important for Strep pneumo due to asplenia);
Dx is Ivemark syndrome (dextrocardia/situs inversus + hypoplasia of various organ systems).
12-month-old female + sickle cell + missed dose of penicillin prophylaxis + now has sepsis; which Abx to give?
answer = cefotaxime; wrong answers are penicillin and ceftriaxone.
Neonate with APGARs good at birth + 3-10 days later has BP 60/35 in upper extremities and unobtainable in lower extremities + O2 sats 98 mmHg but nails appear dusky + 3/6 holosystolic murmur at left sternal border; Q asks what’s responsible for current presentation?
answer = “closure of ductus arteriosus”
Dx = preductal coarctation (the type seen in neonates); CoA can be associated with tricuspid regurgitation and other cardiac abnormalities. Dusky nailbeds don’t equate to cyanosis if O2 sats are normal.
Neonate + pulmonary valvular stenosis; Dx?
Noonan syndrome; second most common
syndrome associated with congenital heart disease after Down.
14F + Down syndrome + polycythemia + moderate cyanosis and digital clubbing + no murmur on cardio exam but loud S2 + echo shows large VSD and dilated main pulmonary artery; mechanism for polycythemia?
answer on Peds NBME = pulmonary artery hypertension”;
Dx is Eisenmenger (large VSD with reversal RàL); large VSDs may present without murmur; pulmonary vessels constrict to compensate for high preload from previous L->R VSD shunt; constriction leads to hypoxia and secondary polycythemia with high EPO; should also be noted that Down syndrome is associated with endocardial cushion defects (AVSD > VSD > ASD; Step 1).
Neonate born vaginally at 43 weeks gestation + cyanotic + pO2 is 26mmHg on 100% oxygen + CXR normal + echo shows normal cardiac anatomy with a right-to-left shunt across the foramen ovale; what is the mechanism for the child’s condition?
“failure of pulmonary vasodilation”à Dx = persistent fetal circulation (aka persistent pulmonary hypertension of the newborn).
Three ways VSD sounds on Peds shelf?
Holosystolic murmur at left sternal border PLUS either parasternal heave or palpable thrill.
Holosystolic murmur at left sternal border PLUS left atrial enlargement (LàR shunt leads to increased preload back to LA in addition to the systemic preload).
Holosystolic murmur at left sternal border PLUS diastolic rumble (volume overload of LA).
3M + elfin-like facies + hypercalcemia + well-developed verbal skills; Dx?
what heart problems?
William syndrome.
Heart problem in William syndrome supravalvular aortic stenosis.
10-month-old girl + sore throat for 2 days + fever 101F + S3 gallop heard on auscultation; what best explains these findings?
myocarditis (rheumatic fever); should be noted that PSGN will take 1-2 weeks to occur after Group A Strep infection, but NBME has RF occurring as early as 2 days after the Strep pharyngitis; type II hypersensitivity via molecular mimicry with Group A Strep M
protein (Step 1); Tx with penicillin.
8M + sore throat + new-onset tic; Dx?
answer = PANDAS (Pediatric Autoimmune Neuropsychiatric
Disorder Associated with Streptococcus)
Group A Strep infection can precipitate OCD, Tourette, ADHD; answer = “check Streptolysin O titers”;
7F + facial grimaces past 5 months + no other motor findings or abnormal sounds + mental status normal; next best step in Mx? Dx?
schedule a follow-up examination in 3 months”
Dx = provisional tic disorder. 1/5 children experience some form of tic disorder; most common ages 7- 12; usually lasts less than a year; “watch and wait” approach recommended. Provisional tic disorder used to be called transient tic disorder; the name was changed because a small % go on to develop chronic tics.
4F + spiking fever followed by a rash + no other findings; Dx?
roseola (HHV-6); all you need to remember is the “spiking fever followed by a rash.”
6M + Q shows you two pics: one of a circular rash (not a target) on the forearm; the other pic is a Bell palsy (asymmetric smile); Q asks you to pick the antibiotic? Dx?
answer = amoxicillin;
Dx = Lyme disease; rash need not be target (erythema chronicum migrans); don’t give doxycycline to kids age <8.
3M + rapid breathing for 1 hour + hyper-resonance on right side of chest + CXR shows overexpansion of right lung; next best step in Mx?
answer = “endoscopic examination of the patient’s airway” (bronchoscopy for foreign body aspiration); this Q is exceedingly HY for Peds shelf; easier Qs will mention a 14-month-old crawling around on the floor beforehand.
6M + just diagnosed with ALL + parents don’t want him to know + you’re now alone with the kid and
he asked you if he’s going to die; what do you say?
“Have you talked to your parents about this?”
